OMNI Office Medicine(tm) for Windows XP

PATIENT CHARGE ENTRY (POS CHECKOUT)

OVERVIEW: The Patient Checkout program is used to record all

procedures or services provided for the patient.

The charges for each procedure are based on information

contained in the Charge Codes Dictionary and Coverage

Definitions Dictionary. The expected amounts will be

automatically listed on the patient and/or insurance

side of the ledger based on the patient's insurance

coverage. All procedures for a date of service for

one patient may be added onto a single entry screen.

PROCEDURE: From the Main Menu, select Option 2 and press <Return>.

The system will display a Medical Patient Checkout

screen.

______________________________________________________________________

EXAMPLE SCREEN:

ENTERING A CLAIM:

ENTER ID: The system will default as to how you signed on. If it

does not, enter your user ID (generally the initials of your first

and last name in capital letters) and press <Return>.

ENTER DATE: The cursor will move to the MM/DD/YY section. If

the default date shown is the date of service, press <Return>.

Otherwise, type in a new date of service and press <Return>.

D/O/E stands for Date of Entry. This is the date

on which you entered the information into your

system and is stored in the ATLmmy file.

D/O/S stands for Date of Service. The D/O/S and

and D/O/E dates will be the same ONLY if you are

doing Patient Checkout on the same date that the

procedure was performed.

ENTER SITE: After you have entered the D/O/S, the cursor will

move to the ENTER Site prompt. The default is the current working

job. Once the Site Code prompt is satisfied, the cursor will move

to the PATIENT prompt.

NOTE: If your practice does not have more than one location,

the system will not ask you to list the jobs for processing.

Search: If you do not know the Site Code, type the first few

letters of the name of the Site and press the <Tab> key. A list

of jobs and their codes will be displayed to your screen. To

make your selection, type the line number of the SiteCode at the

flashing cursor or use the <Up>/<Down> arrow keys to highlight

the line and press <Return>.

Not Found: If you want to enter a Site but it is not listed,

you exit the screen when the cursor is at the ENTER CODE prompt

by typing 0 (zero) and pressing <Return>; type 0 (zero) again

and press <Return>. You should then go into the Dictionary Menu

and add the needed code(s) to the Site Code Definition module.

ENTER PATIENT: At this prompt you may do one of two things:

Enter the patient's name or enter the patient's ID code (a code

of up to 12-digits assigned to the patient). The zeros that

precede account numbers are automatically inserted by the system.

Example: For 000065-1, enter the 65-1, the system will insert the

zeros. Once entered, both the name and the ID code should appear.

The cursor will then move to the Dr.# prompt.

Search: If you enter a Patient ID code or name that is not on

file, your system will prompt at the bottom of the screen:

Patient Data Unavailable, <cr> to cont.,

To search for a patient, type the first few letters of the

patient's LAST name and press <Return>. The system will search

for names beginning with those letters and display a list to

your screen. Please see the example below.

EXAMPLE SCREEN:

You may select the patient in one of two ways: (1) At the flashing

cursor, type the line number of the patient and press <Return>.

(2) Use the <Up>/<Down> arrow keys to highlight the desired line

and then press <Return>. Using either method, the system will

fill in the appropriate information on the Patient Checkout screen

and the cursor will move to the Doctor Number prompt (Dr.#).

DOCTOR #: The system will default to the provider code assigned to

this patient on their Patient Information screen. Press <Return>

to keep the default information. If you need to change the provider

number, you may type over the default information. Press <Return>.

There is an option switch you set at the FMCONTROL module which

activates the Resident Option. If you wish to screen the billing

of a resident provider vs. a non-resident provider, set this switch

to YES.

Search: At the Dr.#: prompt, enter a few letters of the doctor's

surname and press <Tab> to search all Dr's. alphabetically. To

select the doctor, type the number to the far left of the name

and press <Return> or use the <Up>/<Down> arrow keys to highlight

the name and then press <Return>. The system will fill in the

physician information.

FAC-REF: The cursor will move to the FAC-REF: section. This

is a two-step entry.

FACILITY CODE: Enter the Facility Code (up to a 6-character

code from the Facility Code Dictionary) and press <Return> or

press <Return> to enter the default Facility Code defined on

the Patient Information screen. If the Facility Code field

is blank, the Facility Code will appear blank to indicate that

the procedure was performed in the provider's office.

e.g.: FAC-REF: HF HENRY FORD HOSPITAL

Search: If you do not know the Facility Code, type the first

few letters of the name of the facility and press the <Tab> key.

A list of facilities and their codes will be displayed to your

screen.

To select the facility, type the line number of the desired

facility, or use the <Up>/<Down> arrow keys to highlight the

facility and then press <Return>.

Not Found: If the facility you need to enter is not among those

listed, exit the search screen when the cursor is at the ENTER CODE

prompt by typing 0 (zero) and pressing <Return>; type 0 (zero)

again and press <Return>. You should then go into the Dictionary

Menu and add the needed code(s) to the Facility Codes Dictionary.

REFERRAL CODE: Next, enter the referral code (up to an eight

character code from the Referral Code Dictionary) and press

<Return>.

e.g.: FAC-REF: HF HENRY FORD HOSPITAL

A01 ANDREW APPLESEED MD

Search: If you do not know the Referral Code, type the

first few letters of the name of who referred this patient

to the provider and press <Tab>. A list with codes will

be displayed to your screen.

You may select the referral source by typing the line number

of the desired referral, or use the <Up>/<Down> arrow keys

to highlight the referral source and then press <Return>.

Not Found: If the Referral you need to locate is not listed,

exit this screen when the cursor is at the ENTER CODE prompt.

To do this you press <Return>. Your system may or may not

display the following prompt: ENTER PRINT FORM? (Y/N).

If this prompt is displayed, type an N and press <Return>.

The cursor will now be flashing at the ENTER CODE prompt.

