Additional Information
Book Details
Abstract
Prepare for a successful career in medical assisting! Kinn’s The Administrative Medical Assistant, 8th Edition helps you learn the real-world administrative skills essential to working in the health care office. In-depth coverage ranges from professional behavior and interpersonal skills to billing and coding, electronic health records and management of practice finances. Written by administrative medical assisting expert Alexandra Adams, this classic resource also includes an Evolve companion website with exercises and activities, videos, review questions for the CMA and RMA certification exams, and an interactive portfolio builder.
- Step-by-step, illustrated procedures make it easier to learn and understand medical assisting skills, and include rationales for each step.
- Threaded case scenarios let you develop critical thinking skills and apply concepts learned in each chapter to realistic administrative situations.
- Study Guide includes a variety of exercises to test your knowledge and critical thinking skills, case scenarios from the book, and a Procedure Checklists Manual. Sold separately.
- Emergency Preparedness and Assisting with Medical Emergencies chapter prepares you to take action during crises and urgent situations.
- Detailed learning objectives and vocabulary with definitions in each chapter help you study more effectively, with connections icons linking concepts in the text to exercises in the study guide and on the Evolve companion website.
- Patient education and legal and ethical issues are described in relation to the Medical Assistant's job.
- A Portfolio Builder on the Evolve website helps you demonstrate proficiency to potential employers.
- NEW! Charting examples within the procedures are highlighted for easier learning.
- UPDATED coverage of the Electronic Health Record ensures that you are familiar with the technology you'll use on the job.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Half title page | i | ||
| Evolve page | ii | ||
| Kinn's The Administrative Medical Assistant, 8/e | iii | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Distinctive Features of Our Approach | vii | ||
| Key Features in this Edition | vii | ||
| Evolve | vii | ||
| Study Guide and Procedure Checklists | viii | ||
| Kinn’s Medical Assisting Online | viii | ||
| Special Features | ix | ||
| Reviewers | xi | ||
| Acknowledgments | xiii | ||
| Table of Contents | xv | ||
| Procedures | xvii | ||
| Introduction | 1 | ||
| 1 Becoming a Successful Student | 1 | ||
| Learning Objectives | 1 | ||
| Vocabulary | 2 | ||
| Scenario | 1 | ||
| Who You are as a Learner: How Do You Learn Best? | 2 | ||
| Learning Style Inventory | 2 | ||
| Using Your Learning Profile to Be a Successful Student: Where Do I Go from Here? | 3 | ||
| Time Management: Putting Time on Your Side | 4 | ||
| How to Put Time on Your Side | 4 | ||
| Problem Solving and Conflict Management | 5 | ||
| Assertive Communication | 6 | ||
| Nonassertive and Aggressive Behaviors and Language | 6 | ||
| Study Skills: Tricks for Becoming a Successful Student | 7 | ||
| Test-Taking Strategies: Taking Charge of Your Success | 8 | ||
| Becoming a Critical Thinker: Making Mental Connections | 9 | ||
| Connections | 10 | ||
| Study Guide Connection: | 10 | ||
| Evolve Connection: | 10 | ||
| 2 The Healthcare Industry | 11 | ||
| Learning Objectives | 11 | ||
| Vocabulary | 12 | ||
| Scenario | 11 | ||
| The History of Medicine | 13 | ||
| Medical Language and Mythology | 13 | ||
| Medicine in Ancient Times | 13 | ||
| Early Development of Medical Education | 14 | ||
| Early Medical Pioneers | 14 | ||
| Medical Advances in the Eighteenth and Nineteenth Centuries | 15 | ||
| Nineteenth Century Women in Medicine | 17 | ||
| Modern Milestones in Medicine | 18 | ||
| The National View of Healthcare | 20 | ||
| World Health Organization | 20 | ||
| U.S. Department of Health and Human Services | 20 | ||
| U.S. Army Medical Research Institute of Infectious Diseases | 20 | ||
| Centers for Disease Control and Prevention | 21 | ||
| National Institutes of Health | 21 | ||
| Types of Healthcare Facilities | 21 | ||
| Hospitals | 21 | ||
| Ambulatory Care | 23 | ||
| Other Healthcare Facilities | 23 | ||
| Types of Medical Practice | 24 | ||
| Sole Proprietorship | 24 | ||
| Partnership | 24 | ||
| Corporation | 24 | ||
| Healthcare Professionals | 24 | ||
| Title of “Doctor” | 25 | ||
| Doctors of Medicine | 25 | ||
| Doctors of Osteopathy | 25 | ||
| Doctors of Chiropractic | 25 | ||
| Hospitalists | 25 | ||
| Dentists | 27 | ||
| Optometrists | 27 | ||
| Podiatrists | 28 | ||
| Other Doctorates | 28 | ||
| Nurses | 28 | ||
| Registered Nurses | 28 | ||
| Licensed Practical and Vocational Nurses | 28 | ||
| Nurse Practitioners | 28 | ||
| Nurse Anesthetists | 28 | ||
| Other Healthcare Professionals | 28 | ||
| Closing Comments | 28 | ||
| Patient Education | 28 | ||
| Legal and Ethical Issues | 28 | ||
| Connections | 34 | ||
| Study Guide Connection: | 34 | ||
| Evolve Connection: | 34 | ||
| Unit One Introduction to Medical Assisting | 35 | ||
| 3 The Medical Assisting Profession | 35 | ||
| Learning Objectives | 35 | ||
| Vocabulary | 36 | ||
| Scenario | 35 | ||
| The History of Medical Assisting | 36 | ||
| The Scope of Practice of a Medical Assistant | 37 | ||
| A Career in Medical Assisting | 38 | ||
| Professional Appearance | 39 | ||
| Education and Training | 40 | ||
| Classroom Training | 40 | ||
| Externship (Practicum) | 40 | ||
| Continuing Education | 41 | ||
| Professional Organizations | 42 | ||
| American Association of Medical Assistants and Certified Medical Assistants | 42 | ||
| American Medical Technologists and Registered Medical Assistants | 42 | ||
| National Healthcareer Association | 43 | ||
| American Registry of Medical Assisting | 43 | ||
| National Center for Competency Testing | 43 | ||
| Taking Certification Examinations | 43 | ||
| The Difference Between CMAs and RMAs | 44 | ||
| Closing Comments | 44 | ||
| Patient Education | 44 | ||
| Legal and Ethical Issues | 44 | ||
| Connections | 47 | ||
| Study Guide Connection: | 47 | ||
| Evolve Connection: | 47 | ||
| 4 Professional Behavior in the Workplace | 48 | ||
| Learning Objectives | 48 | ||
| Vocabulary | 49 | ||
| Scenario | 48 | ||
| The Meaning of Professionalism | 49 | ||
| Work Ethics | 49 | ||
| Characteristics of Professionalism | 50 | ||
| Loyalty | 50 | ||
| Dependability | 50 | ||
| Courtesy | 50 | ||
| Initiative | 50 | ||
| Flexibility | 51 | ||
| Credibility | 51 | ||
| Confidentiality | 51 | ||
| Attitude | 51 | ||
| Obstructions to Professionalism | 51 | ||
| Personal Problems and “Baggage” | 51 | ||
| Rumors and the “Grapevine” | 52 | ||
| Personal Phone Calls and Business | 52 | ||
| Office Politics | 52 | ||
| Professional Attributes | 53 | ||
| Teamwork | 53 | ||
| Time Management | 53 | ||
| Prioritizing | 53 | ||
| Setting Goals | 53 | ||
| Knowing the Facility and Its Employees | 53 | ||
| Documentation | 54 | ||
| Note Taking | 54 | ||
| Interpersonal Skills | 54 | ||
| Substance Abuse | 54 | ||
| Closing Comments | 55 | ||
| Patient Education | 55 | ||
| Legal and Ethical Issues | 55 | ||
| Connections | 57 | ||
| Study Guide Connection: | 57 | ||
| Evolve Connection: | 57 | ||
| 5 Interpersonal Skills and Human Behavior | 58 | ||
| Learning Objectives | 58 | ||
| Vocabulary | 59 | ||
| Scenario | 58 | ||
| First Impressions | 59 | ||
| Patient-Centered Care | 60 | ||
| Communication Paths | 60 | ||
| Verbal Communication | 60 | ||
| Nonverbal Communication | 61 | ||
| The Process of Communication | 63 | ||
| Listening | 63 | ||
| Warnings Against Advising a Patient | 65 | ||
| Observing Carefully | 65 | ||
| Psychological Disorders | 66 | ||
