+1(978)310-4246 credencewriters@gmail.com
  

ASSIGNMENT 8
H01 Medical Office Management 1
Directions: Be sure to save an electronic copy of your answer before submitting it to
Ashworth College for grading. Unless otherwise stated, answer in complete sentences,
and be sure to use correct English, spelling and grammar. Sources must be cited in APA
format. Your response should be four (4) double-spaced pages; refer to the “Assignment
Format” page located on the Course Home page for specific format requirements.
In Lessons 5 through 8, you learned about the administrative requirements of medical
assistants. You learned about patient reception, appointment scheduling, office
technology, correspondence, medical records, billing and collections, medical insurance,
medical claims and coding, and office management duties. For this written assignment,
the concepts learned from Lessons 5–8 will be applied. Please review the learning
objectives for Lessons 5–8 prior to beginning work on this assignment.
Complete Parts A, B, C, and D for this assignment.
Part A: A pharmaceutical representative has just arrived at the office of Dr. Joseph
Henderson, a board-certified orthopedic surgeon. The waiting room is swarming
with patients waiting to see Dr. Henderson, because he was delayed with an
unexpectedly complicated lumbar spinal fusion and laminectomy.
The representative is very insistent, almost belligerent, about seeing the
physician immediately, even though she did not have an appointment to see
him. In fact, the visit was totally unexpected, as the representative had just been
in two weeks ago. Last time the representative was in, she gave Dr. Henderson a
variety of readily usable and dispensable medications. She has more of the same
today—injectable cortisone with Novocain, muscle relaxants, NSAIDs, and
even some Tylenol with codeine. Usually, Dr. Henderson is quite receptive to
receiving these samples, as they help ease the financial burden on his patients
for whom he uses or to whom he dispenses these samples. The office is, in fact,
running quite low on these particular medications because of Dr. Henderson’s
heavy patient load.
Provide detailed answers for each of the following questions. Your response
should be at least 150 words in length.
•
What is your response to the sales representative?
•
Should a sales representative ever take precedence over scheduled
appointments?
1
•
Does the fact that Dr. Henderson is usually quite anxious to receive any
and all samples for his patients enter in as a factor?
•
Does the diminished supply of these samples alter the situation?
•
Can the medical assistant ever accept delivery of any or all of these
samples?
Part B: Dr. Jonas runs a private practice. He admits patients and makes rounds in two
local hospitals. He uses one type of EHR software in his private office and two
other packages in the two hospitals. Not only must Dr. Jonas learn three
software systems, but he also may at times be unable to move patient
information between those systems because of incompatibility. What might Dr.
Jonas do to address these issues? Your response should be at least 100 words in
length.
Part C: Lisa Medina, a certified coder, performs medical coding for a large multispecialty clinic. You have just been hired as Lisa’s assistant. She has asked you
to review the encounter forms for the day, on which physicians have checked
off the diagnoses of each patient. You notice that Dr. Parker, an endocrinologist,
has checked off the box for Diabetes unspecified for most of his patients
without checking off any manifestations or complications. You think this is
unusual because many diabetic patients do have complications.
Provide detailed answers for each of the following questions. Your response
should at least 150 words in length.
•
What are the options for handling this situation?
•
Which option would you select? Give three reasons for your choice.
•
With whom should you consult before acting on your choice?
Part D: Sarah Egan is the office manager in Dr. Williams’s practice. Nell Jacobs, who
has worked as a CMA (AAMA) in the office for one year, has frequently been
absent or tardy on Mondays. Sarah suspects that Nell has a drinking problem.
However, Nell has never arrived at the office intoxicated—until today. Sarah
has just observed Nell stumbling in the parking lot when getting out of her car.
Her speech is slurred, and her breath has a fruity odor that Sarah thinks could be
alcohol. Nell does not appear to understand anything that Sarah is saying to her.
Provide detailed answers for each of the following questions. Your response
should at least 250 words in length.
•
Given the situation, as the office manager, what should Sarah do
immediately regarding Nell?
2
•
If Sarah decides to send Nell home, should she call Nell’s husband to
come and get her, or, perhaps, insist that Nell go home in a cab?
•
Does Sarah have an obligation to tell Dr. Williams about her suspicions
regarding Nell?
•
Should this incident become part of Nell’s employment record?
•
Is this incident grounds for firing an employee?
•
Because Nell is a CMA (AAMA) and works with patients, is it within
Sarah’s rights to demand a blood and urine screening for alcohol and
drugs?
•
Should the police be notified of the incident?
•
If Nell is indeed intoxicated or under the influence of alcohol, is Sarah
obligated to refer Nell to counseling at an alcohol and drug rehabilitation
facility?
Grading Rubric
Please refer to the rubric on the next page for the grading criteria for this assignment.
3
THIS IS THE END OF ASSIGNMENT 8.
4
Course Name:Medical Office Management I
Lesson 7: Medical Insurance, Claims, and Coding
In this lesson, you’ll be introduced to various medical insurance
programs, including health maintenance organizations (HMOs),
preferred provider organizations (PPOs), and traditional health
insurance programs. You’ll also learn about individual, group,
and government-sponsored health benefits; health insurance
forms; medical claim forms; and the claims submission process.
Finally, you’ll learn about the purpose of diagnostic and
procedural coding, and the basic rules and principles of ICD-10
and CPT code assignment.
LEARNING OBJECTIVES
 Objective 1 Describe the different types of public
and private health insurance programs available
and the various types of coverage they provide.
 Objective 2 Discuss the process for filing
medical insurance claims, including an
explanation of fee schedules, reimbursement
methods, and HIPAA rules regarding privacy and
security of health insurance claims.
 Objective 3 Explain the medical assistant’s role
in diagnostic and procedural coding.
 Objective 4 Assign diagnostic and procedural
codes using the ICD-10 and CPT coding manuals.

Page:1 of 10
Course Name:Medical Office Management I
Text Readings
Pearson’s Comprehensive Medical Assisting, Chapters 15, 16, and 17
Additional Readings
Required Readings
Managed Care (http://youtu.be/R-p67PcNerY)
What’s the Difference between an HMO, PPO, and HDHP Plan? (http://youtu.be/coSyGQI28eM)
TRICARE (https://www.youtube.com/watch?v=8d06l9DAe_s&feature=youtu.be)
ICD-10 (https://www.youtube.com/watch?v=kCV6aFlA-Sc&feature=youtu.be)
Blowing the Whistle on Health Care Fraud (https://www.youtube.com/watch?
v=bcBUk_EnGvA&feature=youtu.be)
Lecture Notes
The U.S. government has played a key role in the development of healthcare programs. Today, we’re watching
history unfold with the implementation of the Patient Protection and Affordable Care Act of 2010, which was
created to help Americans afford better-quality health insurance, to reform the health insurance industry, to
expand Americans’ healthcare rights, and to reduce wasteful healthcare spending.
