1. 7
Patient Reception

2. Learning Outcomes
7.1 List the design items to be considered when setting up an office reception area.
7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.

3. Learning Outcomes (cont.)
7.4 Articulate the cause of most injuries to medical office workers and the four body areas where they occur.
7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
7.6 Implement policies and procedures for opening and closing the office.

4. Introduction Patient reception areas First impression
Sets the stage for successful interactions
The medical office is divided into two broad, functional categories. The “back office” is the clinical area where patient care takes place, and the “front office,” including the reception area, is where business and nonclinical tasks take place.
The facility’s design and furnishings create the office environment, which is key to delivering this care, and the reception area, or point of entry, creates the first impression of the office.
The impression created by the reception area reflects on the quality of care patients can expect to receive.
A carefully designed and well-maintained patient reception area ensures a pleasant and comfortable experience for patients while they wait to receive medical care, and it sets the stage for a successful interaction between the patient and the entire medical staff.

5. Design of the Reception Area
Type of practice
Size and schedule
Number of practitioners
Number of patients per day
Physicians’ schedules
Learning Outcome: 7.1 List the design items to be considered when setting up an office reception area.
The reception is the area where the patient enters the practice, informs the staff of his or her presence by “signing in,” receives a greeting, and waits to be seen.
Avoid using the term waiting room as the term does not have a positive association.
The type of practice is the primary consideration for the design of the reception area.
Size and schedule
Knowing when individual physicians plan to utilize the space is equally important. For example, one surgeon in the practice may have office hours on Mondays, Wednesdays, and Fridays and perform surgeries on Tuesdays and Thursdays. Another surgeon may perform surgeries in the morning and see patients in the afternoon.
These differences in physician scheduling allow better utilization of space and relative ease in planning for the reception size.
Dealing with overlapping office hours and other time and space issues is often part of the medical assistant’s role.

6. Design of the Reception Area (cont.)
Utilization of Space
Type of practice
Avoid overcrowding
HIPAA compliant
Learning Outcome: 7.1 List the design items to be considered when setting up an office reception area.
Utilization of space also differs by type of practice.
An orthopedic office or geriatric office where a significant number of patients will need room for wheelchairs and walkers requires more open space for mobility and devices than does a cardiologist’s office.
Overcrowding in a reception area is undesirable for patient comfort and for the potential of disease transmission.
These areas should be HIPAA-compliant so the patient at the counter cannot overhear staff talking to or about other patients, and cannot view an open computer screen or paper record

7. Design of the Reception Area (cont.)
Décor
Colors
Fabric
Carpet
Learning Outcome: 7.1 List the design items to be considered when setting up an office reception area.
Colors and fabrics are the primary elements that make up a room’s décor
Colors
Decorate in color families to avoid a jarring, unprofessional look. A color family is a group of colors that work well together
Colors fall within two basic areas: cool and warm. Hen choosing the color family, consider the mood you want to create, as studies demonstrate that the use of color affects mood.
You might also want to consider the effect of color when choosing your scrubs or other office attire.
Fabric
Heavy fabrics are more formal,
Lightweight or sheer fabrics create a soft, delicate appearance
Should be easy to clean and maintain
Carpet
Improved noise reduction
Provides a comfortable cushion when people walk through the office
Should be easy to clean and durable enough to handle a large volume of patient traffic

8. Furnishings Chairs Arrangement of furniture Adequate room
Maximum floor space
Wheelchairs
Privacy
Learning Outcome: 7.1 List the design items to be considered when setting up an office reception area.
Chairs should be comfortable but have a straight back to allow the patient to get up easily. Choose chairs and tables with rounded—not sharp—corners to avoid injuries.
To ensure adequate room, allow 12 square feet of space per person.
By this measurement, a 120-square-foot room (10 feet by 12 feet) can accommodate ten people comfortably.
The furniture arrangement should allow maximum floor space
Chairs against the wall
Back to back in the center of the room
Seats should be grouped so that families or friends can sit together.
Reserve room for patients in wheelchairs, and to allow enough space for wheelchairs with extended leg supports.
Place single chairs or small groups of chairs in corners of the room to offer patients some measure of privacy,.

