Additional Information
Book Details
Abstract
Using a clear, hands-on approach to learning front office skills, Medical Office Administration, 4th Edition prepares you for a successful career as an administrative medical office assistant. Performing procedures with SimChart® for the Medical Office (SCMO), you’ll practice day-to-day tasks as if you were in an actual office setting. This new edition adds updated content to support use of the electronic health record, new Affordable Care Act information, insurance/billing/coding content, and SCMO activities woven throughout the text. Covering administrative tasks from appointment scheduling to medical billing, this work text helps you develop the knowledge and skills you need to think critically and respond confidently to the challenges you’ll encounter on the job. Access to SimChart for the Medical Office sold separately.
- A conversational writing style makes it easier for you to read and understand the material.
- Stopping points provide you with thought-provoking questions or activities to break up the narrative in manageable segments.
- HIPAA Hints ensure that you comply with HIPAA mandates.
- Real-world examples apply important concepts to the medical office setting.
- Interactive electronic procedure checklists spell out the individual steps required to complete a full range of administrative procedures, and are based on CAAHEP competencies.
- NEW! SimChart® for the Medical Office (SCMO) throughout text allows you to practice common administrative tasks with real-world office management software.
- NEW! Coverage of the Affordable Care Act and ICD-10 prepares you for what you’ll encounter on the job.
- NEW! Medical Assisting mapping tables tie into CAAHEP and ABHES competencies.
- NEW! High-quality illustrations and updated screenshots helps reinforce content.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| MEDICAL OFFICE ADMINISTRATION: A Worktext | I | ||
| MEDICAL OFFICE ADMINISTRATION: A Worktext | III | ||
| Copyright | IV | ||
| Dedication | V | ||
| EDITORIAL REVIEW BOARD | VI | ||
| PREFACE | VII | ||
| PROCEDURE | VII | ||
| HIPAA HINT | VII | ||
| THINK ABOUT IT | VII | ||
| COMPETENCY ASSESSMENT CHECKLISTS | VII | ||
| ACKNOWLEDGMENTS | VIII | ||
| CONTENTS | IX | ||
| 1 - The Career of a Medical Administrative Assistant | 1 | ||
| CAREER DESCRIPTION | 1 | ||
| A TYPICAL DAY AT THE OFFICE | 3 | ||
| Personal Qualities | 3 | ||
| Empathy | 3 | ||
| Compassion | 3 | ||
| Dependability | 3 | ||
| Teamwork | 4 | ||
| Confidentiality | 4 | ||
| Attention to Details | 4 | ||
| Positive Work Ethic | 4 | ||
| Other Desirable Personality Traits | 4 | ||
| Professional Appearance | 4 | ||
| Dress Codes | 4 | ||
| Uniforms | 4 | ||
| Other Office Apparel | 5 | ||
| Personal Appearance | 6 | ||
| Professional Skills | 6 | ||
| Medical Terminology, Anatomy and Physiology, and Disease Processes | 6 | ||
| Medical Office Procedures and Practices | 6 | ||
| Medical Transcription and Documentation | 6 | ||
| Medical Coding, Billing, and Insurance | 7 | ||
| Communication Skills | 7 | ||
| Computer Technology | 7 | ||
| Internship | 7 | ||
| Student Portfolio | 7 | ||
| Places of Employment | 7 | ||
| Earnings | 7 | ||
| Employment Trends and Forecasts | 7 | ||
| PROFESSIONAL ORGANIZATIONS | 8 | ||
| American Association of Medical Assistants | 8 | ||
| American Medical Technologists | 8 | ||
| American Academy of Professional Coders | 8 | ||
