1

MODESTO JUNIOR COLLEGE

MEDICAL ASSISTING PROGRAM Syllabus

Course Number: MDAST 322 Course Title: Medical Assisting Administrative Procedures Course Description: Medical assisting administrative procedures including patient

scheduling and medical record keeping, financial record keeping, insurance claims, banking procedures and payroll. Students receive training in completing the above procedures manually and by computer.

Credit: 3.5 units Class Hours: 2 hours lecture 4.5 hours lab Instructor: Chelsea Coulson email: coulsonc@mjc.edu Office: Glacier Hall 124 phone: (209) 575-6380 Class location: Glacier Hall 207 Instructor office hours are after class or by appointment.

Teaching Methods: This course will be taught by lecture, collaborative learning

experience, guided discussion, audio-visual materials, simulated lab activities, case studies, and computer activities.

Texts: Proctor, Niedzwiecki, Pepper, Madero, Garrels & Mills (2017).

The Medical Assistant (13th ed.). St. Louis, Missouri: Elsevier Proctor, Niedzwiecki, Pepper, Madero, Garrels & Mills (2017).

Student Study Guide for the Medical Assistant (13th ed.). St. Louis, Missouri: Elsevier

2

Minimum Performance Standards: The student will receive one grade from this course. The

requirements for satisfactory completion and minimum performance in this course will be evaluated by the instructor based on the student's:

I. Tests, quizzes, class assignments, written assignments,

and computer assignments.

II. Successful completion of entry-level procedures for the medical assistant. Each procedure is initially completed as a Peer Evaluation. The student then has a maximum of three attempts to achieve a satisfactory rating by the instructor for each procedure. CAAHEP accreditation requires 100% of Medical Assisting graduates pass 100% of all competencies

Failure to clearly demonstrate any of the Minimum Performance Standards will result in failure of the course.

If the student’s performance falls below a “C”, the instructor will require a counseling session with the student and complete a Student Contact Sheet. If improvement does not take place, the instructor will initiate another meeting with the student and complete a Probation Notice. If the student’s performance remains unsatisfactory, the student will need to repeat the entire course.

Any student required to repeat a medical assisting course will be required to withdraw from the program and reapply to repeat the course the following year.

Grading Scale: The grading policy requires a grade of “C” or better to progress in

the Medical Assisting Program.

A = 100-90% B = 89-80% C = 79-70% D = 69-60% F = 59 and below

3

A. COURSE GOAL As a result of satisfactory completion of this course, the student should be prepared to: Perform a variety of administrative tasks related to the medical office such as; appointment scheduling, billing procedures, banking procedures and medical records management both in the paper and electronic formats. B. STUDENT LEARNING GOALS Mastery of the following learning goals will enable the student to achieve the overall course goal. Required Learning Goals Upon satisfactory completion of this course, the student will be able to: a. Operate the office phone system, schedule appointment, maintain

patient records, and handle the mail. b. Interpret the concept of the usual, customary, and reasonable fee

by using code manuals and fee schedule. c. Demonstrate knowledge of fee determination, extension of credit

and collections. d. Extract from previous bookkeeping and accounting records the

necessary data for the accountant to prepare the required tax records and forms.

e. Employ computer skills in completion of the computer assignments

which cover financial record keeping, insurance claims, banking functions, payroll and medical records.

f. Demonstrate of proper application and utilization of course

concepts regarding office procedures. g. Demonstrate knowledge of insurance principles by abstracting

information and completing a claim form to the specifications of the carriers involved for reimbursement.

4

COURSE LEARNING OUTCOMES Upon satisfactory completion of this course, the student should be prepared to: 1. Demonstrate proper telephone techniques in the medical office. 2. Schedule appointment using both manual and computerized methods. 3. Properly complete various medical forms. 4. Create and manage a patient medical record using manual and

computer methods.

5

CHAPTER 1 Competency-Based Education and the Medical Assistant Student PREPARATION: Read Chapter 1 in The Medical Assistant Complete Chapter 1 in the Study Guide CONTENT: Competency-based learning is ideal for adult learners who are attempting to understand new information and achieve new skills. Educators recognize the adult learners come to the classroom with different work-related experiences and educational background. Therefore, adult students have a wide range of understanding about the knowledge and skills that must be achieved in the program. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Discuss competency-based education and adult learners.

