Frequently Asked Questions 

FAQs: Patient Management | Provider Management | Billing and System

Patient Management

Q:  Is there an income guideline print out to go by so that we can tell if patient meets income eligibility? 

Answer:  Yes, income guideline is available for printing at ADH website, BreastCare webpage. Patients should never see the guidelines or they may report a false income.

Q: If the patient has full coverage insurance, Medicaid or Medicare, will she be eligible for BreastCare?

Answer: No, if the patient has health insurance even though there is a high deductible or limits on number of visits, they are not eligible. If their coverage is for hospital, outpatient and physicians visits, they are not eligible. If it covers 6 office visits a year, it’s still called creditable insurance and makes them ineligible for BreastCare.  If it is a hospital only policy or disease specific policy, they are eligible for BreastCare. If it’s a limited policy such as vision, dental, long term care, they are eligible.

Q: Is there is a maximum age cut-off?

Answer: Yes, BreastCare eligible women are 40 to 64 years old.

Q: Does the income question count everyone in the house?

Answer: Yes, everybody that works except those 18 years and younger and college students who work. Child support, foster care, and disability income should also be counted.

Q: If the BreastCare patient comes in and we see that she is not eligible because of income, what do we do?

Answer: Go into the system to close her Plan/eligibility based on being over-income. Look up her name, go to the BreastCare button and click on Patient Management. It will say “Do you want to close this patient”. Click on “yes” to close the patient and enter the reason for closure as being over income.

Q: If a women is under the age of 40 but having symptoms or problems or a diagnosis, will she be eligible for BreastCare?

Answer: No, women under age 40 cannot be enrolled in BreastCare. Eligible women who have a diagnosis of breast or cervical cancer or CINII, CINIII, CIS and need treatment can be transitioned to Medicaid.

Q: How do we know if a woman should be Plan A or Plan C?

Answer: The system will enroll the woman in the correct plan based on her age. Plan A serves women age 40-49, and Plan C serves women age 50-64.

Q: What do we do when we enroll a patient over the phone, but the information has changed when they come to the clinic?

Answer: If she reports change in income, verify eligibility again. If she reports health insurance, then she is no longer eligible, close her eligibility by going to the Open Plan Options.

Q: Will patients with health insurance qualify for BreastCare?

Answer: The type of insurance is important to know.  Women are still eligible if they have disease specific or limited scope policies like cancer, vision, dental, long-term care, etc or hospitalization only. Those with full insurance like United Health Care, Health Advantage, ARHealth NovaSys, or BC/BS are ineligible. If insurance covers inpatient, outpatient and physician services, the woman is ineligible. If you ask them about what kind of insurance they have before enrollment and you are clear about what type of insurance they have, there is no need to try to enroll them.

Q: Does the system determine if patient is eligible for a Pap test?

Answer: No, the woman will be program eligible every year if she has not had a Pap test in the last 11 months. The nurse will determine if she is eligible for a Pap test.
Pap tests are provided every 2 years for negative results and then every 3 years after 3 negative Pap tests. The nurse will determine if this is the year that she needs a Pap or not. Patients’ medical history determines if the patient gets an annual Pap test. See policy

Q: Some patients may not know what type of insurance they have.  What would be the questions for them?

Answer:

  • Does your insurance pay for doctor/office visits? 
  • Does your insurance pay for at least one day of inpatient hospital stay?
  • Does it pay for you to have an outpatient procedure?

If the insurance does all three things then it is considered creditable insurance and the patient will not qualify for BreastCare.

Q: Does the patient have to be a United States citizen and do we have to prove that?

Answer: No, she does not have to be a U.S citizen to enroll in BreastCare but she must be an Arkansas resident. However, to receive treatment through Medicaid she must be a U.S. citizen or “qualified alien”. 

Q:  Does the patient have to be an Arkansas resident?

Answer:  Yes, Arkansas residency is a requirement. You will know by her address.

Q: Is there going to be a message on the Phone Center number that tells women to enroll at a provider’s office?

Answer: A message was available until July 1, 2012. The Phone Center is no longer operational and will not have a voice message for clients or providers.

Q: For LHUs only - When entering enrollment information, then leaving to go to the scheduler, the information was not saving. Has that been fixed?

Answer: No, that has not been fixed.  To avoid this, go into the scheduler and get an appointment before you enroll the patient, then enter that appointment in the enrollment system if she is eligible, then go back and add her name in the scheduler. After discussion, it was suggested that you open common customer twice, one for enrollment and the other for the scheduler.  That will work until this is fixed at a later date.

Q: Can women who have applied for Family Planning Waiver also be enrolled in BreastCare?

Answer: Yes, if eligible, BreastCare will pay for the woman’s mammogram and family planning will pay for Pap test.

Q: Will the system tell you that the patient is Family Planning and BreastCare?

