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1. Current Medications The Current Medications Tab is a primary work area for daily use By default this nested Tab works in conjunction with Medication History to provide a temporal log of medication actions Whenever Current Medications is updated for a patient a log entry is posted in Medication History reflecting the date and action taken Data Entry Example 1 A patient with no prior medication entry is determined to require use of an antidepressant Click on the Change Current Medication button An Update window will appear Adjust the date if necessary and select START from the popup Type in the medication name the starting dose and then ACCEPT A Current Medication entry is recorded and in the same action a corresponding Medication History entry is created Data Entry Example 2 Two weeks later the same patient needs a dose increase Click the Change Current Medication button and the same Update window appears Adjust the date if necessary select Increase from the popup select the previously entered medication from the popup and enter the corrected dose Accept these entries and observe the changes in Current Medications but also the posting of a corresponding Medication History log entry This type of chronological Medication History will provide instant answers months or years later when a change in treatment strategy 1s being reviewed Prescriptions The Prescriptions nested Tab is both the review and entry point for prescription2. 04001 SAMPLE sample David R Insurance Data 23456 Roosevelt S tem s 2004001 206 46 907 wa Gi ome 2055459807 orl DOB 04 12 1957 DIAGNOSIS 296 32 Ursa ue 000 ome ALLERGIES Penicillin NEW PATIENT Rite Aid 206 543 6754 Fluoxetine 20mg DELETE PATIENT SELECT PATIENT Allergy c desktop p3 2005 development p3 2005 dbfs allergy dbf Record 1 1 Exclusive 16 SAMPLE DavidR 2004001 SAMPLE Sample David R SAMPLE David R 2004001 Spouse Auto LJ H 206 546 9807 Date First Seen 05 01 2004 DOB 04 12 1957 5 his 11 04 01 2004 DIAGNOSIS 296 32 Oe a LAST BALANCE 0 00 See eee be ALLERGIES Penicillin Insurance Diagnosi 296 32 Rite Aid 206 543 6754 qm Verear MD Set None of thes SELECT PATIENT Allergy c desktop p3 2005 development p3 2005 dbfs allergy dbf Record 1 1 Exclusive 17 Ele Edit Utilities Forms Lists SAMPLE David R 2004001 SAMPLE Sample David R Patient Data Sete HCFA Data mary Insurance 4 Secondary Insurance V ING PRIMARY INSURANCE Regence Blue Shield X SAMPLE David R 2004001 H 206 546 9807 DOB 04 12 1957 nsurance ID Number 2 3456789087 DIAGNOSIS 296 32 LAST BALANCE 0 00 G ip Numbe 234557 Rite Aid 206 543 6754 Fluoxetine 20mg SELECT PATIENT A
3. 05 dbfs tee dbf Record 1 10 Exclusive INSURANCE COMPANY SETUP Mutual of Omaha MIL of Omaha Premera Blue Cross Regence Blue Shield Uniform Medical Plan SAMPL amp PX DEL SET cix Exclusive File Edit Utilities Forms Lists Last Billed Balance eame __ Last Balance Example Ptpick c desktop p3 2005 development p3 2005 dbfs patient dbf Record 1 2 Exclusive Other Menu Items GO TO Menu File Select Patient CTRL P Creates keyboard shortcut CTRL P Has the same function as clicking on the SELECT PATIENT button Highlights the Record Locator box to receive last name of desired patient GO TO Menu File Quit CTRL Q To Quit P3 2005 GO TO Menu Edit Undo Sometimes reverses the last action taken depending on context Cut Copy Paste for moving text Find only operates within a Browse List GO TO Menu Utilities Reindex useful in the event of a corrupted index Print Return Labels Clinician Return Address Labels WORK AREAS NESTED TABS Chart Notes The Chart Notes Tab is divided into nested Tabs for Progress Notes and the Initial Evaluation Notes may be both entered and reviewed in this location Although there is only one Initial Evaluation allotted to a patient a patient may have an unlimited number of Progress Notes To review existing Progress Notes place the cursor in the table to the right and move forward and backward in time by using the a
4. 2008001 In rare circumstances the user may wish to override the assigned number although safety features have been designed to prevent accidental reassignment GETTING STARTED The first step in preparing to use P3 2005 involves customizing the program to certain preferences designated by the clinician user These customizations involve 1 Enter clinician name and address Select File Clinician Setup from the System Menu and overwrite the data with your information 2 Set up a standard fee schedule This fee data should represent your regular and normal charges for specific CPT codes Later it will be possible to create patient specific customized fees but at this point it speeds data entry to have a standard set Select File Standard Fee Setup from the System Menu If the CPT codes descriptions and fees shown are not useful feel free to delete or overwrite these and replace them with your preferred data It will be useful to organize these codes from top to bottom in the order of most frequently used codes Later program operation automates data entry using the order of these codes that are set up today 3 Set up the Insurance Companies with whom you conduct billing operations Select File Insurance Company Setup and add or delete companies according to your preferences You will need the Insurance Company name and mailing address for this set up This table will make it easy to update patient records should an insurance company c
