Introduction To Medisoft Office Hours Professional Medical Scheduling Software

After completing the data entry outlined in Getting Started, we are ready to begin data entry and use of the Medisoft program. In the normal flow of an office, the first step in the care of a patient is the appointment scheduling process. Medisoft includes an appointment scheduler program called Office Hours Professional.

In previous versions, Office Hours Professional was an additional purchase add-on. The program came with a basic scheduler simply called Office Hours which offered basic appointment viewing options which worked best in offices with no more than one doctor.

Office Hours Professional offers robust and customizable schedule viewing options. Additionally, it offers a more integrated interface to the Medisoft Program.

Office Hours Professional is also sold as a stand-alone product.

Providers and Resources

Providers

You will first need to identify the different schedules you need to create. The easiest list to create would be a list of Doctors, Nurses, and PA’s. These are the “Providers” who will be seeing, and treating the patients.

Office Hours and Office Hours Professional will automatically read your provider list from Medisoft. If you are using Office Hours Professional as a stand alone product, you will need to set up the Providers for whom you will need schedules. This process will mirror the Provider Setup from the Getting Started module.

This list is accessed under the Lists menu and Provider List.

Resources

After you have set up all the providers you need, you will want to identify the resources within the office for which you would like to create a schedule. Resources could include things like Examination Rooms, Meeting Rooms, and equipment such as X-Ray machines that need to be scheduled.

You can access the Resource List by clicking the Lists menu and Resource List.

When you create a new Resource, you will see that the screen is a fairly simple screen. In the Code field, enter the code you wish to use to identify this resource. The Description field should contain a short description that adequately identifies that resource.

Configuration

After installation, and setting up your providers and resources, it is important to configure your appointment scheduler prior to doing any appointment entry. You should start your configuration with the setup of your Program Options. It is important to note that the options set in program options are for the entire practice. You cannot make different selections for different providers.

It is important to note, that the Standard Program Options screen does not have any tabs. You will not be able to configure Multi-Views, or the Appointment Display settings within Office Hours. You must have the Professional version in order to have these options.

Professional Program Options

Start Time and End Time: Within program options, you will be able to set the start time and end time for your practice. These are basically the hours of operation, or the hours that are available for appointments or breaks to be scheduled. In a practice with multiple providers, you may have providers that have different hours they are in the office and available. This option should be set from the earliest time that any provider is available for an appointment, to the latest time that any provider is available for an appointment.

Interval: The interval field selects the intervals into which you wish to split your schedule. This interval should be the shortest length of appointment that will be scheduled for the office. Additionally, your interval should fit perfectly within the total amount of time available between your start and end times.

Columns: This field is only available in the Standard Office Hours Program Options. Here you will set how many columns (or appointments) you want to have available for each time of day, for each provider. In Office Hours Professional, you can simply right click on a column, and you will have the option to add or remove the column.

Use Pictures: If you select any of the options within Use Pictures, you will include a picture on the right side of your appointment or break display when certain conditions are met. This feature is only available in Office Hours Professional.

  • Break: The entry will display a coffee cup
  • Repeat: The entry will display one box offset and overlapping another box.
  • Note: The entry will display a paper with the corner folded over.


 

Appointment Status: The entry will display any of the following pictures for the corresponding appointment status settings.

Unconfirmed: Question Mark


 

Checked In: Check Mark


 

Missed: X


 

Confirmed: Box


 

Being Seen: Sun


 

Checked Out: C


Rescheduled: None


Cancelled: None

Default Colors: These three settings will determine what color defaults for appointments, breaks, and appointments in conflict with another appointment or break. In Office Hours Professional, you will be able to select colors for individual appointments.

Use Enter to Move Between Fields: This option will give the enter key the same functionality as the Tab key. This option is especially attractive to users used to DOS programs that had this same functionality.

Remind to Save View: Office Hours Professional gives you the option to modify the scheduler views you are using. If you make changes to a view, and this option is checked, it will remind you to save the views.

Use Automatic Word Capitalization: This option will automatically capitalize the first letter of each word you enter, such as the first letters of the patient’s first and last names.

Automatic Refresh: When using the multi-user version of Medisoft and Office Hours/Professional, you may have multiple people entering appointments at the same time. This option will set how often the program goes back and looks at the database, in order to update the view.

Tips and Tricks:

Some versions of Office Hours may allow you to enter a 0 in this field. DO NOT DO THIS. It will cause the program to go into an endless error loop. You will need data repair to fix this problem if it occurs.

