Final Research Paper

Running head FINAL RESEARCH PAPER 1

Final Reasearch Paper

Stephanie Baker

MO 270 Case Study Project

April 25, 2016

Pamela Audette, MBA, MT, RHIA, RMA

FINAL RESEARCH PAPER 2

Final Research Paper

When you think of a medical receptionist what comes to mind? Answering phones and using

a computer to type in basic information, right? There is a far vaster world behind that counter

that patients normally do not know about. That person in front of the patient has great

responsibilities in what they do. There are seven key components that each medical receptionist

also known as Medical Office Administrative Assistance, MOAA, need to deal with on any

given day. Primarily the Medical Office Administration Assistant needs to know the legal

aspects on documentation. Secondly, how that information may be used within and outside of the

facility by following HIPAA’s, also known as Health Insurance Portability and Accountability

Act, rules and regulations. Thirdly, what accommodations are or should be in place for those

with a language barrier or other forms of commination obstacles. Fourthly, a Medical Office

Administrative Assistant needs to be knowledgeable on how the facilities physician billing and

reimbursement processes are. Fifthly, the ability to manage possible conflicts within the facility.

Sixthly, the ability to coincide with a vast diversity within the staff and patience. Lastly, the

importance and the use of the ledger card. Each of these aspects are used day in and day out by

each individual working at the office. The Medical Office Administration team are the front lines

for the medical world. The first and last person a patient sees in the office has an ever growing

knowledge of each of the stated aspects of the medical field. When a patient, another provider or

other authorized parties, such as an insurance agency or clearinghouse, calls, emails or faxes

information, or needs information, pertaining to a specific patient the inquiry primarily goes

through the administrative staff first, then to the needed party. The medical administrative staff

needs to be on their toes and up to date with all of the latest updates to handle the needs of the

facility and the patience. So when a patient enters the facility and goes to the front desk to check


in the medical receptionist is in the position to help the patient transition through the facility and

if possible answer any possible questions, if it is ethically within their means. Legal aspects and

documentation are the first steps in the sea of medical progress. When it comes to documentation

it is critical that the medical staff knows that everything in the patient’s record, also known as

Electronic Health Record or EHR, is considered to be a legal document or record. All of the

contained information must be used in an appropriate and legal manner. These records are

blueprints on the patient’s medical life, meaning anything that the patients underwent such as

medications, surgeries, tests and any other treatments are located within those charts. The chart is

the main document that allows for the medical staff to make the best decision in the continuation

of care (Author Unknown, n.d.).

When documenting there are criteria that need to be met. It first must be complete to the

best of the ability and knowledge of the patient and the health record (Author Unknown, n.d.).

This means that not only the records from that facility must be in there but also of those from all

other facilities that have taken part in that patience care (Author Unknown, Week 1). Second, it

must be correct and accurate (Author Unknown, n.d.). If there is wrongly written or omitted

information it could be hazardous or even fatal to the patient and it can be used against the

facility in a law suit. This also means that the information must have merit and be relevant to the

patient’s health (Author Unknown, Week 1). The third step is the importance of timeliness,

deadlines must be met (Author Unknown, n.d.). The proper documentation and following the

legal requirement’s aid in the timely claims and prompt revenue. This means that the law allots a

specific time frame, such as the EHR must be complete within the seven day following the

patient last being seen (Author Unknown, Week 1). The fourth step is the legality of the records.

The last step is that it must be professional, meaning legible and in order (Author Unknown,


n.d.). This information is then passed from person to person within the facility or whoever else is

in charge of the care for the patients (Author Unknown, Week 1).

Everything that is done as well as seen or heard is to be documented. Example is any

action or movement that is out of character should be documented. Record the exact time,

procedure and result in the chat. Promptness of such documentations can prevent the forgetting

of important information and it will allow for a more prompt and productive treatment plan.

Legally there are guidelines for proper storage, dating of the documents, means of documenting,

the correct use of comments and no use of abbreviations. If the information is written it cannot

be erasable and it needs to be able to be transferred from one source to another without mistakes

(Author Unknown, n.d.).

As stated in Week 1 Discussion post, making the staff aware of regulations regarding the

appropriate use of the gained information is a key part of documenting, but more importantly the

legal aspect. The downfalls that can occur is the multitude of assignments to be done by one

individual at one time. The patient’s record is to remain confidential as per the regulations of

HIPAA, also known as Health Insurance Portability and Accountability Act. There are times

when a member of the team may walk away from a computer and forget to log out or at least

minimize the screen, a file may be left with the name facing up, or one of the office staff may be

on the phone with a patient and their voice is high enough to be heard by others. These instances

can be common in the office but should be avoided at all costs.

