Group 3 CIS214

16 March 2012

New Century Health Clinic Presentation on Project Management

Group 3: Ryan Ormsby, Blake Randolph, Alice Renegar, Jeremy Rood

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

Group 3 CIS214 | TC3

2

Assignments

1. P r e p a r e a c o n t e x t d i a g r a m f o r N e w C e n t u r y ’ s i n f o r m a t i o n

s y s t e m

Ryan Ormsby

2. P r e p a r e a d i a g r a m 0 D F D f o r N e w C e n t u r y . B e s u r e t o s h o w

n u m b e r e d p r o c e s s e s f o r h a n d l i n g a p p o i n t m e n t p r o c e s s i n g , p a y m e n t a n d i n s u r a n c e p r o c e s s i n g , r e p o r t p r o c e s s i n g , a n d r e c o r d s m a i n t e n a n c e . A l s o , p r e p a r e l o w e r - l e v e l D F D s f o r e a c h n u m b e r e d p r o c e s s .

Jeremy Rood

3. P r e p a r e a l i s t o f d a t a s t o r e s a n d d a t a f l o w s n e e d e d f o r t h e

s y s t e m . U n d e r e a c h d a t a s t o r e , l i s t t h e d a t a e l e m e n t s r e q u i r e d .

Alice Renegar

4. P r e p a r e a d a t a d i c t i o n a r y e n t r y a n d p r o c e s s d e s c r i p t i o n f o r o n e

NEW CENTURY HEALTH CLINIC

New Century Health Clinic offers preventive medicine and traditional medical care. In your

role as an IT consultant, you will help New Century develop a new information system.

Background You began t h e s y s t e m s a n a l y s i s p h a s e a t N e w C e n t u r y

H e a l t h C l i n i c b y c o m p l e t i n g a s e r i e s o f i n t e r v i e w s , r e v i e w i n g e x i s t i n g r e p o r t s , a n d o b s e r v i n g o f f i c e o p e r a t i o n s . ( Y o u r i n s t r u c t o r m a y p r o v i d e y o u w i t h a s a m p l e s e t o f i n t e r v i e w s u m m a r i e s . ) As you learned , t h e d o c t o r s , n u r s e s , a n d p h y s i c a l t h e r a p i s t s

p r o v i d e s e r v i c e s a n d p e r f o r m v a r i o u s m e d i c a l p r o c e d u r e s . A l l p r o c e d u r e s a r e c o d e d a c c o r d i n g t o C u r r e n t P r o c e d u r e T e r m i n o l o g y , w h i c h i s p u b l i s h e d b y t h e A m e r i c a n M e d i c a l A s s o c i a t i o n . T h e p r o c e d u r e c o d e s c o n s i s t o f f i v e n u m e r i c d i g i t s a n d a t w o - d i g i t s u f f i x , a n d a r e u s e d f o r a l l b i l l i n g a n d i n s u r a n c e c l a i m s . From your fact-finding, y o u d e t e r m i n e d t h a t s e v e n r e p o r t s a r e r e q u i r e d a t t h e c l i n i c . T h e f i r s t r e p o r t i s t h e d a i l y a p p o i n t m e n t l i s t f o r e a c h p r o v i d e r . T h e l i s t s h o w s a l l s c h e d u l e d a p p o i n t m e n t t i m e s , p a t i e n t n a m e s , a n d s e r v i c e s t o b e p e r f o r m e d , i n c l u d i n g t h e p r o c e d u r e c o d e a n d d e s c r i p t i o n . A s e c o n d d a i l y r e p o r t i s t h e c a l l l i s t , w h i c h s h o w s t h e p a t i e n t s w h o a r e t o b e r e m i n d e d o f t h e i r n e x t d a y ’ s a p p o i n t m e n t s . T h e c a l l l i s t i n c l u d e s t h e p a t i e n t n a m e , t e l e p h o n e n u m b e r , a p p o i n t m e n t t i m e , a n d p r o v i d e r n a m e . T h e t h i r d r e p o r t i s t h e w e e k l y p r o v i d e r r e p o r t t h a t l i s t s e a c h o f t h e p r o v i d e r s a n d t h e w e e k l y c h a r g e s g e n e r a t e d , p l u s a m o n t h - t o - d a t e ( M T D ) a n d a y e a r - t o - d a t e ( Y T D ) s u m m a r y . The fourth report is the statement — a p r e p r i n t e d f o r m t h a t i s

p r o d u c e d m o n t h l y a n d m a i l e d i n a w i n d o w e n v e l o p e . S t a t e m e n t h e a d e r i n f o r m a t i o n i n c l u d e s t h e s t a t e m e n t d a t e , h e a d o f h o u s e h o l d n a m e a n d a d d r e s s , t h e p r e v i o u s

