Best Practices in Medical Office Operations PDF

Module 6 Best Practices in Medical Office Operations Dr. Dana Rozeboom This Week… Discussion – are we compliant? Lesson 1 – Best Practice for Positive Patient Experience Lesson 2 – Ethics and Compliance 2 Knowledge Checks Case Study 2 ...

Module 6 Best Practices in Medical Office Operations Dr. Dana Rozeboom This Week… Discussion – are we compliant? Lesson 1 – Best Practice for Positive Patient Experience Lesson 2 – Ethics and Compliance 2 Knowledge Checks Case Study 2 Telephone Answering Tips Answer with a smile. Sets the No buzzwords and acronyms. tone of the call. Don’t use medical terms that the patient would not understand. Use a professional greeting. How to put callers on hold: Ask Good morning, good the patient if they mind holding, afternoon, thank you for calling say thank you for holding, and acknowledge how long they have been on hold. Mind your manners. Treat others with respect and Empathize with the caller. dignity. Say please and thank Empathy goes a long way to you. turning an experience into a positive one. Listen like a ninja. Give the patient 100% of focus and do not multitask. The Reassuring Close. Anything else I can do? 3 Patient Loyalty Respect the patient at each interaction 91% of patients who were unhappy with their care Quadruple Aim: reduce cost, improve health, patient experience would not go back satisfaction, and well-being of practice staff Raising improving patient satisfaction is a goal Phone trees and patient portals reduce personal interaction. Communication should place the patient at Happy patients start with competent staff the forefront. Patient reminders can be done via text. Studies show 99% of text messages are opened. 4  Patient Satisfaction cont… Accomplish more through text Provide better, more timely patient care HIPAA-compliant text can create efficiencies Mobile devices convenient for patients to communicate. Use phone routing to direct incoming calls to the Telehealth is growing in popularity. 38 times higher than correct person ie, billing, nursing, and scheduling pre-COVID-19. Template responses help save time. Such as driving Templated messages can be sent to patients to help with directions or parking chronic conditions. Request blood pressure readings, Have the patient fill out forms before the visit. etc. 5  Principle of Medical Ethics: Hippocrates was a Greek physician in the 4th & 5th centuries BCE. Physicians take the Hippocratic oath governing physician conduct. Physicians follow the Principle of Medical Ethics developed by the American Medical Association. Medical Ethics They must practice with high standards of patient care, respect patient rights, treat patients with compassion, and safeguard patient confidence. Physicians must also continue to advance and improve their medical skills and knowledge. I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious [harmful] and mischievous.... Whatever, in connection with my professional practice or not in connection with it, I may see or hear in the lives of men which ought not to be spoken abroad, I will not divulge, as reckoning that all such should be kept secret. American Association of Medical Assistants (AAMA) developed a code of ethics and creed that outlines moral and ethical behavior. The Medical Required to: (1) treat all patients with respect, Assistant’s Ethical (2) maintain the confidentiality of patients’ protected health information, Responsibility (3) conduct professional activities in a manner that honors the profession, (4) improve knowledge and skills, and (5) contribute to the community. The creed emphasizes the qualities of effectiveness, loyalty, compassion, courage, and faith. Medical coders have their own code of ethics.  Bioethics Bioethics deals with the ethics of medical treatment and technologies, processes, and scarcity of resources. These issues What rights are involved with using a human fetus? are associated with abortion, the definition of death, patients’ Should genetic engineering—altering cells to produce physical traits or eliminate disease—be encouraged? Suppose one of the outcomes is the cloning rights, and types of medical care. of a human being. How should scarce usable body organs be pretty allocated? In a living will, a person may clearly state the intent to refuse When is it acceptable to remove a patient from life support? Who makes that specific life-sustaining measures and specify the length and decision? methods of these measures. Examples of life-sustaining Should the physician be criminally responsible for assisting a terminally ill measures include patient in his or her suicide? Do individuals have the right to produce a child to provide cells for another receiving artificial hydration. individual? Should providers have the right to refuse healthcare to morbidly obese receiving artificial nutrition. patients? Should the allocation of healthcare be based on the anticipated life- being revived using cardiopulmonary resuscitation (a Do Not expectancy contribution of the patient, such as withholding life-sustaining care Resuscitate [DNR] form must be completed by the patient and on from the aged or chronically ill? file with the medical provider). being intubated. 