|
The clinic uses a transaction processing system to track each charge, payment, and insurance claim. This system reduces administrative costs, speed up insurance reimbursement, and provide controls and reports. A business support system is used to analyze provider workloads, turnaround time for claims and payments, and forecast future staffing needs. A user productivity system increasesoffice efficiency and improve patient satisfaction.
The New Centurey Health Clinic offers a wide veriety of diffrent services. Every day, Lisa Sung types an appointment list for the next day for each of the providers. She also types a call list for the day after that. For example, if today is a Tuesday, then Lisa would prepare individual provider appointment lists for Wednesday's appointments and a call list for Thursday's appointments. Starting first thing Wednesday morning, all patients on the call list for Thursday are telephoned and reminded of their appointments. When a patient has been contacted, we cross his or her name off the call list. Lisa handles most of the calls, but other office staff members sometimes assist her.
Whenever an appointment is completed, the doctor, nurse, or therapist writes on a slip of paper the code numbers of the procedures that were performed. The provider brings that paper along with the patient's file out to Lisa. If the patient wants to pay for the services immediately, Lisa calculates the total charges, makes a note of the payment on the service slip, and prepares a receipt for the patient. The patient file then is passed to Susan Gifford, who records all the new information onto the patient history record. If the patient is covered by insurance, Susan passes the file on to Tom Capaletti who handles all the insurance claim forms. When Tom is done with the file, he returns it to Susan, who refiles it. She then gives the service slip either to Anita Davenport or toher accounting assistant Fred Brown, so we can keep the record of services and charges, by provider.
Tom also prepares a weekly report for the associates meeting. That report is called the Insurance Company Report. It includes a line for each insurance company, showing MTD and YTD totals of the charges sent to the company, the MTD and YTD totals of the payments received from the company, and the outstanding balance (which is the total of the charges sent to the company that have not yet been paid). In addition to the Insurance Company Report, Tom is supposed to prepare a monthly Claim Status Summary that shows, for each insurance company, all services for which claims have been submitted but not yet paid, and how overdue they are. Tom has tried to submit this report monthly, but the best he has been able to do is every other month, because it is such a big job. I know the associates would like to see this report produced more frequently.
Once a month we prepare statements to mail out to the patients. Everyone in the office helps out with statement preparation. But before I can explain the monthly statements, I have to explain about households. Each patient is a member of what we call a household. Each household has a head, the person responsible for paying the bills. The household head is not necessarily a patient. The household head might be employed by a company who provides employees with a medical insurance policy through an insurance company.
Our patient records actually are filed by households. We have one folder for each household. In one folder, we would keep separate patient files for each of the patients who belong to that household. We also keep one charge and payment record for the entire household.
A monthly statement is prepared for a household only if (1) a service was provided that month for a patient in the household, (2) a payment was received that month from any member of the household, (3) a payment was received that month from the household's insurance company, or (4) the household has a positive current balance due. Then the statement is mailed to the head of the household.
The statements are typed on preprinted forms. The top section of a statement, the part above the perforations, is called the header. It includes the date, the household head name and address, the previous month's balance, the total household charges MTD, the total payments MTD, and the current balance. When the statement is folded properly and inserted into a windowed envelope, the name and address are visible through the window.
The bottom section of the statement lists every activity for the month, in date order. For every service performed, there is a line showing the patient's name, the service date, service description, and service fee. For every payment received, there is a line showing the date and amount. If the payment was received from an insurance company, that source is noted on the line. Finally, a running balance appears on each activity line.
|
