1.1 THE INCREASING USE OF TECHNOLOGY IN HEALTHCARE

1.2 FUNCTIONS OF PRACTICE MANAGEMENT PROGRAMS

Creating and Transmitting Claims

Monitoring Claim Status

Receiving and Processing Payments

1.3 FUNCTIONS OF ELECTRONIC HEALTH RECORD PROGRAMS

Health Information and Data Elements

Results Management

Order Management

Decision Support

Electronic Communication and Connectivity

Patient Support

Administrative Processes

Reporting and Population Management

Advantages of Electronic Health Records

1.4 THE MEDICAL DOCUMENTATION AND BILLING CYCLE: PRE-ENCOUNTER

Step 1: Preregister Patients

1.5 THE MEDICAL DOCUMENTATION AND BILLING CYCLE: ENCOUNTER

Step 2: Establish Financial Responsibility

Step 3: Check In Patients

Step 4: Review Coding Compliance

Step 5: Review Billing Compliance

Step 6: Check Out Patients

1.6 THE MEDICAL DOCUMENTATION AND BILLING CYCLE: POST-ENCOUNTER

Step 7: Prepare and Transmit Claims

Step 8: Monitor Payer Adjudication

Step 9: Generate Patient Statements

Step 10: Follow Up Payments and Collections

1.7 THE IMPACT OF LEGISLATION: HIPAA

HIPAA Electronic Transaction and Code Sets Standards

HIPAA Privacy Requirements

HIPAA Security Requirements

State Regulation

1.8 THE IMPACT OF LEGISLATION: HITECH AND ACA

Health Information Technology for Economic and Clinical Health Act (2009)

Patient Protection and Affordable Care Act (2010)

