Computers in the Medical Office - Ch. 8-11
What is a fee schedule?
a list of the provider's standard fees (specifies the amount the provider bills per service)
What is the 1st step for processing a Remittance Advice?
Compare the RA to the original insurance claim (make sure all procedures are included and that the CPT claims have not changed.
What is the 2nd step for processing a Remittance Advice?
Review the payment amount against the expected amount.
What is the 3rd step for processing a Remittance Advice?
Identify the reasons for denials or payment reductions. Resubmit or appeal claims if needed.
What is the 4th step for processing a Remittance Advice?
Post payment information for individual claims to the appropriate patient accounts.
What is the 5th and final step for processing a Remittance Advice?
Bill the patient's secondary health plan (of necessary).
What are some reasons charges may be denied by the insurance carriers?
the procedure may not be covered by the plan, or a procedure/diagnosis may be coded incorrectly.
Where are patient payments entered?
in the Transaction Entry dialog box
Where are insurance payments entered?
in the Deposit List dialog box
In the Deposit List dialog box - What is the Sort By field for?
this drop down box offers several choices for how payment information is listed.
In the Deposit List dialog box - What is the default for the Sort By field?
is sorting payments by date and description.
What are capitation payments?
payments made to physicians on a regular basis (such as monthly) for providing services to patients in the managed care insurance plan.
The Apply Payments/Adjustments to Charges dialog box contains what?
information about all unpaid charges for a patient.
When applying insurance payments to charges - What happens when the "Bill Remaining Insurances Now" box is checked?
claims for any secondary or tertiary payer associated with the claim are created when the current insurance payment is saved.
What must you do to the charges in each patient's account that is covered by a capitation payment?
the patient's account must be adjusted to a zero balance to indicate that the insurance company has met its obligation and that the patient has too (by paying their co-pay)
What is a patient statement?
a list of the amount of money a patient owes, organized by the amount of the time the money has been owed, the procedures performed, and the dates they were performed.
Within the Statement Management Dialog Box - What are the 2 types of statements?
Standard and Remainder
Who is responsible for the printing and mailing of PAPER statements?
Who is responsible for the submission of ELECTRONIC statements?
the practice sends electronic statements electronically to a processing center, which prints them and mails them.
Where can the options for creating reports be accessed?
via the Reports menu
What are the three reports options?
1) Standard Reports
2) Medisoft Report
3) Design Custom Reports and Bills
What is a patient day sheet?
a report that lists the procedures for a particular, grouped by patient, in alphabetical order by chart number
A filter search can be performed by what 3 items?
2) Attending Provider
3) Billing Code
What is a payment day sheet?
a report that lists all payments received on a particular day organized by provider
What is a patient ledger?
a report that lists the transaction details of a patient's account, including charges, payments, and adjustments.
How can the reports identifying patients by diagnosis or insurance carrier accessed?
via the Standard Patient Lists submenu on the Reports menu
What does the Patient by Diagnosis report list?
the diagnosis, chart number, patient name, age, attending provider, facility, and date of last visit.
What is a patient aging report?
a report that lists a patient's balance by age, date, and amount of the last payment, and telephone number.
Collections from patients are considered what kind of collections?
Patient collections are governed by?
Federal and State Laws
What is an acceptable method for collecting a debt over the phone?
ask the patient to make a payment right away
What is an uncollectible account?
it is bad debt or bills that medical practices do not expect to collect.
What happens to uncollectible accounts/bad debts?
they are usually written off the practice's expected accounts receivable.
While specific collection features vary from program to program, common features used include:
aging reports, collection lists, collection letters, and collection reports.
What is the function of the collection list?
it is designed to track activities that need to be completed as part of the collection process.
What are the 3 options available for controlling what appears in the Collection List window at the top of the dialog box?
Item, Responsible Party, and Type
Within the tickler tab - What is the "Action required" field for?
it specifies the action that is to be taken to remedy the problem.
Within the tickler tab - How many characters can be entered in the "Action Required" field?
up to eighty (80)
What is a collection tracer report?
a tool used to keep track of collection letters that were sent.
What does the collection tracer report list?
the tickler item number, the responsible party, the chart number, the account balance, the date the collection letter was sent, and the reasons the account is in collections.
What is the provider's daily schedule?
it is a listing of time slots for a particular day for a specific provider. It is shown in the right half of the screen.
What is the Office Hours Calendar used for?
it is an interactive calendar that is used to select or change dates.
If Medisoft is just being installed, where can the options to set up the Office Hours program be found?
in the Program Options dialog box, which is accessed by clicking the Program Options on the Office Hours File menu
How are appointments entered?
By clicking the appointment entry shortcut button or by doule clicking in a time slot on the schedule.
When entering appointments - what is the repeat box for?
to enter appointments that recur on a regular basis
When booking follow-up appointments - what is the Go ___ Days box for?
this box is used to locate a date that is a specific number of days in the future.
What do you do when a new patient calls the office for an appointment?
schedule the appointment in Office Hours (even though the patient information is not entered in Medisoft).
When adding a patient to the recall list - What is the recall status box used for?
to indicate the action that needs to be taken for the patient.
What are the 3 options available on the recall list?
1) Call again
2) Appointment Set
3) No Appointment
On the recall list - what is the "call again" button for?
it is used when a patient has been called once, but contact was not made. An additional call is necessary.
On the recall list - what is the"appointment set" button for?
it is used when a patient has an appointment already scheduled.
On the recall list - what is the "no appointment" button for?
it is used when a patient has been contacted for an appointment but has declined for some reason.
What is the Office Hours Break?
it is a block of time when a physician is unavailable for appointments with patients.
In most medical offices, provider's schedules are printed how often?
on a daily basis
How can you view a list of all appointments for a provider on a particular day?
by clicking the Appointment List option on the Office Hours Reports menu