Answer:  No, the system will give you her BreastCare Plan A or Plan C.  It will not say anything about Family Planning. LHUs will still choose FP/BC in the AFTIS lab system to submit Pap tests.

Q: Do we follow the same procedure for the mobile mammography events? 

Answer: For the women getting mammograms with mobile mammography van programs, they will have to contact their LHU or local provider to be enrolled prior to their appointment. Follow the revised BreastCare policy dated August 2012 for mobile mammography procedure.

Q: How do we enroll women who have previously been Plan M into BreastCare?

Answer: You will select the “Assess Eligibility” button to verify eligibility.

Q: Can we enroll patients over the phone?

Answer: Yes, the policy states that a woman may be enrolled over the phone or face to face.

Q: Can we enroll patients who call from a breast center and is about to get her mammogram?

Answer: Absolutely. Enroll the patient, give her an appointment to come in for a CBE and/or Pap test, and request her mammogram report. 

Q:  How will we know how many slots we have for patients?

Answer: A box in the top right hand corner of the Patient Management page will tell you if there are any Plan A or Plan C slots available in your region. Or you can contact BreastCare at 501-289-4117

Q:  What should we do if a patient comes in without her card?

Answer:  Look up patient in the system, verify her eligibility and print a new card. 

Q:  Should we mail the ID card if a patient enrolls over the phone.

Answer: It is up to you if you prefer to mail the card or hold it until the patient comes in for appointment. She must have her card to take to her mammogram appointment.

Q:  Will the online system send out annual reminders to patients?

Answer: Beginning July1, 2012, the system will generate automatic e-mail reminders to patients to re-enroll. Therefore, providers should collect the patient’s current email address.

Q: Should we enroll a patient if she wants to go to another provider for her exam?

Answer:  No, the patient must be enrolled with the PCP that she wants to see for her exam.

Q:  Should we enroll a patient referred to us from a participating PCP?

Answer: No, the patient must be enrolled with the PCP that she wants to see. The participating PCP can enroll the patient.

Q:  Do we have to enroll a Spanish speaking woman if she does not have an adult    translator with her? 

Answer:  No, but you can call the following translators for help at  501-526-6678, 501-690-6375, 501-372-6933 or 501-526-6676

Q:  Where do we find the Covered and Non-Covered Services and Welcome to  BreastCare brochure?

Answer: Click on the link below, under “New Information”, scroll down to downloads and you will find the documents in English and Spanish. 

Q: What if a patient does not remember the exact date of her last mammogram and Pap test?

Answer:  Use approximate month and year and first day of the month.

Q: If a patient has already had her mammogram before she enrolls will BreastCare pay for the

Answer:  No.  Services are not covered before a patient enrolls.

Q:  Can I enroll a woman into Plan M for treatment of a cervical pre-cancerous condition before we discuss her pathology results?

Answer: No. Pathology reports must be explained to the client, treatment options discussed/selected then the client must consent to applying for Medicaid before enrollment into Plan M can occur.

Q: Do I have to have a patient’s permission to enroll her into Plan M for treatment?

Answer:  Yes.

Q: If the patient gives a different income on the patient information sheet when they come in than what they gave us over the phone, should we reassess eligibility.

Answer: Yes, but be sure you define the criteria for household income for BreastCare so you are certain the patient understands what she is reporting.

Q: When the BreastCare Phone Center called and made the patient’s appointment, they told us if the patient should get a Pap or not.  Is this something that the nurses will decide now?

Answer: Yes, the nurses decide if the patient gets a Pap test that day. If they have had a Pap within the last 11 months, they won’t be eligible for a pap test, but if it’s been a year, the system will tell you they are eligible for a pap test. Patients may be eligible for just a mammogram.

Q: Is there some indication for the clerks or receptionists that a patient needs a Pap test?

Answer: A Pap test is usually done every two years so you can check the date of the last Pap test. If a patient requires a yearly Pap, the nurse will decide and complete the Pap form.

Q: Can BreastCare accept a screening mammogram report interpreted as BIRADS 3-probably benign?

Answer: No, American College of Radiology’s and Centers for Disease Control has recommended that additional diagnostic images be taken before a final interpretation of BIRADS 3 is reported.  

Q: Is pelvic ultrasound covered by BreastCare for postmenopausal bleeding?

Answer: No, not at this time.

Q: Is a surgical consult required for an abnormal CBE (skin dimpling, nipple discharge or retraction, palpable mass) if the mammogram and ultrasound (US) are negative?

Answer: Yes, a mammogram and US are not 100% accurate at finding an abnormality so a cancer could have been missed.

Q: What tests should be ordered when a woman has a palpable lump on clinical exam?

Answer: She should receive a diagnostic mammogram and breast ultrasound at the same visit.  Many times the ultrasound will rule out a solid mass and a surgical referral is not needed.