8 Moral Values Moral values include compassion, honesty, honor, and responsibility. The primary ethical obligation of a physician is to put the patient’s benefit first. Moral values may dictate that physicians take specific actions and refrain from others. A physician may ethically refuse to use the requested treatment if it does not meet the recognized standard of acceptable care. Physicians find moral values contained within the laws of the state where they practice; these laws must be obeyed. The physician’s belief system, good judgment, and decision- making skills all contribute to the ethical practice of the profession. 9  Etiquette Etiquette is defined as behaviors and customs that are standards for good manners. An employer’s rules of etiquette are frequently found in the policy and procedures manual of the medical practice. Examples of good manners and proper etiquette in the office include: dressing appropriately to show respect for others and the profession. Use proper forms of address for both the physician and patients. extending a cheerful greeting to all who visit the office. using proper telephone techniques. observing the use of polite everyday phrases: “Please,” “Thank you,” and “Excuse me.” 10 Medical Law Medical law regulates the right to practice. Each state grants providers the right to practice under medical practice acts. These acts: Licensing, Certification and Narcotics define medical practice. explain who must be licensed to give healthcare. State medical boards grant providers a license to practice. Some states allow reciprocity. Licenses must be renewed every 1-2 years set rules for obtaining a license and renewal of a license. and require CEUs and fees. Licenses apply to providers, nurses, and some technicians, such as ultrasound technicians and state the duties imposed by the license. billing/coders. cover the grounds on which the license may be revoked. Certified specialization providers must pass the board for their specific specialty and go through a residency program. They must list the statutory reports that must be sent to the government. also be board-certified to practice in their specialty. These acts protect patients by putting penalties on providers for Providers who prescribe narcotics must have a DEA license which misconduct such as a felony, fraud, sexual misconduct, drugs, mental must be renewed every 3 years. illness, etc. Providers can lose their license to practice. 11  Physicians are not legally required to: accept as patients all those who seek his or her services. The Physicians Practice restore a patient to the same condition that existed before illness occurred. Contracts: obtain recovery for every patient. Physician is required after a patient-physician relationship is established: guarantee successful results from an operation or a treatment. possess the ordinary skill and learning commonly held by a reputable physician be familiar with all possible reactions of patients to various medicines. in a similar locality. The patient has the right to believe that the physician is so qualified. Accordingly, the physician’s license should be displayed in the office. be free from errors in complex cases. use his or her learning, skill, and best judgment to benefit the patient. possess the maximum amount of education possible. preserve confidentiality. Continue care after a patient is discharged from a hospital, even if harm could come to the patient. act in good faith. perform to the best of his or her ability. advise against needless or unwise treatment. inform and advise the patient when the physician knows a condition is beyond his or her scope of competency. 12  Consent Implied consent – routine treatment Expressed consent – complicated procedures including surgery and diagnostic tests. Written consent is most Durable Power of Attorney—The patient chooses someone else to make decisions on their behalf. This legal document commonly used. must be in the patient’s chart. Informed consent means that the patient has had their Emancipated Minor – Minor has legally gained independence medical treatment explained in clear language and given from parents. You must have a court order in the patient’s options for treatment or refusal. Patients must also be given chart. options to ask questions. Mature Minor – Only in certain states and allows minors to Legally competent adults can give informed consent. make decisions on their behalf. Advanced Directives – legal documents with the patient’s wishes for medical care. Includes living wills and DNR. POLST – Physician Orders for Life Sustaining Treatment. Patient determines level of life-sustaining services. 