HIPAA mandates that all medical information, whether it is the diagnoses or the patient’s

demographical information, not be released unless it is to an authorized party. The parties consist

of other staff involved in the patients care, other providers outside the facility that are in charge


of other aspects of care, insurance companies and billing and reimbursement organizations like

clearing houses. The patient would need to sign a release of information for anyone not listed

such as spouse or family and/or friends (Author Unknown, Week 1).

The communication between facilities can vary. The main communications are phone,

internal messaging, email, mail and fax. With the phone hushed tones are needed if relaying

identifying information. Internal messaging is within the facility where as email is for outside

parties. If the email contains private medical information there needs to be a disclaimer at the

bottom of the email. Fax is the least safe because there is more that goes into the process, it

needs a cover page with the intendeds name on it as well as words such as “Privileged

Information” and the fax number needs to be double checked and a phone call needs to be made

prior to sending the information to make sure there will be someone there to receive it, these can

end up being read by the wrong party Stanford. (n.d.). If private information is sent in the mail it

needs to be certified.

As what was posted for the initial post for Week 3 miscommunication can have detrimental

effects, not only for the patient but also for the medical facility and its staff. If there are not

policies in place for such circumstances then there need to be. For example according to CNN

the United States is the second largest Spanish speaking country, Mexico has slot one. America

out ranks Spain. Statistics say there are an average of 41 million native speakers and 11.6 million

who are bilingual. The figures for the year 2050 is 132.8 million will be Spanish speakers

(Melendez, Pllar, July 1, 2015). The medical field needs to catch up with the shifts in languages

if they wish to better help the patients.

There are other communication barriers that can prevent patients from gaining the

appropriate care. One is that the patient is blind or hard of seeing. According to a 2014 report


there is an estimated 60,393 children up to the age of 21 who are vision impaired and that is just

the documented cases that are in special schools, in my state alone Pennsylvania has 285,300 for

the year of 2013. Many can use braille, larger print or auditory means, but there are some that

cannot read at all (National Federation of the Blind, March 2016). Medical facilities are not

always adapted for such a situation.

Communication is very important between patient and care provider. These obstacles are just

a few that can create a problem. The language barrier can be alleviated if the school programs

mandated Spanish as part of the curriculum, they do in high school why not college. Blindness is

difficult for the patient because they are unable to see body language or the patient information

given to them.

There are a few others that can prevent the patient from expressing their health problems.

Being deaf is one, they may not have been able to speak from birth or lost their hearing for

another reason. Then there is the possible blind and deaf. Lastly there is those with learning

disability whether it is due to a birth defect or an accident. All of these will provide a barrier

between the much needed medical cares and be able to full understand what is going on.

ICD-10 codes have 141,000 codes. It has up to 7 digits of letters and numbers. More

information available but use less codes. Expanded injury codes, substance abuse codes and

post-op codes. There are three volumes available, volume one is tabular, volume two is

instructional and the third is the alphabetic index (Leder, Suzanne BA, M.Phil., CPC, COBGC,

April 21, 2010).

These are the diagnostic codes used for the claims to be submitted to the insurance

companies so the facility can get paid. HIPAA has an impact on the billing so most medical

facilities will use a third party billing agency that follows the strict protocols. Office of Inspector


General or OIG is in place for smaller facilities or even individuals, their purpose is prevention

of fraudulent claims (Author Unknown, Week 4).

There are many types of insurance for patients. There are two main insurance that the vast

majority of people may know about. There is Medicare, which covers those 65 and over, those

under 65 if they are disabled and those who are in end stage renal failure. Medicare has three

main sections. There is Part A for hospitalization, Part B for medical and Part C you get assigned

to a HMO or a PPO (Bradley, Cheryl, November 25, 2009). The second is Medicaid, which is a

federal and state run insurance for individuals or families that lack the financial standing to

purchase medical insurance. Then there are HMO’s also known as Health Maintenance

Organization. They are a limited network provider option for those receiving Medicare

(Medicare.gov, n.d.). Lastly there are PPO’s, which are Preferred Provider Organization, they

are also a network of providers for little cost but the ability to use outside of the network is

available with addition cost (HealthCare.gov, n.d.).

After a claim is submitted an average of 10% are denied due to processing errors. Most

are denied due to incorrect patient information such as name, age and so on. Sometimes the

patient is no longer covered or the wrong codes were used or the right ones were omitted. An

appeal may happen if all of the needed information is fixed and there is documented proof

(Author Unknown, Week 4).

According to Week 5 PPT Causes for Conflict in the Workplace there are many aspects that

are taken into account. It states that there are eight sources in which conflict can emerge. The

first is conflict needs, which is the basic competition with a limited amount of resources. This

conflict can be represented as the need for supplies or getting allotted time with the boss. The

second conflict is style. This section can be seen best by the work ethics of the individual, how


fast or slow they decide to get something done. The third aspect of conflict is perception. This

one in particular depends on how a staff member feels about another, whether they see them as

an asset or a threat to their standing. The fourth situation is conflicting goals, this is when two or

more people are working towards the same outcome but have different views on how to reach it.