3. Summarize the importance of student portfolios in proving academic success and skill competency.

4. Examine your learning preferences and interpret how your learning style affects your success as a student.

5. Differentiate between adaptive and non-adaptive coping mechanisms.

6. Apply time management strategies to make the most of your learning opportunities.

7. Integrate effective study skills into daily activities.

8. Discuss test-taking strategies that help you take charge of your success.

9. Incorporate critical thinking and reflection to help you make mental connections as you learn material.

10. Analyze healthcare results as reported in graphs and tables.

11. Apply problem-solving techniques to manage conflict and overcome barriers to your success.

12. Relate assertiveness, aggressiveness and passive behaviors to professional communication and discuss the role of assertiveness in effective communication.

6

COMPETENCIES: Cognitive Knowledge:

V.C14. Relate to following behaviors to professional communication: a. assertive b. aggressive c. passive

V.C15. Differentiate between adaptive and non-adaptive coping mechanisms

II.C6. Analyze healthcare results as reported i: a. graphs b. tables

PROCEDURES:

None

7

CHAPTER 4 Therapeutic Communication _________________ PREPARATION: Read Chapter 4 in The Medical Assistant Complete Chapter 4 in the Study Guide CONTENT: Therapeutic communication skills developed by the medical assistant help set the tone of care in a healthcare facility. Patients who visit the healthcare facility may not be at their best, and the way the medical assistant reacts to and interacts with them can make an incredible difference in whether they view the facility and those who care for them positively or negatively. These interactions may also affect the patient’s treatment and recovery. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Discuss first impressions and patient-centered care.

3. Do the following related to communication.

• Identify styles and types of verbal communication. • Identify types of nonverbal communication. • Recognize and respond to verbal and nonverbal communication.

4. Recognize communication barriers.

5. Summarize factors that should be considered when communicating with diverse

patient populations.

6. Identify techniques for overcoming communication barriers.

7. Do the following related to communication during difficult times:

• Recognize the elements of oral communication using the sender-receiver process.

• Apply feedback techniques, including reflection, restatement, and clarification, to obtain information.

• Discuss open and closed questions or statements.

8. Discuss important factors about therapeutic communication across the life span.

9. List and explain the levels of Maslow’s hierarchy of needs.

8

COMPETENCIES: Cognitive Knowledge:

V.C1. Identify styles and types of verbal communication V.C2. Identify types of nonverbral communication V.C3. Recognize barriers to communication V.C4. Identify techniques for overcoming communication barriers V.C.5. Recognize the elemnts of oral communication using s sender-

receiver process V.C17. Discuss the theories of Maslow

Psychomotor Skills:

V.P1. Use feedback techniques to obtain patient information including: a. reflection b. restatement c. clarification

V.P2. Respond to nonverbral communication V.P.3. Use medical terminology correctly and pronounced accurately to communicate information to providers and patients

Affective Behavior: V.A.1. Demonstrate: a. empathy b. active listening c. nonverbral communication V.A.3. Demonstrate respect for individual diversity including: a. gender b. race c. religion d. age e. economic status f. appearance V.A.4. Explain to a patient the rationale for performance of a procedure

PROCEDURES:

4-1 Respond to Nonverbal Communication 4-2 Apply Feedback Techniques, Including Reflection, Restatement, and

Clarification, to Obtain Patient Information

9

CHAPTER 7 Technology and Written Communication PREPARATION: Read Chapter 7 in The Medical Assistant Complete Chapter 7 in the Study Guide CONTENT: The computer can be an effective tool in the medical office. It performs repetitive tasks, reduces errors, speeds up production, recalls information on command, saves time, reduces paperwork, and allows for more creative and productive use of worker’s time. Also, the medical assistant is required to send written communication to patients and other providers as directed by their provider-employers. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Explain what a personal computer is, and identify input and output hardware for personal computer.

3. Identify internal computer components, secondary storage devices, and network and Internet access devices.

4. Explain how to maintain computer hardware.

5. Identify principles of ergonomics that apply to a computer workstation.

6. Differentiate between:

• System software and application software. • Electronic medical records (EMRs) and a practice management system.

7. Explain the importance of data backup and other computer network security activities performed in the healthcare setting.