13  Medical Liability and Communications Liability – means legal responsibility. Assault and Battery – the clear threat of injury to another / bodily Under the legal doctrine of respondeat superior, an employer is contact without permission. In medical law, battery is performing liable for employees’ actions when they act within their employment procedures without patient consent. scope. Therefore, physicians are responsible for the actions of their staff. Fraud – intentionally dishonest practice that deprives patients of their rights. Examples include false licenses, false statements to Malpractice - improper care or treatment of a patient. patients, or unlawful monetary gain. Termination – physician can terminate the care of a patient verbally Litigation – the bringing of lawsuits. or in writing. Civil law – crimes of persons by other persons/malpractice suit Criminal law – commission of a crime Medical Abandonment – physician-patient relationship is terminated without given patient adequate notice. Proper documentation is Steps in litigation: necessary. Have another physician on call when unavailable for Summons – written notice to the defendant patients. Subpoena – legal document orders individual to appear in court Deposition – a sworn statement to the court before a trial begins 14 Medical Law… Alternative to Trial: Statute of Limitations: sets a Good Samaritan Act: time limit for initiating litigation. Voluntarily offers aid in an Varies by state and federal emergency situation. Protects Settlement: the plaintiff and the statutes. physician’s attorney come to an individuals from civil law suits. agreement instead of going to Laws vary by state court. Arbitration: unbiased third party hears both sides and helps the two sides come to an agreement. 15 Medical Law… Stark Law Anti-Kickback Law: Physicians are not permitted to refer patients to an entity that provides designated health services from a federal Patient’s Bill of Rights: False Claims Act: program. Receives payment 1977 passed by Congress from a federal program if the Passed by Congress in 1863 Increase consumers confidence physician or family member has Whistleblowers – individuals a financial relationship with the in healthcare. who have evidence of fraud physician. Exceptions exist. Civil 15 rights involving federal funding. This penalties and crimes ranging includes Medicare from $25,000 - $100,000 and Examples include billing for up to 10 years in jail. services not rendered to the patient and billing at a higher level than rendered 16 Patient’s right to an accurate and easy-to-understand health plan, provider, and facility information in the patient’s preferred mode of communication Patient’s right to choose high-quality healthcare providers Patient’s right to emergency services, without waiting for authorization or incurring a financial penalty, if the patient feels his or her life is in imminent danger from severe pain, illness, or sudden injury Patient’s right to know his or her treatment options—explained in understandable, lay terms—and to participate in or refuse treatment Patient’s right to considerate and respectful healthcare Patient’s right to confidentiality of protected healthcare; to read and be provided a copy of his or her medical record, and the right to ask for corrections to the medical record if the record is incomplete or inaccurate Patient’s right to a fair and fast review process on a complaint as it relates to aspects of the patient’s healthcare; areas included—but not limited to: actions of personnel, wait times, and facility inadequacies Patient’s right to take an active part in the management of his or her own healthcare dropping patient coverage due to an unintentional error on an insurance application form. Imposing lifetime coverage limits. Deciding which provider a patient must see (patients can choose their own provider from within the health plan’s network). Charging more for using an out-of-network emergency center. Denying the patient’s right to appeal a coverage/payment decision to a third party. Denying full coverage (no out-of-pocket expense) for recommended preventive services. Denying coverage for young adults up through their 26th birthday, unless coverage is provided to a young adult by an employer. Medical Compliance OIG and HHS issued Compliance Program Guidance for Role in Compliance – Individual and Small Group Physician Practices Compliance programs include – accurate data entry, Compliance Plan Addresses - billing and coding, accurate documentation, timely filing and storing of reasonable and necessary services, documentation, electronic and paper records, and prompt reporting kickbacks and self-referrals, HIPAA compliance of errors or instances of fraudulent conduct. Medical Compliance Plan: OIG 7 basic elements for Safeguards Against Litigation – compliance: It is easier to prevent malpractice than defend it! The Written policies/procedures, chief compliance officer, textbook lists several suggestions. training and education, effective line of communications, auditing and monitoring, well- publicized disciplinary directives, prompt corrective actions 18  Bioethics Harvoni is a drug for Hepatitis C. It could potentially eradicate the disease, but insurance companies did not want to pay for it. Patients would suffer for years before being considered for the drug, and drug companies would determine who would or would not be able to get it. The drug was originally priced at close to $100,000 for treatment. Drug companies argue they need to recoup the cost of making and testing drugs. If they do not make money back they cannot continue research for future lifesaving drugs. 