Health Informatics: Assignment Week 2

gregueira82

chapter4informt.pdf

Home >Computer Science homework help > Health Informatics: Assignment Week 2

CHAPTER

4 Scheduling

Learning Outcomes

When you finish this chapter, you will be able to:

4.1 Describe the two methods used to schedule

appointments.

4.2 Explain the method used to classify patients as new

or established.

4.3 List the three categories of information new patients

provide during telephone preregistration.

4.4 Identify the information that needs to be verified for

established patients when making an appointment.

4.5 Describe covered and noncovered services under

medical insurance policies.

4-2

Learning Outcomes (Continued)

When you finish this chapter, you will be able to:

4.6 List the three main points to verify with the payer

regarding a patient’s benefits prior to a visit.

4.7 Explain when a preauthorization number or referral

document is required for a patient’s encounter.

4.8 List the four main areas of Medisoft Network

Professional’s Office Hours window.

4.9 Demonstrate how to enter an appointment.

4.10 Demonstrate how to book follow-up and repeating

appointments.

4.11 Demonstrate how to reschedule an appointment.

4-3

Learning Outcomes (Continued)

When you finish this chapter, you will be able to:

4.12 Demonstrate how to create a recall list.

4.13 Demonstrate how to enter provider breaks in the

schedule.

4.14 Demonstrate how to print a provider’s schedule.

4-4

Key Terms

• benefits

• capitation

• coinsurance

• copayment (copay)

• covered services

• deductible

• established patient (EP)

• fee-for-service

• health plan

• indemnity plan

• managed care

4-5

• 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

Key Terms (Continued)

• participating (PAR)

provider

• patient portal

• payer

• policyholder

• preauthorization

• preexisting condition

• premium

• preregistration

• preventive medical

services

4-6

• provider

• provider’s daily schedule

• provider selection box

• referral

• referral number

• schedule of benefits

4.1 Scheduling Methods 4-7

• 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

4.1 Scheduling Methods (Continued) 4-8

• Scheduling systems include these methods:

– Open hours

– Stream scheduling

– Double-booking

– Wave scheduling

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

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)

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

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.

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

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

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

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 employment-

related 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

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

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

4.5 Insurance Basics (Continued) 4-19

• Managed care—system that combines the

financing and delivery of appropriate, cost-

effective 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

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

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.

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

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

4.9 Entering Appointments 4-24

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.

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.

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.

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.

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.

4.13 Creating Provider Breaks 4-29

• 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).

4.14 Printing Schedules 4-30

• 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.