| Defense Mechanisms | 66 | ||
| Verbal Aggression | 66 | ||
| Handling Verbal Aggression | 66 | ||
| Sarcasm | 67 | ||
| Handling Sarcasm | 67 | ||
| Rationalization | 67 | ||
| Handling Rationalization | 67 | ||
| Compensation | 67 | ||
| Handling Compensation | 67 | ||
| Regression | 67 | ||
| Handling Regression | 67 | ||
| Repression | 67 | ||
| Handling Repression | 67 | ||
| Apathy | 67 | ||
| Handling Apathy | 67 | ||
| Displacement | 67 | ||
| Handling Displacement | 68 | ||
| Denial | 68 | ||
| Handling Denial | 68 | ||
| Physical Avoidance | 68 | ||
| Handling Physical Avoidance | 68 | ||
| Projection | 68 | ||
| Handling Projection | 68 | ||
| Conflict | 68 | ||
| Resolving Conflict | 69 | ||
| Boundaries | 69 | ||
| Self-Boundaries | 69 | ||
| The Crazy-Makers: Passive-Aggressive Communication | 70 | ||
| The Avoider | 70 | ||
| The Pseudoaccommodator | 70 | ||
| The Guilt-Maker | 70 | ||
| The Subject Changer | 70 | ||
| The Distracter | 70 | ||
| The Mind Reader | 70 | ||
| The Trapper | 70 | ||
| The Crisis Tickler | 70 | ||
| The Gunnysacker | 70 | ||
| The Trivial Tyrannizer | 70 | ||
| The Beltliner | 70 | ||
| The Joker | 70 | ||
| The Blamer | 70 | ||
| The Contract Tyrannizer | 70 | ||
| The Kitchen Sink Fighter | 70 | ||
| The Withholder | 71 | ||
| The Benedict Arnold | 71 | ||
| Barriers to Communication | 71 | ||
| Physical Impairment | 71 | ||
| Language | 71 | ||
| Prejudice | 71 | ||
| Stereotyping | 71 | ||
| Perception | 71 | ||
| Overcoming Barriers to Communication | 72 | ||
| Communication during Difficult Times | 72 | ||
| Anger | 72 | ||
| Shock | 72 | ||
| Death and Dying | 73 | ||
| Multicultural Issues | 74 | ||
| Communicating with People of Other Cultures | 74 | ||
| Communicating during the Patient Encounter | 74 | ||
| Maslow’s Hierarchy of Needs | 75 | ||
| Approval, Acceptance, and Achievement | 75 | ||
| A Good Night’s Sleep | 75 | ||
| Healthy Nutrition | 75 | ||
| Positive Relationships | 75 | ||
| Healthy Self-Esteem | 76 | ||
| Improving Yourself | 76 | ||
| Comfort Zones | 76 | ||
| Closing Comments | 76 | ||
| Patient Education | 77 | ||
| Legal and Ethical Issues | 77 | ||
| Connections | 79 | ||
| Study Guide Connection: | 79 | ||
| Evolve Connection: | 79 | ||
| 6 Medicine and Ethics | 80 | ||
| Learning Objectives | 80 | ||
| Vocabulary | 81 | ||
| Scenario | 80 | ||
| History of Ethics in Medicine | 83 | ||
| Who Decides What is Ethical? | 83 | ||
| The Role of the American Medical Association and Its Council on Ethical and Judicial Affairs in Issues of Ethics | 84 | ||
| Making Ethical Decisions | 84 | ||
| Elements of Ethics | 84 | ||
| Types of Ethical Problems | 85 | ||
| The Ethical Decision-Making Process | 85 | ||
| Current Opinions of the Council on Ethical and Judicial Affairs and Medicine’s Ethical Issues | 86 | ||
| Abortion | 86 | ||
| Abuse | 86 | ||
| Allocation of Health Resources | 86 | ||
| Artificial Insemination/In Vitro Fertilization | 86 | ||
| Stem Cell Research | 87 | ||
| Surrogate Motherhood | 87 | ||
| Genetic Counseling | 87 | ||
| Family and Intimate Partner Violence | 87 | ||
| Ethical Responsibility to Study and Prevent Error and Harm | 87 | ||
| Physician-Assisted Suicide | 87 | ||
| Surrogate Decision Making | 87 | ||
| Withholding or Withdrawing Life-Prolonging Treatment | 88 | ||
| Quality of Life | 88 | ||
| Fees for Medical Services | 88 | ||
| Organ Donation | 88 | ||
| Capital Punishment | 88 | ||
| Potential Patients | 88 | ||
| Withholding Information from Patients | 89 | ||
| Healthcare Fraud and Abuse | 89 | ||
| National Health Information Technology | 89 | ||
| Genetic Information and the Criminal Justice System | 89 | ||
| Gifts to Physicians from Industry | 89 | ||
| Informed Consent | 89 | ||
| Interprofessional Relationships | 89 | ||
| Confidentiality and Patient Privacy | 90 | ||
| Advertising | 90 | ||
| Communication with the Media | 90 | ||
| Physician Obligations in Emergency Preparedness and Response | 91 | ||
| Malevolent Use of Biomedical Research | 91 | ||
| Racial and Ethnic Healthcare Disparities | 91 | ||
| Diagnostic Imaging on Request | 91 | ||
| Computers | 91 | ||
| Fees and Charges | 91 | ||
| Fee Splitting and Contingent Fees | 91 | ||
| Insurance Forms | 92 | ||
| Waiver of Insurance Co-Payments | 92 | ||
| Professional Courtesy | 92 | ||
| Appointment Charges | 92 | ||
| Prescribing Drugs and Devices | 92 | ||
| Professional and Contractual Relationships | 92 | ||
| Physician Ownership of a Health Facility | 92 | ||
| Ghost Surgery | 92 | ||
| Discipline Within Medicine | 92 | ||
| Physician Health and Wellness | 92 | ||
| Substance Abuse | 92 | ||
| Unethical Conduct by Members of the Health Professions | 93 | ||
| Ethical Issues Regarding HIV | 93 | ||
| Ethics and the Human Genome | 93 | ||
| Closing Comments | 93 | ||
| Patient Education | 94 | ||
| Legal and Ethical Issues | 94 | ||
| Connections | 95 | ||
| Study Guide Connection: | 95 | ||
| Evolve Connection: | 95 | ||
| 7 Medicine and Law | 96 | ||
| Learning Objectives | 96 | ||
| Vocabulary | 97 | ||
| Scenario | 96 | ||
| Jurisprudence and the Classifications of Law | 98 | ||
| Criminal Law | 99 | ||
| Misdemeanors | 99 | ||
| Felonies | 99 | ||
| Treason | 99 | ||
| Civil Law | 99 | ||
| Tort Law | 99 | ||
| Contract Law | 99 | ||
| Administrative Law | 99 | ||
| Anatomy of a Medical Professional Liability Lawsuit | 100 | ||
| What Constitutes a Valid Contract? | 100 | ||
| Breach of Contract | 101 | ||
| The Statute of Frauds | 101 | ||
| Preliminaries of Litigation | 101 | ||
| Preparing for Court | 101 | ||
| Interrogatories | 101 | ||
| Depositions | 102 | ||
| Subpoenas | 102 | ||
| Discovery | 102 | ||
| Preparing Witnesses and Testifying | 102 | ||
| Inside the Courtroom | 103 | ||
| Burden of Proof | 103 | ||
| Outcome of the Case | 104 | ||
| Arbitration | 104 | ||
| Medical Professional Liability and Negligence | 104 | ||
| The Four Ds of Negligence | 105 | ||
| Types of Damages | 106 | ||
| Standard of Care | 106 | ||
| Consent | 106 | ||
| Giving Consent to Medical Procedures | 107 | ||
| Statute of Limitations | 108 | ||
| Confidentiality | 108 | ||
| Law and Medical Practice | 108 | ||
| Legal Disclosure | 109 | ||
| Patient Self-Determination Act | 109 | ||
| Patient’s Bill of Rights | 109 | ||
| Affordable Care Act of 2010 | 110 | ||
| Controlled Substances Act | 110 | ||
| The Uniform Anatomical Gift Act | 112 | ||
| The Health Insurance Portability and Accountability Act | 112 | ||
| The Occupational Safety and Health Act and the Bloodborne Pathogens Standard | 113 | ||
| General Duty Clause | 113 | ||
| Emergency Preparedness | 113 | ||
| Exposure Control Plan | 114 | ||
| OSHA Record-Keeping Regulations | 114 | ||
| Needlestick Safety and Prevention Act | 115 | ||
| OSHA Training Requirements | 116 | ||
| Hepatitis B Vaccination | 116 | ||
| Clinical Laboratory Improvement Amendments | 116 | ||
| Americans with Disabilities Act | 117 | ||
| HITECH Act of 2009 | 118 | ||
| Closing Comments | 119 | ||
| Patient Education | 119 | ||
| Legal and Ethical Issues | 119 | ||
| Connections | 123 | ||
| Study Guide Connection: | 123 | ||
| Evolve Connection: | 123 | ||
| Unit Two Administrative Medical Assisting | 124 | ||
| 8 Computer Concepts | 124 | ||
| Learning Objectives | 124 | ||
| Vocabulary | 125 | ||
| Scenario | 124 | ||
| Computer Basics | 126 | ||
| Getting Started | 126 | ||
| Processing Information | 128 | ||
| Types of Computers | 128 | ||
| Parts of the Computer | 129 | ||
| Microprocessor | 129 | ||
| Monitor | 129 | ||
| Keyboard | 130 | ||
| Mouse | 130 | ||
| Printer | 130 | ||
| Inside the Computer | 130 | ||
| Motherboard | 130 | ||
| Disk Drives | 130 | ||
| CD-ROM | 131 | ||
| Software | 131 | ||
| Modems | 131 | ||
| Speakers and Microphones | 132 | ||
