When the medical assistant opens the office, what should he or she do first?

INTRODUCTION TO PATIENT RECEPTION

The medical assistant may be responsible for opening the office, preparing for patients, and processing patients as they arrive for appointments. It is important to be sure that all parts of the office are prepared for patients because there is little time to pick up or arrange facilities once patient appointments begin. There are several forms that new patients must fill out, and the patient signature must be kept on file as permission to provide treatment, bill insur­ance, and verify that the patient has been given an oppor­tunity to read the office’s Notice of Privacy Practices. At the end of the day, the medical assistant must prepare for the next day and close the medical office.

PREPARING FOR PATIENTS

Opening the Medical Office

Office staff need to arrive at the medical office early enough to make sure the office is prepared for the patients. The medical assistant is often responsible for opening the office (Procedure 37-1). Several activities must be performed immediately:

        Disarming the alarm system (if the office has one)

        Turning on the lights

        Unlocking the door through which patients enter

        Unlocking file cabinets, medical record files, and medica­tion cabinets

        Turning on all of the office equipment that will be used during the day, such as computers and copy machines Depending on the way the medical office is organized,

there may be several other tasks that should be completed before the first patient arrives.

Checking for Messages and/or Faxes

Someone must review messages and prepare the telephone system for the day’s activities. The telephone message must be switched from the night and weekend message to the telephone system used during the day. Usually the night and weekend message states that the office is closed, gives an emergency telephone number, or directs the caller to leave a message if the matter is not urgent. During the day, the medical assistant may answer the telephone directly or the caller may have to select an option from a menu before being connected to a member of the office staff.

If the medical office uses an answering service, the medical assistant must call the service to indicate that the office is open. The medical assistant must also obtain any messages that have come in within the past hour or nonur­gent messages left during the night. For calls relating to illness, the answering service would have contacted the phy­sician on call overnight.

After checking the message mailbox or answering machine, the medical assistant usually checks for faxes that have arrived overnight and routes the messages and faxes to the appropriate person.

A separate mailbox or answering machine may be used for prescription refill requests. If this is the case, the medical assistant should retrieve the messages from this mailbox before the physician arrives.

Preparing for the Day’s Activities

It is helpful to take a minute at the beginning of the day to organize the day’s tasks. This includes reviewing the appoint­ment schedule and noting deviations from the routine schedule, such as physicians who are out of the office for all or part of the day. If the medical office uses a manual day sheet, it must be dated and prepared for use. (This is dis­cussed in detail in Lecture 44.) Reminders about the day’s activities may be stored using an electronic task system and/ or a physical tickler file. A tickler file is a set of 43 file folders, one for each month (for a total of 12 folders) and an additional set of 31 folders for the days of the current month. Written notes, bills to be paid, receipts, or other items are filed in these folders to “tickle” the memory at the time when they must be handled. (Tickler files are also discussed in Lecture 41.)

The medical assistant usually counts the cash in the cash drawer, a fixed amount of money used to make change when patients pay in cash. The cash drawer (change fund) is usually kept locked except when the medical assistant is actually sitting at the reception desk.

Making Sure Patient Charts Are Prepared

Patient charts are usually pulled the evening before the next appointment day or are prepared in the morning before the patients arrive. Even if the office uses an electronic medical record, some providers will want to be able to consult a patient’s old paper medical record. The charts must be arranged for each physician in order of the arrival of the patient. A separate appointment schedule is usually pre­pared for each physician. A charge slip may be created for each person before the visit, or the entire billing and charg­ing system may be electronic. Some offices also print other sheets, for example, a list of medications for the patient to review and update.

Copies of the appointment schedule(s) are printed and placed at designated locations. The medical assistant usually places a schedule in each physician’s office, at the reception desk, and at the medical assistant’s desk. The schedule may be printed the evening before in case of a power outage or server problem, but it is usually updated with new appoint­ments in the early morning so a new schedule should be printed just before patients start arriving.

Charts or other forms for the day are usually kept at the front desk. Some physicians prefer to have all medical records for their scheduled patients on their private desk when they start to see patients.

Checking the Office and Waiting Room

The waiting room, reception area, and examination and treatment rooms all need to be checked for the following: cleanliness, neatness, correct temperature, and appropriate reading material. The medical assistant should make sure that the cleaning service has cleaned all parts of the office and emptied the trash. The medical assistant may need to turn on a television, radio, and/or DVD player in the patient waiting room. Magazines should be stored neatly and replaced with current issues as needed. If there are toys in the waiting room, they should be cleaned regularly and stored neatly. Holders in the waiting room that contain information brochures for patients should be restocked and arranged neatly (Figure 37-1).