Type 0 (zero) and press <Return>; type 0 again and press

<Return>. The system will take you to the Main Menu. From

here you should select the Dictionary Menu and add the

needed code(s) to the Referral Codes Dictionary and then

return to Patient Checkout.

Example of screen with FAC-REF areas filled in.

DISCOUNT: If this patient is to receive a discount, enter the

amount of the discount at this prompt. Press <Return>.

CRNA: Certified registered nurse anesthetist. This prompt is

displayed only if the provider is an anesthesiologist.

ASSIGN: The following numerical entries for the patient's

coverage code dictate what will be displayed at this prompt.

The Coverage Definitions Dictionary is where these entries

are made.

1=The claim will be marked Y (Accept Assignment)

The expected amount(s) from the Charge Codes

Dictionary, based on the patient's coverage code,

will be entered as the insurance balance.

2=The claim will be marked N (Do Not Accept Assignment)

The expected amount(s) will be entered as the patient's

balance.

3=The system will prompt ACCEPT ASSIGNMENT? Y/N (Decide)

ASSIGN CARRIER: A window will open listing all of the patient's

insurances. This allows you to select a carrier other than

the primary carrier. If you press <Return>, the primary

carrier will automatically be assigned.

EXAMPLE SCREEN:

1. 100 NEW YORK LIFE 01011990 - 12319999 <O

2. MDKY KENTUCKY MEDI 01011990 - 12319999

3. BS BLUE CROSS IN 01011990 - 12319999

To select a carrier, enter the line number of that carrier at

the flashing cursor or use the <Up>/<Down> arrow keys to high-

light the line and press <Return>.

FORM: The following entries made in Form field of the patient's

coverage code (see Coverage Definitions section of the Dictionary

Menu) dictate what will be displayed at this prompt.

1=the system will display Y (Print Form)

2=the system will display N (Do Not Print Form)

3=the system will prompt PRINT FORM? (Y/N) (Decide)

PRIOR AUTHORIZATION: If you enter PA in Option 1 or Option 2

in Patient Information, the system will prompt you to enter a

Prior Authorization number on each claim entered for this patient.

The letters PA will be displayed above the word PROCEDURE.

If Needed: Type the Prior Authorization number for this

claim and press <Return>.

Not Needed: If a Prior Authorization number is not needed for

this claim, or the number is not available, press

<Return> to skip past this area.

Needed But

Not Available: If a Prior Authorization is necessary and

not available, you will be able to input the

Prior Authorization Number for this claim in

Automated Billing. Just press <Return> to

bypass this field.

2ND CLAIM? Y/N: If there was a claim previously entered on

this patient for this date of service, the system will alert

you that a claim has been entered for this date with the

2ND CLAIM prompt.

You may proceed to enter a second claim by typing Y and pressing

<Return>. Use the same procedure you did to enter the original

claim.

PRINT FORM? (Y/N): If the coverage code is set to ask PRINT

FORM this prompt appears, otherwise it does not.

If you type Y (yes), the system will Batch Bill this account.

If you type N (no), this account will have to be individually

billed. Once you have answered this prompt, the Patient Checkout

screen will update and the cursor will be flashing at the ENTER

CODE prompt.

COLLECTION DATABASE: If the patient is set up in the Collection

and show the balance on the patient's ledger.

BALANCE: The current balance for this patient is shown on

the line labeled "$Bal ->". The patient balance appears

above PT.AMT; the insurance balance appears above INS.AMT;

the sum of both appears over CHARGE.

ENTERING A PROCEDURE CODE OTHER THAN ONE FOR ANESTHESIA

ENTER CODE: Enter the code (one through five characters) for

the procedure performed and press <Return>. All procedures

must be entered in the Charge Codes Dictionary and have a code

assigned before you can use them.

Procedure Not On File: If this procedure is not on file, the

system will prompt at the bottom of the screen:

Procedure Data Unavailable, <cr> to cont.

Press <Return> to continue entering other services performed

for the patient or <Tab> search.

<Tab>=Search: = Press <Tab> to have a window open listing

procedure codes (numerically/alphabetically)

or enter a few letters/numbers of the Procedure

Code and press <Tab>. Example below.

EXAMPLE SCREEN:

SELECT or SEARCH:

01 EKG AA .EKG

02 76091 AA .MAMMOGRAPHY BILATERAL

03 90050 AA .OFFICE VISIT EXTENDED

To make your selection, type the line number at the flashing

cursor and press <Return> or highlight the line using the

<Up>/<Down> arrow keys and press <Return>.

<Tab>=Add: Press <Tab> to add a procedure code to the

Charge Codes Dictionary. After you have added the

code, type 0 (zero) and press <Return> to go back to

where you were in Patient Checkout.

<Down> Arrow Key: Pressing the <Down> arrow will repeat the code

on the line above. If the DATES OF prompt (in the Charges Codes

Dictionary) is set to Y, the date of service will advance by the

quantity shown if it is more than one.

<Up> Arrow Key: Allows you to navigate all the way back to the

physician number and not loose any procedure or line item

information.

Correcting An Error: Use the Back Space to correct an error.

<Home> to View Ledger: Once you are at an ENTER CODE prompt, you

may press the <Home> key to view the ledger. The system will ask:

TYPE OF LEDGER (F)AMILY, (P)ATIENT

Enter F for Family Ledger or P for Patient Ledger. The cursor

will begin flashing at the STARTING DATE prompt. Type in the

desired date and press <Return>. The cursor will move to the

Going Back To prompt. Enter the desired date and press <Return>.

The system will begin sorting. Upon completion, a window will

open allowing you to select the Ledger Type. Example below.

EXAMPLE SCREEN:

1. FULL DISPLAY <O

2. CHARGES ONLY

3. ALL PAYMENTS

4. PATIENT PAYMENTS

5. INSURANCE PAYMENTS

6. ALL NOTES

7. EXTERNAL NOTES

8. INTERNAL NOTES

9. STATEMENTS

10. OPEN PATIENT ITEMS

Select the Ledger Type and press <Return>. Example below.