5. GIES NONE LISTED v Rite Aid 206 543 6754 gi SELECT PATIENT Medhist c desktop p3 2005 development p3 2005 dbfs medhist db Record 1 1 Exclusive NUM 13 Eile Edit Utilities Forms Lists SAMPLE David R 2004001 DER SAMPLE li CHART NOTES MEDICATIONS REGISTRATION FINANCES QUICK ENTRY Sample David R Bly Sear Current Meds Medication Histony Allergies Medication Allergies SAMPLE David R H 205 545 9807 DOB 04 12 1957 DIAGNOSIS 296 32 LAST BALANCE 0 00 ALLERGIES Penicillin Rite Aid 206 543 6754 Fluoxetine 20mg qAM DELETE SELECT PATIENT Selected 1 record in 0 00 seconds NUM Registration The Registration Tab is divided into the Patient Data Tab and Insurance Data Tab non clinical information relating to the patient such as address phone contacts date of birth and particulars of the insurance circumstances are recorded in these sections Insurance Data can be further subdivided into HCFA Data Primary Insurance and Secondary Insurance Data Entry Example 3 Registering a new patient is quite easy and can be accomplished at the time of the patient s first visit or by telephone prior to the first visit Go to Registration Patient Data and click New Patient unique sequential patient ID is created and the cursor enters the Last Name field Enter the last name and press the tab key Enter the first name an
6. P 3 Private Psychiatric Practice 2005 Independent Psychiatric Services Seattle Washington 206 328 5135 Developed by Richard T Adamson M D P 3 2005 is a database application created with the Microsoft Visual FoxPro design system and provides the practicing mental health clinician with a reliable efficient mechanism for record keeping and billing Program enhancements allow the user to select from a variety of data input viewing and reporting styles so as to match personal tastes and preferences Backed by accessible support and training a substantial group of clinicians including psychiatrists psychologists counselors and nurse practitioners use P3 on a daily basis to run their practices and have reported stability and data integrity for over a decade KEY FEATURES Centralized Patient Chart Patient contact can be fully managed without a paper file Quick Entry Create a Progress Note Template and Charge in a Single Action Rapid Entry of Insurance Vouchers Automated Patient Registration Assigns the critically important Patient ID Customizable Fee Schedule Track Prescriptions Medication History and Currently Used Medications Print HCFA 1500 statements as well as patient statements with automatic posting of Balances forward to the next billing interval INSTALLATION The Installation CD ROM has been configured for Autorun Activation in Windows XP 1 2 3 4 Insert CD into Drive Wait for Autorun Sta
7. d continue tabbing to complete the form The Patient Data screen is also used to set up a customized fee schedule for this particular patient Click the Custom option under Fee Structure and make changes to the table presented This option must be checked for the customized fee structure to remain in effect during later data entry Any time there is a desire to revert to a standard fee structure for this patient simply select the Standard option under Fee Structure In a similar way there is an option to provide a temporary mailing address for the patient by selecting the Alternate Addressing option The mailing address entered in this way will override the primary patient address in printing patient statements as long as this option is checked When the 14 patient returns to the primary address simply uncheck Alternate and resume the Standard Addressing option The text area labeled Additional Notes is a useful entry point for important reminders or information with no other logical location When the patient is later selected through the Record Locator box the Additional Notes information will appear with the Navigation Bar for ready refernce Data Entry Example 4 A new patient is registered into the program and wants to make use of an insurance company with whom there is an existing billing relationship This insurance company has been entered into the system during customization of Insurance Company Setup To enter insurance information for thi