Part 2: MEDISOFT ADVANCED TRAINING

Chapter 2: Introduction to Medisoft

2.1 THE MEDISOFT DATABASES

2.2 THE MEDISOFT MENUS

File Menu

Edit Menu

Activities Menu

Lists Menu

Reports Menu

Tools Menu

Window Menu

Help Menu

Exercise 2-1: Medisoft Menus

2.3 THE MEDISOFT TOOLBAR

Exercise 2-2: Toolbar Buttons

2.4 ENTERING, EDITING, SAVING, AND DELETING DATA IN MEDISOFT

Entering Data

Editing Data

Exercise 2-3: Editing Data

Saving Data

Deleting Data

2.5 CHANGING THE MEDISOFT PROGRAM DATE

Windows XP

Windows Vista and Windows 7

2.6 USING MEDISOFT HELP

Hints

Built-In

Exercise 2-4: Using Built-in Help

2.7 CREATING AND RESTORING BACKUP FILES

Creating a Backup File While Exiting Medisoft

Exercise 2-5: Backing Up

Restoring the Backup File

Exercise 2-6: Restoring a Backup File

2.8 MEDISOFT’S FILE MAINTENANCE UTILITIES

Rebuilding Indexes

Packing Data

Purging Data

Recalculating Patient Balances

2.9 USING MEDISOFT SECURITY FEATURES TO ENSURE HIPAA AND HITECH COMPLIANCE

User Logins and Audit Controls

Auto Log Off and Unapproved Codes

Chapter 3: Scheduling

3.1 THE OFFICE HOURS WINDOW

Program Options

Entering and Exiting Office Hours

3.2 ENTERING APPOINTMENTS

Exercise 3-1: Entering an Appointment, Leila Patterson

Exercise 3-2: Entering an Appointment, Elizabeth Jones

Exercise 3-3: Looking up a Provider and Entering an Appointment

3.3 BOOKING FOLLOW-UP APPOINTMENTS

Exercise 3-4: Booking an Appointment with a Follow-up

3.4 SEARCHING FOR AVAILABLE TIME SLOTS

Exercise 3-5: Searching for Open Time, Ramos

Exercise 3-6: Searching for Open Time, Klein

3.5 ENTERING APPOINTMENTS FOR NEW PATIENTS

Exercise 3-7: Entering an Appointment for a New Patient

3.6 BOOKING REPEAT APPPOINTMENTS

Exercise 3-8: Booking Repeat Appointments

3.7 RESCHEDULING AND CANCELING APPPOINTMENTS

Exercise 3-9: Rescheduling Appointments

3.8 VERIFYING INSURANCE ELIGIBILITY AND BENEFITS

Eligibility Verification Icons

Exercise 3-10: Verifying a Patient’s Eligibility

3.9 CHECKING PATIENTS IN AND OUT

Exercise 3-11: Checking In a Patient

3.10 CREATING AN OVERDUE BALANCE REPORT FOR PATIENTS WITH APPOINTMENTS

Exercise 3-12: Creating an Overdue Balance Report

3.11 CREATING A PATIENT RECALL LIST

Adding a Patient to the Recall List

Exercise 3-13: Adding a Patient to the Recall List

3.12 CREATING PROVIDER BREAKS

Exercise 3-14: Entering a Provider Break

3.13 VIEWING AND PRINTING SCHEDULES

Exercise 3-15: Viewing a Provider Schedule

Applying Your Skills 1: Enter an Appointment for a New Patient

Applying Your Skills 2: Search for an Open Time

Applying Your Skills 3: Preview a Physician’s Schedule

Chapter 4: Entering Patient Information

4.1 HOW PATIENT INFORMATION IS ORGANIZED IN MEDISOFT

4.2 ENTERING NEW PATIENT INFORMATION

Name, Address Tab

Exercise 4-1: Chart Numbers

Other Information Tab

Payment Plan Tab

Exercise 4-2: Adding a New Patient

Adding an Employer to the Address List

Exercise 4-3: Adding an Employer

4.3 SEARCHING FOR PATIENT INFORMATION

Search for and Field Option

Exercise 4-4: Search Using Field Box

Locate Buttons Option

Exercise 4-5 Search Using Locate Button

4.4 EDITING PATIENT INFORMATION

Exercise 4-6: Editing Patient Information

Applying Your Skills 4: Entering a New Patient

Chapter 5: Working with Cases

5.1 UNDERSTANDING CASES