The fifth conflict is pressure, this has to do with multiple parties having to meet the same

deadline but there is a chain reaction to the order, the second depends on the first to finish and so

on. The sixth has to do with the roles of the staff member or members. In this situation an

employee is asked to do an assignment out of their usual scope of expertise and another is asked

to do the same task, there go a “power struggle” occurs. The seventh is values of the individual,

what can the person accept about another, if there is head butting in values division or gossip

occurs. The eighth and final conflict is unpredictable policies, the sudden onset of company

policies can leave the staff with uncertainty of their role in a company, relocation or being let go

may be on their minds (Author Unknown, Week 5).

There are ways of resolving conflicts in the work place. The process starts with flight or

fight. One may choose to walk away and ignore the situation others may take the other approach

and resolve the situation, or fight. The first steps are negotiation and mediation, where each of

the parties are part of the solution. Then there are further actions where others are in control of

the outcome like conciliation, arbitration and up to litigation (Baines, Michael, Eddy, Dionne,

June 2, 2009).

Diversity is an important aspect of any workplace. It is important for all employers to follow

the laws that regulate and abide by the equal rights of all people looking for employment. The

first is that they cannot not hire a person because of their race or ethnicity. The second aspect is

hiring regardless of religious beliefs. The third that was stated was those with disabilities, proper


accommodations may need to be met. The fourth is the applicant’s or established employee’s

age. According the video in California the protected age group is forty and over, if an long

standing employee is let go and a younger than forty person takes there place there needs to be a

legitimate reason for that decision. The fifth and sixth diversity groups are sexual orientation or

gender, whether male, female or other (Witte, Schmaling, Young, Gebert, Windorff, February

15, 2012). There are many others that are used to define diversity. Some include talents,

education level, personal and physical traits, background, appearance and even their view points.

One key reason for diversity is connections. This means that hiring a person who in turn will

broaden the economic and global market (Author Unknown, Week 6). An example that can be

used in the medical field is hiring a qualified person or persons who is a native of Spanish

speaking culture. With that person in the staff there may be an increase in patients in the area that

can only speak Spanish, in turn the patient receives better care and understanding and the facility

brings in better clientele and revenue.

Diversity is managed by creating an equal opportunity to all for employment. Such as those

with disabilities. Other aspects that are considered are Woman in Leadership and/or Management

(Author Unknown, Week 6).

Fair vs Same treatment is a way that gets employer to give equal opportunities to the staff but

also needs to take into consideration that not everyone on the staff will understand that there is

an option to advance. So it is the employer’s obligation to let all of his or her employees know

that that option is available to them in a way that is understood (Author Unknown, Week 6).

There are consequences if the laws for diversity are not being followed. There can be conflict

within the business, such as employees leaving as well as the lack of ability to recruit new

employees due to the discrimination. On slide 8 the example is spot on, the employer of a new


employee who has worked there for a little while is being discriminated against, and the

employee decides to leave. This costs the company money for the training and the pay. So

ignoring problems only costs money and time as well as productivity (Author Unknown, Week

6).

The Ledger Card is considered to be a legally binding document that is data used as part of

the permanent record. It consists of many aspects of the facility such as, services provided, costs,

reimbursements, adjustments and what is still owed by deducting who paid what. The Ledger

Card needs to have the basic information of the patient like their address, phone numbers as well

as the name of the facility. The key information is also the date the procedure or visit occurred

with description of the procedure as well as the charge for each occurrence during that visit. The

card is split into columns. The column that deals with the patients payments is called Credit

Payment. Now the adjustments are another column or more. They consist payments received by

insurance companies, possible professional discounts as well as patient payments. The main

column to view would be the Current Balance. This column is the equation of the charge then

subtract any and all payments and adjustments. It is important to double check that all services

performed are listed and that the charges correlate with the service. Making sure the math is right

is really important. It can be easy to make a mistake on the Ledger Card with the math not

adding or subtracting right. If mistakes are made there can be ramifications from patients who

may think that the facility is over charging them. It is also time consuming to redo the

calculations to fix the error (Student Resources, Week 7).

It seems that the Ledger Card is the glue to the facility. Without it the whole business will

fall apart. There would be chaos, there would be no order to the finances. The billing would not

exists because the charges would not be documented for them to be submitted. The calculations


for what is being paid and what is still owed would not be organized to function. So keeping a

well-organized Ledger Card is the life line for the facility and without it the employees would

not get paid. Seeing as how it is a legal document it seems that it is fair game in the courtroom if

there is a lawsuit or if there is an office audit.

