One of the big challenges in running a successful medical practice is the management of all encounter details. This includes procedures, claims, charges and payments. The TreFre Medical(TFM) tool divides the problem into manageable pieces by providing the mechanisms for documenting, transmitting, tracking, receiving payments, and generating reports for all financial transactions. The following sections of this document briefly describe the how TFM has organized this problem.
A patient has a contract with an insurance provider. That contract specifies the amount of money a provider can collect at the time a patient receives care. The amount collected, called the co-pay, is entered into the Patient Account. The isn't directly associated with an encounter because the co-pay is the amount the payer has identified as the amount the provider can collect at the time of the encounter. The exact amount of the co-pay is reported on the EOP for this encounter. TFM automatically debits the patient account the co-pay the payer specifies in an EOP. Therefore, the Patient Account balance refers to the patient's current balance. For full details read the next chapter.
The Encounter is an event where the patient meets with a care-giver (e.g. a doctor). At the encounter the doctor performs one or more procedures. The encounter is a billable event that may require the patient to make an immediate payment of all or part of the cost of the procedures. If the patient is covered by insurance then a claim must be made to the insurance company for payment of the procedures.
The encounter is a billable event that has a procedure code that identifies the kind of interaction that has occurred. During the encounter, the doctor discusses the patient's condition. Base on that discussion the doctor may perform additional procedures to help diagnose the patient's condition and/or performs the necessary procedures to help the patient.
Each of the procedures, discussed above, has a unique identifier called a Current Procedural Terminology code or CPT code. The medical practice establishes the charge for each procedure and each procedure has one or more associated diagnostic codes. Diagnoses are identified by an International Classification of Diseases 9th revision (ICD-9) code.
Because an encounter is a billable event the patient might be responsible for paying for all or part of the encounter. TFM manages an account for all patients. The patient account tracks several different transactions that occur.
Because an encounter is a billable event the patient is responsible for paying for the encounter. The patient might have insurance or payer that will pay a portion of the cost of the encounter. TFM records a claim each time a payer is notified of an encounter.
TFM provides a couple of the mechanisms for informing the payer that an encounter has occurred.
After a claim has been filed with a payer, the payer will send a payment with an Explanation of Payment (EOP). TFM records the payment details like the payer name, date, amount, check number and type of payment. This information is then used to produce summary reports for a payer. TFM also records each of the procedure payments that are covered with by this payment. Individual procedure payments are automatically applied to encounters.
Daily management of a business is a time consuming activity. TFM provides several reports that help by producing daily, weekly, monthly reports of patient payments and payer payments.
Managing a business and keeping it profitable is difficult. A well managed business will constantly monitor the state of the business to make sure that goals are being achieved, to ensure all payers are making their payments, to discover if it is still cost effective to continue business relationships with payers and many others questions.
It is difficult to answer questions like these without the proper analysis tools. Using a powerful tool, like TFM to record all transactions, allows TFM to provide simple mechanisms to generate several reports to help in the analysis.