Welcome to Registration and Insurance. This PowerPoint presentation is part of the ABR MOB module prepared by the American Association of Medical Assistants. This presentation will cover content for medical assistants working the front lines in a medical practice. We will dive into skills required to effectively work in the front office and talk about different methods to increase productivity and workflow and customer satisfaction. At the end of this presentation, the participants will be able to do the following. List responsibilities for maintaining a safe and secure reception area. Identify required skills of a medical practice receptionist. List key steps to open the practice. Describe proper techniques for answering the telephone in a medical practice. List information required for a detailed telephone message. Identify common appointment scheduling systems used in the practice. Describe the notice of privacy practice. Describe the check-in process. Identify the importance of having knowledge regarding practice equipment. Describe types of third-party coverages. Describe the verification process of accepting health care coverage on a patient. List steps for patient checkout, appointment referrals, and follow-up visits. Identify work habits to improve workflow. Describe characteristics that will improve customer service. List steps to secure the practice at the end of the day. Properly trained staff are essential to maintain calm in the presence of urgency. Regular training of all staff allows an open forum for employees to ask questions and learn or relearn protocols in the office. Working as a team will promote uniformity and consistency even with the different educational levels of the staff. Everyone should know which room is the safest in case of a tornado, where are the exits in case of a fire, where is the crash cart located, and what is a BVM in case asked. Take action yourself. Put lights out in the parking area or entrance and staff exits. Report walkway and driveway damages. Holes in pavement can lead to trips and falls in possible lawsuits. Install deadbolts for the entrance doors if your office is not secure. Install buzzer systems to allow entrance to clinical or back areas. This controls admission to the clinical area. Prevent slip, trip, and fall risks. If you see a potential for a slip, trip, or fall, report it, remove it, fix it. Keep all exits clear. Do not pile boxes in front of exit doors. This is a fire marshal citation. Finally, use caution signs, wet floors, wet paint. Does your office have an evacuation plan? A map of the office where a patient or a staff member can see where they're at and quickly find a safe exit. Safety starts with yourself. Lift objects carefully. Don't hurt your back. Use your legs. Get a dolly. Ask for help. Do you know how to use equipment in the office? Read directions. Follow the manual. How about that fire extinguisher in the corner? Most offices will have a class ABC fire extinguisher that covers paper, wood, plastic, flammables, liquid, gas, and electrical. Do you know how to use it? Remember the word PASS. Pull pin at the top of the extinguisher. Aim at the base of the fire. Squeeze the handle to slowly release the extinguishing agent. Then sweep from side to side until the fire is out. Everyone should know how to use a fire extinguisher. Limit access to physical property by keeping doors locked. Patient secure by limiting only patients to the back office. Learn emergency protocols. Report on safe conditions to your supervisor. Complete safety training yearly. Practice fire drills, tornado drills. Is the entire staff current in CPR? Know the practice workplace safety plan. Look for it or create one. Review it after an emergency to improve on procedures. Medical practice security starts on the outside. Many buildings have cameras on the parking lot, entrances, and exits to the building. Cyber security is critical. All practices must have network or cloud security on their office computers. Limiting access to online activities to only practice related searches. Ransomware is introduced into a practice computer just by a little phishing scam where an email is sent to an employee. It looks legitimate, but items on it, spelling is wrong, letters are wrong, characters. If it gives you a sense of this is not right, it's not right. It's a ransomware attack and they want your sensitive data. So you need to protect the practice and yourself from them gaining access to bank accounts, credit cards, patient information. There are criminal threats everywhere to our patients in practice. So we have to be very careful. Be aware of your surroundings and patients in the practice. As a receptionist, you see patients coming in and going. Always look for inconsistencies. Maybe the caregiver doesn't look correct. The dress of someone, somebody's wearing a big baggy coat and it's 90 degrees out. What are they carrying in the bag that looks very large? If it looks dangerous, it could possibly be dangerous. Unfortunately, we have seen cases of shootings in medical practices. So as the receptionist, you're the front eyes out there. You need to let someone know what's going on. Does your practice have a safe word? They may have a code red for emergencies in the back, but what if there's an emergency in the front office? As a receptionist, you need to help them develop a code word where everyone knows that word. And if they hear it, they come. Provide badges for all employees and nonpatient