CHAPTER
4
Scheduling
McGraw-Hill
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-2
Learning Outcomes
When you finish this chapter, you will be able to:
4.1
4.2
4.3
4.4
4.5
Describe the two methods used to schedule
appointments.
Explain the method used to classify patients as new
or established.
List the three categories of information new patients
provide during telephone preregistration.
Identify the information that needs to be verified for
established patients when making an appointment.
Describe covered and noncovered services under
medical insurance policies.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-3
Learning Outcomes (Continued)
When you finish this chapter, you will be able to:
4.6
4.7
4.8
4.9
4.10
4.11
List the three main points to verify with the payer
regarding a patient’s benefits prior to a visit.
Explain when a preauthorization number or referral
document is required for a patient’s encounter.
List the four main areas of Medisoft Network
Professional’s Office Hours window.
Demonstrate how to enter an appointment.
Demonstrate how to book follow-up and repeating
appointments.
Demonstrate how to reschedule an appointment.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-4
Learning Outcomes (Continued)
When you finish this chapter, you will be able to:
4.12
4.13
4.14
Demonstrate how to create a recall list.
Demonstrate how to enter provider breaks in the
schedule.
Demonstrate how to print a provider’s schedule.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-5
Key Terms
•
•
•
•
•
•
•
•
•
•
•
benefits
capitation
coinsurance
copayment (copay)
covered services
deductible
established patient (EP)
fee-for-service
health plan
indemnity plan
managed care
•
•
•
•
•
•
•
•
•
medical insurance
new patient (NP)
noncovered services
nonparticipating
(nonPAR) provider
Office Hours break
Office Hours calendar
Office Hours patient
information
out-of-network
out-of-pocket
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-6
Key Terms (Continued)
• participating (PAR)
provider
• patient portal
• payer
• policyholder
• preauthorization
• preexisting condition
• premium
• preregistration
• preventive medical
services
•
•
•
•
•
•
provider
provider’s daily schedule
provider selection box
referral
referral number
schedule of benefits
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-7
4.1 Scheduling Methods
• Patient appointments may be scheduled via
telephone or online.
• Patient portal—secure website that enables
communication between patients and health
care providers for tasks such as scheduling,
completing registration forms, and making
payments
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.1 Scheduling Methods (Continued)
4-8
• Scheduling systems include these methods:
–
–
–
–
Open hours
Stream scheduling
Double-booking
Wave scheduling
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.2 New Versus Established Patients
4-9
• New patient (NP)—patient who has not
received professional services from a provider
(or another provider with the same specialty in
the practice) within the past three years
• Established patient (EP)—patient who has
received professional services from a provider
(or another provider with the same specialty in
the practice) within the past three years
• Preregistration—process of gathering basic
contact, insurance, and reason for visit
information before a new patient comes into the
office for an encounter
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.3 Preregistration for New Patients
4-10
• During preregistration, new patients usually
provide three types of information:
– Demographic information
– Basic insurance information
– Reason for the visit (also known as the chief
complaint)
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.3 Preregistration for New Patients
(Continued)
4-11
• Participating (PAR) provider—provider who
agrees to provide medical services to a payer’s
policyholders according to the terms of the
plan’s contract
• Nonparticipating (nonPAR) provider—
provider who chooses not to join a particular
government or other health plan
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.4 Appointments for Established
Patients
4-12
• Medical offices verify established patients’
information prior to an appointment; such
information includes:
– changes to a patient’s address,
– changes to a patient’s health plan or employment.
• The reason for the visit should also be
established to schedule the correct amount of
time for the encounter.
• Patients’ account balances are checked as well.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics
4-13
• Medical insurance—financial plan that covers
the cost of hospital and medical care
• Policyholder—person who buys an insurance
plan; the insured, subscriber, or guarantor
• Health plan—individual or group plan that either
provides or pays for the cost of medical care
• Payer—health plan or program
• Premium—money the insured pays to a health
plan for a health care policy; usually paid
monthly
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-14
• Benefits—amount of money a health plan pays
for services covered in an insurance policy
• Schedule of benefits—list of the medical
expenses that a health plan covers
• Provider—person or entity that supplies medical
or health services and bills for or is paid for the
services in the normal course of business
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-15
• Covered services—medical procedures and
treatments that are included as benefits under
an insured’s health plan
– These may include primary care, emergency care,
medical specialists’ services, and surgery.
