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CIMO Exam 2
Chapter 5 thru 7ish
| Question | Answer |
|---|---|
| CASE | A grouping of transactions that share a common element. Represent services and treatments the physician provided during a visit. |
| CHART | A folder that contains all records pertaining to a patient. Chart information is used to complete the Case dialog box. |
| RECORD OF TREATMENT AND PROGRESS | A physician's notes about a patient's condition and diagnosis. |
| REFERRING PROVIDER | 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. |
| PRIMARY INSURANCE CARRIER | 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 |
| CAPITATED PLAN | payments are made to physician from a managed care company for patients who select the physician as their primary care provider. A check mark in the Capitated Plan box of the Policy 1 tab indicates an insurance plan is capitated |
| SPONSOR | In TRICARE, the SPONSOR is the active-duty service member. Sponsors’ family members are covered by the TRICARE insurance plan. |
| ADJUSTMENTS | Changes to patients' accounts. |
| PAYMENTS | Monies received from patients and insurance carriers. |
| CHARGES | Amounts a provider bills for the services performed. |
| MULTILINK CODES | are groups of procedure code entries that relate to a single activity, and save time when entering multiple CPT codes. |
| NSF Check | A check not honored by a bank because account it was written on does not have sufficient funds to cover it.When a practice receives a NSF notice from a bank, an adjustment is made in the patient’s account. They will owe check amt & additional fee |
| Clean Claims | Claims with all the correct information necessary for payer processing - no errors. |
| Navigator Buttons | Buttons that simplify the task of moving from one entry to another. |
| Filter | A condition that data must meet to be selected. |
| When is it Necesssary to create a New Case in Medisoft? | 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 |
| List the eleven tabs in the Case dialog box. | Personal/Account/Diagnosis Policy 1/Policy 2/Policy 3 Condition/Miscellaneous Medicaid and Tricare/Comment/EDI |
| Review the info. contained in the Personal tab in the Case dialog box. | The Personal tab contains basic information about a patient and his or her employment. |
| Review the info. contained in the Account tab in the Case dialog box. | The Account tab includes information on a patient’s assigned provider, referring provider, and referral source. |
| Discuss information recorded in the Policy 1, 2, & 3 tabs in the Case dialog box. | The Policy 1 tab records information about a patient’s primary insurance carrier and coverage. Only primary claims can be submitted electronically. A check mark in the Capitated Plan box of the Policy 1 tab indicates an insurance plan is capitated. |
| Discuss information recorded in the Policy 1, 2, & 3 tabs in the Case dialog box. | The Policy 2 tab records information about a patient’s secondary insurance carrier and coverage. The Policy 3 tab records information about a patient’s tertiary insurance carrier and coverage. |
| Discuss the information recorded in the Medicaid & Tricare tab in the Case dialog box. | The Medicaid and Tricare tab is used to enter additional information about the government programs. |
| Describe the info. contained in the Diagnosis tab in the Case dialog box. | The Diagnosis tab contains a patient’s diagnosis, information about allergies, and electronic media claim (EDI) notes. |
| Describe the info. contained in the Condition tab in the Case dialog box. | The Condition tab stores data about a patient’s illness, accident, disability, and hospitalization. |
| Review the purpose of the Miscellaneous tab in Medisoft. | The Miscellaneous tab records a variety of miscellaneous information about the patient and his or her treatment. |
| Review the purpose of the Comment tab in Medisoft. | The Comment tab is used to enter case notes. |
| Review the purpose of the EDI tab in Medisoft. | The EDI tab is used to enter information for electronic claims specific to the case. |
| Describe how to edit info. in a case. | 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. |
| Describe 3 types of transactions recorded in Medisoft. | charges, payments, and adjustments |
| Discuss how to select a Patient in Transaction Entry. | Key first several letters of patient’s last name If correct choice is not highlighted, use arrow keys to move up and down through charts When the desired patient is highlighted, press Tab to select and close the drop-down list |
| Discuss how to select a Case in Transaction Entry. | Must locate the patient’s chart first Select the desired choice from the case numbers and descriptions for the patient Only one case can be opened at a time |
| Demonstrate How to Enter Charge Transactions. | Click the New button to open a new line for entering charges. Choose a procedure code from a drop-down list of CPT codes in the database. Tab & fill in rest of info. click the Save Transactions button, or the Update All button. |
| How are Transactions Color Coded? | Transactions are color-coded, making it easy to determine the status of a charge or payment No payment (gray) Partially paid charge (aqua) Overpaid (yellow) |
| What two ways are Payments in Medisoft entered? | Patient payments made at the office are entered in the Transaction Entry dialog box Payments received electronically or by mail, such as insurance payments and mailed patient payments, are entered in the Deposit List dialog box |
| How are patient payments entered at the time of an office visit? | Entering patient payments Patient payments are entered in the Payments, Adjustments, and Comments section of the Transaction Entry dialog box Click the New button, verify/enter the date, and press the Tab key to begin |
| Once payments are entered you need to Apply them. | Applying charges to payments After payments are entered, they must be applied to the appropriate charge Once a charge is selected, choose Apply To Co-pay or Apply to Oldest based on the type of payment received |
| How do you process a refund for a patient? | Adjustments to patient accounts are entered in the same manner as payments are recorded, in the lower third of the Transaction Entry dialog box The New button begins the process of entering an adjustment Overpayments are color-coded yellow |
Created by:
mamslater