19 We are almost at the end! Keep up the good work and have a great week 6! HSM210 Module 5 Dr. Dana Rozeboom  This Week Read 5.2, 5.3, 5.4, 5.7 and 5.8 Discussion Post: Physician Quality Lesson 1 – Components of a Medical Record Knowledge Check 1 Lesson 2 – Assessing Quality in the Medical Office Knowledge Check 2 Case Study 1 – Telehealth Case Study 2 – Improving Patient Experience​ 2 THE MEDICAL RECORD WHAT IS A MEDICAL RECORD? Chart Note: a chronological record LEGAL DOCUMENT of ongoing patient care and progress. May be extensive or Correspondence: All simply a change in condition or correspondence with patients – A legal record of the medical treatment plan. Chart notes from letters, emails, phone calls… practice. other physicians are included in a Clinical Forms: immunization Can be used in court to protect patient’s record. records, etc. provider for malpractice case. History and Physical (H&P): A Medication List: List of all Medicolegal- document of medical history is a patient’s complete medications, doses, dispensing. record admissible in court. medical history, and physical is an Advance Directives and Other Legal Must be complete, legible and well objective evaluation of relevant Forms: DNR, living will, durable maintained. body areas or systems. power of attorney, custody Manager must review and maintain Referral and Consultation Letters: documentation, care for a minor records appropriately. Letters sent or received from other patient. physicians referring for exams, ▪ The record also contains tests, etc. administrative forms and patient Medical Reports: Lab reports, X- data. rays, etc. Once physician has ▪ EMR documentation is listed in reviewed must sign and date. chronological order. 3  MAIN SOURCE FOR A LEGAL RECORD FOR THE COORDINATING OR PRACTICE MEDICAL RECORD REASONS FOR MAINTAINING A MAINTAINING CARE THE MAIN RECORD TO EVIDENCE OF THE COURSE ENSURE APPROPRIATE OF AN ILLNESS OR RECORD REIMBURSEMENT OF TREATMENT A SOURCE OF DATA FOR A RECORD OF THE RESEARCH PURPOSES QUALITY OF CARE PROVIDED TO PATIENTS A TOOL FOR COMMUNICATION AND CONTINUITY OF CARE FROM ONE PROVIDER TO ANOTHER 4  Each time a patient is seen, it must be documented. MEDICAL RECORD If written on paper, it must be in ink. A chart note must contain: 1. Patient identifying information – use account number, not SS# 2. Date of the patient’s visit 3. The signature and title of the provider, and if transcribed, the name of the dictation and initials. 4. Signature log should be maintained. Electronically signed by provider name, date, and time stamped. 5  Making changes in paper-based medical record ▪ Use a strike-through feature or draw a single Correct Method line through the area needing change. ▪ Enter the word error or mistake entry or other reason for the correction ▪ Write the initial and date after the correction. ▪ Enter correct information above or below the inserted line in the medical record. Incorrect Method 6 Electronic Health Record EHR’S EMR vs EHR? Used to store large amounts of data securely. EMR: an electronic medical record of one Mandatory implementation encounter. as part of national health reform. EHR: electronic health record kept over the 90% of medical offices are lifetime of the patient. using EHRs. Only 80% of them use ONC-certified Documents face-to-face electronic health systems. visits, virtual visits, or any non-visit Laptops, desktops, communication such as a dropdowns, and templates phone call to refill a for ease of use. medication. 7 1. Easy and quick updating of medical records 2. Automatic verification of medications 3. Fewer medical misinterpretations due to poor handwriting 4. Higher level of data security by use of passwords, encryption, and frequent backup of OF EHRS ADVANTAGES medical data; the minimum backup requirement is to perform a daily backup, with some practices conducting backups throughout the work shift 5. Greater amount of time spent in patient care as a result of less time spent updating medical records 6. Faster questions and answers related to patient medical information 7. Electronic input and submission of orders and prescriptions 8. Electronic reminders sent either directly to patients or to office personnel for follow-up 9. Access to electronic medical records from multiple locations 8 Training for staff and providers is necessary, and the technology is