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computers
in the
medical office
SUSAN M. SANDERSON, CPEHR

Copyright ©2016 McGraw-Hill Education
Ninth Edition
COMPUTERS IN THE MEDICAL OFFICE, NINTH EDITION
Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2016 by McGraw-Hill Education. All rights
reserved. Previous editions © 2013, 2011, and 2009. No part of this publication may be reproduced or distributed in any form or by any
means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited
to, in any network or other electronic storage or transmission, or broadcast for distance learning.
Some ancillaries, including electronic and print components, may not be available to customers outside the United States.
1 2 3 4 5 6 7 8 9 0 RMN/RMN 1 0 9 8 7 6 5
ISBN 978-0-07-783638-2
MHID 0-07-783638-3
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Medisoft® is a registered trademark of McKesson Corporation and/or one of its subsidiaries. Screenshots and material pertaining
to Medisoft® Software used with permission of McKesson Corporation. © 2013 McKesson Corporation and/or one of its
subsidiaries. All Rights Reserved.
The Medidata (student data file), illustrations, instructions, and exercises in Computers in the Medical Office are compatible with
the Medisoft Advanced Version 19 Patient Accounting software available at the time of publication. Note that Medisoft Advanced
Version 19 Patient Accounting software must be available to access the Medidata. It can be obtained by contacting your
McGraw-Hill sales representative.
All brand or product names are trademarks or registered trademarks of their respective companies.
CPT five-digit codes, nomenclature, and other data are © 2015 American Medical Association. All Rights Reserved. No fee s chedules,
basic units relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.
CPT codes are based on CPT 2015.
ICD-10-CM codes are based on ICD-10-CM 2015.
All names, situations, and anecdotes are fictitious. They do not represent any person, event, or medical record.
Library of Congress Cataloging-in-Publication Data

Sanderson, Susan M.
Computers in the medical office / Susan M. Sanderson, CPEHR.—Ninth edition.
pages cm
Includes index.
ISBN 978-0-07-783638-2 (alk. paper)
1. Medical offices—Automation. 2. MediSoft. I. Title.
R864.S26 2016
610.285—dc23
2015010737
The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate
an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not guarantee the accuracy of the
information presented at these sites.
mheducation.com/highered
brief
contents
part 1 INTRODUCTION TO COMPUTERS IN THE MEDICAL OFFICE 1
CHAPTER 1 Introduction to Health Information Technology and Medical Billing 2
part 2 MEDISOFT ADVANCED TRAINING 47

CHAPTER 2 Introduction to Medisoft 48
CHAPTER 3 Scheduling 85
CHAPTER 4 Entering Patient Information 128
CHAPTER 5 Working with Cases 156
CHAPTER 6 Entering Charge Transactions and Patient Payments 196
CHAPTER 7 Creating Claims 237
CHAPTER 8 Posting Payments and Creating Patient Statements 273
CHAPTER 9 Creating Reports 326
CHAPTER 10 Collections in the Medical Office 371
part 3 APPLYING YOUR SKILLS 409

CHAPTER 11 Appointments and Registration 410
CHAPTER 12 Cases, Transactions, and Claims 416
CHAPTER 13 Reports and Collections 423
CHAPTER 14 Putting It All Together 427
part 4 SOURCE DOCUMENTS 435

GLOSSARY 472
INDEX 476
iii
contents
part 1
INTRODUCTION TO COMPUTERS
IN THE MEDICAL OFFICE 1
Chapter 1
Introduction to Health Information
Technology and Medical Billing 2
1.1 THE CHANGING HEALTHCARE LANDSCAPE 3
HITECH Act 4
Affordable Care Act 4
Implications for Physician Practices 5 Step 8: Monitor Payer Adjudication 25
1.2 FUNCTIONS OF PRACTICE Step 9: Generate Patient Statements 27
MANAGEMENT PROGRAMS 8
Step 10: Follow Up Payments and
Creating and Transmitting Claims 8 Collections 27
Monitoring Claim Status 9 1.7 HIPAA, THEN AND NOW 27
Receiving and Processing Payments 9 HIPAA Electronic Transaction
1.3 FUNCTIONS OF ELECTRONIC HEALTH and Code Sets 28
RECORD PROGRAMS 10 HIPAA Privacy Requirements 30
Health Information and Data Elements 10 HIPAA Security Requirements 35
Results Management 11
Order Management
Decision Support
12
13 part 2
Electronic Communication and MEDISOFT ADVANCED TRAINING 47
Connectivity 13
Patient Support 13
Administrative Processes 13 Chapter 2
Reporting and Population Introduction to Medisoft 48
Management 14 2.1 THE MEDISOFT DATABASES 49
1.4 THE MEDICAL DOCUMENTATION AND 2.2 THE MEDISOFT MENUS 50
BILLING CYCLE: PRE-ENCOUNTER 14
File Menu 50
Step 1: Preregister Patients 16
Edit Menu 51
1.5 THE MEDICAL DOCUMENTATION
Activities Menu 51
AND BILLING CYCLE: ENCOUNTER 16

Step 2: Establish Financial Lists Menu 52
Responsibility 16 Reports Menu 53
Step 3: Check In Patients 17 Tools Menu 53
Step 4: Review Coding Compliance 17 Window Menu 53
Step 5: Review Billing Compliance 23 Help Menu 54
STEP 6: Check Out Patients 23 Exercise 2-1 Medisoft Menus 55
1.6 THE MEDICAL DOCUMENTATION AND 2.3 THE MEDISOFT TOOLBAR 55
BILLING CYCLE: POST-ENCOUNTER 23
Exercise 2-2 Toolbar Buttons 55
Step 7: Prepare and Transmit Claims 23
iv
2.4 ENTERING, EDITING, SAVING, AND 3.4 SEARCHING FOR AVAILABLE TIME
DELETING DATA IN MEDISOFT 57 SLOTS 99
Entering Data 58 Exercise 3-5 Searching for Open Time,
Editing Data 58 Ramos 100
Exercise 2-3 Editing Data 58 Exercise 3-6 Searching for Open Time,
Klein 101
Saving Data 61
3.5 ENTERING APPOINTMENTS FOR NEW
Deleting Data 61 PATIENTS 101
2.5 CHANGING THE MEDISOFT PROGRAM Exercise 3-7 Entering an Appointment
DATE 62 for a New Patient 102
2.6 USING MEDISOFT HELP 64 3.6 BOOKING REPEAT APPPOINTMENTS 102
Hints 64 Exercise 3-8 Booking Repeat Appointments 103
Built-in 64 3.7 RESCHEDULING AND CANCELING
Exercise 2-4 Using Built-in Help 66 APPPOINTMENTS 104
2.7 CREATING AND RESTORING BACKUP Exercise 3-9 Rescheduling Appointments 105
FILES 66 3.8 VERIFYING INSURANCE ELIGIBILITY
Creating a Backup File While Exiting AND BENEFITS 105
Medisoft 66 Eligibility Verification Icons 108
Exercise 2-5 Backing Up 68 Exercise 3-10 Verifying a Patient’s
Restoring the Backup File 69 Eligibility 109
Exercise 2-6 Restoring a Backup File 69 3.9 CHECKING PATIENTS IN AND OUT 109
2.8 MEDISOFT’S FILE MAINTENANCE Exercise 3-11 Checking In a Patient 110
UTILITIES 71 3.10 CREATING AN OVERDUE BALANCE
Rebuilding Indexes 72 REPORT FOR PATIENTS WITH
APPOINTMENTS 111
Packing Data 72
Exercise 3-12 Creating an Overdue
Purging Data 74 Balance Report 111
Recalculating Patient Balances 75 3.11 CREATING A PATIENT RECALL LIST 111
2.9 USING MEDISOFT SECURITY FEATURES Adding a Patient to the Recall List 113
TO ENSURE HIPAA AND HITECH
COMPLIANCE 76 Exercise 3-13 Adding a Patient to
the Recall List 115
User Logins and Audit Controls 78
3.12 CREATING PROVIDER BREAKS 115
Auto Log Off and Unapproved Codes 78
Exercise 3-14 Entering a Provider Break 117
3.13 VIEWING AND PRINTING SCHEDULES 117
Chapter 3
Scheduling 85
3.1 THE OFFICE HOURS WINDOW 86
Program Options 89
Entering and Exiting Office Hours 89

3.2 ENTERING APPOINTMENTS 89
Exercise 3-1 Entering an Appointment,
Leila Patterson 95
Exercise 3-2 Entering an Appointment,
Elizabeth Jones 96
Exercise 3-3 Looking Up a Provider
and Entering an Appointment 97
3.3 BOOKING FOLLOW-UP APPOINTMENTS 98
Exercise 3-4 Booking an Appointment
with a Follow-up 99
CONTENTS v
Exercise 3-15 Viewing a Provider Exercise 5-2 Entering Data in
Schedule 118 the Account Tab 168
Applying Your Skills 1: Enter an 5.4 ENTERING INSURANCE INFORMATION 168
Appointment for a New Patient 119 Policy 1 Tab 168
Applying Your Skills 2: Search for an Exercise 5-3 Entering Data in
Open Time 119 the Policy 1 Tab 171
Applying Your Skills 3: Preview a Policy 2 Tab 171
Physician’s Schedule 119
Policy 3 Tab 172
Medicaid and Tricare Tab 173
Chapter 4 5.5 ENTERING HEALTH INFORMATION 176
Entering Patient Information 128
Diagnosis Tab 176
4.1 HOW PATIENT INFORMATION IS
ORGANIZED IN MEDISOFT® 129 Exercise 5-4 Entering Data in
the Diagnosis Tab 178
4.2 ENTERING NEW PATIENT INFORMATION 130
Condition Tab 178
Name, Address Tab 131
Exercise 5-5 Entering Data in
Exercise 4-1 Chart Numbers 132 the Condition Tab 181
Other Information Tab 134 5.6 ENTERING OTHER INFORMATION 182
Payment Plan Tab 137 Miscellaneous Tab 182
Exercise 4-2 Adding a New Patient 138 Comment Tab 183
Adding an Employer to the Exercise 5-6 Entering Data in
Address List 141 the Comment Tab 185
Exercise 4-3 Adding an Employer 143 EDI TAB 185
4.3 SEARCHING FOR PATIENT 5.7 EDITING CASE INFORMATION 188
INFORMATION 144
Exercise 5-7 Editing a Case 188
Search for and Field Option 145
Exercise 5-8 Copying a Case 189
Exercise 4-4 Search Using Field Box 147
Applying Your Skills 5: Creating a Case
Locate Buttons Option 147 for a New Patient 189
Exercise 4-5 Search Using Locate
Button 149
4.4 EDITING PATIENT INFORMATION 149 Chapter 6
Entering Charge Transactions
Exercise 4-6 Editing Patient Information 150
and Patient Payments 196
Applying Your Skills 4: Entering
a New Patient 150 6.1 UNDERSTANDING CHARGES, PAYMENTS,
AND ADJUSTMENTS 197
6.2 SELECTING A PATIENT AND CASE 197
Chapter 5
Working with Cases 156
5.1 UNDERSTANDING CASES 157
When to Set Up a New Case 157
Case Examples 158

