Copay Collections
Primary Key: Patient ID/name
|
Medicaid or Insurance?
|
Payment history of patient?
|
629962
|
Insurance
|
No Balance
|
906978
|
Medicaid
|
Remaining Balance of $400
|
298730
|
Insurance
|
Remaining Balance of $50
|
Wait Time
Primary Key: Check in/out kiosk status
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Time when the patient checked in?
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What time did they get roomed?
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What time the patient checked out?
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Working
|
7:13am
|
7:20am
|
7:35am
|
Working
|
3:33pm
|
3:36pm
|
3:47pm
|
Working
|
5:00pm
|
5:10pm
|
5:27pm
|
No Show Rates
Primary Key: Patient ID Number
|
When the appointment was made?
|
Who made the appointment?
|
Number of no-shows
|
629962
|
2 months prior
|
Mom of patient
|
0
|
906978
|
1 week prior
|
self
|
3
|
298730
|
Day of appointment
|
self
|
7
|
Relationships
KEY:
Relationship Types:
One-One Relationships: Time of Check-in, Time of Rooming, Time of Check-out, When the appointment was made
One-Many Relationship: Payment history of patient, Insurance, Who is making the appointment, How many no-shows
Each of these processes are very important. Copay collections relates to the patient ID/name because each person’s information is retrieved through this patient ID and then via their name. All personal information about the individual is found through this special ID number which is unique to each individual. It relates to medicaid and insurance because that could depend on whether they need to pay a copay or how much their copay is. Typically medicaid patients do not have a copay or a very small fee, while insurance ranges from $20 each visit to a certain percentage of your total bill, which means on site you would pay nothing while later on you may get a bill for 20% of your total bill. Typically one patient can have 2 insurances (primary and secondary). Payment history of patient shows whether you actually have paid your bills on time previously which shows whether you have been a reliable patient in relation to paying bills. It is key to whether you need to enforce strict payment with the individual, or attempt to get them to set up a payment plan, or in extreme cases remind them that they may be sent to collections. They each relate to each other because all of this is a balance determining how to precisely collect the copay as an employee, and how effective and efficient these things are. Efficiency is the ratio of benefits to costs (Kroenke, 2015, pp. 382). Effective business processes are whether the company is enabled to accomplish its strategy (Kroenke, 2015, pp. 383). There is a one-to-many relationship to history as well because you may have been seen a lot.
Wait time is also something important to the company because individuals are busy and do not have the time to wait, they want to see a physician/nurse practitioner and be on their way out. Wait time is like a check for the company to see if they are providing what each individual needs in a sufficient amount of time. They use the check in and check out kiosk because it is the quickest way to check in because then they do not have to wait on an employee to come and check them in, unless they need help of course. The kiosk helps track what time they arrived at the office, and also what time they are placed in the room, so that we precisely know when they are being seen in the office, with the exact wait time that was requested. Of course then they can check out at the kiosk or with an individual (if another appointment is needed. Therefore the whole appointment is tracked based on time and each person is only allowed so many minutes for their appointment. They are all connected because wait time is a huge factor on whether people continue coming to the office for their needs or whether they take them elsewhere, it also tells the office how efficient they are being with all procedures happening in the office. These are all one-to-one relationships because one individual with one check out time with one entering a room time with one check out time.
No show rates are also a big problem is offices across the U.S. because if a patient does not cancel and just doesn’t show, then it is a wasted appointment slot and therefore money is not coming in. No show rates also start with a patient ID number because that is how they look at previous information about a patient. When scheduling an appointment they can retrieve how many no shows they have previously had which can determine whether they are given an appointment time where they’re really squeezing you in or whether you must wait until a full time slot is available. When the appointment was made is important because if you make it within 24 hours you may not get a reminder text, call, email, etc. This is important because while you should remember it, life is busy and if you have a lot of kids, or are caring for someone else then sometimes things just happen and you forget that you should call and cancel etc. Also if it was made a long time ago and you don’t check your phone or your email (which you probably should), you may just forget and not come to your appointment. This can be a one to many because one person can have many no shows within a given time. Who made the appointment, it can vary who makes appointments, a mother for a teenager, a husband for a wife etc. So if you fall into that situation you may be unaware that you have an appointment so it is important to look back at the call log and see who made the appointment when putting information in the system about no show appointments. This can be a one to many as well because one person could have several people making appointments for them, especially based on how sick they are etc. Number of no-shows is a one to many relationship because one individual can have many no-shows in total over time.
References
Kroenke, D. M. (2015). MIS essentials. New York, NY: Pearson Education.
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