Chapter 28 Medical Office Health Care Science Technology Copyright © The McGraw-Hill Companies, Inc.

Objectives Identify the education and training required to become an administrative medical assistant, a medical insurance specialist, a medical office manager, and a billing and collections specialist. Chapter 28

Objectives (cont.) Compare the job responsibilities of the administrative medical assistant with those of the medical office manager. Summarize the specific duties of the medical insurance specialist and the billing and collections specialist. Analyze the legal and ethical issues related to working with client information in the medical office. Chapter 28

Objectives (cont.) List the various types of technology and office equipment that may be used to perform administrative tasks in the medical office. Use the interpersonal skills necessary for working in a medical office. Successfully complete 6 medical office procedures. Chapter 28

Careers in the Medical Office 28-1 The Administrative Medical Assistant The Medical Insurance Specialist The Medical Office Manager The Billing and Collections Specialist Chapter 28

The Administrative Medical Assistant May be a high school graduate or may have additional vocational training. Certification exams are offered by the American Association of Medical Assistants (AAMA) or the American Medical Technologists (AMT). Chapter 28

The Administrative Medical Assistant (cont.) The Job of the Administrative Medical Assistant Answer phones and take messages. Schedule appointments and create and maintain client financial and medical records. Should be skilled in using various office equipment. Chapter 28

The Administrative Medical Assistant (cont.) The Job of the Administrative Medical Assistant (cont.) Should appear professional and have good communication skills. May wear a uniform, business attire, or lab coat. Should demonstrate empathy to diffuse emotional reactions of clients. Chapter 28

The Medical Insurance Specialist May have an associate’s degree in medical assisting or health information management. Must be skilled in the use of encounter forms (also known as superbills) and medical records. Chapter 28

The Medical Insurance Specialist (cont.) Has a basic knowledge of medical law and ethics. Files forms for reimbursement. Must keep client information confidential. Chapter 28

The Medical Insurance Specialist (cont.) Retrieves information from the client’s medical form, financial records, and encounter form. Completes an insurance claim form, which includes information on the beneficiary, the insured, and possibly dependents. Chapter 28

The Medical Insurance Specialist (cont.) Reviews and files the explanation of benefits form (EOB) based on the benefits available to the insured. May appeal if benefits are denied. Must be knowledgeable about the various plans and benefits available. Chapter 28

The Medical Insurance Specialist (cont.) Must be familiar with plans of private insurance companies, including Blue Cross and Blue Shield, Anthem, and various health maintenance organizations (HMOs). Must be familiar with plans of government providers, including Medicare, Medicaid, and TRICARE. Chapter 28

The Medical Insurance Specialist (cont.) Insurance Fraud and Compliance Fraud, which is the intentional misrepresentation of facts to mislead or deceive another person or entity, is a major concern to the insurance specialist. Chapter 28

The Medical Office Manager Responsible for the staff, supplies, and operation of equipment. In small offices, reports to the physician and may oversee other office workers. In offices with multiple physicians, may report to the human resources manager. Chapter 28

The Medical Office Manager (cont.) May have taken courses in office management and organization, medical law and ethics, therapeutic communication, and human relations. Chapter 28

The Medical Office Manager (cont.) The Job of the Medical Office Manager Supervise employees. Prioritize activities and delegate tasks. May manage the budget. Chapter 28

The Billing and Collections Specialist Collects co-payments or deductibles. Bills and collects payments from clients or insurance carriers. May have formal training in a medical assistant program or may have a background in medical coding, billing, and insurance. Chapter 28

The Billing and Collections Specialist (cont.) The Job of the Billing and Collections Specialist Contact the individual responsible for filing insurance claims for clients. Determine a schedule or process of payment for client or responsible party. Use ledgers to show a history of charges and payments. Chapter 28

The Billing and Collections Specialist (cont.) The Job of the Billing and Collections Specialist (cont.) Send statements to clients with a balance. Check the tickler report daily to review overdue accounts. Chapter 28

The Billing and Collections Specialist (cont.) The Job of the Billing and Collections Specialist (cont.) After 150 days, an account may be turned over to a collection agency. To avoid the collection agency’s fee of up to 40%, the billing and collection specialist should make every effort to collect the overdue account, including using small claims court. Chapter 28

Section 28-1 Apply Your Knowledge Why should the billing and collection specialist make every possible effort to avoid turning an account over to a collection agency? Answer: Collection agencies may charge up to 40% of the balance to be collected. Chapter 28

Medical Office Procedures 28-2 Additional Career Skills Chapter 28

Additional Career Skills Evaluating Client Charts Active – when a client has been seen within a specified amount of time, usually a year. Inactive – can be removed from frequently-accessed records. Closed – when a client has not been to the office for a period of time, usually 3 years. Chapter 28

Additional Career Skills (cont.) Completing Insurance Forms Those working with insurance companies must be familiar with the following terms and practices: Assignment of benefits. Claim. Coinsurance. Preauthorization. Coordination of benefits. Using form locators. Chapter 28

Section 28-2 Apply Your Knowledge What 2 systems may be used to file medical records? Answer: Alphabetic and numeric. Chapter 28

Procedures in Student Text 28A Using the Telephone 28B Scheduling Appointments 28C Greeting a Client 28D Assembling a Client Record 28E Filing Medical Records 28F Using the Physicians’ Desk Reference Chapter 28

Additional Procedures in Lab Activity Manual LM28-1 Evaluating Client Charts LM28-2 Completing Insurance Forms Chapter 28

Chapter 28 Credits Slide 7 Terry Wild Studio Slide 10 Jeff Greenberg/Visuals Unlimited Slide 17 Terry Wild Studio Chapter 28