1. CHAPTER © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5 Working with Cases

2. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes 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. 5-2

3. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes (continued) 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. 5-3

4. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms capitated plan Case crossover claim primary insurance carrier progress notes referring provider sponsor 5-4

5. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.1 Understanding Cases 5-5 In Medisoft, a case is a grouping of transactions that share a common element. –The transactions represent the 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.

6. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.2 Navigating Cases in Medisoft 5-6 Information about a patient’s medical conditions and treatments is stored in the Case dialog box. The Case command buttons are: –Edit Case-Print Grid –New Case-View eStatements –Delete Case-Close –Copy Case

7. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.2 Navigating Cases in Medisoft (continued) 5-7 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

8. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.2 Navigating Cases in Medisoft (continued) 5-8 Case dialog box

9. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.3 Entering Patient and Account Information 5-9 The Personal tab contains basic information about a patient and his or her employment. Personal tab

10. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.3 Entering Patient and Account Information (continued) 5-10 The Account tab includes information on a patient’s assigned provider, referring provider, and referral source. Account tab

11. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.3 Entering Patient and Account Information (continued) 5-11 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.

12. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information 5-12 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.

13. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-13 The Policy 1 tab records information about a patient’s primary insurance carrier and coverage. Policy 1 tab

14. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-14 In a capitated plan prepayments are made to a physician to cover the physician’s services to a plan member for a specified period of time. –A check mark in the Capitated Plan box of the Policy 1 tab indicates an insurance plan is capitated. Crossover claims are claims that are processed by Medicare and then transferred to Medicaid or to a payer that provides supplemental insurance benefits to Medicare beneficiaries.

15. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-15 The Policy 2 tab records information about a patient’s secondary insurance carrier and coverage. Policy 2 tab

16. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-16 The Policy 3 tab records information about a patient’s tertiary insurance carrier and coverage. Policy 3 tab

17. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-17 The Medicaid and Tricare tab is used to enter additional information about the government programs. Medicaid and Tricare tab

18. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.4 Entering Insurance Information (continued) 5-18 In TRICARE, a sponsor is the active-duty service member. –Sponsors’ family members are covered by the TRICARE insurance plan.

19. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.5 Entering Health Information 5-19 The Diagnosis tab contains a patient’s diagnosis and electronic data interchange (EDI) notes. Diagnosis tab

20. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.5 Entering Health Information (continued) 5-20 The Condition tab stores data about a patient’s illness, accident, disability, and hospitalization. Condition tab

21. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.6 Entering Other Information 5-21 The Miscellaneous tab records a variety of miscellaneous information about the patient and his or her treatment. Miscellaneous tab

22. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.6 Entering Other Information (continued) 5-22 The Comment tab is used to enter allergies and notes, EDI notes, and contract information. Comment tab

23. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.6 Entering Other Information (continued) 5-23 The EDI tab is used to enter information for electronic claims specific to the case EDI tab

24. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 5.7 Editing Case Information 5-24 To edit case information: –Select a case –Click the Edit Case button Or open a case for editing by double-clicking directly on the case line in the right half of the dialog box