e billing chapters 3/4/5/6/7
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Created by:
renaealice on March 1, 2010
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85 terms
Terms | Definitions |
|---|---|
 backup data | a copy of data files made at a specific point in time that can be used to restore data to the systems |
| database | a collection of related bits of information |
| knowledge base | a collection of up to date technical information |
| MMDDCCYY format | a specific way in which dates must be keyed, in which MM stands for the month, DD stands for the day, CC represents the century, and YY stands for the year. |
| packing data | the deletion of vacant slots from the database |
| purging data | the process of deleting files of patients who are no longer seen by a provider in a practice. |
| rebuilding indexes | a process that checks and verifies data and corrects any internal problems with the data |
| recalculating balances | the process of updating balances to reflect the most recent changes made to the data. |
| restoring data | the process of retrieving data from backup storage devices |
| what are the 2 ways of issuing a command in medisoft | 1. a command can be issued by clicking options on the menu bar 2. a command can be issued by clicking on the short cut buttons on the toolbar. |
| what are the 2 ways data are entered into a box | 1. you enter data through the menu's or menu bar 2. enter data through buttons on the toolbar keying data into a text box. |
| what are the 3 hints in the help menu | 1. hints 2. built ins 3. online |
| what menu provides access to office hours, Medisofts scheduling feature | you find the office hours under the activities menu |
| what is the purpose of the buttons on the tool bar | the buttons are icons, the represent the dropdown menu on the toolbar at the top |
| what is the format for entering data in Medisoft | the format is MMDDCCYY |
| describe 2 ways of exiting Medisoft | 1. to exit click the file menu button and the click the close button 2. the 2nd ways is to click on the X button in the upper right corner of the screen |
| why it is important to back up data regularly | backdata can be used to restore data to the system in the event the data in the system is accidentally erased |
| why is extra caution required when purging data | once data are purged from the system it cannot be retrieved |
| when is a data restore performed | if you share a computer in an instructional environment, it is recommended that you perform a restore before each new session to be sure you are working with your own data |
| in Medisoft, what are the two places a patients balance can be recalculated? | 1. the first place a balance can be recalculated is in the patient's individual file through the transactions entry dialog box by clicking the account total column. 2. the second place to recalculate the patients is through the file maintenance section on the file menu and access recalculate balance tab |
| how many options are in the reports menu | there are 11 options |
| what is the first choice on the Lists menu | the first choice is Patient/Guarntors and cases |
| list the options on the activities menu 1 | enter transactions |
| list the options on the activities menu 2 | claim management |
| list the options on the activities menu 3 | statement management |
| list the options on the activities menu 4 | enter deposits/payments |
| list the options on the activities menu 5 | Unprocessed transactions |
| list the options on the activities menu 6 | patient ledger, guarantor ledger, |
| list the options on the activities menu 7 | quick balance, patient quick entry |
| list the options on the activities menu 8 | billing charges, small balance write off |
| list the options on the activities menu 9 | colllections list, add collection list item |
| list the options on the activities menu 10 | launch work administrator, final draft, add new task |
| list the options on the activities menu 11 | appointment book, eligibility verification, claims manager |
| what are the 4 options under File Maintenance | purging data, packing data, recalculating balances, rebuilding indexes |
| chart number | a unique number that identifies a patients |
| established patient | a patient who has been seen by a provider in the practice in the same specialty within 3 years |
| guarantor | an individual who is not a patient of the practice, but who is the insurance policyholder for a patient of the practice |
| new patient | a patient who has not received services from the same provider or a provider of the same specialty within the same practice for a period of 3 years |
| how do you create a chart # in Medisoft | under list menu, patient/guarantor, new patient, enter first 5 characters of the patients last name, 2 letters of the first name and the last is a 1 zero |
| How do you create an employer # in Medisoft | employers #s are entered there the list menu, under addresses, click new button, key E for employer, first 2 letters of Employers title followed by 2 zeros |
| what is the quickest way to open a patient or case | is to double click on the line associated with a patient or case |
| what does the copy address button saves | it sames time when entering patients with the same address, such as family members, clicking on the copy address button provides the option to copy demographic information from a patient already in the database |
| throughout Medisoft what function does the F8 button serves | the F8 function key serves as a shortcut for entering data in Medisoft in another part of the program without leaving the current dialog box. |
| right clicking | allows searching easier on a column heading in a window that contains several columns. you can select the located button, or can select alt+ L. This opens a locate window that defaults the fields selection to the column you selected |
| case | a case is a grouping of transactions for visits to a physicians office, organized around a condition. when a patient comes for treatment a case is created |