Checking Equipment and Supplies

The medical assistant should perform a visual safety check of the medical office daily. This includes removing any hazards that might block hallways or exits and making sure that all equipment is performing correctly. It is helpful to fill the paper trays of the copier, printer, and fax machine every morning.

The reception area and examination rooms should be tidied and restocked daily, either in the morning or at closing and sometimes again at a specified time during the day. Biohazard waste containers should be checked, and waste discarded properly if necessary. The medical assistant

Figure 37-1 The waiting area should be kept tidy for patients.

may need to turn on or set up equipment used for clinical procedures, run controls in the laboratory, and/or remove items from a battery charger. It may also be necessary to unload the autoclave and put away items that were sterilized the evening before.

Closing the Medical Office

At the end of the day, the activities of the morning are reversed. Many medical offices run the autoclave in the afternoon so that items can dry overnight. Medical records for the following day may be created for new patients and removed from the files for established patients. This is often done in the afternoon because it leaves more time in the morning. Before leaving the office, the medical assistant must perform the following tasks (Procedure 37-2):

        Prepare the bank deposit and balance the cash drawer. At the end of the day, the money in the cash drawer must be balanced against cash receipts. Any amount above the usual change fund is added to the bank deposit (see Lecture 44).

        Make a backup copy of the main computer hard drive if the office does not subscribe to an online computer backup service.

        Check the fax machine for faxes that have come in during the day.

        Turn off computers, printers, copiers, and other equip­ment (with the exception of the fax machine).

        Change the telephone to the night message or call the answering service to tell them the office is closing.

        Lock the door through which patients enter.

        Lock file cabinets, medical record files, and medication cabinets.

        Make sure the coffee machine or other kitchen equip­ment is turned off.

        Unplug equipment, such as a toaster, that might be a fire hazard.

        Turn off the lights.

        The last person to leave the medical office makes sure the door is locked and sets the alarm system.

PROCEDURE 37-1 Opening the Medical Office

Outcome Open the medical office.

Equipment/Supplies

• Medical office

        Procedural Step. Enter the office and disarm any alarm system immediately.

    Procedural Step. Turn on the lights.

        Procedural Step. Adjust heat or air conditioning to a comfortable setting.

        Procedural Step. Unlock the door through which patients and visitors will enter the office.

Principle. Medical office staff usually enter the office through a different door than patients and visitors.

           Procedural Step. Turn on machines that will be used all day, including computers, printers, and copier.

           Procedural Step. Set the telephone system to the day setting and get messages from the electronic mailbox, telephone answering machine, or answering service.

Continued

Principle. Callers to a business expect calls to be picked up as soon as the business opens. An important telephone message may need attention.

         Procedural Step. Listen to any messages in order, writing down the pertinent information for each message on a message pad. (See Lecture 39, Proce­dure 39-2, Taking a Telephone Message.) Fill in the information, including the name of the caller, busi­ness affiliation (if any), date, time of the call, tele­phone number including area code, and information the caller wishes to leave about the reason for the call. Place your initials on the message in case there are questions.

Principle. Complete information is necessary to return a call.

          Procedural Step. Arrange the messages in order of importance. Deal with any urgent calls at once, then work through other calls. Pull medical records for calls from patients and place the messages in the appropri­ate locations for various office staff to review.

          Procedural Step. Review the day’s activities and note any special tasks that must be completed that day.

10. Procedural Step. Count the money in the cash drawer and record the amount.

             Procedural Step. Check the office for safety hazards including frayed wires, items blocking corridors or walkways, and other hazards.

             Procedural Step. Straighten up the waiting room, including reading material; clean children’s toys as needed; turn on radio, television, and/or DVD player; and restock patient information brochures.

             Procedural Step. Print appointment lists as needed and make sure all patient medical records have been pulled and arranged in order. Print or stamp today’s date on the progress notes and place the medical records in the designated location. If an electronic medical record system is used, be sure any necessary paperwork has been printed.

             Procedural Step. If it is office policy, prepare charge slips and clip to each patient’s medical record or paperwork.

             Procedural Step. Check biohazard waste containers and discard properly.