5.2 NAVIGATING CASES IN MEDISOFT 159
Case Command Buttons 159
The Case Dialog Box 160
5.3 ENTERING PATIENT AND ACCOUNT
INFORMATION 162
Personal Tab 162
Exercise 5-1 Entering Data in
the Personal Tab 164
Account Tab 166
vi CONTENTS
Chart 198 7.6 EDITING CLAIMS 256
Case 199 Carrier 1 Tab 256
Additional Information 199 Carrier 2 and Carrier 3 Tabs 257
6.3 ENTERING CHARGE TRANSACTIONS 200 Transactions Tab 257
Buttons in the Charges Area of the Comment Tab 258
Transaction Entry Dialog Box 204 EDI Note Tab 259
Color Coding in Transaction Entry 206 Exercise 7-4 Reviewing a Claim 260
Saving Charges 207 7.7 CHANGING THE STATUS OF A CLAIM 260
Editing Transactions 208 Exercise 7-5 Changing Claim Status 261
Exercise 6-1 Entering a Charge 7.8 ELECTRONIC CLAIMS WORKFLOW 262
for Hiro Tanaka 208
Exercise 7-6 Perform an Electronic
Exercise 6-2 Entering a Charge Claim Edit Check 263
for Elizabeth Jones 210
7.9 SENDING ELECTRONIC CLAIM
6.4 ENTERING PAYMENTS MADE AT ATTACHMENTS 265
THE TIME OF AN OFFICE VISIT 211
Applying Your Skills 7: Reviewing Claims 267
Applying Payments to Charges 213
Saving Payment Information 216
Exercise 6-3 Entering a Copayment 216 Chapter 8
Exercise 6-4 Entering Charges Posting Payments and Creating
and Copayment 219 Patient Statements 273
6.5 PRINTING WALKOUT RECEIPTS 220 8.1 THIRD-PARTY REIMBURSEMENT
Exercise 6-5 Creating a Walkout Receipt 223 OVERVIEW 274
6.6 PROCESSING A PATIENT REFUND 223 Indemnity Plan Example 274
Exercise 6-6 Processing a Refund 225 Managed Care Example 274
6.7 PROCESSING A NONSUFFICIENT Medicare Participating Example 275
FUNDS (NSF) CHECK 227 8.2 REMITTANCE ADVICE (RA) PROCESSING 276
Exercise 6-7 Processing an NSF Check 228 Claim Adjustments and Denials 278
Applying Your Skills 6: Add a Diagnosis Processing Payments 278
and Enter Procedure Charges 229 8.3 ENTERING INSURANCE PAYMENTS
IN MEDISOFT 279
Chapter 7 The Deposit List Dialog Box 279
Creating Claims 237 The Deposit Dialog Box 282
7.1 THE BASICS OF MEDICAL INSURANCE 238 Exercise 8-1 Entering a Deposit:
ChampVA 285
Types of Health Plans 239
7.2 THE ROLE OF CLAIMS IN THE BILLING
CYCLE 241
Medical Necessity 241
Clean Claims 242

CMS-1500 and X12 837 Health Care
Claim 242
Exercise 7-1 Exploring the CMS-1500
in Medisoft Help 246
7.3 CLAIM MANAGEMENT IN MEDISOFT 248
7.4 CREATING CLAIMS 249
Exercise 7-2 Creating Claims 251
7.5 LOCATING CLAIMS 252
Exercise 7-3 Using the List Only Feature 255
CONTENTS vii
8.4 APPLYING INSURANCE PAYMENTS Patient Day Sheet 336
TO CHARGES 287 Exercise 9-1 Printing a Patient
Exercise 8-2 Applying Payments Day Sheet 338
to Charges: ChampVA 291 Procedure Day Sheet 340
Exercise 8-3 Entering a Deposit and Payment Day Sheet 341
Applying Payments: East Ohio PPO 293
9.4 CREATING ANALYSIS REPORTS 342
Exercise 8-4 Entering a Deposit and
Applying Payments: Blue Cross Billing/Payment Status Report 342
and Blue Shield 295 Practice Analysis Report 344
8.5 PROCESSING A PATIENT PAYMENT Exercise 9-2 Saving a Practice
RECEIVED BY MAIL 297 Analysis Report as a PDF File 344
Exercise 8-5 Entering a Patient Payment Insurance Analysis Report 346
Received by Mail 297
Referring Provider Report 346
8.6 ENTERING CAPITATION PAYMENTS 299
Referral Source Report 347
Exercise 8-6 Entering a Capitation
Payment 303 Unapplied Payment/Adjustment Report 347
Exercise 8-7 Entering a Zero Amount Unapplied Deposit Report 347
Payment 304 Co-Payment Report 347
Exercise 8-8 Adjusting a Capitated Outstanding Co-Payment Report 347
Account 304
Appointment Eligibility Analysis—
8.7 CREATING STATEMENTS 307 Detail and Summary 347
Statement Management Dialog Box 307 Electronic Claims Analysis—Detail
Create Statements Dialog Box 308 and Summary 347
Exercise 8-9 Creating Statements 310 9.5 CREATING PATIENT LEDGER REPORTS 348
8.8 EDITING STATEMENTS 311 Exercise 9-3 Printing a Patient Account
Ledger 349
General Tab 311
9.6 CREATING STANDARD PATIENT LIST
Transactions Tab 312 REPORTS 351
Comment Tab 312 Exercise 9-4 Printing a Patient by
Exercise 8-10 Reviewing a Statement 313 Insurance Carrier List 352
8.9 PRINTING STATEMENTS 313 9.7 NAVIGATING IN MEDISOFT REPORTS 352
Selecting a Format 314 The Medisoft Reports Menus 353
Selecting the Filters and Printing The Medisoft Reports Toolbar 355
the Statements 315 The Medisoft Reports Find Report Box 355
Exercise 8-11 Printing Statements 316 The Medisoft Reports Help Feature 355
Applying Your Skills 8: Enter Insurance 9.8 CREATING AGING REPORTS 356
Payments 318
Exercise 9-5 Printing a Patient
Applying Your Skills 9: Create Statements 318 Aging Report 356
Chapter 9
Creating Reports 326

9.1 CREATING REPORTS IN MEDISOFT 327
Selecting Print Options 327
Selecting Data for a Report 329
9.2 THE IMPORTANCE OF ACCOUNTS
RECEIVABLE REPORTS 334
Daily Reports 334
Monthly Reports 335
9.3 CREATING DAY SHEETS 336
viii CONTENTS
9.9 CREATING CUSTOM REPORTS 356 10.10 CREATING A COLLECTION TRACER
Exercise 9-6 Printing a List of Patients 358 REPORT 399
Exercise 9-7 Printing a List of Exercise 10-8 Creating a Collection
Procedure Codes 358 Tracer Report 400
9.10 USING REPORT DESIGNER 359 Applying Your Skills 12: Print a Patient
Aging Report 401
Exercise 9-8 Modifying a Report 360
Applying Your Skills 13: Add a Patient
Applying Your Skills 10: Print a Patient to the Collection List 401
Day Sheet 363
Applying Your Skills 14: Create
Applying Your Skills 11: Print an a Collection Letter 401
Insurance Payment by Type Report 363
Chapter 10 part 3
Collections in the Medical Office 371 APPLYING YOUR SKILLS 409
10.1 FOLLOWING UP ON INSURANCE CLAIMS 372
Prompt Payment Laws 372
Chapter 11
Working Claim Denials 373
Appointments and Registration 410
Aging Insurance Claims 374
Exercise 11-1 Scheduling an
Resubmitting Claims 374 Appointment: Lawana Brooks 411
10.2 THE IMPORTANCE OF A FINANCIAL Exercise 11-2 Scheduling an
POLICY 374 Appointment: Edwin Hsu 411
10.3 LAWS GOVERNING PATIENT Exercise 11-3 Scheduling an
COLLECTIONS 377 Appointment: Anthony Battistuta 412
10.4 CREATING AND ASSIGNING PAYMENT Exercise 11-4 Scheduling an
PLANS 378 Appointment: Stewart Robertson 412
Exercise 10-1 Creating a Patient Exercise 11-5 Scheduling an
Payment Plan 379 Appointment: Hannah Syzmanski 413
Assigning a Patient Account to a Exercise 11-6 Making an
Payment Plan 380 Appointment Change 413
Exercise 10-2 Assigning a Patient Exercise 11-7 Juggling Schedules 414
Account to a Payment Plan 381
10.5 WORKING WITH COLLECTION AGENCIES 381 Appointment: Michael Syzmanski 414
Exercise 10-3 Posting a Payment Exercise 11-9 Printing a Provider
from a Collection Agency 382 Schedule 415
10.6 WRITING OFF UNCOLLECTIBLE
ACCOUNTS 384
Exercise 10-4 Writing Off a Patient
Balance 384
10.7 USING A PATIENT AGING REPORT
FOR COLLECTIONS 385

Exercise 10-5 Identifying Overdue
Accounts 386
10.8 ADDING AN ACCOUNT TO
THE COLLECTION LIST 387
Using the Collection List Window 387
Entering a Tickler Item 391
Exercise 10-6 Creating a Tickler 393
10.9 CREATING COLLECTION LETTERS 395
Exercise 10-7 Creating a Collection Letter 398
CONTENTS ix
Chapter 12
Cases, Transactions, and Claims 416
Exercise 12-1 Entering Transactions 417
Exercise 12-2 An Unscheduled Visit 417
Exercise 12-3 Changing a Transaction
Record 418
Appointment: Diane Hsu 418
Exercise 12-5 Entering Charges
and Payments: Stewart Robertson 419 Chapter 14
Exercise 12-6 Entering Charges
Putting It All Together 427
and Payments: Diane Hsu 419 Exercise 14-1 Scheduling Appointments 428
Exercise 12-7 Entering Charges Exercise 14-2 Rescheduling and
and Payments: Michael Syzmanski 420 Canceling Appointments 428
Exercise 12-8 Entering and Applying Exercise 14-3 Printing Schedules 429
an Insurance Carrier Payment 420 Exercise 14-4 Creating Cases 429
Exercise 12-9 Creating Insurance Exercise 14-5 Entering Transactions 430
Claims 421
Exercise 14-6 Creating Claims 430
Exercise 12-10 Finding a Patient’s
Balance 421 Exercise 14-7 Entering Insurance
Payments 431
Exercise 12-11 Creating Patient
Statements 422 Exercise 14-8 Creating Patient
Statements 431
Exercise 14-9 Printing Reports 432
Chapter 13 Exercise 14-10 Entering Collection
Reports and Collections 423 Agency and Patient Payments 432
Exercise 13-1 Creating a Patient Exercise 14-11 Reviewing Overdue
Day Sheet Report 424 Accounts 433
Exercise 13-2 Creating a Patient Exercise 14-12 Adding Patients to
Aging Report 424 the Collection List and Creating
Exercise 13-3 Creating a Practice Collection Letters 433
Analysis Report 425
Exercise 13-4 Adding Items to the
Collection List 425 part 4
Exercise 13-5 Creating Collection SOURCE DOCUMENTS 435
Letters 426
Glossary 472
Index 476
x CONTENTS
preface
CiMO™: THE STEP-BY-STEP,
HANDS-ON APPROACH
Welcome to the ninth edition of Computers in the Medical Office
(CiMO)! This product introduces your students to the concepts and
skills they will need for a successful career in medical office billing.
Medical billers are in high demand, and theirs remains one of the
ten fastest-growing allied health/health profession occupations.
CiMO provides instruction on key tasks that students throughout
the health professions curriculum, such as those studying medical
assisting, health information management, and health information
technology, will need to be competent and to move forward. Teach-
ing this material to your students may be challenging because of
the diverse student population that takes this course—some stu-
dents may be very technology-savvy and move through the book
quickly, while others may be computer novices and need more help.
No matter what your students’ skill levels are, CiMO gives not only
the step-by-step instructions they need to learn, but also the “why”
behind those steps.
CiMO is now available with McGraw-Hill Education’s revolutionary
adaptive learning technology, SmartBook®! You can study smarter,
spending your valuable time on topics you don’t know and less
time on the topics you have already mastered. Succeed with Smart-
Book . . . Join the learning revolution and achieve the success you
deserve today!
Here’s what you and your students can expect from CiMO:
• Coverage of Medisoft® Advanced Version 19 patient billing
software, a full-featured software program, including screen
captures showing how the concepts described in the book actu-
ally look in the medical billing software.