| International Association of Administrative Professionals | 9 | ||
| Association for Healthcare Documentation Integrity | 9 | ||
| American Health Information Management Association | 9 | ||
| ADDITIONAL CERTIFICATIONS | 10 | ||
| Continuing Education | 10 | ||
| SUMMARY | 10 | ||
| REVIEW EXERCISES | 10 | ||
| ACTIVITIES | 11 | ||
| SUGGESTED READINGS | 14 | ||
| YOU ARE THE MEDICAL ADMINISTRATIVE ASSISTANT | 14 | ||
| BIBLIOGRAPHY | 14 | ||
| 2 - The Health Care Team | 15 | ||
| HEALTH CARE PROVIDERS | 15 | ||
| Physician | 15 | ||
| NURSING PROFESSIONALS | 21 | ||
| Registered Nurse | 21 | ||
| Licensed Practical Nurse | 21 | ||
| Certified Nursing Assistant | 21 | ||
| ALLIED HEALTH PROFESSIONALS | 22 | ||
| Medical Administrative Assistant | 22 | ||
| Medical Assistant | 22 | ||
| Medical Transcription/Documentation | 22 | ||
| Medical Coder | 22 | ||
| Medical Biller | 22 | ||
| Health Information Professionals | 23 | ||
| Registered Health Information Technician | 23 | ||
| Registered Health Information Administrator | 23 | ||
| Cancer Registrar | 23 | ||
| Physical Therapist | 23 | ||
| Physical Therapy Assistant | 23 | ||
| Occupational Therapist | 24 | ||
| Occupational Therapy Assistant | 24 | ||
| Respiratory Therapist | 24 | ||
| Radiology Technologist | 24 | ||
| Clinical Laboratory Technologist and Technician | 25 | ||
| Pharmacist | 25 | ||
| Social Worker | 25 | ||
| LICENSURE, CERTIFICATION, AND REGISTRATION | 25 | ||
| PROFESSIONAL ORGANIZATIONS | 25 | ||
| HEALTH CARE FACILITIES | 25 | ||
| Clinic | 25 | ||
| Private Practice | 26 | ||
| Hospital | 26 | ||
| Emergency Room | 26 | ||
| Urgent Care Center | 27 | ||
| Outpatient (Ambulatory) Surgery Center | 27 | ||
| Home Health | 27 | ||
| Hospice Care | 28 | ||
| Nursing Home, Assisted Living | 28 | ||
| Public Health | 28 | ||
| SUMMARY | 28 | ||
| REVIEW EXERCISES | 28 | ||
| ACTIVITIES | 32 | ||
| YOU ARE THE MEDICAL ADMINISTRATIVE ASSISTANT | 33 | ||
| BIBLIOGRAPHY | 33 | ||
| 3 - Medical Law | 34 | ||
| LEGAL CONCEPTS AND TERMS | 34 | ||
| What Is Law? | 34 | ||
| Origin of Law | 35 | ||
| Administrative Law | 35 | ||
| Civil and Criminal Law | 35 | ||
| Standards of Care | 35 | ||
| Respondeat Superior | 35 | ||
| Contract Law | 36 | ||
| Essentials of a Contract | 36 | ||
| The Physician–Patient Relationship | 37 | ||
| Terminating a Contract | 37 | ||
| Legal Action Against a Medical Practice | 38 | ||
| Statute of Limitations | 38 | ||
| Medical Malpractice and Negligence | 38 | ||
| Effects of Medical Malpractice Suits | 39 | ||
| Legal Proceedings | 39 | ||
| Interrogatories | 40 | ||
| Depositions | 40 | ||
| Subpoena | 40 | ||
| Subpoena Duces Tecum | 40 | ||
| The Assistant as a Witness | 41 | ||
| Damages | 41 | ||
| LEGAL TOPICS RELATED TO THE MEDICAL OFFICE | 41 | ||
| The Practice of Medicine | 41 | ||
| Consent | 41 | ||
| Confidentiality | 42 | ||
| Release of Confidential Information | 42 | ||
| Required Release of Medical Information | 44 | ||
| Mandated Reportable Injury, Disease, and Occurrences | 45 | ||
| Confidentiality Agreements | 46 | ||
| Protecting Patient Confidentiality | 46 | ||
| Advance Directives | 48 | ||
| Uniform Anatomical Gift Act | 48 | ||
| Controlled Substances Act of 1970 | 49 | ||
| Good Samaritan Statutes | 50 | ||
| Health Insurance Portability and Accountability Act of 1996 | 50 | ||
| Consumer Control | 50 | ||
| Boundaries | 50 | ||
| Accountability | 50 | ||