8. Discuss applications of electronic technology.

9. Recognize the elements of fundamental writing skills.

10. Explain the guidelines for using capitalization, numbers, and punctuation in business communication.

11. Describe each component of a professional business letter.

10

12. Summarize the formats for business letters and memorandums.

13. Compose professional correspondence using electronic technology. COMPETENCIES: Cognitive Knowledge:

V.C7. Recognize elements of fundamental writing skills V.C8. Discuss applications of electronic technology in professional

communication VI.C8. Differentiate between electronic medical records (EMR) and a

practice management system VI.C11. Explain the importance of data back-up XII.C7. Identify principles of:

b. ergonomics

Psychomotor Skills:

V.P8. Compose professional correspondence utilizing electronic technology

PROCEDURES:

7-1 Compose a Professional Business Letter 7-2 Compose a Professional E-mail

11

CHAPTER 8 Telephone Techniques PREPARATION: Read Chapter 8 in The Medical Assistant Complete Chapter 8 in the Study Guide CONTENT: This chapter is designed to help you to recognize how telephone management affects the caller’s regard for the office staff and the physician. The tone or climate of the office and its responsiveness to patients are transmitted over the phone. In addition to focusing on attitude development, information relating to the operation of equipment and the placing of calls will also be stressed. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Identify and explain the features of a multiple-line telephone system, and also explain how each can be used effectively in a healthcare facility.

3. Do the following related to effective use of the telephone:

• Discuss the telephone equipment needed by healthcare facility. • Summarize active listening skills. • Demonstrate effective and professional telephone techniques. • Consider the importance of tone of voice and enunciation.

4. Explain the importance of thinking ahead when managing telephone calls; also,

describe the correct way to answer the telephone in the office

5. Discuss the screening of incoming calls, and list several questions to ask when handling an emergency call.

6. Do the following related to taking message:

• Document telephone messages accurately. • List the seven elements of a correctly handled telephone message. • Report relevant information concisely and accurately.

7. Discuss various types of common incoming calls and how to deal with each.

8. Discuss various types of special incoming calls and how to deal with each.

12

9. Discuss how the medical assistant should handle various types of difficult calls.

10. Discuss typical outgoing calls, including why knowledge of time zones and long distance calling is necessary.

11. Discuss the use of a telephone directory, and describe how answering services and automatic call routing systems are used in a healthcare facility.

12. Discuss the legal and ethical issues related to telephone techniques.

COMPETENCIES: Psychomotor Skills:

V.P6. Demonstrate professional telephone techniques V.P7. Document telephone messages accurately V.P11. Report relevant information concisely and accurately

PROCEDURES:

8-1 Demonstrate Professional Telephone Techniques 8-2 Document Telephone Messages and Report Relevant Information Concisely and

Accurately

13

CHAPTER 9 Scheduling Appointments and Patient Processing________ PREPARATION: Read Chapter 9 in The Medical Assistant Complete Chapter 9 in the Study Guide CONTENT:

In this chapter you will become acquainted with the task of organizing and coordinating appointments. You may first perceive this task as somewhat simplistic and insignificant. On the contrary, the responsibilities of scheduling appointments are indeed challenging and require intelligence and good organizational skills. It is here in scheduling appointments that the physician’s entire medical practice is orchestrated. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Describe guidelines to establishing appointment schedule and creating an appointment matrix.

3. Discuss the advantages of computerized appointment scheduling.

4. Discuss appointment book scheduling and explain how self-scheduling

can reduce the number of calls to the healthcare facility.

5. Discuss the legality of the appointment scheduling system.

6. Discuss pros and cons of various types of appointment management systems.

7. Discuss telephone scheduling and identify critical information required for

scheduling appointments for new patients.

8. Discuss scheduling appointments for established patients.

9. Discuss how the medical assistant should handle scheduling other types of appointments.

14

10. Do the following related to special circumstances in scheduling:

• Discuss several methods of dealing with patients who consistently arrive late.

• Recognize office policies and protocols for rescheduling appointments.

• Discuss how to deal with emergencies, provider referrals, and patients without appointments.

11. Discuss how to handle failed appointments and no-shows, as well as methods to increase appointment show rates.

12. Discuss how to handle cancellations and delays. 13. Discuss patient processing, including the importance of the reception area. 14. Describe how to prepare for patient arrivals, including patient check-in procedures. 15. Explain why using the patient’s name as often as possible is important, as well as how the medical assistant can make patients feel at ease. 16. Describe registration procedures, including obtaining a patient history. COMPETENCIES: Cognitive Knowledge:

VI.C1. Identify different types of appointment scheduling methods VI.C2. Identify advantages and disadvantages of the following

appointment systems: a. manual b. electronic appointment systems

VI.C3. Identify critical information required for scheduling patient procedures

VI.A1. Display sensitivity when managing appointments

15

Psychomotor Skills:

V.P4. Coach patients regarding: a. office policies

VI.P1. Manage appointment schedule using established priorities VI.P2. Schedule a patient procedure VII.P3. Obtain accurate patient billing information

Affective Behavior:

VI.A1. Display sensitivity when managing appointments

PROCEDURES: 9-1 Establish the Appointment Matrix 9-2 Schedule a New Patient 9-3 Create the New Patient Brochure

9-4 Schedule an Established Patient 9-5 Schedule a Patient Procedure

16

CHAPTER 10 Daily Operations in the Ambulatory Care Setting_______ PREPARATION: Read Chapter 10 in The Medical Assistant Complete Chapter 10 in the Study Guide CONTENT: In the healthcare facility, employees must arrive before patients to prepare for the patients. The preparation can differ based on the size of the facility and the practice’s policies on preparation. Also one of the most important responsibilities of the medical assistant is to manage the equipment and supplies in the medical office. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Describe the administrative and clinical opening duties performed by the medical assistant.