Most people associate universal healthcare coverage with President Barack Obama. However, President Harry
Truman was actually the first American president to introduce a plan for universal health coverage. In 1945,
President Truman wanted private insurance for those who could afford it and public services for people who
couldn’t afford it. At the time, President Truman proposed a comprehensive, prepaid medical plan through the
Social Security System that would pay for doctor, hospital, nursing, laboratory, and dental costs. At that time,
Congress didn’t pass the plan. It wasn’t until 1965 that President Lyndon Johnson signed the Medicare bill that
created federal health insurance coverage for the elderly and poor. The new law detailed a program of hospital
insurance for the elderly and health care for needy children under Social Security. This meant that healthcare
services to the elderly and poor would be reimbursed by federal and state sources.
Today, the terms health insurance and medical insurance are often used interchangeably; however, they aren’t
technically the same. To the insurance industry, health insurancemeans protection against income losses for
illnesses or injury, disability income, and accidental death or dismemberment. Medical insurance covers specific
medical expenses. However, we’ll use both terms to mean medical insurance.
Insurance is something that helps protect against loss or risk. Today, there are many different types of insurance
that offer protection to people. In health care, there’s major medical insurance. This type of health insurance
provides benefits for most types of medical expenses incurred, but is subject to a large deductible. These
policies usually pay covered expenses whether an individual is in or out of the hospital.
There’s also group health insurance, which generally provides coverage to a group of employees. This type of
insurance can be in the form of lump sum payment or periodic payments to compensate for income losses due to
bodily injury, sickness, or disease and medical expenses. Private health insurance is also called individual
insurance or nongroup insurance.
Private health insurance is an insurance plan used most often by self-employed people and others who aren’t
eligible for group plans. Private insurance holders pay premiums, or pre-established amounts. The insurance
company then puts that money into a designated account and pays claims out of that account.
Managed Care Organizations
Page:2 of 10
Course Name:Medical Office Management I
A managed care plan is a plan that finances and manages the delivery of healthcare services. Typically,
managed care involves a group of providers who share the financial risk of the plan or who have an incentive to
deliver cost-effective, quality healthcare services.
The purpose of managed care is to deliver quality, cost-effective health care through monitoring and managing
how services are utilized. When managed care first came into existence, many providers had a hard time with it.
Prior to managed care, providers were reimbursed for what they billed insurance companies. However, it wasn’t
long before insurance companies noticed that this method of reimbursement didn’t give providers any incentive
to save money. Providers were ordering whatever tests they wanted for patients and using a great deal of
supplies. With the implementation of managed care, services and supplies are closely monitored.
In general, managed care health plans are different health care systems that office services to a specific
population. Managed care health plans work by
Creating arrangements with selected providers to provide healthcare services to their members
Mandating credentialing standards for the selection of healthcare providers
Creating quality assurance and utilization review programs
Providing financial incentives for members to use providers and facilities associated with the health plan
HMOs
A health maintenance organization, or HMO, is a prepaid plan that provides services to plan members. The
HMO system was developed to funnel as much care as possible through one provider to control the high costs
associated with specialty care.
HMOs work by having medical providers contract with the HMO to provide medical services to plan members.
Members are then required to use only those providers to receive the full benefits of the HMO plan. As you can
imagine, some beneficiaries find the HMO concept to be very limiting because they don’t have the freedom to
choose whatever provider they want to see at any time.
HMOs emphasize preventive care to keep patients healthy, with the goal of reducing healthcare costs. All care is
directed through the primary care physician or other primary healthcare worker. Reimbursement is made on a
fixed payment per patient per month. If the patient must see a specialist, that specialist must also be in the HMO
network. The patient is responsible for any charges for services performed outside of the HMO network.
Just like any healthcare plan, HMOs have both advantages and disadvantages.
The advantages of HMOs include
Predictable costs
Routine coverage
Less paperwork because claim forms don’t need to be completed for each service or visit
HMO disadvantages include
The patient having to use one primary care physician for all services
Approval being required prior to hospitalization or specialty care
HMOs are generally the most restrictive type of managed care plan. This “gatekeeper” type of plan means that
the primary care physician (PCP) or other healthcare professional is the case manager for the patient who is
responsible for overseeing all aspects of the patient’s care. This means that the patient must
Page:3 of 10
Course Name:Medical Office Management I
receive preauthorization by the PCP for a specialty care referral or hospital admission. The only time a
preauthorization isn’t necessary is in an emergency situation.
There are also a number of different types of HMOs:
Group model: The HMO contracts with a multispecialty group to provide services.
Independent (or individual) practice association (IPA): The HMO contracts with an organized group of
individual physicians to provide services.
Network model: The HMO contracts with two or more multispecialty groups to provide services.
Staff model: HMO employs physicians and healthcare workers directly to provide services.
Preferred Provider Organizations
Preferred provider organizations (PPOs) are made up of a group of hospitals and physicians who provide
services to insurance company clients for a set fee. These providers are then listed as preferred providers for
the patients who have this type of insurance. The PPOs’ ability to recruit a large network of hospitals and
physicians affect the success of the plan.
The PPO plan is sometimes considered less restrictive than the HMO plan because it’s a way to contain costs
while still retaining the patient’s choice of physician. The patient has the ability to choose a physician or hospital
from the designated provider list. However, the PPO requires the beneficiary to obtain a referral from the primary
care physician if the patient wants to see another physician within the PPO network.
The advantages of PPOs to patients include
Freedom to choose from a large list of providers
Fixed costs
Generally no or low deductibles
The disadvantages of PPOs include
Larger copayments because of the vast network provided
The patient being responsible for costs and paperwork when care is provided outside of the network
Point-of-Service Plans
Point-of-service (POS) plans are often seen as one of the most flexible managed care plans. POS plans are
similar to HMOs but include some of the features of the PPO model.
POS plans are sometimes called “open-ended HMOs” because the patient must choose a primary care physician
(just as in HMO plans), but there’s an option available for receiving care from hospitals or physicians not in the
POS network.
In this case, the patient doesn’t need a referral, but the deductible and out-of-pocket expenses are higher. The
premiums for POS plans are higher, but some patients are okay with this because it allows more freedom in
choosing providers.
Exclusive Provider Organizations
Exclusive provider organizations, or EPOs, are part of employer groups that are trying to control costs. The EPO
consists of medical providers, mainly physicians and a hospital, who have joined together to offer their services
to specific clients. This means that employees or their beneficiaries can obtain services only from the medical
Page:4 of 10
Course Name:Medical Office Management I
providers who are part of the EPO. However, patients using an EPO generally don’t have to name a primary care
physician or have referrals to see other providers in the network. A downside of these plans is that there are no
out-of-network benefits.
Government Programs
As we discussed earlier, government has played a key role in healthcare programs for years through Medicare
and Medicaid. It’s now taking a larger role with the implementation of the Affordable Care Act.
The federal government provides the following types of insurance:
Medicare
Medicaid
Military health plans
Medicare and Medicaid
The Health Care Financing Administration, or HCFA (pronounced “hic-fuh”), was created under the Department
of Health and Human Services in 1977 as a way to coordinate and administer the Medicare and Medicaid
programs. On July 1, 2001, the HCFA was renamed, and is now called the Centers for Medicare and Medicaid
Services, or CMS, to reinforce the agency’s mission to serve Medicare and Medicaid beneficiaries. Since the
name change, the CMS has placed increased emphasis on responding to the needs of Medicare and Medicaid
beneficiaries and providers.