visitors. That limits access and you know who is in your facility. Show your personal belongings out of sight. That eliminates temptations from someone who may need to find a little bit of extra change. Many practices open and close with the same staff. However, if your practice has extended hours and then work a skeleton crew, be mindful of safety for patients and staff. If you're working late at night, ensure the workspace is well lit. Avoid working in isolation. Let co-workers know when you leave and when you should return. Call for an escort to walk with you to your car or leave together. The medical receptionist position is a very important one. Sometimes a new graduate is hired. Often they may hold a CMA credential, maybe not. Many times this is a first job in health care. Most importantly, the medical receptionist is the first smile a patient will see when they walk into the office. So the medical receptionist must be a good communicator. Try to convey information, speak clearly and loud enough, but not to breach confidentiality. Being a multitasker, the receptionist needs to be able to answer the phone and greet patients at the front desk at the same time. Acknowledge face-to-face the patients with a smile and nod while you are on the telephone. Working the reception desk requires knowledge of complex telephone systems, headphones, computers, monitors, and printers. Learning the various software requires updates, require you to be the technician. If you have a lot of experience with different types of computer programs, that is a big plus. You may be the go-to person in your office. If you are not familiar with various softwares used in the practice, learn them. There are numerous YouTube videos online for different softwares. Be the problem solver for the practice. Do not let a patient walk away mad, upset, or disappointed. Find out what the problem is and find the person who can fix it. Customer service incorporates many areas, and you will see threads of good customer service throughout this presentation. A medical receptionist must be resistant to stress. Develop a turtle shell. Let things roll off your back. Having nerves of steel will allow you to handle multiple patients and tasks at the same time. Interruptions will be part of your day. So carry on and finish the task and then take on the new one. Developing empathy must be used to treat upset, stressed out, and dissatisfied patients. Be the right person to solve patient problems or find someone that will. Use active listening to tune into the patient. Finally, the medical receptionist is the workflow manager. No patient gets seen in the back until the medical receptionist processes them. Characteristics of a receptionist are personable. Make eye contact with patients, smile, never be arrogant or aggressive, be friendly, engage with patients, be reliable, dependable, arrive to work early, 15 to 30 minutes early before you clock in, be attentive to your patients, providers, and staff, colleagues. If you recognize the need for something to be done, act on it, hold open the door, ask others if they need help, show patience with patients as they get IDs out of their wallet or filling out office forms. Be resourceful, know your practice, know your staff, know who is the lead person to contact with issues or problems to troubleshoot. Be respectful, please and thank you, good morning, good manners are never out of style. Please do not use slang in a medical office. Admit mistakes. We are all human, oftentimes admitting an administrative error is the quickest way to resolve an issue. Learn desk training tips, respond quickly, handle patient requests with a smile, actively listen to patients, show patience, you care about them. Always be professional and polite. Keep that positive attitude even until the last patient is seen. Get to know patients. Finally, be helpful. Let's open the practice. Consider the first impression of the physical space of the reception area. Is it organized, clean, with ample seating? Is it safe? No obstacles in the floor or aisles? Is the lighting appropriate for daytime and then later evening clinics? Set the tone for professionalism. Greet your patient as soon as possible. Be prepared with an organized check-in system, clear desk, no coffee cups, and no visible food. Different medical specialties may have different steps for opening. Create a checklist specific to your practice. Online registration, download the forms, kiosk is powered up for new patients to check in. Tablets charged. If you have a paper system, are forms on clipboards ready for those new patients? Staff should be on the clock and prepared to see patients at least 30 minutes before the first scheduled patient. Rushing in late just before the doors open for patients starts the day on a chaotic and hectic note. Being present early prepares you to handle the day with grace. Any day in a medical office is unpredictable, so do not add to it by being late. Let's look at the sample list for opening the practice. Take a visual check of the reception area. Lock the front doors. Adjust the room temperature. Prepare the front desk, turning on computers, printers, generating provider schedules. Retrieve telephone messages and switch over telephones. Retrieve laboratory orders and results. Scan documents for addition to electronic records. Computer laptops and kiosks are powered up and online. If you have copies for the providers, distribute them to each individual provider. You may need to sort