             Procedural Step. Check examination rooms to be sure they are clean and contain all needed supplies and equipment.

             Procedural Step. Run the autoclave as needed, or empty the autoclave if it was run the evening before.

PROCEDURE 37-2 Closing the Medical Office

Outcome Close the medical office.

Equipment/Supplies

• Medical office

            Procedural Step. Make sure examination rooms are clean and contain all necessary supplies.

            Procedural Step. Run the autoclave if needed. Principle. If the autoclave is run at the end of the day, supplies can dry overnight.

            Procedural Step. Print a patient schedule for the next day, and pull paper medical records. Print charge slips and clip to each patient’s medical record if it is office policy.

            Procedural Step. Make sure all cabinets or rooms containing medical records are locked.

            Procedural Step. Balance the cash drawer and prepare the bank deposit. Lock the cash drawer or place the change fund in the office safe. If possible, make the bank deposit at the end of the day.

Principle. It is best to leave as little money in the office as possible. The change fund should be kept under lock and key.

            Procedural Step. Make sure the night system for the telephones is activated. Switch the message on the

electronic telephone system or answering machine, and call the answering service as needed.

            Procedural Step. Turn off all machines throughout the medical office that are used only during the day. Exceptions include the fax machine and telephone system. Unplug machines such as the coffee maker or toaster oven that might pose a fire hazard.

Principle. Machines that generate heat such as coffee makers can pose a fire hazard. Unplugging these machines is also an extra reminder to make sure they do not remain on overnight.

            Procedural Step. Lock the door through which patients and visitors enter the medical office.

            Procedural Step. Turn the heat or air conditioning to the night setting.

       Procedural Step. Turn off the lights.

             Procedural Step. Arm the security system and make sure the door is securely locked as you leave the medical office.

Figure 37-2 If an open desk is used for reception, the waiting room should be large enough to prevent other patients from overhearing the conversation at the desk.

PATIENT CHECK-IN

It is important to acknowledge each person who enters the office as soon as possible to prevent that person from feeling awkward. The medical assistant or a receptionist usually sits at the reception desk. This person should greet everyone who enters the office. If a sign-in sheet is used, it is recom­mended that this sign-in sheet have adhesive peel-off strips for each line so that the medical assistant can remove the patient’s name immediately after check-in.

Maintaining Confidentiality

Many offices have a sliding glass window. This prevents people in the waiting room from hearing telephone conversations or other discussions in the reception area. In some facilities, the medical assistant sits behind a reception desk that is recessed but open (Figure 37-2). Because patients standing near the desk can hear any conversation behind the desk, these offices usually have a separate room for scheduling appointments. When a patient is at the desk, the medical assistant should not carry on a telephone conversation with another patient. Only one patient should be at the desk or window at a time. The medical assistant can instruct other patients and/or family members to have a seat in the waiting room.

If it is necessary to discuss sensitive or personal informa­tion, the patient should be taken to a private area.

New Patients

The office must obtain several types of information about new patients. Personal and insurance information is either obtained when the appointment is made or at the first visit.

The patient is usually asked to sign a statement that allows the office to release information to the insurance company for billing purposes. This consent may be part of the patient information form or may be a separate sheet. If the office accepts payments directly from the insurance company (called accepting assignment of benefits), the patient must also sign a form authorizing this. The assign­ment of benefits statement is usually included with the consent to release information to insurance companies. Figure 37-3 shows an example of a new patient information form. By signing the bottom section, the patient authorizes the physician or medical practice to release information to the insurance company and authorizes the insurance company to pay the medical practice directly. In addition, the patient has agreed to be responsible for charges not covered by insurance. The medical office may also use a more extensive form authorizing the release of protected health information. This form is optional, but it does allow the office to obtain consent to leave voicemail messages at the patient’s home and mail laboratory reports or appoint­ment reminders (Figure 37-4).

Acknowledgement of Receipt of HIPAA Privacy Practices

The Health Insurance Portability and Accountability Act (HIPAA) requires that patients sign a form acknowledging

Figure 37-3 New patient information form.

Patient Consent for Use and Disclosure of Protected Health Information

Figure 37-4 The office may use an optional consent for disclosure of personal health information.

that they were given the opportunity to read or were given a copy of the office Notice of Privacy Practices (Figure 37-5). The Notice of Privacy Practices itself is usually very detailed.

