Prepare a data dictionary entry and process description for one of the system’s functional primitives.

What will be an ideal response?

Answers will vary, because students will be using the data flow diagrams they created in responding to previous questions. This assignment can be approached in several ways. Have students use structured English, decision tables, or another documentation technique. Although the New Century processes do not require a complex logical solution, create an additional New Century guideline, or policy, that would require the use of a decision table or decision tree. For example, New Century might decide to send out special reminders for patients in certain age groups or for those who have had certain procedures performed during the past year. The main objective is to provide an opportunity to practice and apply the skills learned in this chapter.
Many sample documents have been prepared for several of the functional primitives shown in the DFDs on our data flow diagrams. Use these as examples, and encourage students to develop their own solutions. In addition, a full list of the functional primitives, including input and output data flows, have been provided.

SAMPLE DOCUMENTATION FOR PROCESSES 1.1, 1.2, 1.3, AND 1.4:

PROCESS 1.1: MAKE APPOINTMENT
PURPOSE: Schedules a patient's appointment and services.

INPUT DATA FLOWS: APPOINTMENT REQUEST
PATIENT DATA
CPT FEE SCHEDULE

OUTPUT DATA FLOWS: SERVICE DATA
APPT DATA

PROCESS DESCRIPTION:
For each APPOINTMENT REQUEST from PATIENT
Retrieve PATIENT NUMBER from PATIENTS
Verify PATIENT NUMBER
For each CPT CODE in APPOINTMENT REQUEST
Retrieve CPT CODE from CPT FEE SCHEDULE
Add/Change/Delete CPT CODE in SCHEDULED SERVICE DATA
Add/Change/Delete PROVIDER NUMBER in SCHEDULED SERVICE DATA
Add/Change/Delete APPOINTMENT NUMBER, APPOINTMENT DATE, START TIME, PATIENT NUMBER in SCHEDULED APPOINTMENT DATA

PROCESS 1.2: COMPLETE APPOINTMENT
PURPOSE: Processes an appointment that has been completed

INPUT DATA FLOWS: EMPLOYER DATA
PROVIDER DATA
HOUSEHOLD DATA
SERVICE DATA
APPT DATA

OUTPUT DATA FLOWS: CLAIM
CHARGES
PROVIDER CHARGES
SERVICE CHARGE
SERVICE DATA
APPT DATA

PROCESS DESCRIPTION:
For each APPOINTMENT NUMBER
Retrieve HOUSEHOLD NUMBER from PATIENTS
Retrieve EMPLOYER GROUP NUMBER from HOUSEHOLDS
Retrieve INS. CO. NUMBER from HOUSEHOLDS
For each APPOINTMENT NUMBER in COMPLETED APPOINTMENT DATA
Retrieve FEE from SERVICE DATA
Apply CHARGE to HOUSEHOLDS
Apply PROVIDER CHARGES to PROVIDERS
Apply LAST EXAM to PATIENTS
Apply FEE to MTD CHARGES
Add APPOINTMENT NUMBER, APPOINTMENT DATE, START TIME, END TIME, PATIENT NUMBER in COMPLETED APPOINTMENT DATA
Add CPT CODE, PROVIDER NUMBER, FEE in COMPLETED SERVICE DATA
Delete APPOINTMENT NUMBER, APPOINTMENT DATE, START TIME, END TIME, PATIENT NUMBER in COMPLETED APPOINTMENT DATA
Delete CPT CODE, PROVIDER NUMBER in SCHEDULED SERVICE DATA
Send CLAIM to INSURANCE COMPANY

PROCESS 1.3: MODIFY CPT CODE
PURPOSE: Add/Change/Delete an American Medical Association CPT code

INPUT DATA FLOWS: CPT CODES
OUTPUT DATA FLOWS: CPT CODES

PROCESS DESCRIPTION:
For each CPT CODE CHANGE from AMERICAN MEDICAL ASSOCIATION
Apply CPT CODE to CPT FEE SCHEDULE

PROCESS 1.4: MODIFY CPT FEE
PURPOSE: Add/Change/Delete a CPT fee

INPUT DATA FLOWS: FEE DATA
OUTPUT DATA FLOWS: FEE DATA

PROCESS DESCRIPTION:
For each FEE CHANGE from PROVIDER
Apply FEE to CPT FEE SCHEDULE

OTHER FUNCTIONAL PRIMITIVE PROCESSES:

PROCESS 2.1: PROCESS PATIENT PAYMENT
PURPOSE: Process a payment received from a patient

INPUT DATA FLOWS: PATIENT PAYMENT
OUTPUT DATA FLOWS: MTD PAYMENTS
YTD PAYMENTS

PROCESS 2.2: PROCESS INSURANCE PAYMENT
PURPOSE: Process a payment received from an insurance company

INPUT DATA FLOWS: INSURANCE PAYMENT
OUTPUT DATA FLOWS: MTD PAYMENTS
YTD PAYMENTS

PROCESS 3.1.1: CREATE CALL LIST
PURPOSE: Prepare and print the daily call list that shows all patients who are to be called to be reminded of their appointment

INPUT DATA FLOWS: CALL LIST DATA
OUTPUT DATA FLOWS: CALL LIST

PROCESS 3.1.2: CREATE APPOINTMENT LIST
PURPOSE: Prepare and print the daily appointment list that shows all patients and their scheduled services for each provider

INPUT DATA FLOWS: SERVICE DATA
PROVIDER APPOINTMENT DATA
OUTPUT DATA FLOWS: APPOINTMENT LIST


PROCESS 3.2.1: CREATE PROVIDER REPORT
PURPOSE: Prepare and print the weekly provider report that summarizes each provider's charges for the week

INPUT DATA FLOWS: MTD PAYMENTS
PROVIDER REPORT DATA
SERVICE CHARGE
OUTPUT DATA FLOWS: CLAIM STATUS SUMMARY
INSURANCE COMPANY REPORT
PROVIDER REPORT

PROCESS 3.2.2: CREATE REMINDER POSTCARDS
PURPOSE: Prepare and print reminder postcards for each appointment

INPUT DATA FLOWS: REMINDER POSTCARD DATA
OUTPUT DATA FLOWS: REMINDER POSTCARD

PROCESS 3.2.3: CREATE MAILING LABELS
PURPOSE: Prepare and print patient mailing labels

INPUT DATA FLOWS: MAILING LABEL DATA

OUTPUT DATA FLOWS: MAILING LABELS

PROCESS 3.2.4: CREATE STATEMENT
PURPOSE: Prepare and print monthly statements to patients

INPUT DATA FLOWS: STATEMENT DATA
OUTPUT DATA FLOWS: STATEMENT

PROCESS 4.1: MODIFY PATIENT
PURPOSE: Add, change, and delete patient and household data received from patients

INPUT DATA FLOWS: PATIENT CHANGE
OUTPUT DATA FLOWS: PATIENT UPDATE

PROCESS 4.2: MODIFY HOUSEHOLD
PURPOSE: Add, change, and delete household data changes received from patients

INPUT DATA FLOWS: HOUSEHOLD CHANGE
OUTPUT DATA FLOWS: HOUSEHOLD UPDATE

PROCESS 4.3: MODIFY INSURANCE CARRIERS
PURPOSE: Add, change, and delete insurance carrier data received from patients

INPUT DATA FLOWS: EMPLOYER CHANGE
OUTPUT DATA FLOWS: EMPLOYER UPDATE

PROCESS 4.4: MODIFY PROVIDER
PURPOSE: Add, change, and delete provider data

INPUT DATA FLOWS: PROVIDER CHANGE
OUTPUT DATA FLOWS: PROVIDER UPDATE


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