Med Office Procedures
Card Set Information
Med Office Procedures
Ministry health billing privacy act
Chapter 11 - 14
The ministry of health:
Accepts claims, approves claims, monitors claims, investigates claims.
Certain procedures require prior approval.
Sent to random clients for verification.
A billing number consists of:
Group registration number, providers registration number, specialty code.
A code that specifies what specialties the physician has.
Represents the diagnosis a client received
How many characters does a billing code consist of?
A billing code consists of:
Prefix, Numberic Component, Suffix
conversing with another professional
Physician converses once again about what to do about a problem
If a doctor wants an opinion on a small thing, usually quick
General Assessment/Complete Examination
Check-up, everything is billed separately
"Take 2 tylenol and call me in the morning"
Preoperative/Pre-dental General Assessment
They will make sure vitals are good so you are stable before surgery.
If a doctor has to travel far to see you.
House Call Assessment
Doctors going to visit patients at homes.
House Call Assessment - Pronouncement of Death
A coroner comes to pronounce the person dead.
Pronouncement of Death - Intermediate Assessment
When they don't expect to pronounce someone dead; anywhere except home and hospital.
Intermediate or Regional Assessment/Limited Visit
"I think my kid has lice" - "Yes, he has lice."
Well Baby Visits
There are certain things by law in which the doctor must discuss with you.
Annual Health/Physical Exam (child)
On their 3rd visit/year
Parental Visit - Initial Assessment
Asked a lot of questions to know what the baby will be like.
Routine Parental Visits
Very quick, measures stomach
Decidingto have your first child
Talking, billed each 15 minutes with a max of 2 hours, but extra billing codes may be added
Indicates a range of reasons why the claim has been rejected.
Fewer than 1% use this
Machien readable input/output
Info that can be read by a computer
Tape Cartrige / disc
Must be physically couriered to sites, time consuming.
Similar to email
Claim deadlines in Ontario are:
At the end of each month
First step of preparing a claim:
Software Billing Options:
Day Sheet (spreadsheet of patients), Billing (software that submits for you), Electronic Records (paperless system)
Typical claims within your province/territory
Out of province patients
Also billed to the ministry
Describes electronic health information
Canada Health Infoway
A government funded organization focused on developing electronic health records
Any information pertaining to an individual's physical or mental health
Health Information Custodian
Person responsible for managing health information
Continuity of Care
Knowing a client's medical history, treatments, allergies, etc.
Electronic Medical Record
Legal health record in digital format
Electronic Health Record
Accumulation of essential information from an individual's EMR
Reportable diseases, suspected abuse in children, etc.
Up to physician to decide what he shares with a minor and parents
The Privacy Act
Within federal government, rules & policies, individuals have the right to any information they have about them
Personal Information Protection and Electronic Documents Act (PIPEDA)
Shows how organizations within the private sector and collect, use and disclose personal information
10 Principles of PIPEDA:
- Privacy Information Officer
- must inform clients
- must be obtained
Limiting Collection of Personal Info
: a link between why and what we collect must be present
5. Limiting Use, Disclosure and Retention
: Only use what is needed and destroy what is not.
: info should be accurate
: must ensure info is safe
: policies are available to clients
9. Individual Access
: client has right to access their info
10. Challenging Compliance
: process to handle complaints
Paper charts must be kept in Ontario for ___ years.
Records of minors must be kept until ___ years after they reach age of majority.