Patient History Form

Most offices also have a history form for the patient to fill out before being seen by the physician (see Chapter 36). It may be mailed to the new patient before the first appoint­ment, or the patient may fill it out in the waiting room. The medical assistant goes over this form with the patient in the examination room to be sure that all of the relevant information has been included. Medical information should not be discussed at the front desk.

What Would You Do? What Would You Not Do?

Case Study 1

Angela Harris is a 62-year-old new patient. When she comes to the reception desk to check in, she gives Keisha the completed patient history form that had been mailed to her. Keisha hands her a Notice of Privacy Practices and a clipboard and pen. She asks her to fill out a new patient information form and sign the form acknowledging the receipt of the Notice of Privacy Prac­tices. Ms. Harris seems reluctant to take the clipboard. She says, “I’m sorry, I don’t have my reading glasses with me. I didn’t know I would need them. Besides, I gave you all that information on the telephone, didn’t I?” ■

Verifying Insurance and Obtaining Authorizations

After a new patient has filled out the patient information sheet, the medical assistant should ask for his or her insurance

Figure 37-5 The Health Insurance Portability and Accountability Act (HIPAA) requires new patients to sign a form acknowledging receipt of a medical office’s Notice of Privacy Practices.

Figure 37-6 Card reader used to validate insurance coverage for Medicaid and other insurance plans.

card. After making a photocopy of both sides or scanning the card, the copy is stored with the patient’s medical record. It verifies the information given by the patient and sometimes gives additional information needed for billing. An insurance card scanner at the front desk may be used to read both sides of the insurance card and scan it into the computer. Informa­tion from the card can be transferred to the practice manage­ment software, and an image of the card can be saved to the patient’s electronic medical record.

It may also be office policy to verify a patient’s identity at every visit by asking for photo ID or two other forms of identification and retaining photocopies. Medical identity theft has become a more common problem in the past decade.

It can result in incorrect information in the medical record as well as fraudulent charges to insurance companies.

in the office. Many offices use a card reader that can read not only the patient’s insurance card, but also several types of credit cards (Figure 37-6).

For other types of insurance, it may be necessary to call the patient’s insurance company to obtain authorization for treatment (especially if the patient needs minor surgery

Acknowledgement of Receipt of the Notice of Privacy Practices

Please Review Carefully

The Notice of Privacy Practices tells you how [Practice Name] uses and discloses information about you. Not all situations will be described. We are required to give you a notice of our privacy practices for the information we collect and keep about you. We reserve the right to revise this notice, and you can obtain a copy of any revision upon written request.

I,________________________________________________________ , have been given a copy of the Notice of

Privacy Practices.

Patient or Legal Guardian’s Signature                            Date                    Relationship to Patient

Print Patient’s Name                                                  Print Name of Legal Guardian (if any)

Signature of Witness (If signed with an “X’ or mark)                                  Date

Effective Date: April 14, 2003

Some types of insurance require authorization every time the patient visits the primary care physician. Patients with Medicaid must usually have their coverage verified and/or must receive prior authorization for each visit. Medicaid is an insurance program established by the federal government that pays for low-income patients’ medical needs. Each state administers Medicaid, and the program has a different name in each state. The cost is split between the state and the federal government. In some states, some patients on Medicaid receive new identification cards each month; in other states, patients’ insurance coverage can be verified by telephone, fax, or an electronic card reader. An electronic card reader is a small machine in the physician’s office that is connected via telephone to the insurance company’s data­base and can verify insurance benefits while the patient is or a special treatment). This may be done when the patient makes the appointment, when the patient checks in, or after the first visit, when the physician has identified what treat­ment is necessary and how many visits are anticipated.

Each office has its own procedure for verifying insurance. In general, if there is a question whether the patient has insurance coverage, or whether the service will be covered, the medical assistant should contact the insurance company before the service is provided (Procedure 37-3).

Verifying a Managed Care Referral

If the patient has been referred by another physician through a managed care plan, it is important to validate that the patient has a completed referral form from the primary care physician. This may be a paper form. Sometimes the refer­ring physician has sent it in advance, but the patient may bring it personally to the visit. For most managed care plans, it will be possible to access the referral using the Internet. If there is no valid referral, the insurance company may not pay for the visit.

The referral will state how many visits are allowed (how many will be paid for by the managed care plan) and the problem for which the patient is being referred. Depending on the patient’s insurance or managed care plan, the patient may also be required to sign a statement promising to pay any charges that the insurance does not cover.

