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(10U MC976d MARTLET, INC. February, 1995 P.O.Box 37 Herndon, Va. ------------------------ USER MANUAL MEDTRAC PERSONAL COMPUTER PROGRAM (Version 0.4) DOS Version; No mouse required; color optional Runs on ANY IBM-compatible computer Self-teaching For patients with any IBM compatible PC & Primary and second- ary health insurance coverage. Medicare / supplement version. Medtrac organizes all of your claim finances into concise screen reports, including an overview of all your medical accounts. Sub report shows each "Explanation of Benefits". Includes deductible math & totals. Registered users get quarterly updates and manuals. Copyright 1995. MARTLET, INC. -------------------------------- Notes: Version numbers beginning with zero are developmental, released for evolutionary testing. As of February, 1995 this program is still under user test at a rather low price. Health insurance cover- age is constantly undergoing change and MEDTRAC will be upgraded quarterly to reflect not only these changes but enhancements suggested by you, the user. By filling out the registration form below and sending in your comments and suggestions, you will receive the upgrades for a price of $5.00 each (to cover office and mailing). Upgrades will include printed user manuals when available. You will be sent bulletins announcing each upgrade. If you purchased this program as shareware, the same registration and upgrade service applies. The illustrations in this document use dashed lines in some cases for Word Perfect compatibility, whereas the screens displayed by the actual program show solid lines for greater clarity. -------------------------------- ┌────────────────────────────────────────────────────────_ │ █ │ Confucius say: █ │ █ │ A PICTURE IS WORTH A THOUSAND WORDS █ │ █ │ MEDTRAC gives you an accounting PICTURE of all your █ │ medical accounts. Actually TWO pictures. Read on. █ │ █ │ As a computer program, it contains all the math █ │ required to keep all the figures correct. █ │ █ └-▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄▄█ By organizing all of your claim finances with a minimum of complexity, MEDTRAC presents two up-to-date "pictures" which give you a simple insight into the situation. With these two computerized pictures imprinted on you mind, you will have a valuable perspective as to your financial obli- gations. Not only that, but your claim papers are ORGANIZED. MEDTRAC also reduces each complicated EOB statement to its bare essentials, giving you a refreshing new perspective. The two MEDTRAC pictures are shown in Figures 1 and 2. The first picture to appear is the Summary report (Figure 1). This report is a composite of all your active accounts (any service or bill represents an account). ┌──────────────────────────────────────────────────────────────────────────┐ │ Figure 1 │ ├──────────────────────────────────────────────────────────────────────────┤ │ MEDGAP SUMMARY REPORT OF current MEDICAL BILLS FOR Melinda │ ├──────────────────────────────────────────────────────────────────────────┤ │ Item Number ┐│ ├───────┬───────────────────────────────────┬─────────────┬─────────────┐ │ │Service│ Medical Bills Received │ Paid by │ You │ │ │ Date │ From: | date |amount│medicr|supplt│ Paid | owe │ │ ├───────┼───────────────────────────────────┼─────────────┼─────────────┼──┤ │11/2/3 │Fairfax Hospital |11/15/3| 7000│ 4000| 400│ 0| 2600│ 9│ │11/10/3│Dr. Wilkenfeld |11/13/3| 80│ 40| 6│ 0| 34│ 4│ │10/10/3│Reston Hospital |10/27/3| 726│ 325| 4│ 22| 375│ 3│ │9/13/3 │Dr. Smokvena |9/28/3 | 93│ 44| 4│ 0| 45│ 8│ │7/6/3 │Dr. Peerboom |8/1/3 | 55│ 14| 3│ 0| 41│ 6│ │6/26/3 │Dr. Hardy |7/1/3 | 65│ 0| 7│ 0| 58│ 2│ │5/23/3 │Radiology Associate |6/4/3 | 357│ 17| 10│ 0| 336│ 7│ │3/3/3 │Dr. Toon Lee |4/3/3 | 76│ 19| 2│ 0| 55│10│ │10/9/2 │Fair Oaks Hospital |10/24/2| 4000│ 0| 300│ 0| 3700│ 5│ ├───────┴───────────────────────────────────┴─────────────┴─────────────┼──┘ │ TOTAL : | 6844│ ├───────────────────────────────────────────────────────────────────────┤ │Menu: (A)dd line─item, (D)elete,(E)OB report and chance to change (X)it│ └───────────────────────────────────────────────────────────────────────┘ In the summary report, each line-item corresponds to a bill or explanation-of-benefits report. In the Menu -> at the bottom (Figure 3), the user has the option of viewing the EOB report for any line-item. Simply enter the letter "E" and press the return key. The Summary report then reappears, with a prompt at the bottom: "PLEASE ENTER THE ITEM NUMBER FOR THIS EXPLANATION OF BENEFITS (E) OR DELETE (D) OPTION." Let us assume that you reply with line-item 5 and press ENTER. The program responds with: .