• Both a tutorial and a simulation of Medisoft, using a medical
office setting, Family Care Center, and related patient data.
• Detailed, easy-to-understand explanations of concepts balanced
by step-by-step, hands-on exercises, which can be completed
using McGraw-Hill Connect® or the Medisoft software.
• The necessary building blocks for students to establish a strong
skill set and gain confidence to attain the jobs they want.
xi
• Realistic exercises, completed via simulations in Connect or by
using Medisoft, that cover what students will see working in
actual medical practices, no matter what software those prac-
tices might use.
• An understanding of the medical billing cycle and how com-
pleting the related tasks will positively affect the financial
well-being of a medical practice.
ORGANIZATION OF CiMO, 9E
CiMO is divided into four parts:
Part Coverage
1: Introduction to Discusses the changes taking place in the field of

Computers in the healthcare. Covers the medical documentation and
Medical Office billing cycle and the role that computers play in
that cycle. Also covers the use of health
information technology, electronic health records,
HIPAA, the HITECH Act, and the Patient Protection
and Affordable Care Act.
2: Medisoft Advanced Teaches the student how to start Medisoft;

Training schedule appointments, enter patient information;
work with cases; enter charges, payments, and
adjustments; create claims; post insurance
payments; create patient statements; create
reports; and create collection letters. The
sequence takes the student through Medisoft
in a clear, concise manner. Each chapter includes
a number of exercises that are to be done at
the computer.
3: Applying Your Skills Completes the learning process by requiring

the student to perform a series of tasks using
Medisoft. Each task is an application of
knowledge required in the medical office.
4: Source Documents Gives the student the data needed to complete

the exercises. The patient information form,
encounter form, and other forms are similar to
those used in medical offices.
NEW TO THE NINTH EDITION!

The ninth edition of CiMO has been updated to reflect changes that
have occurred in the healthcare field since the last edition, includ-
ing the effects of the Affordable Care Act on physician practices
and the billing specialist in particular. A greater number of
Americans have health insurance, which means more office visits,
especially for family care providers. Patients are responsible for a
greater share of physician payments, requiring physician practices
to collect at the time of service and carefully monitor overdue patient
xii preface
accounts. New physician payment models reward the quality of
service provided, often measured by patient outcomes, rather than
the quantity of services provided. While we introduced ICD-10-CM
codes in the previous edition of CiMO, this edition we are adding
back ICD-9-CM codes for those instructors who would like students
to experience both sets of codes. An ICD mapping utility is also
available in Medisoft Version 19, which is used in this new edition!
Key content changes include:
• Medisoft
• Medisoft Version 19 is used for all databases and illustrations
(screen captures).
• ICD-9-CM and ICD-10-CM codes are included in the diagnosis
code database.
• Exercises now take place in 2018 and 2019.
• Medisoft exercises can be completed using live software via
CD-ROM or in simulated form via Connect.
• HIPAA/Federal Legislation-Related
• Updated information on the effects of HITECH Act more
than five years after its passage.
• Coverage of the major provisions of the Affordable Care Act
and its implications for physician practices.
• Coverage of updates to HIPAA Privacy and Security Rules.
• Pedagogy
• New “Be the Detective” feature. Video Cases with assessment
questions are available in Connect to test students’ critical
thinking skills.
• Technology
• Connect has been updated to reflect changes in the chapters
and feedback from customers, including the new “Be the
Detective” video cases.
• CiMO is now available with SmartBook, an adaptive learning
product.
• Chapter-by-Chapter
• Chapter 1: New key terms: after-visit summary, audit, breach,
bundled payments, business associate, electronic protected
health information (ePHI), electronic remittance advice, fee-for-
service, HIPAA Omnibus Rule, Notice of Privacy Practices,
patient portal; revised introduction with less emphasis on ris-
ing medical costs and more emphasis on quality measures;
updated content on the success of the HITECH Act and the
number of physicians using electronic health records; new
preface xiii
c ontent on the major provisions of the Affordable Care Act and
how it affects physician practices; updated coverage of new
models of healthcare including accountable care o rganizations,
patient-centered medical homes, pay-for-performance, and
bundled payments; additional coverage of how HITECH, ACA,
and the HIPAA Omnibus Rule affected HIPAA rules; updated
Notice of Privacy Practices; updated HIPAA enforcement,
breaches, and monetary penalties.
• Chapter 2: Updated for Medisoft Version 19.
• Chapter 3: Updated Electronic Health Record Exchange fea-
ture to reflect new interface between Medisoft and Medisoft
Clinical; now McKesson Practice Interface Center (MPIC) was
Communication Manager.
• Chapter 4: Updated the Race, Ethnicity, and Language fields
in the Patient/Guarantor dialog box; updated Electronic Health
Record Exchange feature to reflect new interface between
Medisoft and Medisoft Clinical; now McKesson Practice Inter-
face Center (MPIC) was Communication Manager.
• Chapter 5: Added content to cover new fields in the Miscel-
laneous tab of the Case folder for completing boxes on the
CMS-1500 (02/12) form; updated Electronic Health Record
Exchange feature to reflect updated Unprocessed Transac-
tions Edit screen.
• Chapter 6: Updated Electronic Health Record Exchange fea-
ture to reflect updated Unprocessed Transactions Edit screen.
• Chapter 7: Updated information on types of health plans to
reflect changes in the health insurance market; updated chart
showing enrollment in employer-sponsored health plans by
type; updated to final version of CMS-1500 (02/12) form.
• Chapter 8: Updated practice fee schedule to accommodate
new CPT codes.
• Chapter 9: Updated process of entering dates so when creat-
ing reports, dates are now entered without slashes.
• Chapter 10: New learning objective: Demonstrate how to cre-
ate a payment plan and assign a patient account to a payment
plan; new content on creating payment plans in Medisoft;

new content on assigning a patient account to a payment
plan; updated chart on medical bill problems or medical
debt; new exercises 10-1 Creating a Patient Payment Plan and
10-2 Assigning a Patient Account to a Payment Plan.
• Chapters 11–14: Updated dates to 2018–2019
For a detailed transition guide between the eighth and ninth
editions of CiMO, visit the Instructor Resources in Connect.
xiv preface
TO THE INSTRUCTOR
McGraw-Hill knows how much effort it takes to prepare for a new
course. Through focus groups, symposia, reviews, and conversations
with instructors like you, we have gathered information about what
materials you need in order to facilitate successful courses. We are
committed to providing you with high-quality, accurate instructor
support.
USING MEDISOFT ADVANCED VERSION 19 WITH CiMO

CiMO features Medisoft Advanced Version 19 patient accounting
software. Students who complete CiMO find that the concepts and
activities in the textbook are general enough to cover most admin-
istrative software used by healthcare providers. McGraw-Hill has
partnered with Medisoft from the very beginning, going back
twenty years to when the software was DOS-based! The support
you receive when you are using a McGraw-Hill text with Medisoft
is second to none.
There are multiple options to complete the Medisoft exercises.
1. Students complete the exercises in live Medisoft. In this option,
the Medisoft software is installed from a CD onto the computer
and the Student Data File is downloaded from the book’s web-
site and installed onto the computer.
2. Students complete simulated versions of the exercises in
Connect, McGraw-Hill’s online assignment and assessment

solution. No installations or downloads are needed with this
option, and the Student Data File is built into the exercises.
For the CD option, your students will need the following:
• Minimum System Requirements

• Pentium 4
• 1.0 GHz (minimum) or higher processor
• 500 MB available hard disk space
• 1 GB RAM
• 32-bit color display (minimum screen display of 1024 3 768)
• Windows 7 Professional or Ultimate 32- or 64-bit
• Windows 8 Professional 32- or 64-bit
• External storage device, such as a USB flash drive, for storing

backup copies of the working database
• Medisoft Advanced Version 19 patient billing software

• Student patient data, available for download from www.mhhe
.com/medisoft (More details on how to download the software
can be found on the STOP pages between Chapters 1 and 2.)
preface xv
Instructor’s Software: Medisoft Advanced Version 19 CD-ROM
Instructors who use McGraw-Hill Medisoft-compatible titles in
their courses may request a fully working version of Medisoft
Advanced Version 19 software, which allows a school to place
the live software on laboratory or classroom computers. Only
one copy is needed per campus location. Your McGraw-Hill
sales representative will help you obtain Medisoft for your
campus.
Another option is the Student At-Home Medisoft Advanced Version
19 CD (1259671747, 9781259671746), a great option for online courses
or students who wish to practice at home. Available individually or
packaged with the textbook—it’s up to you!
For the Connect option, your students will complete all of the
Medisoft exercises from Chapters 2–14 in the online solution.
Each exercise has the following modes for you to assign as desired:
• Demo Mode—watch a demonstration of the exercise.
• Practice Mode—try the exercise yourself with guidance.
• Test Mode—complete the exercise on your own.
For each Medisoft exercise, the same data are used for all of the
modes in order to reinforce the skills being taught in that exercise.
This is a proven learning methodology.
The Connect course for CiMO, 9e also contains all of the end-of-
chapter exercises, as well as some simple interactives for each
chapter and the new Be the Detective video cases.
Much more information on how to work with each of the Medi-
soft options, including detailed screenshots, can be found in the
McGraw-Hill Guides to Success at www.mhhe.com/medisoft and
in the Instructor Resources under the Library tab in Connect.
One guide covers the following topics: software installation pro-
cedures for both the Instructor Edition and Student At-Home
Edition of Medisoft; Student Data File installation procedures;
use of flash drives; backup and restore processes; the other one
focuses on Connect functionality as well as details on Demo,
Practice, and Test Modes; both contain information on tips and
frequently asked questions; instructor resources; and technical
support.
DIGITAL RESOURCES
Knowing the importance of flexibility and digital learning, McGraw-
Hill Education has created multiple assets to enhance the learning
experience no matter what the class format: traditional, online, or
hybrid. This product is designed with digital solutions to help
instructors and students be successful.
xvi preface
Learn Without Limits: Connect ®
Connect is proven to deliver better results for students and instruc-

tors. Proven content integrates seamlessly with enhanced digital
tools to create a personalized learning experience that drives efficient
and effective learning by delivering precisely what they need, when
they need it. With Connect, the educational possibilities are limitless.
The new release of Connect features a continually adaptive reading
experience, integrated learning resources, a visual analytics dash-
board, and anywhere/anytime mobile access that empower students
so that your class-time is more engaging and effective.
Connect Is the Easiest Integrated Learning System to Use Technol-
ogy can simplify everyday lives when the user’s needs are placed
at the forefront. Year after year, satisfied instructors continue using
Connect for many reasons, but the most frequently cited reason:
“It’s easy-to-use.” The latest release of Connect continues in this
tradition by introducing complete mobile access, online and offline
access, as well as an improved, streamlined user interface. When
combined with Connect’s flexible functionality, seamless systems
integration and comprehensive training and support, it’s no wonder
that Connect remains the most frequently used and recommended
integrated learning system.
✓ Mobile [NEW]: Students and instructors can now enjoy conve-
nient anywhere/anytime access to Connect with a new mobile
interface that’s been designed for optimal use of tablet function-
ality. More than just a new way to access Connect, users can
complete assignments, check progress, study and read material,
with full use of SmartBook and Connect Insight®, Connect’s new
at-a-glance visual analystics dashboard.
✓ User Interface Redesign [NEW]: With a focus on clarity for
users, a redesigned user interface features a seamless integra-
tion of learning tools, placing most important priorities in the
forefront. Our redesign continues to put our users first—a hall-
mark of the Connect platform—and deliver a tool that fully
engages students and solves real-world teaching and learning
challenges.
✓ Flexible: Connect allows you to edit all existing content to
match the way you teach the course. You can upload your own
materials, including: Word documents, PowerPoint files, Excel

spreadsheets, and web links. You can also share your own
notes within our eBooks, record your lectures through Tegrity
lecture capture, include bookmarks, incorporate news feeds
and adjust assignment content within the platform.
✓ LMS Integration: Connect seamlessly integrates with every
learning management system on the market today. Quickly
access all course resources through a single login and simplify
preface xvii
registration, assignments, and gradebook reporting for your
students.
✓ Service, Support & Training: Connect customers receive com-
prehensive service, support, and training throughout every
phase of partnership with us. Customers can access our Cus-
tomer Experience Group at any time of day for immediate assis-
tance, access the Digital Success Academy for on-demand
training materials, and access the Connect Blog for tips on get-
ting up and running quickly.
✓ Our Digital Faculty Consultants are a network of passionate
educators, dedicated to advancing student learning through
educational technologies, resources, and collaboration opportu-
nities. This team of experienced Connect users is ready to help
fellow peers achieve the greatest success using the platform,
either 1:1 or in a group setting. In addition, help content is
accessible directly within the Connect platform to make it eas-
ier to get the help you need when you need it most.
Connect Is an Efficient and Effective Learning Tool for Instructors and
Students—With Connect, Users Get Better Results in Less Time Numer-
ous effectiveness studies conducted since the first release of C
onnect
tell the same story:
Students are more likely to stay in class and get better grades when using
Connect. New visual analytics through Connect Insight now make
it possible for instructors and students to get an instant perspective
on what’s happening in class with the tap of a finger. For those who
want a more in-depth picture, powerful reporting capabilities
within Connect make it easy for instructors to keep students on
track and inspire them to succeed.
Learn more at http://connect.mheducation.com!
Learning at the speed of you: Smartbook