3. Discuss the administrative and clinical closing responsibilities performed by the medical assistant, as well as daily and monthly duties.

4. Explain safety and security procedures important in the healthcare facility.

5. Do the following related to equipment in a medical practice:

• Describe the elements of an equipment inventory list. • Explain the purpose of routine maintenance of administrative and clinical

equipment. • Explain the steps of creating a maintenance log, performing maintenance,

and documenting the maintenance. • Describe the medical assistant’s role in ordering equipment.

6. Do the following related to supplies in the medical practice.

• Discuss the elements on a supply inventory list. • List the steps involved in completing an inventory. • Perform an inventory with documentation. • Prepare a supply order.

7. Describe how the healthcare facility utilizes USPS and other delivery agencies.

8. Use proper body mechanics.

17

COMPETENCIES: Cognitive Knowledge:

VI.C9. Explain the purpose of routine maintenance of administrative and clinical equipment

VI.C10. List steps involved in completing an inventory XII.C7. Identify principles of:

a. body mechanics

Psychomotor Skills:

VI.P8. Perform routine maintenance of administrative or clinical equipment VI.P9. Perform an inventory with documentation XII.P3. Use proper body mechanics

PROCEDURES: 10-1 Perform Equipment Inventory 10-2 Perform Routine Maintenance of Administrative or Clinical Equipment 10-3 Perform an Inventory of Supplies While Using Proper Body Mechanics 10-4 Prepare a Purchase Order

18

CHAPTER 11 The Health Record PREPARATION: Read Chapter 11 in The Medical Assistant Complete Chapter 11 in the Study Guide CONTENT:

The two types of patient’ records are the paper health record and the EHR. With the advances in computer technology, the paper health record has been shown to be much less efficient than EHR. Having learned the concepts related to organizing the patient record, you are ready to integrate the organization of medical records collectively. The chapter introduces filing management systems and mechanics related to maintaining equipment, taking inventory and managing personnel records. The legal implications of the medical record, filing, retrieval and storage must be continuously emphasized. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Name and discuss the two types of patient records.

3. State several reasons that accurate health records are important.

4. Differentiate between objective and subjective information in creating a patient’s health record.

5. Explain who owns the medical record.

6. Distinguish between an electronic health record (EHR) and an electronic medical record (EMR).

7. Do the following related to healthcare legislation and EHRs:

• Explain how the American Recovery and Reinvestment Act (ARRA)

applies to the healthcare industry. • Define meaningful use and relate it to the healthcare industry. • List the three main components of meaningful use legislation.

8. Explore the advantages, disadvantages, and capabilities of an EHR system, and

explain how to organize a patient’s health record.

9. Discuss the importance of nonverbal communication with patients when an EHR system is used.

19

10. Discuss backup systems for the EHR, as well as the transfer, destruction, and retention of health records as related to the EHR.

11. Describe how and when to release health record information; discuss health information exchanges (HIEs).

12. Identify and discuss the two methods of organizing a patient’s paper medical

record.

13. Discuss how to document information in an EHR and a paper health record, and how to make corrections/alterations to health records.

14. Discuss dictation and transcription, and discuss transfer, destruction, and retention of medical records as related to paper records.

15. Identify both equipment and filing supplies needed to create, store, and maintain

medical records.

16. Describe indexing rules, and how to create and organize a patient’s health record.

17. Discuss pros and cons of various filing methods, as well as how to file patient

health records.