================================================================. | FIGURE 2 | |================================================================| |EOB REPORT FOR MEDICARE CONTROL No.843881 |4 STEPS DONE|Item : 5| |================================================================| | MEDICARE EXPLANATION OF BENEFITS :MEDICARE:BALANCE| |-----------------------------------------------:SUPPLMNT: DUE | |Patient: Amanda |Service | Total | Total :Benefit : FROM | |====================| date | charge | on EOB : :PATIENT| | STEP NUMBERS - - > |========1============2====:====3===:=======| |Fairfax Hospital |7/7/4 | 7000| 5000* 2000@ ----- | |-----------------------------------------------:--------:-------| | Part A deductible applied -> | 0: 0: ----- | |-----------------------------------------------:--------:-------| | Approved minus deductible amount -> | 5000: 2000: ----- | |-----------------------------------------------:--------:-------| | Percentage payable of above amount ->|80% :20% : ----- | |Benefit paid (after multiplying by %) | 4000: 400: ----- | |-------------------STEP NO. 4 -----------------:--------:-------| |Paid by you on 8/8/4 --> 233 | ------ : ------ : 2367| .===================================================================. │ This provider has accepted assignment | │* Amount approved, based on: * -> Fee Schedule. @ -> Fee Schedule| │What to do: -> (S)ummary rpt (D)elete, (U)you-input (X)exit | │===================================================================| │ Note: ==1==, ==2==, etc. added here to teach step numbers | ====================================================================' The Explanation of Benefits report of Figure 2 combines billing information and balance due information with the essential EOB figures from both Medicare and Medicare Supplement. The "balance due" is computed by the program. From the viewpoint of your inputs, there are four"steps". Listed in chronological order, they are: 1. Billed date and amount 2. Benefit from Medicare or Blue Cross 3. Benefit from supplement insurer 4. Payment made by patient Data for these four steps are entered one at time when you are in the (U)input / CHANGE sequence described below. Amounts from steps 2 and 3 are obtained from the Explanation-of benefits sent to you by the "carrier". The EOB report of Figure 2 might better be called a claim or item** statement, since it gives you a composite view of all major elements of a certain claim or service (for a certain patient). The "elements" are divided into steps and boxes. The four steps are shown in Figure 2. Two sample boxes for step 3 are illustrated in Figure 4 (identified by = 1 OPEN (box 1) and : 2 EST (box 2). There is no box number for the "benefit paid (after multiplying by %)", because there is not likelihood or provision for you entering an amount here. This line-item is always computed. ** The term "item" corresponds to a line-item on the Summary report (Figure 1). It also represents a medical service or insurance claim. In the case of box 2 "Approved minus deductible amount" however, the deductible amount may vary slightly in the EOB statement from the estimated deductible used by the computer. Every time you enter or change the amount in "Amount Approved" (box 1), MEDTRAC will automatically compute a new amount for box 2. However the expression ": 2 EST :" tells you that you can override the computed amount for box 2 by any different figure that appears in the Explanation of Benefits which arrived in the mail. In other words, when you see ": 2 EST :", you are permitted to enter a different figure to agree with the EOB report. When you have selected step 2 or 3 under the change prompts, you will see the EOB report with boxes identified and the following message at the bottom: " The estimated $_____ may need your input to make it agree with the EOB report. Do you want to change it now 'y' or 'n'?" If you answer 'y' (for "yes"), the program will accept and update the one refinement and change : 2 EST: (estimated) to : 2 ACT: (actual). Box 2 should now be considered CLOSED. If you subsequently change the corresponding box 1 again, the pro- gram will re-estimate and reopen box 2. Whenever you elect to make such an update, MEDTRAC computes the difference between the estimated and actual "Approved minus deductible" amount for that particular EOB, in order to give the program more "experience" for future computations. For steps 1 and 4, there are still two boxes (date and amount), but the terms "EST" and "actual" do not appear. There is a restriction on changes to the service date (step one) but otherwise all boxes in steps one and two are open for initial data entry, correction or update at all times. (This is what is meant by (U)input on the menus). The program keeps track of your annual accumulation against the deductible and gives you a report of the cumu- lative deductible. This report appears whenever you have completed some modifications or data entries and