Interested in what administrative tasks and knowledge a medical assistant needs to be successful? The medical assistant manages multiple tasks and needs extensive administrative knowledge to perform their job responsibilities on a day-to-day basis.
Medical Assistant Administrative Tasks
The medical assistant does many different administrative tasks in the course of work each day, they include:
• Schedule and monitor patient appointments using electronic health record database and paper-based systems
• Verify insurance coverage/financial eligibility based on health insurance plan
• Identify and check-in patients that are seeing the physician for an exam, treatment or procedure
• Verify diagnostic and procedural codes
• Obtain and verify prior authorizations and pre-certifications from insurance companies.
• Prepare documentation, claims and billing requests using current coding guidelines
- ICD-10 – the international classification of diseases. A system used by medical facilities to classify and code all diagnoses, symptoms and procedures.
- CPT – current procedural terminology. Medical code set used to report medical, surgical and diagnostic procedures to health insurance companies and healthcare providers.
• Ensure that documentation complies with government and insurance requirements
• Perform charge reconciliation, entering charges, making adjustments, and accounts receivable procedures.
• Processing bills for patients, insurers, and third-party payers for services performed
• Resolve billing issues with insurers and third-party payers
- Appeals – if the health insurer refuses to pay a claim, the medical assistant will appeal the decision and have it reviewed by a third-party.
- Denials – refusal of an insurance company or carrier to honor a request by an individual to pay for health care services.
• Manage electronic health records and paper medical records
• Facilitate referrals to other healthcare providers for special exams and procedures.
• Provide customer service and facilitate service recovery
- Follow up patient calls after treatment or procedures to check on the patient.
- Appointment confirmations by phone or email
- Collect on accounts that are current and past due
• Enter information into databases or spreadsheets
- Excel – computer software program used to store, organize and manipulate data.
- EHR – Electronic Health Records; comprehensive electronic version of the patients’ complete medical history
- EMR – Electronic Medical Records; electronic version of one physician’s medical records and notes
- Billing Modules – offers a central workflow to connect information capture between different departments.
- Scheduling Systems – allows the medical assistant to keep track of patient appointments for many different physicians and nurses. It also helps them control labor costs.
• Participate in safety evaluations and report safety concerns
• Maintain inventory of clinical and administrative supplies
Medical Assistant Administrative Knowledge
The medical assistant learns knowledge to help them succeed in the medical field while attending a Medical Assisting Program. They must have knowledge of filing systems, scheduling software, telephone etiquette, records management, legal requirements, chart review, government regulations, advanced beneficiary notice, auditing methods, and data entry.
Filing systems – a way in which files are named and where they are placed logically for storage and retrieval.
Scheduling software – helps medical assistants manage appointments and bookings.
• Desktop Applications – maintained on the medical assistants’ computer to create reports and handle scheduling.
• Web-Based Systems – third-party service offers appointment scheduling tools and features accessible by multiple users.
Triage – recognition of urgency of appointment needs
Requirements Related to Duration of Visit – the visit duration depends on the type of medical treatment, exam or procedure and how busy the medical professional is that the patient is seeing.
Telephone Etiquette – it is important for the medical assistant to be consistently polite even when talking to unhappy customers. Calls should be answered as quickly as possible.
Records Management Systems and Software – an organization through the medical records life-cycle including the control of the creation, maintenance, and destruction of medical records.
• Alphabetical – use indirect access, with users locating file headings through a hierarchical or alphabetical list that indicates codes used for filing or retrieval.
• Numeric – a method of classifying medical files for storage and access through the use of numbers that represent a concept.
• Office Storage for Archive Files – paper medical records can be kept on-site in warehouses including Iron Mountain where the medical records are given a reference number for easy retrieval.
• EMR/EHR Software Applications – digital way to create and manage medical records for one physician or throughout a healthcare system.
Legal Requirements Related to Maintenance, Storage, and Disposal of Records – state laws or regulations define the requirements and conditions related to medical records. In the absence of these laws, the HIPPA privacy rule prevails.
• HIPAA – a federal law that sets a national standard to protect medical records and confidential patient information.
• The Privacy Act of 1974 – gives individuals the right to access and request amendments to their medical records.
Categories of the Medical Record – they include administrative, clinical, billing, procedural, notes and consents.
• Administrative – include patient demographics including identifying numbers, date of birth, addresses and contact numbers.
• Clinical – all correspondence relating to clinical matters, laboratory results, X-rays, photographs, videos and audio recordings.
• Billing – records for payment, insurance claims and other billing information between the patient, service provider and insurance company.
• Procedural – medical records that contain information about the action taken and the outcomes of the medical procedure.
