Before the widespread use of computers, and in some small practices today, office finances were monitored with a system called the "pegboard". The pegboard, or write-it-once, bookkeeping system uses a board with pegs running down the left side. The pegs hold a daysheet, or daily journal, in place on the board. All transactions for the day are recorded on this daysheet. Each patient has a ledger card (record of the patient's financial activities). When a patient transaction occurs, the bookkeeper places the ledger card over the daysheet and the charge slip (preprinted patient bill) over the ledger card on the next available entry line and makes the appropriate entry on the ledger card. At the end of the day, all the transactions have been added to the daysheet, allowing for easy tracking of charges, payments, and adjustments.

Your text describes the importance of the daysheet but does not elaborate on the value that the financial information can provide to the office staff. An example can be found when the daysheet includes a column for the CPT code for the service provided. The office manager, or billing specialist, can observe what codes are used most often by each provider. If one provider charges more often for a higher-level code (E&M office visit) than their peers (other providers) this may be a flag that indicates the need to verify chart documentation to ensure that it supports the higher services or may indicate the benefit of providing a "coding in-service" to providers. In other words, the daysheet can be instrumental for process evaluation purposes.

Refer to the daysheet example on slide # 35 of this week's PowerPoint. 1)Compare the different patient information on the sheet and explain the information following the name Timothy Taylor. 2) Review if the daysheet did include the CPT codes and there was an indication that one provider was either upcoding or downcoding (not intentionally of course) 3) New information to keep in mind is that this practice has 4 providers and 3 exam rooms. Mentally, add a column for the CPT codes and a column for the provider's initials. (You will not be turning in a revised daysheet, only discussing possibilities.) Be sure to explain your reasoning.... Any answer can be correct if it is well supported.

Model the process for tracking finances in a medical office.

Include the following aspects in the discussion:

• What do we know about Timothy Taylor?
• Discuss how you would suggest to providers the benefit of a meeting to review E&M coding?
• Discuss one suggestion for how to present a coding in-service to the providers.
• Name one other way that we can use the daysheet as an evaluation tool.
• Make an educated guess for one way that we could use the daysheet as a process evaluation tool.