1. Medical Practice-Management Software
Unit 2

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)

3. 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)

4. Important Terms Appointment scheduling system
Patient registration system
Insurance billing system
CPT-4 codes
ICD-9 codes
Fee schedule
Clearinghouse
HIPAA
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5. Important Terms File maintenance system Procedure posting
Payment posting system
Superbills
Managed care
Dunning message

6. 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
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7. Advantages of Computers in the Medical Office Today
Health care documentation, procedures, and source documents can be:
Generated
Stored
Accessed when required

8. 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)

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

10. Eight Basic Components of Practice Management Software
Components to be used throughout the text:
Appointment Scheduling
Patient Registration
File Maintenance
Procedure Posting
Insurance Billing
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11. 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

12. Appointment Scheduling
Handles most tasks associated with patient visits
May include:
Scheduling clinical support services
e.g., hospital rounds by doctor
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13. Appointment Scheduling
May include:
Assigning, cancelling, and rescheduling appointment times
Creating reference sheets
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14. Appointment Scheduling
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15. 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

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

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

18. 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
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19. File Maintenance
For example, insurance carrier and fee schedule information is entered
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20. File Maintenance This information is used in many areas, including:
Patient registration
Insurance billing
Posting payments
Claims tracking

21. 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

22. 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

23. 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
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24. 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)

25. 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

26. 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)

27. 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

28. 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)

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

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

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

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

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

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

35. Patient Billing
Uses all previous information and generates statements/bill

36. 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

37. 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

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

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

40. 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)

41. 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
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42. 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)

43. 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

44. 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
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45. 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

46. 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
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47. 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