Connect’s Superior Adaptive Technology ‘Fills the Knowledge Gap’ and
Empowers Students Outside of Class for a More Engaging and Interactive
Experience in Class Connect builds student confidence outside of
class with adaptive technology that pinpoints exactly what a stu-
dent knows and what they don’t, and then seamlessly offers up
learning resources within the platform that are designed to have
the greatest impact on that specific learning moment. With Smart-

Book, reading is an interactive and dynamic experience in which
content is tailor-made for each student. Built with the unique
LearnSmart® adaptive technology, it focuses not only on addressing
learning in the moment, but empowers students by helping them
retain information over time, so that they are more prepared and
engaged in class.
✓ LearnSmart: More than 2 million students have answered
more than 1.3 billion questions in LearnSmart since 2009,
xviii preface
aking it the most widely used and intelligent adaptive study
m
tool available on the market today. LearnSmart is proven to
strengthen memory recall, keep students in class, and boost
grades—students using LearnSmart are 13% more likely to
pass their classes, and 35% less likely to dropout.
✓ SmartBook [New Capabilities]: SmartBook makes study time
as productive and efficient as possible. It identifies and closes
knowledge gaps through a continually adapting reading
experience that provides personalized learning resources at the
precise moment of need. This ensures that every minute spent
with SmartBook is returned to the student as the most
value-added minute possible. The result? More confidence,

better grades, and greater success.
✓ Adapts at the Learning Objective Level: All material within
any Connect product or capability (including SmartBook) has
been tagged at the learning objective level. What this means is
that the adaptive experience for students is intimately person-
alized in a very precise way. In addition, any analysis tools
(Connect Insight and reports) are also able to present perfor-
mance data by learning objective. Connect is the only integrated
learning system that features this precise level of adaptive and
analysis precision.
Go to www.LearnSmartAdvantage.com for more information!
Record and distribute your lectures for multiple viewing:

My Lectures—Tegrity
Tegrity records and distributes your class lecture with just a click
of a button. Students can view it anytime and anywhere via com-
puter, iPod, or mobile device. It indexes as it records your Power-
Point presentations and anything shown on your computer, so
students can use keywords to find exactly what they want to study.
Tegrity is available as an integrated feature of Connect and as a
stand-alone product.
A single sign-on with Connect and your Blackboard

course: McGraw-Hill Education and Blackboard—for a
premium user experience
Blackboard, the web-based course management system, has part-
nered with McGraw-Hill Education to better allow students and

faculty to use online materials and activities to complement face-
to-face teaching. Blackboard features exciting social learning and
teaching tools that foster active learning opportunities for students.
You’ll transform your closed-door classroom into communities
where students remain connected to their educational experience
24 hours a day. This partnership allows you and your students
access to Connect and McGraw-Hill Create™ right from within your
Blackboard course—all with a single sign-on. Not only do you
preface xix
get single sign-on with Connect and Create, but you also get deep
integration of McGraw-Hill Education content and content engines
right in Blackboard. Whether you’re choosing a book for your course
or building Connect assignments, all the tools you need are right
where you want them—inside Blackboard. Gradebooks are now
seamless. When a student completes an integrated Connect assign-
ment, the grade for that assignment automatically (and instantly)
feeds into your Blackboard grade center. McGraw-Hill Education
and Blackboard can now offer you easy access to industry leading
technology and content, whether your campus hosts it or we do. Be
sure to ask your local McGraw-Hill Education representative for
details.
Still want a single sign-on solution and using another

Learning Management System?
See how McGraw-Hill Campus® makes the grade by offering uni-
versal sign-on, automatic registration, gradebook synchronization,
and open access to a multitude of learning resources—all in one
place. MH Campus supports Active Directory, Angel, Blackboard,
Canvas, Desire2Learn, eCollege, IMS, LDAP, Moodle, Moodlerooms,
Sakai, Shibboleth, WebCT, BrainHoney, Campus Cruiser, and Jenzi-
bar eRacer. Additionally, MH Campus can be easily connected with
other authentication authorities and LMSs. Visit http://mhcampus
.mhhe.com/ to learn more.
Assemble a textbook organized the way you teach:

McGraw-Hill Create
With Create, you can easily rearrange chapters, combine material
from other content sources, and quickly upload content you have
written, such as your course syllabus or teaching notes. Find the
content you need in Create by searching through thousands of
leading McGraw-Hill Education textbooks. Arrange your book to
fit your teaching style. Create even allows you to personalize
your book’s appearance by selecting the cover and adding your
name, school, and course information. Order a Create book and
you’ll receive a complimentary print review copy in 3 to 5 busi-
ness days or a complimentary electronic review copy via e-mail
in minutes. Go to http://create.mheducation.com today and reg-
ister to experience how Create empowers you to teach your stu-

dents your way.
Need help? Contact the McGraw-Hill Education Customer

Experience Group (CXG)
Visit the CXG website at www.mhhe.com/support. Browse our
FAQs (frequently asked questions) and product documentation and/
or contact a CXG representative.
xx preface
ADDITIONAL INSTRUCTORS’ RESOURCES
You can rely on the following materials to help you and your s tudents
work through the material in the book, all of which are available in
the Instructor Resources under the Library tab in Connect: (available
only to instructors who are logged into Connect)
Supplement Features
Instructor’s Manual —Answer keys for all exercises

(organized by Learning —Documentation of steps and screenshots for Medisoft exercises
Outcomes)
PowerPoint —Key terms

Presentations (organized —Key concepts
by Learning Outcomes)
Electronic Testbank —EZ Test Online (computerized)

—Word version
—Questions have tagging for Learning Outcomes, level of difficulty, level of
Bloom’s Taxonomy, topic, and the accrediting standards of ABHES, CAAHEP, and
CAHIIM where appropriate
Tools to Plan Course —Correlations of the Learning Outcomes to accrediting bodies such as CAHIIM,
ABHES, and CAAHEP
—Sample syllabi and lesson plans
—Conversion guide for CiMO, 8e to CiMO, 9e
—Asset map—a recap of the key instructor resources, as well as information on
the content available through Connect
Medisoft Advanced —Implementation Guides for Live and Simulated Medisoft

Version 19 Tools —Technical support information
—First day of class PowerPoint presentation
—Installation videos and directions
—Student Data File
—Backup and restore videos, directions, and files for live Medisoft use. (The
Medisoft backup files are an important resource if students make mistakes with
their data and you want them to have the correct data to start the next chapter.)
—Certificate of completion
Case Studies for use with This book provides a capstone simulation using Medisoft Advanced Version 19.
Computers in the Medical It offers students enhanced training that is meant to improve their qualifications
Office, 9e for a variety of medical office jobs. Extensive hands-on practice with realistic
source documents teaches students to input information, schedule appointments,
*NOTE: The exercises in and handle billing, reports, and other essential tasks. The book provides
this book can be only additional activities, including more complex activities for advanced students.
completed with the live On the website you will find:
Medisoft software. They —Instructor’s Manual with sample syllabi and answer keys
are not available in —PowerPoint presentations
Connect. —Conversion guides
—Correlations to accrediting bodies
—Asset Map
—Information on how to load Student Data File for this book and CiMO at the
same time
preface xxi
Want to learn more about this product? Attend one of our online
webinars. To learn more about the webinars, please contact your
McGraw-Hill sales representative. To find your McGraw-Hill repre-
sentative, go to shop.mheducation.com and click “Find Your Learn-
ing Technology Representative” on the “CONTACT US” page.
xxii preface
about
the author
Susan M. Sanderson has authored all Windows-based editions
of Computers in the Medical Office. She has also written Case Studies
for use with Computers in the Medical Office, Electronic Health Records
for Allied Health Careers, and Practice Management and EHR: A Total
Patient Encounter for Medisoft® Clinical.
In her more than fifteen years’ experience with Medisoft, Susan has
participated in alpha and beta testing, worked with instructors to
site-test materials, and provided technical support to McGraw-Hill
customers.
In 2009, Susan earned her CPEHR (Certified Professional in Elec-
tronic Health Records) certification. In addition, she is a member of
the Healthcare Information and Management Systems Society
(HIMSS) and the eLearning Guild. Susan is a graduate of Drew
University with further study at Columbia University.
xxiii
acknowledgments
Suggestions have been received from faculty Sharon Breeding
and students throughout the country. This is Bluegrass Community and Technical
vital feedback that is relied upon with each College
edition. Each person who has offered com-
Susan M. Bremer, MS, RHIA
ments and suggestions has our thanks.
Central Lakes College
The efforts of many people are needed to
Renae V. Brown, M.ED
develop and improve a product. Among these
Essex County College
people are the reviewers and consultants who
point out areas of concern, cite areas of strength, Debra Charles, RHIA, CCS, CCS-A
and make recommendations for change. In this Front Range Community College
regard, the following instructors provided
Jean M. Chenu, MSEd
feedback that was enormously helpful in pre-
Genesee Community College
paring the ninth edition of CiMO.
Amanda Davis-Smith, CPC, NCMA
Jefferson Community and Technical College
SURVEYS Denise J. DeDeaux, MBA
A number of instructors teaching in this course Fayetteville Technical Community College
area participated in a survey to help guide the
Bobbi J Fields, CMA (AAMA), MPA, BS-HA
revision of the book and related materials.
Moraine Park Technical College
Monika Bell, CMA
Savanna Garrity, CPC, MPA
Monterey Peninsula College
Madisonville Community College
Chantalle Blakesley-Boddie, BS, CMA
Sheila Guillot, MSEd, CAP
Lake Washington Institute of Technology
Lamar State College-Port Arthur
Amy L. Blochowiak, MBA, ACS, AIAA,
Howard Gunning, MSEd, CMA (AAMA)
AIRC, ARA, FLHC, FLMI, HCSA, HIA,
Southwestern Illinois College
HIPAA, MHP, PCS, SILA-F
Northeast Wisconsin Technical College Alice Kathryn Hansen, BS, CPC, REEGT
Bluegrass Community and Technical
Jennifer K. Boles, MSN, RN
College
Cincinnati State Technical and Community
College Lisa Huehns, MAEd
Lakeshore Technical College
Dr. Tammie Bolling, CBCS, CHI, CMAA,
MOS, CEHRS, CHITS-TR Shalena Jarvis, RHIT, CCS
Pellissippi State Community College Hazard Community and Technical College
Donna W. Brantley, CCS-P Diana Johnson, CMA (AAMA), RMA, RPT
Nash Community College Medical Professional Institute
xxiv
NaTunya D. Johnson, EdS J. Ashleigh Spear, RN
Holmes Community College Blue Ridge Community and Technical
College
Michelle Jubeck
Blackhawk Technical College Slavica Tumminelli, CPC, CGSC, CHI,
CBCS, CEHRS
Jean M. Kindrick, MEd
Advantage Career Institute
Fox College
Elizabeth Wanielista, M.Ed
Keita Kornegay, BS Valencia College
Wilson Community College
Colette Washington, DME, MEd, CMA-R,
Marta Lopez, MD, LM, CPM, RMA, BMO CPC, RHIA
Miami Dade College Southeastern School of Health Sciences
Barbara Marchelletta, CMA (AAMA), Jodi Wijewickrama, RHIA
RHIT, CPC, CPT Haywood Community College
Beal College
Dana Woods, CMA (AAMA)
Suzanne Mays, BS, MSH, MSIT Southwestern Illinois College
University of Phoenix
Bettie Wright, MBA, CMA (CCMA)
Tina Mazuch, MS, RHIA Umpqua Community College
Northeast Community College
LaQuinta S. Yates, M.Ed
Vonadean McFarland, BS Trident Technical College
Salt Lake Community College Virginia V. York, MD
Revel Metzger, MAE Ohio Business College
Elizabethtown Community & Technical
College
TECHNICAL EDITING/ACCURACY
Jane O’Grady MSEd, RN, CMA, CPC PANEL
Northwestern CT Community College
A panel of instructors completed a technical
Tatyana Pashnyak, M.Ed, CHIS-TR, COI edit and review of all of the content in the
Bainbridge State College book page proofs to verify its accuracy, espe-
Mitzi Poore, BS, MA cially in relation to Medisoft.
Surry Community College Renae V. Brown, M.Ed
Leslie Quinn, RMA Essex County College
Eastern Florida State College Jean M. Chenu, MSEd
Kimberly K. Rash Genesee Community College
Gateway Community & Technical College Savanna Garrity, MPA, CPC
Lisa Rocks, M.Ed Madisonville Community College
Allegany College of Maryland Keita Kornegay, BS