9. Furnishings (cont.) Specialty items Artificial plants Aquariums
Heavy objects
Refreshment centers
Toys
Learning Outcome: 7.1 List the design items to be considered when setting up an office reception area.
Artificial plants and floral arrangements are preferred due to allergies, poisons, and the potential for microbes associated with living plants; plants should be kept dust-free.
Aquariums are popular and soothing but require upkeep; some have virtual aquariums.
Heavy objects like large aquariums should be built into a wall if possible or securely fastened and stabilized to avoid injury. Likewise, large pictures, shelving, and bookcases should be securely fastened to walls
Refreshment centers (coffee, tea) are not wise for pediatric practices due to the danger of hot water, or for practices where many patients are fasting in preparation for procedures. In general, avoid glass objects when possible as they can break and cause injury.
Toys and toy pieces should be easily and frequently disinfected and be larger than would fit into a small child’s mouth. Balls or other throwing toys are dangerous in the medical environment.
Try to select specialty items that will be pleasing or helpful to patients.

10. Other Considerations Lighting – bright but not glaring
Room temperature
Music
Learning Outcomes: 7.1 List the design items to be considered when setting up an office reception area.
Lighting should be adequate for reading and completing forms and provide a pleasant atmosphere; softer lights are preferred in geriatric offices since glare is a problem for this age group. Pediatric offices tend to have brighter lighting.
Room Temperature:
Maintain an average, comfortable temperature. In an uncomfortable setting, waiting time can seem much longer than it really is.
Set the thermostat at a temperature that feels comfortable to you and to the office staff. Periodically survey patients to see if they are comfortable and adjust the setting accordingly. For a geriatric practice or if the office sees a large number of elderly patients, the temperature setting may have to be increased.
Music:
Because the music is meant to calm patients, it should be chosen accordingly. Classical music, light jazz, and soft rock are appropriate choices.

11. Educational/Entertainment Materials
Magazines and books
Current
Varied topics
Appeal to varied age groups
Screen for medical content
Learning Objective: 7.1 List the design items to be considered when setting up an office reception area.
Practice-appropriate educational and entertainment materials are more likely to be read by patients if the materials are placed on tables close to the seating.
Wall and countertop racks are appropriate and conserve space, however, keep some materials on tables for easier access by the elderly and disabled. The publications should be relatively current and reflect the interests and languages of the populations served.
Materials should be neatly arranged, tasteful, and not torn or dirty. Some large-print editions should be available for elderly and other sight-impaired patients.
Screen publications for medical content so that you can alert physicians to articles that might stimulate patient questions

12. Educational/Entertainment Materials (cont.)
Patient information packets
Medical Information – brochures and pamphlets
Patient
Information Packet
Learning Objective: 7.1 List the design items to be considered when setting up an office reception area.
Patient information packet:
A simple flyer to a formal folder with pockets to hold individual sheets of information.
Topics covered in the packet can range from billing and insurance processing policies to biographical information on each physician in a group practice.
Medical information:
Information that pertains to their general health or to specific conditions
Read pamphlets and brochures thoroughly to ensure they provide accurate information; both you and the physicians may want to review them for medical accuracy and to prepare for any questions patients may have.

13. Educational/Entertainment Materials (cont.)
Bulletin board
Change format and content frequently
Tailor items to patient interests
Television and Videos
Regular or satellite news
Entertainment stations
Videos
Informative healthcare videos
Learning Objective: 7.1 List the design items to be considered when setting up an office reception area.
Bulletin board: Include area support group meetings, and offer other current information. Remove items that are out of date
Some Appropriate bulletin board display items
Policies and procedures (no smoking, etc.)
Nutrition information
Requests from American Red Cross or local blood bank for blood donors
Pamphlets or flyers distributed by nonprofit health-care organizations
Flyers on upcoming health fairs; blood pressure or other health screening notices
Community notices for food drives or similar charity events
Information about staff members
Office brochure
Television and Videos
Tune to regular or satellite news or entertainment stations
Play preselected videos
Informative healthcare videos of general interest to their patients or videos that meet the more specific interests of the practice.
Videos are helpful for patients with limited reading ability and can also be helpful if customized for non-English speakers.