| Peripheral Devices | 132 | ||
| Scanners | 132 | ||
| Digital Cameras | 132 | ||
| Flash Drives | 132 | ||
| External Hard Drives | 132 | ||
| Adding a Program to a Computer | 132 | ||
| File Formats | 132 | ||
| Computer Networking | 133 | ||
| Servers | 133 | ||
| The Internet | 133 | ||
| Browsers | 134 | ||
| Using a Phone to Perform Computer Functions | 134 | ||
| The Computer as a Co-Worker | 134 | ||
| Computer Security | 135 | ||
| HIPAA Regulations and Computers | 135 | ||
| Electronic Signatures | 136 | ||
| Computers and Ergonomics | 136 | ||
| Closing Comments | 136 | ||
| Patient Education | 136 | ||
| Legal and Ethical Issues | 136 | ||
| Connections | 138 | ||
| Study Guide Connection: | 138 | ||
| Evolve Connection: | 138 | ||
| 9 Telephone Techniques | 139 | ||
| Learning Objectives | 139 | ||
| Vocabulary | 140 | ||
| Scenario | 139 | ||
| Effective Use of the Telephone | 140 | ||
| Active Listening | 140 | ||
| Developing a Pleasing Telephone Voice | 140 | ||
| Holding the Telephone Handset Correctly | 141 | ||
| Maintaining Confidentiality | 141 | ||
| Thinking Ahead | 142 | ||
| Managing Telephone Calls | 142 | ||
| Answering Promptly | 142 | ||
| Identifying the Facility | 142 | ||
| Identifying the Caller | 142 | ||
| Screening Incoming Calls | 143 | ||
| Minimizing Wait Time | 144 | ||
| Transferring a Call | 144 | ||
| Taking a Telephone Message | 145 | ||
| Taking Action on Telephone Messages | 146 | ||
| Ending a Call | 146 | ||
| Retaining Records of Telephone Messages | 146 | ||
| Typical Incoming Calls | 146 | ||
| New Patients and Return Appointments | 146 | ||
| Directions | 146 | ||
| Inquiries about Bills | 147 | ||
| Inquiries about Fees | 147 | ||
| Participating Provider | 147 | ||
| Requests for Assistance with Insurance | 147 | ||
| Radiology and Laboratory Reports | 147 | ||
| Satisfactory Progress Reports from Patients | 147 | ||
| Routine Reports from Hospitals and Other Sources | 147 | ||
| Office Administration Matters | 147 | ||
| Requests for Referrals | 147 | ||
| Prescription Refills | 148 | ||
| Special Incoming Calls | 148 | ||
| Patients Refusing to Discuss Symptoms | 148 | ||
| Unsatisfactory Progress Reports | 149 | ||
| Requests for Test Results | 149 | ||
| Requests for Information from Third Parties | 149 | ||
| Complaints about Care or Fees | 149 | ||
| Calls from the Physician’s Family and Friends | 149 | ||
| Calls from Staff Members’ Family and Friends | 149 | ||
| Handling Difficult Calls | 149 | ||
| Angry Callers | 149 | ||
| Aggressive Callers | 150 | ||
| Unauthorized Inquiry Calls | 150 | ||
| Sales Calls | 150 | ||
| Physician Shopping | 150 | ||
| Complaints | 150 | ||
| Callers with Difficulty Communicating | 150 | ||
| Emergency Calls | 150 | ||
| Screening Guidelines | 151 | ||
| Getting the Information the Physician Needs | 151 | ||
| Typical Outgoing Calls | 151 | ||
| Telephone Services | 151 | ||
| Voice Mail | 151 | ||
| Answering Services | 151 | ||
| Automatic Call Routing | 152 | ||
| Call Forwarding | 152 | ||
| Caller ID | 152 | ||
| Caller ID Blocking | 152 | ||
| Cellular Phones | 152 | ||
| Fax Machines | 152 | ||
| Headsets | 153 | ||
| Using Long Distance and Special Services | 153 | ||
| Time Zones | 153 | ||
| International Service | 153 | ||
| Wrong Numbers | 153 | ||
| Conference Calls | 153 | ||
| Operator-Assisted Calls and Services | 154 | ||
| Office Telephone Equipment Needs | 154 | ||
| Number and Placement of Telephones | 154 | ||
| Using a Telephone Directory | 155 | ||
| Organizing a Personal Phone Directory | 155 | ||
| Identifying Community Resources | 155 | ||
| Closing Comments | 155 | ||
| Patient Education | 155 | ||
| Legal and Ethical Issues | 155 | ||
| Connections | 157 | ||
| Study Guide Connection: | 157 | ||
| Evolve Connection: | 157 | ||
| 10 Scheduling Appointments | 158 | ||
| Learning Objectives | 158 | ||
| Vocabulary | 159 | ||
| Scenario | 158 | ||
| Using Established Priorities for Appointment Scheduling | 159 | ||
| Patient Needs | 159 | ||
| Physician Preferences and Habits | 160 | ||
| Available Facilities | 160 | ||
| Duration of Office Visits | 160 | ||
| Methods of Scheduling Appointments | 160 | ||
| Computer Scheduling | 160 | ||
| Appointment Book Scheduling | 161 | ||
| Self-Scheduling | 161 | ||
| Advance Preparation | 161 | ||
| Legality of the Appointment Book | 161 | ||
| Types of Appointment Scheduling | 162 | ||
| Open Office Hours | 162 | ||
| Scheduled Appointments | 163 | ||
| Flexible Office Hours | 163 | ||
| Wave Scheduling | 164 | ||
| Modified Wave Scheduling | 164 | ||
| Double-Booking | 164 | ||
| Grouping Procedures | 164 | ||
| Advance Booking | 164 | ||
| Time Patterns | 164 | ||
| Patient Wait Time | 164 | ||
| Telephone Scheduling | 165 | ||
| Scheduling Appointments for New Patients | 165 | ||
| Scheduling Appointments for Established Patients | 166 | ||
| In Person | 166 | ||
| By Telephone | 166 | ||
| Scheduling Other Types of Appointments | 166 | ||
| Inpatient Surgeries | 167 | ||
| Outpatient and Inpatient Procedure Appointments | 167 | ||
| Outside Visits | 169 | ||
| Special Circumstances | 169 | ||
| Late Patients | 169 | ||
| Rescheduling Canceled Appointments | 169 | ||
| Emergency Calls | 169 | ||
| Physician Referrals | 171 | ||
| Patients Without Appointments | 171 | ||
| Failed Appointments | 171 | ||
| No-Show Policy | 172 | ||
| Recording the Failed Appointment | 172 | ||
| Increasing Appointment Show Rates | 172 | ||
| Automated Call Routing | 172 | ||
| Appointment Cards | 172 | ||
| Confirmation Calls | 172 | ||
| E-Mail Reminders | 172 | ||
| Mailed Reminders | 172 | ||
| Handling Cancellations and Delays | 172 | ||
| When the Patient Cancels | 172 | ||
| When the Physician is Delayed | 172 | ||
| When the Physician Is Called to an Emergency | 173 | ||
| When the Physician Is Ill or Out of Town | 173 | ||
| Other Types of Appointments | 174 | ||
| Physicians | 174 | ||
| Pharmaceutical Representatives | 174 | ||
| Salespeople | 174 | ||
| Planning for the Next Day | 174 | ||
| Closing Comments | 174 | ||
| Patient Education | 174 | ||
| Legal and Ethical Issues | 174 | ||
| Connections | 176 | ||
| Study Guide Connection: | 176 | ||
| Evolve Connection: | 176 | ||
| 11 Patient Reception and Processing | 177 | ||
| Learning Objectives | 177 | ||
| Vocabulary | 178 | ||
| Scenario | 177 | ||
| The Office Mission Statement | 178 | ||
| The Reception Area | 178 | ||
| Preparing for Patient Arrival | 180 | ||
| Preparing Medical Records | 180 | ||
| Greeting the Patient | 181 | ||
| Patient Check-In | 181 | ||
| Patient Interaction | 182 | ||
| Registration Procedures | 183 | ||
| Obtaining a Patient’s History | 184 | ||
| Showing Consideration for Patients’ Time | 184 | ||
| Patients with Special Needs | 185 | ||
| Escorting and Instructing the Patient | 185 | ||
| Medical Record Placement | 185 | ||
| Challenging Situations | 186 | ||
| Talkative Patients | 186 | ||
| Children | 186 | ||
| Angry Patients in the Reception Area | 186 | ||
| Patient’s Relatives and Friends | 186 | ||
| The Friendly Farewell | 186 | ||
| Patient Checkout | 186 | ||
| Closing Comments | 187 | ||
| Patient Education | 187 | ||
| Legal and Ethical Issues | 187 | ||
| Connections | 189 | ||
| Study Guide Connection: | 189 | ||
| Evolve Connection: | 189 | ||
| 12 Office Environment and Daily Operations | 190 | ||
| Learning Objectives | 190 | ||
| Vocabulary | 191 | ||
| Scenario | 190 | ||
| The Office Policy and Procedures Manual | 191 | ||
| Using the Office Policy Manual | 191 | ||
| Opening the Office | 193 | ||
| Preparing for the Day Ahead | 193 | ||
| Patient Traffic Flow | 194 | ||
| Visitors to the Office | 194 | ||
| Daily, Weekly, and Monthly Duties | 195 | ||
| Constant Cleaning | 195 | ||
