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CHAPTER

McGraw-Hill

Check-in Procedures

Learning Outcomes

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

5.1 List the six types of information that are gathered as part of the registration process for new patients.

5.2 Determine which health plan is primary when there is more than one.

5.3 Describe the purpose of a practice’s financial policy.

5.4 List the types of payments that may be collected from patients at check-in.

5.5 Discuss the advantages of tracking patients electronically during a visit.

5-2

Learning Outcomes (Continued)

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

5.6 In Medisoft Network Professional, describe the organization of patient data.

5.7 Discuss how a new patient is added to the database.

5.8 Name the two options used to conduct searches.

5.9 Describe when it is necessary to create a new case or to utilize an existing case.

5.10 Analyze the information contained in the Personal and Account tabs.

5.11 Discuss the information recorded in the Policy 1, 2, 3, and Medicaid and Tricare tabs.

5-3

Learning Outcomes (Continued)

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

5.12 Describe the information contained in the Diagnosis and Condition tabs.

5.13 Discuss the purpose of the Miscellaneous, Multimedia, Comment, and EDI tabs.

5-4

Key Terms

accept assignment
advance beneficiary notice of noncoverage (ABN)
assignment of benefits
birthday rule
capitated plan
case
chart
chart number

5-5

coordination of benefits (COB)
financial policy
guarantor
patient information form
patient tracking features
primary insurance plan
record of treatment and progress
referring provider

Teaching Notes: There are a lot of key terms, but many of them might already be familiar to your students. Give a pop quiz of the terms to see how many of them students know. The quiz could be multiple-choice, matching, or simply a list of terms for which students supply definitions. Grade the quiz in class and use the results to focus your lecture on the terms that most or all students missed.

Key Terms (Continued)

registration
secondary insurance plan
sponsor

5-6

Teaching Notes: See notes on Slide 5.

5.1 Patient Registration

5-7

Registration—process of gathering personal and insurance information about a patient before an encounter with a provider
If the patient is new to the practice, these six types of information are gathered:

Medical history

Detailed patient and insurance information

Identification verification

Financial agreement and authorization for treatment

Assignment of benefits statement

Acknowledgment of Receipt of Notice of Privacy Practices

Learning Outcome: 5.1 List the six types of information that are gathered as part of the registration process for new patients.

Teaching Notes: Ask why so many pieces of information need to be obtained from a new patient upon registration.

5.1 Patient Registration (Continued)

5-8

Patient information form—form that includes a patient’s personal, employment, and insurance data needed to complete a health care claim (also known as a registration form)
Guarantor—person who is the insurance policyholder for a patient of the practice
Assignment of benefits—authorization by a policyholder that allows a health plan to pay benefits directly to a provider

Learning Outcome: 5.1 List the six types of information that are gathered as part of the registration process for new patients.

Teaching Notes: Discuss the benefits of having the PIF available online versus in hard copy format. Direct students to Figure 5.2 in their textbook to see a sample insurance card.

5.1 Patient Registration (Continued)

5-9

Accept assignment—participating physician’s agreement to accept the allowed charge as payment in full
Advance beneficiary notice of noncoverage (ABN)—Medicare form used to inform a patient that a service to be provided is not likely to be reimbursed by Medicare

Learning Outcome: 5.1 List the six types of information that are gathered as part of the registration process for new patients.

Teaching Notes: An ABN form will provide the following information: identification of service/procedure for which Medicare is unlikely to pay, the reason Medicare is unlikely to pay, and an estimate of the patient’s out-of-pocket costs for the uncovered items.

5.2 Other Insurance Plans: Coordination
of Benefits

5-10

Primary insurance plan—health plan that pays benefits first when a patient is covered by more than one plan
Secondary insurance plan—health plan that pays benefits after the primary plan pays when a patient is covered by more than one plan
Coordination of benefits (COB)—clause in an insurance policy that explains how the policy will pay if more than one insurance policy applies to the claim

Learning Outcome: 5.2 Determine which health plan is primary when there is more than one.

Teaching Notes: Discuss the pros and cons of having secondary insurance. Important points include the cost of paying for two insurance policies, one the one hand, versus the potential for fewer out-of pocket costs if treatment or procedures are necessary, on the other hand.

When dealing with COB, Medicaid is known as the “payer of last resort,” since it will only pay after all other possible avenues of coverage are exhausted.