faxes or labs, but the day will be wonderful. If your office uses paper charts, we need to get everything ready, so we're going to pull charts one day before our patients are seen. We're going to check patient notes for laboratory work. Retrieve telephone messages and pull related charts. Retrieve laboratory orders and results and get those ready for the provider to review. Prepare guts for paper charts for new patients. And prepare the sign-in sheet and have pens available. Always be courteous on the telephone. It takes only a few seconds for someone to pick up on your attitude from listening to the tone of your voice. Developing excellent telephone skills is a valuable tool. Do not underestimate this valuable skill to learn and develop. If you are a new medical receptionist, you may want to role-play with other employees some common scenarios for your medical office. Your personality comes through your voice. What part of your personality are you exposing? Confidence, efficiency, and knowledge can be heard through your voice. Avoid bad attitudes and distrust and disinterest at home. Walk into work with a positive, happy attitude and it will show in your communication style. Develop clarity in speaking on the telephone. Talk naturally, purposefully. Do not use medical terminology to patients. Speak clearly into the mouthpiece. Smile while talking. Enunciate your words properly. Avoid slang. Monotone voices leave callers bored and think the speaker has no interest in what they are talking about. If you speak too slowly or with a low pitch, that creates an image of sad and lonely. On the opposite end, a high-pitched, empathetic voice creates enthusiasm. Speaking abruptly, fast, and loud leads a receiver thinking you are angry and closed to input from them. When the call is coming in to a close, finish with thank you, goodbye, Mrs. Smith. Always let the caller hang up first. Remember to keep calls brief as possible with pleasant and professional dialogue. Avoid personal calls and leave for emergency only during work hours. Do not use your personal cell phone during work. Answer messages and callbacks during breaks of your day. Answer calls in the office promptly after the second ring before the third ring. Good morning. Family practice. Debbie speaking. How may I help you? If you must place a caller on hold, ask them, can you hold, wait on a response, yes, then place the call on hold for no longer than a couple of minutes. Upon returning, thank the caller for holding. If you know it takes too long to get the answer, ask them to call them back. Keeping a pen and notepad by the telephone allows you to be ready to take action. Get the caller information you need and act on the call. If you must leave a voicemail, keep it brief and do not leave any information that would breach patient privacy. Check if they allow messages to be left on their privacy notice form. The confidential communications preferences outlines how the patient wishes to be contacted by home phone, cell phone, or work phone. It also allows patients to give permission to offices to send text or voice messages. You will receive routine calls for appointments, prescription refills, possible referrals to other specialists. Follow your office procedures. If a patient asks to speak to the doctor, let them know the provider is with the patient. Ask if you can take a message. Maybe you can assist the caller with the information they need. Many times the provider will tell the patient to give me a call and let me know how you're doing on this new medication. Patients think they need to talk to the provider, but you can take a message, then share that with the provider. The provider may call the patient or have you return the call with specific information for the patient. When transferring a caller to another person in the practice, give the caller the direct number and the name of who you are transferring them to. The direct telephone number is given in case there is a disconnection. Then ask the caller to hold while you make the transfer. Inform the receiver of the transferred call, the caller's name and the reason for the call, and then make the transfer per your telephone system. Set up referrals to medical specialties within the timeframe provided the provider had requested. Unfortunately, appointments are sometimes weeks or months out. So if it is an urgent referral, let the office know your provider needs the patient to be seen ASAP. Sometimes providers will consult with other providers to get patients seen a little faster. Again, it depends on the diagnosis, specialty and location you live in. More difficult if you live in a rural area versus an urban. There are areas that are deserts and have limited medical specialties and patients have to travel long distances. You know if you live in an area like I'm describing. Emergency calls from patients need to be handled carefully. Triaging a call may be left to the clinical staff and it is up to the receptionist to transfer that call to the clinical supervisor, the doctor, PA, RN, LPN or CMA. They will then triage the call. Patients may be told to go straight to the ER and the clinical lead will call the ED and inform them of the patient's arrival. Some patients will need an ambulance sent to their house and you may need to call 911 as the clinical lead speaks to the patient or caregiver that called the office. To address patient's language need, urban healthcare facilities may offer interpreter services. Many times a family