| Cleaning Services | 195 | ||
| Filing | 195 | ||
| Supplies and Equipment in the Physician’s Office | 195 | ||
| Identifying the Need for Specific Supplies | 196 | ||
| Budgeting | 196 | ||
| Comparing Prices | 196 | ||
| Ordering Supplies | 198 | ||
| Replenishing Supplies | 199 | ||
| Ordering Equipment | 199 | ||
| Receiving an Order | 200 | ||
| Warranty Information | 200 | ||
| Invoices and Statements | 200 | ||
| Troubleshooting Equipment Failure | 200 | ||
| Equipment Maintenance | 200 | ||
| Preventing Waste | 200 | ||
| Lunch and Break Times | 201 | ||
| Sending and Receiving E-Mail | 202 | ||
| Internet Research | 202 | ||
| Traveling for Business Purposes | 202 | ||
| Seminars and Workshops | 203 | ||
| Scheduling Travel, Hotel Rooms, and Car Rentals | 203 | ||
| Travel Receipts | 203 | ||
| Basic Safety and Security in the Medical Office | 204 | ||
| Suspicious Persons | 204 | ||
| Robbery | 204 | ||
| Office Security | 204 | ||
| Smoke Alarms and Fire Extinguishers | 204 | ||
| Fire Exits and Exit Routes | 205 | ||
| Emergency Preparedness | 205 | ||
| Evacuating the Health Facility | 207 | ||
| Waste Storage and Destruction | 207 | ||
| Ergonomics | 208 | ||
| Identifying and Sharing Community Resources | 210 | ||
| Emergency Phone Numbers | 210 | ||
| Closing the Office | 211 | ||
| Closing Comments | 211 | ||
| Patient Education | 211 | ||
| Legal and Ethical Issues | 212 | ||
| Connections | 213 | ||
| Study Guide Connection: | 213 | ||
| Evolve Connection: | 213 | ||
| 13 Written Communications and Mail Processing | 214 | ||
| Learning Objectives | 214 | ||
| Vocabulary | 215 | ||
| Scenario | 214 | ||
| Importance of Written Communications | 215 | ||
| Reflection on the Physician | 215 | ||
| Writing Skills and Composing Tips | 216 | ||
| Grammar Review | 218 | ||
| Parts of Speech | 218 | ||
| Nouns. | 218 | ||
| Pronouns. | 218 | ||
| Verbs. | 218 | ||
| Adjectives. | 218 | ||
| Adverbs. | 218 | ||
| Prepositions. | 218 | ||
| Conjunctions. | 218 | ||
| Interjections. | 218 | ||
| Making Sense of Sentences | 218 | ||
| Types of Sentences. | 218 | ||
| Sentence Structure. | 218 | ||
| Sentence Errors. | 218 | ||
| Personal Tools | 218 | ||
| Equipment and Supplies | 218 | ||
| Equipment | 219 | ||
| Computers | 219 | ||
| Copiers | 219 | ||
| Scanners | 219 | ||
| Printers | 219 | ||
| Supplies | 219 | ||
| Stationery | 219 | ||
| Sizes and Types of Letterhead Paper. | 219 | ||
| Continuation Pages. | 219 | ||
| Envelopes. | 219 | ||
| Letter Styles | 219 | ||
| Block Letter Style | 219 | ||
| Modified Block Letter Style | 219 | ||
| Modified Block Letter Style with Indented Paragraphs | 219 | ||
| Simplified Letter Style | 219 | ||
| Types of Punctuation for Letter Styles | 220 | ||
| Spacing and Margins | 221 | ||
| The Parts of a Letter | 222 | ||
| Heading | 222 | ||
| Opening | 222 | ||
| Body | 222 | ||
| Closing | 222 | ||
| Postscripts | 223 | ||
| Continuation Pages | 223 | ||
| Signing the Letter | 223 | ||
| Other Types of Written Communication | 223 | ||
| Telephone Messages | 223 | ||
| E-Mail and Text Messages | 223 | ||
| Faxed Messages | 224 | ||
| Memorandums | 224 | ||
| Editing | 224 | ||
| Developing a Portfolio | 225 | ||
| U.S. Postal Service | 225 | ||
| Mail Processing | 225 | ||
| Incoming Mail | 225 | ||
| Opening the Mail | 226 | ||
| Annotating | 226 | ||
| Responding to the Mail | 227 | ||
| Mail Requiring Special Handling | 227 | ||
| Payment Receipts | 227 | ||
| Insurance Information | 228 | ||
| Drug Samples | 228 | ||
| Vacation Mail | 228 | ||
| Outgoing Mail | 228 | ||
| Addressing the Envelope | 228 | ||
| Delivery Addresses. | 228 | ||
| Return Addresses. | 230 | ||
| Notations. | 230 | ||
| Sealing and Stamping Hints | 230 | ||
| Cost-Saving Mailing Procedures | 230 | ||
| Using ZIP Codes. | 230 | ||
| Presorting. | 231 | ||
| Using Correct Postage. | 231 | ||
| Getting Faster Mail Service | 231 | ||
| Postage Meters. | 231 | ||
| Mailing Practices. | 231 | ||
| Classifications of Mail | 231 | ||
| Express Mail. | 231 | ||
| First-Class Mail. | 231 | ||
| Priority Mail. | 231 | ||
| Standard Mail. | 231 | ||
| Media Mail. | 232 | ||
| Business Mail. | 232 | ||
| Nonprofit Mail. | 232 | ||
| Special Services | 232 | ||
| Insured Mail. | 232 | ||
| Registered Mail. | 232 | ||
| Postal Money Orders. | 233 | ||
| Special Delivery. | 233 | ||
| Special Handling. | 233 | ||
| Certified Mail. | 233 | ||
| Certificate of Mailing. | 233 | ||
| Private Delivery Services | 233 | ||
| Handling Special Situations | 233 | ||
| Forwarding and Obtaining a Changed Address. | 233 | ||
| Recalling Mail. | 233 | ||
| Returned Mail. | 234 | ||
| Tracing Lost Mail. | 234 | ||
| Using Mail Merge | 234 | ||
| Closing Comments | 234 | ||
| Patient Education | 234 | ||
| Legal and Ethical Issues | 234 | ||
| Connections | 236 | ||
| Study Guide Connection: | 236 | ||
| Evolve Connection: | 236 | ||
| Unit Three Health Information in the Medical Office | 237 | ||
| 14 The Paper Medical Record | 237 | ||
| Learning Objectives | 237 | ||
| Vocabulary | 238 | ||
| Scenario | 237 | ||
| The Importance of Accurate Medical Records | 238 | ||
| Ownership of the Medical Record | 239 | ||
| Creating an Efficient Medical Records Management System | 240 | ||
| Types of Records | 240 | ||
| Organization of the Medical Record | 240 | ||
| Source-Oriented Records | 240 | ||
| Problem-Oriented Medical Records | 240 | ||
| Contents of the Complete Case History | 242 | ||
| Subjective Information | 242 | ||
| Personal Demographics | 242 | ||
| Personal and Medical History | 242 | ||
| Patient’s Family History | 242 | ||
| Patient’s Social History | 242 | ||
| Patient’s Chief Complaint | 242 | ||
| Objective Information | 243 | ||
| Physical Examination Findings and Laboratory and Radiology Reports | 243 | ||
| Diagnosis | 243 | ||
| Treatment Prescribed and Progress Notes | 243 | ||
| Condition at the Time of Termination of Treatment | 244 | ||
| Obtaining the History | 244 | ||
| The Medical Assistant’s Role | 244 | ||
| Making Additions to the Patient’s Record | 246 | ||
| Laboratory Reports | 246 | ||
| Radiology Reports | 247 | ||
| Progress Notes | 247 | ||
| Making Corrections and Alterations to Medical Records | 247 | ||
| Keeping Records Current | 248 | ||
| Transfer, Destruction, and Retention of Medical Records | 249 | ||
| Regular Transfer of Files | 249 | ||
| Retention and Destruction | 250 | ||
| Protection of Records | 250 | ||
| Long-Term Storage | 250 | ||
| Releasing Medical Record Information | 250 | ||
| Dictation and Transcription | 252 | ||
| Voice Recognition Software | 253 | ||
| Filing Equipment | 253 | ||
| Drawer Files | 253 | ||
| Shelf Files | 253 | ||
| Rotary Circular Files | 253 | ||
| Lateral Files | 253 | ||
| Compactable Files | 253 | ||
| Automated Files | 253 | ||
| Card Files | 253 | ||
| Special Items | 254 | ||
| Filing Supplies | 254 | ||
| Divider Guides | 254 | ||
| OUTguides | 254 | ||
| File Folders | 254 | ||
| Labels | 255 | ||
| Filing Procedures | 255 | ||
| Conditioning | 255 | ||
| Releasing | 255 | ||
| Indexing and Coding | 255 | ||
| Sorting | 256 | ||
| Storing and Filing | 256 | ||
| Locating Misplaced Files | 256 | ||
| Indexing Rules | 256 | ||
| Filing Methods | 257 | ||
| Alphabetic Filing | 257 | ||
| Numeric Filing | 257 | ||
| Subject Filing | 259 | ||
| Color-Coding | 259 | ||
| Alphabetic Color-Coding | 259 | ||
| Numeric Color-Coding | 259 | ||
| Other Color-Coding Applications | 259 | ||
| Organization of Files | 259 | ||
| Health-Related Correspondence | 259 | ||
| General Correspondence | 260 | ||
| Practice Management Files | 260 | ||
| Miscellaneous Files | 260 | ||
| Tickler or Follow-Up Files | 260 | ||
| Transitory or Temporary File | 260 | ||
| Closing Comments | 261 | ||