18. Discuss organization of files, as well as health-related correspondence.

19. Discuss patient education, as well as legal and ethical issues, related to the health record.

COMPETENCIES: Cognitive Knowledge:

VI.C4. Define types of information contained in the patient’s medical record

VI.C5. Identify methods of organizing the patient’s medical record based on: a. problem-oriented medical record POMR b. source-oriented medical record SOMR

VI.C6. Identify equipment and supplies needed for medical records in order to: a. Create b. Maintain c. Store

20

VI.C7. Describe filing indexing rules VI.C8. Differentiate between electronic medical records (EMR) and a

practice management system VI.C12. Explain meaningful use as it applies to EMR

Psychomotor Skills:

VI.P3. Create a patient’s medical record VI.P4. Organize a patient’s medical record VI.P5. File patient medical records VI.P6. Utilize an EMR VI.P7. Input patient data utilizing a practice management system

Affective Behavior:

X.A2. Protect the integrity of the medical record

PROCEDURES: 11-1 Register a New Patient in the Practice Management Software. 11-2 Upload Documents to the Electronic Health Record 11-3 Create and Organize a Patient’s Paper Health Record 11-4 File Patient Health Records

21

CHAPTER 12 Basics of Diagnostic Coding __ PREPARATION: Read Chapter 12 in The Medical Assistant Complete Chapter 12 in the Study Guide CONTENT:

The objective of this chapter is the understanding of assigning and reporting codes that are clearly supported by concise documentation in the patient chart. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Describe the historical use of the International Classification of Disease (ICD) in the United States.

3. Describe transition from ICD-9-CM diagnostic coding to ICD-10-CM diagnostic coding.

4. Identify the structure and format of the ICD-10-CM.

5. Describe how to use the Alphabetic Index to select main terms, essential modifiers, and the appropriate code (or codes) and code ranges.

6. Do the following related to the Tabular list:

• Explain how to use the Tabular List to select main terms, essential modifiers, and the appropriate code (or codes) and code ranges.

• Summarize coding conventions as defined in the ICD-10-CM coding manual.

7. Review coding guidelines to assign the most accurate ICD-10-CM diagnostic codes.

8. Explain how to abstract the diagnostic statement from a patient’s health record.

9. Describe how to use the most current diagnostic codes and perform diagnostic codeing.

10. Identify how encoder software can help the coder assign the most accurate

diagnostic codes.

22

11. Explain the importance of coding guidelines for accuracy, and discuss special rules and considerations that apply to the code selection process.

12. Use tactful communication skills with medical providers to ensure accurate code selections.

13. Review medical coding ethical standards. OMPETENCIES: Cognitive Knowledge:

IX.C2. Describe how to use the most current diagnostic coding classification system

Psychomotor Skills:

IX.P2. Perform diagnostic coding

Affective Behavior:

IX.A1. Utilize tactful communication skills with medical providers to ensure accurate code selection

PROCEDURES: 12-1 Perform Coding Using the Current ICD-10-CM Manual

23

CHAPTER 13 Basics of Procedural Coding Preparation: Read Chapter 13 in The Medical Assistant Complete Chapter 13 in the Study Guide CONTENT:

In this chapter the medical assistant facilitates accurate medical record keeping and the efficient processing of claims by using the CPT coding and HCPS code, which identifies appropriate procedures and services common to the physician’s office. LEARNING OBJECTIVES:

1. Define, spell, and pronounce the terms listed in the vocabulary.

2. Describe the organization of the Current Procedural Terminology (CPT) manual.

3. Report the history of procedural coding.

4. Distinguish between the Alphabetic Index and the Tabular List in the CPT code set.

5. Classify the six different sections of the CPT code set.

6. Discuss special reports, and explain the importance of modifiers in assigning CPT codes.

7. Review various conventions in the CPT code set.

8. Identify the required medical documentation for accurate procedural coding.

9. Describe how to use the most current procedural coding system and perform procedural coding for surgery.

10. Discuss how to use the Alphabetic Index..

11. Identify common CPT coding guidelines for evaluation and management (E/M) procedures.

12. Identify common CPT coding guidelines for anesthesia procedures.

13. Identify common CPT coding guidelines for surgical procedures.

14. Discuss coding factors for the integumentary system and muscular system, and for maternity care and delivery.

24

15. Identify common CPT coding guidelines for Radiology, Pathology and Laboratory, and Medicine sections.

16. Do the following related to the HCPS code set and manual:

• Identify procedures and services that requires HCPS codes. • Describe how to use the most current HCPS level II coding system.

17. Perform procedural coding of an office visit and an immunization.

18. Summarize common HCPS coding guidelines.

COMPETENCIES: Cognitive Knowledge:

IX.C1. Describe how to use the most current procedural coding system IX.C3. Describe how to use the most current HCPCS level II coding

system

Psychomotor Skills:

IX.P1. Perform procedural coding

Affective Behavior:

IX.A1. Utilize tactful communication skills with medical providers to ensure accurate code selection

PROCEDURES: 13-1 Perform Procedural Coding: Surgery 13-2 Perform Procedural Coding: Office Visit and Immunization

25

CHAPTER 14 Basics of Health Insurance PREPARATION: Read Chapter 14 in The Medical Assistant Complete Chapter 14 in the Study Guide CONTENT:

The objective of this chapter is the understanding of how insurance plans handle reimbursement of benefits this is challenging for a patient as well as the medical assistant. LEARNING OBJECTIVES:

1. Define, spell and pronounce the terms listed in the vocabulary.

2. Discuss the purpose of health insurance and explain the health insurance contract between the patient and the health plan.