EXAMPLE SCREEN: FULL DETAIL LEDGER CARD

2004 #000300 LIKES AM APPT NEXT APPT IN A YEAR PAGE: 1

PATIENT : JONES, JANE FAMILY :00/00/0000 00/00/0000

SUBSCRIBER: JONES, JANE $78.00 $00.00

ADDRESS : 111 SUNSET ROSEVILLE MI48066 PATIENT:00/00/0000 00/00/0000

CARRIER(S): BCBS TYPE: 1_________________ $78.00 $00.00

DATE DR PROC DX DESCRIPTION BILLED INSBAL PTBAL INSAMT PTAMT BY SB

072195 001 69210 38870 EAR IRRIGAT 13.00 13.00 .00 13.00 .00 HS

072195 001 0 0 Patient and Insurance Charges 022195 13.00+ .00+HS

BILLED:

JANE BALANCE 072195 1 13.00+ .00+

070195 001 57500 V726 BIOP CERVIC 65.00 65.00 00.00 65.00 .00 HS

070195 001 0 0 Patient and Insurance Charges 020195 .00 .00 HS

BILLED:

JANE BALANCE 070195 1 65.00

(S)tart Over, (B)ackup, (T)ype of Ledger, (I)nsurance, <Ret>=Cont, Esc=END

(S)tart Over: Takes you to the following ledger prompt:

TYPE OF LEDGER (F)AMILY, (P)ATIENT

(B)ackup: Takes you to the previous screen.

(T)ype of Ledger: Opens a window allowing you to select a ledger

type to view.

EXAMPLE SCREEN:

1. FULL DISPLAY

2. CHARGES ONLY

3. ALL PAYMENTS

4. PATIENT PAYMENTS

5. INSURANCE PAYMENTS

6. ALL NOTES

7. EXTERNAL NOTES

8. INTERNAL NOTES

9. STATEMENTS

10. OPEN PATIENT ITEMS

(I)nsurance: Opens a window that displays expanded insurance

information (policy information and insurance

balances are shown). Example below.

Esc=END: Displays the Auxiliary Function Line shown on the

next page.

(H)ARDCOPY, (R)EDRAW, (T)YPE OF LEDGER, (I)NSURANCE, <RET> to Cont:O

(H)ARDCOPY: To print a hardcopy of the ledger, type H and press

<Return>. A screen similar to the one below will be displayed.

EXAMPLE SCREEN:

1. HP 1320 (LP)

2. Okidata 320 (P1)

3. HP Laser 4200N (P2)

4. Your Terminal Screen (TR)

5. ----> EXIT <----

Select the appropriate output device and press <Return>.

(R)EDRAW: To redraw the screen, type an R and press <Return>.

(T)YPE OF LEDGER: Opens a window allowing you to select a ledger

type. Example below.

EXAMPLE SCREEN:

1. FULL DISPLAY <O

2. CHARGES ONLY

3. ALL PAYMENTS

4. PATIENT PAYMENTS

5. INSURANCE PAYMENTS

6. ALL NOTES

7. EXTERNAL NOTES

8. INTERNAL NOTES

9. STATEMENTS

10. OPEN PATIENT ITEMS

(I)NSURANCE: Opens a window that displays expanded insurance

information (policy information and insurance

balances are shown). Example on previous page.

<RET> to Continue: Returns you to the ENTER CODE prompt of the

Patient Checkout screen.

Esc=END: To exit Patient Checkout from the ENTER CODE prompt, type

0 (zero) and <Return>. If charges were entered, total out. If no

charges were entered, the cursor will move to the ENTER ID prompt.

Zero and <Return> again to go to the Main Menu.

ENTER AN ANESTHESIA PROCEDURE CODE:

ENTER CODE: Enter the anesthesia procedure code and press <Return>.

All procedures must be entered in the Charge Codes Dictionary and

have a code assigned before you can use them.

Procedure Not On File: If this procedure code is not on file,

the system will prompt at the bottom of the screen:

Procedure Data Unavailable, <cr> to cont.

Press <Return> to continue entering other anesthesia procedure

codes for the patient or press <Tab> to search.

<Down> Arrow Key: Pressing the <Down> arrow will repeat the code

on the line above. If the DATES OF prompt (in the Charges Codes

Dictionary) is set to Y, the date of service will advance by the

quantity shown if it is more than one.

Correcting An Error: When entering a code, use the Back Space

to correct an error.

<Home> to View Ledger: Once you are at an ENTER CODE prompt, you

may press the <Home> key to view the ledger. The system will ask:

TYPE OF LEDGER (F)AMILY, (P)ATIENT

Documentation on viewing a ledger is on page 9.

Anesthesia Concurrency Screen: After you 0 (zero) and <Return>

at the ENTER CODE prompt, a window will open as shown below.

EXAMPLE SCREEN:

Physical Stat : Age: Emergency:

Start Time: : Ending: 00:00

CONCURRENCY CHECK

CALCULATED FEE: .00

ACCEPT FEE Y/N: ( )

ENTER UNITS:

ENTER FEE :

RATE/UNIT : MINS/UNIT : B+MODS:

BASE UNIT : ADD UNITS : TIME:

ROUND AMT : MEDCR MAC : TOTAL:

DEFINITION OF FIELDS:

Physical Status: Choices are 1, 2, 3. You need to define these

in the Charge Codes Dictionary as P1, P2, P3. How you define

these (healthy or ill, including OBs) will vary by insurance

compamy.

Age: Choices are Y (yes, age is a factor= over 70 or less than

one year) or N (no, age is not a factor. You will also need to

define age in the Charge Codes Dictionary as AGE.

Emergency: Choices are Y (yes) or N (no). Again, you will need

to devine these in the Charge Codes Dictionary as EMG.

