health informatics week 3

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CHAPTER

5 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

Key Terms (Continued)

• registration

• secondary insurance

plan

• sponsor

5-6

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:

1. Medical history

2. Detailed patient and insurance information

3. Identification verification

4. Financial agreement and authorization for treatment

5. Assignment of benefits statement

6. Acknowledgment of Receipt of Notice of Privacy

Practices

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

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

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

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

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.

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.

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

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

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

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

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.

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

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

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

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

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.

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