| Public Responsibility | 51 | ||
| Security | 51 | ||
| Emergency Medical Treatment and Labor Act of 1986 | 51 | ||
| Risk Management | 51 | ||
| SUMMARY | 51 | ||
| REVIEW EXERCISES | 52 | ||
| ACTIVITIES | 55 | ||
| YOU ARE THE MEDICAL ADMINISTRATIVE ASSISTANT | 56 | ||
| BIBLIOGRAPHY | 56 | ||
| 4 - Medical Ethics | 58 | ||
| DEFINITION OF ETHICS | 58 | ||
| LAW VERSUS ETHICS | 58 | ||
| HISTORY OF ETHICS | 58 | ||
| ETHICAL BEHAVIOR FOR PHYSICIANS | 59 | ||
| AMA Council on Ethical and Judicial Affairs | 59 | ||
| Current Opinions of the CEJA | 60 | ||
| Failure to Abide by Ethical Standards | 60 | ||
| ETHICAL BEHAVIOR FOR MEDICAL ADMINISTRATIVE ASSISTANTS | 61 | ||
| ETHICAL ISSUES IN HEALTH CARE | 61 | ||
| The Study of Ethical Issues in Health Care | 62 | ||
| Abortion | 62 | ||
| Reproductive Rights | 63 | ||
| Artificial Insemination | 63 | ||
| Amniocentesis | 63 | ||
| In Vitro Fertilization | 63 | ||
| Surrogate Motherhood | 63 | ||
| Issues Near the End of Life | 64 | ||
| AIDS, HIV | 64 | ||
| SUMMARY | 65 | ||
| REVIEW EXERCISES | 65 | ||
| ACTIVITIES | 66 | ||
| YOU ARE THE MEDICAL ADMINISTRATIVE ASSISTANT | 66 | ||
| BIBLIOGRAPHY | 67 | ||
| 5 - The Diverse Community of Patients | 68 | ||
| INFLUENCE OF CULTURE | 68 | ||
| Interactions With Patients of Different Cultures | 68 | ||
| EXPECTATIONS WHEN SERVING PATIENTS | 69 | ||
| LANGUAGE BARRIERS | 70 | ||
| English as a Second Language | 70 | ||
| Speech Difficulty | 70 | ||
| Medical Terminology | 70 | ||
| SPECIFIC PATIENT GROUPS | 70 | ||
| Elderly Patients | 70 | ||
| Children | 73 | ||
| Patients With Disabilities | 73 | ||
| Angry Patients | 74 | ||
| Defusing an Angry Patient | 74 | ||
| Violent Patients | 74 | ||
| Anxious Patients | 74 | ||
| Depressed Patients | 75 | ||
| Dying or Grieving Patients | 75 | ||
| SUMMARY | 75 | ||
| SUGGESTED READINGS | 76 | ||
| REVIEW EXERCISES | 76 | ||
| ACTIVITIES | 77 | ||
| YOU ARE THE MEDICAL ADMINISTRATIVE ASSISTANT | 77 | ||
| BIBLIOGRAPHY | 77 | ||
| 6 - Interpersonal Communications | 78 | ||
| COMMUNICATION CONCEPTS | 78 | ||
| COMMUNICATION BASICS | 78 | ||
| Communicating Effectively | 79 | ||
| Nonverbal Communication | 80 | ||
| Personality Styles | 81 | ||
| Communication Within the Health Care Team | 81 | ||
| Communicating With Your Supervisor | 81 | ||
| TELEPHONE COMMUNICATION | 81 | ||
| Proper Telephone Technique | 81 | ||
| Incoming Calls | 82 | ||
| A Pleasant Telephone Greeting | 83 | ||
| Communications Equipment | 89 | ||
| Telephone Services | 91 | ||
| Outgoing Calls | 91 | ||
| Using a Telephone Directory | 91 | ||
| Web Directories | 91 | ||
| Developing a Personal Directory | 91 | ||
| Leaving Messages for Patients | 91 | ||
| WRITTEN COMMUNICATION | 92 | ||
| Business Letters | 93 | ||
| Components of a Letter | 93 | ||
| Proper Format | 96 | ||
| Envelopes | 96 | ||
| Letter Portfolio | 98 | ||
| Memos | 99 | ||
| Components | 99 | ||
| Proper Format | 99 | ||
| 99 | |||
| Patient Portals | 100 | ||
| Email Format | 100 | ||
| Email Etiquette | 100 | ||
| U.S. Postal Service Delivery Services | 100 | ||
| Processing Incoming Mail | 101 | ||
| Processing Outgoing Mail | 101 | ||
| SUMMARY | 103 | ||
| REVIEW EXERCISES | 103 | ||
| ACTIVITIES | 108 | ||
| BIBLIOGRAPHY | 113 | ||
| 7 - Appointment Scheduling | 114 | ||
| COMPUTERIZED APPOINTMENT SCHEDULING | 114 | ||
| Software Packages for Appointment Scheduling | 117 | ||
| Concerns When a Computerized Appointment System Is Used | 117 | ||