| Patient Education | 261 | ||
| Legal and Ethical Issues | 261 | ||
| Connections | 263 | ||
| Study Guide Connection: | 263 | ||
| Evolve Connection: | 263 | ||
| 15 The Electronic Medical Record | 264 | ||
| Learning Objectives | 264 | ||
| Vocabulary | 265 | ||
| Scenario | 264 | ||
| Executive Order to Promote Interoperability of EMR Systems | 265 | ||
| Technologic Terms in Health Information | 265 | ||
| American Recovery and Reinvestment Act (ARRA) | 266 | ||
| HITECH Act and Meaningful Use | 266 | ||
| Advantages and Disadvantages of the EMR | 267 | ||
| Incentives for Implementing EMR Systems | 268 | ||
| Capabilities of EMR Systems | 268 | ||
| Patients’ Concerns About the EMR | 270 | ||
| Making Additions and Corrections to the EMR | 270 | ||
| Nonverbal Communication with the Patient When Using the EMR | 270 | ||
| The Nationwide Health Information Network | 272 | ||
| Backup Systems for the EMR | 272 | ||
| The Medical Assistant and the EMR | 273 | ||
| Closing Comments | 273 | ||
| Patient Education | 273 | ||
| Legal and Ethical Issues | 273 | ||
| Connections | 275 | ||
| Study Guide Connection: | 275 | ||
| Evolve Connection: | 275 | ||
| Reference | 275 | ||
| 16 Health Information Management | 276 | ||
| Learning Objectives | 276 | ||
| Vocabulary | 277 | ||
| Scenario | 276 | ||
| Evolution of the Profession | 277 | ||
| Health Information Certifications | 277 | ||
| Uses of Healthcare Data | 279 | ||
| What are High-Quality Data? | 279 | ||
| Challenges of Quality Assurance Problems | 280 | ||
| National Center for Health Statistics | 281 | ||
| Total Quality Management | 281 | ||
| The Concept of Total Quality Management | 282 | ||
| The Joint Commission | 282 | ||
| Risk Management | 282 | ||
| Acknowledging and Disclosing Medical Errors | 283 | ||
| Closing Comments | 285 | ||
| Patient Education | 285 | ||
| Legal and Ethical Issues | 286 | ||
| Connections | 287 | ||
| Study Guide Connection: | 287 | ||
| Evolve Connection: | 287 | ||
| Reference | 287 | ||
| Bibliography | 287 | ||
| 17 Privacy in the Physician’s Office | 288 | ||
| Learning Objectives | 288 | ||
| Vocabulary | 289 | ||
| Scenario | 288 | ||
| Health Insurance Portability and Accountability Act | 289 | ||
| Effect of the HIPAA Privacy Rule | 290 | ||
| Title I and Title II Provisions | 290 | ||
| Provisions of Administrative Simplification | 290 | ||
| Patients’ Rights | 290 | ||
| Right to Notice of Privacy Practices | 291 | ||
| Right to Access Protected Health Information | 292 | ||
| Right to Request Restrictions on Certain Uses and Disclosures of Protected Health Information | 292 | ||
| Right to Request Confidential Communications | 292 | ||
| Right to Request Amendment of Protected Health Information | 292 | ||
| Right to Receive an Accounting of Disclosures of Protected Health Information | 292 | ||
| Responsibilities of Providers or Health Plans | 293 | ||
| HIPAA and Electronic Fund Transfers | 293 | ||
| Permission to Disclose Protected Health Information | 294 | ||
| Identifying the Patient | 294 | ||
| Patients’ Names and Sign-In Sheets | 294 | ||
| Placement of Patient Medical Records | 295 | ||
| Children’s Health Records | 296 | ||
| Discussing Information with Family and Friends | 297 | ||
| Telephone Messages and Faxes | 297 | ||
| Emergencies | 298 | ||
| Complaints About Privacy Violations | 298 | ||
| HIPAA and Emergency Preparedness | 298 | ||
| Closing Comments | 299 | ||
| Patient Education | 300 | ||
| Legal and Ethical Issues | 300 | ||
| Connections | 302 | ||
| Study Guide Connection: | 302 | ||
| Evolve Connection: | 302 | ||
| Unit Four Billing and Coding Procedures | 303 | ||
| 18 Basics of Diagnostic Coding | 303 | ||
| Learning Objectives | 303 | ||
| Vocabulary | 304 | ||
| Scenario | 303 | ||
| Getting to Know the ICD-9-CM | 305 | ||
| What Is Diagnostic Coding? | 305 | ||
| Why Use ICD-9-CM Codes? | 305 | ||
| Evolution of ICD Coding | 306 | ||
| ICD-9-CM Codes | 306 | ||
| Structure of the ICD-9-CM | 306 | ||
| Tabular Index (Volume 1) | 307 | ||
| Supplemental Classifications | 307 | ||
| V Codes. | 307 | ||
| E Codes. | 307 | ||
| Appendixes | 307 | ||
| Conventions Used in the Tabular Index | 308 | ||
| Abbreviations. | 308 | ||
| Punctuation. | 308 | ||
| Symbols. | 309 | ||
| Other Conventions. | 309 | ||
| Instructional Notations. | 309 | ||
| Related Terms | 309 | ||
| Alphabetic Index (Volume 2) | 309 | ||
| Supplementary Sections of the Alphabetic Index | 310 | ||
| Procedures (Volume 3) | 310 | ||
| Beginning the Coding Process | 310 | ||
| Medical Documentation | 310 | ||
| Encounter Form | 310 | ||
| Treatment or Progress Notes | 310 | ||
| History and Physical Exam | 310 | ||
| Discharge Summary | 310 | ||
| Operative Report | 311 | ||
| Radiology, Laboratory, or Pathology Report | 311 | ||
| Extracting Diagnostic Statements | 311 | ||
| Main and Modifying Terms | 311 | ||
| Steps in ICD-9-CM Coding | 312 | ||
| Using the Alphabetic Index (Volume 2) | 312 | ||
| Using the Tabular Index (Volume 1) | 312 | ||
| Diagnostic Coding Decision Tree | 314 | ||
| Special Coding Instructions | 316 | ||
| Coding of Signs and Symptoms | 316 | ||
| Coding Suspected Conditions | 316 | ||
| Multiple Coding | 316 | ||
| Using Combination Codes | 316 | ||
| Coding Late Effects and the Past Medical History | 316 | ||
| Coding Impending or Threatened Conditions | 316 | ||
| Coding Infectious and Parasitic Diseases | 317 | ||
| Coding Organism-Caused Diseases | 317 | ||
| Human Immunodeficiency Virus (HIV) Infection and Acquired Immunodeficiency Syndrome (AIDS) | 318 | ||
| Coding Complications of Care | 318 | ||
| Coding the Etiology and Manifestation | 318 | ||
| Coding Neoplasms | 318 | ||
| Terms Defining Malignant Neoplasm Sites | 319 | ||
| Definitions of Benign, Uncertain Behavior, and Unspecified Nature Neoplasms | 319 | ||
| Five Steps for Coding Neoplasms | 319 | ||
| Coding for the Circulatory System | 319 | ||
| Myocardial Infarction | 319 | ||
| Arteriosclerotic Cardiovascular Disease | 319 | ||
| Hypertensive Disease | 319 | ||
| Coding for Complications of Pregnancy, Childbirth, and the Puerperium | 320 | ||
| Obstetric Coding Guidelines | 320 | ||
| Cesarean Delivery | 321 | ||
| Outcome of Delivery and Liveborn Infant Codes | 321 | ||
| Newborn Coding | 321 | ||
| Liveborn Infant Category | 321 | ||
| Coding Injuries | 321 | ||
| Coding Fractures | 321 | ||
| Burns | 321 | ||
| Steps for Coding Burns | 322 | ||
| Using E Codes | 322 | ||
| Table of Drugs and Chemicals | 322 | ||
| E Codes Used with the Table of Drugs and Chemicals | 323 | ||
| V Codes: Classification of Factors Influencing Health Status and Contact with Health Service | 323 | ||
| V Code Index for History Codes | 323 | ||
| Diabetes Mellitus | 323 | ||
| Maximizing Third-Party Reimbursement | 323 | ||
| Closing Comments | 324 | ||
| Patient Education | 324 | ||
| Legal and Ethical Issues | 324 | ||
| Connections | 325 | ||
| Study Guide Connection: | 325 | ||
| Evolve Connection: | 325 | ||
| 19 Basics of Procedural Coding | 326 | ||
| Learning Objectives | 326 | ||
| Vocabulary | 327 | ||
| Scenario | 326 | ||
| Getting to Know the CPT | 328 | ||
| The Evolution of CPT Coding | 328 | ||
| Purpose of CPT Procedural Coding | 328 | ||
| The CPT Code | 328 | ||
| Category I Codes | 328 | ||
| Product Pending U.S. Food and Drug Administration Approval | 328 | ||
| Bundled Codes | 328 | ||
| Unbundled Codes | 328 | ||
| Category II | 328 | ||
| Category III | 329 | ||
| Modifiers | 329 | ||
| Format of the CPT Coding Manual | 329 | ||
| CPT Content | 329 | ||
| The Indexes | 330 | ||
| Main Text | 330 | ||
| Evaluation and Management Section | 330 | ||
| Anesthesia Section | 330 | ||
| Surgery Section | 330 | ||
| Radiology Section | 331 | ||
| Pathology and Laboratory Section | 331 | ||