Medicare was formally known as Title XVIII of the Social Security Act and was initially commonly referred to as
Health Insurance for the Aged and Disabled. It was part of the bill that President Johnson signed into law in
1965. Medicare is a federal government program for persons age 65 and older as well as those who fall into
disability categories outlined by Medicare.
Medicaid is part of Title XIX of the Social Security Act. Medicaid reimbursement comes from both federal and
state sources to help people in need.
TRICARE
TRICARE is a healthcare program available for all seven branches of the uniformed services, their families and
survivors, and retired members and their families.
In the 1990s, the program was reorganized and the name was changed to reflect the new three-part program
that includes TRICARE Prime, Extra, and Standard. TRICARE covers healthcare services for active military
personnel and their dependents. Those persons covered by TRICARE are able to receive treatment from any
military healthcare facility.
CHAMPVA
The Civilian Health and Medical Program of the Department of Veterans Affairs, or CHAMPVA, covers most
healthcare services for
Dependents and survivors of permanently and totally disabled veterans
Survivors of veterans who died from service-related conditions
Survivors of those who died in the line of duty
TRICARE and CHAMPVA are often confused. If you’re eligible for TRICARE, you can’t be eligible for CHAMPVA.
A military retiree or the spouse of a veteran who was killed in action is a TRICARE beneficiary. CHAMPVA is a
Department of Veterans Affairs program and is for eligible veterans and their families.
Page:5 of 10
Course Name:Medical Office Management I
Medical Insurance Claims
An insurance claim is simply the form that the physician or hospital submits to the insurance company for
payment. An important part of the medical assistant’s job may be to assist in processing insurance claims for the
provider. Because insurance claims are what’s provided to the insurance company and are how providers get
paid, it’s important to have a thorough understanding of them.
CMS-1500
The CMS-1500 is the CMS’s universal healthcare claim form for professionals. The CMS-1500 is the claim form
used by providers of outpatient health services to bill insurers for their fees.
The claim for payment is generated from information found in the patient’s medical record. Specific information is
then transferred to the CMS-1500 claim form and sent to the third-party payer for reimbursement. The claim can
be submitted manually or electronically.
CMS-1450
The CMS-1450 is also known as the UB-04, or the Uniform Bill. It’s the institutional claim form used by
hospitals to receive payment from third-party payers. As with the CMS-1500, the information entered on the
CMS-1450 also comes from the patient’s medical record.
CMS-1450 versus CMS-1500
There are distinct differences between the CMS-1500 and the CMS-1450 claim forms. The CMS-1500 claim form
is the professional claim form used by the physician office for services and procedures. The CMS-1450 is the
institutional claim form used for any services performed in the hospital.
You may be thinking, “Wouldn’t it be easier to use one claim form for all services?” This would be easier, but the
hospitals and physician offices use different coding, billing, and reimbursement methods. The CMS-1500 and
CMS-1450 each have the specific information needed for each type of facility.
Unpaid Claims
Unfortunately, a normal part of health care is dealing with claim denials, or rejections. This means that there’s a
discrepancy in what the provider has submitted and what the payer thinks should be reimbursed. The payer will
always specify why it’s denying the claim, and the provider often has a chance to resubmit the claim with the
accurate or complete information.
Reasons for claim denials can include
Incorrect or outdated codes provided on the claim
Incorrect claim form or format used
Missing information on the claim form
No precertification or authorization
Time limit for filing expired
Incorrect copay or deductible amounts
Coverage issues (e.g., didn’t show medical necessity)
The denial of a claim is serious because it means that a provider isn’t being reimbursed for services provided.
Can you imagine working and then never receiving a check from your job? Claims denials are like that, so they
should be taken care of immediately by following the claim denial appeal process so that the provider can be
reimbursed.
Page:6 of 10
Course Name:Medical Office Management I
Medical Coding
Medical coding is the process of assigning numerical and alphanumerical codes to the patient’s diagnoses and
procedures. These codes are then reported on an insurance claim form for reimbursement. The codes are
grouped together into categories so that they translate into a specific number and a specific reimbursement
amount. The insurance company then reimburses the provider that amount for the healthcare services provided
to the patient.
Being reimbursed for services is directly related to the correct codes being submitted on claim forms. If the MA or
billing personnel assigns incorrect codes, then the hospital or physician office won’t be fully reimbursed and will
lose money.
If you’re not familiar with the coding and reimbursement process, then it can seem overwhelming. Here’s a basic
overview of what happens in the medical coding process:
1. A patient is seen in a physician office or hospital.
2. The office staff member responsible for coding (i.e., coder, billing specialist, or MA) reviews the patient’s
medical record and notes all relevant diagnoses and procedures for that patient’s visit.
3. The diagnoses and procedures are entered into a specialized coding and billing computer program.
4. The computer program translates the names of the diagnoses and procedures into the corresponding codes.
5. The computer program then groups all the codes into one numerical classification system and reports it on the
claim form.
6. The claim form is sent to the insurance company for reimbursement.
7. The insurance company equates the codes to a specific reimbursement (or payment) amount.
8. The reimbursement is then sent from the insurance company to the provider (hospital or physician office).
Initially, all of this was done by a lengthy paper process of reviewing the record, documenting the information on
paper claim forms, and then sending the claim to the insurance company in the mail. If the claim was initially
denied, additional time was then required to send the information back to the provider and for the provider to
gather the proper information and remail the claim back to the insurance company.
As you can imagine, this process was time consuming, and sometimes it would be months before a provider was
paid. However, today most of the process is done electronically, and what once took weeks now just takes a few
days.
Medical coding isn’t just a random assignment of numbers to diagnoses and procedures. Instead, it relies on the
use of organized classification systems. The classification system used depends on the type of provider. For
example, you’ll report different types of codes if you work for a hospital than if you’re working for a physician
office. Additionally, different insurers will have different reporting requirements.
Medical coding systems have reference books where coding and billing specialists can look up the codes that
need to be assigned to diagnoses and procedures. However, today, much of the coding and billing process is
done online via specialized software.
Coding Classification Systems
The three main coding classifications systems used in medical coding are the ICD, the HCPCS, and the CPT.
All HIPAA-covered entities are required to report codes using the ICD-10-CM/PCS classification system. ICD-10
is a relatively new system that has created more accurate reimbursement and helps to facilitate processes and
outcomes. The ICD-10 system allows for the addition of new codes and enables providers to define diagnoses
Page:7 of 10
Course Name:Medical Office Management I
and treatments more specifically.
ICD-10-CM codes include three to seven digits, which may be letters or numbers. For example, the ICD-10-CM
diagnosis code for pneumonia without an organism identified is J18.9.
The HCFA Common Procedure Coding System is more commonly known as HCPCS (pronounced “hic-pics”).
The HCPCS classification system has several different levels. The most commonly used level is the CPT level,
or Current Procedural Terminology.
The CPT codes are published by the American Medical Association. CPT codes are five-digit codes that are
used to describe the procedures and services performed by providers, especially physician offices. For example,
a stress test performed at a cardiology office would have a CPT code of 93015.
You may be wondering how ICD-10 codes differ from CPT codes. ICD-10 codes cover both diagnoses and
procedures and are used mainly for inpatient hospital settings. CPT codes are procedure codes used mainly in
outpatient and physician settings. However, a physician’s office may report the diagnosis using ICD-10 codes
and the procedures and services using CPT.