| MANUAL SYSTEM FOR APPOINTMENT SCHEDULING | 117 | ||
| Concerns When a Manual Scheduling System Is Used | 118 | ||
| APPOINTMENT SCHEDULING METHODS | 119 | ||
| Double-Booking (Overbooking) of Appointments | 119 | ||
| Walk-in Patients | 119 | ||
| Walk-in Clinics | 120 | ||
| Group (Block) Scheduling | 120 | ||
| Series of Appointments | 120 | ||
| Multiple Appointments | 120 | ||
| APPOINTMENT SCHEDULING PROCEDURES | 121 | ||
| Establishing Appointment Parameters | 121 | ||
| Multiphysician Practices | 121 | ||
| Facility Limitations | 121 | ||
| Setting the Schedule | 121 | ||
| Advance Booking | 121 | ||
| Components of an Appointment | 122 | ||
| Name of Patient | 122 | ||
| Reason for Appointment | 123 | ||
| Telephone Number | 123 | ||
| Medical Record Number | 123 | ||
| Date of Birth | 123 | ||
| Prioritizing Appointments | 124 | ||
| No-Show Appointments | 125 | ||
| Documentation of No-Shows | 125 | ||
| Canceled and Rescheduled Appointments | 126 | ||
| Ancillary and Referral Appointments | 126 | ||
| Surgical Appointments | 127 | ||
| Pharmaceutical and Other Sales Representatives’ Appointments | 128 | ||
| Appointment Reminders | 128 | ||
| Written Reminders | 128 | ||
| Telephone Reminders | 128 | ||
| Posting the Schedule | 129 | ||
| Planning for the Unexpected | 129 | ||
| SUMMARY | 129 | ||
| REVIEW EXERCISES | 129 | ||
| ACTIVITIES | 131 | ||
| 8 - Patient Reception and Registration | 137 | ||
| EXCEPTIONAL PATIENT SERVICE | 137 | ||
| PATIENT INFORMATIONAL MATERIALS | 138 | ||
| GETTING THE OFFICE READY | 138 | ||
| Unlock the Door | 138 | ||
| Review the Day’s Schedule | 139 | ||
| Start and Check Office Equipment | 139 | ||
| Switch on Television or Music System | 139 | ||
| Count Cash Drawer | 139 | ||
| WELCOMING PATIENTS | 139 | ||
| PATIENT REGISTRATION | 139 | ||
| Registration Information | 140 | ||
| Patient’s Personal Information | 140 | ||
| Patient’s or Responsible Party’s Information | 142 | ||
| Patient’s Insurance Information | 142 | ||
| Patient’s Referral Information | 143 | ||
| Emergency Contact | 143 | ||
| Authorizations | 143 | ||
| Patient History Form | 143 | ||
| Notice of Privacy Practices | 143 | ||
| Confidentiality When Registering Patients | 143 | ||
| RECEPTION AREA | 145 | ||
| Layout and Design of the Reception Area | 145 | ||
| Welcoming Atmosphere | 145 | ||
| Traffic Patterns | 145 | ||
| Seating Arrangement | 146 | ||
| Television or Music System | 146 | ||
| Reading Material | 146 | ||
| Something for Kids | 146 | ||
| Refreshments | 146 | ||
| Wheelchair | 146 | ||
| Other Reception Area Fixtures | 146 | ||
| Reception Area Maintenance | 146 | ||
| At the End of the Day | 147 | ||
| EMERGENCY SITUATIONS | 147 | ||
| What Is an Emergency? | 147 | ||
| Common Medical Emergencies | 147 | ||
| Chest Pain | 147 | ||
| Seizure | 147 | ||
| Respiratory Distress | 148 | ||
| Diabetic Emergencies | 148 | ||
| Profuse, Uncontrolled Bleeding | 148 | ||
| Head Injury | 148 | ||
| Syncope | 148 | ||
| Psychotic Episode | 149 | ||
| Eye Injury | 149 | ||
| Burns | 149 | ||
| What a Medical Administrative Assistant Should Do | 149 | ||
| Other Situations | 149 | ||
| Fractures | 149 | ||
| Acutely Ill or Uncomfortable Patients | 150 | ||
| Planning for Emergencies | 150 | ||
| SUMMARY | 150 | ||
| REVIEW EXERCISES | 150 | ||
| ACTIVITIES | 151 | ||
| BIBLIOGRAPHY | 156 | ||
| 9 - Health Information Management | 157 | ||
