1. 5
Working with Cases

2. Learning Outcomes When you finish this chapter, you will be able to:
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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.

3. Learning Outcomes (Continued)
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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.

4. Key Terms capitated plan case chart primary insurance carrier
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capitated plan
case
chart
primary insurance carrier
record of treatment and progress
referring provider
sponsor

5. 5.1 Understanding Cases
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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

6. 5.2 Navigating Cases in Medisoft
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Information about a patient’s medical conditions and treatments is stored in the Case dialog box
The Case command buttons are:
Edit Case
New Case
Delete Case
Copy Case
Print Grid
Quick Entry
Close

7. 5.2 Navigating Cases in Medisoft (Continued)
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Eleven tabs of the Case dialog box:
Personal
Account
Diagnosis
Policy 1
Policy 2
Policy 3
Condition
Miscellaneous
Medicaid and Tricare
Comment
EDI

8. 5.2 Navigating Cases in Medisoft (Continued)
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Case dialog box

9. 5.2 Navigating Cases in Medisoft (Continued)
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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

10. 5.3 Entering Patient and Account Information
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The Personal tab contains basic information about a patient and his or her employment
Personal tab

11. 5.3 Entering Patient and Account Information (Continued)
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The Account tab includes information on a patient’s assigned provider, referring provider, and referral source
Account tab

12. 5.3 Entering Patient and Account Information (Continued)
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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

13. 5.4 Entering Insurance Information
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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

14. 5.4 Entering Insurance Information (Continued)
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The Policy 1 tab records information about a patient’s primary insurance carrier and coverage
Policy 1 tab

15. 5.4 Entering Insurance Information (Continued)
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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

16. 5.4 Entering Insurance Information (Continued)
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The Policy 2 tab records information about a patient’s secondary insurance carrier and coverage
Policy 2 tab

17. 5.4 Entering Insurance Information (Continued)
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The Policy 3 tab records information about a patient’s tertiary insurance carrier and coverage
Policy 3 tab

18. 5.4 Entering Insurance Information (Continued)
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The Medicaid and Tricare tab is used to enter additional information about the government programs
Medicaid and
Tricare tab

19. 5.4 Entering Insurance Information (Continued)
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In TRICARE, a sponsor is the active-duty service member
Sponsors’ family members are covered by the TRICARE insurance plan

20. 5.5 Entering Health Information
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The Diagnosis tab contains a patient’s diagnosis, information about allergies, and electronic media claim (EDI) notes
Diagnosis tab

21. 5.5 Entering Health Information (Continued)
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The Condition tab stores data about a patient’s illness, accident, disability, and hospitalization
Condition tab

22. 5.6 Entering Other Information
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The Miscellaneous tab records a variety of miscellaneous information about the patient and his or her treatment
Miscellaneous tab