constantly updating and changing. Converting from paper charts to EHR is very expensive and time- consuming. Every form needs to be scanned and filed appropriately in the system. Transferring from one EHR costs about $50,000 and takes months to map data. OF EHRS CHALLENGES There is less face-to-face interaction with providers because they are typing and documenting during the visit. Some providers use scribes to help. 9  Every office should have policies and procedures for changing an EHR system. Be very careful about altering information already signed and dated in the CORRECTIONS IN record. Add an amendment to the record instead of changing existing data. Must be signed, dated, and time stamped and done promptly. You can include a late entry to add data. It should be titled “Late Entry.” However, many EHR systems will not allow this. Once a document is signed off, no changes should be made. It is best to add an addendum. MAKING AN EHR 10  CMS DEVELOPED MIPS TO TIE MEDICARE PART B PAYMENTS TO MIPS PROVIDER QUALITY, COST EFFICIENCY AND HEALTH OUTCOMES. MANDATORY! QUALITY 30% OF SCORE It looks at the quality of the care you provide to a patient. For instance, have you done an A1c on a diabetic patient? PROMOTING INTEROPERABILITY 25% Measures patient engagement. This includes patient portals, can your EMR electronically transfer data. Also includes points if you send data to a registry. IMPROVEMENT ACTIVITIES 15% Activities have different weights. Includes expanded access, care coordination, patient safety, and behavioral health COST 30% Measures providers ability to control cost while providing quality care. Medicare Spending Per Beneficiary (MSPB) 11  MEDICAL TERMINOLOGY AND ABBREVIATIONS Read 5.4 in the text for a list of useful abbreviations. Don’t make up abbreviations.. Used a standardized set of medical terminology. a.c. – before meals b.i.d. – twice a day F/U – follow up FUO – fever of unknown origin Fx – Fracture n.p.o. – nothing by mouth p.c. – after meals p.o. – by mouth p.r.n. – as needed b.i.d. – three times a day 12 Ownership, quality assurance, and record retention The American Medical Association Council on Ethical and Judicial Affairs addresses the ownership of medical records. According to the Council, medical notes made by a physician— the actual chart notes, reports, and other materials—are the physician’s property. The notes are for the physician’s use in the patient’s treatment. A physician cannot hold information at his/her wishes. Patients alone hold the authority to release information to anyone not directly involved in their care. A fee may be charged for furnishing copies of complex medical reports; however, information should not be withheld because of an unpaid fee. State laws should be referenced when determining if a patient may be charged for copied medical documents and, if so, how much may be charged. 13 Ownership, quality assurance, and record retention, cont.. The assistant should make sure that each record contains the following: Dated notations describing the service received by the patient Notations regarding every procedure performed Accurate notations: an addendum by the physician should be made if a discrepancy occurs (for example, a previous notation about a condition may have stated “left side,” while the latest notation states “right side”) Justification for hospitalization If necessary, a discharge summary regarding hospitalization before the patient arrives for a follow-up visit Patients have the right to inspect their records and request correction. 14 Ownership, quality assurance, and record retention, cont.. For management purposes, these files are classified as Active files about current patients. Inactive files, related to patients who have not seen the physician for a stated period of time, such as 3 years or longer. This time period may be shorter or longer depending on the medical specialty. A practice may classify a file as inactive when the patient is no longer an established patient (has not seen the physician or a physician of the same specialty in the same practice within the last 3 years). Closed files, those of patients who have died, moved away or terminated their relationship with the physician. Why do we keep records? Financial purposes, legal purposes and continuum of care. 15 Legal Requirements Federal law does not regulate, but states have unique guidelines. If a provider takes Medicare/Medicaid, it must follow CMS rules. In 2013, the American Health Information Management Association (AHIMA) proposed the following guidelines in a practice brief: At a minimum, a records retention schedule must ensure patient health information is available to meet the needs of continued patient care, legal requirements, research, education, and other legitimate uses of the organization. include guidelines that specify which information is kept, the time period for which it is kept, and the storage medium on which it will be maintained (e.g., paper, microfilm, optical disk, magnetic tape). include clear destruction policies and procedures that include appropriate methods of destruction of each medium on which information is maintained. 