• Notes – handwritten physician or medical assistant notations
• Consents – a signed form by a patient prior to a medical procedure to confirm that they agree to the procedure and are aware of any risks that might be involved.
Required Documentation for Patient Review and Signature – the documentation should include the reason for the encounter, relevant history, findings, test results and date of service. It should also include the assessment and impression of the diagnosis and the plan of care with date and identity of observer.
E-referrals – enable the seamless transfer of patient information from one physician to another.
Financial Eligibility, Sliding Scales, and Indigent Programs – financial eligibility is based on the insurance plan chosen, plan premium, the deductible, co-pay and other medical costs.
• Sliding Scales – used to meet the needs of the uninsured or underinsured, providing reduced costs on medical services for those that qualify. No one will be denied access to services at Primary Health Networks, as services are offered regardless of insurance status or ability to pay.
• Medically Indigent Adult (MIA) – a person who does not have health insurance and who are not eligible for other health care coverage. Many government programs help medically indigent adults pay for medical care.
Government Medical Regulations – a rule of order having the force of law, prescribed by an authority, relating to the actions of those in the medical industry.
• Meaningful Use Regulations – The Medicare and Medicaid EHR Incentive Programs provide financial incentives for the “meaningful use” of certified EHR technology.
• MACRA – the Medicare Access and CHIP Reauthorization Act which replaces the current Medicare reimbursement schedule with a new pay-for-performance program. MACRA rewards health care providers for giving better care instead of more service.
• MIPS – Merit-Based Incentive Payment System based on four categories including, quality, resource use, clinical practice improvement activities, and meaningful use of certified electronic health records (EHR) technology.
Advanced beneficiary notice (ABN) – a waiver of liability or a notice a provider should give to the patient before they receive a service that their provider has reason to believe Medicare or insurance will not pay for.
Specialty pharmacies – compounding and nuclear pharmacies that dispense radioactive materials for use in nuclear medicine.
• Liquid – referred to as elixirs, syrups, solutions or mixtures. Liquids are used for those patients that have difficulty swallowing tablets.
• Elixir – a sweetened liquid usually containing alcohol used in medication for its medicinal ingredients.
• Balm – a healing or soothing substance that is applied to the outer portion of the body.
• Ointment – a smooth oily preparation that is rubbed on the skin for medicinal purposes.
Insurance Terminology – a medical assistant must become familiar with insurance terms to process charts, insurance and help educate patients.
• Co-Pay – a payment made by a beneficiary for medical services in addition to the payment made by an insurer.
• Co-Insurance – a type of insurance where the insured pays a share of the payment made against a medical claim.
• Deductible – a specified amount of money that the insured must pay before an insurance company will pay a claim.
• Tier Levels – the levels of payment that a medical plan will pay for medical services. Most coverage levels are categorized by Bronze, Silver, Gold and Platinum and are given the tier based on the percentage of the cost of medical services they will pay for an insured.
• Explanation of Benefits – a statement sent by a health insurance company to the insured explaining what medical treatments and services were paid for on their behalf.
Accounts Receivable – money owed to the medical facility by a patient or third-party vendor.
• Aging Reports – the list of unpaid customer invoices and unused credit memos by date range. Used to determine which invoices are overdue for payment.
• Collections Due – the cost of services that are overdue.
• Adjustments – allocating payments to the period in which they actually occurred so income and expenses match.
• Write-Offs – a cancellation from a patient’s account of a bad debt.
Online Banking for Deposits and Electronic Transfers – a method of banking in which transactions are conducted electronically via the Internet.
Authorizations to Approve Payment Processing – the approval of electronic debit or credit card transactions for payment by the issuer to the medical facility.
Auditing Methods, Processes, and Sign-Offs
• Product Audits – an examination of products to evaluate whether they conform to requirements.
• Process Audits – a verification of processes working in established limits including time, accuracy, temperature, pressure, composition, responsiveness, and component mixture.
• System Audit – documented activity performed to verify, by examination and evaluation of objective evidence, the applicable elements of the system are appropriately delivered, documented and implemented in accordance with specified requirements.
Data Entry and Data Fields – the medical assistant should be proficient at QWERTY and 10-Key typing for proper charting, billing and management of electronic records.
Enjoy being part of a team that cares about their patients? Want to become a medical assistant? PCI Health Training Center’s Medical Assistant programs prepares a graduate to work as an entry-level Medical Assistant. Within this general career category there are several specialty areas, including Medical Administrative Office Assistant, Clinic Assistant, Clinic Tech, Medical Office Manager, Phlebotomist, Physical Therapy Aide in a doctor’s office, clinic or hospital out-patient clinic. Contact PCI Health Training Center for more information on how to become a medical assistant and start a rewarding career today.
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