is displayed prior to the Summary report at that time. I N S T R U C T I O N S If we exclude the Blue Cross version for the moment, there are two slightly different Medicare programs: SAMPLE - which gives you a typical group of claims to play with, as a means of training yourself. MED - Which you will use for your own personal account. SCENARIO FOR THE MED PROGRAM: 1. If this is your first run of >MED, the program asks you to enter the patient's first name. After typing in the name (and backspacing <-- if necessary to correct any errors), you must press the "ENTER" key. If you have already entered the name however, it asks you if you wish to CHANGE the patient's name: 'y' or 'n' (which should seldom be necessary). Again, your name input must be followed by the "ENTER" key. 2. After the program has received your new or changed patient name and the ENTER key is pressed, the program automatically brings up the Summary screen (Figure 1.) 3. The first time you run MEDTRAC for this patient, the summary report will be empty, with no accounts entered. In order to add accounts and their data, you use the menu bar (Figure 3) at the bottom of the summary report. Type "A", for "add item" and you will see the following series of prompts: Date of Service: Provider Name: Date of bill from provider: Amount billed by provider: -----------------------------------------------------------------------------. Figure 3 ------------------------------------------------------------------------------ Menu:->(A)dd line-item,(D)elete(E)OB report and chance to change,(X)exit ------------------------------------------------------------------------------ The program actually says:"chance to ENTER DATA'"instead of "chance to change". Both terms may be confusing, because "entering data" is technically a "change" from zero to some higher amount.Actually the process allows you to correct typographical errors as well as enter updates from your mail. The so-called "chance" refers to the (U)you-input option of Figure 2, which switches you to the CHANGE menu described below. The computer can tell from the provider name whether or not it is a hospital. To obtain necessary details for the claim analysis, and assuming here that the provider is not a hospital, the program displays the following menu: THIS IS A MEDICARE PART B CLAIM 1. Surgeon 2. Laboratory test 3. Internist 4. Nursing facility 5. Home nurse 6. Blood transfusion 7. In-office operation PLEASE SELECT A SERVICE TYPE FROM THE ABOVE MENU. The program uses this information to predict how much the insurers will or should approve, and also the deductible. After you have entered all the data for a new line-item and typed in 's', you will immediately see a confirmation copy of the Summary screen, showing your first account and the data as entered. Figure 1. After looking at the Summary report showing a new service**, you might want to correct something or add additional figures from you mail. You may do so by typing in 'E'. You will then be prompted as follows: "PLEASE ENTER THE ITEM NUMBER FOR THIS EXPLANATION OF BENEFITS (E) OR DELETE (D) OPTION." If you are still considering your first line-item, you respond to this prompt by typing in the number "1", followed by the ENTER key. This will return you to the Explanation-of-Benefits (EOB) display, after which you can enter 'U' (U-input or change) to get you into a CHANGE menu. The CHANGE menu asks you which of the four steps you wish to alter. After selecting one of these you will see a version of Explanation of Benefits like Figure 4. The Figure 4 EOB asks you for a BOX number (1 or 2) under the particular step which you have chosen to update. You now see the message: YOU MAY NOW RESPOND TO THE PROMPTS BELOW BY ENTERING DATA OR CHANGES (WITH NO DECIMAL POINT OR CENTS ENTERED). A sample prompt is: "Amount of your latest payment" When you see such a prompt, you are to enter the date or amount (as in this example), and press the ENTER key. This will automatically return you to the EOB screen, to show your entry in its proper place in the EOB table. You may return to the Summary Report and press 'A' in order to add other claim/accounts. There may be revisions to be made later, as described above: using the 'E' option on Figure 3. AFTER YOU HAVE ENTERED ALL OF YOUR ACCOUNTS (ITEMS) You are now ready to start using the computer for your medical insurance bookeeping. Henceforth it will be a matter of updating the EOB and account summary for each new piece of paper received and for each bill that you pay. There are two types of transactions which can come by mail: . A bill from a provider for a specific service such as a con- finement, treatment, operation or laboratory test. In most cases this represents a new line-item or claim. Instructions appear above for adding new items. . An explanation of benefits from