Ryan Ormsby Question one

1. Prepare a context diagram for New Century’s information system.

Includes: Scheduled Appointment times, Includes: Reminders for next day appointments, Patient Names, Services Performed, Patient name, telephone number, appointment Procedure Code and Description. time and provider name. Includes: Each of the providers, and Weekly charges generated. Plus a month to date And year to date summaries. Preprinted form that is produced monthly

And mailed in a window envelope. Top section: Statement Header Info. Includes: the

Date, Head of household name and address, month balance, total household charges MTD, total payments MTD, and current balance. Bottom section includes: all activity in past month. Shows each service performed: an activity line shows the patient name, date, procedure code and description and the charge. Also shows all dates and amounts of payments and insurance claims. When an insurance payment is received, the source and amount are noted on the form. If a claim is only partially paid or denied, a code is used to explain the reasoning. A balance records at the far right of each activity line.

New Century Health Clinic

-information system-

Report 1: Daily

Appointment List

Report 2: Call List

Report 3: Weekly

Provider Report

Report 4: The Statement

Report 5: Weekly Insurance

Company Report

Report 6: Monthly

Claim Status Summary

Report 7: Reminders

to Patients

Reports 5 and 6 get

there information

from that patients

and businesses

statements.

Includes: Mailing labels, computer

generated postcards. Usually they

are mailed twice a month.

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

[Type text]

Page 1

March 16, 2012Clinic Context Diagram

0

Clinic System

Patient Provider

Insurance Company

Office Staff

Request Appointment

Appointment Reminder

Monthly Statement

Payment

Appointment List

Provider Report

Mailing Labels

Insurance Payment

Claim Decision

Insurance Reports

Submit Claim

Verify Patient Info

Jeremy Rood

Question 2 Prepa re a diag ram 0 DF D f or New Cent ury . Be s ure to sh ow n umbe red processes fo r handl ing a ppoint men t processin g, pay ment an d in surance processing , repo rt p rocess ing, and rec ord s mainte nance . Also, p repa re lower -level DF Ds fo r e ach nu mbe red process.

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

[Type text]

Page 2

March 16, 2012Clinic DFD 0

1

Create AppointmentPatient

Request Appointment

Office Staff

Verify Information

Appointment Details

Patient Info

Appointment Reminder

2

PaymentSubsystem

Insurance Company

Provider

Appointment List

Provider Report

Payment

Insurance Payment

Claim Decision

Submit Claim

Monthly Statement

D3 | Accounts Receivable

Invoice

3

Report Processing

4

Records Maintenance

Insurance Reports

D1 | Appointments

Update Appointments

D2 | Patients

Update Patient

Info

D4 | Insurance Data

Update Insurance Info

Mailing Labels

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

Group 3 CIS214 | TC3

6

Page 3

March 16, 2012Clinic DFD 2

2.1

Patient Payment

Payment

D3 | Accounts Receivable

2.2

Insurance Payment

MTD Payments

MTD Payments

Insurance Company

Insurance Payment

D5 | Claim Data

2.3

Claim Processing

Claim Decision

Update Claim Data

D6 | Payment Records

Update Payment Info

Update Payment Info

Jeremy Rood

Question 2 Prepa re a diag ram 0 DF D f or New Centu ry . Be su re to show n umbe red processes f or ha ndl ing app ointme nt processin g, pay ment an d in surance processin g, rep ort p rocessi ng, an d records mainte nance . Also, p repa re lower-level DF Ds fo r e ach nu mbere d process .

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

Group 3 CIS214 | TC3

7

Alice Renegar

Question 3 Prepa re a l i st o f data s tores a nd dat a f lows n eeded fo r the sy stem. Unde r e ach dat a s tore, l i st t he dat a e le ments require d Data Store::Patients