14. Accommodating Children
Familiar and comfortable.
Two areas
sick children
Well children
Toys, games, videos, and books
Should encourage quieter play
Should be easy to clean
Learning Objective: 7.1 List the design items to be considered when setting up an office reception area.
It is important to make the setting feel familiar and comfortable.
Include two reception areas—one for well visits and one for children who are potentially contagious—to separate the sick children from those who are well.  
Because children—even sick ones—do not usually like to sit still for long periods, you may want to consider including toys, games, videos, and books Puzzles and blocks are good choices because they encourage quieter play.
All toys should be easy to clean (a bleach-water solution or nonaerosol disinfectant can be used) and, for safety and health reasons, should not include stuffed animals.

15. Apply your Knowledge Nice Job!
The medical assistant is responsible for putting reading material, including medical information such as brochures and pamphlets, in the reception area. How should the medical assistant do this?
ANSWER: The medical assistant should review all materials with medical information for validity before placing the items in the reception area. Magazines should be checked for medical articles so the office staff is aware of the information.
Nice Job!

16. The Importance of Cleanliness
Maintain a high standard of cleanliness
Housekeeping
Professional service
Office staff
Clean daily with emergency cleanups as needed
Learning Objectives: 7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
The reception area will be unappealing if it is not clean. A practice with a spotless, attractive reception area reassures patients that they have chosen a practice with high standards of cleanliness.
You may be responsible for supervising the work of a professional cleaning service.
In a small medical office or, in smaller practices, you may be required to clean the area yourself, using appropriate antibacterial agents and a vacuum.
Cleaning should occur daily, with emergency cleanups as needed.
Professional services generally clean in the evening after business hours so you may be asked to provide feedback to the cleaning company.
It may also be your responsibility to outline the tasks you expect workers to complete, including any special requests.

17. Housekeeping Tasks Equipment Check throughout the day
Spot-clean and straighten items
Equipment
Vacuums, mops, brooms
Trash bags, cleaning solutions, rags, buckets
Gloves
Learning Objective: 7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
See the Caution: Handle with Care section for information about maintaining a clean reception area.
Even if the office employs a professional cleaning service, the reception area should be checked for cleanliness throughout the day.
Taking time between patient appointments or at midday to spot-clean small areas that no longer appear “spotless” and to neaten items helps to keep the patient reception area pleasing to the eye.
It is a good idea to have some basic cleaning materials on hand in case an emergency cleanup job is needed during office hours.
Always wear gloves when doing cleaning of any kind and use OSHA guidelines for safety.
Be sure to also obtain the MSDS for any cleaning materials stored in the office and insert the sheets in the office MSDS binder.

18. Importance of Cleanliness (cont.)
Cleaning stains – spot-clean spills
Removing odors
Good ventilation system
Disinfectant or deodorizing sprays
Learning Objective: 7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
Stain removal
Try to remove stain as soon as possible.
Blot as much of the stain as possible before rubbing it with a cleaning solution.
Take special precautions in handling stains involving blood, feces, or urine. Put on latex gloves before blotting or scraping up the stain.
Wipe the area with a cleaning solution and water.
Blood, urine, and feces may require special cleaners with an enzyme that breaks down organic waste.
Use cold water instead of hot water; hot water often sets stains into fabric.
Keep all cleaning materials within easy reach for quick action when a stain occurs.
Removing odors
A good ventilating system with charcoal filters
Disinfectant sprays and deodorizing sprays ; use sparingly as more and more people are developing allergies to many of the scents used to mask odors
Display “Thank You for Not Smoking” signs prominently in the patient reception area.
People with asthma or other breathing disorders, or who are feeling unwell for any reason, are particularly sensitive to smoke and strong odors.

