Administrative • Means you organize and process. • You are the key member in the front office operations. • You are responsible for ensuring the fast-paced workplace runs smoothly.
Acute Care • For patients who need immediate assistance for recently-developed diagnoses. • Ex. Someone who suddenly develops severe abdominal pain and vomiting is having an acute problem and needs acute care.
Non-acute care • For patients who have chronic, persistent or long-lasting, diagnoses. • Ex. Someone who has Alzheimer’s disease for many years and is relatively stable has a chronic medical condition and can use non-acute services.
Short-term Vs. Long-termcare • Short-term: For patients who have diagnoses that health care workers can quickly resolve. • Long-term: For patients who have diagnoses that will take a little longer to resolve.
Emergent vs. non-emergent care • Emergent: For patients who need immediate assistance. • Ex. A patient who suddenly develops severe chest pain needs to see a physician right away. • Non-emergent: For patients who do not. • Ex. Someone who has mild signs and symptoms of the flu for a day or so, but is still able to function, can wait a bit to see a physician.
Walk-in clinic • Generally offer non-acute, non-emergent, short-term care and services. • May be staffed with any of the following: Physician, physicians assistant, nurse practitioner, nurse, and medical assistants. • Typically do not treat complex problems, and they cannot provide monitoring for any significant period of time. • Some clinics have a stable patient population, but many people use clinic on an as-needed basis. • Alternative to an ER in some cases.
Urgent Care Centers • Retail Walk-in clinics. • A higher level of care. • Can only treat non-life threatening diagnoses. • If the case is more serious the center will stabilize patient and arrange for transport to the Hospital Emergency room. • Staff includes: Physicians, PA’s, nurses, nursing assistants, medical administrative assistants, office personnel, medical assistants and phlebotomy technicians.
Providers Office • Typically have a stable patient population. • Little to no walk-in accommodations. • Some provide medical exams, basic laboratory work, and provider evaluations, while others perform treatments and procedures. • Staff includes: Physicians, Nurses, NP’s, PA’s, Medical administrative assistants, office personnel, Medical Assistants, Phlebotomy techs.
Hospitals • Provide Acute, Non-acute, Emergent, Non-emergent care. • Some also provide Long-term care. • Hospitals can monitor patients for more than a short period of time (Admissions) • Capabilities depend on equipment, facilities, staff, and medical specialties.
Hospitals • Admitting privileges: a provider who has a formal agreement with the hospital and can admit patients to that hospital. • Attending physicians: The provider that has admitting privileges. These physicians are responsible for day-to-day care of hospitalized patients. • Staff includes: Physicians, (some interns at teaching hospitals) NP’s, PA’s, RN’s, LPN’s, CNA’s, and various technicians.
Long-term Facilities • Skilled nursing facilities or assisted living facilities (formerly known as nursing homes) • Staff includes: RNs, LPNs, Nursing assistants.
Emergency Medical Services (EMS) • Respond to community medical emergencies and treat and transport injured or sick individuals to the appropriate health care service. • EMS Staff: 911 operators, EMT’s, paramedics. In some areas nurses participate too. • Poison control can also be part of the EMS system.
Laboratories • Can be part of a hospital or clinic, or be independent. • Obtain samples of blood, feces, urine, and other body fluids. • Staff include: medical technologist and technicians, phlebotomists, specimen processors, physicians known as pathologists
Pharmacies • Generally community-based pharmacies serve the community and hospital based serve hospital patients. • Some hospitals do have public pharmacies.
Administrative and Financial Organizations • Do not provide patient care • They manage the delivery of care, develop guidelines for standards of care, monitor and safeguard public health, and play a role in the financial aspects of health care. • Some are responsible for licensing and disciplining health care professionals. • Ex. Public Health dept., State boards of medicine or nursing, health insurance co., CDC, FDA
Physicians • Doctors: diagnose illnesses and injuries, prescribe treatments, and perform procedures. • They are legally and professionally responsible for determining why a patient is suffering and how to treat the condition. • Other professionals who diagnose and treat do so under the supervision of a physician
Physician specialties • Physicians can specialize in an area of health and medicine, a specific disease, or a specific organ system. • Ex. Cardiologist, Surgeon, Pediatrician • Physicians spend 4 years in medical school, pass a licensing exam and are legally allowed to diagnose and prescribe. • Physicians then spend years in training (internship/residency)
Nurses • Nurse Practitioner: advanced practice registered nurses, with a master’s degree or doctorate and a specialized are of practice. • They can prescribe and treat as well as independently bill insurance companies. • Nurse: Provides direct care to patients. • Nursing Assistant: (Patient care assistants) direct patient care, rarely administer meds.
