Getting Started in the Computerized Medical Office Fundamentals and Practice

by Correa, Cindy

• ISBN13: 9781401830380
• ISBN10: 1401830382
• Edition: 1st
• Format: Spiral Bound
• Copyright: 2005-01-25
• Publisher: CENGAGE Delmar Learning

Summary

Getting Started in the Computerized Medical Office: Fundamentals and Practice appeals to those programs needing a more elementary software and approach for students who may not be as adept as others with technology. This reference provides basic hands-on computer skills in a modular unit so instructors can choose to omit it in their class or user it as a review. It allows total flexibility for teaching billing and office management separately and addressing the needs of students to learn medical software and basic computer skills.

Table of Contents

Foreword	xiii
Preface	xv
Acknowledgments	xxv
About the Author	xxvii
How to Use This Book	xxviii
How to Use MOSS Software	xxx
Introduction to Computers	1	(32)
Objectives	1	(1)
Types of Computers	2	(1)
The Data Processing Cycle	2	(2)
Software	4	(2)
Applications Software	4	(1)
Systems Software	5	(1)
Hardware	6	(4)
Drives	6	(2)
Random Access Memory (RAM)	8	(1)
Serial, Parallel, and USB Port Connections	8	(1)
Devices for Internet Access	8	(2)
Connecting and Installing Hardware	10	(1)
Using The Computer: A Tour Of Windows	10	(1)
Booting the Computer	10	(1)
Let's Try It! Booting and Shutting Down the Computer	11	(8)
The Microsoft Windows® Desktop	10	(2)
Application and Document Windows	12	(1)
Using Windows	12	(4)
Dialog Boxes	16	(2)
The Taskbar	18	(1)
Let's Try It! Learning to Navigate Windows	19	(2)
How Files Are Stored	21	(2)
Windows® Explorer	22	(1)
Let's Try It! Taking a Look at Windows Explorer	23	(3)
Open and Save Dialog Boxes	24	(2)
Let's Try It! Opening and Saving Files in Windows	26	(1)
Final Notes	27	(1)
Check Your Knowledge---Unit 1 Review	28	(5)
Medical Practice-Management Software	33	(38)
Objectives	33	(1)
Components of a Practice-Management Software Application	34	(8)
Patient Registration	34	(1)
File Maintenance	35	(1)
Procedure Posting	36	(2)
Insurance Billing	38	(1)
Posting Payments	39	(1)
Patient Billing	40	(2)
Report Generation (Running Reports)	42	(1)
Appointment Scheduling	42	(1)
Advantages and Disadvantages of Computers in the Medical Office	42	(5)
Advantages of Computer Use	43	(2)
Disadvantages of Computer Use	45	(2)
Health Insurance Portability and Accountability Act (HIPAA)	47	(4)
Using Thomson Delmar Learning's Medical Office Simulation Software	51	(1)
Using the Software from the Book	51	(1)
Using the Network Version in a Computer Laboratory or Classroom	51	(1)
Let's Try It! Logon Procedure for MOSS Network Version	51	(2)
Let's Try It! Navigating Thomson Delmar Learning's Medical Office Simulation Software	53	(6)
Using Help Captions and Feedback Features	59	(2)
Let's Try It! Data Entry Guidelines	61	(4)
Final Notes	65	(1)
Check Your Knowledge---Unit 2 Review	66	(5)
Basic Management Concepts for Medical Administrative Staff	71	(42)
Objectives	71	(1)
The Back Office and the Front Office	71	(1)
Basic Principles of Appointment Scheduling	72	(8)
Established and New Patients	72	(1)
Information Details for Appointment Scheduling	73	(2)
Factors that Affect Appointment Scheduling	75	(1)
Situations that Complicate Appointment Scheduling	76	(1)
Appointment Scheduling Tools	77	(3)
Let's Try It! Navigating the Appointment Scheduler	80	(6)
Let's Try It! Scheduling Appointments for Established Patients	86	(6)
Let's Try It! Scheduling Appointments for New Patients	92	(6)
Let's Try It! Searching and Rescheduling Patient Appointments	98	(4)
Let's Try It! Review and Practice: Scheduling Appointments	102	(1)
Flow of the Office: The Information Cycle	103	(6)
Preparing for Patient Visits: The Day Before Appointments	103	(1)
Preparing Files for Established Patients	104	(1)
Patient Hours: The Check-in and Check-out Process	105	(3)