 

Show Notes on New Appointments: If you check this box, Office Hours or Office Hours Professional will automatically give you a warning if notes are entered into the patient’s case.


Use Automatic Zip Codes: Medisoft and Office Hours both offer you the capability of remembering which City and State belong to a particular Zip Code. If this option is selected, your tab order will skip over the City and State fields, to the Zip Code field, when entering any address information. If you enter a Zip Code that has been previously utilized with a particular City and State, that information will automatically populate those fields.

Use Transaction Entry to make Copays: When integrated with Medisoft, Office Hours Professional will allow you to enter copay information from the scheduler screen. Within Medisoft, it is possible to enter payments either through Transaction Entry, or through the Deposit List. If this option is checked, Medisoft will automatically open Transaction Entry to that patient and case, whenever the Copay option is selected from within Office Hours Professional. If this option is not checked, the copay will be entered directly into the deposit list.

Tips and Tricks:

In most circumstances, at the time the copay is made, the services for which the patient is paying have not yet been performed. If you enter your copay into Transaction Entry, you will be asked to apply the payment immediately, unless the payment code selected is a prepayment.

For this reason, we suggest entering your copays through Office Hours Professional into the Deposit List.

 

Speed Report: Office Hours Professional gives you the ability to assign one report to a Speed Report icon that appears at the top of the screen. This option determines which report will print when this icon is selected.

 

 

 

 

 

 

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EDI

Refer to your EDI documentation for detailed descriptions on the functionality of these fields. Some insurance companies and or insurance clearinghouses have unique information requirements and that information might be entered here on this screen.


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Comment

Allergies and Notes: This is a reminder field entry box only.  Enter any special conditions for the patient.  Data entered here will appear in pop-up windows in Transaction Entry and/or Office Hours, if enabled.

EDI Notes: This section is specifically for sending ambulance claims electronically.

Contract Information: The Contract Information fields populate Loop 2400, Segment CN1 in electronic claims.

 

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New mobile ipad, iphone apps for Medisoft in version 18 sp2 to be released soon. Now enter superbills and appointments on your ipad or iphone and the info will show up on the office database. To be available soon, stay tuned…

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Multimedia

The Multimedia tab allows you to attach multi-media files of various types to a case. One of the most common uses for this tab is attaching images, such as pictures or scanned insurance cards, to a patient account. You can also attach sound files, such as recorded voice notes.


To attach a new file, click the New button. You will be brought to the following screen:


Here you will be asked to attach a description to the file you are uploading. You also have the option to give the file a note, and designate it for viewing on the Patient screen.

Click the button labeled Load From File. A Browse window will open, allowing you to browse to the Multimedia file you wish to attach. Once all options and files are selected, click Save.

Tips and Tricks:
The Multimedia tab of the case is a great tool for some users. However, if you are using older equipment, you may run into performance issues if you extensively utilize this feature. It will significantly increase the size of your dataset.

 

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Medicaid and Tricare

Similar to the Condition tab, the Medicaid and Tricare tab contains information that will affect both paper and electronic claims. For specifics on these situations, refer to the Help File and the Clickable CMS (HCFA) form, or to your EDI Documentation.


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Miscellaneous


Outside Lab Work: By selecting the check box for Outside Lab Work, you indicate that the patient has received outside lab work and the Lab Charges field should be completed.

Lab Charges: If Outside Lab Work has been done, enter the amount of the charges for the lab work that had been done.

Local Use A: This field is available for instances when insurance carriers need additional information. On paper claims, it will print in box 10d. If the insurance carrier is Medicare, use this field ONLY to enter Medicaid information. If the patient is entitled to Medicaid, enter the patient’s Medicaid number preceded by the MCD.

Local Use B: Similar to Local Use B, this field is for use when an insurance carrier requires additional information. When printing paper claims, this field will populate box 19. If you are dealing with Chiropractic claims, enter the last X-Ray date into this field.

Indicator: The Indicator field is similar to the indicator field available within the Patient setup screen. This field will allow you to enter 5 characters that can be used to filter transactions in the claim creation process. If you are going to utilize this feature, you will want to track all the entries you have utilized, and what the definition of each entry is.

Referral Date: Referral Dates are required when dealing with referring providers and managed care. If you have a referral, enter the date of that referral into this field.