Managed care plans usually do not allow physicians who accept referrals to bill for excess charges to the patient (a practice known as balance billing). Medicare also does not allow balance billing from providers who agree to accept Medicare patients. The medical office is allowed to bill for services that the patient’s insurance plan does not cover.

If the patient has not yet obtained a referral authoriza­tion, or if it is uncertain that the insurance will cover the services, the patient must be informed before any service is provided that he or she will be responsible for payment of the bill.

Established Patients

If the patient has been seen in the office before, it is neces­sary to verify that the billing information is still correct. When checking a patient in, the medical assistant should verify the patient’s address and telephone number. Patients who have moved may assume that the office is aware of the change, so it is recommended to ask, “Is your address still…?” and “Is your telephone number still…?” The patient should also be asked for his or her insurance card. If any information has changed, the new card should be photocopied and the updated information should be entered into the computer billing system and into the medical record, whether paper or electronic. As stated previously, established patients may also be asked to verify their identity using a photo ID if they are not personally known to the person checking them in.

Accepting Copayments

A copayment is a fixed amount of money that the patient is required to pay each time he or she receives medical treatment. The amount of the copayment is usually printed on the patient’s insurance card. If there is any question about the amount of the copayment, it may be easily deter­mined by checking the patient’s eligibility on the website of his or her insurance company. Many offices collect the copayment before the visit because it is a fixed fee, although this can also be done at the end of the visit. The amount paid is entered on the patient’s charge slip or entered directly into the computer. A receipt should be given to the patient at the time the copayment is made. It may be generated by the computer when the payment is entered. Most offices use a numbered receipt system for handwritten receipts so that payments are accounted for.

What Would You Do? What Would You Not Do?

Case Study 2

Joseph Ritano is a 38-year-old new patient. While filling out the new patient information form, he comes to the desk and says, “I don’t seem to have my insurance card with me today. I must have forgotten to put it back in my wallet when I gave you the information over the telephone last week. I know that the company is Bristol Medical Care, but I don’t know my ID number. Do you have it in the computer? I know that my copayment is $10.00.” ■

Keisha White: One of my duties during my externship was to prepare the medical records and charge slips each day. In the afternoon, I was given an appointment schedule for each physician, and I pulled the medical record for each patient on the schedule. Sometimes I had to hunt for one. Occasionally it was misfiled, but usually I found it on the desk of the physician, office manager, or insurance specialist. Then I prepared a charge slip for each patient. This was about 8 years ago, and at that time we were doing them by hand. Now we print the charge slips when the patient arrives. I wrote in the patient’s name and address, date of birth, telephone number, insurance information, and the date on the top of the form. Then I clipped the form to the front of the medical record. I opened the record to be sure that there was room for the physi­cian to write on the top sheet, and I stamped tomorrow’s date after the last note. I arranged the medical records in order and placed the records for each physician in a neat pile with the appointment list on top. The next day, I would check the list about once an hour. If any patients had been added to the schedule, I would find the medical record for those patients and prepare a charge slip. Once or twice I couldn’t find a medical record, even after I had looked everywhere. For those patients, we would make up a temporary progress note sheet and clip it to the charge slip. The first time this happened, it took us a week to find the medical record. It had slipped behind the others in the vertical file cabinet and gotten wedged in the back. The other time, the physician found the medical record in his office that afternoon. Everyone was relieved when all the records were accounted for. ■

Outcome Obtain information from a new patient, obtain consents, and validate insurance coverage.

PROCEDURE 37-3

Equipment/Supplies

        Clipboard

        Pen

        New patient information form containing consent to treatment and assignment of benefits consents

        Notice of Privacy Practices

        Receipt of Notice of Privacy Practices form

        Consent for release of protected health information (optional)

         Procedural Step. Place a new patient information form on a clipboard with a pen, and ask a new patient to complete the form and return it to you.

Principle. Complete information about the patient facilitates the billing and insurance process.

         Procedural Step. Make sure the form is complete and the patient or authorized representative has signed the form as needed.

Principle. The patient must consent in writing to treatment, to allowing the office to bill the insurance company, and to allowing the insurance company to pay the physician.

         Procedural Step. Ask to see the insurance card of the patient or other insured person.

         Procedural Step. Photocopy both sides of the insur­ance card and place the copy in the patient’s medical record.

Principle. The insurance card contains information about the patient’s copayment amount, as well as the address and telephone number of the insurance company.

