MEDICAL MANAGER Unit 1 ICBS 170. MEDICAL MANAGER All daily activities in the medical office are built around the treatment of patients

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  • MEDICAL MANAGER All daily activities in the medical office are built around the treatment of patients.
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  • MEDICAL MANAGER Information flows in a circle in a medical office Starts with an appointment scheduled between the front desk and the patient Ends with the patient making arrangements for payment or another appointment
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  • Patient calls and schedules appointment Eligibility verified. Encounter form printed Chart is pulled Patient arrives and checks in Nurse takes patient and chart to exam room and takes vital signs Doctor examines patient documents in chart and on encounter from Encounter form is returned to biller Charges are entered into patients account and schedules return appointment Payment collected from patient Insurance company and patients are billed Payments posted from patients and insurance companies Next appointment reminder or recall notice is mailed to patient FLOW OF INFORMATION IN A PHYSICIANS OFFICE
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  • MEDICAL MANAGER Efficient operation of the medical office depends on correct scheduling of appointments Entire staff depends on the smooth flow of patient traffic to maintain a workable schedule Appointments must be made to allow time for each patients medical condition to be treated thoroughly without wasteful time gaps
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  • MEDICAL MANAGER Scheduling of appointments is based on the severity of the patients medical condition If the patients call is urgent, you must make time during the day for the patient to see the physician
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  • MEDICAL MANAGER The appointment schedule serves as the daily planning guide by showing: Names of all patients to be seen Time of each patients appointment Each patients telephone number Brief reason for the visit
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  • MEDICAL MANAGER One of the advantages of using a computerized appointment scheduling system is that time slots can be designated for different types of appointments: New patients 30 Consultation45 Complete physical45 All other patients15
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  • MEDICAL MANAGER Appointments can be scheduled Manually in a daily appointment book Will have to search for empty slots or holes Electronically in the MM systems scheduler Computer will search for a computer opening To increase efficiency, ask patients to arrive at least 15 minutes early to fill out necessary paperwork
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  • MEDICAL MANAGER Overbooking refers to double scheduling Medical offices sometimes overbook their patients Scheduling more patients than the physician can see during a reasonable amount of time. Overbooking is not recommended Delays schedule Frustrates patients Frustrates physicians Frustrates staff
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  • MEDICAL MANAGER Patient Eligibility Ensure that the patients insurance policy is in effect Ensure that the patient will be covered for scheduled services before they are performed Verify coverage with the insurance company Either on the phone or by using a computer system Can be done when the patients appointment is scheduled
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  • MEDICAL MANAGER Encounter Forms (see pg. 7 for ex) Communication device between the doctor and the front office Printed list of the most common procedures and diagnoses used by the doctor Returned to the front desk after each exam so items can be posted Number of encounter forms should match number of patients seen that day
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  • MEDICAL MANAGER Patient Checkout Patients charges and payments should be posted as the patient is checking out If patient needs to schedule a follow up appointment, the physician will notate this on the encounter form If appointments are made months in advance, the patients name is added to a recall file so that they may be reminded of their appointment, closer to the date
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  • MEDICAL MANAGER Methods for Collecting Payments Patient pays in full and files an insurance claim themselves Patients use encounter form to bill their insurance company Insurance company will reimburse patient Patient pays and office files an insurance claim Insurance plan reimburses patient Assignment of benefits to patient not doctor Insurance plan pays doctor and patient pays the remainder Assignment of benefits to doctor not patient Payment sent directly to doctor Patient billed for remainder or co-pay is taken at time of visit, thus leaving the balance zero
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  • MEDICAL MANAGER Types of Health Insurance Coverage Basic General physician Hospital Surgical fees Maternity care Major Medical Catastrophe Helps offset huge medical expenses Comprehensive Combination of Basic and Major Medical May require a small deductible
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  • MEDICAL MANAGER Health Care Financing Plans Blue Cross and Blue Shield Organized under laws of the state Regulated by boards of directors Public representatives, physicians and other healthcare providers Blue Shield plans pay for physicians and other providers Blue Cross plans pay for hospital services