Start Time: Enter time anesthesia was started.

Ending: Enter the time anesthesia was ended.

CONCURRENCY CHECK: A check to see if the anesthesiologist is

concurrently serving more than one patient.

CALCULATED FEE: Calculation based on rate and units for procedure

performed.

ACCEPT FEE Y/N: If you need to start over, press <Return> at this

prompt and the cursor will move to the Start Time prompt.

Y = calculated fee is acceptable.

N = calculated fee is not acceptable.

If you enter an N, the prompt below will be displayed.

ENTER UNITS: Enter the units of administered anesthesia. The fee

will be recalculated and the new calculation will be displayed.

The system will then prompt:

ACCEPT FEE Y/N: Y = calculation correct- fee acceptable.

N = calculation not correct- fee not acceptable.

Once you enter Y and <Return>, the window will close and you may

continue with patient checkout.

The fields below have been defined in the Provider and Charge Codes

Dictionaries. They are not fields you can edit in this window.

RATE/UNIT : Dollar amount charged per unit.

BASE UNIT : Base units used for this procedure.

ROUND AMT : Amount to round up to the nearest dollar amount.

(Often used by private carriers in patient billing.)

Example: 7 units at $43.25 per unit generates a total charge

of $302.75. By entering the number 10 in the ROUND AMT

field, this charge amount would be rounded to $310.00.

MINS/UNIT : This is the number of minutes per unit.

ADD UNITS : Additional units to add to each procedure

automatically.

MEDCR MAC : This is the Medicare MAC amount.

B+MODS: This is base plus modifiers.

TIME: Number of anesthesia units for time.

TOTAL: Total of B+MODS and TIME.

PROMPTS

ENTER CODE: The first prompt will be _____ENTER CODE. You

enter the procedure code and press <Return>.

The various fields that were given a Yes answer

in the Charge Codes Dictionary will be displayed

for you to answer.

The screen below is an example of where the

various prompts will appear.

EXAMPLE SCREEN:

PAGE:01 MEDICAL PATIENT CHECKOUT D/O/E: 08/01/95

AA 000030 AA 002 DR 002

NAMES: SMITH, MARY FAC-REF: BS HF HENRY FORD HOSPITALB

_______________________ AO1 ANDRE APPLESEED MD

10785 S. SAGINAW BS DISC:N AA 002 ASGN:Y FORM:YB

P.A. $BAL-> 100.00+ .00+ 100.00+B

PROCEDURE DAY DATE DX # CODE PT.AMT INS.AMT CHARGE

90060 ICD DIAG?____

Pt.=

Pc.=

EXAMPLE OF PROMPTS:

QUANTITY? DISCH?_______

PLACE/O/S? (3 3 3 3) MISC?________

ICD DIAG?_______ PM-1?

Pt.= PM-2?

Pc.=

PL:

DOS?_______

TO?________

ADMIT?_____

*QUANTITY: Enter the number of times this service was performed

on this date.

*PLACE/O/S: At the PLACE/O/S prompt, indicate the place where

the procedure was performed. (i.e.: 1=inpatient

hospital, 2=outpatient hospital, 3=office, etc.

These codes are defined by BS, MR, and MD.) The

system will prompt you with the information as

previously entered in the Charge Codes Dictionary

as the usual and customary PLACE OF SERVICE. If

you press the <Return> key, the system will

default to P/O/S in the Dictionary.

*ICD DIAGNOSIS: Enter the 3-5 digit ICD diagnosis code and press

<Return>. This is a mandatory field.

Search: If you do not know the diagnosis code, type the

first few letters of the diagnosis and press the

<Tab> key. A list of codes with their description

will appear on your screen. Type the number to

the left of the diagnosis and press <Return>.

The system will complete line one in the body of

the entry screen. A description of the diagnosis

will appear at the bottom of the screen. The cursor

will be flashing at a new ENTER CODE prompt if there

are no other prompts that need to be satisfied.

Not Found: If the diagnosis you need is not found on your

system you may go ahead and use the diagnosis

code as found in the ICD9 book. The code will be

listed without a description until you add it to

the Diagnosis Library.

Default for If the patient has a diagnosis listed in Patient

Pat. Info. Information screen, it will be displayed. This

Diag.Code: is shown as "Pt.= ". If the diagnosis is

correct, press <Return>; otherwise, type the

correct diagnosis.

Default for If this procedure code was assigned a diagnosis in

Procedure the Charge Codes Dictionary, it will be displayed

Code: This is shown as "Pc.= ". If several codes are shown,

enter the correct one and press <Return>. If there

is NO diagnosis listed in Patient Information, the

first diagnosis listed under the procedure code is

the default when you press <Return>.

Problem At the DIAG? prompt, you may press the <Down> arrow

Diagnosis to obtain a diagnosis history on this patient. A

List: window will open (example on the next page) displaying

this information. Use the arrow keys to highlight the

correct diagnosis and press <Return>. The system will

automatically complete the Checkout Line for you.

EXAMPLE SCREEN:

1. 2500 DIABETES

3. 5990 URINARY TRACT INFECTION

DIAG: When entering additional procedures, the default

(cont.) diagnosis will be the last diagnosis code used.

Example: OV ICD DIAG?_____

Pt.=78650

Pc.=4019 486 78650 2859

*D/O/S: If this procedure was performed on a date different

(from) from the date of service entered at the top of the

screen, type the correct date (mmddyy) and <Return>.

From and To dates advance automatically when the

DATES OF field in the Charge Codes Dictionary

is set to Yes. This will also calculate correctly

when the quantity (MULTIPLES) field in the Charge

Codes Dictionary is set to Yes.

*TO: The date performing of the procedure ends.

(i.e., Subsequent hospital care days.)

*ADMIT: Enter the DATE the patient was ADMITTED to the

hospital and press <Return>. If there was no

admission date, press <Return>.