To wrap up the main points of this paper includes many aspects of a medical facility. First,

there is the documentation, simply document anything and everything that the patient states and

what is seen and done. Second, there are the legalities to consider, such as HIPAA. This act

protects the rights of the patient and allows for all medical information to remain confidential

with very few exceptions. Third, communication is key between staff members and the patient.

So if the patient is blind, deaf, and hard of hearing make the proper accommodations such as a

quiet room or braille materials. As for those who are fluent in another language, have a staff

member or an interpreter readily available to assist. Fourth, office procedure and billing

practices. With this aspect it is important to know the regulations of the office making sure that

faxes, emails and calls are done properly, along with the proper supplies are stocked and the

medical codes and fees are up to date. Fifth, conflict is almost inevitable it seems. There are

positive conflicts and then there are negative ones. With the negative the productivity slows

down and time and money is wasted. Sixth, diversity in the work place seems to be endless,

whether it is sex, religion or race, plus many more. There are many laws and regulations

protecting every individual’s rights when in the workplace. They are in place to make sure that

employers do not discriminate the applicants and that ramifications are not tolerated for “Whistle

Blowers”. Lastly, the Ledger Card, the glue to the facility. Without the Ledger Card the income

would not be well documented. It keeps track of procedures and services and the costs, along

with what is being paid by insurance and patients. Each of these sections are just a snap shot of


what a facility expects from their administrative staff as well as the other staff members. It is best

to follow all rules and regulations of the facility, the state and the government. The ramification

of breaking such regulation may warrant different negative outcomes. Organization, tolerance,

accommodations and procedures may be key for a well-rounded facility.


Reference Page

Author Unknown. (n.d.). PPT 1 Script for Week 1 Course Development: Documentation and

Legal Aspects. Student Resources. Retrieved from

https://sas.elluminate.com/site/external/launch/play.jnlp?sid=2010456&psid=2012-02

03.0821.M.1E344E9D2CB5B3465BF76508B9E62B.vcr

Author Unknown. (Week 1). Documentation of Medical Records. Required and Suggested

Readings. Retrieved from

https://herzing.blackboard.com/webapps/blackboard/execute/content/file?cmd=view&co

tent_id=_9013254_1&course_id=_98103_1

Author Unknown. (Week 4). Script PPT FAQs for Medical Billing and Reimbursement.

Retrieved from


tent_id=_9013571_1&course_id=_98103_1&framesetWrapped=true

Author Unknown. (Week 5). PPT -1 Script Causes for Conflict in the Workplace Week 5.

Retrieved from



Author Unknown. (Week 6). Script PPT FAQs about Diversity in the Workplace. Retrieved from



Baines, Michael, Eddy, Dionne. (June 2, 2009). The Cost and Cure of Conflict in the Work Place

Part 1. Retrieved from https://www.youtube.com/watch?v=A6Bwu-S0Z6o







Bradley, Cheryl. (November 25, 2009). Basic Medicare Billing. Retrieved from

https://www.youtube.com/watch?v=7uD9KdBkCjs

Gebert, Schmaling, Young, Windorff, Witte. (February 15, 2012). Workforce Diversity.


15.1349.M.D340D509BCB354A6DD2369318B2ADA.vcr

HealthCare.gov. (n.d.). Preferred Provider Organization (PPO). Retrieved from

https://www.healthcare.gov/glossary/preferred-provider-organization-PPO/

Leder, Suzanne BA, M.Phil., CPC, COBGC. (April 21, 2010). ICD-10 Coding: What You Need

to Know Now 1 and 2. Retrieved from https://www.youtube.com/watch?

v=hWDOkmeyNwA

Medicare.gov. (n.d.). Health Maintenance Organization (HMO) Plan. Retrieved from

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare

advantage-plans/hmo-plans.html

Melendez, Pllar CNN. (July 1, 2015). United States Has More Spanish Speakers Than Spain

Does, Report Says. Retrieved from http://www.cnn.com/2015/07/01/us/spanish-speakers

united states-spain/

National Federation of the Blind. (March 2016). Blindness Statistics. Retrieved from

https://nfb.org/blindness-statistics

Stanford. (n.d.) HIPAA: Privacy Guidelines. Retrieve from https://acp.stanford.edu/hipaa/hipaa

privacy-guidelines

Student Resources. (Week 7). Power Point Script for the Ledger Card. Retrieved from




https://acp.stanford.edu/hipaa/hipaa

http://www.cnn.com/2015/07/01/us/spanish-speakers

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare

https://www.youtube.com/watch?v=hWDOkmeyNwA

https://www.youtube.com/watch?v=hWDOkmeyNwA


https://www.youtube.com/watch?v=7uD9KdBkCjs

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