Transcript 5 - Walla Walla Community College | …Your Best Choice

Working with Cases
5
Learning Outcomes
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
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•
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capitated plan
case
chart
primary insurance carrier
record of treatment and
progress
• referring provider
• sponsor
5-4
5.1 Understanding Cases
• 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
5-5
5.2 Navigating Cases in Medisoft
• Information about a patient’s medical conditions
and treatments is stored in the Case dialog box
• The Case command buttons are:
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–
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Edit Case
New Case
Delete Case
Copy Case
Print Grid
Quick Entry
Close
5-6
5.2 Navigating Cases in
Medisoft (Continued)
• Eleven tabs of the Case dialog box:
1. Personal
2. Account
3. Diagnosis
4. Policy 1
5. Policy 2
6. Policy 3
7. Condition
8. Miscellaneous
9. Medicaid and Tricare
10. Comment
11. EDI
5-7
5.2 Navigating Cases in
Medisoft (Continued)
• Case dialog box
5-8
5.2 Navigating Cases in
Medisoft (Continued)
• 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
5-9
5.3 Entering Patient and Account
Information
• The Personal tab contains basic information
about a patient and his or her employment
Personal tab
5-10
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)
• 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
5-12
5-13
5.4 Entering Insurance Information
• 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)
• The Policy 1 tab records information about a
patient’s primary insurance carrier and
coverage
Policy 1 tab
5-14
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)
• The Policy 2 tab records information about a
patient’s secondary insurance carrier and
coverage
Policy 2 tab
5-16
5.4 Entering Insurance Information
(Continued)
• The Policy 3 tab records information about a
patient’s tertiary insurance carrier and
coverage
Policy 3 tab
5-17
5.4 Entering Insurance Information
(Continued)
• The Medicaid and Tricare tab is used to enter
additional information about the government
programs
Medicaid and
Tricare tab
5-18
5.4 Entering Insurance Information
(Continued)
• In TRICARE, a sponsor is the active-duty
service member
– Sponsors’ family members are covered by the
TRICARE insurance plan
5-19
5.5 Entering Health Information
• The Diagnosis tab contains a patient’s
diagnosis, information about allergies, and
electronic media claim (EDI) notes
Diagnosis tab
5-20
5.5 Entering Health Information
(Continued)
• The Condition tab stores data about a
patient’s illness, accident, disability, and
hospitalization
Condition tab
5-21
5.6 Entering Other Information
• The Miscellaneous tab records a variety of
miscellaneous information about the patient
and his or her treatment
Miscellaneous tab
5-22