Both ICD-10 and HCPCS (CPT) codes are updated annually. It’s imperative that an office have the most up-todate coding manuals and ensure that the codes are updated in the coding and billing software. Submitting
incorrect or outdated codes is a sure way to get claims denied.
Coding Compliance
A coding compliance program is an important aspect of healthcare coding and reimbursement. A compliance
program will help to ensure that a healthcare provider is coding correctly and submitting the correct codes on
claims.
Coding compliance has become extremely important due to increasing issues with reimbursement claims and
denials and improper payments.
“Improper payments” can be defined as
Federal funds distributed to the wrong recipient
Underpayment or overpayment
Payments that aren’t supported by the documentation
Improper use of funds
Reducing improper payments is a high priority for CMS. To assist with this, CMS is implementing claims payment
safeguards such as
Increased prepayment medical review
Enhanced analytics
Augmented education and outreach to the provider and supplier communities
Expanded review of paid claims by the CMS recovery auditors
Improved clarity and consistency of payment policy instructions
Better targeting of providers and suppliers with a history of submitting improper Medicare claims
Coding Errors and Compliance
Page:8 of 10
Course Name:Medical Office Management I
As discussed earlier, reimbursement claims can contain a variety of errors. In the majority of cases, mistakes are
due simply to lack of staff training and knowledge. Another big reason for errors is that the office hasn’t
implemented the latest updates to the coding and billing software. When an office has implemented a coding
compliance program that helps check the codes, issues can be identified and corrected prior to the claim being
submitted, reducing the risk of denial.
Upcoding and Unbundling
In most cases submitting claims with incorrect codes is just a mistake; however, if it’s done on a regular basis it
can be seen as committing fraud, which has serious repercussions. Two of the most common types of fraud are
upcoding and unbundling.
Upcoding means that codes are assigned and reported on the claim that aren’t supported in the patient’s record.
This practice is used to illegally increase reimbursement for healthcare services.
Unbundling involves assigning multiple codes when only one code is necessary. Most often, this happens as a
mistake because of lack of knowledge or training. However, a number of offices have been charged with fraud for
using unbundling to obtain higher reimbursement for the healthcare services provided. Whether unbundling
occurs accidentally or not, it’s still incorrect. It will cause claim denials or even more serious charges of fraud.
Upcoding and unbundling, whether done intentionally or by accident, are considered to be fraud and abuse of the
healthcare reimbursement system. Ongoing upcoding and unbundling practices may lead to an investigation into
the facility’s coding and reimbursement practices.
One of the country’s largest fraud cases involved healthcare giant HCA Inc. and its subsidiaries. In 2003, HCA
agreed to pay the U.S. government over $1.7 billion, including $631 million for civil penalties and damages
arising from false claims allegedly submitted to Medicare and other federal health programs. The case was
brought to the government’s attention by something known as qui tam whistleblowers.
Qui Tam Whistleblowers
Qui tam lawsuits are civil cases by whistleblowers, or those who report wrongdoing to the government. The
False Claims Act was enacted to help the government combat the growing number of cases of fraud seen with
federal programs such as Medicare. Under this act, civilians are able to sue an individual or business and reclaim
a portion of the funds (15% to 30%) the government recovers in these cases. Companies or individuals found
guilty can be required to pay up to three times the amount owed to the government, plus penalties, for each false
claim.
Auditing and Monitoring
Another element of ensuring that claims are accurate is to implement an ongoing monitoring and auditing
program. Coding and claims should be monitored and reviewed at regular intervals to ensure that they comply
with changing regulations, guidelines, and code updates. Putting policies and procedures in place will help
facilitate this, and the policies and procedures should be communicated to all employees and medical staff.
Coding compliance programs ensure
Accurate documentation
Complete claim forms
Compliance with regulations
PowerPoint Lecture Notes
Use the lecture notes available in PowerPoint as you study this chapter by CLICKING THE LINK BELOW.
These notes will help you identify main concepts and ideas presented in this chapter.
Page:9 of 10
Course Name:Medical Office Management I
If you do not have PowerPoint on your computer, you can download a free viewer from Microsoft by clicking
here (http://www.microsoft.com/downloads/details.aspx?FamilyID=048dc840-14e1-467d-8dca19d2a8fd7485&DisplayLang=en).
Chapter 15 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch15_lesson01_lecture.ppt)
Chapter 15 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch15_lesson02_lecture.ppt)
Chapter 15 Presentation 3 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch15_lesson03_lecture.ppt)
Chapter 16 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch16_lesson01_lecture.ppt)
Chapter 16 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch16_lesson02_lecture.ppt)
Chapter 17 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch17_lesson01_lecture.ppt)
Chapter 17 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_07/../../V4/PowerPoints/beaman_ch17_lesson02_lecture.ppt)
Page:10 of 10
Course Name:Medical Office Management I
Lesson 6: Medical Records, Billing, Collections,
and Financial Management
In this lesson, you will study problem-oriented medical records,
the SOAP charting method, file storage units and filing systems,
cross-referencing systems, quality assurance, statutes of
limitations, electronic versus paper records, converting to
electronic records, HIPAA compliance for electronic records, and
personal digital assistants. You’ll also learn about fee
determination, billing methods and statement preparation, credit
policies and collections processes, aging accounts, check-writing
systems, accepting third-party payments, methods for endorsing
checks, recurring monthly expenses, making deposits, and
reconciling bank statements.
LEARNING OBJECTIVES
 Objective 1 Describe the different types of
medical records, paper record storage and filing
systems, and quality assurance practices.
 Objective 2 Identify the benefits of electronic
medical records, and discuss conversion and
implementation procedures for moving from
paper-based to electronic records.
 Objective 3 Describe the process of fee
determination, and discuss billing methods and
billing statements.
 Objective 4 List the steps in the debt-collection
process, and explain how to handle aging
accounts.
 Objective 5 Review check-writing systems, the
three types of endorsements, and the various
risks involved in accepting checks.
 Objective 6 Outline the steps for making bank
deposits and reconciling bank statements.
Page:1 of 7
Course Name:Medical Office Management I
Text Readings
Pearson’s Comprehensive Medical Assisting, Chapters 13, 14, 18 and 19
Additional Readings
Required Readings
Terminal-Digit Filing (https://youtu.be/Y6Ndml7Y96M)
Health Information Privacy: The HIPAA Privacy Rule (http://youtu.be/TSvh5kkZskU)
Improving the Quality of Care at the Practice Level (http://youtu.be/55DvfxnA3s8)
Quality and Safety Resources for Joint Commission Customers (http://www.youtube.com/watch?
v=lvlcpodd4Ec&feature=share&list=PL3341991B787EEED4&index=1)
EMR versus EHR (https://www.youtube.com/watch?v=y85HfTG4UpU&feature=youtu.be)
EHR Implementation (https://www.youtube.com/watch?v=lmtAzbpI6_Y&feature=youtu.be)
How Do Deductibles and Coinsurance Work? (http://youtu.be/47tkrN-YQqs)
How Businesses Handle Collections is Closely Regulated Under the Fair Debt Collection Practices Act,
(https://www.consumer.ftc.gov/articles/0149-debt-collection)
Payroll Deductions (https://www.youtube.com/watch?v=A6RobHXRcMI&feature=youtu.be)
Lecture Notes
Medical records have a long history in medicine. However, standardization of those records doesn’t. Early on,
physicians kept sporadic notes on a patient’s health care. It wasn’t until 1928 that the American College of
Surgeons, or ACOS, decided to implement standards for improving health care, including the standardization of
medical records. The ACOS realized that physicians could provide better care for patients when there was
documentation of their medical history and treatment.
