MEDICAL MANAGERUnit 1

ICBS 170

MEDICAL MANAGER

• All daily activities in the medical office are built around the treatment of patients.

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

Patient calls and schedules appointment

Eligibility verified.Encounter form printedChart is pulled

Insurance company andpatients are billed

Patient arrives and checks in

Nurse takes patient and chart to

exam room and takes vital signs

Payment collected from patient

Charges are entered

into patient’s account and schedules

return appointment

Doctor examinespatient documents in chart and on encounter from

Encounterform is returned

to biller

Paymentsposted from patientsand insurance companies

Next appointment reminder

or recall notice is mailedto patient

FLOW OF INFORMATION

IN A PHYSICIAN’S

OFFICE

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 patient’s medical condition to be treated thoroughly without wasteful time gaps

MEDICAL MANAGER

• Scheduling of appointments is based on the severity of the patient’s medical condition

• If the patient’s call is urgent, you must make time during the day for the patient to see the physician

MEDICAL MANAGER

• The appointment schedule serves as the daily planning guide by showing:– Names of all patients to be seen– Time of each patient’s appointment– Each patient’s telephone number– Brief reason for the visit

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– Consultation 45– Complete physical 45– All other patients 15

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 system’s 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

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

MEDICAL MANAGER

• Patient Eligibility– Ensure that the patient’s 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 patient’s appointment is

scheduled

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

MEDICAL MANAGER

• Patient Checkout– Patient’s 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 patient’s name is added to a recall file so that they may be reminded of their appointment, closer to the date

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

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

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

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

– HMO’s• Pay in advance membership• No unexpected medical costs• Patients must use physicians named by the HMO

MEDICAL MANAGER

– PPO’s• 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 physician’s fees minus a

deductible• Hospital insurance pays for most, but not all of

charges incurred

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 Defense’s healthcare

program• Covers medical care for uniformed service

personnel and their families• Injuries or illness not related to military

service

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

– Worker’s 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

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

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

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 PCP’s

– Have to be approved by insurance company and sent to specialist’s office

MEDICAL MANAGER

• Computers in Today’s 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

MEDICAL MANAGER

– Reduces the risk of medical malpractice– Makes auditing easier– Saves physicians time and money– Makes day-to-day management easier

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

computer’s memory

• Reduced Mundane Paperwork– Time can be better allocated to more productive tasks

• Minimization of Duplication– Services and financial transactions entered only once

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

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

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)

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

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