• Preventive medical services—care that is
provided to keep patients healthy or to prevent
illness, such as routine checkups and screening
tests
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-16
• Noncovered services—medical procedures
that are not included in a plan’s benefits; these
things may include:
– Dental services, eye care, treatment for employmentrelated injuries, cosmetic procedures, infertility
services, or experimental procedures
– Specific items such as vocational rehabilitation or
surgical treatment of obesity
– Prescription drug benefits
– Treatment for preexisting conditions—illnesses or
disorders of a beneficiary that existed before the
effective date of insurance coverage
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-17
• Indemnity plan—type of medical insurance that
reimburses a policyholder for medical services
under the terms of its schedule of benefits
• Deductible—amount that an insured person
must pay, usually on an annual basis, for health
care services before a health plan’s payment
begins
• Coinsurance—portion of charges that an
insured person must pay for health care services
after payment of the deductible amount; usually
stated as a percentage
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-18
• Out-of-pocket—expenses the insured must pay
before benefits begin
• Fee-for-service—health plan that repays the
policyholder for covered medical expenses
• Capitation—prepayment covering provider’s
services for a plan member for a specified
period
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-19
• Managed care—system that combines the
financing and delivery of appropriate, costeffective health care services to its members;
basic types include:
–
–
–
–
Health maintenance organizations (HMOs)
Point-of-service (POS) plans
Preferred provider organizations (PPOs)
Consumer-driven health plans (CDHPs)
• Out-of-network—provider that does not have a
participation agreement with a plan
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.5 Insurance Basics (Continued)
4-20
• Preauthorization—prior authorization from a
payer for services to be provided
• Copayment (copay)—amount that a health plan
requires a beneficiary to pay at the time of
service for each health care encounter
• Referral—transfer of patient care from one
physician to another
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.6 Eligibility and Benefits Verification
4-21
• Except in a medical emergency, the following
information should be obtained/verified from a
patient’s health plan before an encounter:
– Patient’s general eligibility for benefits
– Amount of the copayment for the visit, if one is
required
– Whether the planned encounter is for a covered
service that is medically necessary under the payer’s
rules
• Patients should be informed if their policy does
not cover a planned service.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.7 Preauthorization, Referrals, and
Outside Procedures
4-22
• Managed care payers often require
preauthorization before a patient:
– sees a specialist,
– is admitted to the hospital, or
– has a particular procedure.
• If the payer approves the service, it issues a
preauthorization number that must be entered in
the PM and included on the claim.
• Referral number—authorization number given
by a referring physician to the referred physician
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.8 Using Office Hours—Medisoft Network
Professional’s Appointment Scheduler
4-23
The Office Hours window contains four main
areas:
– Provider selection box—selection box that
determines which provider’s schedule is displayed in
the provider’s daily schedule
– Provider’s daily schedule—listing of time slots for a
particular day for a specific provider that corresponds
to the date selected in the calendar
– Office Hours calendar—interactive calendar that is
used to select or change dates in Office Hours
– Office Hours patient information—area that
displays information about the patient who is selected
in the provider’s daily schedule
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-24
4.9 Entering Appointments
To enter an appointment in Medisoft Clinical:
– Select the appropriate provider from within the Office
Hours program.
– Choose an appointment time slot.
– Complete the fields in the New Appointment Entry
dialog box.
– Click the Save button to enter the information on the
schedule.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.10 Booking Follow-up and Repeating
Appointments
4-25
• To create follow-up appointments in Office
Hours:
– Click the Go to a Date shortcut button on the toolbar;
the Go To Date dialog box will be displayed to allow a
choice of date.
– After a future date option is selected, click the Go
button to close the dialog box and begin the search.