3. Identify types of third-party plans. 4. Discuss the Affordable Care Act’s effect on patient access. 5. Summarize the different health insurance benefits available and interpret information on a health insurance identification (ID) card. 6. Explain the importance of verifying eligibility and be able to verify eligibility of services, including documentation. 7. Explain the health insurance contract between the healthcare provider and the health insurance company. 8. Explain how insurance reimbursements are determined and discuss the effect health insurance has on provider reimbursements.

9. Summarize privately sponsored health insurance plans. 10. Differentiate among the different types of managed care models. 11. Outline managed care requirements for patient referral and obtain a referral with documentation. 12. Describe the process for preauthorization and how to obtain preauthorization including documentation.

26

13. List and discuss various government-sponsored plans.

14. Review employer-established self-funded plans. COMPETENCIES: Cognitive Knowledge:

VIII.C1. Identify: a. types of third party plans.

VIII.C2. Outline managed care requirements for patient referral VIII.C3. Describe processes for:

a, verification of eligibility for services c. preauthorization

Psychomotor Skills:

VIII.P1. Interpret information on an insurance card VIII.P2. Verify eligibility of services including documentation VIII.P3. Obtain preauthorization including documentation

PROCEDURES: 14-1 Interpret Information on an Insurance Card 14-2 Verify Eligibility of Services, Including Documentation 14-3 Obtain a Referral with Documentation 14-4 Obtain Preauthorization for a Surgical Procedure with Documentation

27

CHAPTER 15 Medical Billing and Reimbursement _ PREPARATION: Read Chapter 15 in The Medical Assistant Complete Chapter 15 in the Study Guide CONTENT:

Insurance processing in the medical office is undergoing major transitions. The use of computerized systems of insurance processing in the medical office is increasing. Concepts and general objectives related to insurance processing should be stressed, but it should be emphasized that the insurance business continually undergoes change and the health care system as a whole is in the process of restructuring. LEARNING OBJECTIVES:

1. Define, spell, and pronounce the terms listed in the vocabulary.

2. Identify steps for filing a third-party claim.

3. Identify the types of information contained in the patient’s billing record.

4. Apply managed care policies and procedures, describe processes for precertification, and obtain precertification, including documentation.

5. Explain how to submit health insurance claims, including electronic claims, to various third-party payers.

6. Review the guidelines for completing the CMS-1500 Health Insurance Claim Form, and complete an insurance claim form.

7. Differentiate between fraud and abuse.

8. Discuss the effects of upcoding and downcoding.

9. Discuss methods of preventing the rejection of claims, and display tactful

behavior when speaking with medical providers about third-party requirements.

10. Describe ways to checking a claim’s status.

11. Review and read an Explanation of Benefits.

12. Discuss reasons for denied claims.

28

13. Define “medical necessity” as it applies to diagnostic and procedural coding; also, apply medical necessity guidelines.

14. Explain a patient’s financial obligations for services rendered, and inform a patient of these obligations.

15. Show sensitivity when speaking with patients about third-party requirements.

COMPETENCIES: Cognitive Knowledge:

VII.C5 Identify types of information contained in the patient's billing record VII.C6. Explain patient financial obligations for services rendered VIII.C1. Identify:

b. information required to file a third party claim c. the steps for filing a third party claim

VIII.C3. Describe processes for: c. precertification

VIII.C5. Differentiate between fraud and abuse IX.C4. Discuss the effects of:

a. upcoding b. downcoding

IX.C5. Define medical necessity as it applies to procedural and diagnostic coding

Psychomotor Skills:

VII.P4. Inform a patient of financial obligations for services rendered VIII.P1. Interpret information on an insurance card VIII.P3. Obtain precertification including documentation VIII.P4. Complete an insurance claim form IX.P3. Utilize medical necessity guidelines

29

Affective Behavior

VII.A1. Demonstrate professionalism when discussing patient’s billing record VIII.A2. Display tactful behavior when communicating with medical providers regarding third party requirements VIII.A3. Show sensitivity when communicating with patients regarding third party requirements