8. hange its mailing address in the future In that event the address data only needs to be changed once rather than for every patient with this particular insurance 4 Enter Existing Patients into the system GO TO Patient Chart Registration a Gather existing records with name address insurance information and last Balance for the patient b Click New Patient button and enter data into the blank record When all existing patients have been entered GO TO Menu File Lists For Patients Listed by Last Balance and enter the last prior Balance for each patient seen in the scrolling list this is a one time task For previously unbilled patients this task is handled automatically Clinician Registration 4 lam 4020 E Madison Street Suite 210 State 5 Seattle en 206 328 5135 206 328 7761 SSN or EIN 92 980765 Standard Fee Structure CPTCode Fee Description E 150 00 IndividualPsychotherapy 90807 150 00 IndivPsychobi wMed 90805 1 100 00 IndivPsychob wMed 90801 195 00 Interview mappt 150 00 missed Appointment 90804 10000 ndivPsychob 30mim __ 90853 50 00 Group Psychotherapy 90847 160 00 Conjoint Psychotherapy phone 2500 PhoneConsultation ADD STANDARD FEE DELETE STANDARD FEE SAMPL 2 X Fee c rick desktop p3 2005 development p3 20
9. he Finances Section 2 Select Insurance Claims 3 Ensure the correct patient has been located in the Chart 4 Select Single Insurance Claim 5 Enter Billing Interval Dates 6 Preview or Print Single HCFA Quick Entry this information coming 20
10. information Click New and a New Prescription window appears Enter the prescription information and then Accept Note that Unit Size is presumed to be in milligrams and is entered as a numeric without units After entering Unit Size Number Prescribed Refills and Mg day the system calculates the Number of Days Supply and the Due Date of the next prescription This calculated Next Due date is a useful tool in determining medication compliance at subsequent prescription encounters A significant time saving feature in this section involves use of the Repeat This Prescription checkbox If a refill of a prior prescription is being duplicated select the desired prescription in the table and then check the Repeat This Prescription option An exact copy of the selected prescription is posted substituting the current date and calculating a new Next Due date a useful feature for determining the date of the next appointment for the patient This feature can be used and then edited for minor changes such as number of refills authorized significantly shortening the time need to reenter similar data Medication History Usually data will be recorded in this section through its association with the Current Medications Tab If needed an entry or deletion can occur here and will not be mirrored in other sections of the program Allergies Medication allergies should be recorded here Click the New button and then highlight the entry text replacing that
11. lect Form Type 6 Enter Billing Interval Dates T Preview or Print Batch Statements Internal calculations are performed during the printing process A Posting Screen will appear but do not Post Balances until you have examined the paper statements for accuracy When satisfied that the statements reflect the expected data click Post Balances and all Prior Balances will be updated for the next billing cycle Single Printing Patient Statements To ensure internal accounting accuracy Single Patient Statements are available only as a reprinting from a prior Batch Printed Interval It is not possible to print a single statement covering dates of service that are not part of a prior Batch 1 Select Perform Billing within the Finances Section 2 Select Patient Statements 3 Ensure the correct patient has been located in the Chart 4 Select Single Patient Statement 5 Select Form Type 6 Select the Closing Date for the previous Interval from the popup 7 Preview or Print the single archival statement Batch Printing HCFA 1500 Claims 1 Select Perform Billing within the Finances Section 2 Select Insurance Claims 3 Select Batch Insurance Processing 4 Enter Billing Interval Dates 5 Preview or Print Batch HCFA Claims 19 HCFA 1500 claims which do not depend on a prior Balance may be printed in batch or singly at any time for any billing interval Single Printing HCFA Insurance Claims 1 Select Perform Billing within t