         Procedural Step. Confirm patient eligibility for insur­ance coverage using a card reader, computer, or tele­phone if required by the patient’s insurance, and confirm that there is a complete referral form if neces­sary. If the visit will not be completely covered by insurance, discuss the patient’s financial responsibility. If personal information is discussed, take the patient to a private area.

Principle. The patient has a right to know what his or her financial obligation will be before receiving service.

         Procedural Step. Ask to see a+ photo ID or two other forms of identification if it is office policy.

Principle. Verifying patient identity may be part of the office’s plan to prevent identity theft.

         Procedural Step. Give the patient a copy of the Notice of Privacy Practices and ask the patient to sign the

         Photocopier

         Insurance card reader (optional)

         Telephone

         Medical record

         Computer

         Scanner form acknowledging the receipt of the Notice of Privacy Practices. Sign the form as a witness to the patient’s signature.

Principle. HIPAA requires that the patient acknowl­edge the receipt of the Notice of Privacy Practices in writing.

          Procedural Step. Ask the patient to read and sign any consent for release of protected health information used by the office.

Principle. A general consent for release of personal health information enables the office to obtain written consent to leave messages on the patient’s answering machine, to send laboratory results to the patient’s home address, and so on.

          Procedural Step. Insert any new forms into the medical record and place it with the charge slip to indicate that the patient is ready to be examined. Ask the patient to have a seat and tell him or her the approximate waiting time for the examination. Principle. When the paperwork is complete, it will help the patient feel more in control to know how long he or she can expect to wait before the examination.

             Procedural Step. Transfer the information from the new patient information form to the patient’s com­puter account, or validate that information obtained by telephone is correct.

Principle. Billing is almost always performed using the computer.

             Procedural Step. Scan the new patient information form, insurance card, and other consent forms if it is office policy (usually if the office uses an electronic medical record).

Principle. If the office stores a patient’s medical record electronically in addition to billing records, all new paper forms must be scanned into the computer.

Indicating That the Patient Is in the Waiting Room

After the patient has been checked in at the front desk, the charge slip and the medical record or information printed from the electronic record are placed in the designated space for patients who are ready to be seen. If a computerized record is used, copies of the most recent progress notes, copies of recent lab work, and/or a form for patients to complete updating medical history and current medications may be printed at the time of the visit.

ORIENTING PATIENTS TO THE MEDICAL OFFICE

Information for New or Prospective Patients

The medical assistant may be responsible for informing new patients and prospective patients about the medical office and its policies and procedures (Procedure 37-4). The medical assistant should be familiar with all of the following information:

        A brief description of the physicians, how long each has been in practice, each physician’s credentials, and whether each physician is accepting new patients.

        Specialties of the physicians in the practice, types of patients seen, and basic philosophy of the physician(s).

        Information about languages spoken by staff, whether the physician practices alternative therapies (e.g., acu­puncture), or whether the physician insists that patients stop smoking.

        Location of the main office and satellite offices, direc­tions to each office, and a description of available parking and access to public transportation, if applicable.

        The types of insurance that the practice accepts, whether the patient’s insurance will be accepted, and whether payment is required at each visit.

        How to make appointments and the policy regarding canceling appointments. Patients are normally asked to give 24 hours’ notice if possible for a cancellation.

        The telephone procedure and whether the physician has call-in times (when the physician takes telephone calls).

        What hospital(s) each physician is affiliated with; some patients might also want to know whether the physician makes nursing home visits.

        How medication refills are handled.

A physician might not be accepting new patients for a few reasons:

        A physician may have so many patients that he or she cannot in all fairness accept new patients. If the patient load decreases, the physician may begin again to accept new patients.

        The physician may be returning from a maternity, family, or personal disability leave and be working a reduced schedule.

        The physician may be easing back before retiring.

The medical assistant should also be able to tell prospec­tive patients how much time to allow for a first (new

patient) visit. Most physicians see new patients only on certain days and at certain times. Medical assistants should be sure to remind new patients to bring all of their medica­tions to the initial appointment, as well as a written list of concerns.

What Would You Do? What Would You Not Do?