Joni Schlatz, MS, RHIT Wilson Community College
Central Community College Tatyana G. Pashnyak, MEd, CHIS-TR, COI
Karen K. Smith, M.Ed, RHIA, CPC Bainbridge State College
University of Arkansas for Medical Kimberly K. Rash
Sciences Gateway Community and Technical College
Helen Spain, M.Ed Lisa Rocks, M.Ed.
Wake Technical Community College Allegany College of Maryland
acknowledgments xxv
DIGITAL PRODUCTS Patricia Hamilton, BS
Pittsburgh Technical Institute
Several instructors helped author and review
the digital content for Connect, SmartBook, Judy Hurtt, MEd
and more! East Central Community College
Monika Bell, CMA Tatyana Pashnyak, M.Ed, CHIS-TR, COI

Monterey Peninsula College Bainbridge State College
Shauna Phillips, RMA
Chantalle Blakesley-Boddie, BS, CMA
Fortis College
Lake Washington Institute of Technology
Wendy Schmerse, CMRS
Jennifer K. Boles MSN, RN
Southern California Health Institute
Cincinnati State Technical & Community
College Karen K. Smith, M.Ed
University of Arkansas
Denise J. DeDeaux, MBA
Fayetteville Technical Community College Angela M.B. Oliva, BSHA
Heald College
Amy Ensign, BHSA
Gina F. Umstetter, BA
Baker College of Clinton Township
Delta College of Arts & Technology
Savanna Garrity, MPA, CPC Deborah Zenzal, MS
Madisonville Community College Ameritech College
ACKNOWLEDGMENTS FROM THE AUTHOR

To the students and instructors who use this book, your feedback
and suggestions have made CiMO a better learning tool for all.
I especially want to thank the editorial team at McGraw-Hill—Chad
Grall, Bill Lawrensen, and Michelle Flomenhoft—for their enthusi-
astic support and their willingness to go the extra mile to take a
successful book to the next level.
Hats off to the Customer Experience Group at McGraw-Hill for provid-
ing outstanding technical assistance to students and instructors. In
addition, thank you to Katie Ward for her help on the digital front.
The CDD staff was also outstanding; senior designer Srdj Savanovic
created a terrific updated interior design and fantastic cover design,
which was implemented through the production process by Vicki
Krug, content project manager; Laura Fuller, buyer; Lori Hancock
and Lorraine Buczek, content licensing specialists; and Brent dela
Cruz, content project manager.
This book would not be in its ninth edition were it not for the t ireless
efforts of Roxan Kinsey, Executive Marketing Manager, who believed
in Computers in the Medical Office and Medisoft from day one.
A big thanks also goes to Amy Blochowiak for her help on the
Medisoft simulations!
Finally, I would like to thank Cynthia Newby of Chestnut Hill Enter-
prises, Inc., for providing wisdom and support throughout the years.
This book is truly the result of a group effort.
xxvi acknowledgments
part 1
INTRODUCTION TO
COMPUTERS IN THE
MEDICAL OFFICE
Chapter 1:
Introduction to Health Information Technology and Medical Billing
chapter 1
INTRODUCTION
TO HEALTH
INFORMATION
TECHNOLOGY
AND MEDICAL
BILLING
key terms learning outcomes

accountable care When you finish this chapter, you will be able to:
organization (ACO)
1.1 Explain the major changes taking place in the healthcare
adjudication
field.
Affordable Care Act
1.2 Describe the functions of practice management programs.
(ACA)
after-visit summary (AVS) 1.3 Identify the core functions of electronic health record
programs.
audit
1.4 List the step in the medical documentation and billing
audit trail
cycle that occurs before a patient encounter.
breach
1.5 List the steps in the medical documentation and billing
bundled payments
cycle that occur during a patient encounter.
business associate
1.6 List the steps in the medical documentation and billing
clearinghouse
cycle that occur after a patient encounter.
coding
1.7 Discuss how the HIPAA Privacy Rule and Security Rule
covered entity protect patient health information.
Current Procedural
Terminology (CPT®)
diagnosis
diagnosis code
documentation
electronic data
interchange (EDI)
electronic health record
(EHR)
electronic prescribing
electronic protected health
information (ePHI)
2
1.1 THE CHANGING HEALTHCARE key terms continued
LANDSCAPE electronic remittance
In the United States, the healthcare system is in a period of ongoing advice (ERA)
upheaval, as government legislation changes the way individuals encounter form
buy, access, and pay for medical care. Over the past decade, it explanation of benefits
became obvious that major reform was needed. Survey after survey (EOB)
reported that while the United States spends more than any other fee-for-service
country on healthcare, it ranks below most other countries on qual- HCPCS
ity and outcome measures. According to the Commonwealth Fund, health information
the U.S. spent $8,508 per person on healthcare in 2011—more than technology (HIT)
twice the $3,406 the United Kingdom spent, which ranked first Health Information
overall in quality. Despite spending more, the U.S. ranks last over- Technology for Economic
all among 11 industrialized countries on measures of quality, effi- and Clinical Health
ciency, access to care, equity, and healthy lives (see Table 1-1). (HITECH) Act
Health Insurance Portability
Beginning in 2009, in an attempt to rein in spending and improve and Accountability Act of
overall quality, the federal government—the largest payer for 1996 (HIPAA)
HIPAA Omnibus Rule
HIPAA Privacy Rule
TABLE 1-1 U.S. Healthcare Rankings HIPAA Security Rule
International Classification
Category U.S. Ranking of Diseases, Ninth
Revision, Clinical
Healthy lives The U.S. ranks last on infant mortality, last on Modification (ICD-9-CM)
deaths that were potentially preventable if the
person had timely access to care, and next-to-last International Classification
on healthy life expectancy at age 60. of Diseases, Tenth
Revision, Clinical
Access to care The U.S. ranks last on every measure of cost-related Modification (ICD-10-CM)
access to healthcare. Individuals are not receiving a meaningful use
recommended test, treatment, or follow-up care over
medical documentation
one-third of the time because of cost.
and billing cycle
Healthcare The U.S. ranks near the top on providing effective Notice of Privacy
quality care and patient-centered care, while it does not Practices
perform as well when it comes to providing safe or patient-centered medical
coordinated care. home (PCMH)
patient information form
Efficiency The U.S ranks last, due to the amount of time spent
on insurance administration, the lack of communication patient portal
among healthcare providers, and duplicate medical practice management
tests performed by more than one provider. programs (PMP)

procedure
Equity The U.S. ranks last. Almost 40 percent of adults
with below-average incomes reported a medical procedure code
problem but did not visit a doctor because of costs. protected health
Individuals with lower incomes also had to wait information (PHI)
longer to receive certain types of care, such as
seeing a specialist.
remittance advice (RA)
revenue cycle
[Source: K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 management (RCM)
Update: How the U.S. Health Care System Compares Internationally, The Commonwealth Fund,
June 2014.]
Chapter 1 Introduction to Health Information Technology and Medical Billing 3

