5 Working with Cases

Learning Outcomes When you finish this chapter, you will be able to: 5-2 When you finish this chapter, you will be able to: 5.1 Describe when it is necessary to create a new case in Medisoft. 5.2 List the eleven tabs in the Case dialog box. 5.3 Review the information contained in the Personal tab and the Account tab. 5.4 Discuss the information recorded in the Policy 1,2,3 and Medicaid and TRICARE tabs in Medisoft. 5.5 Describe the information contained in the Diagnosis tab and the Condition tab in Medisoft.

Learning Outcomes (Continued) 5-3 When you finish this chapter, you will be able to: 5.6 Review the purpose of the Miscellaneous, Comment, and EDI tabs in Medisoft. 5.7 Describe how to edit information in a case.

Key Terms capitated plan case chart primary insurance carrier 5-4 capitated plan case chart primary insurance carrier record of treatment and progress referring provider sponsor

5.1 Understanding Cases 5-5 In Medisoft, a case is a grouping of transactions that share a common element Represent services and treatments the physician provided during a visit New cases are set up when: A patient has two or more unrelated conditions Changes in a patient’s insurance occur A patient is injured at work and is treated under Worker’s Compensation insurance

5.2 Navigating Cases in Medisoft 5-6 Information about a patient’s medical conditions and treatments is stored in the Case dialog box The Case command buttons are: Edit Case New Case Delete Case Copy Case Print Grid Quick Entry Close

5.2 Navigating Cases in Medisoft (Continued) 5-7 Eleven tabs of the Case dialog box: Personal Account Diagnosis Policy 1 Policy 2 Policy 3 Condition Miscellaneous Medicaid and Tricare Comment EDI

5.2 Navigating Cases in Medisoft (Continued) 5-8 Case dialog box

5.2 Navigating Cases in Medisoft (Continued) 5-9 A chart is a folder that contains all records pertaining to a patient Information is used to complete the Case dialog box A record of treatment and progress is a physician’s notes about a patient’s condition and diagnosis

5.3 Entering Patient and Account Information 5-10 The Personal tab contains basic information about a patient and his or her employment Personal tab

5.3 Entering Patient and Account Information (Continued) 5-11 The Account tab includes information on a patient’s assigned provider, referring provider, and referral source Account tab

5.3 Entering Patient and Account Information (Continued) 5-12 A referring provider is a physician who recommends that a patient see a specific other physician The Referring Provider box of the Account tab contains the name of the physician who referred the patient

5.4 Entering Insurance Information 5-13 The primary insurance carrier is the first carrier to whom claims are submitted There may also be a secondary carrier or a tertiary carrier Only primary claims can be submitted electronically

5.4 Entering Insurance Information (Continued) 5-14 The Policy 1 tab records information about a patient’s primary insurance carrier and coverage Policy 1 tab

5.4 Entering Insurance Information (Continued) 5-15 In a capitated plan, payments are made to the physician from a managed care company for patients who select the physician as their primary care provider, regardless of whether the patients visit the physician A check mark in the Capitated Plan box of the Policy 1 tab indicates an insurance plan is capitated

5.4 Entering Insurance Information (Continued) 5-16 The Policy 2 tab records information about a patient’s secondary insurance carrier and coverage Policy 2 tab

5.4 Entering Insurance Information (Continued) 5-17 The Policy 3 tab records information about a patient’s tertiary insurance carrier and coverage Policy 3 tab

5.4 Entering Insurance Information (Continued) 5-18 The Medicaid and Tricare tab is used to enter additional information about the government programs Medicaid and Tricare tab

5.4 Entering Insurance Information (Continued) 5-19 In TRICARE, a sponsor is the active-duty service member Sponsors’ family members are covered by the TRICARE insurance plan

5.5 Entering Health Information 5-20 The Diagnosis tab contains a patient’s diagnosis, information about allergies, and electronic media claim (EDI) notes Diagnosis tab

5.5 Entering Health Information (Continued) 5-21 The Condition tab stores data about a patient’s illness, accident, disability, and hospitalization Condition tab

5.6 Entering Other Information 5-22 The Miscellaneous tab records a variety of miscellaneous information about the patient and his or her treatment Miscellaneous tab