Chapter 28Medical Office

Health Care Science Technology

Copyright © The McGraw-Hill Companies, Inc.

Chapter 282 Copyright © The McGraw-Hill Companies, Inc.

Objectives

Identify the education and training required to become an administrative medical assistant, a medical insurance specialist, a medical office manager, and a billing and collections specialist.

Chapter 283 Copyright © The McGraw-Hill Companies, Inc.

Objectives (cont.)

Compare the job responsibilities of the administrative medical assistant with those of the medical office manager.

Summarize the specific duties of the medical insurance specialist and the billing and collections specialist.

Analyze the legal and ethical issues related to working with client information in the medical office.

Chapter 284 Copyright © The McGraw-Hill Companies, Inc.

Objectives (cont.)

List the various types of technology and office equipment that may be used to perform administrative tasks in the medical office.

Use the interpersonal skills necessary for working in a medical office.

Successfully complete 6 medical office procedures.

Chapter 285 Copyright © The McGraw-Hill Companies, Inc.

Careers in the Medical Office 28-1

The Administrative Medical Assistant

The Medical Insurance SpecialistThe Medical Office ManagerThe Billing and Collections

Specialist

Chapter 286 Copyright © The McGraw-Hill Companies, Inc.

The Administrative Medical Assistant

May be a high school graduate or may have additional vocational training.

Certification exams are offered by the American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT).

Chapter 287 Copyright © The McGraw-Hill Companies, Inc.

The Administrative Medical Assistant (cont.)

The Job of the Administrative Medical Assistant– Answer phones and take

messages.– Schedule appointments

and create and maintain client financial and medical records.

– Should be skilled in using various office equipment.

Chapter 288 Copyright © The McGraw-Hill Companies, Inc.

The Administrative Medical Assistant (cont.)

The Job of the Administrative Medical Assistant (cont.)

– Should appear professional and have good communication skills.

– May wear a uniform, business attire, or lab coat.

– Should demonstrate empathy to diffuse emotional reactions of clients.

Chapter 289 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist

May have an associate’s degree in medical assisting or health information management.

Must be skilled in the use of encounter forms (also known as superbills) and medical records.

Chapter 2810 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist (cont.)

Has a basic knowledge of medical law and ethics.

Files forms for reimbursement.

Must keep client information confidential.

Chapter 2811 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist (cont.)

Retrieves information from the client’s medical form, financial records, and encounter form.

Completes an insurance claim form, which includes information on the beneficiary, the insured, and possibly dependents.

Chapter 2812 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist (cont.)

Reviews and files the explanation of benefits form (EOB) based on the benefits available to the insured.

May appeal if benefits are denied.Must be knowledgeable about the

various plans and benefits available.

Chapter 2813 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist (cont.)

Must be familiar with plans of private insurance companies, including Blue Cross and Blue Shield, Anthem, and various health maintenance organizations (HMOs).

Must be familiar with plans of government providers, including Medicare, Medicaid, and TRICARE.

Chapter 2814 Copyright © The McGraw-Hill Companies, Inc.

The Medical Insurance Specialist (cont.)

Insurance Fraud and Compliance– Fraud, which is the intentional

misrepresentation of facts to mislead or deceive another person or entity, is a major concern to the insurance specialist.

Chapter 2815 Copyright © The McGraw-Hill Companies, Inc.

The Medical Office Manager

Responsible for the staff, supplies, and operation of equipment.

In small offices, reports to the physician and may oversee other office workers.

In offices with multiple physicians, may report to the human resources manager.

Chapter 2816 Copyright © The McGraw-Hill Companies, Inc.

The Medical Office Manager (cont.)

May have taken courses in office management and organization, medical law and ethics, therapeutic communication, and human relations.

Chapter 2817 Copyright © The McGraw-Hill Companies, Inc.

The Medical Office Manager (cont.)

The Job of the Medical Office Manager– Supervise employees.– Prioritize activities and

delegate tasks.– May manage the budget.

Chapter 2818 Copyright © The McGraw-Hill Companies, Inc.

The Billing and Collections Specialist

Collects co-payments or deductibles. Bills and collects payments from

clients or insurance carriers. May have formal training in a medical

assistant program or may have a background in medical coding, billing, and insurance.

Chapter 2819 Copyright © The McGraw-Hill Companies, Inc.

The Billing and Collections Specialist (cont.)

The Job of the Billing and Collections Specialist– Contact the individual responsible for

filing insurance claims for clients.– Determine a schedule or process of

payment for client or responsible party.– Use ledgers to show a history of

charges and payments.

Chapter 2820 Copyright © The McGraw-Hill Companies, Inc.

The Billing and Collections Specialist (cont.)

The Job of the Billing and Collections Specialist (cont.)

– Send statements to clients with a balance.

– Check the tickler report daily to review overdue accounts.

Chapter 2821 Copyright © The McGraw-Hill Companies, Inc.

The Billing and Collections Specialist (cont.)

The Job of the Billing and Collections Specialist (cont.)

– After 150 days, an account may be turned over to a collection agency.

– To avoid the collection agency’s fee of up to 40%, the billing and collection specialist should make every effort to collect the overdue account, including using small claims court.

Chapter 2822 Copyright © The McGraw-Hill Companies, Inc.

Section 28-1Apply Your Knowledge

Why should the billing and collection specialist make every possible effort to avoid turning an account over to a collection agency?

Answer:

Collection agencies may charge up to 40% of the balance to be collected.

Chapter 2823 Copyright © The McGraw-Hill Companies, Inc.

Medical Office Procedures 28-2

Additional Career Skills

Chapter 2824 Copyright © The McGraw-Hill Companies, Inc.

Additional Career Skills

Evaluating Client Charts– Active – when a client has been seen

within a specified amount of time, usually a year.

– Inactive – can be removed from frequently-accessed records.

– Closed – when a client has not been to the office for a period of time, usually 3 years.

Chapter 2825 Copyright © The McGraw-Hill Companies, Inc.

Additional Career Skills (cont.)

Completing Insurance Forms– Those working with insurance companies must

be familiar with the following terms and practices:

Assignment of benefits. Claim. Coinsurance. Preauthorization. Coordination of benefits. Using form locators.

Chapter 2826 Copyright © The McGraw-Hill Companies, Inc.

Section 28-2 Apply Your Knowledge

What 2 systems may be used to file medical records?

Answer:

Alphabetic and numeric.

Chapter 2827 Copyright © The McGraw-Hill Companies, Inc.

Procedures in Student Text

28A Using the Telephone28B Scheduling

Appointments28C Greeting a Client28D Assembling a Client

Record28E Filing Medical Records28F Using the Physicians’

Desk Reference

Chapter 2828 Copyright © The McGraw-Hill Companies, Inc.

Additional Procedures in Lab Activity Manual

LM28-1 Evaluating Client Charts

LM28-2 Completing Insurance Forms

Chapter 2829 Copyright © The McGraw-Hill Companies, Inc.

Chapter 28 Credits

Slide 7 Terry Wild Studio

Slide 10 Jeff Greenberg/Visuals Unlimited

Slide 17 Terry Wild Studio