– The future date will be located and displayed in the
calendar schedule accordingly.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.10 Booking Follow-up and Repeating
Appointments (Continued)
4-26
• To create repeating appointments in Office
Hours:
– Open the New Appointment Entry dialog box.
– Click the Change button; the Repeat Change dialog
box is displayed.
– Make selections and enter information in the Repeat
Change dialog box.
– When done, click the OK button, and then the Save
button, to enter the repeating appointments on the
schedule.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.11 Rescheduling and Canceling
Appointments
4-27
To locate an appointment that needs to be
rescheduled:
– Click the Appointment List option on the Office Hours
Lists menu; the Appointment List dialog box appears.
– Use the Cut and Paste commands to move an
appointment.
– Use the Cut command to cancel an appointment.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4.12 Creating a Patient Recall List
4-28
To create or maintain a recall list in MNP:
– Click Patient Recall on the Lists menu; the Patient
Recall List dialog box is displayed.
– Patients are added to the recall list by clicking the
New button in the Patient Recall List dialog box or by
clicking the Patient Recall Entry shortcut button; the
Patient Recall dialog box is displayed.
– After the information has been entered in the dialog
box, click the Save button.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-29
4.13 Creating Provider Breaks
• Office Hours break—block of time when a
physician is unavailable for appointments with
patients
• To set up a break for a current provider:
– Click the Break Entry shortcut button; the New Break
Entry dialog box will appear.
– Enter the information in the dialog box, and click the
Save button to enter the break(s).
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
4-30
4.14 Printing Schedules
• To print a provider’s schedule within Office
Hours:
– Use the Appointment List option on the Office Hours
Reports menu to view a list of all appointments for a
provider for a given day.
– The report can be previewed on the screen or sent
directly to the printer.
• Alternatively, click the Print Appointment List
shortcut button.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
CHAPTER
3
Introduction to
Medisoft Clinical
McGraw-Hill
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3-2
Learning Outcomes
When you finish this chapter, you will be able to:
3.1
3.2
3.3
3.4
3.5
3.6
List the practice management and electronic health
record applications in Medisoft Clinical.
Discuss three security features in Medisoft Clinical
that protect patients’ health information.
List the menus in Medisoft Clinical Patient Records.
List the menus in Medisoft Network Professional.
Describe how pre-encounter tasks are completed in
Medisoft Clinical.
Describe how encounter tasks are completed in
Medisoft Clinical.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3-3
Learning Outcomes (Continued)
When you finish this chapter, you will be able to:
3.7
3.8
3.9
Describe how post-encounter tasks are completed in
Medisoft Clinical.
Explain how to create and restore backup files in
Medisoft Clinical.
Discuss the types of help available in Medisoft
Clinical.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3-4
Key Terms
•
•
•
•
•
•
•
•
•
•
access levels
Auto Log Off
backing up
chart
chief complaint
dashboard
database
disaster recovery plan
knowledge base
Medisoft Clinical
• Medisoft Clinical Patient
Records (MCPR)
• Medisoft Network
Professional (MNP)
• park
• password
• restoring
• user name
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.1 Medisoft Clinical: A Practice
3-5
Management/Electronic Health Record Program
• Medisoft Clinical—integrated practice
management (PM) and electronic health record
(EHR) program
• Medisoft Network Professional (MNP)—
practice management application within Medisoft
Clinical
• Medisoft Clinical Patient Records (MPCR)—
electronic health record application within
Medisoft Clinical
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.2 Security Features in Medisoft Clinical
3-6
Medisoft Clinical has a number of built-in security
features
• User name—name that an individual uses for
identification purposes when logging onto a
computer or an application
• Password—confidential authentication
information
• Access levels—security option that determines
the areas of the program a user can access, and
whether the user has rights to enter or edit data
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.2 Security Features in Medisoft Clinical
(Continued)
3-7
• Park—privacy and security feature in MPCR that
allows a user to leave a workstation for a brief
time without having to exit the program
• Auto Log Off—feature of MNP that
automatically logs a user out of the program
after a period of inactivity
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.3 Medisoft Clinical Patient Records
3-8
• Standard menu items in MCPR include:
–
–
–
–
–
–
–
File
View
Task
Maintenance
Reports
Window
Help
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.3 Medisoft Clinical Patient Records
(Continued)
3-9
• Database—collection of related bits of
information
• Chart—folder that contains all records
pertaining to a patient
• Dashboard—panel in MCPR that offers
providers a convenient view of important
information
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.4 Medisoft Network Professional
3-10
• Names of the menus in MNP are listed on the
menu bar, and include:
–
–
–
–
–
–
–
–
File
Edit
Activities
Lists
Reports
Tools
Window
Help
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.5 Using Medisoft Clinical to Complete
Pre-Encounter Tasks
3-11
• Pre-encounter steps include preregistration and
appointment scheduling.