To oversee these improvements in medical records, the ACOS implemented the American Association of Record
Librarians. This organization is still in existence today, but it’s now known as the American Health Information
Association, or AHIMA.
You may be wondering how we’ve moved from no records, to standardized paper records, to today’s electronic
medical records. The healthcare industry became interested in using computers as early as the 1960s, when
computers were becoming more popular. However, not many computers existed, with only around 2,000
computers being used in the United States in 1960! Computers were also very different from what we know
today. They were very expensive, and the processors were huge. You may have even seen some early
photographs of computer systems that took up entire rooms!
It wasn’t until the 1980s that healthcare organizations started using computers.
Many started with transitioning their master patient index, or MPI, which lists all of the patients and the dates
they were seen in the hospital, into an electronic format that could be stored on a computer. Computer systems
back then weren’t like we know them today. The different computer systems weren’t able to “talk” to each other
and share information. For example, a billing office system might not have been able to share information with
the system in the medical records department or the pharmacy. However, computer manufacturers and software
companies continued to work on improving technologies throughout the 1990s.
Page:2 of 7
Course Name:Medical Office Management I
In 2000, a real emphasis was placed on creating a true electronic medical record that could share information
across departments and, in some cases, across different healthcare facilities within the same network. The
Centers for Medicare and Medicaid (CMS) headed this push as a way to reduce documentation errors that were
resulting in patient harm and even death. The CMS also wanted decision-support systems that would help
physicians and other healthcare providers make better choices.
Today, most healthcare facilities have hybrid medical record systems, meaning that they use both paper-based
and electronic medical records. Converting paper medical records can be time consuming and costly, so many
facilities still have some medical records on paper. However, the Health Information Technology for Economic
and Clinical Health (HITECH) Act was signed into law on February 17, 2009, to help promote the adoption and
use of health information technology.
To encourage healthcare providers to implement electronic medical records, the CMS created the Medicare and
Medicaid EHR Incentive Programs to “provide incentive payments to eligible professionals, eligible hospitals,
and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful use of
certified EHR technology.” Incentive payments can range from $44,000 to just over $63,000.
We’ve taken you through a brief history of the medical record, all the way up to where we are today. Now, let’s
take a closer look at the traditional paper-based record and then the electronic medical record to give you a
better understanding.
Medical records are legal documents that contain all of the medical history and treatment information on a
patient being seen by a healthcare provider. In a paper-based record system, each healthcare provider
maintains his or her own medical record on the patient. This can create issues when a patient has been seen at
one hospital and then later is treated at another. In some cases, one healthcare provider may need to request a
copy of the patient’s record from another healthcare provider to completely understand the patient’s medical
history and previous treatment.
Medical records can include the following:
Patient demographic information
History and physical reports
Laboratory reports
Progress notes
Therapy notes
Surgical reports
X-rays
Nursing notes
Medical Record Formats
Although information and reports may be similar, not all medical records are formatted the same way. The layout
and format of a medical record depends on the type of healthcare facility and its particular information needs.
Chronological medical records are one of the most common medical record types used in health care. In
chronological records, each patient visit is sectioned by date. For example, all of the December 3, 2016,
information is filed together in the record. Then, the patient’s March 14, 2017, visit information is filed together on
top of the December 2016 visit.
Page:3 of 7
Course Name:Medical Office Management I
Problem-oriented medical records, or POMRs, list a patient’s “problem” or diagnosis, at the front of the record.
Whenever new issues are identified with the patient, they’re noted on the problem list. This helps healthcare
providers quickly identify patient issues and also identify trends.
The POMR is divided into four parts:
1. Database
2. Problem list
3. Plan
4. Progress notes
SOAP charting is a common approach used by physicians that’s often also taught to medical students and other
healthcare professionals. It’s referred to as “SOAP” based on the first letter of each section:
Subjective
Objective
Assessment
Plan
SOAP charting can actually be part of another medical record format. For example, physician notes may use the
SOAP format, but all the other reports in the record may be in the POMR format.
The source-oriented medical record, or SOMR, is a commonly used format in environments such as clinics. The
patient information is in reverse chronological order, with each report or note type filed together. For example, if a
patient was in the hospital for surgery on March 31, 2017, and then again for surgery on November 2, 2017, the
November 2 information would be filed on top of the March 31 information. Each section, such as progress
notes, surgical reports, X-rays, nurses’ notes, etc., are each sectioned within the record. So, all the progress
notes are together, all the surgical reports are together, etc., with the most recent date filed on top.
One of the biggest complaints with this format type is that it’s difficult to identify patterns or see all of the
information about one hospital stay or office visit because it’s filed in different sections.
Do’s and Don’ts of Medical Records
As we mentioned earlier, medical records are also legal records. Not only do they help the healthcare provider to
understand a patient’s treatment, but they’re also used to communicate with others about what happened with
the patient during the physician encounter or hospital stay. That means that many people may see and use the
information. Because of this, there are important guidelines to follow when documenting information in the
patient’s medical record.
When documenting in the patient’s record:
Document only facts.
Include everything that’s done and discussed with the patient.
Write legibly in black ink.
When working with medical records:
Don’t record opinions.
Page:4 of 7
Course Name:Medical Office Management I
Don’t document issues with the office or between employees.
As a legal document, it’s important that documentation errors are treated in the correct way in the patient’s
medical record. If a patient’s record is subpoenaed for a court case but has a bunch of information scribbled out,
it might look like the healthcare provider is trying to hide information.
When dealing with medical record documentation errors:
Don’t erase the information.
Don’t scribble through the information so that it can’t be read.
Don’t correct the information using correction fluid (e.g., Wite-Out).
To correct medical record documentation errors, strike through the statement with a single line, note above it
“error,” and then supply the date and your initials. If additional information needs to be added, title it “addendum”
and then document the correct information.
When using an electronic medical record, information can be deleted and reentered if it hasn’t been saved yet. If
an error is discovered after the file has been saved, an addendum should be added as a separate note with the
title “Correction.”
Medical Record Storage
As you can imagine, it’s important to store medical records in a safe and secure place. It’s the healthcare
provider’s responsibility to ensure that the patient’s privacy and confidentiality are protected at all times. It’s also
the healthcare provider’s responsibility to provide the patient treatment information, as needed.
There are three types of records that a healthcare provider will primarily deal with: active, inactive, and
closed. Active records are records for patients who have been treated within the past three years. Inactive
records are records for patients who haven’t been treated at the facility within the past three years. Closed
records are records of patients who are no longer being seen—they may have moved away, started seeing
another physician, or died.
Federal and state regulations specify where records should be stored and how long a patient’s medical record
should be kept, depending on the type of record.