| Medicine Section | 331 | ||
| Conventions of the CPT Main Text | 331 | ||
| Guidelines | 332 | ||
| Notes | 332 | ||
| Unlisted Procedure or Service Code | 332 | ||
| Special Reports | 332 | ||
| Appendixes | 332 | ||
| Beginning the Coding Process | 333 | ||
| Medical Documentation | 333 | ||
| Using the Alphabetic Index | 333 | ||
| Searching the Alphabetic Index | 334 | ||
| Using See and See Also in the Alphabetic Index | 335 | ||
| Use of the Semicolon | 335 | ||
| Stand-Alone Codes and Code Ranges | 335 | ||
| Steps for Using the Alphabetic Index | 335 | ||
| Using the Tabular Index (Main Text) | 335 | ||
| Steps for Using the Main Text (Tabular Index) | 336 | ||
| Coding Decision Tree | 336 | ||
| Surgery Coding | 337 | ||
| General | 337 | ||
| Surgical Package Definition | 337 | ||
| Integumentary System | 337 | ||
| Excision of Lesions—Benign or Malignant | 337 | ||
| Repair (Closure) | 337 | ||
| Instructions for Listing Services for Wound Repair | 337 | ||
| Musculoskeletal System | 338 | ||
| Fractures | 338 | ||
| Cardiovascular System | 339 | ||
| Grafting for Coronary Bypass | 339 | ||
| Venous Grafts | 339 | ||
| Arterial Grafts | 339 | ||
| Maternity Care and Delivery | 339 | ||
| Understanding Evaluation and Management | 339 | ||
| Identifying the Place of Service | 339 | ||
| Identifying the Patient Status | 339 | ||
| Determining the Level of Service Provided | 339 | ||
| Key Components and Contributing Factors | 339 | ||
| History. | 339 | ||
| Levels of History | 340 | ||
| Examination. | 340 | ||
| Levels of Examination. | 340 | ||
| Medical Decision Making. | 340 | ||
| Number of Diagnoses and Management Options. | 342 | ||
| Amount and Complexity of Data Reviewed. | 342 | ||
| Risk of Complications and Morbidity or Mortality. | 342 | ||
| Medical Decision Making Complexity Levels. | 342 | ||
| Contributing Factors | 342 | ||
| Counseling. | 342 | ||
| Nature of Presenting Problem. | 342 | ||
| Coordination of Care. | 342 | ||
| Time. | 342 | ||
| Anesthesia Coding | 342 | ||
| Anesthesia Formula | 343 | ||
| Basic Unit Value (B) | 343 | ||
| Time Unit (T) | 343 | ||
| Modifying Unit (M) | 344 | ||
| Qualifying Circumstances (QC). | 344 | ||
| Physical Status Modifiers. | 344 | ||
| Conversion Factors | 344 | ||
| Calculating Anesthesia Services | 344 | ||
| Radiology Coding | 344 | ||
| Pathology and Laboratory Section | 345 | ||
| Coding for the Medicine Section | 345 | ||
| Immune Globulins | 345 | ||
| Immunization Administration for Vaccines or Toxoids | 345 | ||
| Vaccines/Toxoids | 345 | ||
| Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusion | 345 | ||
| Home Health Procedures and Services | 346 | ||
| Healthcare Common Procedure Coding System (HCPCS) | 346 | ||
| Coding Levels: CPT and HCPCS | 346 | ||
| HCPCS Codes | 346 | ||
| HCPCS Manual | 346 | ||
| Closing Comments | 347 | ||
| Patient Education | 348 | ||
| Legal and Ethical Issues | 349 | ||
| Connections | 350 | ||
| Study Guide Connection: | 350 | ||
| Evolve Connection: | 350 | ||
| 20 Basics of Health Insurance | 351 | ||
| Learning Objectives | 351 | ||
| Vocabulary | 352 | ||
| Scenario | 351 | ||
| The Purpose of Health Insurance | 353 | ||
| Impact of Insurance Billing on the Medical Office | 353 | ||
| Cycle of Health Insurance | 354 | ||
| Tasks Related to the Cycle of Health Insurance | 354 | ||
| Determining Primary and Secondary Coverage | 354 | ||
| Cost of Coverage | 354 | ||
| Types of Health Insurance | 355 | ||
| Group Policies | 355 | ||
| Individual Policies | 355 | ||
| Government Plans | 355 | ||
| TRICARE | 355 | ||
| Medicaid | 355 | ||
| Medicare | 355 | ||
| Workers’ Compensation | 355 | ||
| Self-Insured Plans | 355 | ||
| Medical Savings Account | 356 | ||
| Types of Insurance Benefits | 356 | ||
| Hospitalization | 356 | ||
| Surgical | 356 | ||
| Basic Medical | 356 | ||
| Disability (Loss of Income) Protection | 357 | ||
| Dental Care | 357 | ||
| Vision Care | 357 | ||
| Medicare Supplement | 358 | ||
| Special Risk Insurance | 358 | ||
| Liability Insurance | 358 | ||
| Life Insurance | 358 | ||
| Long-Term Care Insurance | 358 | ||
| How Benefits are Determined | 358 | ||
| Indemnity Schedules | 358 | ||
| Service Benefit Plans | 358 | ||
| Resource-Based Relative Value Scale | 358 | ||
| Usual, Customary, and Reasonable Fee | 359 | ||
| Health Insurance Providers | 359 | ||
| Managed Care | 359 | ||
| Managed Care Policies and Procedures | 360 | ||
| Models of Managed Care | 360 | ||
| Health Maintenance Organization. | 360 | ||
| Independent Practice Association. | 360 | ||
| Staff Model. | 360 | ||
| Group Model. | 360 | ||
| Exclusive Provider Organization. | 360 | ||
| Preferred Provider Organizations. | 360 | ||
| Blue Cross/Blue Shield | 361 | ||
| Medicaid | 361 | ||
| Medicare | 362 | ||
| Medicare Part A | 362 | ||
| Medicare Part B | 362 | ||
| Medicare Advantage (formerly Medicare + Choice) | 363 | ||
| Medicare Part D | 363 | ||
| TRICARE | 363 | ||
| CHAMPVA | 363 | ||
| Workers’ Compensation | 363 | ||
| Disability Programs | 363 | ||
| Commercial Insurance | 364 | ||
| Understanding Insurance Plan Requirements | 364 | ||
| Utilization Management/Utilization Review | 364 | ||
| Verification of Insurance Benefits | 365 | ||
| Precertification and Preauthorization | 366 | ||
| Fee Schedules | 370 | ||
| Resource-Based Relative Value Scale | 370 | ||
| Deductibles and Co-Insurance | 370 | ||
| Patient Education | 371 | ||
| Legal and Ethical Issues | 371 | ||
| Closing Comments | 372 | ||
| Connections | 374 | ||
| Study Guide Connection: | 374 | ||
| Evolve Connection: | 374 | ||
| 21 The Health Insurance Claim Form | 375 | ||
| Learning Objectives | 375 | ||
| Vocabulary | 376 | ||
| Scenario | 375 | ||
| Types of Claims | 376 | ||
| Hard Copy (Paper) Claims | 376 | ||
| Advantages and Disadvantages of Paper Claims | 376 | ||
| Intelligent Character Recognition | 377 | ||
| Electronic Claims | 377 | ||
| Electronic Claims Submission | 378 | ||
| Direct Billing. | 378 | ||
| Clearinghouse Submission. | 378 | ||
| Advantages of Electronic Submission | 378 | ||
| Data Gathering Guidelines | 378 | ||
| Verification of Eligibility and Benefits | 378 | ||
| Preauthorization and/or Referral | 382 | ||
| Completing the CMS-1500 Form | 382 | ||
| Section 1: Carrier Block | 382 | ||
| Section 2: Patient/Insured Section—Blocks 1 to 8 (Figure 21-3) | 382 | ||
| Section 3: Patient/Insured Section—Blocks 9 to 13 (Figure 21-4) | 389 | ||
| Physician/Supplier Section—Blocks 14 to 23 (Figure 21-5) | 390 | ||
| Physician/Supplier Section—Blocks 24 to 33 (Figure 21-6) | 391 | ||
| Guidelines for Claims Review before Submission | 393 | ||
| Preventing Claim Rejection | 393 | ||
| Denied or Rejected Claims | 393 | ||
| Explanation of Benefits | 393 | ||
| Checking a Claim’s Status | 394 | ||
| Audit Trails | 394 | ||
| Patient Education | 396 | ||
| Legal and Ethical Issues | 396 | ||
| Closing Comments | 396 | ||
| Connections | 398 | ||
| Study Guide Connection: | 398 | ||
| Evolve Connection: | 398 | ||
| 22 Professional Fees, Billing, and Collecting | 399 | ||
| Learning Objectives | 399 | ||
| Vocabulary | 400 | ||
| Scenario | 399 | ||
| How Fees are Determined | 400 | ||
| Impact of Managed Care | 400 | ||
| Prevailing Rate in the Community | 400 | ||
| Usual, Customary, and Reasonable Fees | 401 | ||
| Fee Setting by Third-Party Payers | 401 | ||
| Physician’s Fee Profile | 401 | ||
| Insurance Allowance | 401 | ||
| Explaining Fees to Patients | 401 | ||
| Discussion of Fees in Advance | 402 | ||
| Explanation of Additional Fees | 402 | ||
| Fee Estimates | 402 | ||
| The Guarantor’s Ultimate Responsibility | 402 | ||
| Charging the Patient for Medical Services and Procedures | 402 | ||
| Computations Used on Patient Accounts | 403 | ||
