Copyright 2016 by Elsevier Inc. All rights reserved.

Lesson 39.1 Objectives Describe how to open the medical office and prepare for the day’s activities. Compare and contrast the tasks necessary to open and close the medical office. Discuss measures to protect the confidentiality of patients in the reception areas. Copyright 2016 by Elsevier Inc. All rights reserved.

Opening the Medical Office
Duties of first person in the office: Disarm the alarm system Turn on the lights Unlock the door through which patients enter Unlock file cabinets, medical records files, and medicine cabinets Turn on all of the office equipment that will be used How are office alarm systems usually armed and disarmed? Why does the office alarm system have to be disarmed as the first task when the medical assistant enters the office? Why does office staff use a different door than the door through which patients enter the office? See Procedure 39-1: Opening the Medical Office. Copyright 2016 by Elsevier Inc. All rights reserved.

Checking for Messages and/or Faxes
Duties to prepare telephone system for the day’s activities: Switch from the night/weekend message to the day message on the voice mail system If office uses an answering service, need to notify service that office is open Why should the medical assistant call the answering service soon after entering the office in the morning? What is the difference between the day message on the telephone system and the message used at night or on weekends? Copyright 2016 by Elsevier Inc. All rights reserved.

Checking for Messages and/or Faxes (Cont.)
Checking for faxes that have arrived overnight Route to the appropriate person Make sure fax machine has adequate amount of paper Retrieve messages from a separate prescription request mailbox Why is the fax machine left on overnight? Are all faxes received by the medical office important? Why do medical offices often have a separate telephone line or voice mailbox for prescription messages? Describe your own experiences with leaving messages for prescription refills. Copyright 2016 by Elsevier Inc. All rights reserved.

Preparing for the Day’s Activities
Review the day’s tasks Note any deviations from normal routine Prepare manual day sheet if it will be used Review electronic task system or tickler file Tickler file is set of 12 folders (one for each month) plus 31 additional folders (one for each day of the month Contains notes, bills to be paid, other items for the day when it must be handled Why is it helpful to review the day’s tasks or activities before patients start arriving? Discuss any experience you have had using an electronic task system. Discuss any experience you have had using a manual tickler file. How does an electronic task system or tickler file help the medical assistant to stay organized? Copyright 2016 by Elsevier Inc. All rights reserved.

Making Sure Patient Charts Are Prepared
Patient charts are usually pulled the evening before the appointment Charts are arranged with an appointment schedule for each physician A charge slip is printed for each person and placed with the record May be printed when charts are pulled May be printed when the patient arrives In what order should patient charts be placed when preparing them for patient appointments? Why is a charge slip printed for each patient? What are the advantages and disadvantages of printing charge slips when the medical records are pulled instead of when patients arrive? If the office has an electronic medical record, when should patient charge slips be printed? Copyright 2016 by Elsevier Inc. All rights reserved.

Making Sure Patient Charts Are Prepared (Cont.)
Appointment schedules are updated as patients are added Appointment schedule printed for each physician and placed throughout the office Charts are usually kept at the front desk until the patient arrives How many copies of the daily appointment schedule should be printed? Where should appointment schedules be placed? Where should the official appointment schedule be kept? How should patient confidentiality be maintained in respect to patient medical records and appointment schedules? Where are the medical records for the day’s patients usually kept? Copyright 2016 by Elsevier Inc. All rights reserved.

Checking the Office and Waiting Room
Waiting room should be checked for: Cleanliness Neatness Correct temperature What should be checked in the office waiting room before patients arrive? Copyright 2016 by Elsevier Inc. All rights reserved.

Checking the Office and Waiting Room (Cont.)
Television, radio, and/or DVD player in waiting room should be turned on Any toys in children’s play area are cleaned regularly Holders for patient information brochures are tidied and restocked Why is music often played in the waiting room of a medical office? Why is it important to clean toys that may be available for children in an office waiting room? How often would you clean them? What kinds of patient information brochures are usually placed in an office waiting room? Copyright 2016 by Elsevier Inc. All rights reserved.

Checking Equipment and Supplies
Office should be checked visually for safety Fill paper trays of copier and printer Check examination rooms and restock as needed Turn on equipment in laboratory as needed and run controls Unload autoclave if it was used the night before When checking the office for safety, what hazards might the medical assistant notice? What supplies might need to be restocked in the reception area before patients arrive? What supplies might need to be restocked in the examination room before patients arrive? Why should the medical assistant run controls in the laboratory before patients arrive? Copyright 2016 by Elsevier Inc. All rights reserved.

Closing the Medical Office
Autoclave may be run and medical records pulled at the end of the day Allows instruments to dry overnight Gives more time in the morning Make backup copy of main computer hard drive as needed What is the advantage of running the autoclave in the evening and unloading it in the morning? What are possible disadvantages to this practice? Who should be responsible for making backups for the office computer system? See Procedure 39-2: Closing the Medical Office. Copyright 2016 by Elsevier Inc. All rights reserved.