19. Infectious Waste Human waste and tissue Body fluids
Waste such as needles, scalpels, dressings
Proper cleaning and disposal are required
Learning Objectives: 7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
Infectious waste (biohazardous waste): Waste that can be dangerous to those who handle it or to the environment.
Infectious waste is not commonly generated in the patient reception area. If a situation occurs, you must clean up the waste promptly.
Infectious waste must be handled in accordance with federal law and following OSHA guidelines – commercially prepared hazardous waste kits are available for use in cleaning up spills
Deposit waste in a biohazard container.
Disinfect the site
Refer to the chapter on Basic Safety and Infection Control to review OSHA guidelines and Standard Precautions..

20. Apply Your Knowledge SUPER!
A patient is coming to see the physician because of bleeding at the surgical site (right upper thigh). While the patient is waiting in the reception area, the blood gets into the chair cushion of the patient’s seat. What should the medical assistant do in this situation?
ANSWER: Put on gloves and remove the chair from the reception area immediately. Special cleaning procedures based on OSHA guidelines must be followed when handling blood and body fluids.
Learning Objective: 7.2 Describe the housekeeping tasks required to keep the reception area neat and clean.
SUPER!

21. Office Access for All Parking arrangements Entrances
On-street vs. off-street
Free parking lots improve access
Entrances
Clearly marked
Wide enough for wheelchairs and walkers
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Office access: The path patients must take to get from the parking area or street to the office and then back out again.
Parking:
A free parking lot or parking garage improves office access. Parking lots and garages should be well lit for safety.
Determine the number of parking spaces the office needs; allow one parking spot per appointment and include parking spaces for office staff. Periodically reevaluate the office’s parking needs because they may change over time.
All offices must also provide handicapped parking spaces for patients.
Entrances:
The entrance to the office should be clearly marked so that patients can find the office easily. A foyer or double-door arrangement helps minimize the weather’s effects by keeping the office at a consistent, comfortable temperature.
All doorways must be wide enough to accommodate patients using wheelchairs and walkers.
Hallways should be well lit and without obstructions.

22. Safety and Security
Building exits – Clearly labeled “Exit” signs
Smoke detectors – must sound an alarm by law
Security systems – valuable protection for medical records
Learning Objective: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Exits:
Be familiar with all building exits. It may be necessary to leave the office quickly, as during a fire, flood, or other emergency
Post evacuation plans near each exit
The office should have at least two doorways that lead directly to the outside or to a hallway that leads to stairs
All exits must be clearly labeled with illuminated red “Exit” signs
Smoke detectors :
By law smoke detectors must sound an alarm when triggered by heat or smoke.
Know what to do if the smoke alarm sounds
Check regularly to ensure that they are operating properly.
Security systems:
A security alarm system offers valuable protection for the confidential patient information
Know how to arm and disarm it easily and know what to do if it is accidentally activated.
Each staff member should have her or his own individually assigned security access code which should never be shared.

23. Considerations for Patients with Special Needs
Special needs patients
Require reasonable accommodations
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Some patients who come into the medical office will be disabled or have special needs.
Special needs patients – born with or acquire a condition that limits or changes abilities.
They can perform the same tasks that other people can with special accommodations.
Some requirements include:
Wider halls and doorways for wheelchair
Ramps instead of steps
Provide additional space in the reception area for wheelchairs, walkers, crutches, and guide dogs.
See Procedure 7-2: Creating a Reception Area Accessible to Patients with Special Needs

24. Americans with Disabilities Act – 1990
Federal civil rights act
Forbids discrimination on the basis of physical or mental handicap
Provides equal access and reasonable accommodation in several important areas, including employment, facilities, sports, and education.
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
ADA
Forbids discrimination based on physical or mental handicaps.
Provide equal access and reasonable accommodation in several important areas, including employment, facilities, sports, and education.
Required and reasonable facility accommodations:
Handicapped parking
Wheelchair ramps
Wheelchair-accessible doors, halls, and bathrooms
Handrails in halls and bathrooms
Handicapped bathrooms including toilets, sinks, and room for a wheelchair to turn
Braille elevator floor indicators
Large-print patient forms
Devices to communicate with the hearing impaired, as discussed the Telephone Techniques chapter