Prescription Date: This field is required for hearing and vision claims. Enter the prescription date. This field is used for electronic claims sent in the ANSI format.

Prior Authorization Number: The Prior Authorization Number field is closely linked to insurance claims and insurance authorizations. This number will print in box 23 of your paper claims, and will also transmit on electronic claims.

Outside Primary Care Provider: This field is necessary because the Primary Care Provider is NOT always the referring provider. If a managed care patient is seen in an emergency situation, they may be assigned to a provider who needs to refer the patient to another provider for a specific type of care, such as imaging. This field pulls from the Referring Provider list, so any providers needed for this field must be entered there. This field is transmitted on electronic claims, and is required in some instances.

Date Last Seen: Date Last Seen is referring to the date the patient was last seen by the Primary Care Provider. This field is also often a required field on electronic claims.

Chiropractic Fields: There are certain fields on this tab that are only visible if the Practice Type (Within Practice Information) is set to Chiropractic.

Nature of Condition: In Nature of Condition, enter a one-character code. Select from the following:

A = Acute

C = Chronic

M = Acute manifestation of chronic condition

Condition Desc 1 and 2:  These fields allow entry of descriptions of the condition – up to 80 characters.

Treatment Months/Years: In Treatment Months/Years, enter the letter M (for Month) or Y (for Year) and then up to two digits to indicate the number of months or years treatment has been rendered to the patient for this particular ailment.

No. Treatments-Month: In No. Treatments-Month, enter up to two digits indicating the number of treatments the patient has received during the current month.

Date of Manifestation: The Date of Manifestation field is used only if M is entered in the Nature of Condition field. When applicable, enter or select the correct date.

Complication Ind.: The Complication Ind field requires one character: C if the condition is complicated or U if the condition is uncomplicated.

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Condition

The condition tab contains various fields related to the patient’s condition. Most of these fields are necessary for insurance billing in certain situations. We will not discuss each of these fields. For information on when to use these fields, refer to the Clickable CMS (HCFA) form within the Help File, or your Electronic Claims documentation for information on how to populate these fields.

In this section we will focus on different functionality available within the fields listed on this screen.

As you can see, there are date fields that offer the drop down calendar, such as the First Consultation Date. There are also date fields, such as the Injury/Illness/LMP Date, that do not offer the drop down calendar. The fields without the drop down calendar are used to enter non-date values into these fields.

There are two valid non-date values for these fields:

G: This value is used to designate the field as Gradual. If you type a G and tab off of the field, you will notice that it fills in with the word Gradual.

N: This value is used to designate N/A or Not Applicable.


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Policy 1

The Policy 1 tab is where you enter the patient’s primary insurance information. Many of the fields included on this screen are similar to those included on the Policy 2 and 3 screens, with the difference being that they would apply to the secondary or tertiary insurance carriers if they were entered on those other screens.

Insurance 1: This field will be where you specify the Insurance Code for the primary carrier you wish to add to this case.

Policy Holder 1: Many people confuse the Policy Holder field with the Guarantor field. The Policy Holder field should contain the chart number of the patient or guarantor that holds the insurance policy.

Depending on circumstances, this may be a different person than the Guarantor that was specified on the Personal tab.

Relationship to Insured: The Relationship to Insured field corresponds directly to the Policy Holder 1 field. You will need to specify how the patient is related to the person listed as the Policy Holder 1.

Tips and Tricks:
The Policy Holder field for Medicare patients should always be the same as the patient Chart Number. Additionally, the Relationship to Insured field should always be set to self. Medicare does not offer family plans. Failure to accurately enter these fields for Medicare claims will result in claim rejections.

 

Policy/Group Number: You will find the patient’s policy and/or group number listed on their insurance card.

Policy Dates: These dates designate the policy effective dates. If these are applicable, they will also be listed on the patient’s insurance card.

Claim Number: Claim Number refers not to a standard Healthcare claim, rather a claim number that refers to a different type of insurance claim, such as an auto insurance claim, that is responsible for paying for the medical services being rendered. This field holds the claim number for that insurance claim.

Assignment of Benefits/Accept Assignment: This field determines who is going to receive payment for charges entered into this case. If you place a check mark in this field, that means the provider accepts assignment of the patient benefits, and the insurance carrier will send the payment directly to the provider. If you do not place a check mark in this field, the check will be sent to the Patient. The doctor’s office will be responsible for billing to and collecting from the patient in this situation. See Accept Assignment Handout.

