Basic Terminology

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This is for the beginning SSI® user and assumes you have no prior computer experience.

There are five key facts to remember if you are a new user:

 

•If you learned to type many years ago, you were taught to use the letter "el" (l) in the place of the number one (1). This program distinguishes between the letter and the number; the letter "el" (l) cannot substitute for the number one (1).
•You cannot use the letter "oh" (O) to represent the number zero (0), the program distinguishes between the letter and the number.
•Whenever you have completed entering your answer to a question (filling information into a field) you must press [Tab]. See the brackets around the word "enter" and "return"? These brackets mean that you should press a key on your keyboard called an "enter" or "return" key; you are not typing in the word enter or return.
•There are three keys on your keyboard (Shift, Alt, and Ctrl) which you will use in conjunction with other keys. For example, you may be asked to press [Ctrl+W]. For these keys, you must hold down the [CTRL] key while you press [W] key.
•You should be in Caps Lock and Num Lock when using SSI. To produce a lowercase letter without removing [CAPS LOCK], just hold down the [SHIFT] key while pressing the letter. If you type on the numeric keypad (usually located on the right side of your keyboard) and you do not see numbers appearing on the screen, you need to press the [Num Lock] button to activate the number key pad.

 

Previously the government agency that administered the Medicare and Medicaid programs was named "The Health Care Financing Administration" or HCFA

 

Now it is named "Center for Medicare and Medicaid Services" - CMS

 

If you see HCFA in this or other documents, it probably is the same as CMS

 

 

Other

In the program you will see references to various database table records (computer disks/folders/directories). This may be a foreign concept to you. Think if it as drawers or shelves or paper folders in a filing cabinet where you can put information in an organized/sorted manner so you can retrieve it quickly. You may have paper folders now where you keep patient charts, accounts payable receipts, etc.

 

For example:

 

1. You can put patients in the 'patients file folder'

2. You can put charges and payments in the 'transaction folder'

 

Some other references may not be quite so straight forward, but we have to call them something. We have defaulted to terminology that you can see in programming specifications that the government publishes. These specs are used by Stratford to publish software that will produce reports and files that are accepted by payers. This enables our clients to be paid for the services they provide to patients.

 

For example, we use 'Laboratories' in various screens. Depending on what you think a 'Laboratory' is, we may not mean exactly what you think. Yes, we think a 'Laboratory' does lab tests such as an SMA24, CBC, etc, but more than that we think of it as a separate company or entity, unrelated to the provider that provides services that the patient receives, possibly because the provider orders it. So, if you get an X-Ray, we could think of the Radiology company as a 'Laboratory'

 

Another example is the word 'Facility'. Again, depending on what you think a 'Facility' is, we may not mean exactly what you think. Yes, a hospital or a nursing home is a facility. So is the provider's office. What a 'Facility' is - is a place/location/address, etc where the provider renders services to a patient.

 

So what if the Nursing home bills Medicare for services that it provides to the patient? What is it then? Well, if it provides services to a patient, it is a 'provider' - think of it the same as a physician.

 

So a provider has a billing address which may or may not be the same as the 'Facility' where s/he provides services to patients. A provider may have several different addresses (Facilities) where s/he provides services to patients.

 

To sum up, Facilities are places/buildings and Laboratories are entities/companies.

 

More 'other'

 

We keep insurance names and addresses in the insurance company/payer files.

 

We keep patient insurance information with the patient's other demographic information such as age.

 

We keep employer names and addresses in the employer files

 

We keep the Patient's employer name with the patients other demographic information such as the telephone number.

 

So why have insurance/payers in a different file from the patient insurance information? 2 reasons (maybe more)

 

1. keeping insurance names and addresses and specific details of how to bill them in a separate file makes it easy to access because you may have many patients that subscribe to the same insurance. You do not want to enter that information over and over. You would rather put a simple code in the patient's file that 'points' to the insurance.

 

2. The patient has insurance information that is different from any other patient, even patients with exactly the same insurance company, group and plan. The patient has a unique ID. The patient has a relationship to the insured. For Medicare, the patient is usually the subscriber. However, for private payers, the subscriber may be a spouse or a parent. All that information is unique to that patient and so it must be kept with the patient. When you send a bill to the payer, you can't simply tell them they owe you $250.00. They will be somewhat hesitant to pay you. They want more information than that. Much more.