25. Americans with Disabilities Act (cont.)
Service animals
Certified
Do not distract while “on duty.”
Vision and hearing impairments
Offer to assist as needed
Provide an interpreter
TDD
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Service animals
The dog is the most common service animal.
Service animals wear a special vest that identifies them should have a certification.
Do not distract while “on duty.”
Vision and Hearing Impairments:
Offer to assist patients with hearing or vision impairments as needed from the reception area to the examination room
Hearing impaired may request the presence of a certified sign language interpreter to assist in communicating with the medical staff. Federal law requires that the office provides and pays for this interpreter.
The office may provide a telecommunications device for the deaf (TDD), for hearing-impaired patients. This specially designed telephone, formerly called a TTY (teletypewriter), looks very much like a laptop computer with a cradle for the receiver of a traditional telephone. Some states offer a relay service for patients with hearing impairments or speech disabilities. Be careful not mistake the call as an unwanted marketing call.

26. Older Americans Act of 1965
Eliminate discrimination against the elderly
Guarantees elderly citizens the best possible healthcare
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
The fasting growing segment of the American population is the elderly. Many elderly people face discrimination due to not only age but medical conditions and disorders that create physical limitations.
Older Americans Act of 1965
make sure that the print on all office signs is large and easy to read.
The office staff must be sensitive to the special needs of the elderly
The reception area
should be comfortable for patients with arthritis, failing eyesight, and other common ailments of the elderly
Have large-print books and magazines available within easy reach of the chairs
Office signs should be large and easy to read
Reception area and restrooms should be well lit

27. Special Situations Patients from diverse cultural backgrounds
Provide reading material in languages of cultures served
Decorate the office for culturally diverse holidays
Post signs that are in languages of cultures served
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Make the reception area reflect aspects of the local cultural backgrounds whenever possible.
Post signs in English and the language of the culture served to acknowledge the fact that both languages are spoken in that neighborhood
Provide reading materials, like newspapers and magazines, in a second language.

28. Special Situations (cont.)
Patients who are highly contagious
Protect other patients
Separate from other patients in reception area
Learning Outcome: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Contagious: Having a disease or condition that can be easily transmitted to others.
Patients may have to come into the physician's office when they are highly contagious. This fact is a concern for all patients, but it is especially critical for patients who are immunocompromised who are at greater risk than the average person for becoming sick.
You may need to separate a highly contagious patient from the other patients in the reception area. One way is to bring them directly into an examination room to wait.
The goal is to minimize the chances of exposing other people unnecessarily to potentially contagious conditions

29. Apply Your Knowledge Good Answer!
It is not adequate simply to have smoke detectors in a medical office. What responsibility does the office staff have related to smoke detectors?
ANSWER: Office staff must routinely check the smoke detectors to be sure they are functioning properly and must know what to do in the event the smoke detector alarm sounds, i.e., how to evacuate patients safely from the building.
Learning Objective: 7.3 Describe the Americans with Disabilities and Older American Acts and how these acts have helped to make physical access to the medical office easier for all patients.
Good Answer!

30. Preventing Injury in the Front Office
Physical tasks
Repetitive movement injuries
Learning Objective: 7.4 List four body areas that medical office workers commonly injure and the cause of most of these injuries, including carpal tunnel syndrome.
The medical office environment’s many work functions require many physical tasks.
The associated movements are often performed using repetitive motions, like typing, lifting, bending, stooping, and sitting. One of the most common office-related injuries are those occurring to office workers, including medical assistants, who spend much of their work day seated at a computer station.
Common injuries or conditions involve the forearm, wrist, hand, and back.
See Table 7-1 OSHA Computer Workstations Checklist for ergonomic excerpts from an OSHA computer station checklist to use in prevention of these common injuries.

31. Apply Your Knowledge Good Answer!
As a medical assistant working in the front office, you are responsible for making appointments and data entry into the EHR. You begin to experience tingling and numbness in your hands. What might this be and what is it caused by?
ANSWER: It is probably carpal tunnel syndrome and it is a repetitive motion injury probably from using the keyboard for long periods at a time.
Learning Outcome: 7.4 List four body areas that medical office workers commonly injure and the cause of most of these injuries, including carpal tunnel syndrome.
Good Answer!

