Medical College of Georgia |
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Information for Students>Clinical Policies and Procedures>Chapter 5 |
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Chapter 5 Student Fee Tickets/Data Forms5-1. Student fee ticket/data forms (SFT) - General comments: Student fee ticket/data forms (SFT) are required for each patient visit. They are printed from the appointment information provided by the student when making an appointment. They are delivered to the appropriate clinic. The heading of the ticket contains basic identification and account balance information. The bottom segment lists the procedures to be done, data that is to be collected (completion status, supervising faculty number, grade, etc.) are entered in the appropriate columns. A. Each clinical department uses a Student fee ticket/data form (SFT) for recording all pertinent information concerning a clinical procedure performed in that department. The information gleaned from the clinical data forms serves several purposes. The information records patient treatment progress and student progress. For several departments they are important in determining a grade. They are of value historically and for research activities. Hence the student should be diligent in the use, completion, and proper disposition of these forms. B. Fee tickets for each procedure recorded on a treatment plan are obtained from the dental assistants at the clinic supply stations after the treatment plan has been approved. C. To obtain a fee ticket for a treatment step which has not been approved, it is necessary for a faculty member in that department to authorize addition to the procedure in the progress notes. Staff in Clinic 12 or the Business Office can then print the fee ticket. D. Each data form is similar in its design but unique in its application. Most entries are self-explanatory. If the student is to receive an accurate computer print‑out of his clinical activities, then it is most imperative that accurate input be recorded on the fee ticket. E. Because of the new accounting policy, all fee tickets (Paid or Unpaid/Used or Unused) must be turned in at the end of the appointment. It is recommended that the student retain the goldenrod copy for personal records and present the yellow copy to the patient. INSTRUCTIONS FOR STUDENT FEE TICKETS REQUIRED FOR PATIENT TREATMENT A computer generated Student Fee Ticket is required in order for a student to treat a patient in the clinic. No handwritten Student Fee Tickets will be allowed. The procedures to be done for this appointment will be preprinted on the Student Fee Ticket. If a Fee Ticket does not have procedures preprinted, treatment will not be allowed. The Student Fee Ticket is generated from the appointment system, and it will be delivered to the clinic. The Student Fee Ticket will be turned in after each appointment (even if the procedure is incomplete), and another Fee Ticket will be generated for the next appointment. ACCOUNTABILITY FOR EVERY STUDENT FEE TICKET EVERY Student Fee Ticket has its own unique ticket Number. This allows the computer and us to track and account for each one. Therefore, every Student Fee Ticket must be turned back in so data entry personnel can record the result of this scheduled appointment. Academic credit to the student, student attendance in the clinic, tracking of canceled patient appointments and generation of charges to the patient is obtained from these Student Fee Tickets. If a patient does not show up for their appointment, you must check “Broken Appointment” or write “Patient Canceled” at the bottom of the Fee Ticket, and turn it back into the dental assistant in the clinic. (The patient's copy of the Fee Ticket must be shredded, but the student should keep his/her copy.) DISTRIBUTION AND HANDLING All four parts of the Student Fee Ticket should remain intact until the end of the appointment. At the end of the appointment, the supervising faculty member should keep the original and third copy and deposit them in the designated collection basket/tray within the clinic. The student should get the fourth copy for his/her records, and the patient should get the second copy and go to the cashier to make payment. HEADER INFORMATION Most information in the header is self explanatory. The top right-hand corner gives the clinic location and the time of the appointment. The bottom left-hand corner gives the patient’s account number (MED#). Below this is "F/C" which stands for Financial Class. Examples of this may be Insurance, Self‑Pay, Returned Mail, Bad Debt, etc. Treatment should not be provided for Bad Debt patients unless it is accompanied by a signature of someone from the Business Office. Patients with Returned Mail should be directed to the Business Office to give their correct address. COMPLETING THE BLOCKS/LINES FOR EACH PROCEDURE Preprinted information is provided for Student # (STU), Tooth/Surface (TH/SURF), Procedures/Step # (PROC/STP #), DESCRIPTION, STATUS, and AMOUNT. Complete the remaining columns as follows: "DIS" Stands for Discipline. Leave this column blank. "SN" Stands for Session. Circle "A" for a morning appointment or "P" for an afternoon appointment. S Circle if started today but not finished today I S Circle if started today and finished today C Circle C if started at a previous appointment and finished today *a grade is normally recorded at the completion of procedures