| WHAT IS HEALTH INFORMATION MANAGEMENT? | 157 | ||
| Purposes of Record Keeping | 157 | ||
| Types of Records | 158 | ||
| CONFIDENTIALITY | 158 | ||
| Confidentiality Agreements | 159 | ||
| Confidentiality and Computerized Medical Records | 159 | ||
| HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 | 159 | ||
| Notice of Privacy Practices | 159 | ||
| Failure to Comply with HIPAA | 160 | ||
| COMPONENTS OF THE MEDICAL RECORD IN A MEDICAL OFFICE | 160 | ||
| Summary Sheet | 161 | ||
| Medical History | 161 | ||
| Progress Notes | 161 | ||
| S = Subjective | 161 | ||
| O = Objective | 162 | ||
| A = Assessment | 162 | ||
| P = Plan | 162 | ||
| Recording Information in a Patient’s Medical Record | 163 | ||
| Medication Records | 163 | ||
| Immunizations | 163 | ||
| Laboratory and Pathology Reports | 163 | ||
| Radiology Reports | 164 | ||
| Other Specialized Reports and Documents | 165 | ||
| Correspondence | 165 | ||
| Hospital Reports | 166 | ||
| History and Physical | 166 | ||
| Operative Report | 172 | ||
| Discharge Summary | 172 | ||
| MEDICAL TRANSCRIPTION | 172 | ||
| Skills Needed | 172 | ||
| Equipment Used | 173 | ||
| Signature | 174 | ||
| Correcting Information in a Patient’s Medical Record | 175 | ||
| ORGANIZING THE MEDICAL RECORD | 175 | ||
| Charting Methods | 175 | ||
| Chart Order | 176 | ||
| Documentation Guidelines | 176 | ||
| What Does Not Belong in the Record | 176 | ||
| Records Flow | 177 | ||
| Quantitative Analysis | 178 | ||
| FILING SUPPLIES | 179 | ||
| Charts | 179 | ||
| Labels | 179 | ||
| Outguides | 179 | ||
| FILING METHODS | 180 | ||
| Numerical Filing Systems | 180 | ||
| Consecutive Number Filing | 180 | ||
| Terminal Digit Filing | 181 | ||
| Alphabetical Filing | 181 | ||
| Alphanumeric Filing | 182 | ||
| Color Coding | 182 | ||
| Why Use Color Coding? | 183 | ||
| Locating Missing Files | 183 | ||
| Records Retention and Disposal | 184 | ||
| Tickler File | 184 | ||
| FILE STORAGE AND PROTECTION | 185 | ||
| Disaster Plan | 185 | ||
| Medical Offices with Multiple Locations | 185 | ||
| LEGAL AND ETHICAL ISSUES | 186 | ||
| Release of Information | 186 | ||
| Methods of Releasing Medical Information | 186 | ||
| Fax Machines | 186 | ||
| Redisclosure of Medical Information | 186 | ||
| When a Release Is Not Required | 186 | ||
| Ownership | 189 | ||
| Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Records | 189 | ||
| THE FUTURE OF HEALTH RECORDS | 189 | ||
| SUMMARY | 189 | ||
| REVIEW EXERCISES | 190 | ||
| ACTIVITIES | 195 | ||
| BIBLIOGRAPHY | 198 | ||
| 10 - Procedure and Diagnosis Coding | 199 | ||
| MEDICAL CODING | 199 | ||
| Procedure Coding—Current Procedural Terminology (CPT) | 199 | ||
| HCPCS System | 200 | ||
| Format of the CPT Manual | 200 | ||
| Basics of Procedure Coding (CPT–HCPCS Level II) | 200 | ||
| Sections of the CPT Manual | 201 | ||
| Evaluation and Management (E&M)—99201-99499 | 201 | ||
| Anesthesia Coding—00100–01999 | 202 | ||
| Surgery Coding—10021–69990 | 202 | ||
| Radiology Coding—70010–79999 | 203 | ||
| Pathology and Laboratory Coding—80048–89356 | 203 | ||
| Medicine Coding—90281–99602 | 203 | ||
| CPT Appendices | 204 | ||
| Symbols | 204 | ||
| Special Considerations | 204 | ||
| Procedure Coding—HCPCS Level II—National Codes | 204 | ||
| Modifiers | 204 | ||
| Table of Drugs | 204 | ||
| Diagnosis Coding—International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) | 205 | ||