32. Functions of the Reception Staff
Greet
Register
Direct
Answer phone
First impression of office staff
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
The receptionist’s main function is to greet people, register them, give them direction, and answer the phone.
The receptionist gives the first impression of the office staff and sets the perception of the care the patient will receive from the medical staff.
The receptionist should immediately acknowledge and greet the arriving patient with a smile and pleasant voice.
If the receptionist is on the phone, looking up at the patient with a smile and head nod is appropriate to acknowledge the patient and let them know she will be with them shortly.

33. Patient Registration and HIPAA
Patient registration –may not include reason for visit
Forms
New vs. established patient
Scan or copy insurance card and picture identifier
Notify clinical side
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
Two commonly used forms of check-in or sign-in (patient registration) are the paper version and the digital or electronic version. Both may include the arrival time, appointment time, and the practitioner’s name. Sign-in sheets are allowable, as long as the reason for the visit is not included on the sign-in sheet.
The receptionist provide the patient with appropriate forms. Returning patients may receive a copy of their information to update.
New patients receive a complete new patient registration packet that includes:
Demographic/insurance coverage form
Authorizations for release of information to insurance carriers, assignment of benefits, and financial responsibility
Notice of privacy practices
Health history
Information regarding the payment and other policies of the practice.
Scanning the patient’s or insured party’s insurance card and a picture identifier is one method to help reduce healthcare fraud.
Once the patient has completed the appropriate paperwork, the medical assistant initiates a medical record or electronic health record.

34. Patient Registration and HIPAA (cont.)
Payment
Co-payment
No third-party checks
Follow-up and referral appointments
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
Collecting the patient’s insurance copayment may also be the receptionist’s responsibility. .
This may be done prior to the visit or upon completion of the appointment.
The amount of the copayment, if applicable, is usually shown on the patient’s insurance card.
Follow-up and referral appointments are often also scheduled at the front desk.
Once all patient transactions are completed, the receptionist should extend a pleasant farewell to all patients.
Financial transactions will be covered in the chapter, Financial Management.

35. Observation and Updates
Observe waiting patients
Address spills, trash, and any potential hazards
Traffic control
Keep patients updated about wait time
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
Another function of the front desk staff is to be observant. Patients should not sit in the main reception area. These include patients who are:
Having chest pain (adults);
Experiencing shortness of breath;
Bleeding;
Feeling faint (syncope), dizzy, light-headed;
Vomiting; or
Experiencing an undiagnosed or contagious rash.
If a patient complains of any of these symptoms, or if you notice a change in a patient’s status, immediately notify a member of the clinical staff .
Address spills, trash, and any potential hazards—like frayed cords, broken furniture, or tears in rugs—as quickly as possible.
The receptionist may have to ensure seating is available if the reception area becomes overcrowded,
Keep patients updated if appointments are running late. If the wait time is significant, giving patients the option of rescheduling their appointments shows respect for the patient’s time.

36. The Red Flags Rule Medical identity theft
Programs to detect the warning signs, or red flags, of identity theft
Compliance if they fall into one or both categories
Creditors
Covered account
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
Medical identity theft is using another person’s name or insurance to seek healthcare and results in millions of dollars in uncompensated care, and it creates the potential risk of a person receiving incorrect treatment if treatment is based on another person’s medical record.
The Red Flags Rule was enacted by the Federal Trade Commission in 2009.
It requires certain businesses, including most medical offices and other healthcare facilities, to develop written programs to detect the warning signs, or red flags, of identity theft.
The law applies to and defines two categories that determine if a business must comply.
1. Creditors—entities that regularly defer payment for goods or services or arrange the extension of credit. An example of extending credit is billing patients after the service is rendered, including fees that are billed after insurance payments are received.
2. Covered account—a consumer (patient) account that allows multiple payments or transactions. Most patient records fall in this category.

