Preview

Hospital and Appointment Management Purposes

Satisfactory Essays
Open Document
Open Document
472 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Hospital and Appointment Management Purposes
Homework Assignment #2

03/04/13
Please provide your answer after each problem and submit the file with your answers through Angel.

Problem #8 from page 145
Using the Crow’s Foot methodology, create an ERD that can be implemented for a medical clinic, using at least the following business rules: a. A patient can make many appointments with one or more doctors in the clinic, and a doctor can accept appointments with many patients. However, each appointment is made with only one doctor and one patient. b. Emergency cases do not require an appointment. However, for appointment management purposes, an emergency is entered in the appointment book as “unscheduled.” c. If kept, an appointment yields a visit with the doctor specified in the appointment. The visit yields a diagnosis and, when appropriate, treatment. d. With each visit, the patient’s records are updated to provide a medical history e. Each patient visit creates a bill. Each patient visit is billed by one doctor, and each doctor can bill many patients. f. Each bill must be paid. However, a bill may be paid in many installments, and a payment may cover more than one bill. g. A patient may pay the bill directly, or the bill may be the basis for a claim submitted to an insurance company. h. If the bill is paid by an insurance company, the deductible is submitted to the patient for payment.

[pic]

Problem #2 from page 173
Given the following business scenario, create a Crow’s Foot ERD using a specialization hierarchy if appropriate. Tiny Hospital keeps information on patients and hospital rooms. The system assigns each patient a patient ID number. In addition, the patient’s name and date of birth are recorded. Some patients are resident patients (they spend at least one night in the hospital) and others are outpatients (they are treated and released). Resident patients are assigned to a room. Each room is identified by a room number. The system also

You May Also Find These Documents Helpful

  • Good Essays

    Fundamentals Review

    • 360 Words
    • 2 Pages

    D) An asthmatic client’s concern regarding the lack of insurance to pay for her medications…

    • 360 Words
    • 2 Pages
    Good Essays
  • Good Essays

    A: Some patients may be experiencing a financial difficulty and cannot pay a balance in its entirety. By offering other payment options like setting up a payment plan where the patient agrees to pay a portion of their balance by a certain date each month or week, allows them to pay their bill but not add further financial strain or stress on the patient. The patient is still meeting their obligation, the office still gets paid and it allows for a good relationship to continue between the patient and…

    • 602 Words
    • 2 Pages
    Good Essays
  • Powerful Essays

    A patient’s experience comes from more than just what happens during the time of service. The experience is continued after when they are trying to get services paid by insurance or their self. A common misinterpretation of understanding why an insurance may pay or may not pay contributes to this. The billing department being able to explain these questions to a patient helps the satisfaction of the patient. According to the public opinion survey conducted by Copatient shows that 72% of Americans are confused by medical bills (Understanding Your Medical Bills, n.d.).…

    • 1281 Words
    • 6 Pages
    Powerful Essays
  • Good Essays

    Assignment CaseProblems

    • 819 Words
    • 4 Pages

    with the hospital the payment for services to be rendered by the hospital. The first of these four…

    • 819 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Bsbwor504 Final Project

    • 887 Words
    • 4 Pages

    | | |If Patient doesn’t have Insurance Policy, then he must pay either in cash or credit/debit cards |…

    • 887 Words
    • 4 Pages
    Good Essays
  • Good Essays

    There are ten steps included in the billing process and are used to help process the patient’s information from preregistration to the follow up payments. Each patient has the responsibility to pay for their services once they have received care from a facility by themselves or an insurance company. Many different health insurance companies that may help an individual cover their medical expenses or even pay the entire bill. This billing process is usually done in the back office whereas the registration and collection of information is done in the front office.…

    • 749 Words
    • 3 Pages
    Good Essays
  • Better Essays

    2. Establish Financial Responsibility – When a patient has insurance; the health plan coverage should be reviewed and eligibility needs to be verified (Valerius, Bayes, Newby, & Seggern, 2008). It should also be determined whether or not there is more than one insurance company. If that is the case, the first payer should be determined. Check to verify that all conditions for payment have been met and the correct steps followed to assure payment for service (Valerius et al.).…

    • 958 Words
    • 4 Pages
    Better Essays
  • Good Essays

    Mism Phs Case Study

    • 610 Words
    • 3 Pages

    1. Create a table that lists the benefits to the patient and to the hospital of an enterprise system for patient medical information and for patient prescriptions and related medical therapies.…