*DISCH: Enter the DATE the patient was DISCHARGED from the

hospital and press <Return>. If there was no

discharge date, press <Return>.

*MISC: Enter the MISCELLANEOUS DATE and press <Return>.

(This date is used as the date of injury, L.M.P.,

onset of symptom, etc. and prints in box number 24

on the Michigan Health Benefits Claim form.

*PM-1 AND If the procedure requires a MODIFIER that may vary

PM-2: depending upon the specific circumstances for this

procedure code, enter the MODIFIER and press <Return>.

Presssing the <Up> arrow on the second price modifier

will allow you to edit the first price modifier.

A <Return> will use modifiers as defined in the

Charge Codes Dictionary or bypass the field.

AMT/CHARGE: Will prompt for amount/charge if amount #1 in

Charge Code Dictionary is left blank.

**PROBLEM LIST: This prompt, if turned on in the FMCONTROL program,

writes to the Problem List page of Patient Information.

The default for this prompt is N (no).

* Will be asked only if prompt is turned on in the Charge Codes

Dictionary.

ACCOUNTING SECTION

PRICE CHANGE: To change the amount on an entered procedure,

Hold down the <Shift> and then press the <Tab> key. The

cursor will move to the amount columns and permit you to change

the dollar amount. Use the <Right> Arrow key to move from the

left column to the right columns.

If you list an amount lower than the original,

the claim will still indicate the original billed amount.

If you list a higher amount, the claim will

show the higher amount.

The difference in $ figures will appear as an

adjustment on the Monthly Financial Report.

VARIABLE PRICE: If you left amount #1 blank in the Charge Codes

Dictionary, you will be prompted to enter the price during

patient checkout. You must have an amount listed on Line 1 for

each procedure code, or you will be prompted for a price.

12 LINE ITEMS: The screen will allow you to put in up to 12

claim lines before it prompts ADDITIONAL PAGE? Y/N. If you

have more claim lines to enter for this patient, type Y and

press <Return>. This will create an additional page and allow

you to continue. If this was your last entry for this patient,

and you do not need an additional page, type N and press <Return>.

PROCEDURE(S) When all procedure codes have been entered for

ENTERED: this patient, type 0 (zero) and press <Return>

at the ENTER CODE prompt. PT.AMT, INS.AMT,

and CHARGE AMT are calculated and entered as a

SUBTOTAL by the system.

The TOTAL balances contain both the previous

balance as well as the charges for the claim(s)

just entered.

BALANCE: The current balance for this patient is shown on

the line labeled $Bal->. The patient balance is

above PT.AMT.; insurance balance is above INS.AMT.;

and the combined total is above CHARGE.

AMOUNT PAID: At this prompt, enter the amount paid and press

<Return>. The system will assume you are

entering whole dollar amounts unless you include

the decimal point.

Example: 1=one dollar

1.00=one dollar

100=one hundred dollars

PAYMENT TYPE: Enter the code for the type of payment received.

Codes for Payment Type are set up in your

Transaction Codes Dictionary.

The most commonly used are : C=cash, K=check,

and V=charge.

EXPLAIN: If the toggle for this prompt is set to yes, it

will display and you may proceed as follows:

Enter up to 50 characters if needed, or press

<Return> to skip. Information entered here will

appear on Line 19 of the Medicare/AMA HICFA

form or box 23 of the AMA 1500 form or box 39 of

the Blue Shield Health Benefits claim form. You

may enter up to 50 characters. Press <Return> to

skip.

FINAL AMOUNTS: Final dollar amounts are then calculated and

recorded by the system. The new current

balances are now shown at the bottom of your

screen in the appropriate sections.

PT.AMT INS.AMT CHARGE

The patient balance is below PT.AMT and contains

the previous balance, plus the current patient

charges, minus the patient payment.

The insurance balance is below INS.AMT and

contains the previous insurance balance, plus the

current insurance charges.

The combined total is below CHARGE and contains

the previous balance, plus the current charges,

minus the payment.

There is an auto adjustment which represents the

difference between the gross and expected amounts.

ACTION LINE FUNCTIONS:

V= VERIFY: If information is correct, type V and press <Return>.

The system will ask:

INVOICE? Y/P/N: The Patient Checkout program will provide each

patient with an ITEMIZED RECEIPT/INVOICE for

each visit. This receipt will be printed on

plain white paper.

Default=N: If you press the <Return> key, the system will

default to No and will not print an invoice.

Y: Enter Y and press <Return> to print out a standard

invoice containing both the patient and insurance

balances. This receipt will contain all the

necessary information for the patient to submit

to their insurance company for reimbursement. The

receipt will total the above procedures billed,

indicate if any payment was made, any previous

balance, and list the current balance of the

account.

P: Enter P and press <Return> to print out an invoice

containing only the amounts owed by the patient.

APPT/RECALL? Do you wish to have the system help you keep

1/2/R/N: track of when this patient is due to return

to the office?

1 or 2: By entering either 1 or 2 the screen will go

to item Number 13 on the Main Menu which is the Time

Management System.

1 and 2 are both appointment scheduling

programs. The only difference is the

format they use.

For a further explanation, please see the corresponding

section in this manual.

R=Recall: If this patient should be set up with a recall

date. Type R and press <Return>, the screen will prompt:

ENTER RECALL DATE: MMDDYY TIME: HHMM

PROC:____1/2/R/N:R

Type in the date to be recalled. If the patient is to return

in several weeks or months with no definite date, enter the

number of months. If a date is given, use the six-digit format.

If this patient has an appointment time set up, and you are

using the recall to remind the patient of his/her appointment,

you can fill in the hour and minute of the scheduled appointment.

You may press <Return> without filling in the time.

You must fill in the procedure code at the PROC:___ prompt to

allow the computer to set up the recall.

N=No: If this patient should not be set up with a recall

date, type N and press <Return>. OR, since this is also

the default, you may press <Return> without typing N for No.