PROCEDURES: 15-1 Show Sensitivity When Communicating With Patients Regarding Third-Party

Requirements 15-2 Perform Precertification with Documentation 15-3 Complete an Insurance Claim Form 15-4 Utilize Medical Necessity Guidelines: Respond to a “Medical Necessity Denied”

Claim 51-5 Inform a Patient of Financial Obligations for Services Rendered

30

CHAPTER 16 Patient Accounts, Collection, and Practice Management______ PREPARATION: Read Chapter 16 in The Medical Assistant Complete Chapter 16 in the Study Guide CONTENT: Every patient encounter is a financial transaction for a healthcare facility. Transactions generated by the patient encounter include a variety of charges, payments, and adjustments that need to be accounted for on a daily basis. Financial management is essential if the owner of a healthcare practice is to pay his or her business operating expenses. LEARNING OBJECTIVES:

1. Define, spell, and pronounce the terms listed in the vocabulary.

2. Define bookkeeping and all the different transactions recorded in patient accounts.

3. Do the following related to patient account records:

• List necessary data elements in patient account records. • Discuss a pegboard (manual bookkeeping) system. • Explain when transactions are recorded in the patient account. • Perform accounts receivable procedures for patient accounts, including

charges, payments, and adjustments.

4. Describe special bookkeeping procedures for patient account records, including credit balances, third-party payments, and refunds; explain how to interact professionally with third-party representatives.

5. Discuss payment at the time of service, and give an example of displaying sensitivity when requesting payment for services rendered.

6. Describe the impact on the Truth in Lending Act on collections policies for patient accounts.

7. Discuss ways to obtain credit information, and explain patient billing and

payment options.

8. Review policies and procedures for collecting outstanding balances on patient accounts.

31

9. Do the following related to collection procedures:

• Describe successful collection techniques for patient accounts. • Discuss strategies for collecting outstanding balances through personal

finance interviews. • Describe types of adjustments made to patient accounts, including

nonsufficient checks (NSF) and collection agency transactions.

10. Define bookkeeping terms, including accounts receivable and accounts payable.

11. Discuss patient education, in addition to legal and ethical issues, related to patient accounts, collections, and practice management.

COMPETENCIES: Cognitive Knowledge:

VII.C1. Define the following bookkeeping terms: a. charges b. payments c. accounts receivable d. accounts payable e. adjustments

VII.C4. Describe types of adjustments made to patient accounts including:

b. collection agency transaction c. credit balance d. third party

Psychomotor Skills:

VII.P1. Perform accounts receivable procedures to patient accounts including posting: a. charges b. payments c. adjustments

32

Affective Behavior:

VII.A2. Display sensitivity when requesting payment for services rendered VIII.A1. Interact professionally with third party representatives

PROCEDURES: 16-1 Perform Accounts Receivable Procedures for Patient Accounts: Charges 16-2 Perform Accounts Receivable Procedures for Patient Accounts: Payments and

Adjustments

33

CHAPTER 17 Banking Services and Procedures PREPARATION: Read Chapter 17 in The Medical Assistant Complete Chapter 17 in the Study Guide CONTENT: Financial transactions in the professional office nearly always involve banking services and the use of checks. Therefore, a medical assistant must understand the responsibilities involved in accepting payments, endorsing and depositing checks, writing checks, and regularly reconciling bank statements. LEARNING OBJECTIVES 1. Define, spell, and pronounce the terms listed in the vocabulary. 2. Explain the purpose of the Federal Reserve Bank and the types of banks it

manages.

3. Identify common types of bank accounts. 4. Do the following related to banking in today’s business world:

• Discuss the importance of signature cards. • Explain how online banking has made standard banking processes

more efficient. • Review the benefits of customer-oriented banking.

5. Do the following related to checks:

• Compare different types of negotiable instruments. • Identify precautions in accepting checks from patients. • Explain how checks are processed from one account to another. • Review the procedure followed when the healthcare facility

receives a nonsufficient funds (NSF) check.

6. Identify precautions in accepting cash. 7. Discuss the use of debit and credit cards, including advantages and precautions.

34

8. Do the following related to banking procedures in the ambulatory care setting:

• Describe banking procedures as related to the ambulatory care setting.

• Explain the importance of depositing checks daily. • Prepare a bank deposit. • Compare types of check endorsements.