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The empress Elizabeth had a passion for building; Peter the
Great’s summer palace and even the empress Anna’s winter palace
appeared to her small and confined. Upon the site of the latter she
began to build the present edifices; during her reign was also built
the vast, elegant, and beautiful palace at Tsarskoi Selo; the palace of
Oranienbaum was reconstructed, and the fine churches of the
Smolni convent, of Vladimirskaia and of Nicholas Morskoi (in St.
Petersburg) were also erected. Some handsome private houses
were built by Elizabeth’s noblemen, and in general St. Petersburg,
which had not long before been a desert place, consisting chiefly of
wooden houses, became greatly embellished; the palace quay, as
may be seen from drawings and engravings of the time, already
showed a continuous row of huge stone edifices.
Of course all these buildings cost enormous sums which led
private persons into debt and the government into superfluous
expenditure, but it is impossible not to observe that there was to be
seen in this luxury an artistic quality which had never before existed.
The finest edifices of that period form a special style, which after
temporary neglect is now beginning to be imitated; the creator of this
style in Russia was Count Rastrelli—a foreigner, of whom, however,
Russia has the right to speak. The palaces and churches built by
Rastrelli merit description, and although painting at that time did not
represent a very high standard, yet the ceilings painted in
accordance with the fashion of the day, with bouquets of flowers and
mythological goddesses, even now attract the attention of artists.
The grandees gave high prices for pictures by foreign masters; their
houses became distinguished not only for their handsome façades
but also for the comfort of their interior arrangements; it would hardly
be possible, for instance, to imagine anything more nobly elegant
than the house of the chancellor Vorontzov (now the corps des
Pages).
All these beautiful architectural productions, and likewise those of
music and painting, were for the greater part the work of foreign
artists—visitors to Russia; but under their influence Russian artists
were formed and taste developed. The church of Nicholas Morskoi
was built by a pupil of Rastrelli. The almost daily theatrical
representations produced at court gave rise to the idea of organising
similar representations at the corps des Cadets. The empress took a
lively interest in them; she often assisted at them and lent her
diamonds for the women’s costumes. In their turn these
representations could not but assist the development of a taste for
the stage, for dramatic art and literature in general and from amongst
the number of cadet actors not a few became well known writers, as
for instance Beketov, Kheraskov, and Sumarokov.
We must dwell for a few moments on Sumarokov—a man who in
his time enjoyed an extensive literary reputation and secured for
himself the appellation of Father of the Russian Stage. The love of
literature, and especially of the stage, was already developed in
Sumarokov when he was in the corps des Cadets; when he was
afterwards made aide-de-camp to Razumovski, he could almost
daily assist at operas and ballets. At that period he read with avidity
the dramatic authors then in fashion: Corneille, Racine, Voltaire, and
Molière became his idols; he decided to try to imitate them in his own
native language then very undeveloped, and in 1747 he wrote a
tragedy, the Chorists.
It was not the merits of this work, which were very insignificant, but
the unwontedness of the appearance of an original Russian tragedy,
and besides that the fact of its being in verse, that so astounded and
enraptured his contemporaries that they proclaimed Sumarokov the
“Russian Racine”; encouraged by such a success he wrote a second
and yet, a third tragedy; he took up comedy (for which he had hardly
any more vocation) and in fact wrote a whole repertory; there were,
however, no actors; because neither in St. Petersburg nor in Moscow
did there any longer exist such company and such theatres as were
begun in the time of Peter.
Meanwhile, far away from both capitals, in Iaroslav there was
formed, almost of itself without any commands or even any
encouragement being given, a Russian dramatic company which is
indissolubly bound up with the name of Volkov. Theodore Volkov was
the son of a merchant and had been educated in the Iaroslav
seminary, where, following the example of the Academy of Kiev, and
others, representations of a spiritual or religious character were
given. They produced a great impression upon the young merchant;
when later on he managed to get to St. Petersburg and saw on the
stage of the corps des Cadets a dramatic representation given with
scenery, lighting, and mechanical contrivances, Volkov was stupefied
with rapture and astonishment. Being to the highest degree sensitive
to every artistic impression, being a painter, a musician, and a
sculptor—all self-taught—Volkov was also endued with that
constancy and patience without which even gifted natures do not
attain to any results. Volkov studied the material side of scenic art to
the smallest details—that is, the arrangement of the machinery, of
the scenes, etc.; when he returned to Iaroslav he asked his parents,
with whom he lived, to let him have an empty tanner’s shed; there he
arranged a pit and a stage, and making up a company of young
merchants like himself, sons of citizens and clerks, gave
representations which aroused the enthusiasm of all the spectators.
The intelligent and practical Volkov, seeing how the population of
Iaroslav flocked to his representations, named a price for them—a
five kopeck piece for the first rows—and thus little by little he
amassed a sum with which in 1752 he was able to build a general
public theatre with room for one thousand spectators.
The taste for the stage had meanwhile greatly spread in St.
Petersburg; in various private houses dramatic representations were
given at evening parties; it was therefore not surprising that the
Iaroslav theatre soon began to be talked of. The empress invited
Volkov to come to St. Petersburg with his company, as she wished to
see his representations given on the stage of the court theatre. She
was remarkably pleased with them, and four years later issued an
ukase for the establishment of a public theatre. The first director of
this theatre and almost the only dramatic writer was Sumarokov;
according to the testimony of contemporaries Volkov was one of its
most talented actors and his friend and fellow worker Dmitrievski a
great artist.
We must here speak of another still more remarkable Russian
native genius—Lomonosov. It is well known how, when he was a
youth of sixteen, devoured by a thirst for knowledge, he secretly left
the paternal roof and made his way on foot from Kholmogori to
Moscow. How unattractive must life and learning have appeared to
him in those early days! “Having only one altyn (a three-kopeck
piece) a day for salary, it was impossible for him to spend more on
food than a halfpenny a day for bread and a halfpenny worth of
kvass (a kind of beer or mead); the rest had to go for paper, books,
and other necessities.” Thus he described his life in the
Zaikonospaskvi Ecclesiastical Academy to Ivan Shuvalov and
concluded with the following words: “I lived thus for five years and
did not abandon science!” Theodore Prokopovitch, when he was
already an old man, visited the Moscow academy a few years before
his death; he noticed Lomonosov there and praised him for his
laboriousness and learning. In 1737 Lomonosov was sent abroad to
perfect himself and placed himself under the surveillance of the then
famous scholar, Wolff, who, while despising him for his disorderly
life, spoke with respect of his capacities and success in study.
Lomonosov followed the lectures of the German professors and
amused himself with the German students. The news of Minikh’s
great victories and the taking of Khotin reached him; his patriotic
feelings were aroused, and he wrote an ode. When the verses were
received in St. Petersburg everyone was struck with their harmony;
and when Lomonosov returned from Germany in the beginning of
Elizabeth’s reign his reputation as a poet had already preceded him
—the more he wrote the greater his fame became. Poetry, however,
was not Lomonosov’s strongest point, and verses do not occupy a
quarter of his entire works. His mind worked even more than his
imagination, and his scholarly writings are striking in their variety. He
composed a grammar of the Russian language from which several
generations have learned; he laid down rules of versification, the
foundation of which are even now recognised by everyone; he wrote
on chemistry, physics, astronomy, metallurgy, geology; he composed
a Russian history, wrote a hypothesis concerning the great learned
expeditions and memoranda bearing on questions of the state (as for
instance measures for increasing and maintaining the population in
Russia): in fact, Lomonosov’s extraordinary intellect seemed to touch
upon every branch of mental activity. He was made a member of the
St. Petersburg Academy of Sciences, but there the German element
reigned supreme and Lomonosov was one of those who, while
venerating the work of Peter the Great and the European learning
introduced by him, yet was oppressed by foreign tutorage and took
offence when the Germans put forward their own countrymen to the
detriment of meritorious Russians. Continual disputes and quarrels
arose between Lomonosov and his fellow members; nor, being of a
very impetuous and obstinate nature, was Lomonosov always in the
right. His rough and sharp measures frequently led him into quarrels
even outside the academy, for instance with his literary brethren,
Frediakovski and Sumarokov. All this might greatly have injured
Lomonosov, but fortunately for him he possessed powerful
protectors in the persons of Count Worontzov and Count
Razumovski, who liked to show favour to the first Russian scholar
and poet.
But the strongest, truest, and most constant of his protectors was
Ivan Shuvalov. Shuvalov had many defects—his character was
weak, lazy, and careless; but he nevertheless represented one of the
most consolatory types of his epoch: strong, energetic types were
not uncommon in the first half of the eighteenth century, but gentle,
benevolent, indulgent natures were rarely to be met with. Shuvalov
was not captivated by clamorous deeds, like the men of Peter’s time,
but by the peaceful progress of science and art. Therefore if the
weakness of his character made him an instrument for the ambitious
designs of his cousin, his heartfelt sympathies drew him towards
Lomonosov, of whom he naturally learned much and—what is of
more importance—with whom he devised means for the spread of
education in Russia. The result of these deliberations was a vast
plan for the establishment of schools throughout the governments,
and finally of a university in Moscow. The establishment of a
university seemed of the first necessity, as it was to furnish Russia
with teachers; this had been Peter’s intention with regard to the
academy: but it had not been fulfilled. In his report to the senate
upon this subject, Shuvalov wrote that it would be desirable to
appoint a “sufficient number of worthy men of the Russian nationality,
acquainted with the sciences, to spread education in distant parts
among the common people, so that thus superstition, dissent, and
other like heresies proceeding from ignorance might be destroyed.”
The senate approved Shuvalov’s proposition and in 1755 the
University of Moscow was founded.
We have given as just and complete a picture of the period of the
empress Elizabeth as is possible in view of the scarcity of
information obtainable concerning many circumstances of that time.
Elizabeth left behind her if not a great memory yet, broadly speaking,
a good one. Her administration may be reproached with much: in its
foreign policy it was not sufficiently independent; it was not
sufficiently watchful in interior affairs, where oversights occasioned
special evils; moreover examples of unlawful enrichment attained
huge dimensions. But her reign may be said to have led Russia out
of bondage to the Germans, while the level of education was not in
the smallest degree lowered, but on the contrary considerably
raised. Much that brought forth such brilliant fruits under Catherine II
was sown under Elizabeth.d
Bain’s Estimate of Elizabeth
It is the peculiar glory of Elizabeth Petrovna that she consulted

once for all the life work of her illustrious father. During the first
fifteen years after the death of the great political regenerator, his
stupendous creation, Russia, (before him we only hear of Muscovy,)
was frequently in danger. The reactionary boyars who misruled the
infant empire under Peter II would have sacrificed both the new
capital and the new fleet, the twin pivots upon which the glory and
the prosperity of the new state may be said to have turned; the
German domination under the empress Anna, directly contrary as it
was to the golden rule of Peter, “Russia for the Russians,”
threatened the nation with a western yoke far more galling than the
eastern or Tatar yoke of ruder times. From this reaction, from this
yoke the daughter of Peter the Great set the nation free, and
beneath her beneficent sceptre Russia may be said to have
possessed itself again. All the highest offices of state were once
more entrusted to natives and to natives only, and whenever a
foreigner was proposed for the next highest, Elizabeth, before
confirming the appointment, invariably inquired: “Is there then no
capable Russian who would do as well?” Moreover she inherited
from her father the sovereign gift of choosing and using able
councillors, and not only did she summon to power a new generation
of native statesmen and administrators, but she constrained them to
work harmoniously together despite their mutual jealousies and
conflicting ambitions. She herself had advantageously passed
through the bitter but salutary school of adversity. With all manner of
dangers haunting her path from her youth upwards, she had learnt
the necessity of circumspection, deliberation, self-control; she had
acquired the precious faculty of living in the midst of people intent on
jostling each other, without in any way jostling them; and these great
qualities she brought with her to the throne without losing anything of
that infinite good-nature, that radiant affability, that patriarchal
simplicity which so endeared her to her subjects and made her,
deservedly, the most popular of all the Russian monarchs. As
regards her foreign policy, it may be safely affirmed she laid down
the deep and durable foundations upon which Catherine II was to
build magnificently indeed, but too often, alas! so flimsily. The
diplomacy of Elizabeth, on the whole, was not so confident or so
daring as the diplomacy of her brilliant successor; but, on the other
hand, it was more correct, equally dignified and left far less to
chance. It must also be borne in mind that the energy and firmness
of Elizabeth considerably facilitated the task of Catherine by
rendering Prussia, Russia’s most dangerous neighbour, practically
harmless to her for the remainder of the century. This of itself was a
political legacy of inestimable value, and it was not the only one. All
the great captains, all the great diplomatists of the “ever victorious
Catherine,” men like Rumiantsev, Suvarov, Riepnin, Besborodko, the
Panins and the Galitzins, were brought up in the school of Elizabeth.
Excellent was the use which the adroit and audacious Catherine
made of these instruments of government, these pioneers of empire,
but it should never be forgotten that she received them all from the
hands of the daughter of Peter the Great.g
PETER III (1762 A.D.)