member is an interpreter for a patient. Follow your medical practice guidelines. You may have a bilingual employee to help in this situation. Patients that are hearing impaired may have telecommunications relay services that provide a voice carryover or hearing carryover options. Others may have a basic TTY system that has a keyboard, display screen and modem which operates over telephone lines to relay text. Telephone calls for prescription refills generally go into a queue and message information is documented and processed for provider to authorize. Depending on the size of the medical practice, a receptionist may take this information or a clinical medical assistant may proceed in obtaining authorization from the provider. If an office does not have an automated prescription option on the telephone, the receptionist would take the request, patient information, pharmacy phone number, medication to be refilled and prescription number if available on the medication bottle for the refill process. Authorization must be obtained from the provider to refill a prescription. Personal calls and business calls should be held until break. Business calls will be placed by the employee in the medical practice using a non-listed phone number as to not tie up the incoming line for the practice. If the provider is expecting a personal or business call, they generally will let someone know. These situations rarely occur now since everyone has a personal cell phone. Placing a caller on hold when necessary. If you cannot find the information requested within two minutes, take a message and get the phone number and call them back. Do not waste the caller's time hanging on, especially if you do not know the answer. Remember to ask the caller, can you hold? Then thank them for holding when you return. Proper documentation of a telephone message is critical. Record the date, time, name, date of birth, gender, good phone numbers and a detailed accurate message. Include your name. All calls should be marked as urgent or routine and routed to the provider. Confirm all documentation is correct in the patient chart, either electronic health record or the paper chart. If it is a paper chart, you'll need to pull the chart, attach the message, submit it to the provider for action. Best practice is to verify two patient identifiers, date of birth and complete name. Answering the telephone and scheduling appointments are two challenging tasks for a medical receptionist. Electronic scheduling has made it easier to multitask this procedure. You need to be organized and have great communication skills. Without patience, your provider will have no practice and you will not be employed. Scheduling patients is critical to sustaining a medical practice. It is helpful if the medical office has a pre-approved telephone screening manual for staff to refer to. All receptionists following an established system provides continuity in asking the same questions. This avoids omissions of information. Document what the patient says, ask specific questions and wait for a response. Ask specific questions related to the caller. Refer to the telephone screening manual and proceed to scheduling an appointment. So within appointment scheduling, we need to establish a matrix. We'll talk about different methods of scheduling, information required for follow-up appointment, appointment documentation and referral appointments. Let's look at establishing a matrix. A fixed matrix blocks off time slots in a paper schedule with an X or automatically blocked out in the computer schedule screen. Blocks of time are set up for hospital rounds, surgeries, meetings, and finally, availability for patients. Creating a manual or paper system requires time and information from providers. Selection for surgery days, patient appointment days with start and end times, and provider days off. These are all selected months in advance of working up the appointment matrix. Changes in a provider schedule to take off for an out-of-town meeting is no easy task. It requires moving appointments and piling up appointments. Practices may set up a paper matrix for six months in advance. Practice management systems vary by vendor and type of software purchased for medical specialties. A matrix can be created electronically and rolled over each month to best suit the needs of the practice. Instead of having one appointment book, like the manual book, a matrix can be set up for six months in advance. Instead of having one appointment book, like the manual book, having an electronic system, multiple people can work within the appointment scheduling software. At times, areas may be off limits or locked out while someone else is in the system. There are pros and cons to each electronic appointment scheduling system within a practice management program. Let's look at some scheduling methods. First off is clustering. Appointments are scheduled for specific types of visits or conditions, such as return OBs or well-child checks or school physicals. They may be offered Thursday afternoons or Monday afternoons, Wednesday mornings, but those specific types of patients are all scheduled on those days. Double booking is where two patients are allotted the same specific time. It's best to check with the provider to see if they will approve the double booking because a double booking will cause the schedule to slow down and you can really not see two people at one time. Walk-in hours. This is where the practice hours are posted