5.2 Other Insurance Plans: Coordination
of Benefits (Continued)

5-11

Birthday rule—guideline that determines which of the two parents with medical coverage has the primary insurance for a child

Learning Outcome: 5.2 Determine which health plan is primary when there is more than one.

Teaching Notes: Discuss Table 5.1 in the textbook to look at all possible scenarios for determining insurance coverage.

Provide various examples of the “birthday rule” and let students decide who’s plan would be primary in each situation.

5.3 Financial Policy of the Practice

5-12

Financial policy—practice’s rules governing payment for medical services from patients

New patients are given information about the practice’s financial policy so they understand that they are responsible for payment of charges that are not paid by their health plan.
Established patients are reminded of their financial obligations.

Learning Outcome: 5.3 Describe the purpose of a practice’s financial policy.

Teaching Notes: The financial policy is often displayed at the reception counter. Ask students if they believe patients read the financial statement; why or why not? If not, why is it displayed at the counter?

5.4 Estimating and Collecting Payment

5-13

Patient payments are estimated and collected at check-in.
Payments collected at check-in include:
copayments,
outstanding balances, and
partial payments.

Learning Outcome: 5.4 List the types of payments that may be collected from patients at check-in.

Teaching Notes: Ask what the purpose of a copayment is. Explain that most practice management software programs can quickly and easily show if a patient has a copay or an outstanding balance when they check in.

Have students complete Exercise 5.1.

5.5 Patient Tracking

5-14

Patient tracking features—function attached to the electronic scheduler that is used during a patient encounter to track where the patient is during the different steps of the encounter

allows any member of a medical administrative team to see a patient’s whereabouts at a glance
in some programs, offers the creating of reports

Learning Outcome: 5.5 Discuss the advantages of tracking patients electronically during a visit.

Teaching Notes: Explain to students that the current version of Medisoft Network Professional does NOT have a patient tracking feature, but the next edition will contain a function called Office Hours for Network Professional that will allow office assistants to track patients with the following tags (reference Figure 5.7 in text):

Unconfirmed
Confirmed
Checked In
Missed
Cancelled
Being Seen
Checked Out
Rescheduled

Also mention that tracking features are most helpful in large practices, where so many patients are seen that they are sometimes double-booked.

5.6 Patient Information in Medisoft
Network Professional

5-15

The Patient List dialog box lists all patients, guarantors, and cases currently in the database.
Left side of the window displays information about patients.
Right side of the window contains information about cases.
Patient and Case radio buttons activate their respective sides.
Case—grouping of transactions for visits to a physician office organized around a specific medical condition

Learning Outcome: 5.6 In Medisoft Network Professional, describe the organization of patient data.

Teaching Notes: Explain that patient information is critical to the success and efficiency of a practice. Information must be entered accurately and always kept up-to-date. The information entered on the patient list and case screens becomes the links to EHRs and the eventual billing and reimbursement process.

Ask students what they think the purpose of separating patients/transactions by CASE might be.

5.7 Entering New Patient Information

5-16

To add a new patient in MNP:
Click the New Patient button; the Patient/Guarantor dialog box opens.
Enter information from the patient information form.
Complete the three tabs: the Name, Address tab; the Other Information tab; and the Payment Plan tab.
Chart number—unique alphanumeric code that identifies a patient

Learning Outcome: 5.7 Discuss how a new patient is added to the database.

Teaching Notes: When discussing chart numbers, explain that different medical practices may use their own systems for creating and updating chart numbers, but there are two guidelines that must be followed by all practices: no two chart numbers may be the same, and no special characters (hyphens, periods, spaces) may be used.

Have students complete Exercises 5.2 and 5.3.

5.8 Searching for and Updating Patient
Information

5-17

To update patient information, select the Patients/Guarantors and Cases option from the Lists menu.
The program offers two options for conducting searches:
Search for and Field boxes
Locate buttons

Learning Outcome: 5.8 Name the two options used to conduct searches.

Teaching Notes: Note that the process for updating patient information is similar to entering new patient information.

When discussing the Search for, Field, and Locate functions, reference Figure 5.20 (Search for/Field) and 5.22 (Locate) in the textbook.

Ask students to brainstorm instances when either the Search for/Field search or the Locate search would work better.

Have students complete Exercises 5.4 and 5.5.

5.9 Navigating Cases in Medisoft
Network Professional

5-18

Transactions are usually grouped into cases based on the medical condition for which the patient seeks treatment.
Patients with chronic conditions often have many transactions in a single case.
Patients may require more than one case per office visit if treatment is provided for two or more unrelated conditions.
When a patient is treated under workers’ compensation insurance, a new case must be created.