| Format of the ICD-10-CM Manual | 205 | ||
| Conventions Used in I-10 | 205 | ||
| Updates for ICD-10-CM | 205 | ||
| Outpatient Guidelines | 206 | ||
| Level of Detail in Coding | 206 | ||
| Laterality | 206 | ||
| Basics of Diagnosis Coding (I-10) | 206 | ||
| The Index | 206 | ||
| Table of Drugs and Chemicals | 207 | ||
| Tabular List | 207 | ||
| V, W, X, and Y Codes—Chapter 20 of I-10 Tabular | 207 | ||
| Z Codes—Chapter 21 of I-10 Tabular | 208 | ||
| Late Effects | 208 | ||
| LEGAL AND ETHICAL ISSUES IN CODING | 209 | ||
| Ethics | 209 | ||
| Compliance | 209 | ||
| The Coding Profession | 209 | ||
| SUMMARY | 210 | ||
| REVIEW EXERCISES | 210 | ||
| ACTIVITIES | 211 | ||
| BIBLIOGRAPHY | 212 | ||
| 11 - Medical Billing | 213 | ||
| THE BILLING PROCESS | 213 | ||
| Registration | 213 | ||
| Superbill | 214 | ||
| CREDIT | 217 | ||
| Statements of Account | 218 | ||
| Aging Accounts | 219 | ||
| Collection | 219 | ||
| Collection Guidelines | 220 | ||
| Fair Debt Collection Practices Act | 220 | ||
| Collection Methods | 220 | ||
| Initial Collection Methods | 220 | ||
| Telephone Collection | 221 | ||
| Collection Letters | 221 | ||
| In-Person Collection | 221 | ||
| Locating a Missing Guarantor | 221 | ||
| Private Agency Collection and Small Claims Court | 221 | ||
| BILLING TOPICS | 222 | ||
| What Does the Doctor Charge? | 222 | ||
| Assignment of Benefits | 223 | ||
| Fees for Medical Care | 223 | ||
| LEGAL AND ETHICAL ISSUES IN MEDICAL BILLING | 223 | ||
| Medical Debt | 223 | ||
| Confidentiality | 224 | ||
| Billing Fraud | 224 | ||
| Identity Theft | 226 | ||
| Fee Splitting | 226 | ||
| Charges for Minors | 226 | ||
| Estate Claims | 226 | ||
| Missed Appointments—To Bill or Not to Bill | 227 | ||
| Medical Records | 227 | ||
| SUMMARY | 227 | ||
| REVIEW EXERCISES | 228 | ||
| ACTIVITIES | 229 | ||
| BIBLIOGRAPHY | 232 | ||
| 12 - Health Insurance and Health Benefits Programs | 233 | ||
| INSURANCE TERMINOLOGY | 234 | ||
| CENTERS FOR MEDICARE AND MEDICAID SERVICES | 235 | ||
| CMS-1500 CLAIM FORM | 235 | ||
| THE INSURANCE CLAIM PROCESS | 235 | ||
| Electronic Claims Processing | 241 | ||
| Paper Processing of CMS-1500 | 241 | ||
| Coordination of Benefits | 241 | ||
| Troubleshooting Claims | 242 | ||
| Timelines for Filing | 242 | ||
| Filing an Appeal | 243 | ||
| TYPES OF INSURANCE PLANS | 243 | ||
| Fee-for-Service | 243 | ||
| Health Maintenance Organizations | 243 | ||
| Preferred Provider Organizations | 244 | ||
| GOVERNMENT HEALTH INSURANCE PROGRAMS | 244 | ||
| Medicare | 244 | ||
| Medicare Coverage and Enrollment | 244 | ||
| Medicare Enrollment | 244 | ||
| Part A Coverage | 245 | ||
| Part A Premiums | 245 | ||
| Part A Deductible | 245 | ||
| Part B Coverage | 245 | ||
| Part B Premium | 246 | ||
| Part B Deductible and Coinsurance | 246 | ||
| Medicare Advantage Plans (Part C) | 246 | ||
| Medicare Part D | 246 | ||
| Processing of Medicare Claims | 247 | ||
| Medicare Assignment | 248 | ||
| Advance Beneficiary Notice | 248 | ||
| Medicare Statistics | 249 | ||
| Medigap | 249 | ||
| Medicaid | 249 | ||
| Medicaid Eligibility | 249 | ||
| Medicaid Coverage | 249 | ||
| Medicaid Payments | 250 | ||
| Children’s Health Insurance Program (CHIP) | 250 | ||
| TRICARE | 250 | ||
| CHAMPVA | 251 | ||
| WORKERS’ COMPENSATION | 251 | ||
| PRIVATE HEALTH INSURANCE | 251 | ||
| Insurance Coverage | 251 | ||
| Blue Cross/Blue Shield | 251 | ||
| Disability Insurance | 252 | ||
