Transcript Chapter 28 Medical Office - Sault Ste. Marie Area Public

Chapter 28
Medical Office
Health Care
Science
Technology
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Objectives
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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.
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Chapter 28
Objectives (cont.)
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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.
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Chapter 28
Objectives (cont.)
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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.
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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
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Chapter 28
The Administrative
Medical Assistant
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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).
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Chapter 28
The Administrative
Medical Assistant (cont.)
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The Job of the
Administrative Medical
Assistant
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Answer phones and take
messages.
Schedule appointments
and create and maintain
client financial and medical
records.
Should be skilled in using
various office equipment.
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Chapter 28
The Administrative
Medical Assistant (cont.)
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The Job of the Administrative Medical
Assistant (cont.)
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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.
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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.
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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.
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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.
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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.
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Chapter 28
The Medical Insurance
Specialist (cont.)
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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.
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Chapter 28
The Medical Insurance
Specialist (cont.)
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Insurance Fraud and Compliance
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Fraud, which is the intentional
misrepresentation of facts to
mislead or deceive another person
or entity, is a major concern to the
insurance specialist.
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Chapter 28
The Medical Office Manager
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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.
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Chapter 28
The Medical Office Manager (cont.)
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May have taken courses in
office management and
organization, medical law and
ethics, therapeutic
communication, and human
relations.
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Chapter 28
The Medical Office Manager (cont.)
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The Job of the Medical
Office Manager
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Supervise employees.
Prioritize activities and
delegate tasks.
May manage the budget.
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Chapter 28
The Billing and
Collections Specialist
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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.
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Chapter 28
The Billing and
Collections Specialist (cont.)
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The Job of the Billing and
Collections Specialist
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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.
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Chapter 28
The Billing and
Collections Specialist (cont.)
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The Job of the Billing and
Collections Specialist (cont.)
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Send statements to clients with a
balance.
Check the tickler report daily to
review overdue accounts.
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Chapter 28
The Billing and
Collections Specialist (cont.)

The Job of the Billing and Collections
Specialist (cont.)
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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.
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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.
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Chapter 28
Medical Office Procedures 28-2
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Additional Career Skills
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Chapter 28
Additional Career Skills
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Evaluating Client Charts
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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.
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Chapter 28
Additional Career Skills (cont.)
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Completing Insurance Forms
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Those working with insurance companies must
be familiar with the following terms and
practices:
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Assignment of benefits.
Claim.
Coinsurance.
Preauthorization.
Coordination of benefits.
Using form locators.
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Chapter 28
Section 28-2
Apply Your Knowledge
What 2 systems may be used to
file medical records?
Answer:
Alphabetic and numeric.
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Chapter 28
Procedures in Student Text
28A
28B
28C
28D
28E
28F
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Using the Telephone
Scheduling Appointments
Greeting a Client
Assembling a Client Record
Filing Medical Records
Using the Physicians’ Desk
Reference
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Chapter 28
Additional Procedures in
Lab Activity Manual
LM28-1
LM28-2
28
Evaluating Client Charts
Completing Insurance Forms
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Chapter 28
Chapter 28 Credits
Slide 7
Slide 10
Slide 17
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Terry Wild Studio
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Chapter 28