Physician Assistant • Examines patients, diagnoses, prescribes treatments and medications, and performs treatments and procedures. Must perform under the direct supervision of a Physician.
Work environment • Fast-paced with long hours. Sometimes reporting to multiple physicians and working weekends • Stressful because of the high level of accuracy and competency required. • Highly interactive with patients, physicians, health insurance companies, pharmacists all while under pressure.
Before the patients arrive • Check the environment (no safety issues). • Make sure the reception area is clean and well-organized. • Confirm the patient reception area is clean as well as examination rooms. • Review the schedule. • Gather patient charts and review them. • Have Emergency contacts readily available. • Look for missing or incomplete paperwork. • Open Electronic Medical Records program if used.
When patients arrive • Greet the patients with eye contact and a pleasant tone of voice. • Utilize sign in sheet if necessary. • Look for signs of discomfort or visible sickness. • Use good judgment if a patient appears to be in distress and have a nurse or physician see the patient immediately.
Unexpected disruptions • Medical emergencies • Staff absence • Poor staffing • Late or no-show patients • Patients who end up requiring more time • Be adaptable and imaginative. Document no-shows, follow up with patient. If a true emergency refer them to the ER
Policies and procedures • Make patient aware of privacy issues, financial obligations, and how to make, cancel and confirm appointments. • Paperwork: Insurance information, consent for treatment, Release of information (ROI), Referral forms, medications, basic information • Be aware that sometimes patients show up on the wrong day/time. Always confirm their appointment when they sign in.
Escorting the patient to a room • Confirm identity • Confirm by asking information instead of telling them. They may agree and have not heard you correctly.
Checking out • Collect copayments or coinsurance • Give any referral paperwork • Give any written prescription • Schedule a follow-up visit if necessary • Ask if there are any additional questions they may have before they leave.(refer to a nurse if they have a clinical question)
sCHEDULING • If there is a disruption during the day make sure patients are aware of their wait time. • May need to call afternoon patients to reschedule. • Confirm appointments prior to the day. • Base scheduling on patient need. • Check to see if they were referred. • Obtain patient information. • See if there is a physician preference. • Give preparation instructions.
Written Orders • Written orders are necessary for patient care to proceed smoothly and to minimize the error rate. These orders are documentations of the treatment plan that the physician has for the patient. Hospitals need written orders to admit a patient, and once a patient is in the hospital, written orders dictate any tests, treatments, or medications the patient needs. • Verbal orders are usually given in emergency situations. • Pas, NPs can write orders for tests, medications, and treatments, but those are the only health care professional that can do so.
Documents • Pharmacy: Drug enforcement administration (DEA) identifies the physicians who can legally prescribe narcotics. (oxycontin, oxycodone, hydrocodone, fentanyl, lorcet, vicoden, codeine) • Non-narcotic drugs prescriptions are written on a pad and are also known as a “script” • Referrals: Similar to a prescription, is for other services. • Protected Health information (PHI)
Health insurance forms • Claims form is a standardized form that a provider’s office submits to a health insurance company. • It is a request for payment for the services the provider has given to the patient. • The Centers for Medicare and Medicaid Services (CMS) designed and approved a standard, commonly-used form called the CMS-1500 claim form.
Other forms • Health insurance referrals: some insurance companies require a referral to see a specialist. • Patient Health History: Quick reference sheet for the provider to see the patients medical history. • Informed Consent: Identifies the patient, procedure or operation that he will receive, as well as the physician that will be performing the procedure or operation. Lists and explains the potential risks of the procedure or operation.
Other forms • ROI (release of information) • HIPAA: confidentiality forms • Order Forms: for diagnostic procedures. May be paper or electronic. • Advance Directives: (living wills) a set of instructions that outline what type of care a patient wants, and what type of care she does not want, in the event she can no longer make these decisions. (do they want cpr)
Other Medical Forms • Nurses notes • Vital sign charts • Medication records • Assessment sheets • Discharge order sheets • Triage sheets • Office specific forms: Ex. Dermatology uses forms illustrating the human body to document the location of skin lesions.
