Medical Office Administration, 6th Edition

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1 The Career of a Medical Administrative Assistant
Career Description
Job Duties
A Typical Day at the Office
Personal Qualities
Professional Appearance
Professional Skills
Student Portfolio
Places of Employment
Earnings
Employment Trends and Forecasts
Professional Organizations
American Association of Medical Assistants
American Medical Technologists
American Academy of Professional Coders
International Association of Administrative Professionals
Association for Healthcare Documentation Integrity
American Health Information Management Association
Additional Certifications
Continuing Education
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities
You are the Medical Administrative Assistant
Suggested Readings

2 The Healthcare Team
Healthcare Providers
Physician
Physician Assistant
Nurse Practitioner
Certified Nurse Midwife
Podiatrist
Psychologist
Chiropractor
Optometrist
Nurse Anesthetist
Nursing Professionals
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistant
Allied Health Professionals
Medical Administrative Assistant
Medical Assistant
Health Documentation Specialist
Medical Coder
Medical Biller
Health Information Professionals
Physical Therapist
Physical Therapy Assistant
Occupational Therapist
Occupational Therapy Assistant
Respiratory Therapist
Radiology Technologist
Clinical Laboratory Technologist and Technician
Pharmacist
Social Worker
Licensure, Certification, and Registration
Professional Organizations
Health Care Facilities
Clinic
Private Practice
Hospital
Emergency Room
Urgent Care Center
Outpatient (Ambulatory) Surgery Center
Home Health
Hospice and Palliative Care
Nursing Home and Assisted Living
Public Health
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities
You are the Medical Administrative Assistant

3 Medical Law and Ethics
Legal Concepts and Terms
What Is Law?
Origin of Law
Administrative Law
Civil and Criminal Law
Standards of Care
Respondeat Superior
Res Ipsa Loquitur
Contract Law
Legal Action Against a Medical Practice
Legal Proceedings
Legal Topics Related to the Medical Office
The Practice of Medicine
Consent
Confidentiality
Advance Directives
Uniform Anatomical Gift Act
Controlled Substances Act of 1970
Good Samaritan Statutes
Health Insurance Portability and Accountability Act of 1996
Emergency Medical Treatment and Labor Act of 1986
Risk Management
Medical Ethics Concepts and Terms
Definition of Ethics
Law Versus Ethics
History of Ethics
Ethical Behavior for Physicians
The American Medical Association Council on Ethical and Judicial Affairs
Ethics Opinions of the Council on Ethical and Judicial Affairs
Failure to Abide by Ethical Standards
Ethical Behavior for Medical Administrative Assistants
Ethical Issues in Healthcare
The Study of Ethical Issues in Healthcare
Abortion
Reproductive Rights
Issues Near the End of Life
Acquired Immunodeficiency Syndrome, Human Immunodeficiency Virus
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities
You are the Medical Administrative Assistant

4 The Diverse Community of Patients
Influence of Culture
Interactions With Patients of Different Cultures
Expectations When Serving Patients
Language Barriers
English as a Second Language
Speech Difficulty
Medical Terminology
Specific Patient Groups
Elderly Patients
Children
Patients With Disabilities
Lesbian, Gay, Bisexual, Transgender, Queer/Questioning
Angry Patients
Violent Patients
Anxious Patients
Depressed Patients
Dying or Grieving Patients
Summary
Review Exercises
Activities
You are the Medical Administrative Assistant
Suggested Readings

5 Interpersonal Communications
Communication Concepts
Communication Basics
Communicating Effectively
Nonverbal Communication
Personality Styles
Communication Within the Healthcare Team
Communicating With Your Supervisor
Telephone Communication
Proper Telephone Technique
Incoming Calls
Outgoing Calls
Written Communication
Business Letters
Memos
Email
U.S. Postal Service Delivery Services
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

6 Appointment Scheduling
Computerized Appointment Scheduling
Software Packages for Appointment Scheduling
Concerns When a Computerized Appointment System Is Used
Manual System for Appointment Scheduling
Concerns When a Manual Scheduling System Is Used
Appointment Scheduling Methods
Double-Booking (Overbooking) of Appointments
Walk-in Patients
Group (Block) Scheduling
Series of Appointments
Multiple Appointments
Virtual Visits
Appointment Scheduling Procedures
Establishing Appointment Parameters
Components of an Appointment
Prioritizing Appointments
No-Show Appointments
Canceled and Rescheduled Appointments
Ancillary and Referral Appointments
Surgical Appointments
Pharmaceutical and Other Sales Representatives’ Appointments
Wait Lists
Appointment Reminders
Accessing the Schedule
Planning for the Unexpected
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

7 Patient Reception and Registration
Exceptional Patient Service
Patient Informational Materials
Getting the Office Ready
Unlock the Door
Review the Day’s Schedule
Start and Check Office Equipment
Switch on Television or Music System
Count Cash Drawer
Welcoming Patients
Patient Registration
Registration Information
Reception Area
Layout and Design of the Reception Area
Reception Area Maintenance
Emergency Situations
What Is an Emergency?
Common Medical Emergencies
What a Medical Administrative Assistant Should Do
Other Situations
Planning for Emergencies
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