| Comparison of Manual and Computerized Bookkeeping Systems | 404 | ||
| Computerized Bookkeeping Systems | 404 | ||
| Manual Bookkeeping Systems | 405 | ||
| Preparing Patient Accounts for Daily Transactions | 406 | ||
| Entering and Posting Transactions | 406 | ||
| Posting Other Payments and Charges | 406 | ||
| Summarizing Accounting Transactions | 406 | ||
| Special Bookkeeping Entries | 407 | ||
| Adjustments | 407 | ||
| Credit Balances | 407 | ||
| Refunds | 409 | ||
| Insufficient Funds Checks | 410 | ||
| Balancing the Accounts Receivable and Accounts Receivable Control | 411 | ||
| Payment Options | 411 | ||
| Payment at the Time of Service | 411 | ||
| Billing after Payment Arrangements | 411 | ||
| Using Credit for Medical Services | 411 | ||
| Truth in Lending Act | 412 | ||
| Fair Debt Collection Practices Act | 412 | ||
| Obtaining Credit Information | 412 | ||
| Insurance or Other Third-Party Payers | 413 | ||
| Billing Procedures | 413 | ||
| Computer-Generated Statements | 414 | ||
| Encounter Forms | 414 | ||
| Photocopied Statements | 414 | ||
| Online Billing Statements | 414 | ||
| Itemizing the First Statement | 414 | ||
| Time and Frequency of Billing | 414 | ||
| Once-a-Month Billing | 414 | ||
| Cycle Billing | 414 | ||
| Professional Courtesy | 415 | ||
| Billing Minors | 415 | ||
| Collection Procedures | 415 | ||
| Medical Care for Those Who Cannot Pay | 415 | ||
| Fees in Hardship Cases | 416 | ||
| Pitfalls of Fee Adjustments | 416 | ||
| Medicare and Advance Beneficiary Notices | 416 | ||
| Preparing Accounts for Collection Activity | 416 | ||
| Collection Techniques | 416 | ||
| Telephone Collection Calls | 416 | ||
| Collection Letters or Reminders | 419 | ||
| Personal Interviews | 419 | ||
| Special Collection Situations | 419 | ||
| Tracing “Skips” | 419 | ||
| Address Change Service. | 419 | ||
| Claims Against Estates | 420 | ||
| Bankruptcy | 420 | ||
| Using Outside Collection Services | 421 | ||
| Using a Collection Agency | 421 | ||
| Working with the Collection Agency | 421 | ||
| Posting Collection Agency Payments | 421 | ||
| Making the Decision to Sue | 422 | ||
| Small Claims Court | 422 | ||
| Closing Comments | 422 | ||
| Patient Education | 423 | ||
| Legal and Ethical Issues | 423 | ||
| Connections | 424 | ||
| Study Guide Connection: | 424 | ||
| Evolve Connection: | 424 | ||
| Unit Five Financial and Practice Management | 425 | ||
| 23 Banking Services and Procedures | 425 | ||
| Learning Objectives | 425 | ||
| Vocabulary | 426 | ||
| Scenario | 425 | ||
| Banking in Today’s Business World | 426 | ||
| Online Banking | 426 | ||
| Online Convenience | 426 | ||
| Customer-Oriented Banking | 427 | ||
| Electronic Funds Transfers | 427 | ||
| Checks | 427 | ||
| Debit Cards | 427 | ||
| Types of Checks | 428 | ||
| Bank Draft | 428 | ||
| Cashier’s Check | 428 | ||
| Limited Check | 428 | ||
| Money Order | 428 | ||
| Traveler’s Check | 428 | ||
| Voucher Check | 428 | ||
| The Banking System | 429 | ||
| The Federal Reserve | 429 | ||
| Routing and Account Numbers | 429 | ||
| American Bankers Association Number | 429 | ||
| How Checks Are Processed | 429 | ||
| Clearinghouses | 429 | ||
| Magnetic Ink Character Recognition | 429 | ||
| Bank Accounts | 430 | ||
| Common Types of Accounts | 430 | ||
| Checking Accounts | 430 | ||
| Savings Accounts | 430 | ||
| Interest-Bearing Accounts | 430 | ||
| Money Market Savings Account | 430 | ||
| Individual Retirement Accounts | 430 | ||
| The Business Account | 430 | ||
| What to Look for in a Business Account | 430 | ||
| Perks for Businesses | 430 | ||
| Business Checks | 431 | ||
| Computer-Generated Checks. | 432 | ||
| One-Write Check Writing. | 432 | ||
| Bill Paying and Check Writing | 432 | ||
| Establishing a Bill-Paying System | 432 | ||
| Designated Times | 433 | ||
| Paying Bills to Maximize Money | 433 | ||
| Automatic Withdrawals and Deductions | 433 | ||
| Online Bill Paying | 433 | ||
| Writing Checks | 433 | ||
| Instructions | 433 | ||
| Checkbook Stubs | 434 | ||
| Signing Checks | 434 | ||
| Handling Corrections | 434 | ||
| Writing Cash Checks | 434 | ||
| Mailing Checks | 435 | ||
| Special Problems with Checks | 435 | ||
| Overdraws or Overdrafts | 435 | ||
| Stop-Payments | 435 | ||
| Precautions for Accepting Checks | 435 | ||
| Acknowledging Payment in Full | 435 | ||
| Precautions for Accepting Credit and Debit Cards | 436 | ||
| Returned Checks | 436 | ||
| Charging Fees | 436 | ||
| Legal Options | 436 | ||
| Endorsements | 437 | ||
| Why an Endorsement Is Necessary | 437 | ||
| Types of Endorsements | 437 | ||
| Blank Endorsement | 437 | ||
| Restrictive Endorsement | 437 | ||
| Special Endorsement | 437 | ||
| Qualified Endorsement | 437 | ||
| Methods of Endorsement | 437 | ||
| Stamp | 437 | ||
| Signature | 437 | ||
| Making Deposits | 437 | ||
| Preparing the Deposit | 438 | ||
| Direct Deposits | 439 | ||
| Other Methods of Deposit | 439 | ||
| Bank Statements and Reconciliation | 439 | ||
| Mailed Statements | 439 | ||
| Online Statements | 439 | ||
| Reconciling the Bank Statement | 439 | ||
| Signature Cards | 440 | ||
| Bonding | 440 | ||
| Closing Comments | 441 | ||
| Patient Education | 441 | ||
| Legal and Ethical Issues | 442 | ||
| Connections | 443 | ||
| Study Guide Connection: | 443 | ||
| Evolve Connection: | 443 | ||
| 24 Financial and Practice Management | 444 | ||
| Learning Objectives | 444 | ||
| Vocabulary | 445 | ||
| Scenario | 444 | ||
| What is Accounting? | 445 | ||
| Accounting Bases | 445 | ||
| Financial Summaries | 445 | ||
| The Rules of Bookkeeping | 446 | ||
| Kinds of Financial Records | 447 | ||
| Daily Journal | 447 | ||
| Checkbook | 447 | ||
| Disbursements Journal | 448 | ||
| Petty Cash Records | 448 | ||
| Accounting Systems | 448 | ||
| End of Day Summarizing | 448 | ||
| Trial Balance of Accounts Receivable | 449 | ||
| Locating and Preventing Errors | 449 | ||
| Accounts Payable Procedures | 449 | ||
| Invoices and Statements | 449 | ||
| Paying for Purchases | 450 | ||
| Recording Disbursements | 450 | ||
| Accounting for Petty Cash | 450 | ||
| Common Periodic Financial Reports | 451 | ||
| Recent Legislation for Small Businesses and Their Expenses | 451 | ||
| Payroll Records | 451 | ||
| Payroll Reporting Forms | 451 | ||
| Income Tax Withholding | 452 | ||
| Employers Income Tax | 453 | ||
| Social Security, Medicare, and Income Tax Withholding | 453 | ||
| Quarterly Returns | 453 | ||
| Annual Returns | 453 | ||
| Federal Unemployment Tax | 453 | ||
| State Unemployment Taxes | 453 | ||
| State Disability Insurance | 453 | ||
| Budgets | 453 | ||
| Insurance | 454 | ||
| Closing Comments | 454 | ||
| Patient Education | 454 | ||
| Legal and Ethical Issues | 454 | ||
| Connections | 456 | ||
| Study Guide Connection: | 456 | ||
| Evolve Connection: | 456 | ||
| 25 Medical Practice Management and Human Resources | 457 | ||
| Learning Objectives | 457 | ||
| Vocabulary | 458 | ||
| Scenario | 457 | ||
| Today’s Office Managers | 458 | ||
| Who’s in Charge? | 458 | ||
| Duties of the Medical Office Manager | 459 | ||
| The Power of Influence | 459 | ||
| The Manager as a Leader | 459 | ||
| Types of Leaders | 460 | ||
| Styles of Management | 460 | ||
| Theories X, Y, and Z | 460 | ||
| Maslow’s Hierarchy of Needs | 460 | ||
| Leading During Transitions and Change | 461 | ||
| The Role of Power | 461 | ||
| Abuse of Power and Authority | 461 | ||
| The Power of Motivation | 461 | ||
| The New Office Manager | 462 | ||
| Creating a Team Atmosphere | 462 | ||
| Use of Incentives and Employee Recognition | 462 | ||
| Problem Employees | 463 | ||
| Problem Patients | 463 | ||
| Preventing Burnout | 463 | ||
| Keeping the Management Relationship Professional | 464 | ||