16  PATIENT HEALTH RECORDS (COMPETENT ADULTS): 10 YEARS AFTER PATIENT’S MOST RECENT ENCOUNTER FRAMES RECORD RETENTION TIME PATIENT HEALTH RECORDS (MINORS): AGE OF MAJORITY (VARIES BETWEEN 18 AND 21 YEARS OF AGE) PLUS STATUTE OF LIMITATIONS ON MALPRACTICE (SOME STATES REQUIRE THE PROVIDER TO MAINTAIN A MINOR’S MEDICAL RECORD FOR 10 YEARS PAST THE STATE’S AGE OF MAJORITY) DIAGNOSTIC IMAGES (SUCH AS X-RAYS): 7 TO 10 YEARS OR PERMANENTLY MASTER PATIENT INDEX, REGISTER OF BIRTHS, REGISTER OF DEATHS, REGISTER OF SURGICAL PROCEDURES: PERMANENTLY INSURANCE POLICIES: CURRENT POLICIES ARE KEPT IN SAFE STORAGE IN AN ACCESSIBLE FILE, AND PROFESSIONAL LIABILITY POLICIES ARE KEPT PERMANENTLY. EQUIPMENT RECEIPTS: RECEIPTS FOR MEDICAL AND OFFICE EQUIPMENT ARE KEPT UNTIL THE VARIOUS PIECES OF EQUIPMENT ARE FULLY DEPRECIATE D—THAT IS, UNTIL THE VALUE OF THE EQUIPMENT HAS COMPLETELY DIMINISHED. PERSONAL RECORDS AND LICENSES: PROFESSIONAL LICENSES AND CERTIFICATES ARE KEPT PERMANENTLY IN SAFE STORAGE. INDIVIDUAL STATE STATUTES SHOULD BE REFERENCED WHEN DETERMINING HOW LONG TO MAINTAIN MEDICAL AND BUSINESS -RELATED RECORDS. 17  Destruction of records Proper methods include burning or shredding. Under HIPAA, covered entities must have policies and procedures in place to dispose of PHI. When medical data are destroyed, the practice must maintain a record/log of the destruction. The destruction log should include the date and method of destruction. a description of the record (patient name, contents, etc.). the date range of records destroyed (i.e., January through December 2028). signatures of the individual(s) who destroyed the records and of the individual(s) who witnessed the destruction. a statement saying that the medical records were destroyed as part of normal business operations. If the destruction of records is outsourced, a Certificate of Destruction is issued and maintained by the outsourced company. 18  QUALITY Who is the customer in a medical office? Patient relationships need: trust, communication and respect the patient’s time When a patient measures quality who are they considering? Physician, MA and front desk. 19 When to use telehealth or telemedicine? The appropriate use of telehealth may depend on the patient or situation, and the provider ultimately decides it. Generally good for: Wellness TELEHEALTH Test Results Dermatology Nutrition Behavioral Health Not generally good for: Complex conditions Gynecology Dental Abdominal Pain Eye Concerns 20  TELEHEALTH Medicare made changes to telemedicine during COVID-19 due to the public health emergency (PHE). Expanded access through December 2024. Audio only will be doing away. Changes vary by state. Know your guidelines. 21  Meaning of the word Patient: The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering,' and akin to the Greek verb πάσχειν (paskhein, to suffer) and its cognate noun πάθος (pathos). PATIENT EXPERIENCE If you were recommending care to a friend, How likely is it for a patient to recommend a what factors would matter most to you? hospital? What matters most to the patient? Teamwork, Trust and Compassion A cohesive group of providers working together to provide care.  HAVE A GREAT WEEK! HSM210: MEDICAL OFFICE ADMINISTRATION Dr. Dana Rozeboom AGENDA Assignment Review Recording Transactions Course Objectives Insurance Claims Week 4 Lesson: Revenue Cycle Management Payments from Patients Delinquent Accounts  ASSIGNMENT REVIEW This Photo by Unknown Author is licensed under CC BY-SA WEEK 4: COURSE OBJECTIVES Understand a general overview of the revenue cycle management (RCM) process Recognize and calculate charges for medical services and process patient statements based on the patient encounter form and the physician’s fee schedule Compare and contrast the process of completing and transmitting insurance claims using both hardcopy and electronic methods Describe the different types of billing options used by medical practices for billing patients Paraphrase the procedures and options available for collecting delinquent accounts. This Photo by Unknown Author is licensed under CC BY-SA  Recording Transactions RECORDING TRANSACTIONS: PATIENT ENCOUNTER FORM Used to record the details of patients’ encounters for billing and insurance purposes (also called: charge slip, superbill, routing slip, or patient service form) Information that is recorded in different sections of an encounter form: Patient’s name, address, phone information, and type of insurance, as well as patient return information (why would you always check a patient’s license or ID card?) Date of service Diagnosis or diagnoses for the current visit Procedure information Financial information Physician identifying information RECORDING TRANSACTIONS: PATIENT ENCOUNTER FORM (CONT’D) Procedure for using a patient encounter form: An encounter form is attached to the patient’s file when the patient registers for the visit As the physician performs various procedures during the visit, check marks are made in the appropriate boxes on the encounter form (or the appropriate items on the form are circled); the diagnoses and corresponding codes are also recorded on the form At the end of the visit, the form is taken to the checkout area for the administrative medical assistant to record, or post, the necessary transactions in the office’s billing system; the patient may be asked to validate the information on the encounter form by signing the form. A charge capture explains what took place at the visit. RECORDING TRANSACTIONS: OTHER IMPORTANT TRANSACTIONS Fee Schedule Lists the usual procedures the office performs and the corresponding charges. Patient Statements The patient’s copy of the information stored in the patient ledger (hardcopy or electronic); also referred to as the patient bill. Computerized Billing Most medical practices using an EHR system have the capability to handle patients’ billing. If not, a separate software program may be used to handle the practice’s financial tasks. Example of a Fee Schedule If you are in a network with insurance, you will be paid the rate based on your negotiated fee schedule. Medicare lists its fee schedule annually. If you are out of network or offer a non-covered service, you have flexibility in your prices. It is called balance billing. If you are in-network with an insurance company, you would not charge a patient above the negotiated rate. Example of a Patient Statement: Statements often confuse patients because they include adjusted amounts and list patient responsibility. Patients sometimes need help understanding co-pays and deductibles. Many offices are getting away from mailing paper statements. Often, you will see text to pay or online billing through patient portals. Notice that the diagnosis/procedure is listed on the statement. IDC10/CPT codes COMPUTERIZED BILLING A daily report, called a “day sheet,” listing all charges, payments, and adjustments entered during that day Monthly reports summarizing the operation of the practice Aging reports, which list the outstanding balances owed to the practice by insurance companies or patients Lists of the amounts of money generated by various departments, such as laboratory, x-ray, and physical therapy Lists of the amounts generated by individual physicians in the practice Reports on the frequency of procedure codes reported by each physician in the practice Insurance Claims INSURANCE CLAIMS: OVERVIEW Most medical practices complete an insurance claim form on behalf of the The insurance claim form contains both patient clinical and financial information and is transmitted to the patient’s insurance Billing process starts with the insurance carrier for partial or full reimbursement claim of the services rendered Billing claims – billers review for payment INSURANCE CLAIMS: USING CMS-1500 (PAPER/HARDCOPY CLAIM FORM) Two medical office forms used to complete the CMS-1500 claim form: Patient information form – may also include release-of-information and assignment-of- benefits statements Patient encounter form INSURANCE CLAIMS: SUBMITTING PAPER/HARDCOPY OR ELECTRONIC CLAIMS Electronic claims are prepared on a computer and transmitted electronically (from one computer to another) to an insurance carrier for processing Advantages of using electronic claims Immediate transmission Faster payment (Medicare claims are paid within 14 days versus 29 days) Easier tracking of claim status Fewer errors INSURANCE CLAIMS: PROCESSING BY A THIRD-PARTY PAYER Step-by-step review or adjudication process The claim is received in the payer’s system; the claim is prescreened for any missing information (coding edit) The patient’s eligibility and benefit level are determined The discount is applied The claim edits and payer payment rules are applied to the claim The final payment is determined The EOB and/or ERA is generated and the payment is sent INSURANCE CLAIMS: RECEIVING AN EOB OR ERA After the insurance carrier reviews the claim and makes a final reimbursement determination, it sends a remittance advice to the patient and the provider with an explanation of its decision The remittance advice (RA) also takes into account any deductibles or coinsurance the insured may owe If the insurance company determines that there are benefits to be paid, a check for the appropriate amount is attached to the provider’s report or an electronic deposit is made into the provider’s financial account. In cases where the benefits have not been assigned to the provider, the remittance is sent directly to the patient INSURANCE CLAIMS: ADDITIONAL BUT IMPORTANT STEPS Checking the Reimbursement Details After the medical office receives the remittance advice (the EOB or ERA), the administrative medical assistant reviews it and checks it against the original claim. Billing the Patient If the