As Elizabeth, on her death-bed, had confirmed the rights of Peter
III; and as the conspirators, deprived of Bestuzhev their guide, were
unable to act with energy, the new emperor encountered no
opposition. On the contrary, he was immediately recognised by the
military; and the archbishop of Novgorod, in the sermon preached on
the occasion, thanked heaven that a prince so likely to imitate his
illustrious grandfather was vouchsafed to Russia. Catherine was
present. She wore a peculiar dress to conceal her pregnancy, and
her countenance exhibited some indication of the anxious feeling
which she was obliged to repress. Compelled to defer the execution
of her ambitious purposes, and uncertain what vengeance the czar
might exert for her numerous infidelities, she might well be
apprehensive.
But she had no real foundation for the fear. Of all the sovereigns of
that or any age, Peter was among the most clement. Whether he
thought that clemency might bind to his interests one whose talents
he had learned to respect, or that her adherents were too numerous
and powerful to allow of her being punished—whether, in short, he
had some return of affection for her, or his own conscience told him
that she had nearly as much to forgive as he could have, we will not
decide. One thing only is certain—that, in about three months after
his accession, he invested her with the domains held by the late
empress. Certainly his was a mind incapable of long continued
resentment. His heart was better than his head. Resolved to
signalise his elevation by making others happy, he recalled all whom
his predecessor had exiled, except Bestuzhev. Many he restored to
their former honours and possessions. Thus the aged Munich was
made governor-general of Siberia, restored to his military command;
while Biron, who certainly deserved no favour, was reinvested with
the duchy of Courland. He did more: he restored the prisoners made
by the generals of Elizabeth, and gave them money to defray their
passage home. And, as Frederick had always been the object of his
idolatry, the world expected the armistice which he published, and
which was preparatory to a peace between the two countries.
That declaration was an extraordinary document. In it the emperor
declares that, his first duty being the welfare of his people, that
welfare could not be consulted so long as hostilities were continued;
that the war, which had raged six years, had produced no advantage
to either party, but done incredible harm to both; that he would no
longer sanction the wanton destruction of his species; that, in
conformity with the divine injunction relative to the preservation of
the people committed to his charge, he would put an end to the
unnatural, impious strife; and that he was resolved to restore the
conquests made by his troops. In this case he had been praised, and
with great justice, for his moderation. We fear, however, he does not
merit so high a degree of praise of humanity as many writers have
asserted. At this moment, while proclaiming so loudly his
repugnance to war, he was sending troops into his native principality
of Holstein, with the intention of wresting from the king of Denmark
the duchy of Schleswig, which he considered the rightful inheritance
of his family. He even declared that he would never rest until he had
sent that prince to Malabar.
Nor must we omit to add that
from the enemy he became the
ally of Frederick; that his troops
joined with the Prussians to
expel the Austrians from the
kingdom. His humanity only
changed sides; if it spared the
blood of Prussians, it had little
respect for that of Austrians. We
may add, too, that there was
something like madness in his
enthusiastic regard for
Frederick. He corresponded with
that monarch, whom he
Peter III proclaimed his master, whose
uniform he wore, and in whose
(1728-1762) armies he obtained the rank of
major-general. Had he been
capable of improvement, his
intercourse with that far-sighted prince might have benefited him.
Frederick advised him to celebrate at Moscow his coronation—a rite
of superstitious importance in the eyes of the multitude. He was
advised, too, not to engage in the Danish war, not to leave the
empire. But advice was lost on him.
In some other respects, Peter deserves more credit than the
admirers of Catherine are willing to allow him. (1) Not only did he
pardon his personal enemies—not only did the emperor forget the
wrongs of the grand duke—but on several he bestowed the most
signal favours. He suppressed that abominable inquisitorial court,
the secret chancery, which had consigned so many victims to
everlasting bondage, which had received delations from the most
obscure and vicious of men, which had made every respectable
master of a family tremble lest his very domestics should render him
amenable to that terrible tribunal. Had this been the only benefit of
his reign, well would he have been entitled to the gratitude of Russia.
(2) He emancipated the nobles from the slavish dependence on the
crown, so characteristic of that barbarous people. Previous to his
reign, no boyar could enter on any profession, or forsake it when
once embraced, or retire from public to private life, or dispose of his
property, or travel into any foreign country, without the permission of
the czar. By breaking their chains at one blow, he began the career
of social emancipation. (3) The military discipline of the nation loudly
demanded reform, and he obeyed the call. He rescued the officers
from the degrading punishments previously inflicted; he introduced a
better system of tactics; and he gave more independence to the
profession. He did not, however, exempt the common soldier from
the corporal punishment which at any moment his superior officers
might inflict. (4) He instituted a useful court to take cognisance of all
offences committed against the public peace, and to chastise the
delinquencies of the men entrusted with the general police of the
empire. (5) He encouraged commerce, by lessening the duties on
certain imports, and by abolishing them on certain exports. (6) In all
his measures, all his steps, he proved himself the protector of the
poor. In fact, one reason for the dislike with which he was regarded
by the nobles arose from the preference which he always gave to the
low over the high.
Impolitic Acts of Peter III

But if impartial history must thus eulogise many of this monarch’s
acts, the same authority must condemn more. He exhibited
everywhere great contempt for the people whom he was called to
govern. He had no indulgence for their prejudices, however
indifferent, however inveterate. Thus, in commanding that the
secular clergy should no longer wear long beards, and should wear
the same garb as the clergy of other countries, he offended his
subjects to a degree almost inconceivable to us. In ordering the
images to be removed from the churches—he was still a Lutheran, if
anything—he did not lessen the odium which his other acts had
produced. The archbishop of Novgorod flatly refused to obey him,
and was in consequence exiled; but the murmurs of the populace
compelled the czar to recall him. Still more censurable were his
efforts to render the church wholly dependent on the state—to
destroy everything like independence in its ministers; to make
religion a mere engine in the hands of arbitrary power for the
attainment of any object. His purpose, in fact, was to seize all the
demesnes of the church—its extensive estates, its numerous serfs—
and to pension the clergy like other functionaries.
In the ukase published on this occasion, he expressed a desire to
relieve ecclesiastics of the temporal cares so prejudicial to their
ghostly utility; to see that they indeed renounced the world, and free
from the burden of perishing treasures, applied their whole attention
to the welfare of souls. He therefore decreed that the property of the
church should in future be managed by imperial officers; and that the
clergy should receive, from the fund thus accumulated, certain
annual pensions, corresponding to their stations. Thus the
archbishops of Novgorod, Moscow, and St. Petersburg were to have
each 2,500 rubles; and the same sum was to be allowed for the
support of their households, of their capitular clergy, and for the
sustentation of the sacred edifices. But the twenty-three other
archbishops and bishops were to have only 3,000 rubles for both
purposes. The salaries of the other ecclesiastics were carefully
graduated. The inferior were divided into three classes—individuals
of the first to receive 500, of the second 300, of the third 150 rubles
per annum. The surplus funds were to be applied to the foundation
of hospitals, to the endowment of colleges, and to the general
purposes of the state.
Peter attempted these and other innovations in virtue of the two-
fold character which, from the time of his grandfather, the czars had
been anxious to assume, as supreme heads alike of religion and of
the state. Not even the grand lama of Thibet ever arrogated a higher
degree of theocratic authority. Indeed, our only surprise is that in
addition to their other functions they did not assume that of bishops;
that they did not array themselves in pontificals, and celebrate mass
at the altar. But they certainly laid something like a claim to the
sacerdotal character. Thus, on the death of the patriarch, Peter I
opposed the election of another supreme head of the church; and
when he found that the synod durst not venture on so far irritating
the people as to dispense with the dignity, he insisted on being
elected himself. If the sultan of Constantinople combined with
himself the two-fold character, why should it be refused to him? The
reign of Peter was too short to permit his designs of spoliation to be
carried into effect; but, by confirming the dangerous precedent of his
grandfather, he had done enough, and his successor Catherine was
enabled to complete the robbery which he commenced.
But the most impolitic measure of Peter—that which rendered
those who might have defended him indifferent to his fate—was his
conduct towards the imperial guards. Two regiments he ordered to
be in readiness for the Danish war. This was contrary to custom. In
the faith of remaining near the court, most of the soldiers had
embraced the military life; and they were as indignant as they were
surprised when told that they must exchange the dissipations of a
metropolis for the fatigues and privations attending a distant
campaign. They were offended, too, with the introduction of the
Prussian discipline, which they found by experience to be far more
rigid than that to which they had hitherto been subject; and they
patriotically condemned the innovation as prejudicial to the military
fame of the empire. Still more irritating was the preference which he
everywhere gave to the German over the native troops. His most
intimate friends were Germans; the officers around his person were
of the same nation; Germans directed the manœuvres not only of his
household but of all his regiments; and a German—Prince George of
Holstein, his uncle—was placed at the head of all the imperial
armies.
Couple these acts of imprudence with others of which he was
hourly guilty. In his palace of Oranienbaum he constructed a
Lutheran chapel; and though he appears to have been indifferent to
every form of religion, he held this in much more respect than the
Greek form, which in fact, he delighted to ridicule. If churchmen
became his enemies, the people in general were not likely to
become his friends when they heard of a boast—probably a true one
—that in the last war he had acquainted the Prussian monarch with
the secrets of the imperial cabinet. Lastly, he insulted men of honour
by making them the jest of his buffoons.
Circumstances much less numerous and much less cogent than
these would have sufficed so ambitious, able, and unprincipled a
woman as Catherine to organise a powerful conspiracy against the
czar. But he was accused of many other things of which he was
perfectly innocent. In fact, no effort seems to have been spared to
invent and propagate stories to his disadvantage. In some instances,
it is scarcely possible to separate the true from the false. Whether,
for example, he, from the day of his accession, resolved to divorce
his wife, to marry his mistress, to set aside Paul from succession,
and to adopt Ivan, still confined in the fortress of Schlüsselburg, can
never be known with certainty. That he secretly visited that unhappy
prince seems undoubted; but we have little evidence for the
existence of the design attributed to him. If, in fact, he sincerely
contemplated raising the daughter of Count Vorontzov to the imperial
throne, he would scarcely have adopted Ivan, unless he felt assured
that no issue would arise from the second marriage. He could not,
however, entertain any regard for a consort who had so grievously
injured him, and little for a boy whom he knew was not his own. And,
as there is generally some foundation for every report, there seems
to be no doubt that Peter had promised to marry his mistress if she
survived his wife. The report was enough for Catherine: on it she
built her own story that her life was in danger; and that if her son
were not designed for a similar fate, he would at least have that of
Ivan.
Catherine Plots against the Czar
The anxiety of the empress to secure adherents was continually