OUTPUT DEVICE: Select the printer on which the receipt is to

be printed by typing the number that precedes the printer name

at the flashing cursor, or use the <Up>/<Down> arrow keys to

highlight the line and then press <Return>. If you did not

instruct the system to print an invoice, this prompt will not

be displayed.

REPRINT?: If the patient requests a copy of the bill, you may

print a second copy at the REPRINT? prompt. If there is no need

for an additional copy, type N and press <Return>. The patient's

claim displayed on the screen will clear and permit you to enter

a claim for another patient. If you answered N to invoice and

then the patient requests a receipt, you can exit to the Main

Menu, select Option 7 (Patient Reports), and from the Patient

Reports Menu select Option 3, Reprint Previous Receipt.

D= DELETE: Type D to have the system delete the transaction and

exit the patients file. The cursor will be flashing at the

ENTER ID prompt. You may now proceed to select another patient.

C= CORRECT: C to correct from the Action Line will only allow

you to <Up> arrow and remove the line above. When you type C

and <Return>, the cursor will move to the last line entered and

be flashing at the ENTER CODE prompt. You may use the <Up> arrow

to delete the last procedure entered.

OMNI Office Medicine(tm) for Windows XP

PATIENT CHECKOUT

(FPC #) Rev.2/2004 v8.4

O=OPTIONS: If it is necessary to indicate that you are attaching

documentation to the claim, enter O (alpha character, not zero)

for an OPTION screen. Depending on which insurance you are

working with, one of the following option screens (HCFA 1500 or

Blue Cross) will be displayed.

H C F A 1500 FORM OPTIONS MENU

The fields in parentheses correspond to those found on the

HCFA 1500 form.

EXAMPLE SCREEN:

FORM H C F A 1 5 0 0 OPTIONS MENU

ITEM FIELD DESCRIPTION CURRENT VALUE

1. (8) PATIENT STATUS :

2. (10a) EMPLOYMENT RELATED :

3. (10b) AUTO ACCIDENT :

4. (10c) OTHER ACCIDENT :

5. (10d) RESERVED FOR LOCAL USE :

6. (14) DATE OF CURRENT ILLNESS :

7. (15) DATE OF SIMILAR ILLNESS :

8. (16) DATE UNABLE TO WORK FROM:

9. (16) DATE UNABLE TO WORK TO :

10. (19) RESERVED FOR LOCAL USE :

11. (20) OUTSIDE LAB :

12. (22) MD RESUBMISSION CODE :

13. (22) MD ORIGINAL CLAIM REF NO:

ITEM #__ TO CHANGE - PRESS <RETURN> TO RETURN TO CLAIM

ITEM #__ TO CHANGE: Type the item number for which you need to

enter a value and press <Return>.

PRESS <RETURN> TO RETURN TO CLAIM: Press <Return> to go back to

the claim you are working with.

DEFINITION OF HCFA 1500 OPTIONS MENU FIELDS:

1. (8) PATIENT STATUS: Valid responses are E=Employed, F=Full Time

Student, P=Part Time Student, or you may leave this field blank.

2. (10a) EMPLOYMENT RELATED: Was this claim due to an employment

related accident. Valid responses are Y=Yes, N=No, or you may leave

this field blank.

3. (10b) AUTO ACCIDENT: Was this claim due to an auto accident.

Valid reponses are Y=Yes, N=No, or you may leave this field blank.

4. (10c) OTHER ACCIDENT: Was this claim due to an accident other

than the two mentioned above. Valid responses are Y=Yes, N=No, or

you may leave this field blank.

5. (10d) RESERVED FOR LOCAL USE: Valid responses vary from state-

to-state.

6. (14) DATE OF CURRENT ILLNESS: Using the MMDDYY format, enter the

date of the current illness (first symptom), injury (accident), or

pregnancy (LMP).

7. (15) DATE OF SIMILAR ILLNESS: Using the MMDDYY format, enter the

date the patient had same or similar illness.

8. (16) DATE UNABLE TO WORK FROM:

9. (16) DATE UNABLE TO WORK TO: Using the MMDDYY format, enter the

dates patient unable to work in current occupation.

10. (19) RESERVED FOR LOCAL USE: This field may be used for free

text.

11. (20) OUTSIDE LAB: If there are Lab charges, was the service

performed by an outside lab. Valid responses are Y=Yes, N=No,

or you may leave this field blank.

12. (22) MD RESUBMISSION CODE: For this code, you will need to

refer to Medicaid guidelines.

13. (22) MD ORIGINAL CLAIM REF NO: For this reference number, you

will need to refer to Medicaid guidelines.

BLUE CROSS OPTIONS-MICHIGAN USE ONLY

The fields in parentheses correspond to those found on the

Michigan Blue Cross form.

EXAMPLE SCREEN:

OPTIONAL MEDICAID FORM OPTIONS MENU (VARIES BY STATE)

ITEM FIELD DESCRIPTION CURRENT VALUE

1. (20) CONDITION RELATED TO :

2. (25) INJURY CODE :

3. (28) EMERGENCY :

4. (45) NO ATTACH. :

5. (46) ADJ. :

6. (47) CO-INSURANCE :

7. (48) DEDUCTIBLE :

8. (53) ORIG CLAIM REFERENCE NO :

9. (54) NO. :

10. (60) MED. STATUS :

11. (61) RESOURCES :

12. (62) OTHER INS. :

13. (63) DATE OTHER INS CLM SUB :

ITEM #__ TO CHANGE - PRESS <RETURN> TO RETURN TO CLAIM

ITEM #__ TO CHANGE: Type the item number for which you need to

enter a value and press <Return>.

PRESS <RETURN> TO RETURN TO CLAIM: Press <Return> to go back to

the claim you are working with.

The above screen is for the Blue Shield Options. The information

you enter here will be permanently stored as part of this patient's

claim.