Because of space limitations, it often isn’t practical to keep every single patient record for the entire time a
provider is in practice. Healthcare providers should be aware of the state and federal regulations that govern the
retention of records for the types of patients they serve. For example, an average time to keep an inactive or
closed record is 10 years. However, for minors the records must be kept until they’re at least 18 years old.
Filing Medical Records
Medical records must be filed in such a way that they can be retrieved quickly and easily whenever they’re
needed. There are actually different methods of filing medical records depending upon the facility and provider’s
needs.
The following are common types of filing systems:
Alphabetic
Numeric
Subject matter
Color coding
Page:5 of 7
Course Name:Medical Office Management I
There are a number of variations with the numeric filing method that the medical assistant should be familiar
with:
Straight numeric: Records are filed based on the sequential number.
Terminal digit: Records are filed with the last two numbers filed first (the “primary” numbers). For example,
with 12-24-00, the 00 is looked at first, and then back to the beginning to file under 12, then 24.
Middle digit: Records are filed with the two middle digits first. For example, with 12-24-00, the 24 is looked
at first, and then the 12, then 00.
Unit: Assigns one number to a patient that’s used for every visit.
Serial: Assigns a different medical record number each time the patient is seen.
Releasing Medical Records
A normal part of healthcare office work is releasing patient information. Due to the confidential and private nature
of patient information, strict laws, rules, and regulations must be followed when releasing a patient’s information.
Naturally, a patient (or the patient’s legal guardian) can release his or her own information. However, when can
healthcare facilities release patient information without the patient’s authorization? Medical records can be
released without patient authorization to
Healthcare workers treating the patient
Business associates of the healthcare provider who provide services necessary for the information
(transcription companies, insurance agencies, etc.)
Qualified research and educational institutes
Government agencies, as permitted by law
Legal authorities for lawsuits
Quality Assurance
Quality assurance, or QA, in health care ensures that standards of care are being met within a facility.
Designated staff members within the healthcare organization monitor and evaluate the services provided to make
sure that patients are receiving quality care.
By standardizing care, healthcare providers understand what’s needed to treat certain diagnoses no matter
where they’re treated. Some organizations that help ensure that quality standards are met include
The Joint Commission (TJC)
Occupational Safety and Health Administration (OSHA)
HIPAA
Electronic Medical Records
Electronic medical records (EMRs) are often called electronic health records (EHRs). Although the terms are
often used interchangeably, EMRs and EHRs aren’t the same thing. EMRs contain all of the data used to treat
patients at a particular office. However, EHRs are broader; they not only contain patient data, but they also go
beyond that to network with ancillary providers and other facilities’ systems to provide the entire history of a
patient’s treatment. Today, the term “EHR” is becoming more widely used, probably because CMS uses that term
when discussing upcoming technology implementation requirements.
Page:6 of 7
Course Name:Medical Office Management I
EHRs have the following advantages over paper-based medical records:
Easier and faster access to information
Ability to access information from any computer
Easy to update patient information
Quick sharing of patient information between providers
Converting from a paper-based record to an electronic record can be time consuming and extremely costly.
That’s why many healthcare providers are reluctant to make the change. In many cases, providers hire an
outside company that specializes in the conversion and schedules it to happen over a period of time.
PowerPoint Lecture Notes
Use the lecture notes available in PowerPoint as you study this chapter by CLICKING THE LINK BELOW.
These notes will help you identify main concepts and ideas presented in this chapter.
If you do not have PowerPoint on your computer, you can download a free viewer from Microsoft by clicking
here (http://www.microsoft.com/downloads/details.aspx?FamilyID=048dc840-14e1-467d-8dca19d2a8fd7485&DisplayLang=en).
Chapter 13 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch13_lesson01_lecture.ppt)
Chapter 13 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch13_lesson02_lecture.ppt)
Chapter 13 Presentation 3 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch13_lesson03_lecture.ppt)
Chapter 14 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch14_lesson01_lecture.ppt)
Chapter 18 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch18_lesson01_lecture.ppt)
Chapter 18 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch18_lesson02_lecture.ppt)
Chapter 19 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch19_lesson01_lecture.ppt)
Chapter 19 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_06/../../V4/PowerPoints/beaman_ch19_lesson02_lecture.ppt)
Page:7 of 7
Course Name:Medical Office Management I
Lesson 5: Patient Reception, Appointment
Scheduling, Office Technology, and
Correspondence
In this lesson, you’ll learn about receptionist responsibilities,
legal and ethical duties, opening and closing the medical office,
handling angry patients and waiting room emergencies,
scheduling systems, and documentation. You’ll also learn about
office flow, HIPAA regulations for medical records, basic office
equipment, letter writing, and computer hardware, software,
security, and maintenance.
LEARNING OBJECTIVES
 Objective 1 Identify office responsibilities related
to the patient reception area.
 Objective 2 Discuss the legal and ethical issues
related to being a medical receptionist.
 Objective 3 Describe the six types of office
scheduling systems, the equipment used in
scheduling, and the process of scheduling
patients for appointments and procedures.
 Objective 4 Explain the elements of office flow.
 Objective 5 Review functions, security, and
maintenance of basic office equipment and
computers.
 Objective 6 Discuss HIPAA in relation to office
equipment and correspondence.
Page:1 of 9
Course Name:Medical Office Management I
Text Readings
Pearson’s Comprehensive Medical Assisting, Chapters 8, 9, 10, 11 and 12
Additional Readings
Required Readings
An Exploratory Study into the Factors that Influence Patients’ Perceptions of Cleanliness in an Acute NHS
Trust Hospital (http://shura.shu.ac.uk/913/1/fulltext.pdf)
Overview (http://www.aama-ntl.org/about/overview#.WRyl92jyuM9)
Health Information Privacy FAQ (https://www.hhs.gov/hipaa/for-professionals/faq/570/does-hipaa-permithealth-care-providers-to-use-email-to-discuss-health-issues-with-patients/index.html)
Lecture Notes
In some offices, the medical assistant (MA) may be tasked with running the patient reception desk and
scheduling appointments. This may not be the medical assistant’s full-time responsibility, but there will be times
when the MA is responsible for answering the phones, speaking to patients arriving for appointments, and also
scheduling appointments.
As you can probably imagine, being the person that all the patients talk to—either by checking them in when they
enter the office or speaking to them on the phone answering questions and scheduling appointments—can be
demanding and stressful. The person who works patient reception and also performs appointment scheduling
must be organized and a master multitasker. The MA deals with important and confidential patient information on
a daily basis, and this information shouldn’t just be jotted down on pieces of scrap sheet of paper to be dealt with
later.
Additionally, anyone working reception must have specific personality traits. Working the front desk requires a
calm demeanor and patience; the MA must be able to handle nice patients just as well as difficult patients. A
great question to always keep in mind is, “How would I feel walking into our office or talking to the receptionist on
the phone right now?” Always keeping this in mind will help the office to continuously improve customer service
from the reception standpoint.
One of the things that medical assistants like about working in the healthcare industry is that no two days are
exactly the same. Many MAs will perform both back-office duties and front-office tasks. Because of this, it’s
important that MAs fully understand how to deal with the patient reception area and how to schedule
appointments.