8 Health Information Management
What is Health Information Management?
Purposes of Recordkeeping
Types of Records
Confidentiality
Confidentiality Agreements
Confidentiality and Computerized Medical Records
Health Insurance Portability and Accountability Act of 1996
Notice of Privacy Practices
Failure to Comply With HIPAA
Components of the Medical Record in a Medical Office
Summary Sheet
Medical History
Encounters/Progress Notes
Medication Records
Immunizations
Laboratory and Pathology Reports
Radiology Reports
Other Specialized Reports and Documents
Correspondence
Hospital Reports
Medical Transcription and Documentation
Skills Needed
Equipment Used
Signature
Organizing the Medical Record
Charting Methods
Chart Order
Documentation Guidelines
What Does Not Belong in the Record
Records Flow
Quantitative Analysis
Filing Supplies
Charts
Labels
Outguides
Filing Methods
Numeric Filing Systems
Alphabetical Filing
Color Coding
Records Retention and Disposal
Tickler File
File Storage and Protection
Disaster Plan
Medical Offices With Multiple Locations
Legal and Ethical Issues
Release of Information
Ownership
Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Records
The Future of Health Records
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

9 Procedure and Diagnosis Coding
Medical Coding
Procedure Coding—Current Procedural Terminology
Sections of the Current Procedural Terminology Manual
Procedure Coding—HCPCS Level II—National Codes
Diagnosis Coding—International Classification of Diseases, 10th Revision, Clinical Modification
Legal and Ethical Issues in Coding
Ethics
Compliance
The Coding Profession
Summary
Review Exercises
SimChart for the Medical Office Applications

10 Medical Billing
The Billing Process
Registration
Superbill
Billing Office Processes
Computerized Billing Systems
Credit
Statements of Account
Aging Accounts
Collection
Collection Methods
Billing Topics
What Does the Doctor Charge?
Assignment of Benefits
Fees for Medical Care
Legal and Ethical Issues in Medical Billing
Medical Debt
Confidentiality
Billing Fraud
Identity Theft
Fee Splitting
Charges for Minors
Estate Claims
Missed Appointments—To Bill or Not to Bill
Medical Records
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

11 Health Insurance and Health Benefits Programs
Insurance Terminology
Centers for Medicare and Medicaid Services
CMS-1500 Claim Form
The Insurance Claim Process
Electronic Claims Processing
Paper Processing of CMS-1500
Coordination of Benefits
Troubleshooting Claims
Timelines for Filing
Filing an Appeal
Types of Insurance Plans
Fee-for-Service
Health Maintenance Organizations
Preferred Provider Organizations
Government Health Insurance Programs
Medicare
Children’s Health Insurance Program
Tricare
Champva
Workers’ Compensation
Private Health Insurance
Insurance Coverage
Blue Cross/Blue Shield
Disability Insurance
Long-Term Care Insurance
Insurance Resources
Current Topics in Health Insurance
Insurance Fraud and Abuse
Confidentiality
Cobra
Insurance Industry Statistics
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

12 Business Operations of the Medical Office
Organizational Structure of the Medical Office
Types of Ownership
Organizational Hierarchy
Healthcare–Related Organizations
The Joint Commission
Occupational Safety and Health Administration
Clinical Laboratory Improvement Amendments Program
Other Office Support Responsibilities
Office Supplies
Office Meetings and Communications
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

13 Financial Management
Bookkeeping and Accounting Procedures in a Medical Office
Financial Reports
Accounts Receivable
Receiving Payments on Account
Preparing a Bank Deposit
Refunding Overpayment of a Patient’s Account
Processing Returned Checks
Petty Cash
Accounts Payable
Purchase Orders
Banking Procedures for Accounts Payable
Reconciling the Bank Account
Business Record Retention
Summary
Review Exercises
SimChart for the Medical Office Applications
Activities

14 Human Resource Management
Participatory Management Style
The Employment Process
Posting an Open Position
The Interview
Hiring a New Employee
Employee Training and Probationary Period
Policy Manuals
Procedure Manuals
Payroll
Timekeeping
Employee Compensation Record
Payroll Deductions
Human Resource Records
Employee Evaluation
Employee Discipline or Termination
Separation of Employment
References for Former Employees
Employee Health
Adapting to Change
Labor Laws and Legal Issues
Labor Law Enforcement
Fair Labor Standards Act
Family and Medical Leave Act
Americans With Disabilities Act
Sexual Harassment
Workers’ Compensation
Information on Employment Matters
Summary
Review Exercises
Activities

15 Job Search Essentials
Preparation for Employment
Social Media
Applying for a Position
Developing a Winning Résumé
Heading
Career Objective
Education
Work Experience or Work History
Achievements, Awards, Interests, or Skills
References
Cover Letter
Finding Out About Job Openings
Internet Job Search
Networking
Academic Placement Services
Professional Employment Services
Classified Ads
Professional Organizations
Cold Calls
Internship Opportunities
An Application for Employment
Preparing for a Great Interview
The Interview
Choosing The Right Position
Summary
Review Exercises
Activities

Appendix A Answers to Think About It Questions
Appendix B Competency Assessment Checklist
Appendix C Using SimChart
Glossary
Index

Brenda A. Potter, BS, CPC-I, CPC, Medical Administrative Program Director, Minnesota State Community & Technical College, Moorhead, MN, USA