DEFINITION OF BLUE CROSS OPTIONS MENU FIELDS:

1. (20) CONDITION RELATED TO: Valid responses are E=Employment

related, A=Auto related, O=Other, or you may leave this field

blank.

2. (25) INJURY CODE: Valid inputs are 1, 2, 3, 4, 5, or you

may leave this field blank. These pertain to Medicaid only.

Refer to your Medicaid Manual for definitions of these codes.

3. (28) EMERGENCY: Valid inputs are 1, 2, 3, or you may leave

this field blank. For definitions of these codes, refer to your

Medicaid Manual.

4. (45) NO ATTACH.: Enter the number of attachments.

5. (46) ADJ: Mark this field with an X if this claim is being

submitted as an adjustment claim form. This is used for Medicaid.

6. (47) CO-INSURANCE: If a co-insurance is involved, enter the

co-insurance amount. This pertains to Medicaid only.

7. (48) DEDUCTIBLE: If the primary insurance has applied an amount

to the deductible, enter the amount here. This pertains to Medicaid.

8. (53) ORIG CLAIM REFERENCE NO: This is for Medicaid only.

9. (54) NO.: Enter the line number this claim reference is for.

10. (60) MED. STATUS: Valid inputs are 1, 5, 6, 7. This pertains

to Medicaid only. For definitions of these codes, refer to your

Medicaid Manual.

11. (61) RESOURCES: Valid inputs are 1, 2, 5, 6, 7. This pertains

to Medicaid only. For definitions of these codes, refer to your

Medicaid Manual.

12. (62) OTHER INS.: This is a one-character field. Refer to your

Medicaid Manual for choices to enter in this field.

13. (63) DATE OTHER INS CLM SUB: Using the MMDDYY format, enter

the date this claim was submitted to the other insurance company.

OMNI Office Medicine(tm) for Windows XP

PATIENT CHECKOUT

(FPC #) v8.4

U=UB OPTIONS: Type U at the Action Line to access the UB92 Form

Options Menu.

UB OPTIONS SCREEN

Setting UBOPTS to Yes (This is done through FMCONTROL for PTEX.)

will allow you to access the UB Options Screen shown below from

Patient Checkout. Type U at the Action Line of Patient Checkout

and press <Return>.

The item numbers in parentheses correspond to those found on the

UB92 form.

EXAMPLE SCREEN:

ITEM-FIELD CURRENT VALUE ITEM-FIELD CURRENT VALUE

1. (2) BOX 2 : 20. (33b) OCCUR CODE:

2. (7) COV D. : 21. (34b) OCCUR CODE:

3. (8) N-C D. : 22. (35b) OCCUR CODE:

4. (9) C-I D. : 23. (36a) OCCUR SPAN:

5. (10) L-R D. : 24. (36b) OCCUR SPAN:

6. (11) BOX 11 : 25. (37) BOX 37 :

7. (16) MS : 26. (39a) VAL CODE :

8. (18) ADMIT HOUR: 27. (40a) VAL CODE :

9. (19) ADMIT TYPE: 28. (41a) VAL CODE :

10. (20) ADMIT SRC : 29. (39b) VAL CODE :

11. (21) D HR : 30. (40b) VAL CODE :

12. (22) STAT : 31. (41b) VAL CODE :

13. (24+) COND CODES: 32. (39c) VAL CODE :

14. (31) BOX 31 : 33. (40c) VAL CODE :

15. (32a) OCCUR CODE: 34. (56) BOX 56 :

16. (33a) OCCUR CODE: 35. (57) BOX 57 :

17. (34a) OCCUR CODE: 36. (76) ADM DIAG :

18. (35a) OCCUR CODE: 37. (77) E-CODE :

19. (32b) OCCUR CODE: 38. (78) BOX 78 :

ITEM # TO CHANGE, R FOR REMARKS, PRESS <RETURN> TO RETURN TO CLAIM

ITEM #__ TO CHANGE: Type the item number for which you need to

enter a value and press <Return>.

R FOR REMARKS: Type R to access a remarks line.

PRESS <RETURN> TO RETURN TO CLAIM: Will return you to the claim

you are working with.

DEFINITION OF UB OPTIONS SCREEN FIELDS:

1. (2) BOX 2: This is an unlabeled field. Generally used for a

claim reference number or document control number.

2. (7) COV D: Covered Days. The number of days covered by the

primary payer, as qualified by the payer organization.

3. (8) N-C D: Not Covered Days. The number of days not covered

by the primary payer.

4. (9) C-I D: Co-Insurance Days. The inpatient Medicare days

which occur after the 60th days and before the 91st days in a

single benefit period and the SNF days from the 21st days in a

benefit period are considered co-insurance days.

5. (10) L-R D: Lifetime Reserve Days. Each Medicare beneficiary

has a lifetime reserve of 60 additional days of inpatient hospital

services during a benefit period.

6. (11) BOX 11: Medicaid sponsor physician identification number.

The Medicaid Provider Identification Number of the physician

primarily responsible for the medical care of a patient enrolled

in the Physician Sponsor Plan.

7. (16) MS: Patient Marital Status (MS). The marital status of

the patient at date of admission, outpatient service, or start

of care.

8. (18) ADMIT HOUR: Admission Hour. The hour when the patient

was admitted for inpatient care.

9. (20) ADMIT TYPE: Type of Admission. A code indicating the

priority of this admission (Hospital Inpatient only).

10. (20) ADMIT SCR: Source of Admission. A code indicating the

source of this admission or outpatient registration.

11. (21) D HR: Discharge Hour. Hour that the patient was

discharged from inpatient care.

12. (22) STAT: Patient Status. A code indicating the patient

status as of the Statement Covers Period date.

13. (24+) COND CODES: Condition Codes. Codes that have been

developed for the purpose of giving additional information about

the patient or circumstances regarding the services rendered.