| Long-term Care Insurance | 252 | ||
| INSURANCE RESOURCES | 252 | ||
| CURRENT TOPICS IN HEALTH INSURANCE | 252 | ||
| Insurance Fraud and Abuse | 252 | ||
| Confidentiality | 254 | ||
| COBRA | 254 | ||
| Insurance Industry Statistics | 254 | ||
| SUMMARY | 254 | ||
| REVIEW EXERCISES | 254 | ||
| ACTIVITIES | 259 | ||
| BIBLIOGRAPHY | 264 | ||
| 13 - Business Operations of the Medical Office | 265 | ||
| ORGANIZATIONAL STRUCTURE OF THE MEDICAL OFFICE | 265 | ||
| Types of Ownership | 265 | ||
| Financial Interests of Physicians | 265 | ||
| Organizational Hierarchy | 266 | ||
| HEALTH CARE–RELATED ORGANIZATIONS | 266 | ||
| The Joint Commission | 266 | ||
| Occupational Safety and Health Administration | 267 | ||
| Employee Injury | 267 | ||
| Ergonomics | 270 | ||
| Employee Rights Under the Occupational Safety and Health Act | 271 | ||
| Safety Data Sheets | 271 | ||
| OSHA Information | 271 | ||
| Bloodborne Pathogens and Standard Precautions | 271 | ||
| Hazard Communication Standard | 272 | ||
| Clinical Laboratory Improvement Amendments Program | 273 | ||
| OTHER OFFICE SUPPORT RESPONSIBILITIES | 273 | ||
| Office Supplies | 274 | ||
| Supply Scams | 274 | ||
| Office Meetings and Communications | 274 | ||
| Interoffice Memo | 274 | ||
| Office Meetings | 275 | ||
| Other Meetings | 277 | ||
| Travel Planning | 277 | ||
| SUMMARY | 279 | ||
| REVIEW EXERCISES | 279 | ||
| ACTIVITIES | 280 | ||
| BIBLIOGRAPHY | 281 | ||
| 14 - Financial Management | 282 | ||
| BOOKKEEPING AND ACCOUNTING PROCEDURES IN A MEDICAL OFFICE | 282 | ||
| Financial Reports | 282 | ||
| ACCOUNTS RECEIVABLE | 283 | ||
| Receiving Payments on Account | 284 | ||
| Preparing a Bank Deposit | 285 | ||
| Refunding Overpayment of a Patient’s Account | 285 | ||
| Processing Returned Checks | 285 | ||
| PETTY CASH | 285 | ||
| ACCOUNTS PAYABLE | 287 | ||
| Purchase Orders | 287 | ||
| Banking Procedures for Accounts Payable | 287 | ||
| Reconciling the Bank Account | 288 | ||
| BUSINESS RECORD RETENTION | 289 | ||
| SUMMARY | 291 | ||
| REVIEW EXERCISES | 291 | ||
| ACTIVITIES | 292 | ||
| BIBLIOGRAPHY | 294 | ||
| 15 - Human Resource Management | 295 | ||
| PARTICIPATORY MANAGEMENT STYLE | 295 | ||
| THE EMPLOYMENT PROCESS | 297 | ||
| Posting an Open Position | 297 | ||
| The Interview | 298 | ||
| Hiring a New Employee | 298 | ||
| Employee Training and Probationary Period | 299 | ||
| POLICY MANUALS | 299 | ||
| PROCEDURE MANUALS | 300 | ||
| PAYROLL | 300 | ||
| Timekeeping | 300 | ||
| Employee Compensation Record | 301 | ||
| Payroll Deductions | 301 | ||
| Payroll Taxes | 302 | ||
| HUMAN RESOURCE RECORDS | 305 | ||
| Employee Evaluation | 305 | ||
| Essentials of a Performance Review | 306 | ||
| Employee Discipline or Termination | 307 | ||
| Separation of Employment | 307 | ||
| References for Former Employees | 307 | ||
| EMPLOYEE HEALTH | 308 | ||
| Adapting to Change | 308 | ||
| Job Security | 308 | ||
| Resistance to Change | 308 | ||
| New Technology | 309 | ||
| Stress Management | 309 | ||
| LABOR LAWS AND LEGAL ISSUES | 309 | ||
| Labor Law Enforcement | 309 | ||
| Fair Labor Standards Act | 309 | ||
| Family and Medical Leave Act | 309 | ||
| Americans With Disabilities Act | 310 | ||
| Sexual Harassment | 310 | ||
| Workers’ Compensation | 311 | ||
| Information on Employment Matters | 311 | ||
| SUMMARY | 311 | ||
| REVIEW EXERCISES | 311 | ||
| Exercise 15-1 True or False | 311 | ||