an insurer. This type of mail usually means a "change" to an existing line-item, using the (U)input option. Every time that you finish an (A)dd or (U)input sequence, you will note that computations are performed automatic- ally in the process of producing new EOB and summary screens. There are actually three formats for the EOB report. The two not mentioned above are shown in Figure 4. Figure 4 is the format which appears in conjunction with a change process. Its format differs in that box numbers such as: '-BOX 2 EST-', '=BOX 1 OPEN =', and '-BOX 2 ACT-' appear, to identify the step being changed and allow selec- tion of one element in that step. Figure 2 shows how the steps are numbered, as indicated by the headers: =step=1==, ==2==, ==3== and --4--. These numbers indicate the chrono- logical sequence of transactions for a typical claim. To refresh your memory, those steps are as follows: 1. Billed date and amount 2. Benefit from Medicare or Blue Cross 3. Benefit from supplement insurer 4. Payment made by patient The symbol EST means "estimated" (for short). For long, it means "Estimated by the computer". .================================================================. | FIGURE 4 | |================================================================| |EOB REPORT FOR MEDICARE CONTROL No. 843881|This step: 3|Item : 2| |================================================================| | MEDICARE EXPLANATION OF BENEFITS :MEDICARE:BALANCE| |-----------------------------------------------:SUPPLMNT: DUE | |Patient: Amanda |Service | Total | Total :Benefit : FROM | |====================| date | charge | on EOB : :PATIENT| | Surgeon |=========================== 1 OPEN ========| |Dr. Hardy |6/26/3 | 65| 30* 38@ ----- | |-----------------------------------------------:--------:-------| | Part B deductible applied -> | 100 : 0: ----- | |-----------------------------------------------: 2 EST :-------| | Approved minus deductible amount -> | 0: 38: ----- | |-----------------------------------------------:--------:-------| | Percentage payable of above amount ->|80% :20% : ----- | |Benefit paid (after multiplying by %) | 0: 7: ----- | |-----------------------------------------------:--------:-------| |Paid by you on --> 0 | ------ : ------ : 58| .===================================================================. │PLEASE ENTER THE BOX NUMBER (ENCLOSED IN the == 1 OPEN ==== or | │: 2 EST : SYMBOLS ABOVE IT) FOR THE BOX TO BE FILLED, FOR EOB STEP:| | │3 - - OR TYPE s IF YOU WISH TO RETURN TO THE SUMMARY REPORT | ====================================================================' Whenever a line-item is all paid up, you will usually want to delete it, using the (D)elete command, which is a menu option under both the Summary and the EOB reports. In Figure 3 you will note that "X" will cause the program to terminate or exit. When this happens, an updated file is saved on the same disk as the program, so that the Summary report for the next run of the program will be the same as that which you saw when you terminated the previous run of the program. SCENARIO FOR THE SAMPLE PROGRAM Start with the command: C:>\sample The program begins by asking you the name of the patient. Next the Summary Report appears, but with ten sample accounts shown for practice purposes. You may add, delete or change each line-item exactly as described above. The only difference with sample program operation is that the two deductibles are automatically restored whenever the patient's name is changed. The instructions are the same as the above scenario, except that everything in the SAMPLE scenario can be fictitious and arbitrary. Continuing with instructions for the SAMPLE program: of course if you want to get out your medical papers and use actual hospital or doctor names and amounts, that would be good training. First you might have to delete most of the fictitious items to make room however. Also, whatever real entries you make would have to be done over with the MED program. Therefore don't spend too much time entering real data while running the SAMPLE program. ________________________________________________________________ REGISTRATION FORM. MEDTRAC PROGRAM Name _________________________________ Date: __/__/__ City _______________________________ State __ Zip ________ If you supply information below, you will be notified about each upgrade and entitled to receive each one for $5.00. Comments: ________________________________________________________________ ________________________________________________________________ Suggestions for next update to program: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ _ Your health-care liability: 0 - 10,000 |_| _ 10,000 - 50,000 |_|, over $50,000 |_| MARTLET, INC. Box 37, Herndon VA. 22070 ________________________________________________________________