The Condition Codes are grouped into eleven (11) categories.

Insurance Codes (01-16)

Special Conditions Codes (17-30)

Student Status Codes (31-35)

Accommodation Codes (36-45)

CHAMPUS Information Codes (46-54)

SNF Information Codes (55-59)

Prospective Payment Codes (60-70)

Renal Dialysis Setting Codes (71-76)

Other Codes (77-93)

IPD Codes 994-96)

State Assigned Codes (97-99)

Special Program Indicator Codes (A0-B9)

PRO Approval Indicator Codes (C0-C9)

Claim Change Reasons (D0-W9)

Medicaid Information (X0-Z9)

When preparing a claim where there is only one Condition Code,

F.L. 24 should be used.

If a claim requires more than one Condition Code, the Condition

Codes should be in ascending order in F.L. 24-30.

14. (31) BOX 31: Unlabeled - reserved for national use.

15. (32a) - 22. (35b): Occurrence Codes and Dates. The code of

a significant event relating to treatment. Fields 32a-35a must

be completed before fields 32b-35b.

23. (36a) - 24. (36b): Occurrence Span. When occurrence code

fields 32a-35b are filled, then 36a&b may be used to capture

additional occurrence codes. In some instances the through

date may be left blank.

25. (37) BOX 37: Internal/Document Control Number (unlabeled).

The control number assigned to the original bill by the payer

or the payer's intermediary.

26. (39a) - 33. (40c) VAL CODE: Value Codes and Amounts. A code

structure to relate amounts or values to identified data elements

necessary to process this claim, as qualified by the payer organi-

zation. The purpose is to determine eligibility of benefits.

34. (56) BOX 56: Unlabeled - reserved for state use.

35. (57) BOX 57: Unlabeled - reserved for national use.

36. (76) ADM DIAG: Admitting Diagnosis. The ICD-9-CM diagnosis

code provided at the time of admission as stated by the physician.

37. (77) E-CODE: The ICD-9-CM code for the external cause of

injury, poisoning, or adverse effect.

38. (78) BOX 78: Diagnostic Related Group (unlabeled). The

Diagnostic Related Group (DRG) code for the bill, as determined

by the provider.

Below is an example of a completed patient checkout screen.

EXAMPLE COMPLETED PATIENT CHECKOUT SCREEN:

EXIT: To exit Patient Checkout, type 0 (zero) at the ENTER ID

prompt and press <Return>. You will be returned to the

Main Menu.

ACDCONTROL PROGRAM FOR PATIENT CHECKOUT

This program gives you the ability to "activate" or "turn off"

the prompts shown in the screen below.

From the Command Line of the Main Menu, type FMCONTROL and press

<Return>. At the ENTER CODE prompt, type PTEX and press <Return>.

The screen similar to the one below will be displayed.

EXAMPLE SCREEN:

BPGN: FMCONTROL < SYSTEM CONTROLS RECORD MAINTENANCE > MAX:10000B

BDBX: /usr/OMNI/ ENTER CODE - PTEX ACTIVE: 381B

1. C_FIELD1: DR=NO, DX=PC, CONSULTREFERRAL=YES, TODATE=YES

2. C_FIELD2: GENERIC=YES, ALLRECEIPTS=YES, PT=LAST

3. C_FIELD3: EXPLAIN=YES, PL=YES, RESIDENT=NO

4. C_FIELD4: AUTOAPPLY=YES, DR2=YES

5. C_FIELD5: REC=EXPECT, UBOPTS=YES, LINKxx=BILLED

6. C_FIELD6: DX=DEFINED

ACTION-> (ENTER # TO CORRECT, (D)ELETE, (P)RINT, (0)=END)

FIELD 1:

DR: If set to NO, a <Return> will default to the doctor in Patient

Information.

If set to YES, you must type in a doctor number, even if it is

the default doctor.

DX: If set to PC, defaults to first diagnosis, Field 43, in the

Charge Codes (Procedure Codes) Dictionary.

If set to PT, default comes from Patient Information, Field 17.

CONSULTREFERAL:

If set to YES, will not allow you to bypass if you have a

procedure code identified by Medicare, BC, etc. as a consultation

procedure in the Charge Codes Dictionary.

If set to NO, no matter what procedure code you enter, you

will be able to bypass this prompt.

TODATE:

If set to YES, you will have to satisfy the To date? prompt.

FIELD 2:

GENERIC:

If set to YES, searches procedure code down to master level.

ALLRECEIPTS:

If set to YES, will print a receipt for all visits for that

day.

PT: If set to LAST, it will default to the patient you previously

worked with.

If set to NULL, it will not recycle that number.

FIELD 3:

EXPLAIN:

If set to YES, it turns on the Explain prompt.

PL: If set to YES, it turns on the Problem List prompt.

RESIDENT: If you wish to screen the billing of a resident

provider vs. a non-resident provider, set this switch to

YES.

FIELD 4:

AUTOAPPLY:

If set to YES, should payment be more than expected amount on

the date of service, you will be allowed to apply the extra amount

to a different date of service.

If set to NO, it will overpost for that date of service.

DR2: If set to YES, allows you to enter a second doctor on the

claim. The default is DR# 000.

If set to NO, it looks for one doctor number only.

FIELD 5:

REC: If set to EXPECT, system looks for the expected amount instead

of the billed amount.

If set to BILLED, system looks for the billed amount.

UBOPTS: If set to YES, allows the UB Option screen to be

displayed.

LINKEDxx=BILLED: If this toggle is not present, any deductibles

will be based on the expected/approved amount as usual.

If this toggle is present, xx=the first two bytes

of the carrier code. This will calculate the deductible based on

the billed amount instead of expected amount.

FIELD 6:

DX: If set to DEFINED, the diagnosis has to be defined in the

Diagnosis Library.

If set to NODEF, you may just enter a number out of the

ICD-9 book.