Medical Practice-Management Software Unit 2

Objectives Know eight basic components of medical practice management software application and their functions Know advantages and disadvantages of computerization in medical office (continued)

Objectives Understand Health Insurance Portability and Accountability Act (HIPAA) regarding privacy of electronic records Be able to log on, navigate, and enter data into Medical Office Simulation Software (MOSS)

Important Terms Appointment scheduling system Patient registration system Insurance billing system CPT-4 codes ICD-9 codes Fee schedule Clearinghouse HIPAA (continued)

Important Terms File maintenance system Procedure posting Payment posting system Superbills Managed care Dunning message

Advantages of Computers in the Medical Office Today Modern health care office are more dependent on computers than ever Due to many changes in health care industry, including: Many managed-care plans Reimbursement methods Varying rules for authorizing procedures and referral process (continued)

Advantages of Computers in the Medical Office Today Health care documentation, procedures, and source documents can be: Generated Stored Accessed when required

Common Documents Generated in Today’s Medical Office Source documents Generated from computer software Entail patient care, diagnosis, and procedures regarding patient care e.g., encounter form, visit/fee slip, charge ticket, superbill (most common)

When going through exercises in the text, understand how each piece fits together as information is entered

Eight Basic Components of Practice Management Software Components to be used throughout the text: Appointment Scheduling Patient Registration File Maintenance Procedure Posting Insurance Billing (continued)

Eight Basic Components of Practice Management Software Components to be used throughout the text: Posting Payments Patient Billing Report Generation Each piece integrates with other parts to ensure continuity and health care logistics are managed

Appointment Scheduling Handles most tasks associated with patient visits May include: Scheduling clinical support services e.g., hospital rounds by doctor (continued)

Appointment Scheduling May include: Assigning, cancelling, and rescheduling appointment times Creating reference sheets (continued)

Appointment Scheduling (continued)

Appointment Scheduling Tracking patient utilization of clinic may be performed Depends on software program Important to learn fundamentals of appointment system Especially as it applies to specific specialties and needs of medical office

Patient Registration Allows entry of patient information taken from patient information data sheet Mostly filled on patient’s first visit to practice (continued)

Patient Registration Captures information e.g., demographics, insurance and guarantor information, HIPAA information Can be updated as patient accumulates history with provider

File Maintenance Specific to practice operations Can be modified to suit purpose of practice for which it provides Each file relies on others for arrangement and detail Your software works in same fashion Contains common information used by various systems within the software (continued)

File Maintenance For example, insurance carrier and fee schedule information is entered (continued)

File Maintenance This information is used in many areas, including: Patient registration Insurance billing Posting payments Claims tracking

Key Term: Fee Schedule Fee schedule Price list of services provided within or contracted with the practice to provide Price or fee for each CPT-4 code

File Maintenance Computer technology and networking becoming more practical Physician offices, hospitals, pharmacies, and diagnostic centers often part of system where interchange of patient data and other information can be centrally accessed

Procedure Posting When patient receives services, fees must be applied to patient’s account Whether in office, hospital, nursing home, or other facility In procedure posting system, fees for services applied based on fee schedule in file maintenance (continued)

Procedure Posting Other information relevant to patient-physician encounter also include: Date(s) of service (DOS) Place of service (POS) CPT-4 codes must have appropriate ICD-9 codes to support procedures performed (continued)

Procedure Posting Example of typical form filled out by provider during patient’s visit Turned in to front desk upon patient’s departure from practice

Key Term: Managed Care Advent of managed care and various types of models and plans available has contributed much toward changing how procedures and payments are accounted for (continued)

Key Term: Managed Care Managed care Broad term Describes organizations that combine delivery for health care and reimbursement for services to control costs and manage access to health care

Insurance Billing Designed to prepare claims to be sent to insurance companies to receive payment for services rendered by medical providers Billing system gathers patient information, POS codes, CPT-4 and ICD-9 codes, and uses appropriate fee schedule to produce claims (continued)

Insurance Billing Claims can be submitted electronically or by mail Electronic ones sent to insurance clearinghouse

Key Term: Insurance Clearinghouse Service that facilitates movement of electronic claims from medical office to insurance companies All claims must be error-free

Posting Payments Automates manual method of “peg-boarding” Records payments as received Applies to appropriate patient account (continued)

Posting Payments Allows adjustments that reflect contract agreements, credits, refunds, discounts, bad debt, corrections to erroneous entries, and other accounting situations (continued)

Posting Payments Once payment from primary insurance company received and appropriate adjustments posted, software can generate claim to secondary insurance

Patient Billing Provides patients with ongoing picture of financial standing of their account and status of insurance billing activity (continued)

Patient Billing Uses all previous information and generates statements/bill

Key Term: Dunning Message Short collections note that can appear on patient bills e.g., exact amount due, over due Office policy dictates how this should be used Most billing systems include this feature Exact wording can be set up in file maintenance area

Report Generation Retrieves and organizes data from various parts of practice management software into useful information Reports can be as simple as list of diagnostic codes to as complex as analytical reports reflecting practice’s financial statistics

Advantages of Computers in the Medical Office Efficient work Easy accessibility Speed and cost reduction (long-term)

Disadvantages of Computers in the Medical Office System failures and problems Patient confidentiality

HIPAA Since 1996, health care providers are required to protect patient’s health information Every entity must comply Including medical practices that transmit or store electronic data and records (continued)

HIPAA Three components of HIPAA regulations: Transactions and code sets Uniformity of CPT-4 and ICD-9 codes in all health care arenas Eliminates off-the-wall or local codes Security Rules Final mandatory rule established in 2003 regarding safeguarding electronic information from unauthorized disclosure (continued)

HIPAA Three components of HIPAA regulations: Privacy Rules Health information that can be individually identified in any form Oral, paper, or electronic Protected health information (PHI)

Getting Familiar with MOSS Once logged in, first screen is main menu Take time to get familiar with each button Open and close to understand their operation

Hints to Success with the Software and Text Exercises First and foremost: don’t skip any exercises Stay on track and periodically save work See Let’s Try It! 2-4 in your text If using network version, use log on and password as assigned by instructor If unsure about something, ask Proofread entries as if really doing exercises for actual clinic (continued)

Hints to Success with the Software and Text Exercises Second: it’s not a race Each task is designed to ensure a working knowledge of each section as if in a clinic Each Let’s Try It! exercise gives step-by-step instruction when starting a new concept

Let’s Try It! Now, Let’s Try It! Follow the instructions to perform Let’s Try It! 2-2 and 2-3 in your text When finished, be sure to close all open windows except the main menu screen Ensures work is saved (continued)

Let’s Try It! If using single-user version of MOSS, perform Let’s Try It! 2-4 in your text to practice backing up and restoring work