| Exercise 15-2 Chapter Concepts | 312 | ||
| Exercise 15-3 Payroll Calculations | 313 | ||
| ACTIVITIES | 313 | ||
| Activity 15-2 Federal Income Tax | 314 | ||
| Activity 15-3 State Income Tax | 314 | ||
| Activity 15-4 Family and Medical Leave Act (FMLA) | 314 | ||
| Activity 15-5 Stress Management | 314 | ||
| Activity 15-6 Sexual Harassment | 314 | ||
| Activity 15-7 Mission Statement | 314 | ||
| BIBLIOGRAPHY | 314 | ||
| 16 - Job Search Essentials | 315 | ||
| PREPARATION FOR EMPLOYMENT | 315 | ||
| APPLYING FOR A POSITION | 315 | ||
| DEVELOPING A WINNING RÉSUMÉ | 316 | ||
| Heading | 317 | ||
| Career Objective | 317 | ||
| Education | 317 | ||
| Work Experience or Work History | 319 | ||
| Achievements, Awards, Interests, or Skills | 319 | ||
| References | 319 | ||
| COVER LETTER | 320 | ||
| FINDING OUT ABOUT JOB OPENINGS | 320 | ||
| Networking | 321 | ||
| Academic Placement Services | 321 | ||
| Professional Employment Services | 321 | ||
| Classified Ads | 321 | ||
| Internet Job Search | 321 | ||
| Professional Organizations | 322 | ||
| Cold Calls | 322 | ||
| Internship Opportunities | 322 | ||
| AN APPLICATION FOR EMPLOYMENT | 322 | ||
| PREPARING FOR A GREAT INTERVIEW | 322 | ||
| The Interview | 323 | ||
| Employee Benefits Packages | 323 | ||
| CHOOSING THE RIGHT POSITION | 325 | ||
| SUMMARY | 325 | ||
| REVIEW EXERCISES | 326 | ||
| ACTIVITIES | 327 | ||
| BIBLIOGRAPHY | 327 | ||
| A- Answers to Think About It Questions | 328 | ||
| CHAPTER 1 | 328 | ||
| CHAPTER 2 | 328 | ||
| CHAPTER 3 | 328 | ||
| CHAPTER 4 | 329 | ||
| CHAPTER 5 | 329 | ||
| CHAPTER 6 | 330 | ||
| CHAPTER 7 | 330 | ||
| CHAPTER 8 | 331 | ||
| CHAPTER 9 | 331 | ||
| CHAPTER 10 | 331 | ||
| CHAPTER 11 | 332 | ||
| CHAPTER 12 | 332 | ||
| CHAPTER 13 | 332 | ||
| CHAPTER 14 | 333 | ||
| CHAPTER 15 | 333 | ||
| CHAPTER 16 | 333 | ||
| B - Competency Assessment Checklist | 335 | ||
| C - Using SimChart | 371 | ||
| ABOUT SIMCHART | 371 | ||
| THREE MODULES OF SIMCHART | 371 | ||
| Info Panel | 371 | ||
| Front Office | 371 | ||
| Clinical Care | 371 | ||
| CODING & BILLING | 372 | ||
| COMMON ICONS | 373 | ||
| MEDICAL OFFICE TASKS | 373 | ||
| Appointments | 373 | ||
| Schedule time off/breaks for a provider | 375 | ||
| Scheduling an appointment for an existing patient | 376 | ||
| Scheduling an appointment for a new patient | 376 | ||
| Locating appointments | 377 | ||
| Rescheduling appointments | 377 | ||
| Patient appointment status | 377 | ||
| Printing appointment schedules | 377 | ||
| Registration | 377 | ||
| DOCUMENTATION | 377 | ||
| Create a Phone Encounter | 377 | ||
| Create a New Office Visit Encounter | 377 | ||
| Document Progress Notes | 377 | ||
| Prepare Patient and Office Communication | 378 | ||
| Prepare Patient and Office Forms | 378 | ||
| BILLING AND INSURANCE | 378 | ||
| Complete a Superbill | 378 | ||
| Submit a Claim | 380 | ||
| Update a Ledger | 380 | ||
| Complete a Day Sheet | 380 | ||
| ENCODER | 381 | ||
| Performing a Search | 381 | ||
| Search Results | 382 | ||
| GLOSSARY | 384 | ||
| INDEX | 390 | ||
| A | 390 | ||
| B | 390 | ||
| C | 391 | ||
| D | 392 | ||
| E | 392 | ||
| F | 393 | ||
| G | 393 | ||
| H | 393 | ||
| I | 394 | ||
| J | 394 | ||
| K | 394 | ||
| L | 394 | ||
| M | 395 | ||
| N | 395 | ||
| O | 396 | ||
| P | 396 | ||
| Q | 397 | ||
| R | 397 | ||
| S | 397 | ||
| T | 398 | ||
| U | 398 | ||
| V | 398 | ||
| W | 398 | ||
| X | 398 | ||
| Y | 398 | ||
| Z | 398 |