Working with Cases

1. 5 Working with Cases

2. 5-2 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.

3. 5-3 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.

4. 5-4 Key Terms • capitated plan • case • chart • primary insurance carrier • record of treatment and progress • referring provider • sponsor

5. 5-5 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

6. 5-6 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: • Edit Case • New Case • Delete Case • Copy Case • Print Grid • Quick Entry • Close

7. 5-7 5.2 Navigating Cases inMedisoft (Continued) • Eleven tabs of the Case dialog box: • Personal • Account • Diagnosis • Policy 1 • Policy 2 • Policy 3 • Condition • Miscellaneous • Medicaid and Tricare • Comment • EDI

8. 5-8 5.2 Navigating Cases inMedisoft (Continued) • Case dialog box

9. 5-9 5.2 Navigating Cases inMedisoft (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

10. 5-10 5.3 Entering Patient and Account Information • The Personal tab contains basic information about a patient and his or her employment Personal tab

11. 5-11 5.3 Entering Patient and Account Information (Continued) • The Account tab includes information on a patient’s assigned provider, referring provider, and referral source Account tab

12. 5-12 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

13. 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

14. 5-14 5.4 Entering Insurance Information(Continued) • The Policy 1 tab records information about a patient’s primary insurance carrier and coverage Policy 1 tab

15. 5-15 5.4 Entering Insurance Information(Continued) • 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. 5-16 5.4 Entering Insurance Information(Continued) • The Policy 2 tab records information about a patient’s secondary insurance carrier and coverage Policy 2 tab

17. 5-17 5.4 Entering Insurance Information(Continued) • The Policy 3 tab records information about a patient’s tertiary insurance carrier and coverage Policy 3 tab

18. 5-18 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

19. 5-19 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

20. 5-20 5.5 Entering Health Information • The Diagnosis tab contains a patient’s diagnosis, information about allergies, and electronic media claim (EDI) notes Diagnosis tab

21. 5-21 5.5 Entering Health Information(Continued) • The Condition tab stores data about a patient’s illness, accident, disability, and hospitalization Condition tab

22. 5-22 5.6 Entering Other Information • The Miscellaneous tab records a variety of miscellaneous information about the patient and his or her treatment Miscellaneous tab

23. 5-23 5.6 Entering Other Information(Continued) • The Comment tab is used to enter case notes Comment tab

24. 5-24 5.6 Entering Other Information(Continued) • The EDI tab is used to enter information for electronic claims specific to the case EDI tab

25. 5-25 5.7 Editing Case Information • 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