Case Study 3

Donna Pohl calls the office to ask about the medical practice. An acquaintance has recommended Dr. Sylvia Lawrence. She says that she prefers a female physician. She asks for information about her and her specialty. Dr. Lawrence specializes in general internal medicine. At the current time the doctor is pregnant, and her due date is 1 month away. Although Dr. Lawrence is still seeing established patients, she has instructed Keisha not to make any appointments for her with new patients for the next 4 months. The other physician in the practice, Dr. William Rudner, also specializes in general internal medicine. ■

Patient Informational Materials

An increasing number of practices today have a website that contains the previously mentioned information. There are also often photographs of the office and office staff. Pages on the website usually include information about the practice as well as directions to the main facility and any satellite facilities. There may be a section related to health and wellness with information about specific medical conditions, especially those related to the specialty of the practice. Maintaining the website is usually not the responsibility of the medical assistant, but he or she can remind the office administrator if certain informa­tion needs to be updated. Photographs of patients should be used only if the patient has signed a release form. The Web address of the practice website can be added to the business cards of the practice physicians.

In addition to a practice website, there is usually infor­mation about each physician available on the website of the hospital(s) where the physician has privileges as well as the website of any large group with which the medical practice is affiliated. Most of these websites have a “find a doctor” feature for all their physicians, and these usually link to an information page about each physician. These links may need updating if the physician obtains new cre­dentials or if the physician starts or stops accepting new patients.

Patient informational booklets are another very success­ful marketing and public relations tool, but they must be kept up to date. A patient information booklet should include all the information listed section above that describes information to give to new patients. Patients appreciate having something in writing to which they can refer. A patient informational booklet should be given to a new patient at the first visit and should be on display for estab­lished patients to request if they want one.

Outcome Orient a new or prospective patient to the medical office.

Equipment/Supplies

         Patient information booklet (if available)                                                • List of points to cover

         Map

PROCEDURE 37-4

         Procedural Step. Offer to give or send the patient a patient information booklet if one is available. Principle. A patient information booklet provides a handy resource to answer questions about a medical practice.

         Procedural Step. Identify the name, credentials, and specialties of physicians who are accepting patients in the medical office.

Principle. Some physicians may not currently be accepting patients.

         Procedural Step. Offer information as required about languages spoken by staff in the medical office and additional services or specialized complementary practices.

         Procedural Step. Identify the location of the office and/or satellite offices and give directions as needed. Identify where the patient can park if necessary.

         Procedural Step. Tell the patient if the office accepts his or her medical insurance plan and discuss expecta­tions for payment of the patient’s bill.

Principle. The patient has a right to know what his or her financial obligation will be before receiving service.

         Procedural Step. Describe how far in advance to make appointments and the office policy on canceling appointments.

Principle. Most offices reserve the right to charge the patient if the appointment is not cancelled at least 24 hours in advance.

         Procedural Step. Tell the patient when and how to contact the office, and notify the patient if the physi­cian has specific call-in times (times when he or she takes telephone calls.)

          Procedural Step. Explain how prescriptions and pre­scription refills are handled as needed.

          Procedural Step. Identify the hospital(s) with which each physician is affiliated. Answer any questions about other services (e.g., nursing home visits) that each phy­sician may provide.

HMEDIGAL PRACTICE and the LAW

One function of the medical office that has been affected by the Health Insurance Portability and Accountability Act (HIPAA) is patient check-in. The Privacy Rule is not specific about sign-in lists, but medical offices need to take all possible measures to protect patient privacy. Not all offices use sign-in sheets, but if they are used, they should have adhesive peel-off strips for each line so that patients who come later cannot read the names of patients who arrived earlier. The Privacy Rule does permit inciden­tal disclosures of certain information as long as the health care facility has reasonable safeguards to protect against disclosure of protected health information. Silent wireless paging systems are available but are usually too expensive for medical offices. Gener­ally, it is considered acceptable to have patients say their names at the reception desk and to call patients by name from the waiting room unless patients have asked specifically for the staff not to do this. In some offices, however, patients may check in at the window by signing a sheet with a map of the waiting room that indicates their seat location. They do not have to say their names out loud, and they can be located without having their names called.

It is important to protect information on paper and computer screens at the information desk from being seen by others. The computer screen should be turned so that it cannot be read from the patient side of the reception desk. If medical assistants leave the reception desk for any reason, they should log off from their computer account. In addition, all patient records and information should be stored so that names and other information are not visible to patients who approach the desk. A shredder is usually available at the front desk so that any information that will not be filed in the patient’s medical record can be destroyed.