Learning Outcome: 5.9 Describe when it is necessary to create a new case or to utilize an existing case.

Teaching Notes: Provide various patient scenarios and have students speculate about whether the patient in question would have a single or multiple cases. Use scenarios to discuss the issue of cases. You may want to use the examples in the textbook as a starting point.

Discuss the use of the “Delete case” button in Medisoft – it should be used with caution, since the action cannot be undone, but there are circumstances which require using the delete case command.

5.9 Navigating Cases in Medisoft
Network Professional (Continued)

5-19

Chart—folder than contains all records pertaining to a patient
Record of treatment and progress—physician’s notes about a patient’s condition and diagnosis

Learning Outcome: 5.9 Describe when it is necessary to create a new case or to utilize an existing case.

Teaching Notes: Explain to students that all the information needed to fill out the case tabs is contained within the Chart.

5.10 Entering Patient and Account Information

5-20

Personal tab—contains basic information about a patient and his or her employment
Account tab—includes information on a patient’s assigned provider, referring provider, and referral source
Referring provider—physician who refers the patient to another physician for treatment

Learning Outcome: 5.10 Analyze the information contained in the Personal and Account tabs.

Teaching Notes: Explain to students that, while working in the Accounts tab, if a referring provider is not listed in the drop-down, a new entry will need to be added to the provider database. HOWEVER, you do not need to close out of the current tab in order to enter the new provider; it can be done simply by clicking F8 while in the Referring Provider tab. A box pops up that allows the proper information to be entered, and the process can be continued.

Ask students why it is important to note the referring provider in a patient’s record.

Have students complete Exercises 5.6 and 5.7.

5.11 Entering Insurance Information

5-21

Policy 1 tab—used to record information about a patient’s primary insurance carrier
Claims are sent to the primary insurance carrier first.
Capitated plan—insurance plan in which prepayments made to a physician cover the physician’s services to a plan member for a specified period of time
Policy 2 tab—used to record information about a patient’s secondary insurance carrier
Policy 3 tab—used to record information about a patient’s tertiary insurance carrier

Learning Outcome: 5.11 Discuss the information recorded in the Policy 1, 2, 3, and Medicaid and Tricare tabs.

Teaching Notes: When discussing capitated plans, stress that the prepayments are made to a physician WHETHER OR NOT a patient seeks medical treatment during that time. Ask students to brainstorm why that may be; use responses to launch discussion.

Ask students what type(s) of situations might require a patient to have tertiary (3rd party) insurance coverage.

Have students complete Exercise 5.8.

5.11 Entering Insurance Information (Continued)

5-22

Medicare and Tricare tab—used to enter additional information about Medicaid or TRICARE for patients covered by government programs
Sponsor—in TRICARE, the active-duty service member

Learning Outcome: 5.11 Discuss the information recorded in the Policy 1, 2, 3, and Medicaid and Tricare tabs.

Teaching Notes: Ask students why there might be a special type of insurance coverage for military personnel and their families. Why could they not be covered under other government plans?

5.12 Entering Health Information

5-23

Diagnosis tab—contains a patient’s diagnosis, information about allergies, and electronic media claim (EDI) notes
Condition tab—stores data about a patient’s illness, accident, disability, and hospitalization
Information is used by insurance carriers to process claims.

Learning Outcome: 5.12 Describe the information contained in the Diagnosis and Condition tabs.

Teaching Notes: Use this information in discussing coding, and the importance of proper diagnosis reporting and coding. Discuss the differences between a DIAGNOSIS and a CONDITION.

Have students complete Exercises 5.9 and 5.10.

5.13 Entering Other Information

5-24

Miscellaneous tab—records a variety of miscellaneous information about the patient and his or her treatment
Multimedia tab—used to save a multimedia file
Comment tab—used to enter case notes
EDI tab—used to enter information for electronic claims specific to this case

Learning Outcome: 5.13 Discuss the purpose of the Miscellaneous, Multimedia, Comment, and EDI tabs.

Teaching Notes: The Miscellaneous tab is kind of a “catch-all.” Pose this question to students: If this information is not applicable anywhere else, why does it need to be captured?

When discussing the Multimedia tab, have students brainstorm reasons why a multimedia file could be important and what types of things could constitute a multimedia file. (A picture of a procedure? A photo of a lesion or sore? Etc.)