    • 610 Words
    • 3 Pages
    Good Essays
  • Good Essays

    Payment Entry Process

    • 1356 Words
    • 6 Pages

    When a claim has been processed and paid, the amount paid will have to be applied to the amount charged for individual patient’s treatment in the Medical Billing Software. This makes it possible for the billing office to track the payments received from different angles. The billing office would want to track the payments received based on differed criteria.…

    • 1356 Words
    • 6 Pages
    Good Essays
  • Better Essays

    The receptionist or other clerical worker will either call, or receive a call from a “patient” or other authorized individual. During this communication, the associate must be careful to observe HIPAA rules related to “protected health information.” when “schedule, canceling, or rescheduling” encounters. When gathering benefit “information,” the representative must be diligent to accurately enter data into the “patient’s” file. Discerning insurance cards, policies, and all applicable guidelines of each plan are applicable to the “front and back” office. Abiding by the payer’s regulations, and the coordination of benefits,” associates will input this data into the patient management program (PMP). During these procedures, insurance specialists will be cautious to correlate the correct information with the correct patient. The “front or back office” will then confirm coverage with designated plans, along with all essentials, such as if a “referral or preauthorization” is a requisite. Prior to consulting with the physician, patients will need to be alerted about their rights, in coordination with HIPAA privacy standards, as well as those of the provider. During that time, if the patient owes any monies for coinsurance, or copayments, this will be submitted to the “front office.” While checking out patients, insurance specialists will transfer the descriptions of “diagnoses and procedures” from the “physician’s report” into appropriate “codes” for ‘claim” generation. This facet is most crucial, because of the HIPAA specifications regarding the transfer of PHI “by covered entities” (Valerius et al., p.…

    • 1235 Words
    • 5 Pages
    Better Essays
  • Satisfactory Essays

    * This is a very important step because it involves the determining of who is financially responsible for the visit. It also is used to establish what services may be covered under the type of insurance they have, along with payment options plan options if any, and what types may be available to the patient.…

    • 672 Words
    • 3 Pages
    Satisfactory Essays
  • Satisfactory Essays

    Step4. Check-out Patients; the patient will be checked out after their visit with the provider and the provider gives the findings to the check-out clerk so they can record the medical codes for the visit that will be billed to the health plan and the…

    • 613 Words
    • 3 Pages
    Satisfactory Essays
  • Good Essays

    1. When the patient is contacted, you must identify yourself, the practice, and the purpose of the call. When you are speaking to the patient, you must verify that the patient has received a copy of the bill. You must also inform the patient of the status of their account and what needs to be accomplished.…

    • 390 Words
    • 2 Pages
    Good Essays
  • Good Essays

    Third-party payers include private insurers, such as Blue Cross and Blue Shield, and public (government) insurers, such as Medicare and Medicaid. Third-party payers use several reimbursement methods to pay providers, depending on the specific payer and the type of service rendered (Gapenski 2013). There are two classifications for payment-fee-for-service and capitation. Fee-for-service means exactly what it says. So, the more services done, the more the reimbursement will be. Reimbursement is based on charge, cost and prospective payment. With charged-based reimbursement, the doctor is in control. The payer pays based on a rate schedule, which the doctor creates. Cost based reimbursement guarantees the doctor will be paid if the service is delivered. Prospective payment reimbursements are determined before the service is done. The charge can be per procedure, diagnosis, per day, bundled payment, etc. Capitation is a bit different. The doctor is paid a fixed amount (monthly), regardless of the services completed. Coding on reimbursement does not only affect the doctor’s pay. An inaccurate code could result in the doctor being underpaid by thousands of dollars. It also affects the patient’s quality of care. It is very important that doctor document every detail regarding the…

    • 489 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    Many of our patients have been in car accidents or slip and falls, they are being referred to our surgeons, neurologists, primary physicians, and orthopedists from attorneys. If the pain is tolerable we do not recommend surgery, however when patients are in excruciating pain we have them see our neurologist to have various neurological tests performed. When we have a new patient referred to our office, we gather all of their demographics and insurance information, if they do not have insurance many times there is a liable party information involved.. First we call the attorney to get more information on the case, next we fax the attorney letters of protection. Some of our cases are funded so we fax the funding company the information…

    • 542 Words
    • 3 Pages
    Satisfactory Essays