active; and as her husband passed so much time in drunkenness,
her motions were not so closely scrutinised as they should have
been. Gregory Orlov, her criminal favourite, was the man in whom
she placed the most reliance. Gregory had four brothers—all men of
enterprise, of courage, of desperation; and none of them restricted
by the least moral principle. Potemkin, afterwards so celebrated, was
the sixth. This man was, perhaps, the most useful of the
conspirators, as by means of his acquaintance with the priests of the
metropolis he was able to enlist that formidable body in the cause.
They were not slow to proclaim the impiety of the czar, his contempt
of the orthodox faith, his resolution “to banish the fear of the Lord”
from the Russian court, to convert churches into hospitals and
barracks, to seize on all revenues of the church, and to end by
compelling the most orthodox of countries to embrace the errors of
Luther. The archimandrites received these reports from the parish
priests, the bishops from the archimandrites; nor was there much
difficulty in obtaining an entrance for them into the recesses of the
neighbouring monasteries. The hetman of the Cossacks, an officer
of great authority and of great riches, was next gained. Not less
effectual than he was the princess Dashkov, who, though the sister
of Peter’s mistress, was the most ardent of the conspirators: perhaps
the threatened exaltation of that sister, by rendering her jealous, only
strengthened her attachment to the czarina. Through the
instrumentality of this woman, Count Panin, the foreign minister and
the governor of the grand duke Paul, was gained over. Whether the
argument employed was, as one writer asserts, the sacrifice of her
sister, or whether, as another affirms, she was the daughter of the
count, who notoriously intrigued with her mother, is of no moment.
What is certain is, that the count was exceedingly fond of her; and
one authority expressly asserts that he became acquainted with the
details of the conspiracy before her, and admitted her into the plot.
This, however, is less probable than the relation we have given; for
the princess had long been the friend of Catherine.
Her activity was unceasing. A Piedmontese adventurer, Odart by
name, being forced to leave his native country for some crime, and
having tried in vain to obtain a subsistence in the neighbouring
capitals, wisely resolved to try his fortune in St. Petersburg—a city
where guilt might reside with impunity, and where it had only to be
successful to win the applause of mankind. As he had a
considerable knowledge of the fine arts, especially of music and
painting, he had little difficulty in obtaining an introduction to the
princess Dashkov. She, who had a shrewd insight into human
character, soon perceived that this supple, crafty, active, sober,
intriguing, unprincipled foreigner was just the man that was required
to act as spy and confidential agent. He was introduced to Catherine,
whose opinion confirmed that of her favourite. No choice could,
indeed, have been better. Little cared he in what service he was
employed. If a partisan were to be gained, no man could be more
insinuating: if an enemy were to be removed, he had his pistols and
his dirk, without which he never appeared in the street. His
penetration soon enabled him to secure the aid of two other bravos
—the one, Possik, a lieutenant in the guards; the other, Globov, a
lawyer in the employment of the senate. Of the character of these
men, some notion may be formed from the fact that Possik offered to
stab the emperor in the midst of the court. He knew how to ally
duplicity with desperation; he was at once the hypocritical intriguer
and the remorseless bravo.
Through the same Princess Dashkov, Volkonski, major-general of
the guards, was won; and by Potemkin, or his ghostly allies, the
archbishop of Novgorod was soon in the secret. The hetman of the
Cossacks went further. Great as was the danger of entrusting that
secret to many, he assembled the officers who served under him,
assured them that he had heard of a conspiracy to dethrone the
emperor, too irresistible to be appeased; and exhorted them to seize
the favourable moment of propitiating the favour of the czarina,
rather than, by remaining hostile or inactive, to bring down
vengeance on their own heads. His advice had all the success that
he could desire.
While these most vicious and in every way most worthless of men
were thus employed in her behalf, Catherine was no less active. She
knew that Count Panin espoused the cause of her son—less,
perhaps, from affection to his charge, than from the hope of
exercising more power under an infant emperor than under one of
the mother’s enterprising character. Her promise, that his influence
should be second only to her own, made him her willing instrument.
His defection constrained the rest of the conspirators: there was no
more heard of a regency; and Catherine was to be proclaimed
autocratrix of all the Russias.
Without increasing unnecessarily the number of the initiated, she
yet prepared the minds of many for some impending change, and
rendered them eager for its arrival by her artful and seasonable
insinuations. If an officer of the guards stood near her, she
whispered in his ear that the emperor had resolved on disbanding
the present force, and exiling its chiefs; if an ecclesiastic, she
bewailed the fate of the pure orthodox church; if a less interested
person, she lamented her own misfortunes and those of her son—
both doomed to immediate imprisonment, and she, at least, to an
ultimate death. If a senator were near, she deplored the meditated
destruction of the venerable and patriotic body to which he belonged;
the transformation of the debauchees, perpetually around the
emperor, into judges; and the substitution of the Code Frederic for
the ancient law of Russia.
By these means she prepared the minds of the people for the
revolution: her affability, in fact, was the theme of their praise. But
she did not trust merely to their good will. She knew that, unless two
or three regiments were secured, the insurrection might not find
immediate supporters, and that the critical moment might be lost.
Without money this object could not be obtained; and though both
she and her confidential agents voluntarily disbursed all that they
could command, and converted their most valuable effects into coin,
the amount was alarmingly inadequate. In this emergency she
applied to the French ambassador for a loan; and when he showed
less readiness to accommodate her than she expected, she
addressed herself, we are told, to the ambassador from England,
and with more success. But this statement is untrue: it was not the
English ambassador, but an English merchant, who furnished her
with the sum she demanded. With this aid, she prevailed on the
greater part of three regiments to await the signal for joining her.
Though the conspirators were, in point of numbers, formidable,
their attempt was one of danger. Peter was about to leave Russia for
Holstein, to prosecute the war against the Danish king; and of the
troops whom he had assembled, though the greater part were on
their march, some were now with him, and might be induced to
defend him. Besides, the two great divisions of his fleet were at
Kronstadt and Revel, and nobody could foresee how they would act.
The conspirators agreed that he should be taken by surprise; that
midnight should see him transferred from the throne to a dungeon.
The festival of St. Peter and St. Paul—one of high importance in the
Greek church—was approaching: the following day the emperor had
resolved to depart. It was to be celebrated at Peterhov; there it was
resolved to arrest him.
But accident hastened the execution of the plot. Until the arrival of
the festival, Peter left St. Petersburg for Oranienbaum, to pass in riot
and debauchery the intervening time. Accompanied by the most
dissolute of his favourites, and by many of the court ladies, he
anticipated the excesses which awaited his arrival. That he had
received some hints of a plot, though he was unacquainted alike with
its object and authors, is exceedingly probable. His royal ally of
Prussia is said to have advised him to be on his guard, and several
notes are supposed to have been addressed to him by his own
subjects. If such information was received, it made no impression on
him; and indeed its vagueness might well render him indifferent to it.
But on the eve of his departure, when the superior officer of Passik,
who had accidentally learned that danger attended the steps of the
emperor, denounced the lieutenant, and the culprit was arrested, he
had an opportunity of ascertaining all the details of the conspiracy.
He treated the denunciation with contempt; affirmed that Passik
belonged to the dregs of the people, and was not to be dreaded; and
proceeded to Oranienbaum. The culprit, though narrowly watched,
had time to write a line to the hetman, whom he exhorted to instant
action, if they wished to save their lives. The note fell into the hands
of the princess Dashkov, who immediately assembled the
conspirators.
Not a moment was to be lost: the presence of Catherine was
indispensable; and, though it was midnight and she was at Peterhov,
seven leagues distant from St. Petersburg, one of the Orlovs went to
bring her. He arrived at the fortress, entered a private door, and by a
secret staircase ascended to the apartments occupied by the
empress. It was now two o’clock in the morning: the empress was
asleep; and her surprise was not unmixed with terror, when she was
awakened by a soldier. In a moment she comprehended her
situation: she arose, called one of her women, and both, being
hastily clad in a strange habit, descended with the soldier to one of
the gates, passed the sentinel without being recognised, and
stepped into the carriage which was waiting for her. Orlov was the
driver, and he urged the horses with so much severity that before
they had proceeded half way from Peterhov to St. Petersburg, they
fell down from exhaustion. The situation of the empress was critical:
she might at any moment be overtaken; and she was certain that
with the dawn of day Peter would acquire some more definite
intelligence of the plot. In a state bordering on distraction, she took
refuge in the first house that she approached: it was a tavern, and
here she burned the letters which had passed between her and the
conspirators. Again she recommenced her journey on foot: by good
fortune she met a countryman with a cart; Orlov seized the vehicle,
the peasant ran away; Catherine ascended it, and, in this undignified
manner, she, her woman, and Orlov entered St. Petersburg about
seven o’clock on the morning of July the 9th.
Catherine Usurps the Crown
No sooner was Catherine in the capital than she was joined by the
hetman; and, accompanied by him, she hastened to the barracks of
the troops which he commanded. Four companies immediately
declared for her; their example constrained the rest of the regiment;
three other regiments, hearing the acclamation, and seeing the
people hurry to the spot, joined in the cry; all St. Petersburg was in
motion; a report was spread that she and her son had just escaped
assassination by order of the czar; her adherents rapidly multiplied:
and, accompanied by about two thousand soldiers, with five times
that number of citizens, who loudly proclaimed her sovereign of
Russia, she went to the church of Our Lady of Kazan. Here
everything was prepared for her reception: the archbishop of
Novgorod, with a host of ecclesiastics, awaited her at the altar; she
swore to observe the laws and religion of the empire; the crown was
solemnly placed on her head; she was proclaimed sole monarch of
Russia, and the grand duke Paul her successor; and Te Deum
concluded the eventful ceremony.
From the church she proceeded to the palace occupied by the late
empress; the mob crowded to see her, and to take the oath of
allegiance; while the more respectable portion of the citizens were
awed into submission, or at least into silence, by a report that Peter
had just been killed by falling from his horse. To gratify the populace,
the taverns were abandoned to them: the same fate visited the
houses of all who were obnoxious to the conspirators; intoxication
was general; robbery was exercised with impunity; the palace, to
which Catherine had hastened, was strengthened; a numerous
guard was stationed in its defence; a manifesto was proclaimed; a
notification was delivered into the hands of each foreign minister,
and the revolution was complete.
One object of the conspirators had been to close every avenue of
egress from the capital, that Peter might not be acquainted with the
revolution until it was too powerful to be repressed. All the troops in
the vicinity were called within the walls; but there was one regiment
about sixteen hundred strong, which lay between the city and
Peterhov, the conduct of which was doubtful. Without the slightest
knowledge of what had taken place, the colonel arrived in the city,
and was soon persuaded not only to declare for the new sovereign
but to prevail on the regiment to follow his example. He was
successful; and, with the whole body, he returned in triumph to the
capital. On this very day Peter had promised to dine with Catherine:
on reaching Peterhov he was surprised to hear of her flight.
Vorontzov, the father of his mistress, the father also of the princess
Dashkov, who had witnessed without repugnance the dishonour
alike of his wife and daughter, proposed to the emperor to visit St.
Petersburg to ascertain the cause of her departure; and, if any
insurrection were meditated, to suppress it. He arrived in the
presence of the empress, was induced to swear allegiance to her,
and was ordered to retire into his own house.
But Peter had already been informed of the revolution; and he
traversed with hasty steps the gardens of Peterhov, indecisive and
terrified. Yet he was not wholly deserted. The brave Munich, whose
locks were ripened by age, and whose wisdom equalled his valour,
advised him instantly to place himself at the head of his Holstein
troops, march on the capital, and thereby enable all who were yet
loyal to join him. Whether the result would have been such as the
veteran anticipated, viz. a counter-revolution, may well be doubted;
but there can be no doubt that a considerable number of soldiers
would have joined him, and that he would have been able to enter
into negotiations with the hostile party. He was too timid to adopt the
suggestion: nothing, in fact, could urge him to decisive action. When
informed that Catherine was making towards Peterhov, at the head
of ten thousand men, all that he could resolve to do was to send
messengers to her with proposals. His first was that the supreme
power should be divided between them; the second, when no reply
was deigned to his letter, that he should be allowed to leave Russia,
with his mistress and a favourite, and pass the rest of his days in
Holstein. She detained his messenger, and still advanced.
Munich now advised him to embark for Kronstadt, and join his
fleet, which was still faithful; but unfortunately he delayed so long
that one of Catherine’s emissaries had time to corrupt the garrison of
the fort: on arriving, he was prohibited from disembarking, and told
that if he did not immediately retire his vessel would be sunk by the
cannon of the place. Still he had a fleet at Revel; and if it were
disloyal he might escape into Prussia, Sweden, or Holstein. With the
fatality, however, which characterised all his measures on this

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Library of Congress Cataloging-in-Publication Data

part 2 MEDISOFT ADVANCED TRAINING 47

part 3 APPLYING YOUR SKILLS 409

CHAPTER 14 Putting It All Together 427

part 4 SOURCE DOCUMENTS 435

AND BILLING CYCLE: ENCOUNTER 16

Entering and Exiting Office Hours 89

Case Examples 158

Clean Claims 242

Creating Reports 326

FOR COLLECTIONS 385

ally look in the medical billing software.

1: Introduction to Discusses the changes taking place in the field of

2: Medisoft Advanced Teaches the student how to start Medisoft;

3: Applying Your Skills Completes the learning process by requiring

4: Source Documents Gives the student the data needed to complete

NEW TO THE NINTH EDITION!

plan; new content on creating payment plans in Medisoft;

USING MEDISOFT ADVANCED VERSION 19 WITH CiMO

• Minimum System Requirements

• Windows 8 Professional 32- or 64-bit

• External storage device, such as a USB flash drive, for storing

• Medisoft Advanced Version 19 patient billing software

Connect is proven to deliver better results for students and instruc-

materials, including: Word documents, PowerPoint files, Excel

Learning at the speed of you: Smartbook

the greatest impact on that specific learning moment. With Smart-

Record and distribute your lectures for multiple viewing:

A single sign-on with Connect and your Blackboard

nered with McGraw-Hill Education to better allow students and

Still want a single sign-on solution and using another

Assemble a textbook organized the way you teach:

ister to experience how Create empowers you to teach your stu-

Need help? Contact the McGraw-Hill Education Customer

Instructor’s Manual —Answer keys for all exercises

PowerPoint —Key terms

Electronic Testbank —EZ Test Online (computerized)

Medisoft Advanced —Implementation Guides for Live and Simulated Medisoft

Copyright ©2016 McGraw-Hill Education

Allegany College of Maryland Keita Kornegay, BS

Monika Bell, CMA Tatyana Pashnyak, M.Ed, CHIS-TR, COI

ACKNOWLEDGMENTS FROM THE AUTHOR

key terms learning outcomes

tests performed by more than one provider. programs (PMP)

Chapter 1 Introduction to Health Information Technology and Medical Billing 3

Bain’s Estimate of Elizabeth

It is the peculiar glory of Elizabeth Petrovna that she consulted

PETER III (1762 A.D.)