Getting Started with SimChart for the Medical Office
Transcription
Getting Started with SimChart for the Medical Office
Getting Started with SimChart for the Medical Office Access your SimChart for the Medical Office course: 1. Go to http://evolve.elsevier.com. 2. Log-in using your Evolve Username and Password. 3. Click on your SimChart for the Medical Office course. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 1 Evolve Info Panel Use the Evolve Info Panel to access SimChart for the Medical Office, access grades for all submitted assignments, and review resources in the Student Resource folder prior to class. The Help button in the toolbar is a quick way to access Evolve Customer support if you are experiencing technical issues. Grades: Quick view of Assignment grades • Access current course grade • Review grades for submitted assignments • View assignments left to complete Course Calendar: View assignment due dates listed by Instructor SimChart for the Medical Office: Link to application • Access Open and Graded Assignments • Maintain front office calendar • Document clinical care • Code and bill patient encounters • Practice documenting in the Simulation Playground Student Resources: Help guides for completing assignments • Quick Guides • Job Readiness • Portfolio Tips Copyright © 2014 by Elsevier Inc. All Rights Reserved. 2 Front Office, Clinical Care, Coding & Billing Practice Assignments Use the following click path to access the Simulation Playground and complete the practice assignments in order. Any documentation recorded in the Simulation Playground is not tied to any instructor grading and should be viewed as a learning and practice environment to perform tasks and improve your documentation skills while mastering the competencies. 1. Select the SimChart for the Medical Office link from the Evolve Info Panel. 2. Select the Simulation Playground button from the Open Assignments screen. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 3 Front Office Practice Assignment Schedule Appointment for Henry Wright Assignment Objectives Search for a patient record. Create a new patient. Schedule patient appointment. Competencies • Execute data management using electronic healthcare records such as the EMR, ABHES 7-b.2, CAAHEP V.P-5 • Manage appointment schedule, using established priorities, ABHES 8-c, CAAHEP V.P-1 • Perform basic keyboarding skills by locating the keys on a keyboard, ABHES 7-a.1 • Recognize office policies and protocols for handling appointments, ABHES 8-c, CAAHEP V.C-3 Assignment Description Henry Wright, 43, has been experiencing mild chest pains for the past few weeks. He does not go to a regular doctor but would like to begin seeing Dr. Martin as his primary provider. Create a new patient record for Mr. Wright and schedule a 30-minute appointment for 1:30 p.m. tomorrow. Insurance: Blue Cross Blue Shield SSN: 123-44-8875 Policy Holder: Henry G Wright ID #: 444325 Group #: 34567GW Date of Birth: June 7, 1971 Copyright © 2014 by Elsevier Inc. All Rights Reserved. 4 Front Office Practice Assignment How to Schedule an Appointment 1. Within the weekly calendar, click on a time slot to open the New Appointment window. 2. Select the Patient Visit radio button as the Appointment Type. 3. Select New patient visit from the Visit Type dropdown. 4. Document “Recurring mild chest pains” in the Chief Complaint text box. 5. Select the Search Existing Patients radio button. 6. Using the Patient Search fields, search for Wright, Henry in the patient database. Searching for a patient record confirms that patient does not already exist within the system. 7. Helpful Hint: Confirming a patient’s date of birth will help to ensure that you have located the correct patient record. 8. Select Cancel to return to the New Appointment overlay. 9. Select the Create New Patient radio button. 10. Document Mr. Wright’s demographics, provider and insurance information from the Assignment Description. 11. Click Save. 12. Select an exam room for the patient’s appointment using the Exam Room dropdown. 13. Confirm the correct appointment date or use the calendar picker to select the correct date. 14. Select a start and end time for the appointment using the Start Time and End Time dropdowns. 15. Type “New patient.” in the Description text field. 16. Click the Save button. A confirmation message will appear. 17. Click the OK button to proceed. 18. Mr. Wright’s appointment will be displayed on the calendar. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 5 Front Office Practice Assignment Post-EHR Workflow • Since there are no Quiz questions or grading attached to the Simulation Playground, this is the end of the Practice Assignment for the Front Office module. • However, when taking an Open Assignment, your next step will be to select the Back to Assignment link to return to the assignment description after documenting in the EHR and select the Quiz tab to begin the question and answer section. • After all of the Quiz questions have been answered and saved, click the Submit Assignment button to submit the completed assignment to the Instructor view for auto-grading. Remember: only the Quiz questions are automatically graded; your charting work must be reviewed by your Instructor. • To review the auto-grade for a submitted assignment, select the Graded Assignments tab from the Assignment list and select the desired assignment. You will be able to review your answers, any Instructor comments and your automatically-calculated grade for the Quiz questions. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 6 Clinical Care Practice Assignment Document Vital Signs, Allergies and Medications for Henry Wright Assignment Objectives Search for a patient record. Create an encounter. Document Vital Signs. Document Allergies. Document Medications. Competencies • Execute data management using electronic healthcare records such as the EMR, ABHES 7-b.2, CAAHEP V.P-5 • Document accurately in the patient record, CAAHEP IX.P-7 • Document patient care, CAAHEP IV.P-8 • Organize a patient’s medical record, ABHES 8-b/CAAHEP V.P-3 • Maintain medication and immunization records, ABHES 9-g Assignment Description Henry Wright has arrived at the clinic for his first appointment with Dr. Martin. Mr. Wright is a heavy smoker who exercises 1-2 times a week. He states that he feels his mild chest pains occur most often during the late afternoon and evening before bed. He believes the pain to be heartburn but it is concerned it might be due to worsening high blood pressure. He takes a Lisinopril 5 mg po QD for hypertension. His vital signs are measured as T: 98.5°F (TA), P: 85 reg, strong radial, R: 14 reg, BP: 170/90 left arm, sitting. Mr. Wright also states that he has a mild food allergy to peanuts with hives and itching. Create a New Patient Encounter for Mr. Wright and document his vital signs, allergies and medications in the patient record. Address: 111 Meadowlark Anytown, AL 12345 Home Phone: 123-337-9531 SSN: 123-44-8875 Emergency Contact: Martha Wright Emergency Contact Phone: 123-858-7741 Employer: Anytown High School Primary Provider: Dr. James Martin Provider Address: 1234 Anystreet Anytown, AL 12345 Date of Last Visit: 1/20/2011 Phone: 123-123-1234 Copyright © 2014 by Elsevier Inc. All Rights Reserved. 7 Clinical Care Practice Assignment How To Complete Patient Demographics 1. To complete Mr. Wright’s patient registration, click on the Patient Demographics icon and search for Wright, Henry. 2. Complete all three tabs with the information provided in the Assignment Description. 3. Click Save Patient. How To Create a Patient Encounter 1. Click the Office Visit tab in the Info Panel on the left side of the screen. 2. Select New Patient Visit from the Visit Type drop down menu. 3. Click Save. 4. The Allergies screen of the patient record will display for the new encounter. How To Document Allergies 1. Click Add Allergy. 2. Select the Food radio button. 3. In the Allergen section, type P and select Peanuts from the dropdown menu. 4. Click on the Itching and Hives checkboxes in the Reactions section. 5. Click on the radio button next to Mild in the Reaction Severity section. 6. Click on the radio button next Self in the Informant section. 7. Click Save and then OK. 8. The allergy will be displayed in the Allergies record. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 8 Clinical Care Practice Assignment How to Document Medications 1. Click on the Records button and select Medications from the dropdown menu. 2. Click on Add Medication. 3. In the Medication section, type Lisinopril and select Lisinopril tablet – (Prinvil, Zestril) from the dropdown menu. 4. Click on the drop down menu in the Strength section and click on 5. 5. Click on the drop down menu in the Form section and click on Tablet. 6. Click on the drop down menu in the Route section and click on Oral. 7. Click on the drop down menu in the Frequency section and click on Daily. 8. Click on the radio button next to Active. 9. Click Save and then OK. 10. The new medication will be displayed on the Medications record. How to Document Vital Signs 1. Click on the Record button and select Vital Signs from the drop down menu. 2. Click on Add. 3. Enter 98.5 in the Fahrenheit field and click on Forehead from the Site drop down menu. 4. Enter 85 reg, strong in the Pulse field and click on Radial from the Site drop down menu. 5. Enter 14 reg in the Respiration field. 6. Enter 170 in the Systolic field, enter 90 in the Diastolic field, click on Left arm from the Site drop down menu, click on Sitting from the Position drop down menu. 7. Click on Save and then OK. 8. The vital signs will be displayed on the Vital Signs record. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 9 Coding & Billing Practice Assignment Post-EHR Workflow • Since there are no Quiz questions or grading attached to the Simulation Playground, this is the end of the Practice Assignment for the Clinical Care module. • However, when taking an Open Assignment, your next step will be to select the Back to Assignment link to return to the assignment description after documenting in the EHR and select the Quiz tab to begin the question and answer section. • After all of the Quiz questions have been answered and saved, click the Submit Assignment button to submit the completed assignment to the Instructor view for auto-grading. Remember: only the Quiz questions are automatically graded; your charting work must be reviewed by your Instructor. • To review the auto-grade for a submitted assignment, select the Graded Assignments tab from the Assignment list and select the desired assignment. You will be able to review your answers, any Instructor comments and your automatically-calculated grade for the Quiz questions. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 10 Coding & Billing Practice Assignment Post charges to the Superbill, Ledger, and Complete Claim for Henry Wright Assignment Objectives Search for a patient record. Complete a Superbill . Update a patient ledger. Complete a claim. Competencies • Utilize computerized office billing systems, ABHES 8-w/CAAHEP • Document accurately in the patient record, ABHES 4-a/CAAHEP IX.9-7 • Complete insurance claim forms, ABHES 8-u/CAAHEP VII.P-3 Assignment Description Henry Wright has completed his visit with the physician and now the billing procedures need to be done. The physician indicated that this was a new patient, detailed office with a diagnosis of hypertension (ICD-9 401.1, ICD-10 I10). Complete the Superbill using the fee schedule to determine the correct CPT code and charge amount for this visit. Complete the Ledger using the information from the Superbill. Complete the Claim using the information from the Ledger. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 11 Coding & Billing Practice Assignment How To Complete a Superbill NOTE: The Clinical Care Practice Assignment must be completed before the Coding and Billing Practice Assignment. 1. Click on the Coding & Billing Tab. Search for Wright, Henry. Click the radio button next to his name and click on the Select button. 2. Select the correct encounter from the Encounters Not Coded table and confirm the auto-populated details. 3. Helpful Hint: The View Progress Notes and View Fee Schedule links in the top right corner of the Superbill provide information necessary in completing the Superbill. 4. Click on the Fee Schedule link in the top right corner to obtain the charges for the NP Detailed OV (99203). 5. Document “70.00” in the Today’s Charges field. 6. Document “70.00” in the Balance Due field. 7. Select the Same Name as Patient checkbox below the Insured Name’s field to indicate that Mr. Wright is the insured patient for the visit. 8. Select the Same Address as Patient checkbox beneath the Insured’s Address text box. 9. Select the Self radio button in the Patient Relationship to Insured field. 10. Select the Single radio button in the Patient Status field. 11. Select the No radio buttons to indicate that the patient condition is not related to employment or an accident. 12. Click the Save button and then OK. 13. Click the Next button to proceed to page two of the Superbill. 14. Select the ICD-10 radio button. 15. In the Rank 1 row of the Diagnoses box, document “Hypertension I10”. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 12 Coding & Billing Practice Assignment 16. Document “1” in the Rank column for the “Detailed” Office Visit and document the corresponding CPT code “99203” in the New column. 17. Click the Save button. 18. Click the Next button twice to progress to the fourth/final page of the Superbill. 19. Scroll down and select the “I am ready to submit the Superbill” checkbox. 20. Scroll down and select the Yes radio button to indicate that there is a Signature on file. 21. Document today’s date in the Date field. 22. Select Save and then Ok. How to Complete a Ledger 1. Select Ledger from the left Info Panel. 2. Search for Henry Wright using the Patient Search fields. 3. Select the radio button for Henry Wright and click the Select button. 4. Confirm the auto-populated details in the header. 5. 6. 7. 8. Document the current date in the Date column using the calendar picker. Document “Henry Wright” in the Patient column. Click the View Schedule link in the top right corner to determine the correct code and fee. Helpful Hint: The View Fee Schedule link in the top right corner provides information necessary in completing Coding & Billing assignments. 9. Document “99203” in the Service column. 10. Document “70.00” in the Charges column. 11. Document “0.00 ” in the Payment column. 12. Document “0.00” in the Adjustment column. The balance will auto-populate in the Balance column and the total will auto-populate in the Total field below the grid. 13. Click the Save button. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 13 Coding & Billing Practice Assignment How to Complete a Claim Form 1. Select Claim from the Info Panel and search for Mr. Wright. 2. Select the correct encounter and confirm the auto-populated details. Six tabs appear within the claim: Patient Info, Provider Info, Payer Info, Encounter Notes, Claim Info and Charge Capture. Review the auto-populated patient information and document any additional information needed. 3. Click the Save button. 4. Click the Provider Info tab. Review the auto-populated information and document any additional information needed. 5. Click the Save button. 6. Click the Payer Info tab. Review the auto-populated information and document any additional information needed. 7. Click the Save button. 8. Click the Encounter Notes tab. Review the auto-populated information. 9. Select the Yes radio button to indicate that the HIPAA form is on file for Mr. Wright and document today’s date in the Dated field. Document any additional information needed. 10. Click the Save button. 11. Click the Claim Info tab. Review the auto-populated information and document any additional information needed. 12. Click the Save button. 13. Click the Charge Capture tab. 14. Document the patient encounter date in the DOS From and DOS To columns. 15. Document “99203” in the CPT/HCPCS column. 16. Document “11” in the POS column. 17. Document “1” in the DX column. 18. Document “1” in the Units column. 19. Document “70.00 ” in the Charge column. Document any additional information needed. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 14 Coding & Billing Practice Assignment 20. Select the “I am ready to submit the Claim” checkbox. 21. Click the Yes radio button to indicate there is a Signature on file. 22. Document today’s date in the Date field. 23. Click on the Save button, then click on the Submit Claim button. 24. A confirmation message will appear. Post-EHR Workflow • Since there are no Quiz questions or grading attached to the Simulation Playground, this is the end of the Practice Assignment for the Coding and Billing module. • However, when taking an Open Assignment, your next step will be to select the Back to Assignment link to return to the assignment description after documenting in the EHR and select the Quiz tab to begin the question and answer section. • After all of the Quiz questions have been answered and saved, click the Submit Assignment button to submit the completed assignment to the Instructor view for auto-grading. Remember: only the Quiz questions are automatically graded; your charting work must be reviewed by your Instructor. • To review the auto-grade for a submitted assignment, select the Graded Assignments tab from the Assignment list and select the desired assignment. You will be able to review your answers, any Instructor comments and your automatically-calculated grade for the Quiz questions. Copyright © 2014 by Elsevier Inc. All Rights Reserved. 15