The Reimbursement Process	108	(1)
Final Notes	109	(1)
Check Your Knowledge---Unit 3 Review	109	(4)
Fundamentals of Medical Insurance	113	(26)
Objectives	113	(1)
General Information about Medical Insurance	114	(2)
Group and Individual Plans	116	(1)
Common Types of Medical Insurance Plans	116	(8)
Indemnity Plans	116	(1)
Reimbursement and Indemnity Plans	117	(2)
Managed-Care Plans	119	(3)
Consumer-Driven Health Plans	122	(2)
Medicare and Medicaid	124	(6)
Important Details About Medicare	125	(1)
The Original Medicare Plan	125	(4)
Medicare + Choice Plans	129	(1)
The Medicaid Program	130	(1)
Insurance Plans Used for Book Simulations	130	(4)
FlexiHealth PPO Plan	131	(1)
Signal HMO Plan	131	(1)
Medicare	132	(1)
Century SeniorGap Plan	132	(1)
Consumer One HRA	132	(2)
Final Notes	134	(1)
Check Your Knowledge---Unit 4 Review	134	(5)
Patient Registration and Data Entry	139	(58)
Objectives	139	(1)
The Patient Registration Process	140	(3)
The Registration Form	140	(3)
Let's Try It! Registering Patients in the Office	143
Case Studies: New Patients	141	(37)
Case Study 5--A--Montner, Martin	141	(7)
Special Notes Regarding Case Study 5--A	148	(1)
Case Study 5--B---Adams, Minnie	149	(6)
Special Notes Regarding Case Study 5--B	155	(1)
Case Study 5--C---Corbett, Melissa	155	(5)
Case Study 5--D---Zuhl, Rodney	160	(3)
Case Study 5--E---Tomanaga, Marie	163	(6)
Case Study 5--F---Villanova, Ricky	169	(2)
Case Study 5--G---Pradhan, Kabin	171	(3)
Case Study 5--H---Beals, Kimberly	174	(2)
Case Study 5--I---Kinzler, Linda	176	(2)
Services Rendered Outside the Office	178	(5)
The Physician as an Information Source	179	(1)
New Patients at Outside Facilities	180	(3)
Let's Try It! Patients at Outside Facilities	183	(2)
Registering New Patients Who Receive Services Out-of-Office	185	(9)
Case Study 5--J---Tate, Jason	185	(1)
Case Study 5--K---Munoz, Geraldo	186	(2)
Case Study 5--L---Ruhl, Mary	188	(2)
Case Study 5--M---Mallory, Christina	190	(2)
Case Study 5--N---Goodnow, Leona	192	(2)
Final Notes	194	(1)
Check Your Knowledge---Unit 5 Review	194	(3)
Procedure Posting Routines	197	(84)
Objectives	197	(1)
Parts of the Superbill	198	(2)
Let's Try It! Posting Procedure Charges	200	(1)
Case Study 6--A---Posting Procedures: Practice, Patty	200	(15)
Correcting Errors	206	(2)
Posting Payments at the Time of Service	208	(5)
Scheduling Follow-up Appointments	213	(2)
Case Study 6--B---Manaly, Richard	215	(4)
Case Study 6--C---Montner, Martin	219	(4)
Case Study 6--D---Conway, John	223	(3)
Case Study 6--E---Shektar, Paula	226	(4)
Case Study 6--F---Villanova, Ricky	230	(4)
Case Study 6--G---Adams, Minnie	234	(3)
Case Study 6--H---Worthington, Cynthia	237	(4)
Case Study 6--I---Zuhl, Rodney	241	(3)
Case Study 6--J---Shinn, Robert	244	(3)
Case Study 6--K---Pradhan, Kabin	247	(2)
Case Study 6--L---Tomanaga, Marie	249	(4)
Case Study 6--M---Beals, Kimberly	253	(2)
Case Study 6--N---Gordon, Eric	255	(1)
Case Study 6--O---Ybarra, Elane	256	(2)
Case Study 6--P---Kinzler, Linda	258	(2)
Case Study 6--Q---James, David	260	(3)
Let's Try It! Posting Charges for Services Outside the Office	263	(1)
Outside Facility Case Studies	263	(4)
Case Study 6--R---Blanc, Francois	263	(2)
Case Study 6--S---Chang, Xao	265	(1)
Case Study 6--T---Pinkston, Anna	266	(1)
Using Extended Billing Information	267	(11)
Case Study 6--U---Tate, Jason	268	(2)
Case Study 6--V---Munoz, Geraldo	270	(3)
Case Study 6--W---Ruhl, Mary	273	(2)
Case Study 6--X---Mallory, Christina	275	(2)
Case Study 6--Y---Goodnow, Leona	277	(1)
Final Notes	278	(1)
Check Your Knowledge---Unit 6 Review	279	(2)
Insurance Billing Routines	281	(38)
Objectives	281	(1)
The Claims Management Process	282	(1)
Requirements for Insurance Claims Submission	283	(1)
Provider Identification Numbers	284	(1)
Insurance Claims Forms	284	(8)
The CMS-1500 Claims Form	285	(7)
Preparing Claims for Submission	292	(1)
Let's Try It! Preparing Paper Claim Forms for Consumer HRA	293	(4)