Duties of a Receptionist
The receptionist in a physician office is generally the first contact that a patient has with the office. Whether it be
in person or over the phone, it’s important to always present a professional demeanor no matter what the
situation.
Receptionists should be
Warm
Welcoming
Positive
Patient
Page:2 of 9
Course Name:Medical Office Management I
Calm
Professional
Attentive
Efficient
Think about it: how medical assistants treat the patients, families, vendors, and others they come into contact
with at the front desk is a direct reflection on the entire office. So, if a receptionist has a bad day and lets that
show, then it may cause the office to lose business or gain a bad reputation.
The responsibilities of the MA will vary based on the type and size of the office or practice. However, no matter
where an MA works, there are general duties that you should be familiar with.
MAs need to know how to
Open and close the office where they work
Greet patients appropriately
Help patients to complete the appropriate paperwork
Collect payments
Keep the reception area safe and clean
Handle unhappy patients and medical emergencies
Schedule follow-up appointments
Call patients for upcoming appointments
When working at the reception desk, MAs won’t only deal with patients. They’ll also deal with family members,
pharmaceutical representatives, vendors, staff, and others on an ongoing basis. A professional demeanor is
important at all times because it directly reflects on the physicians and other staff at the office.
Reflection of a Reception Room
Have you ever walked into a restaurant or store and immediately felt it wasn’t going to be a good experience?
Maybe the lighting was dark or the walls were dingy. Perhaps the floor was dirty, and it was the first thing you
noticed. In some cases, you may have even taken your business elsewhere and never returned to that place of
business.
In our minds, we often automatically connect disarray and dirt to a business not being able to meet our needs.
Have you ever thought in a restaurant, “If they can’t even take the time to clean their bathroom, then there’s no
way that the kitchen is clean”? Patients and vendors entering a healthcare facility or physician office have the
same mind-set. If the reception area is dirty or disorganized, then patients may assume that the physicians aren’t
capable of performing effectively.
Cleanliness is especially important in health care because patients may assume that lack of cleanliness will
make them ill.
Another cleanliness factor that MAs need to be aware of is personal hygiene. How an MA looks and smells will
also affect the patient’s perception of the office or healthcare facility.
A United Kingdom study revealed that the following factors affected patients’ perceptions of facility cleanliness:
Staff wearing clean uniforms
Page:3 of 9
Course Name:Medical Office Management I
Staff regularly washing hands
Staff seen tidying up the area
Visible cleaning staff doing a thorough job
Other MA Responsibilities
Again, depending on the size and type of office or facility where an MA works, MA responsibilities may vary. MA
responsibilities can include
Opening and/or closing the office
Collecting records or lab results for the patients being seen for the day
Greeting and signing in patients
Ensuring that new patients are properly registered
Collecting the information for the charge slips and ensuring they’re complete
Treating patients with respect
Escorting the patient to the examination room
Managing disturbances
Legal and Ethical Considerations for MAs
Medical assistants will deal with legal and ethical issues on a regular basis. Legal refers to written laws created
by the government that everyone is required to follow. Ethics means doing the right thing, which may vary based
on people’s opinions as to what’s right or wrong.
For medical assistants, the American Association of Medical Assistants (AAMA) has created ethical and moral
standards for those working in the industry.
AAMA members should “strive” toward the following: Render service with full respect for the dignity of
humanity. Respect confidential information obtained through employment unless legally authorized or required
by responsible performance of duty to divulge such information. Uphold the honor and high principles of the
profession and accept its disciplines. Seek to continually improve the knowledge and skills of medical assistants
for the benefit of patients and professional colleagues. Participate in additional service activities aimed toward
improving the health and well-being of the community.
—AAMA Code of Ethics
It’s important to have a code of ethics within in an organization to
Promote high standards
Define acceptable behaviors
Help employees be responsible for their actions
Professional organizations, and sometimes even offices, may have a creed in addition to a code of ethics.
A creed is a statement of beliefs, whereas a code of ethics is a policy stating how someone working in a
particular environment should conduct himself or herself with honesty and integrity.
Appointment Scheduling
Page:4 of 9
Course Name:Medical Office Management I
Appointment scheduling will probably be part of your daily responsibilities as a medical assistant. The person
who is responsible for covering the front desk is often tasked with scheduling patient appointments.
If you’ve never worked in a physician’s office scheduling appointments, you may not even know that there are
different types of scheduling. The type of scheduling system used will depend on how the office or facility runs its
business.
Specified-time scheduling is probably the system you’re most familiar with based on your personal experience in
making doctor’s appointments. This type of appointment scheduling gives patients a specific time frame based
on why they need to see the physician. The advantage of this system is that it helps prevent backlogs or long
waiting times for patients. However, the disadvantage is that when a patient doesn’t accurately describe the
reason for the visit and stays in the appointment longer, it can create a backlog of patients.
Wave scheduling is based on hour time slots and how many patients a physician can see in that hour. One of
the advantages of this type of scheduling is the flexibility to work with patients in an office where they’re usually
late. However, if all the patients come in at once, the last patient will have to wait the longest.
Modified wave scheduling is also built on hour time blocks, but allows the doctor to spend time slots with
patients however he or she wants to see them (e.g., at the beginning or end of the hour).
Medical assistants may also work with the following scheduling methods:
Grouping procedures : Scheduling similar procedures at the same time
Double booking : Scheduling two patients for the same time slot
Open office hours : Also known as “walk-in,” where office hours are posted and patients visit whenever
they want
Scheduling Systems
Scheduling actually serves very important functions for a physician office. It not only helps organize the patients
who need to be seen, but also helps facilitate the workflow through the office.
In this day and age of technological advancements, almost all physician offices have moved away from paper
appointment books and onto computerized scheduling systems. There are even computerized scheduling
systems that are geared specifically to healthcare facilities and physician offices.
Computerized scheduling systems offer a number of advantages:
Additions, updates, and changes can be seen in real time across several computers.
Information on patients, results, and other information can easily be searched for.
The system can monitor patterns for patients or groups.
Patient information can be retrieved quickly and shared among multiple healthcare providers.
However, computerized scheduling systems do have a number of disadvantages:
Some people are concerned about the privacy, security, and confidentiality of information stored on
computers.
If there’s a power outage or software glitch, it may not be possible to access important patient information.
The learning curve for such systems can be steep for new employees.
Implementation of a computerized system may be costly.
Page:5 of 9
Course Name:Medical Office Management I
The Medical Office Facility
An important job of those who work in physician offices and other healthcare facilities is to ensure the safety of
patients and visitors coming into the building. A variety of federal, state, and sometimes even local laws and
requirements help ensure the safety of employees, patients, and visitors.
Although safety is one of the most important considerations when designing an office, the aesthetics and layout
of an office are important, too. Aesthetics refers to how a person reacts to the beauty of his or her surroundings.
This can include cleanliness, as we discussed earlier, but it can also include office layout, use of color, and
lighting. All of these things can affect not only the patients and the visitors, but also the employees of a facility.