Circle I if started at a previous appointment and not finished today "FAC #" Stands for Faculty #. The supervising faculty member should write his/her faculty # here. "EVA" Stands for Evaluation. The supervising faculty member should write the grade given for this procedure, if applicable. "FAC" Stands for Faculty. The supervising faculty member should write his/her initials here. Draw a line through all information for procedures that had no activity for this appointment. If a procedure was not started, cross out the line. If treatment changes at chairside or additional procedures are done, you may hand write these procedures on the blank lines. All handwritten procedures must be neatly written so the data entry person can enter them into the computer. If a second student is providing a surgical assist, faculty should write it on the fee ticket and initial it. If a student is assisting a faculty or resident a surgical assist form must be filled out and turned in with the Student Fee Tickets. EXPLANATION OF PROCEDURE CODES The ADA developed procedure codes (numerical identifiers or descriptors for all forms of dental treatment). These codes provide an accurate, uniform and specific method to report dental treatment. The procedure codes listed on our fee tickets are ADA approved. The suffix accompanying the procedure codes (STP#) further clarifies treatment being done that day. Step numbers include the following: /02 – adult patient treatment /03 – pediatric patient treatment /04 – competency procedure /05 – SRTA Board procedure PRE-PRINTED FEE TICKET WITH NO CHANGES If you have a pre-printed fee ticket and there are NO changes to be made, then faculty MUST: STATUS: Circle: SI (procedure started today but not finished today) I (previously started procedure in progress, NOT complete) C (procedure completed at this appointment previously started) Don't Forget to Sign and Date the Treatment Plan SC (procedure started today and finished today) Date the Treatment Plan Write in FACULTY # Write in GRADE - 2 digits (if needed by dept.) for completed procedure ONLY Write in FACULTY INITIALS If daily grade is STAMPED at bottom, enter FACULTY #, Grade and INITIAL
NEVER let the student leave the clinic with the white copy of the fee ticket NEVER change the patient's name on the fee ticket - if the pt. Is different, a new fee ticket is needed NEVER use ALL for root planing - MUST be identified by quadrant (UR, UL, LR, LL) If the correct student is not printed on the fee ticket, then PLEASE make sure the PROPER STUDENT # gets written in (SOPHOMORE BLOCK, ESPECIALLY) NEVER WRITE VOID ON A FEE TICKET (Look below for options, question #8) How Do I? 1. How do I CHANGE a procedure already printed on the fee ticket? If a procedure is printed on the fee ticket and changes are to be made in the clinic - EXAMPLE: You have a two surface amalgam and you want to change it to a three surface amalgam Inform the patient of a fee change Planned: 02 DO 02150 Amal 2SF permanent Done: 02 DOL You want to change 2SF to 3SF DO Add the surface Cross out the procedure code Change description (Student Support Office will look up the new code) 2. How do I DELETE a procedure on the fee ticket? Procedure(s) that are on the fee ticket that will NEVER BE DONE, write DELETE on the line and on the treatment plan found in the chart and initial changes on both. 3. How do I DELETE a procedure that is not on the fee ticket, but is on the Treatment Plan? Write "DELETE" on the proper line of the Treatment Plan (located in the front of the chart or on the bottom of a fee ticket) then take the chart to Angie Hodges (AD 2315) and she will delete the step from the electronic treatment plan and sign it. 4. If a procedure IS NOT started and is on the fee ticket how do I CANCEL the procedure? Procedure(s) that are on the fee ticket and are not started on this day,
BUT you know will be done at a LATER DATE - then just draw a line
through the procedure 5. How do I CHANGE a fee ticket to show the procedure was a competency? In the column labeled PROC/STP# change step # to 04 if a procedure is completed as a competency. 6. How do I ADD a procedure to a treatment plan? If a procedure is JUST BEING ADDED to the treatment plan, but NOT STARTED on this day, write the addition at the bottom in the comment section - EX: Add 02 DO amalgam. (Data Entry will look up the new code and add it to the treatment plan). 7. How do I START a procedure not on the fee ticket? Look on the Treatment Plan. If the procedure is ON THE PLAN write ALL INFORMATION on the fee ticket EXACTLY as it appears on the treatment plan (located in the front of the chart). If the procedure is NOT ON THE TREATMENT PLAN, but is started today, then write all the information required (tooth, surface, description, etc.) on the next empty line on the fee ticket. 8. What do I put on a fee ticket if no treatment occurs? Write 1 of the following in the COMMENT section CA - Late cancellation, broken appointment or either no student or patient SA - If the student is absent, patient shows (Always call Conference Dr at 7284) No TX - Patient and student show but for whatever reason no treatment is provided DUP - Duplicate appointment, student makes 1 or more appointments with the same patient, same clinic, same day, different chair 9. Why does the fee show every time a procedure is chosen? A fee is charged to the patient account when S (started) is circled. The fee will appear each time the step is selected, regardless of payment - it is not recharged a second time. Location Codes Maintenance
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Medical College of Georgia |
Patient Services October 13, 2006 |