Medical Office Administration 1B: Vital to the Front Office
Unidades del curso de orientación profesional para administradores de consultorios médicos
Unit 1: Managing the Medical Office
Managing the medical office is no easy feat. A medical office manager must be familiar with each employee’s role and responsibilities, from entering new patient information to processing insurance claims. Management includes functions such as planning, organizing, directing, staffing, and controlling people and things. Office managers usually have college degrees, and they demonstrate a wide variety of skills to be able to effectively manage the office. They have many responsibilities and must be able to prioritize tasks and direct people. Good office managers are able to manage the office effectively and motivate their people in a way that encourages them to want to be a better employee and improve their work as they learn and gain more experience. Managing a medical office can be a most rewarding experience.
Unit 2: Medical Insurance, Coding, & Billing
Medical offices provide many types of medical services to patients, from routine physical exams to minor procedures. Someone must pay for these services and most often, payment is the patient’s responsibility. Most people don’t know if and when they may need medical services; therefore, in order to make sure they can pay for these services, they purchase medical insurance. Providers in medical offices agree to see and treat patients in exchange for payment. This payment is usually received from health insurance companies and/or the patient. If a patient does not have health insurance, they must cover the cost of any services themselves unless someone else is responsible for their payment. Medical offices must employ qualified personnel to manage their insurance, billing, and coding functions to ensure revenue is received and in a timely manner. These occupations offer individuals job security and a good income, and can lead to other, higher-paying billing and management positions.
Unit 3: Medical Coding
Medical coding is the use of standardized codes that represent diagnoses, procedures, and other services in health care. All healthcare facilities must use these diagnosis and procedures (services) codes, and they are primarily used to bill insurance companies for reimbursement for medical services. The standardized code sets include the International Classification of Diseases (ICD), the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). The purposes of medical codes are to show medical necessity, provide statistical analyses, receive reimbursement, and determine where to allocate resources. Medical offices employ at least one medical coder or designate someone who will be responsible for coding, and it’s that person’s responsibility to analyze medical records for documentation compliance, review codes for accuracy, and educate providers and staff on code changes. The financial success of the practice is impacted by the efficiency of their medical coding process and personnel.
Unit 4: Healthcare Quality
Anyone considering a career in health care must understand the importance of providing quality health care to patients. Providing quality care includes many things, such as employing caring, professional, and knowledgeable people; developing and monitoring office processes and procedures; and asking patients about their care. These are only a few elements that promote the delivery of quality care. Quality care primarily depends on the providers. Providers such as physicians, nurse practitioners, and physician assistants have obtained the required education and training for their job, but they must also continue to maintain current knowledge in their field. From the receptionist to the provider, everyone in the office is responsible for providing quality care to their patients.
Unit 5: Patient Safety
Did you know millions of patients suffer from injuries or die because of unsafe or bad health care? The World Health Organization reported that globally, medication errors were a leading cause of injury in healthcare systems. Patients expect their providers and the medical office to deliver safe health care in a safe environment, and all employees in the medical office are responsible for patient safety. The office should have procedures in place—procedures that all employees know and follow to protect their patients. It is the responsibility of all healthcare providers to do what is necessary to promote and prevent patient safety. Failure to do so not only results in poor patient outcomes, but also increased costs and potential legal issues. Offices should promote a culture of patient safety so that employees are constantly aware of their role in providing safe health care.
Unit 6: Accounting Day to Day
Medical office staff perform a variety of accounting functions in the medical office. From the time the patient arrives for their appointment to the point where final payments are made, there are accounting procedures that must be followed to ensure an accurate accounting of money received and spent. Focus is on daily accounting procedures such as posting transactions, processing and submitting insurance claims, posting reimbursement from insurance companies, managing and collecting delinquent accounts, and creating reports. Most medical offices use computerized patient accounting systems as well as written policies and procedures to complete these daily accounting functions. Employees responsible for accounting tasks possess specific accounting skills and must be trained on the office’s accounting procedures. The profit and integrity of the practice depend on all employees understanding and adhering to respectable accounting practices.
Unit 7: Accounting: The Bigger Picture
Healthcare facilities must focus on their finances in order to continue providing healthcare services, improve services, buy new equipment, train personnel, and make countless other improvements. Whether facilities are not-for-profit or for-profit, there must be someone—or even several people—in charge of the bigger picture. These are not the people entering daily charges and transactions. These are the office managers, providers, and other involved personnel who have a stake in the business. They are creating, reviewing, and analyzing financial reports on a regular basis in order to make informed decisions that will impact the financial success of the office. Individuals working in this field of health care must possess excellent organizational, problem-solving, mathematical, and critical thinking skills.