with no scheduled appointments. A lot of times you see walk-in hours at urgent care centers. A single booking is one patient is allotted time for one specific time slot. Streaming appointments are scheduled for specific times based on patient needs. If a physical exam requires 30 minutes on the books, 30 minutes is scheduled. If a blood pressure check or follow-up requires 15 minutes on the book, 15 minutes is scheduled. Wave scheduling. Patients are scheduled during the first half hour and no patients are scheduled the last half hour. So you may have four patients told to come in at nine o'clock and they will be seen based on their arrival. Someone usually shows up early. Someone will show right at nine o'clock and then someone will show up at nine 10 or nine 15. So there you have your wave and patients are seen as they arrived. A modified wave is similar to the wave except one or two patients are scheduled to fill the last half hour. So instead of having everybody scheduled for nine o'clock, you have two for nine o'clock and then one for nine 30 and one for nine 45. So you have a modified wave. Communication and scheduling is very important with your patient. When a patient calls for an appointment, you must determine if they are a new patient or established patient returning to the clinic. You can ask them, when were you last seen in the office or which provider did you see last? Then the answer may be, I'm a new patient. But you do need to verify that. You also need to ask the patient if they have health insurance and what type. The answer to those questions will allow you to determine which provider the patient may see or if your office does not accept the insurance. So you would need to follow your office protocol and determine if the patient will be a cash patient or be referred to a medical practice that accepts their insurance. The patient needs to be allowed to choose. Politely ask the patient's name and verify spelling. So you can correctly input into the practice management or appointment system. Ask for the date of birth and complete the address if the system requires this information as well. The system may also want insurance information so verification can be obtained. Verify the reason for the visit and any preference on dates and times. Do you prefer morning or afternoon appointments? Determine the provider is available. Confirm the date and time of the appointment before the call ends. Many practices have patient portals and the new patient is then set up with information to create an account once patient demographics are added. Let's review some common abbreviations used in appointment scheduling. BP for blood pressure check, C, canceled, CPE, complete physical exam, ECG, electrocardiogram. However, some providers may still call it EKG. FU, follow-up exam, lab for laboratory tests, or studies, NS, a no-show, PNP, PAP and pelvic, or RE, maybe a recheck. Depending on the medical specialty you work in, there may be a larger list of abbreviations that you need to learn. How will you know if a follow-up visit is required? Check the following information if a follow-up visit is required. Check the patient's progress notes. The physician may have jotted down return in two weeks. So verify that. Next, verify the correct spelling of the patient's name. Check with the patient the date and time of preference and any alternative days. Now you'll need to check to see when the physician is available. And his availability or the provider's availability and the patient's availability, do they match up within that timeframe of two weeks? Figure out the best time. And also, is there a special room? Sometimes a follow-up visit may require a special procedure. If there are laboratory tests required prior to the next visit, you need to make sure that the patient is aware of that and orders have been put in. And then place the appointment in the electronic system or paper appointment scheduling book. Give the patient an appointment reminder card. Or if you have a patient portal, ask, do you want a reminder card or will you look it up in your patient portal? I always like to be asked the difference. Sometimes a card is handy or sometimes going to the patient portal is handy. But give the patient a choice. The Health Insurance Portability and Accountability Act of 1996, signed into law by President Bill Clinton, requires healthcare providers to protect patient information. Medical practices must inform patients that patient information will be protected at all times. The notice of privacy practice is given to the patient to read and then sign that they received it. This notice is in addition to the confidential communications preference document and is usually presented to patients at the same time. Patients need to be ensured that their personal information is protected. The check-in process. We need to make a positive first impression. Smile, greet your patients with a good morning or good afternoon. Determine patient status. Is this patient new to the office or established? Ask the new patient to complete paperwork or if they downloaded it from the computer and print it online. Ask the patient to sign in. This may vary based on the practice setting. A paper on a clipboard may be a sign-in sheet. Tablets on the table or computer kiosk with touchscreen may also be a means of signing in. I myself prefer the personal greeting and check-in at the same time. Verify the patient name, spelling, date of birth, address, insurance information