Capitated Plan: Capitated plans pay a doctor or group of doctors a pre-negotiated amount of money per month to see a group of patients under a particular insurance carrier. These payments are not based on how many procedures are performed. The same payment will be made if no patients under that plan make a visit during the month. If this patient is part of a capitated plan, place a check mark in this box. See Capitated Plan Handout.

Deductible Met: This field is used to indicate whether the patient has met his or her annual deductible. When the deductible is met, click this box. The amount of the deductible paid is displayed in the Transaction Entry window. When the full amount has been paid, the program reflects the amount entered in the Annual Deductible field in this window in the YTD field in Transaction Entry. In other words, if the patient has a $250 deductible and the Deductible Met check box is checked, then the YTD field also reflects $250. This field is reset annually.


Annual Deductible: The Annual Deductible field is a reference field that will be displayed within Transaction Entry. If you know the amount of your patient’s annual deductible, enter it here.

Copayment Amount: Copayment Amount allows you to enter in the amount of the copay that this patient has for each visit. This field will display within transaction entry as the Policy Copay. This field is a reference field only. It will not automatically enter a copay for you. You will not be able to bill a patient for a missed copay until after the insurance carrier has paid. You will not be able to enter the copay reference as a percentage. It is strictly a dollar amount copay.

Insurance Coverage By Service Classification: The main function of Service Classifications is to provide a more accurate division of the patient and insurance portions when transactions are totaled. It is based on the premise that all similar procedures are reimbursed at the same percentage rate by the majority of carriers.

Because a carrier doesn’t normally pay the same percentage for every type of procedure, it is essential that procedures be divided into service classifications in order to assign the proper percentage to each class. These are set up at the time the procedure codes are created and, although they can be changed, they cannot be deleted.

A common example of the variation is the difference in percentages paid for office visits and those paid for lab work. Normally, office visits are paid at 80%, while lab work is covered at 100%. To handle this difference, when the procedure codes are created, office visits are put in service Class A (paid at 80%) and lab work is put in Class B (paid at 100%). In the Case (Policy 1, 2, and 3) windows, in the Service Classification fields, A shows 80% and B shows 100%. These classifications are used in calculating allowed amounts (Apply Payment/Adjustments to Charges window).

In the Insurance Coverage Percents by Service Classification fields, indicate the percentage amount of coverage indicated in the applicable insurance policy. There are eight fields to enter Service Classifications. You assign the fields. Field A is generally used for common procedures, and Field B could be for surgery or lab charges. Field C could be those services that are not covered by most insurance policies, etc.

The Service Classification fields in this window are completely separate from the 26 Charge Amount fields (A – Z) provided for in the Procedure/Payment/Adjustment edit window, Account tab.   The values for the Service Classification fields can be anything between 0% and 100%. Place a zero default for procedures not covered by the insurance carrier. Any of these figures can be changed by typing over the number, and the dollar amount charged can be overwritten in Transaction Entry.

Policy 2

Crossover Claim: The Crossover Claim field is the only field that is different in functionality from the Policy 1 tab. This field designates transactions entered under this case as crossover transactions. This means that the Primary insurance carrier will be forwarding the claim to the Secondary carrier. If this is the case, you will not want to print or send a secondary claim manually, as it would be a duplicate claim. If this box is checked, secondary information will be included on Medicare claims (for Medigap crossovers). Additionally, you will not be able to print or send the secondary claim for these transactions.

Policy 3

There are no fields on this tab with different functionality than the fields listed for Policy 1 or Policy 2.

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Diagnosis


Default Diagnosis 1-4: Medisoft offers you the ability to assign default diagnosis codes to patient cases. Transactions entered into this case will automatically be assigned any diagnosis codes entered into the Default Diagnosis code fields. These fields do not contain the diagnosis codes that will appear or transmit on an insurance claim, rather they only set the default codes for transaction entry when this case is used. It is important to note that many doctors, such as family practitioners, will not have a use for default diagnosis codes, as their patients are always coming in for different ailments. This functionality is better used by specialty offices who will only be seeing that patient for one particular ailment.

Allergies and Notes: The allergies and notes field is used to give you pop up messages when certain functions are performed within Medisoft. These messages will appear when this case is accessed in either Transaction Entry or Office Hours. The messages can be used to warn of allergies a patient may have, or that a patient previously bounced a check.

EDI Report Type and Transmission Codes: Refer to your electronic claims documentation for specifics regarding these triggers.

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