PART 1 Introduction to Polaris Medical Group

1.1 The PMG Patient Services Team

Statement of Purpose

Organization and Staff

1.2 Medical Records

Information in the Medical Record

Standards

1.3 SOAP Format

1.4 HIPAA/HITECH and Patient Privacy

HIPAA Privacy Rule

Authorizations

HIPAA Security Rule

HIPAA Electronic Health Care Transactions and Code Sets

Polaris Medical Group HIPAA Compliance Program

1.5 Qualities and Attitudes of the Patient Services Specialist

1.6 Your Typical Day at Polaris Medical Group

Part Summary

Quiz: Part 1

Critical Thinking Questions

PART 2 Polaris Medical Group Policy and Procedure Manual

Reading Acknowledgment

Contents

2.1 Practice Information

Equal Employment Opportunity , Nondiscrimination , and Affirmative Action Statements

Employment Levels

2.2 Wages and Compensation

Pay Rates

Overtime Compensation

Pay Dates

Employee Time Records

Performance Evaluations

Employee Benefits

Employee Grievances

2.3 Resignation , Termination , Discharge , and COBRA Benefits

Resignation

Termination

Discharge

COBRA Benefits

2.4 Personnel Conduct Issues

Contributions and Solicitations

Identification Badges

Inclement Weather

Sexual Harassment

Dress Code

Smoking and Tobacco Use

Substance Abuse

Personal Telephone Calls and Visits

Personal Use of Computers and E-mail

Cell Phones and Social Networking

Universal Precautions

Ethics

2.5 Office Hours and Attendance

Definitions of Absences

Attendance Policy

2.6 Telephone Procedures

Documenting Telephone Calls

Screening Telephone Calls

Taking Telephone Messages

Handling Emergency Telephone Calls

2.7 Patient Privacy and Confidentiality Procedures

Polaris Medical Group Patient Privacy Guidelines—General

Polaris Medical Group Patient Privacy Guidelines—Information Technology

Violations of PMG’s Patient Privacy Guidelines

2.8 Office Visit Procedures

Receptioning

Gathering Patient Information

Verifying Insurance Coverage

Checking for Preauthorization Requirements

Checking for Referral Requirements

Concluding the Patient’s Visit

Appointments

2.9 Payment Processing

The Collections Policy

The Billing Cycle

Insurance Claims

Billing Guidelines

Review of RAs

Patient Billing Disputes

2.10 Daily Reports

2.11 Guidelines for Medicare , Medicaid , and Workers’ Compensation

Medicare

Medicaid

Workers’ Compensation

2.12 PMG Fee Schedule and Health Plan Information Pages

Standard Health Care , Inc.—PPO

Blue Cross and Blue Shield of Ohio—Fee-for-Service Plan

TRICARE—HMO

Columbus Medical Care—PPO

Cigna Healthplan—HMO

Aetna Health Plans— Ohio HMO—Network

Ohio Insurance Company—Fee-for-Service Plan

Nationwide Medicare—HMO

Ohio Department of Human Services—Medicaid

Blue Cross and Blue Shield of Ohio—Workers’ Compensation

Nationwide Medicare—Parts A and B

Part Summary

Quiz: Part 2

Critical Thinking Questions

PART 3 On the Job

Using the Allowed Amounts Feature in Medisoft

Week 1 , Day 1

Medisoft Training Topic 1: Claim Rejection Messages

Daily Worksheet

Week 1 , Day 2

Medisoft Training Topic 2: Creating a Patient by Insurance Carrier Report and Exporting It to a PDF File

Daily Worksheet

Week 1 , Day 3

Medisoft Training Topic 3: Adding a New Provider

Daily Worksheet

Week 1 , Day 4

Medisoft Training Topic 4: Printing a Patient Face Sheet

Daily Worksheet

Week 1 , Day 5

Medisoft Training Topic 5: Using Quick Balance

Daily Worksheet

End-of-Week-1 Job

Medisoft Training Topic 6: Printing a Copayment Report

Week 2 , Day 1

Medisoft Training Topic 7: Entering Prior Authorization Numbers

Daily Worksheet

Week 2 , Day 2

Medisoft Training Topic 8: Entering Additional Diagnosis Codes

Medisoft Training Topic 9: Adding a New Insurance Carrier

Daily Worksheet

Week 2 , Day 3

Medisoft Training Topic 10: Entering Referrals

Medisoft Training Topic 11: Entering Visit Authorization Numbers

Medisoft Training Topic 12: Closing Cases

Daily Worksheet

Week 2 , Day 4

Medisoft Training Topic 13: Entering Additional Procedure Codes and Allowed Amounts

Daily Worksheet

Week 2 , Day 5

Medisoft Training Topic 14: Using Final Draft , Medisoft’s Integrated Word Processor

Daily Worksheet

End-of-Month Jobs

PART 4 Source Documents

Glossary

Index