9. Review check-writing procedures used to pay the operational expenses of a healthcare facility. 10. Understand the purpose of bank account reconciliation for auditing purposes. 11. Discuss patient education, as well as legal and ethical issues, related to banking services and procedures. COMPETENCIES: Cognitive Knowledge:

VII.C2. Describe banking procedures as related to the ambulatory care setting

VII.C3. Identify precautions for accepting the following types of payments: a. cash b. check c. credit card d. debit card VII.C4. Describe types of adjustments made to patient accounts including: a. non-sufficient funds (NSF) checks

Psychomotor Skills: VII.P2. Prepare a bank deposit

PROCEDURES: 17-1 Prepare a Bank Deposit

35

CHAPTER 18 Supervision and Human Resource Management PREPARATION: Read Chapter 18 in The Medical Assistant Complete Chapter 18 in the Study Guide CONTENT: The management of a professional healthcare facility can greatly influence the success of the business. Good management allows the provider to see and treat patients in a functional environment with the confidence that the business side of the facility is operating as it should be. LEARNING OBJECTIVES:

1. Define, spell, and pronounce the terms listed in the vocabulary.

2. Define the qualities and responsibilities of a successful office manager in a healthcare facility.

3. Explain the chain of command in the medical office.

4. Do the following related to the power of motivated:

• Identify several ways in which employees are motivation. • Explain how the abuse of power and authority can negatively affect

productivity in a healthcare facility.

5. Do the following related to creating a team atmosphere:

• Discuss strategies to create a team environment in the healthcare facility. • Recognize and overcome communication barriers. • Demonstrate respect for individual diversity, including gender, race,

religion, age, economic status, and appearance.

6. Summarize strategies to introduce a new office manager.

7. List several ways to prevent burnout.

8. Do the following related to finding the right employee for the job: • Identify the need to find the right employee for an opening in the medical

office. • Review a general job description for medical assistants. • Explain how to search through resumes and applications for potential

candidates.

36

• List and discuss legal and illegal interview questions. • Explain how to select the most qualified candidates. • Identify follow-up activities the office manager should perform after an

interview.

9. Review new employee orientation, including paperwork, training and development; also explain how to conduct a staff meeting with an agenda.

10. Discuss strategies for addressing a problem employee, giving an employee a poor evaluation, terminating an employee, and determining fair salaries and raises.

COMPETENCIES: Cognitive Knowledge:

V.C3. Recognize barriers to communication V.C4. Identify techniques for overcoming communication barriers X.C9. List and discuss legal and illegal applicant interviews questions

Affective Behavior:

V.A3. Demonstrate respect for individual diversity including: a. gender b. race c. religion d. age e. economic status f. appearance

PROCEDURES: 18-1 Prepare for a Staff meeting

37

CHAPTER 19 Medical Practice Marketing and Customer Service PREPARATION: Read Chapter 19 in The Medical Assistant Complete Chapter 19 in the Study Guide CONTENT: A medical practice is a business; therefore, success lies in bringing in new patients and retaining current patients to maintain cash flow. Marketing and customer service are both essential for a healthcare facility to grow. LEARNING OBJECTIVES:

1. Define, spell, and pronounce the terms listed in the vocabulary.

2. Do the following related to the marketing needs of a healthcare practice: • Explain the need for marketing for a healthcare facility. • Identify the target market. • Discuss why a SWOT analysis is important to identify the target market.

3. Do the following related to marketing tools:

• Review ways a healthcare practice or facility can promote their practice

through community involvement. • Define and discuss automated call distribution. • Explain how newsletters and blogs can be effective marketing tools. • Discuss marketing through print ads in magazines and newspapers. • Determine the value of Internet marketing for a healthcare practice or

facility.

4. Distinguish between advertising and public relations.

5. Discuss the value of marketing through social media.

6. Develop website content, organization, and design to attract new patients; also review strategies to increase website traffic.

7. Explain how to successfully deliver high-quality customer service, including how to identify with patients, and the value of patient surveys.

8. Identify strategies to manage problem patients. 9. Review the importance of the new patient information packet, and develop a current list of community resources related to patients’ healthcare needs.

38

10. In the role of patient navigator, facilitate referrals to community resources. 11. Define a patient-centered medical home (PCMH). 12. Discuss applications of electronic technology in professional communication. COMPETENCIES: Cognitive Knowledge:

V.C8. Discuss applications of electronic technology in professional communication

V.C12. Define patient navigator V.C13. Describe the role of the medical assistant as a patient navigator VIII.C4. Define a patient-centered medical home (PCMH)

Psychomotor Skills:

V.P9. Develop a current list of community resources related to patients’ healthcare needs

V.P10. Facilitate referrals to community resources in the role of a patient navigator

PROCEDURES: 19-1 Develop a Current List of Community Resources Related to Patients’ Healthcare

Needs and Facilitate Referrals Revised July /2016sb