and employer. All this demographic information in which the program management system requires. Insurance information should have already been electronically verified prior to the visit. If not, you may need to complete this step by signing into the insurance company database and submit the patient insurance information. If a deductible or copayment is required, follow your office policy. Collect copayments prior to the visit or mention that the deductible will be calculated and collected at the end of the visit. So let's review the patient information required. I know we've talked about many of these already. We need a patient's full name and verify the spelling. We need the patient's date of birth, social security number, marital status, current address. If they give a PO box, get a physical address of where the patient is living. Telephone numbers. Home, cell, business. Many people only have a cell number and have eliminated a landline or house phone. Name of the responsible party or guarantor. Who is responsible for payments? If your patient is a child, then the parent or caregiver would be the responsible party. And then finally, insurance information. Copy or scan the insurance card both front and back. Additional registration patient information required would be occupation and address. Where do they work and what do they do? Their health insurance information. Again, you received a copy of their card, but do you need any other information? Copy of the driver's license. Identity theft is prevalent even in medical offices. So we need to make sure that we are dealing with the correct person. And then finally, verify and update patient demographic information yearly. Most practices require this done yearly. Verify insurance yearly or monthly, depending on the plan. What is third-party reimbursement? Some entity other than the patient that reimburses and manages healthcare expenses. Basically paying all or part of an insurance claim. The third-party payers are insurance companies, government, payers, or even employers through self-insured companies. After a patient visit, either the visit is paid by the patient by cash or check and is responsible for the entire amount or an insurance claim is filed in the office by staff. The claim will then cover charges and will note how much was paid by the patient in the form of a deductible or copayment. The insurance claim will be sent electronically to the health insurance claims processor. The processor checks the claim for accuracy and whether the type of service was covered by the insurance policy. If the claim is complete and accurate and the service was covered by the insurance company, they will remit a check to the provider, either electronically or by mail. Now, group health plans, or GHPs. This is a health insurance extended to members or employees of a company or organization. An example would be state group health. A self-insured plan. Larger companies, the employer collects premiums from the enrollees or the employees and takes on the responsibility of paying employees and dependents medical claims. Many times you must go to company providers. Health and Maintenance Organization, or HMO. Patients must go to certain doctors and hospitals within its network of contracted providers. They may have more restrictions in the policy allowing certain number of visits, tests, and treatments. Select a primary care physician is required and will determine what treatment a patient needs. They're considered a gatekeeper. If a patient opts to see a provider outside of the HMO, the patient may pay the entire cost of medical services, unless it's an emergency situation. An EPO, or an Exclusive Provider Organization, is a managed care plan with covered services their physician network provider, specialists, and hospitals, but they do not require a primary care provider, or PCP, to refer patients to a specialist like the HMO. EPOs will cover medical costs in an emergency situation as well. This EPO is in between an HMO and a PPO. A PPO is a Preferred Provider Organization, which are more flexible, uses a network of physicians' providers a lot larger than an HMO, PPOs have fewer restrictions on seeing non-network providers, and payment to non-network providers is available at lower rates. Patients are allowed to see a specialist without having to go through their primary care physician, or PCP. Indemnity plans, also known as fee-for-service plans, the insurer pays only a predetermined portion of the doctor or hospital bill. They pay a fixed rate deductible, and reimbursement is at 80% thereafter of the reasonable and customary charges for service. Finally, we have workers' compensation. Workers' compensation insurance is provided to employees, both medical and wage benefits, who are injured or become ill at work. An office would file medical expenses with the workers' compensation insurance carrier. Types of government-sponsored health insurance. Medicare is federal health insurance for anyone aged 65 or older, and some under 65 with certain disabilities and conditions. Medicaid is a joint federal and state program that helps cover medical costs for people with limited income and resources. The federal government has general rules that all state Medicaid programs must file, but each state runs its own program. Both Medicare and Medicaid is administered by the Centers of Medicare and Medicaid Services. State Children's Health Insurance Program is a partnership between federal and state