The Red Flags Rule of the Federal Trade Commission has been enforced since August 2009. It requires businesses considered “creditors” to set up a written identity theft detection program that identifies red flags of identity theft and provides a program to respond when red flags are detected. Medical offices that bill patients for an account balance or deductible after insurance has paid would usually be considered “creditors” who must comply with the Red Flags Rule. If patients must pay before service is provided or if accounts are covered by Medicaid or another program in which the patient has no responsibility for the fees, the office would not be considered a creditor. ■

What Would You Do? What Would You Not Do? responses

What Did Keisha Do?

          Checked to see if there were other patients in the waiting room. Because there were, she took Ms. Harris to a private area.

          Asked Ms. Harris for each piece of information on the new patient information form and filled it in for her.

          Read each statement at the bottom of the form out loud and showed Ms. Harris where to sign the form.

          Explained that Ms. Harris could read the Notice of Privacy Practices at a later time when she had her glasses, but Keisha asked her to sign the form acknowledging receipt of the Notice of Privacy Practices.

What Did Keisha Not Do?

          Did not tell the patient that she should have realized she might need her reading glasses.

          Did not tell the patient to sign any of the consents without reading them to her.

          Did not ask for protected health information where another patient could hear the conversation.

What Would You Do/What Would You Not Do?

Review Keisha’s response and place a checkmark next to the

information you included in your response. List the additional infor­mation you included in your response.

Case Study 2

Page 923

What Did Keisha Do?

          Looked up the policy number for Mr. Ritano in the computer and handed it to him in writing so that he could write it on the form.

          Attempted to call the insurance company to verify his coverage.

          Explained that she needed to take a photocopy of his insurance card and asked him to bring it in as soon as possible.

          Accepted his check for $10.00 for his copayment.

          Explained that if it turned out that his insurance did not cover this visit or if he needed an authorization or referral, he would be responsible to pay the charges for the visit.

          Gave him an estimate of the cost of the visit.

          Allowed him to reschedule if he wanted to wait until he had his insurance card.

What Did Keisha Not Do?

          Did not refuse to let Mr. Ritano see the physician until he brought his insurance card.

          Did not make negative comments about forgetting the insur­ance card or imply that she didn’t believe he had insurance.

          Did not discuss his protected health information in front of other patients.

          Did not talk to other staff members about the forgotten insur­ance card to other staff members unless he stated he would bring the card when she did not expect to be in the office.

What Would You Do/What Would You Not Do?

Review Keisha’s response and place a checkmark next to the information you included in your response. List the additional infor­mation you included in your response.

What Did Keisha Do?

          Explained that Dr. Sylvia Lawrence would be out on leave and could not accept appointments for 4 months.

          Offered to make an appointment with Dr. Lawrence after the 4-month period.

          Offered to make an appointment with Dr. William Rudner as soon as he had one available.

          Listened sympathetically if Ms. Pohl was displeased about not being able to be seen more promptly by a female physician.

          Responded calmly and in a normal speaking voice if the patient became irritated or upset.

          Made a recommendation about another female physician only if specifically instructed to do so by Dr. Lawrence.

What Did Keisha Not Do?

          Did not agree to make an appointment with Dr. Sylvia Lawrence before the end of the 4-month period just this once.

          Did not become defensive or imply that Ms. Pohl’s preference for a female physician was silly.

          Did not become irritated or upset with Ms. Pohl.

          Did not talk about the telephone conversation later to other office staff.

What Would You Do/What Would You Not Do?

Review Keisha’s response and place a checkmark next to the

information you included in your response. List the additional infor­mation you included in your response.

Medical Term

Word Parts

Definition

Assignment of benefits

Call-in times

Copayment

Medicaid

Tickler file

Authorization given by the patient to allow the insurance company to make payments directly to the health care provider instead of to the patient.

Blocks of time when a physician accepts telephone calls from patients.

A fixed amount of money that the patient is responsible to pay at each visit.

A federal and state insurance program for low-income patients. The Medicaid program has a different name in each state.

A chronological file containing reminders of things to be done.

^ ON THE WEB

For information on HIPAA

U.S. Department of Health and Human Services, Office for Civil Rights—HIPAA: www.hhs.gov/ocr/hipaa Sample Notice of Privacy Practices at Medicare.gov: www.medicare.gov/privacypractices.asp For information on the Red Flags Rule:

Federal Trade Commission: www.ftc.gov/bcp/edu/microsites/redflagsrule/index.shtml