Closing the Medical Office (Cont.)
Other duties are reverse of opening the office: Turn off all equipment except fax machine and telephones Change telephone system to night message and/or call answering service Lock the door through which patients enter Lock file cabinets, medical record files, and medication cabinets Make sure kitchen equipment is turned off Turn off lights Alarm system is set as the last person leaves Why is it often recommended to unplug certain machines at night? What are examples of the types of machines that the medical assistant might unplug? Why are medication cabinets, medical record files and file cabinets locked separately? If medical records are stored on open shelves, how can they be secured to protect patient confidentiality? Copyright 2016 by Elsevier Inc. All rights reserved.

Patient Check-In Important to acknowledge each person who enters the office as soon as possible Prevents person from feeling awkward Sign-in sheet should have adhesive peel-off strips to preserve confidentiality Have you experienced entering a medical office when there was no one sitting at the front desk? If so, what did you do, and how did you feel? Have you experienced entering a medical office where there was a sign-in sheet? How did the staff monitor the sheet? How can a sign-in sheet protect patient confidentiality? Copyright 2016 by Elsevier Inc. All rights reserved.

Maintaining Confidentiality
Sliding glass window prevents people in the waiting room from hearing telephone conversations, etc., in the reception area If open desk, medical assistant (MA) avoids conversation with patient when another patient is at the desk Only one patient at the reception desk at a time If information provided is sensitive, patient is taken to private area What has your experience been with the reception desk at medical offices or other health care facilities? Did you feel that your privacy was protected? Should the patient be asked for medical information at the reception desk? Why or why not? What should the medical assistant say if two patients are standing in line at the reception desk? When should the medical assistant take the patient to a private area instead of continuing the check-in process at the reception desk? Copyright 2016 by Elsevier Inc. All rights reserved.

Lesson 39.2 Objectives List information that must be obtained from new patients. Describe the proper procedure to check in a new or established patient. Discuss procedures that are necessary to validate that a patient’s insurance will pay the bill. List information that must be given to a new patient about the practice. Describe different types of informational materials for new and prospective patients. Copyright 2016 by Elsevier Inc. All rights reserved.

New Patients Forms completed and/or signed by a new patient Personal and insurance information (if not already recorded) Consent for treatment/release of information form Form authorizing assignment of benefits Payment will go directly to the office What instructions should the medical assistant give the patient related to the new patient information form? Why do almost all offices require a patient to sign an assignment of benefits form? Why is it common to require patients to sign a form acknowledging that they will be responsible for any charges not paid by insurance? Why must patients sign a form consenting to treatment and allowing the office to release information to the insurance company? See Procedure 39-3: Obtaining New Patient Information. Copyright 2016 by Elsevier Inc. All rights reserved.

Acknowledgement of Receipt of HIPAA Privacy Practices
New patient is given a copy of the notice of office privacy practices New patient signs a form acknowledging receipt of notice of privacy practices If office policy, new patient signs a general form consenting to release of information When you are given a notice of a medical office’s privacy practices do you usually read it? Do you usually take it home? Why or why not? What should the medical assistant do with the forms after a patient has signed them? Copyright 2016 by Elsevier Inc. All rights reserved.

Patient History Form New patient fills out a history form before seeing the physician May be mailed to the patient or given before the first visit Why is it helpful to mail the patient history form for the patient to fill out at home before the first office visit? Even if the office mails the history form, do you think that new patients always remember to bring it to the first office visit? If a patient comes to the reception desk with a question about the patient history form, what should the medical assistant tell the patient? See Figure 39-3 to see a sample of a new patient information form. Copyright 2016 by Elsevier Inc. All rights reserved.

Verifying Insurance and Obtaining Authorizations
Photocopy both sides of the insurance card Some insurance companies require authorizations every time the patient sees the primary care physician Medicaid patients usually have to be verified and/or receive prior authorization for each visit Medicaid is an insurance program established by the federal government Medicaid pays for low-income patients’ medical needs Medicaid patients can be verified by card reader, telephone, or fax Why should the medical assistant photocopy both sides of the patient’s insurance card? When do most medical offices make a copy of each patient’s insurance card? How is authorization obtained for Medicaid patients? Copyright 2016 by Elsevier Inc. All rights reserved.

Verifying Insurance and Obtaining Authorizations (Cont.)
Some insurance companies require authorizations every time the patient sees the primary care physician Other types of insurance may necessitate calling the patient’s insurance company to obtain authorization for treatment Call if there is a question about whether the insurance will cover the visit before patient is seen When does the medical assistant usually have to call the patient’s insurance company to obtain authorization for treatment? Is it usually necessary to obtain authorization for a visit to the patient’s primary care provider? Why or why not? Copyright 2016 by Elsevier Inc. All rights reserved.