governments that provide low-cost health coverage to children and families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. The SCHIP program works with state Medicaid programs. They provide comprehensive coverage for routine checkups, immunizations, doctor visits, and prescriptions. Each state has their own qualification rules. Now through the Department of Defense, we have TRICARE. TRICARE is the health care program for uniformed service members, retirees, and their families around the world. TRICARE has various coverage plans, TRICARE Prime, TRICARE Select, TRICARE for Life, TRICARE Reserve Select, and TRICARE Young Adult. These programs may change through the years, so you would need to follow up with TRICARE. TRICARE Prime is a Civilian Health Maintenance Organization, or HMO. Members are assigned a primary care manager and must get referrals to access specialty care. TRICARE Select is a civilian PPO with a primary care manager and self-referral to specialists. TRICARE Reserve Select is for guard and reservists and is exactly like TRICARE Select. TRICARE for Life supplements health coverage for retirees and their spouses over age 65 that are enrolled in Medicare Part B. So if you have a patient with TRICARE and they have Medicare, they will have TRICARE for Life. Their young adult is available for young adults age 21 to 25 if they are in school or not, and there are some certain situations. All of these coverages may change and based on eligibility and service years to the Department of Defense. So you would need to truly follow up on their coverage. Veterans Health Care is an enrollment system based on priority groups for veterans that were actually wounded in war. And so they have a priority group one through three, which is service-connected veterans who have received a VA disability rating, former POWs or prisoners of war, awarded the Purple Heart or Medal of Honor. Priority group four through eight have other eligibilities based on medical conditions, combat status, and environmental exposures and income. Again, Veterans Health Care is not automatic. They must meet certain requirements for enrollment. And all active duty members and retirees and family members, dependents have TRICARE. So Veterans Health Care is totally separate from TRICARE. Indian Health Services is not part of the Department of Defense, but in some areas of the country, this service is housed within the U.S. Department of Health and Human Services. Indian Health Services provide direct medical and public health services to members of federally recognized Native American tribes and Alaska Native people. The Indian Health Service is not an insurance program. It is funded each year through appropriations by the U.S. Congress. If you live in an area, you know of Indian Health Service benefits and you would file appropriately. So verification of health insurance coverage, we would collect patient insurance information when the appointment is scheduled, contact the insurance provider for verification of coverage, confirming deductibles, policy information, plan exclusions, and effective dates. Then run an eligibility check on the patient prior to the appointment. Let's go over some common abbreviations used in insurance. In ABN, Advanced Beneficiary Notice, a patient would sign this prior to a test or treatment that may not be covered by Medicare. The patient is then responsible for payment of services. EOB, an explanation of benefits, which is a description of services and payment for each procedure code. DOB, date of birth, you've seen that before. HIPAA, Health Insurance Portability and Accountability Act. And NPP, Notice of Privacy Practices, PHI, Protected Health Information, and then SSN, Social Security Number. I could have filled this page with 100 more abbreviations, but I chose not to. Aren't you glad? It's time for the patient to check out. So we need to review the patient's account. We need to collect payment if additional fees are required, that deductible that we needed to calculate. And then schedule that follow-up appointment if one is required by the provider. Maybe the provider has required the patient to go to a specialist, and so we may need to schedule a referral appointment. Remind that the patient, if an emergency arises after hours, to go to the emergency room or call 911. Thank the patient for choosing your practice. Collecting payments at the time of checkout may be in the form of cash, where you need to make change, credit cards, where you need to process the credit card. And then if the patient writes a check, it must be a valid check for the exact amount. No corrections should be on the check, and do not accept a third-party check. All checks should be endorsed immediately with the office's stamp. Thank the patient for payment. There are some key steps to close the medical practice. First, you need to ensure that the practice is free of all patients. Check all exam rooms and bathrooms. Knock on the door. Make sure that no one is in there. Lock the front doors. Straighten the reception area. You may have a cleaning crew come in, but tidy up a little bit. Ensure all patient charts are filed if you have a paper system. They need to be secured, nothing laying on the desk. You can receive documents for the electronic health record so they can be processed. Update the computer with the practice manager procedure. If you have a paper chart system, pull charts for tomorrow if that was not already done earlier in the day. And the last