Getting Started in the Computerized Medical Office Fundamentals and Practice

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ISBN: 9781401830380 | 1401830382
Cover: Spiral Bound
Copyright: 1/25/2005

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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.

Foreword

xiii

Preface

Acknowledgments

xxv

About the Author

xxvii

How to Use This Book

xxviii

How to Use MOSS Software

xxx

Introduction to Computers

(32)

Objectives

(1)

Types of Computers

(1)

The Data Processing Cycle

(2)

Software

(2)

Applications Software

(1)

Systems Software

(1)

Hardware

(4)

Drives

(2)

Random Access Memory (RAM)

(1)

Serial, Parallel, and USB Port Connections

(1)

Devices for Internet Access

(2)

Connecting and Installing Hardware

(1)

Using The Computer: A Tour Of Windows

(1)

Booting the Computer

(1)

Let's Try It! Booting and Shutting Down the Computer

(8)

The Microsoft Windows® Desktop

(2)

Application and Document Windows

(1)

Using Windows

(4)

Dialog Boxes

(2)

The Taskbar

(1)

Let's Try It! Learning to Navigate Windows

(2)

How Files Are Stored

(2)

Windows® Explorer

(1)

Let's Try It! Taking a Look at Windows Explorer

(3)

Open and Save Dialog Boxes

(2)

Let's Try It! Opening and Saving Files in Windows

(1)

Final Notes

(1)

Check Your Knowledge---Unit 1 Review

(5)

Medical Practice-Management Software

(38)

Objectives

(1)

Components of a Practice-Management Software Application

(8)

Patient Registration

(1)

File Maintenance

(1)

Procedure Posting

(2)

Insurance Billing

(1)

Posting Payments

(1)

Patient Billing

(2)

Report Generation (Running Reports)

(1)

Appointment Scheduling

(1)

Advantages and Disadvantages of Computers in the Medical Office

(5)

Advantages of Computer Use

(2)

Disadvantages of Computer Use

(2)

Health Insurance Portability and Accountability Act (HIPAA)

(4)

Using Thomson Delmar Learning's Medical Office Simulation Software

(1)

Using the Software from the Book

(1)

Using the Network Version in a Computer Laboratory or Classroom

(1)

Let's Try It! Logon Procedure for MOSS Network Version

(2)

Let's Try It! Navigating Thomson Delmar Learning's Medical Office Simulation Software

(6)

Using Help Captions and Feedback Features

(2)

Let's Try It! Data Entry Guidelines

(4)

Final Notes

(1)

Check Your Knowledge---Unit 2 Review

(5)

Basic Management Concepts for Medical Administrative Staff

(42)

Objectives

(1)

The Back Office and the Front Office

(1)

Basic Principles of Appointment Scheduling

(8)

Established and New Patients

(1)

Information Details for Appointment Scheduling

(2)

Factors that Affect Appointment Scheduling

(1)

Situations that Complicate Appointment Scheduling

(1)

Appointment Scheduling Tools

(3)

Let's Try It! Navigating the Appointment Scheduler

(6)

Let's Try It! Scheduling Appointments for Established Patients

(6)

Let's Try It! Scheduling Appointments for New Patients

(6)

Let's Try It! Searching and Rescheduling Patient Appointments

(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

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Getting Started in the Computerized Medical Office Fundamentals and Practice

Summary

Table of Contents

Supplemental Materials