| example of case | all treatments and procedures for a patient's bronchial asthma would be stored in a case called "Bronchial Asthma" |
| when do you set up a new case | a new case should be set up each time a patient comes to see the physician for a NEW CONDITION or when there is a change in the provider or insurance carrier |
| why set up a new case when the ins. carrier changes | you set up an new case for the insurance carrier because it makes it easier to submit insurance claims to the appropriate carrier. |
| would you set up more than one case per office visit | yes, you would if the customer was diagnosed with 2 or more unrelated conditions. |
| when are cases closed | when the patient is no longer being treated for the condition, or when the insurance policy in the case is no longer in effect, or when the patient leaves the practice |
| where are cases created | in the list dialogue box under the patients/guarantors selection then select the Case radio button |
| what options can you create once the case radio button is selected | you can delete, edit, new, copy case print grid, quick entry, and close |
| in the Edit section of Case radio button | it contains 11 different tabs that can be edited. the condtion, misc, medicid and tricare, comment, EDI, Personal, ACcount, Diagnosis, Policy 1, Policy 2, Policy 3 (all info to change the insurance carriers) |
| what is the only thing you cannot change in the edit section of the radio button | you cannot change the case number |
| the delete case button | will delete the case from the system if their are not open transactions that have not been fully paid by the insurance carrier or the the policyholder. |
| the delete case button 1 | should be used with caution because the information cannot be retrieved and will be lost forever. the case should only be deleted when the patients records will never be needed again. |
| what is the normal policy in retaining case information | the normal retention period is 5 years for cases |
| copy case button | copies all the information from an existing case into a new case. it is especially useful for existing patients that present with a new condtion |
| the print grid | is used to select or deselect columns of information for printing purposes |
| quick entry | allows the office to customize the way patient data is entered |
| close button | closes the patient list dialog box |
| chart | is a folder that contains all records pertaining to a patient |
| record of treatment and progress | contains the physicians notes about a patients condition and diagnosis. |
| encounter form | is a list of services performed and the charges for those services |
| referring provider | a physician who recommends that a patient see a specific other physcian |
| account tab | on the case area includes info on a patients assigned provider, referring provider, and referral source, as well as other information that may be used is some medical practices but not others |
| account tab=attorney box | is used for accident cases. if a patient has an attorney, the name of the attorney should be selected from the drop down list, if not there enter under list menu, under addresses |
| account tab-case billing code | is a one or 2 character box used by some practices to classify and sort patients by insurance carriers, diagnosis, billing cycle, or other kinds of information |
| account tab-price code | the price code determines which set of fees is used when entering transactions for this case. |
| where are price code fees entered | they price code fees are entered under the list menu, drop down to the Procedure, payment, adjustment |
| primary insurance carrier | the first carrier to who claims are submitted |
| policy 1 tab | is where information about a patient's primary insurance carrier and coverage is recorded |
| insurance 1 section | lists the code number and name of insurance carrier, use f8 to add new insurance companies from this screen |
| policy holder 1 | is the guarantor on policy, if not a patient of this practice, you must establish a chart # for the guarantor |
| capitated plan | an insurance plan in which payments are made to a physician by a managed care company for a patient who selects the physician as his or her primary care provider, regardless of whether the patient visits the physician |
| UB-04 | is the treatment authorization field in the policy 1 section that record the treatment authorization Used for hospital claims |
| insurance coverage percents by service classification | the % of fees that an ins. carrier covers is entered in the Ins. Coverage Percents by Service Classification box. some ins. plans pay different percentages of charges based on the type of service provided. example 80 for medical, 100% lab, 50 % for outpaitent mental health |
| crossover claim box | located in Policy 2 section of the case section is only used when a patient has medicare as the primary carrier and Medicaid as the secondary carrier |
| the Condition Tab | contains or stores data about a patients illness, accident, disability and hospitalization. this information is used by ins carriers to process claims |
| charges | amounts a provider bills for the services performed |
| payments | monies received from patients and insurance carrierswha |
| adjustments | changes to patients accounts that alter the amounts charged or paid |
| what are the 3 transactions performed in Medisoft | payments, adjustments, charges are the 3 transactionsqw |
| what are examples of adjustments in Medisoft | return check fees, insurance writeoffs, medicare adjustments, and changes in treatment |
| what are the 2 locations payments are entere | in the activities menu, in the enter transaction drop down menu (use if payment received at time of office vist) or in the deposits, payments menu (use when receive payments from ins. carriers by mail or electronically . also for mailed payment from patients) |
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