37. The Red Flags Rule (cont.)
Suspicious documents
Suspicious personal identifying information
Suspicious activities
Notification of identity theft
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
The red flags include:
Suspicious documents:
Those with an altered or forged appearance
Photo or description is inconsistent with the patient’s appearance
Inconsistent information provided, such as date of birth, chronic medical condition
Suspicious personal identifying information from other sources like a Social Security number different from what you have on file.
Suspicious activities such as mail being returned repeatedly but the patient continuing to keep appointments and maintain that address on file (this emphasizes the importance of verifying patient information at every visit), and inconsistency with physical exam and past medical treatment.
Notifications of identity theft from patients or staff.

38. Identity Theft Prevention Program
Prevention—implementing sound electronic and other security systems
Detection—staff training and electronic “red flagging”
Mitigation—ensuring medical records are not co-mingled
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
In many instances, HIPAA and medical identity theft go hand in hand.
A three-pronged approach for the medical office’s prevention program is recommended:
Prevention—implementing sound electronic and other security systems maintaining HIPAA compliance
Detection—staff training on what to look for and electronic “red flagging” such as automatic on-screen identification of a difference in date of birth
Mitigation—ensuring medical records of the perpetrator and the authentic patient are not co-mingled.
The medical assistant should know what to look for in suspicious behaviors and how to both report such behaviors as well as how to find out if suspicious behavior by the patient has been previously reported.

39. Apply Your Knowledge
Why is it important to verify a patient’s identification using a photo id?
ANSWER: To prevent medical identify theft.
Learning Objective: 7.5 Explain the Red Flags Rule, giving the four red flags that the reception staff should be alert to.
Good Answer!

40. Opening and Closing the Office
Beginning the day
Arrive early
Ensure safety
Check that specimens were picked up
Check answering service or voice mail
Turn on fax
Make coffee
Learning Objective: 7.6 Explain the rationale for creating and maintaining policies and procedures for opening and closing the office.
Opening and closing the facility is generally the responsibility of the staff member in the reception area. Following a set routine and using specially designed check sheets ensures no process is overlooked.
The person opening the office arrives approximately 30 minutes prior to the scheduled time for office operations to begin.
Safety is a consideration. Be aware of the activity outside the office door such as persons in the parking area, elevators, or hallways.
Ensure the specimens were picked up from the previous day.
Do not completely turn your back while unlocking the door. Once inside, deactivate the security system.
The first priority is accessing the answering service or answering machine to determine if: any staff member may have called in with an emergency; patients have canceled appointments; patients need a same-day appointment; or hospitals reported patients seen during the night. Notify the correct staff member.
The fax machine is usually the next priority: turning it on if it is not kept on at night; reviewing newly arrived faxes; distributing these faxes to the appropriate personnel; and ensuring the paper trays are full.
Table 7-2 Daily Checklist for Opening the Office.

41. Opening and Closing the Office (cont.)
Ending the day
Turn off equipment
Secure all patient information
Check supplies in exam rooms
Ensure reception area is neat
Learning Objective: 7.6 Explain the rationale for creating and maintaining policies and procedures for opening and closing the office.
Table 7-3 Daily Checklist for Closing the Office.
Ending the day efficiently is just as important as beginning the day efficiently.
The person closing the office that has extended or split hours may not be the same person who opened the office.
Tasks:
Turn off equipment
Ensure that confidential information is not in view for any cleaning or security personnel that may enter the office after hours
Check exam rooms to be sure supplies are well stocked for the next day and give the reception room one last “look” to be sure it is neat and presentable for the morning patients.

42. Opening and Closing the Office (cont.)
Ending the day
Notify answering service
Be sure specimens are in container for pick-up
Be alert when leaving office
Learning Objective: 7.6 Explain the rationale for creating and maintaining policies and procedures for opening and closing the office.
Table 7-3 Daily Checklist for Closing the Office.
Tasks:
Notify the answering service that the office is closing or turn on the answering machine
Ensure laboratory specimens are placed in the proper container for pick-up. Activate the security system
Be alert when exiting the building for any unusual or suspicious activity.
Following consistent policies and procedures guarantees that important tasks are not forgotten, and in this case, ensures that the office, its equipment, medications, and its private information remains safe and secure at all times.