Let's Try It! Sending Medicare Claims Electronically	297	(5)
Let's Try It! Sending Signal HMO Claims Electronically	302	(4)
Let's Try It! Sending FlexiHealth PPO In-Network Claims Electronically	306	(4)
Let's Try It! Sending FlexiHealth PPO Out-of-Network Claims Electronically	310	(3)
Final Notes	313	(1)
Check Your Knowledge---Unit 7 Review	314	(5)
Posting Payments and Secondary Insurance Billing	319	(56)
Objectives	319	(1)
Payments from Insurance Companies	320	(2)
Components of the Explanation of Benefits	320	(2)
Posting Medicare Payments	322	(1)
Let's Try It! Posting Medicare Payments---Minnie Adams	322	(7)
Let's Try It! Posting Medicare Payments---All Patients	329	(6)
Let's Try It! Applying Deductibles for Medicare	335	(4)
Reading a General Explanation of Benefits (EOB)	339	(1)
Let's Try It! Using a General EOB to Post Deductibles for Out-of-Network Services---Stanley Kramer	340	(4)
Let's Try It! Using a General EOB to Post an In-Network FlexiHealth PPO Payment---Linda Kinzler	344	(2)
Let's Try It! Posting Payments for Multiple Patients Listed on One EOB	346	(6)
Let's Try It! Posting Payments from HRA Plans	352	(5)
Coordination of Benefits and Secondary Billing	357	(3)
Determining Primary and Secondary Payer	358	(2)
Secondary Insurance Billing Routines	360	(1)
Processing Secondary Insurance Claims	360	(1)
Let's Try It! Sending Secondary Claims to Century SeniorGap	360	(5)
Let's Try It! Preparing and Processing Secondary Claims---Richard Manaly	365	(2)
Let's Try It! Preparing and Processing Secondary Claims---Mary Ruhl	367	(2)
Let's Try It! Printing Secondary Claims for the Patient Record	369	(1)
Final Notes	370	(1)
Check Your Knowledge---Unit 8 Review	371	(4)
Patient Billing and Collections	375	(52)
Objectives	375	(1)
Discussing Financials with Patients	376	(2)
Let's Try It! Role Play Financial Discussions with Patients	378	(1)
Preparing Patient Statements	379	(3)
The Billing Cycle	379	(1)
Dunning Messages	380	(1)
Reports as Tools for Preparing Statements	381	(1)
Let's Try It! Generating Reports for Evaluating Patient Accounts	382	(8)
Let's Try It! Preparing Patient Statements with Dunning Messages	390	(6)
Patient Payments by Mail	396	(2)
Inspecting Payments	397	(1)
Let's Try It! Posting Payments from Patients---Rodney Zuhl	398	(4)
Let's Try It! Posting Payments---All Remaining Patients	402	(9)
Christina Mallory	402	(2)
Vito Mangano	404	(2)
Jason Tate	406	(1)
Cynthia Worthington	407	(2)
Leona Goodnow	409	(1)
Wilma Stearn	410	(1)
Aging Patient Accounts and Collections	411	(3)
The Collections Process	411	(1)
Writing Collections Letters	412	(2)
Let's Try It! Generating Reports for Aging Accounts	414	(1)
Let's Try It! Writing Collections Letters	415	(4)
Do's and Don'ts of Telephone Collections	418	(1)
Let's Try It! Role-Play Telephone Collections Calls	419	(3)
Final Notes	422	(1)
Check Your Knowledge---Unit 9 Review	423	(4)
Secondary Insurance Payments, Claims Follow-Up, and Dispute Resolution	427
Objectives	427	(1)
Payments from Secondary Insurance Carriers	428	(1)
Let's Try It! Posting Secondary Insurance Payments from Century SeniorGap---Geraldo Munoz and Marie Tomanaga	428	(4)
Marie Tomanaga	432	(3)
Let's Try It! Posting Secondary Insurance Payments from Medicaid---Francois Blanc, Xao Chang, and Anna Pinkston	435	(5)
Let's Try It! Posting Secondary Insurance Payments from Medicare---Richard Manaly and Mary Ruhl	440	(5)
Tracking and Follow-Up of Outstanding Insurance Claims	445	(1)
Types of Problem Claims	445	(2)
Disputing Payment Decisions	447	(1)
Claims Review and Appeals	447	(3)
Assertive Collections Tactics	450	(2)
Let's Try It! Using Reports to Track Insurance Payments	452	(2)
Let's Try It! Documenting Tracking and Follow-Up Information for Outstanding Insurance Claims	454	(1)
Let's Try It! Rebilling Outstanding Insurance Claims after Follow-Up	455	(1)
Final Notes	456	(1)
Check Your Knowledge---Unit 10 Review	457