When to Set Up a New Case

Case Examples

5.2 NAVIGATING CASES IN MEDISOFT

Case Command Buttons

The Case Dialog Box

5.3 ENTERING PATIENT AND ACCOUNT INFORMATION

Personal Tab

Exercise 5-1: Entering Data in the Personal Tab

Account Tab

Exercise 5-2: Entering Data in the Account Tab

5.4 ENTERING INSURANCE INFORMATION

Policy 1 Tab

Exercise 5-3: Entering Data in the Policy 1 Tab

Policy 2 Tab

Policy 3 Tab

Medicaid and Tricare Tab

5.5 ENTERING HEALTH INFORMATION

Diagnosis Tab

Exercise 5-4: Entering Data in the Diagnosis Tab

Condition Tab

Exercise 5-5: Entering Data in the Condition Tab

5.6 ENTERING OTHER INFORMATION

Miscellaneous Tab

Comment Tab

Exercise 5-6: Entering Data in the Comment Tab

EDI Tab

5.7 EDITING CASE INFORMATION

Exercise 5-7: Editing a Case

Exercise 5-8: Copying a Case

Applying Your Skills 5: Creating a Case for a New Patient

Chapter 6: Entering Charge Transactions and Patient Payments

6.1 UNDERSTANDING CHARGES, PAYMENTS, AND ADJUSTMENTS

6.2 SELECTING A PATIENT AND CASE

Chart

Case

Additional Information

6.3 ENTERING CHARGE TRANSACTIONS

Buttons in the Charges Area of the Transaction Entry

Dialog Box

Color Coding in Transaction Entry

Saving Charges

Editing Transactions

Exercise 6-1: Entering a Charge for Hiro Tanaka

Exercise 6-2: Entering a Charge for Elizabeth Jones

6.4 ENTERING PAYMENTS MADE AT THE TIME OF AN OFFICE VISIT

Applying Payments to Charges

Saving Payment Information

Exercise 6-3: Entering a Copayment

Exercise 6-4: Entering Charges and Copayment

6.5 PRINTING WALKOUT RECEIPTS

Exercise 6-5: Creating a Walkout Receipt

6.6 PROCESSING A PATIENT REFUND

Exercise 6-6: Processing a Refund

6.7 PROCESSING A NONSUFFICIENT FUNDS (NSF) CHECK

Exercise 6-7: Processing an NSF Check

Applying Your Skills 6: Add a Diagnosis and Enter

Procedure Charges

Chapter 7: Creating Claims

7.1 THE BASICS OF MEDICAL INSURANCE

Types of Health Plans

7.2 THE ROLE OF CLAIMS IN THE BILLING CYCLE

Medical Necessity

Clean Claims

CMS-1500 and X12 837 Health Care Claim

Exercise 7-1: Exploring the CMS-1500 in Medisoft Help

7.3 CLAIM MANAGEMENT IN MEDISOFT

7.4 CREATING CLAIMS

Exercise 7-2: Creating Claims

7.5 LOCATING CLAIMS

Exercise 7-3: Using the List Only Feature

7.6 EDITING CLAIMS

Carrier 1 Tab

Carrier 2 and Carrier 3 Tabs

Transactions Tab

Comment Tab

EDI Note Tab

Exercise 7-4: Reviewing a Claim

7.7 CHANGING THE STATUS OF A CLAIM

Exercise 7-5: Changing Claim Status

7.8 ELECTRONIC CLAIMS WORKFLOW

Exercise 7-6: Perform an Electronic Claim Edit Check

7.9 SENDING ELECTRONIC CLAIM ATTACHMENTS

Applying Your Skills 7:Reviewing Claims

Chapter 8: Posting Payments and Creating Patient Statements

8.1 THIRD-PARTY REIMBURSEMENT OVERVIEW

Indemnity Plan Example

Managed Care Example

Medicare Participating Example

8.2 REMITTANCE ADVICE (RA) PROCESSING

Claim Adjustments and Denials

Processing Payments

8.3 ENTERING INSURANCE PAYMENTS IN MEDISOFT

The Deposit List Dialog Box

The Deposit Dialog Box

Exercise 8-1: Entering a Deposit: ChampVA

8.4 APPLYING INSURANCE PAYMENTS TO CHARGES

Exercise 8-2: Applying Payments to Charges: ChampVA

Exercise 8-3: Entering a Deposit and Applying Payments: East Ohio PPO

Exercise 8-4: Entering a Deposit and Applying Payments: Blue Cross and Blue Shield