one to leave the practice would activate the security system. Remember, leave the practice in a group. No stragglers. Wait on your co-workers. It's safe in numbers. Be familiar with the equipment you use daily in the office. You need to know how to change the paper or toner cartridge in the printers and photocopy machine. Learn how to troubleshoot the equipment in the office. Is there an FAQs on troubleshooting on the manufacturer's website? If so, download it. Maintain a paper file or electronic file with the owner's manual and keep a maintenance log for each piece of equipment. Note the purchase date and highlight required maintenances for the piece of equipment. Have a checklist of daily operation for each piece of equipment used in the office. Tablets at the end of the day, place on charge, clean, disinfect the screens properly. You should know how to clear a paper jam, add paper, change the toner cartridges on the printer and photocopy machine. Take time to learn the equipment you use and an approximate work area. So not necessarily if you're the receptionist, you know all the equipment in the back office, but you should be familiar with all the equipment in the front office. Knowledge is power. Frequently changed or replaced part numbers. An example would be to keep a list of the toner cartridges for the printer and photocopy machine so you don't have to constantly go to the website to look it up. You've got it on a little cheat sheet somewhere. To develop good customer service skills, I have already discussed the importance of communicating clearly. You need to be an active listener with your patients, colleagues, providers. Because good communication goes hand in hand with customer service. You provide customer service as a receptionist to the entire office, your patients and your coworkers. So practice those active listening skills. Emphasize with your patients. Let them know you understand and that you will do whatever possible to help you find that answer. Use positive language. Always be willing to learn. If you don't know the answer, you will find the answer and then you will know the answer the next time you're asked. Improve your technical skills. As mentioned before, if you're not up on all the different softwares required in your practice because you were just hired, take it upon yourself to learn a new software skill each month and then you can grow in your technical skills. Know your practice. The more you know about the specialty you work at, the physicians, the more in tune you will be to the practice and you'll be able to assist your patients a lot easier. And again, admit mistakes. When you make a mistake on the administrative end, admit it right away. Even on the clinical end, but this talk is on administration. You need to admit your mistakes so it can be fixed. It can be corrected. Improving habits increases workflow. Show up on time to scheduled meetings. Arrive to work 30 minutes before you see patients, 15 minutes before you clock in. Meet deadlines. Be respectful of others' time. If you are not ready for the meeting, cancel the meeting, reschedule. Communicate clearly. Be proactive and take initiative. If you know that something needs to be finished before everyone leaves for the day, ask, can I help you with that? Take initiative. If you find a problem, propose a solution or work with others to propose a solution. Stay organized and take care of yourself. A healthy you makes a healthy employee and you can work better and increase your workflow. I'm concluding this presentation with the first thing I mentioned as far as greeting your patients and making a positive first impression. When you see that patient, smile, make eye contact, greet your patient. Even if you're on the telephone, you can make eye contact, nod your head and let that patient that just walked into the reception area feel that they have been recognized by you. Always be well-groomed, clean, pressed, uniform, free of wrinkles. Your hair, your makeup, subtle. This is a professional workplace and patients expect you to look professional. Have open and confident body language. Don't hold your hands around your chest. Have them down at your side. Be open to communication and interaction with your patients. Be a good listener, attentive listener, active listener. Avoid interrupting your patients. Let them finish speaking. Then ask questions that will help you seek the information you need. Be positive in all your actions. Think positive. Arrive to work in a good attitude. Be useful, helpful. If you're finished with your job, see if someone else can use your help. Everyone wants to get out on time and you may have been very productive during the day and someone else might have been snowed under with extra things or someone called out and they're having to do the work of two. So offer your assistance. You work as a team. Healthcare is a team. Working in the physician's office, it's team work and offer your assistance whenever you can. You never know, someone may need to help you one day. You never get a second chance to make a first impression. So make it a lasting, great first impression. Thank you so much for spending time with me, listening to this presentation. There is a short quiz for you to complete after the presentation.

medical receptionists

front office

telephone answering techniques

appointment scheduling systems

patient safety

customer service

communication

confidentiality

security protocols

patient checkout procedures