The most important things when creating an office and reception area are safety and functionality. Layout isn’t
just about making an office look good, it also means making sure that the office is accessible to those with
special needs. For example, the Americans with Disabilities Act (ADA) states that public places must be
accessible to everyone, including those with disabilities. Additionally, the office must provide clearly marked exits
in the case of an emergency such as a fire.
Color also has a direct effect on our mental and physical health. There are actually experts who help healthcare
facilities and businesses choose the colors that will be most soothing to their customers or help their employees
to be more productive.
Here are some of the colors that decorators use for various purposes:
White : The color white reflects light and gives a room a cleaner look; however, it can also show dirt
quickly. Physicians and doctors wear white, and it gives patients the impression of a sterile, clean
environment.
Red : The color red increases heart rate and breathing in people and raises their energy levels. It’s
considered to be the most “emotionally intense” color. It’s good to use when trying to draw attention to
something, but not when trying to soothe people.
Blue : Perceived as peaceful, the color blue can actually help people produce calming chemicals in their
bodies. However, it’s seen as an unappetizing color, so it’s not good in rooms used for food.
Yellow : Often seen as sunny and optimistic, some find yellow to be an overpowering color. It elicits strong
emotional responses in some, including frustration.
Green : This is the easiest color on the eye and makes people feel relaxed. Hospitals and businesses will
often use it to produce a calming effect.
Brown : Often related to nature (wood), in some the color brown can elicit emotions of sadness or
depression.
Much as how color evokes emotional responses, so can lighting. There are lighting experts that help businesses
the same way there are color experts. There’s also light therapy to help people with seasonal affective
disorder (i.e., those who are adversely affected by the long, dark days of winter).
Bright light is great for work areas, but it can also make those areas feel hard and cold. Soft light is created with
lamps placed around a room or dimmed overhead lights. Soft light can have a calming effect. Soft lights are often
thought of as “creating ambiance.” However, soft lights only can sometimes be too dark and create somber
feelings.
Office Equipment and Supplies
Medical assistants work with a wide variety of office equipment and supplies. If you’ve worked in an office before,
you’re probably already familiar with some of them—telephones, copy machines, fax machines, printers, and
more. However, if you’re new to health care, you’ll probably experience equipment that’s new to you. If you work
Page:6 of 9
Course Name:Medical Office Management I
in a technologically advanced office, you may even have the opportunity to work with voice recognition
technology —technology that recognizes the voice of a physician and then types what he or she is saying.
One of the roles of a medical assistant may be to purchase supplies for the office.
This may seem like a minor responsibility, but the amount of money spent on supplies can directly affect the
bottom line of a business. In some cases, offices may keep track of orders and their supply needs in their
computerized office management system.
Depending on office, the medical assistant may be tasked with keeping track of drug samples . Pharmaceutical
representatives stop by physician offices and medical centers and provide samples in hopes that doctors will
prescribe their brand of drug. Physicians will give these samples to patients for free for them to try. Even though
these are just free samples, they’re tightly regulated by the federal Drug Enforcement Agency, or DEA, and also
by some state regulations. The samples must be inventoried, with a list maintained, and remain under locked
control at all times in the office.
Written Communication
Many medical assistants are surprised at the amount of written communication they’re required to complete.
Written communications can include
Patient emails and letters
Patient record notes
Vendor correspondence
Letters to other healthcare providers
When writing, it’s important to
Use a positive tone
Avoid technical terms that may be difficult for patients to understand
Avoid using “I” a great deal
Remove “gender bias” (e.g., don’t refer to the patient as “he” if you don’t know the gender for sure, or don’t
refer to all nurses as “she”)
Use short, concise sentences and paragraphs
Avoid providing personal advice or input
Double-check for spelling and grammar errors
Avoid abbreviations and slang terms
Communication, both written and verbal, in the healthcare field is very different from that in other industries.
Because the healthcare industry handles confidential patient information, healthcare communications are
governed by rules, regulations, and laws that must be followed to ensure patient privacy. For example, the
medical assistant can’t just call and leave patient medical information with the person who answers the phone.
The medical assistant must follow strict guidelines for releasing information and discussing medical conditions
via email or phone.
Computers in the Medical Office
Page:7 of 9
Course Name:Medical Office Management I
Computers are an important part of everyday life in the physician office. They help us to be more efficient,
retrieve patient data and information faster, save money, and in many cases even provide a higher quality of care
to the patients. Technology has become part of almost every step in health care today.
Medical assistants regularly use computers to
Check information in patient records
Schedule appointments
Assist with the bookkeeping
Help with patient billing
Complete insurance claims processing
Review inventory and supply data for reordering
It’s not unusual for patients to go in to see their doctor today and have the MA, nurse, or physician use a laptop
or tablet device to record the patient information.
Depending on where you work as an MA, you may use a desktop computer or a laptop for your daily work. In
other offices, you may use a smartphone or a tablet device to perform patient and office functions.
It’s required that healthcare facilities ensure that patient information and data are private and secure. HIPAA’s
Standards for Privacy of Individually Identifiable Health Information is more widely known as the “Privacy Rule.”
The Privacy Rule sets forth requirements that healthcare providers must use and disclose patient information
only in ways that meet HIPAA’s requirements.
Another portion of HIPAA is the “Security Rule.” The Security Rule sets out requirements for administrative,
physical, and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected
health information , or EPHI :
Administrative safeguards are things like office policies and procedures that outline how to protect patient
information.
Physical safeguards are things like door locks on rooms or the part of the office that houses patient
information.
Technical safeguards are things like password requirements for accessing the online medical record or
scheduling software.
The following are just some of the ways that medical offices can ensure that patient information remains private
and secure:
Implement privacy and security policies and procedures that are regularly reviewed with existing
employees as well as with new employees.
Make sure that office doors automatically lock and require codes or keys to enter.
Create auto-logouts when a computer hasn’t been used for a specific amount of time.
Use privacy screens that can’t be seen by those not using the computer.
Regularly change passwords.
Implement firewalls and antivirus software.
Page:8 of 9
Course Name:Medical Office Management I
PowerPoint Lecture Notes
Use the lecture notes available in PowerPoint as you study this chapter by CLICKING THE LINK BELOW.
These notes will help you identify main concepts and ideas presented in this chapter.
If you do not have PowerPoint on your computer, you can download a free viewer from Microsoft by clicking
here (http://www.microsoft.com/downloads/details.aspx?FamilyID=048dc840-14e1-467d-8dca19d2a8fd7485&DisplayLang=en).
Chapter 8 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch08_lesson01_lecture.ppt)
Chapter 8 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch08_lesson02_lecture.ppt)
Chapter 9 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch09_lesson01_lecture.ppt)
Chapter 9 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch09_lesson02_lecture.ppt)
Chapter 10 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch10_lesson01_lecture.ppt)
Chapter 10 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch10_lesson02_lecture.ppt)
Chapter 11 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch11_lesson01_lecture.ppt)
Chapter 11 Presentation 2 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch11_lesson02_lecture.ppt)
Chapter 12 Presentation 1 (https://courses.portal2learn.com/content/enforced/9066-H01V_20_1/_coursesystem-files/Lesson_05/../../V4/PowerPoints/beaman_ch12_lesson01_lecture.ppt)
Page:9 of 9

Purchase answer to see full
attachment

  
error: Content is protected !!