| Laws Affecting Employment | 464 | ||
| Selecting the Right Staff Members | 464 | ||
| Understanding the Needs of the Office | 465 | ||
| Reviewing Resumés and Applications | 465 | ||
| Arranging the Personal Interview | 465 | ||
| The Interview | 468 | ||
| Follow-Up Activities | 469 | ||
| Making the Selection | 470 | ||
| Paperwork for New Employees | 470 | ||
| Orientation and Training: Critical Factors for Successful Employees | 470 | ||
| Job Description | 471 | ||
| Staff Development Training | 471 | ||
| Delegation of Duties | 471 | ||
| Using Performance Reviews Effectively | 474 | ||
| Peer Evaluations | 477 | ||
| Poor Evaluations Made Easier | 477 | ||
| Terminating Employees | 477 | ||
| Fair Salaries and Raises | 479 | ||
| Staff Meetings | 479 | ||
| Seeing the Whole Picture | 479 | ||
| Office Management Tools | 480 | ||
| Patient Information Booklet | 480 | ||
| Financial Policy Folder | 481 | ||
| Patient Instruction Sheets | 481 | ||
| Medical Practice Acts | 481 | ||
| Physician Licensure and Registration | 482 | ||
| Licensure | 482 | ||
| Examination | 482 | ||
| Reciprocity | 482 | ||
| Endorsement | 482 | ||
| Exemptions | 482 | ||
| Registration and Reregistration | 482 | ||
| Revocation or Suspension | 482 | ||
| Closing Comments | 482 | ||
| Patient Education | 483 | ||
| Legal and Ethical Issues | 483 | ||
| Connections | 484 | ||
| Study Guide Connection: | 484 | ||
| Evolve Connection: | 484 | ||
| 26 Medical Practice Marketing and Customer Service | 485 | ||
| Learning Objectives | 485 | ||
| Vocabulary | 486 | ||
| Scenario | 485 | ||
| Developing Marketing Strategies | 486 | ||
| Branding | 486 | ||
| Knowing the Target Market | 487 | ||
| Ethics, Marketing, and Public Relations | 487 | ||
| The Four Ps | 487 | ||
| Deciding What Services to Offer | 487 | ||
| Developing a Plan for Marketing | 488 | ||
| Promoting the Practice | 488 | ||
| Tapping into Free Community Resources | 488 | ||
| Advertising Plans and Agencies | 489 | ||
| Communication as a Marketing Tool | 489 | ||
| Promoting a New Practice | 489 | ||
| Developing and Giving Presentations | 489 | ||
| Overcoming Anxiety | 490 | ||
| During the Presentation | 490 | ||
| Building a Practice Web Site | 492 | ||
| Defining Objectives | 492 | ||
| Designing Pages | 492 | ||
| Locating a Web Server | 492 | ||
| Uploading Pages | 492 | ||
| Evaluating the Web Site | 493 | ||
| Social Media and Networking | 493 | ||
| High-Quality Customer Service in the Medical Practice | 493 | ||
| Treating the Patient as a Customer | 493 | ||
| Helpful Attitude | 494 | ||
| Phrases That Undermine Successful Customer Service | 494 | ||
| Identifying with Patients | 494 | ||
| What Do Patients Expect? | 494 | ||
| Remembering the Internal Customer | 494 | ||
| Closing Comments | 495 | ||
| Patient Education | 495 | ||
| Legal and Ethical Issues | 495 | ||
| Connections | 497 | ||
| Study Guide Connection: | 497 | ||
| Evolve Connection: | 497 | ||
| Unit Six Assisting with Medical Specialties | 498 | ||
| 27 Emergency Preparedness and Assisting with Medical Emergencies | 498 | ||
| Learning Objectives | 498 | ||
| Vocabulary | 499 | ||
| Scenario | 498 | ||
| Safety in the Healthcare Facility | 499 | ||
| Patient Safety | 499 | ||
| Employee Safety | 499 | ||
| Environmental Safety | 501 | ||
| Disposal of Hazardous Waste | 503 | ||
| Emergency Preparedness | 504 | ||
| Community Resources for Emergency Preparedness | 504 | ||
| Assisting with Medical Emergencies | 506 | ||
| Emergency Supplies | 506 | ||
| Defibrillators | 507 | ||
| Precautions for Automated External Defibrillators | 508 | ||
| General Rules for Emergencies | 509 | ||
| Telephone Screening | 509 | ||
| Management of On-Site Emergencies | 510 | ||
| Life-Threatening Emergencies | 511 | ||
| Unresponsive Patient | 511 | ||
| Cardiac Emergencies | 514 | ||
| Choking | 515 | ||
| Cerebrovascular Accident (Stroke) | 517 | ||
| Shock | 519 | ||
| Common Office Emergencies | 519 | ||
| Fainting (Syncope) | 519 | ||
| Poisoning | 519 | ||
| Animal Bites | 522 | ||
| Insect Bites and Stings | 522 | ||
| Asthma Attacks | 522 | ||
| Seizures | 523 | ||
| Abdominal Pain | 523 | ||
| Sprains and Strains | 523 | ||
| Fractures | 523 | ||
| Burns | 524 | ||
| Tissue Injuries | 524 | ||
| Nosebleeds (Epistaxis) | 526 | ||
| Head Injuries | 526 | ||
| Foreign Bodies in the Eye | 526 | ||
| Heat and Cold Injuries | 526 | ||
| Dehydration | 526 | ||
| Diabetic Emergencies | 527 | ||
| Closing Comments | 527 | ||
| Patient Education | 527 | ||
| Legal and Ethical Issues | 527 | ||
| Connections | 530 | ||
| Study Guide Connection: | 530 | ||
| Evolve Connection: | 530 | ||
| Unit Seven Career Development | 531 | ||
| 28 Career Development and Life Skills | 531 | ||
| Learning Objectives | 531 | ||
| Vocabulary | 532 | ||
| Scenario | 531 | ||
| What Does the Employer Want? | 532 | ||
| Assessing Strengths | 533 | ||
| Developing Career Objectives | 533 | ||
| Knowing Personal Needs | 533 | ||
| Finding a Job | 533 | ||
| Two Best Job Search Methods | 534 | ||
| Internet and the Job Search | 535 | ||
| Traditional Job Search Methods | 535 | ||
| School Career Placement Offices | 535 | ||
| Newspaper Ads | 535 | ||
| Employment Agencies | 535 | ||
| Professional Organizations | 535 | ||
| Volunteering | 535 | ||
| Mailing Resumés | 535 | ||
| Cold Calling | 536 | ||
| Performing Well on Externships | 536 | ||
| Organizing the Job Search | 536 | ||
| Developing a Resumé | 536 | ||
| Critical Resumé Errors | 537 | ||
| Argument about Length | 541 | ||
| Purpose of a Resumé | 541 | ||
| Cover Letter | 542 | ||
| Job Applications | 543 | ||
| Job Interview | 546 | ||
| Preparation for the Interview | 546 | ||
| Interview | 548 | ||
| Follow-Up after the Interview | 549 | ||
| Negotiation | 550 | ||
| You Got the Job! | 550 | ||
| Common Early Mistakes | 550 | ||
| Being a Good Employee | 550 | ||
| Dealing with Supervisors | 551 | ||
| Performance Appraisals | 551 | ||
| Asking for a Raise | 552 | ||
| Leaving a Job | 552 | ||
| Life Skills | 552 | ||
| Personal Growth | 552 | ||
| Self-Control | 552 | ||
| Self-Esteem | 552 | ||
| Problem-Solving Skills | 553 | ||
| Decision-Making Skills | 553 | ||
| Stress Management | 553 | ||
| Planning a Budget | 553 | ||
| Student Loans | 553 | ||
| Guideline Budget | 554 | ||
| Getting a Paycheck | 554 | ||
| Dangerous Habits | 554 | ||
| Closing Comments | 555 | ||
| Patient Education | 555 | ||
| Legal and Ethical Issues | 555 | ||
| Connections | 557 | ||
| Study Guide Connection: | 557 | ||
| Evolve Connection: | 557 | ||
| ICD-10 Diagnostic Coding | e1 | ||
| Learning Objectives | e1 | ||
| Vocabulary | e1 | ||
| Scenario | e1 | ||
| Introduction to the International Classification of Diseases Coding System | e2 | ||
| Two Major Coding Structures | e2 | ||
| History and Development of the ICD Coding System | e2 | ||
| Uses of Coded Data | e2 | ||
| Why the Change to ICD-10-CM? | e2 | ||
| ICD-10-CM Coding and Reporting Guidelines | e3 | ||
| Process of Classifying Diseases | e3 | ||
| ICD-10-CM Code Structure | e5 | ||
| Format of the ICD-10-CM Manual | e5 | ||
| Alphabetic Index | e6 | ||
| Main Terms. | e6 | ||
| Essential and Nonessential Modifiers. | e8 | ||
| Conventions Used in Alphabetic Index | e9 | ||
| Parentheses. | e9 | ||
| Cross-References (See and See also). | e9 | ||
| Example | e9 | ||
| Glossary | 558 | ||
| Index | 573 | ||
| A | 573 | ||
| B | 574 | ||
| C | 574 | ||
| D | 576 | ||
| E | 576 | ||
| F | 577 | ||
| G | 577 | ||
| H | 578 | ||
| I | 578 | ||
| J | 579 | ||
| K | 579 | ||
| L | 579 | ||
| M | 580 | ||
| N | 581 | ||
| O | 581 | ||
| P | 582 | ||
| Q | 583 | ||
| R | 583 | ||
| S | 583 | ||
| T | 584 | ||
| U | 584 | ||
| V | 584 | ||
| W | 585 | ||
| X | 585 | ||
| Z | 585 |