Why: To ensure awareness that the Agreement for Services system policy and procedure is being followed.
Content: Employees completing the registration are responsible for explaining the Agreement for Services and obtaining signature from the patient or authorized representative. This document is not intended to be an informed consent for procedures, anesthetics, or other medical services. There are three workflow processes.
1) Aspirus Hospitals – If the patient has multiple appointments on the same day, a signature is required for each registration.
2) Aspirus Provider-Based Clinics – If the patient has multiple appointments at the same provider-based clinic on the same day, only one signature is required.
3) Aspirus Non-Provider-Based Clinics – Obtain signature on the Agreement for Services - Clinics form annually.
Hospitals and clinics that are obtaining electronic signatures from patients or authorized representatives are required to display a printed copy of the Agreement for Services at each registration area. Patients are also to be offered a printed copy if requested.
Patients who refuse to sign the Agreement for Services should be informed that they will be registered as self-pay, and their insurance will not be billed. A note should be placed on the patient's account indicating the Agreement for Services was not signed and insurance was removed. Patients may strike any portion of the Agreement for Services to indicate their dissent.
I. If a patient or legal guardian strikes section 8 - Assignment of Payment Benefit to Hospital, it is the responsibility of the employee completing the registration to confirm the patient would like their insurance billed.
II. If a patient or legal guardian strikes section 7 or 12 - Telephone Consumer Protection Act Consent, it is the responsibility of the employee to update the Communications Preference Activity with EPIC to remove automated calls.
Call to Action: Please display a laminated, printed copy of the Agreement for Services at each registration area in accordance with our infection control guidelines.
Questions?
Sherri Schreiner, Director System Financial Clearance
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