43. Apply Your Knowledge
What safety precautions should you take if you are responsible for opening and closing a medical office?
ANSWER: Be alert for unusual activity when entering or exiting the building. Do not completely turn your back when locking or unlocking the door. If you feel uncomfortable, notify security or have another staff member open and close with you.
Gold Star Answer!
Learning Objective: 7.6 Explain the rationale for creating and maintaining policies and procedures for opening and closing the office.

44. In Summary
7.1 The size of the space and the schedule of the physicians must be considered first. The décor should suit the practice type. Furnishings should be comfortable and easy to clean. Lighting should be appropriately bright. Accessories should complement the décor, but not make the room feel cluttered. Current magazines and other reading materials of multiple topics should be available to entertain and inform the patient. TV and/or informational DVDs may also be played.
7.1 The size of the space you have to work with and the schedule of the physicians seeing patients must be considered first. Utilize the space to give as much room and privacy as possible.
The décor should include a color family to suit the practice type. Furnishings should be comfortable, but easy to get in and out of, and easy to clean.
Lighting should be appropriately bright to avoid accidental falls.
Accessories like wall hangings, aquariums, coat racks, and magazine racks should complement the décor, but not make the room feel cluttered.
Current magazines and other reading materials of multiple topics should be available to entertain and inform the patient.
TV and/or informational DVDs may also be played. If the practice sees children, special accommodations to entertain them must also be made

45. In Summary (cont.)
7.2 Housekeeping tasks for the reception area include:
overseeing the professional cleaning staff
keeping everything in its place;
disposing of trash;
preventing visible dust and dirt on surfaces;
spot cleaning areas that become soiled;
disinfecting areas exposed to body fluids;
handling items with care.
Follow OSHA guidelines and post standards
7.2 Housekeeping tasks for the reception area include:
Overseeing the professional cleaning staff (if one is employed);
Keeping everything in its place
Disposing of trash
Preventing visible dust and dirt on surfaces; spot cleaning areas that become soiled
Disinfecting areas exposed to body fluids; and handling items with care
OSHA guidelines should be followed in all aspects of keeping the office neat and clean.
Standards of office cleanliness should be created and posted for all staff to see.

46. In Summary (cont.)
7.3 The American with Disabilities Act, and the Older Americans Act, both prevent discrimination based solely on a person’s physical or mental disability or age. Both of these acts mandate accessibility.
7.3 The American with Disabilities Act, and the Older Americans Act, both prevent discrimination based solely on a person’s physical or mental disability or his/her age.
Both of these acts mandate accessibility for the differently-abled, including, but not limited to, adequate parking for vehicles with and carrying assistive devices such as wheelchairs, ramps instead of stairs, wider doorways and hallways, well lit areas throughout the office, large print instructions, and Braille markings for elevators and other instructions.

47. In Summary (cont.)
7.4 Most office-related injuries are those associated with repetitive motions, like typing, lifting, bending, stooping, and sitting. Common injuries or conditions involve the forearm, wrist, hand, and back.

48. In Summary (cont.)
7.5 The Red Flags Rule was enacted to detect medical identity theft.
The four red flags that all medical staff, particularly reception staff, should be alert to are
suspicious documents,
suspicious personal identifying information,
suspicious activity
notification of identity theft by patients or staff.
7.5 The Red Flags Rule was enacted to detect medical identity theft.
The four red flags that all medical staff, particularly reception staff, should be alert to are
Suspicious documents
Suspicious personal identifying information
Suspicious activity like mail being returned although the patient insists the mail address is correct
Notification of identity theft by patients or staff

49. In Summary (cont.)
7.6 Maintaining specific policies and procedures for opening and closing the office ensures the necessary tasks are completed daily in a uniform manner. This results in an efficient and prepared medical office each day.

50. End of Chapter 7
Creativity and courage help us know how to reach out and help those with particularly unique needs.
~ Mary H. Allen
(From A Daybook for Nurses: Making a Difference Each Day)