Input Flow :: Scheduling Information Time/Date Provider Notes

Input Flow :: Provider Notes Provider Notes

AMA code Service description

Diagnosis codes Input Flow :: Office Notes

Cancellations Payments Outstanding bills Insurance Status Claim Status

Input Flow :: Payment Notes Amount Paid

Insurance covered portion Length of time overdue

Output Flow :: Daily Appointments List Patient Name Services Required

Output Flow :: Daily Call List Patient name

Patent telephone

Output Flow :: Monthly Patient Statement Head of household

Address Patient Name

Service Date AMA Code

Description Monthly Activity

Diagnosis codes Output Flow :: Weekly Insurance Company Report

Patient name Services required

Diagnosis code Service Code

Output Flow :: Monthly Claim Status Summery Patient Name Service Code

Diagnosis code if applicable

Output Flow :: Appointment Reminders Patient Name Patient Address

Data Store :: Appointments

Input Flow :: Scheduling Changes Cancellation date

No show date

Input Flow :: New Appointments Date

Provider Patient name

notes Input Flow :: Patient loss/gain

name address preferences w/r/t appt. notifications

Output Flow :: Daily Appointment List Appointment Time

Output Flow :: Daily Call List Appointment date/time

Output Flow :: Monthly Patient Statement Appointment Date

Output Flow :: Weekly Insurance Company Report

Appointment Date

Output Flow :: Monthly Claim Status Summery Appointment Date

Output Flow :: Appointment Reminders Appointment Date/time

Data Store :: AMA codes

Input Flow :: AMA Report Input Flow :: Get Code

Procedure Description

Output Flow :: Give Code AMA Code

Data Store :: Providers Input Flow :: HR

SSN Name

Address Telephone

Pay Rate

Input Flow :: Appointments Schedule Notes

Input Flow :: Patients Patient History Patient diagnosis Patient Name

Input Flow :: Billing Charges generated

Output Flow :: Daily Appointments List Provider Name

Output Flow :: Daily Call List Provider Name

Output Flow :: Weekly Provider Report Provider Name Charges generated by provider WTD

Charges generated by provider MTD Charges generated by provider YTD

Output Flow :: Weekly Insurance Company Report

Provider Name Provider Code

Services performed Service Code

Diagnosis code if applicable

Output Flow :: Monthly Claim Status Summery Provider Name Provider Code

Services performed Service Code

Diagnosis code if applicable

Output Flow :: Appointment Reminders Provider Name

Data Store :: Billing

Input Flow :: Services Provided Provider Name

Service Code Date

Input Flow :: Payments received from patient Payment received

date

Input Flow :: Insurance claim status Payment received

Claim Status Date

Output Flow :: Weekly Provider Report Charges generated by provider WTD

Charges generated by provider MTD Charges generated by provider YTD

Output Flow :: Weekly Insurance Company Report

Service Cost Adjusted Cost

Output Flow :: Monthly Claim Status Summery Services paid for by Insurance

Outstanding amounts Output Flow :: Monthly Patient Statement

Previous month’s balance

Household charges MTD Household payments MTD

Current Balance MTD All payments All insurance payments Monthly charges by service

Data Store :: Reports

Input Flow :: Daily Appointment List Report Copy

Input Flow :: Daily Call List Report Copy

Input Flow :: Monthly Patient Statement Report Copy Date Sent

Input Flow :: Weekly Provider Report Report Copy

Input Flow :: Weekly Insurance Company Report Report Copy Date Sent

Input Flow :: Monthly Claim Status Summery Report Copy Date Sent

Input Flow :: Appointment Reminders Patient/household list Appointment List Date Sent

Output Flow :: Past Report Lookup Report (Various) Report Date/Time produced

Data Store :: Insurance Claims Output Flow :: Service Provided

AMA Code Date

Diagnosis Code

Output Flow :: Insurance billing Prev. Claim Number

Output Flow :: Monthly Patient Statement Date Amount paid Amount outstanding Adjustments Claim status Payment amount

Output Flow :: Weekly Insurance Company Report

Amount Paid Outstanding

Service Codes Service Dates Claim Codes

Output Flow :: Monthly Claim Status Summery Amount Paid

Outstanding Service Codes Service Dates Claim Codes

Output Flow :: Billing Co-pay

Patient responsibility Amount paid Amount outstanding Adjustments

Data Store :: Insurance Carriers

Output Flow Insurance billing Carrier name

Group code Ind. Code

Date active Provider/employer Through/Card owner Ins address Ins Phone co-pay

Output Flow :: Monthly Patient Statement Carrier Name

Group Name

Output Flow :: Weekly Insurance Company Report

Carrier name

Group code Ind. Code

Date active

Provider/employer Through/Card owner Ins Address Ins Phone

Output Flow :: Monthly Claim Status Summery Carrier name Group code

Ind. Code Date active

Provider/employer Through/Card owner Ins Address Ins Phone

Output Flow :: Billing Co-pay

Patient responsibility

Project Name: NEW CENTURY HEALTH CLINIC Group Number: 3

Systems Planning / Chapter Number: 5

Group 3 CIS214 | TC3

Blake Randolph

Question 4 Prepa re a dat a dict iona ry e nt ry and process desc ription fo r o ne of t he s ystem ’s func tional pri mitives.