8.5 PROCESSING A PATIENT PAYMENT RECEIVED BY MAIL

Exercise 8-5: Entering a Patient Payment Received by Mail

8.6 ENTERING CAPITATION PAYMENTS

Exercise 8-6: Entering a Capitation Payment

Exercise 8-7: Entering a Zero Amount Payment

Exercise 8-8: Adjusting a Capitated Account

8.7 CREATING STATEMENTS

Statement Management Dialog Box

Create Statements Dialog Box

Exercise 8-9: Creating Statements

8.8 EDITING STATEMENTS

General Tab

Transactions Tab

Comment Tab

Exercise 8-10: Reviewing a Statement

8.9 PRINTING STATEMENTS

Selecting a Format

Selecting the Filters and Printing the Statements

Exercise 8-11: Printing Statements

Applying Your Skills 8: Enter Insurance Payments

Applying Your Skills 9: Create Statements

Chapter 9: Creating Reports

9.1 CREATING REPORTS IN MEDISOFT

Selecting Print Options

Selecting Data for a Report

9.2 THE IMPORTANCE OF ACCOUNTS RECEIVABLE REPORTS

Daily Reports

Monthly Reports

9.3 CREATING DAY SHEETS

Patient Day Sheet

Exercise 9-1: Printing a Patient Day sheet

Procedure Day Sheet

Payment Day Sheet

9.4 CREATING ANALYSIS REPORTS

Billing/Payment Status Report

Practice Analysis Report

Exercise 9-2: Save a Practice Analysis Report as a PDF File

Insurance Analysis Report

Referring Provider Report

Referral Source Report

Unapplied Payment/Adjustment Report

Unapplied Deposit Report

Co-payment Report

Outstanding Co-Payment Report

Appointment Eligibility Analysis—Detail and Summary

Electronic Claims Analysis—Detail and Summary

9.5 CREATING PATIENT LEDGER REPORTS

Exercise 9-3: Printing a Patient Account Ledger

9.6 CREATING STANDARD PATIENT LIST REPORTS

Exercise 9-4: Printing a Patient by Insurance Carrier List

9.7 NAVIGATING IN MEDISOFT REPORTS

The Medisoft Reports Menus

The Medisoft Reports Toolbar

The Medisoft Reports Find Report Box

The Medisoft Reports Help Feature

9.8 CREATING AGING REPORTS

Exercise 9-5 Printing a Patient Aging Report

9.9 CREATING CUSTOM REPORTS

Exercise 9-6: Printing a List of Patients

Exercise 9-7: Printing a List of Procedure Codes

9.10 USING REPORT DESIGNER

Exercise 9-8: Modifying a Report

Applying Your Skills 10: Print a Patient Day Sheet

Applying Your Skills 11: Print an Insurance Payment by Type Report

Chapter 10: Collections in the Medical Office

10.1 FOLLOWING UP ON INSURANCE CLAIMS

Prompt Payment Laws

Working Claim Denials

Aging Insurance Claims

Resubmitting Claims

10.2 THE IMPORTANCE OF A FINANCIAL POLICY

10.3 LAWS GOVERNING PATIENT COLLECTIONS

Using Payment Plans

10.4 WORKING WITH COLLECTION AGENCIES

Exercise 10-1: Posting a Payment from a Collection Agency

10.5 WRITING OFF UNCOLLECTIBLE ACCOUNTS

Exercise 10-2: Writing Off a Patient Balance

10.6 USING A PATIENT AGING REPORT FOR COLLECTIONS

Exercise 10-3: Identifying Overdue Accounts

10.7 ADDING AN ACCOUNT TO THE COLLECTION LIST

Using the Collection List Window

Entering a Tickler Item

Exercise 10-4: Creating a Tickler

10.8 CREATING COLLECTION LETTERS

Exercise 10-5: Creating a Collection Letter

10.9 CREATING A COLLECTION TRACER REPORT

Exercise 10-6: Creating a Collection Tracer Report

Applying Your Skills 12: Print a Patient Aging Report

Applying Your Skills 13: Add a Patient to the Collection List

Applying Your Skills 14: Create a Collection Letter

Part 3: APPLYING YOUR SKILLS

Chapter 11: Appointments and Registration

Exercise 11-1: Scheduling an Appointment: Lawana Brooks

Exercise 11-2: Scheduling an Appointment: Edwin Hsu

Exercise 11-3: Scheduling an Appointment: Anthony Battistuta

Exercise 11-4: Scheduling an Appointment: Stewart Robertson

Exercise 11-5: Scheduling an Appointment: Hannah Syzmanski

Exercise 11-6: Making an Appointment Change

Exercise 11-7: Juggling Schedules

Exercise 11-8: Scheduling an Appointment: Michael Syzmanski

Exercise 11-9: Print a Provider Schedule

Chapter 12: Cases, Transactions, and Claims

Exercise 12-1: Entering Transactions

Exercise 12-2: An Unscheduled Visit

Exercise 12-3: Changing a Transaction Record

Exercise 12-4: Scheduling an Appointment: Diane Hsu

Exercise 12-5: Entering Charges and Payments: Stewart Robertson

Exercise 12-6: Entering Charges and Payments: Diane Hsu

Exercise 12-7: Entering Charges and Payments: Michael Syzmanski

Exercise 12-8: Entering and Applying an Insurance Carrier Payment

Exercise 12-9: Creating Insurance Claims

Exercise 12-10: Finding a Patient’s Balance

Chapter 13: Reports and Collections

Exercise 13-1: Creating a Patient Day Sheet Report

Exercise 13-2: Creating a Patient Aging Report

Exercise 13-3: Creating a Practice Analysis Report

Exercise 13-4: Adding Items to the Collection List

Exercise 13-5: Create Collection Letters

Chapter 14: Putting It All Together

Exercise 14-1: Scheduling Appointments

Exercise 14-2: Rescheduling and Canceling Appointments

Exercise 14-3: Printing Schedules

Exercise 14-4: Creating Cases

Exercise 14-5: Entering Transactions

Exercise 14-6: Creating Claims

Exercise 14-7: Entering Insurance Payments

Exercise 14-8: Creating Patient Statements

Exercise 14-9: Printing Reports

Exercise 14-10: Entering Collection Agency and Patient Payments

Exercise 14-11: Reviewing Overdue Accounts

Exercise 14-12: Adding Patients to the Collection List and Creating Collection Letters

Part 4: SOURCE DOCUMENTS

Glossary

Index

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