Managing incoming/outgoing correspondence • You must learn to prioritize by urgency. • Document all calls both incoming and outgoing. • Outgoing: Physician referrals…you may be responsible for scheduling the patients appointment with a specialist. • Referrals can also be sent with the patient or faxed to the office. • Follow-up must be done to ensure contact was made.
Preparing Specimens for Delivery to the laboratory • Must clearly label with patient’s name, medical record number or SSN, the date and time obtained. • Typically done by a phlebotomist, lab tech, nurse, but occasionally a medical administrative assistant. • A requisition should go with the specimen including all information noted above, insurance information, name of the test, and the physician who ordered the test. Also contact information for the office.
Procedures and tests • Simple blood work or a routine chest x-ray typically do not need an appointment. A faxed order will be enough for the patient to arrive at their convenience. • Other tests and procedures will require an appointment. • Ex. Ultrasounds and MRIs
Inpatient admission • Requires an order from a physician • Phone # for the hospital • Copy of patient’s chart/medical record • Phone # for patients insurance company • Call the hospital admissions dept and they will give you instructions for the when and where the patient is to arrive.
Confirmation • Part of your professional communication involves CONFIRMATION. • Need to confirm that faxes are sent to the correct place. (follow-up with a phone call) • Never alter a form. If you make a mistake when you are filling out a hard copy document, or form, do not attempt to erase or use correction fluid. Instead, start over.
correspondence • You may be asked to : • Transcribe, whether from dictations or drafts, medical histories, physician’s orders, or medical records. • Writing or editing other types of correspondence, such as memos, letters, report forms, invoices, and financial statements. • Editing and/or proofreading incoming and outgoing correspondences. • Signing for packages, opening mail, sorting and processing mail, as well as routing mail to the appropriate staff member.
correspondence • Much of the correspondence that comes from a clinic or physician’s office is formal, business-type correspondence. Creativity is not necessary, but being concise is. When you are writing or editing documents, make sure there are no spelling or typographical errors and that the content of the correspondence is accurate. The correspondence should have the name, address, telephone # of the clinic or office. The tone and content should be professional, and the correspondence should contain only the necessary information to transmit the message.
Managing patient medical records • Patient chart documents: • Patient care: what care the patient receives and why, who delivers the care and when, and how the patient responded • Medical history: past and current medical problems, including surgical procedures • Medication list: all of the medications a patient is currently taking, as well as medications he has previously taken • Test results: from blood tests, EKGs, and x-rays • Notes: any professional who cares for the patient must document their care.
Responsibilities of a MOAA • Secure the chart. • Ensure privacy. Only release information with the patient’s consent. • Electronic medical records are secured by password protection given to only certain staff. • Only transmit information to someone who has a legitimate interest in the patient’s care. Known as Treatment, Payment, and Operations (TPO)
Working with other doc’s, forms, files, and records • Reports for insurance companies • Claims forms, Medicare audits • Professional continuing education records • State professional licensure doc’s • Tax documentation • Financial transactions • Inventory • Business contacts (utilities, computer services, phone services)
Confidential forms • Track all confidential information that you email, fax, mail. • If a physician directs you, you may have to respond to subpoenas for medical records. • Subpoenas is a legally binding request for records or documentation. • Make sure you notify and obtain approval from the physician for the release of the record or documents. • Send a copy, not the original.
Professional conduct • Be Punctual, dependable • Be Honest • Provide updates to patients • Be accurate • Have empathy You may also be required to arrange continuing education classes, seminars, conferences for the staff.
Financial procedures • Premiums: Health insurance companies, often referred to as a third-party payers, agree to pay for a patient’s health care costs, such as medications, hospital stays, and physician fees, in exchange for monthly or yearly payments called premiums. • In some cases, workers comp, or auto insurance may pay for care.
Medicare vs. Medicaid • Medicare: provides health insurance to older adults, retired individuals. • Medicaid: provides health insurance for the indigent and to some people who have disabilities.
Health Maintenance organizations (HMOs) • Managed care organizations that are typically more structured and organized than traditional health insurance companies. • These take an active role in encouraging and rewarding healthy behavior and preventative care. • Take an active role in overseeing the distribution and use of health care services. Practices who agree to treat patients with a HMO must agree to the guidelines and restrictions of the HMO.
Aspects of Health insurance • Contracts • Insurance companies/health care professionals/ patients enter into contracts with one another. • Insurance co. agree to pay in exchange for premiums from the patient. • Medical professionals agree to accept a certain amount of reimbursement from the health insurance co. • Financial implications for breaches in the contracts.