Verifying a Managed Care Referral
For physician other than primary care provider, a paper or electronic referral form may be required Referral form will state how many visits are allowed Why is it necessary to be sure that the patient has a completed referral form before the patient visit if the patient’s insurance requires one? Referral forms will be discussed in more detail in later in the book. Copyright 2016 by Elsevier Inc. All rights reserved.

Verifying a Managed Care Referral (Cont.)
Referral form will state problem for which the patient is being referred If a referral, must accept what insurance pays If not covered by insurance or no referral form, patient must be informed of responsibility for bill Do patients usually need referral forms for appointments with their primary care providers? Why or why not? If the patient does not have a referral form, why is the patient usually asked to sign a form promising to be responsible for the bill? Copyright 2016 by Elsevier Inc. All rights reserved.

Established Patients Verify that billing information is correct each time patient visits the office Update information when there are any changes What information is obtained from an established patient? Does an established patient have to complete and sign forms? If so, which forms? Copyright 2016 by Elsevier Inc. All rights reserved.

Accepting Copayments Copayment is a fixed amount of money that the patient is required to pay each time he or she receives medical treatment Amount is usually printed on the patient’s insurance card Copayment may be collected before the visit because it is a fixed fee Patient is given a receipt for copayment and amount is recorded on patient’s charge slip What is a copayment? Why are copayments usually collected at the time of the patient visit? How does the medical assistant know the amount of the copayment? If the patient’s insurance card lists different copayment amounts, how can the medical assistant find out the amount that the patient must pay? Why should a receipt book always keep a copy of any receipt that is given to a patient? Why is the amount paid by the patient marked on the patient charge slip? Copyright 2016 by Elsevier Inc. All rights reserved.

Indicating that the Patient Is in the Waiting Room
After patient has been checked in, medical record is placed in designated space Patient placed in examination room when one is free Forms are inserted in the medical record or scanned into an electronic medical record How does the medical assistant know that a patient has been checked in and is ready to be placed in an examination room? What is done with the forms that the patient has signed if the office uses a paper medical record? An electronic medical record? Copyright 2016 by Elsevier Inc. All rights reserved.

Indicating that the Patient is in the Waiting Room (Cont.)
Charge slip is usually attached to front of medical record or routing slip Physician will complete the charge slip Patient information is checked and/or added in the computer Why must the medical assistant usually enter information from the new patient information form into the computer? Why does the charge slip go with the patient to the examination room? Copyright 2016 by Elsevier Inc. All rights reserved.

Information for New or Prospective Patients
Brief description of the physicians and information about them How long each physician has been in practice Each physician’s credentials Which physicians are accepting new patients Why is it important for the medical assistant to know which physicians are accepting new patients? What information should the medical assistant give to new patients who call to schedule an appointment? See Procedure 39-4: Explaining Office Policies and Procedures. Copyright 2016 by Elsevier Inc. All rights reserved.

Information for New or Prospective Patients (Cont.)
Specialties of each physician in the office Information about languages spoken Location of the main office and satellite offices Directions to office(s) Information about parking Information about access to public transportation, if applicable When might a patient want to know if there are physicians from more then one medical specialty working in the medical office? Do all patients need to know what languages are spoken in the medical office? Why or why not? When should the medical assistant tell a patient about satellite offices? How can the medical assistant find out if a patient needs directions to the medical office? Copyright 2016 by Elsevier Inc. All rights reserved.

Types of insurance that the practice accepts Payment policy How far in advance to make appointments and policy on canceling appointments “Call-in” times or when the physician will return calls What hospitals and/or nursing homes the physician is affiliated with How medication refills are handled What other information should a medical assistant give a new patient who calls for information about the medical practice? Copyright 2016 by Elsevier Inc. All rights reserved.

Some doctors may not be accepting patients They already have as many patients as they can handle They have been out on leave They are planning to retire What are reasons that physicians stop accepting new patients? What can the medical assistant say to inform a prospective patient that at the current time none of the physicians in a practice are accepting new patients? How should the medical assistant respond if a prospective patient asks for one physician, but that physician is not accepting new patients? Copyright 2016 by Elsevier Inc. All rights reserved.

Tell patients how much time to allow for the visit Remind patients to bring all medications to an initial visit Why are patients instructed to bring all medications or a list of all medications to an initial visit? What else should the patient be instructed to bring to the initial office visit? Copyright 2016 by Elsevier Inc. All rights reserved.

Patient Information Booklet Many offices have an information booklet or brochure Important to keep booklet up-to-date Patient information booklets are very successful marketing tools Have you seen patient information booklets for medical practices? What information was included? Why is it important to keep a patient information booklet up-to-date? What problems arise when trying to keep patient information materials up-to-date? How can a patient information booklet be a useful marketing tool? Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

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