12. llergy c desktop p3 2005 development p3 2005 dbfs alleray dbf Record 1 1 Exclusive NUM Finances Transactions this information coming Patient Statements this information coming Perform Billing P3 is designed to be used with a CASH ACCOUNTING system which is of the BALANCE FORWARD type The program accumulates charges and payments for a monthly billing interval Each month a new Balance is calculated as a running total of charges payments refunds and adjustments applied to the previous month s ending Balance This new Balance is presented to the patient in the form of a monthly statement Patient Statements These are the paper statements given or mailed to patients at the end of each month They have been designed to include all information a private insurer requires for processing a claim Such items as clinician name address tax ID number and patient information such as diagnosis dates of service CPT codes and charges are included Two templates for the 18 patient statement are available within the program Additional customized forms are available by request HCFA 1500 Statements These are the standardized claim forms used universally by all insurance companies and must be purchased Batch Printing Patient Statements 1 Complete and verify accuracy of entered financial transactions 2 Select Perform Billing within the Finances Section 3 Select Patient Statements 4 Select Batch Printing 5 Se
13. or Balance current charges current payments whether by insurance or out of pocket current refunds and current adjustments The four types of transactions tracked by the program are Charges Payments Adjustments and Refunds Charges and payments are intuitive reflecting the most common actions taken against the Balance However the use of Adjustments and Refunds requires some advance planning In this program all transactions are typically entered as positive numbers and effect the Balance in predictable ways A Charge results in an Increase in the patient Balance A Payment results in a Decrease in the patient Balance An Adjustment when positive results in a Decrease in the patient Balance This transaction is most often used to document a contractual deduction in the standard fee A Refund when positive results in an Increase in the patient Balance This transaction is most often used to document the repayment of a patient when a negative Balance has accumulated due to overpayment by two sources such as the patient and his insurance company Patient ID When a new patient is registered the program assigns a seven 7 digit Patient ID number as the unique identifier for that patient All data is tracked by association to that number The assigned number consists of the year of registration followed by a sequence number ranging from 001 to 999 The first patient registered in a new year e g 2008 would be assigned the number
14. rrow keys With each change in the row of dates the selected Progress Note changes on screen To go to a particular note click its date once with the mouse and that record is selected and displayed To enter a new Progress Note click the New button This action will result in the posting ofa blank Progress Note with the current date inserted Adjust this date and tab key to the CPT Code field and enter the code 90806 90801 etc needed to describe the clinical event Sometimes the event being described is not a typical clinical encounter and is best described with alternatives such as Other Phone or m appt The system recognizes events coded in this way as unusual and while it will submit these events for billing to the patient they are suppressed in HCFA billing to insurance companies In other words only sessions coded with numeric characters may be printed to a HCFA insurance form Tab key again and begin entering the body of the Progress Note To enter an Initial Evaluation go to that work area and click the New button A blank form with the current date is created and may be edited freely to complete the Initial Evaluation Medications The Medications Tab is divided into 4 nested Tabs for Current Medications Prescriptions Medication History and Allergies Considerable time saving features have been included in these sections and will greatly enhance work productivity for those clinicians who regularly prescribe medications
15. rt If CD fails to start Select START MENU RUN and type x setup exe in the box where x drive letter for your CD Drive Follow on screen instructions to install program When program installation is completed you will see the P3 2005 Fox icon on your desktop Double click the Fox to start the program P3 2005 The following image shows the Patient Chart centered on the System Screen Access to program features is through the Menu at the top of the System Screen and through tabbed headings in the Patient Chart By clicking each tab the user can move to specific work areas such as Registration Medications Finances and Chart Notes Tabbing deeper reveals nested tabs that grant access to other associated work areas File Edit Utilities Forms Lists SAMPLE David 2004001 CHART NOTES MEDICATIONS REGISTRATION FINANCES QUICK ENTRY Sample David R Progress Notes DATE CPT CODE 08 17 2005 90806 08 17 2005 The patient was seen in a 90806 session for 08 5 2005 evaluation and treatment of diagnosis 296 32 SAMPLE David a 2004001 07 21 2005 07 14 2005 90807 206 546 9807 05 21 2004 90807 MW 05 14 2004 05 07 2004 DOB 04 12 1957 05 01 2004 90801 DIAGNOSIS 296 32 LAST BALANCE 0 00 ALLERGIES NONE LISTED ____ Rite Aid 206 543 5754 SELECT PATIENT NEW DELETE Progress c p3 2005 dbfs progress dbf Record 14 18 Exclusi