– To enter preregistration information about a new
patient, click the New Patient button, and complete
the Patient/Guarantor dialog box.
– To enter an appointment in Office Hours, select a
provider, select a date and time slot, and save.
• Chief complaint—patient’s description of the
symptoms or reasons for seeking medical care
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.6 Using Medisoft Clinical to Complete
Encounter Tasks
3-12
• Encounter steps include all activities that take
place from the patient’s arrival until the patient’s
departure from the office, such as:
– Establishing financial responsibility—real-time
insurance eligibility can be checked
• Insurance information is entered in one or more of the Policy
tabs in the Case folder in MNP.
– Check-in—reviewing account balance, updating
patient information, recording documentation and
examination findings
• The Patient/Guarantor dialog box is updated as needed.
• SOAP notes are recorded.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.6 Using Medisoft Clinical to Complete
Encounter Tasks (Continued)
3-13
• Encounter steps (continued):
– Coding—assigning codes based on the services
provided and the provider’s determination
• In MPCR, codes are selected from lists provided on an
electronic encounter form.
– Checkout—payments are calculated and posted,
follow-up appointments and tests are scheduled,
materials are dispensed, and referrals are provided
• The Unprocessed Charges dialog box in MCPR is used to
post and review charges.
• Scheduling is performed in Office Hours.
• Referral and prescriptions are created within MCPR.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.7 Using Medisoft Clinical to Complete
Post-Encounter Tasks
3-14
• After the patient visit is complete, activities focus
on payment for services, including:
– Preparing and transmitting claims
• In MNP, claim functions are located on the Activities menu.
• The Claim Management dialog box is used for current claims
and to create new claims.
• Claims are transmitted through MNP’s Revenue
Management feature.
– Monitoring payer adjudication
• Payer adjudication is tracked using the Deposit List window.
• Charges are applied in the Apply Payment/Adjustment to
Charges dialog box.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.7 Using Medisoft Clinical to Complete
Post-Encounter Tasks (Continued)
3-15
• Activities focused on payment for services
(continued):
– Generating patient statements
• In MNP, the Statement Management option on the Activities
menu contains options for creating and printing patient
statements.
• Selections in the Create Statements dialog box determine
which statements will be created.
– Following up on payments and collections
• In MNP, collection functions are located on the Activities
menu and on the Reports Menu.
• The Collection List feature on the Activities menu is used to
place an account in collections.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.8 Backing Up and Restoring Files
3-16
• Disaster recovery plan—plan for resuming
normal operations after a disaster such as a fire
or a computer malfunction
• Backing up—making a copy of data files at a
specific point in time that can be used to restore
data
– In MNP, the Backup Data option on the File menu can
be used to make a backup copy of the database.
• Restoring—process of retrieving data from a
backup storage device
– Files are restored using the Restore Data feature on
the File menu.
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
3.9 The Medisoft Clinical Help Feature
3-17
• MNP and MCPR offer built-in and online help
files.
– Built-in help feature is accessed via the Help menu.
– Help menu also provides access to help available
online at the MNP website.
• Knowledge base—collection of up-to-date
technical information
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
Purchase answer to see full
attachment