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  • MEDICAL MANAGER Commercial Insurance Carriers Aetna, Prudential, Equitable Life Assurance Society, The Travelers Company, etc For profit organizations Offer individual or group basic health and major medical insurance Annual fee or premium HMOs Pay in advance membership No unexpected medical costs Patients must use physicians named by the HMO
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  • MEDICAL MANAGER PPOs Medical services offered at preset fees Large group of insured individuals are sent to specific doctors and or hospitals Larger referral base allows lower cost of services Medicare Elderly and disabled Pays 80% of allowable physicians fees minus a deductible Hospital insurance pays for most, but not all of charges incurred
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  • MEDICAL MANAGER Medicaid Financial assistance program sponsored by federal government along with states Provides healthcare for the poor Generally pays the Medicare deductible Medicaid participants generally do not have to pay for healthcare TRICARE Department of Defenses healthcare program Covers medical care for uniformed service personnel and their families Injuries or illness not related to military service
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  • MEDICAL MANAGER CHAMPVA Civilian Health and Medical Program of the Veterans Administration Covers dependants of totally disabled veterans whose disabilities are service related Surviving dependants of veterans who have died from service related disabilities Workers Compensation Covers an employee for heathcare when he/she suffers a work related injury Primary purpose of WC is to return the employee to work Provides medical treatment, hospital care, surgery and therapy until recovery from the injury or illness
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  • MEDICAL MANAGER Managed Care Keeps medical costs down Ensures the patient receives quality medical care Contractual rates for services the physician performs Patient sees contracted physician and avoids out of network costs Physician has access to a large number of members enrolled in the Managed Care program
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  • MEDICAL MANAGER Insurance plan has a contract with physicians and hospitals to accept a certain amount of money for the services provided Patient portion is clearly defined Co-payment/Co-pay Capitation plans Physician is paid a fixed amount monthly from the insurance company Capitation Payment Payment amount depends on the number of patients enrolled in that Managed Care plan
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  • MEDICAL MANAGER Referrals PCP may not be able to treat every condition Patient sent to specialist PCP must refer patient to the specialist May limit the number of visits, the total dollar amount of treatment, consist of a certain date range in which the service must be obtained Only other providers under the same Managed Care plan can receive referrals from PCPs Have to be approved by insurance company and sent to specialists office
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  • MEDICAL MANAGER Computers in Todays Medical Office Record keeping Patient accounting Billing Insurance form preparation Appointment scheduling Payroll Word processing Database management Determining proper dosage of medicine Drug interaction contraindications
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  • MEDICAL MANAGER Reduces the risk of medical malpractice Makes auditing easier Saves physicians time and money Makes day-to-day management easier
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  • MEDICAL MANAGER Medical Manager Software Helps manage daily activities of medical office Increased income Professional statements result in faster payments Greater Accuracy Correct fees charged because fees are stored in computers memory Reduced Mundane Paperwork Time can be better allocated to more productive tasks Minimization of Duplication Services and financial transactions entered only once
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  • MEDICAL MANAGER Faster Insurance Processing Forms created automatically Can be mailed daily or weekly Fewer rejections Less typographical errors Electronic Media Claims Claims sent through a modem Eliminates paperwork for insurance company and medical office Much faster payment Professional Image Forms are neatly printed without typographical errors and contain accurate and complete information
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  • MEDICAL MANAGER Tasks that can be completed using the Medical Manager system Schedule appointments Create encounter forms Post charges and payments Produce patient receipt Complete insurance claim forms Prepare daily deposit slip Age accounts receivable Compile various reports
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  • MEDICAL MANAGER The date that you enter when logging into the Medical Manager system is VERY important. NEVER change the date unless you are told to do so!! You will have to navigate through a system of menus to effectively use the Medical Manager software Some menus start programs, others lead to other menus All functions start with the Main Menu (Menu 1)
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  • MEDICAL MANAGER Within the Medical Manager system information is stored in files File Maintenance Menu (Menu 2) Easy method for modifying files Existing information can be expanded New information can be added Old information can be deleted Help Window Access to lists of information the user might have to look up on paper otherwise Type ? to access help window
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  • MEDICAL MANAGER Insert your Medical Manager disks and open your textbook to page 14 and follow along with your instructor to complete the exercises throughout the rest of Unit 1


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