16. s patient go to Registration Insurance Data HCFA Data and complete this form With the patient s insurance card in hand go to Registration Insurance Data Primary Insurance and complete this form This insurance data entry takes less than one minute and is usually completed at the first patient visit A similar process allows for the use ofa Secondary Insurance if there is a desire to bill two companies for each visit Data Entry Example 5 The process differs only slightly if there is a desire to use an insurance company that has not previously been registered within the program If such a situation arises and a decision is made to add this new company to the list of billable insurers first go to File Insurance Company Setup and add the new insurance company usually obtaining the mailing address from the patient s insurance card It is then necessary to close the Patient Chart by clicking the close box in the upper right corner of the window and then go to Forms Recall Patient Chart from the system menu This allows the changes made in the Insurance Company Setup to be reflected in the Registration options under Primary and Secondary Insurance In order to avoid a program error it is necessary to always choose an insurance company from the popup of previously entered companies rather than attempting to type in the name of the new insurer in the box within Registration Insurance Data Primary Insurance 15 SAMPLE DavidR 20
17. text with the name of the offending medication Subsequently this allergy will appear in the Navigation Bar for easy reminder whenever this Patient Chart is called from the Record Locator 10 SAMPLE DavidR 2004001 SAMPLE Sample David R Allergies SAMPLE David R 2004001 H 206 546 9807 G DOB 04 12 1957 DIAGNOSIS 296 32 LAST BALANCE 0 00 ALLERGIES NONE LISTED Rite Aid 206 543 6754 SELECT PATIENT Nmcurmed c desktop p3 2005 development p3 2008 dbfs nmcurm Record 1 1 Exclusive 11 Ele Edit Utilities Forms Lists SAMPLE David R 2004001 SAMPLE Sample David 0771812005 IM SAMPLE David R 0203 2006 Eu escbed Refill 2004001 H 206 546 9807 i enressent Gi MEDICATION DOSE now man noa Due 7 18 2005 Fluoxetine 100 1 020372006 DOB 04 12 1957 DIAGNOSIS 296 32 LAST BALANCE 0 00 ALLERGIES NONE LISTED Rite Aid 206 543 6754 _ _ MM p zi SELECT PATIENT c desktop p3 2005 development p3 2005NdbisNprescrip dERecord 1 1 Exclusive NUM 12 Ele Edit Utilities Forms Lists SAMPLE DavidR 2004001 TAX SAMPLE Sample David R edication New Dose luoxetine 20mg qAM 07 18 2005 SAMPLE David R 2004001 H 206 546 9807 Gi DOB 04 12 1957 DIAGNOSIS 296 32 LAST BALANCE 0 00 ALLER
18. ve CONVENTIONS YOU NEED TO KNOW Although each patient has a unique Patient ID used to collate data the Last Name of the patient is the key to navigating the program The Navigation Bar on the left side of the Patient Chart remains constantly visible while other work areas come and go during program use This allows for easy identification of the currently selected patient and provides access to phone numbers date of birth and diagnosis while performing other work such as telephoning prescriptions Dates are entered using an eight 8 digit format e g 04 06 2003 In most circumstances it will not be necessary to type the slash character Financial numbers requiring direct entry are recorded without a currency sign This occurs primarily with payments adjustments and refunds where odd monetary amounts are encountered Charge data is usually automated and does not require typed entries All transactions are presumed to be in U S currency Patient Accounts are maintained with a cumulative Balance that reflects all unpaid charges Balances are updated each billing cycle based on the total of charges payments adjustments and refunds recorded for the patient during that billing interval Unpaid Balances during any given month are carried forward and appear as a Prior Balance on the billing statement issued the following month Program screens and printed patient statements make it possible to determine at a glance the patient s pri
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