patient still owes money to the medical practice after the EOB or ERA has been received - usually for charges that were not fully reimbursed by the insurance company, such as deductibles or noncovered services - the administrative medical assistant bills the patient for the amount due. Appealing Claims If the physician thinks that the reimbursement decision is incorrect or unfair, the medical office may initiate an appeal Appeals must be filed within a stated period after the determination of claim benefits or denial Most insurance carriers have an upward structure for appeals, beginning at the lowest level and progressing upward INSURANCE CLAIMS: ADDITIONAL BUT IMPORTANT STEPS (CONT’D) Completing and Transmitting the Claim Form Verifying insurance information. Checking the accuracy of essential claim information. Completing the CMS-1500 claim form. Using computer billing programs. Electronic claims versus paper claims. Using clearinghouses. Following Up on Claims When an EOB or ERA from a third-party payer arrives, the assistant checks that: ▪ all the procedures listed on the claim also appear on the EOB/ERA. ▪ any unpaid charges are explained. ▪ the codes on the EOB/ERA match those on the claim. ▪ the payment listed for each procedure is correct.  Payments from Patients PAYMENTS FROM PATIENTS Methods of Payment The assistant must be careful to enter each cash payment in the patient’s ledger and in the daily summary record; the patient’s name, the services rendered, the charges, the payment received on the account, and any balances should be included. Sending Statements Although most bills are sent out once a month, a statement may be sent at the end of a procedure or episode of care, or upon discharge from the hospital; practices decide to do either monthly billing or cycle billing. PAYMENTS FROM PATIENTS: PAYMENT PLANS Payment Plans For the patient who is unable to pay a medical bill in one lump sum, a schedule of payments, or contract, can be agreed upon. The agreement should be in writing, and a copy of the plan should be given to the patient as a reminder of the commitment to pay the physician. The amount to be paid weekly or monthly is stated in the agreement, and it is used as a reference when corresponding with the patient about unpaid bills. Details of the contractual agreement should be documented in the patient’s hardcopy or electronic record. A Truth-in Lending Agreement must be signed if the practice meets the four following criteria. ‒ Credit is offered to patients. ‒ Credit is offered on a regular basis, more than 25 times per year. ‒ Finance charges are applied. ‒ More than four payment installations. PAYMENTS FROM PATIENTS Fee Adjustment Should the need arise, the physician can adjust the cost of any procedure; the physician will then inform the administrative medical assistant of the fee adjustment. Fees should not be reduced to receive payment quickly and avoid collection procedures. Filing an insurance claim and collecting benefits while waiving deductibles and other required payments are unlawful and violate Anti-Kickback laws. Health insurance Patients are billed at the time of service. Patients are billed after the insurance claim has been processed. Third-Party Liability Sometimes a person other than the patient assumes liability, or responsibility, for the charges; such responsibility is called third-party liability. The assistant must contact this third party for verification of financial obligation. Guarantor is an individual who is financially responsible for the account; often, it is the policyholder of the insurance plan that covers the patient. Delinquent Accounts DELINQUENT ACCOUNTS Communicating with Patients In a sense, the collection process begins with effective communication with patients about their responsibility to pay for services. Collecting the payments is usually not a problem when patients understand the charges and agree to pay them in advance. For high price services, it is a good idea to give the patient their out-of-pocket cost upfront. Guidelines for Payment Management or the accounting department in every office must determine the collection ratio (total collections divided by net charges of the practice). The percentage will show the effectiveness of the collections (the higher the percentage, the more effective the collections). The Office Collection Policy It is often the duty of the administrative medical assistant to collect payments on overdue accounts; each month delinquent accounts (any unpaid accounts with a balance that is 30 days past due) should be aged to show their status in the collection process (that is, 30, 60, or 90 days past due). Try to keep less than 10% of your AR over 90 days. DELINQUENT ACCOUNTS (CONT’D) Laws Governing Collections Collections from payers are considered business collections; collections from patients, however, are consumer collections and are regulated by federal and state law. The Fair Debt Collection Practices Act of 1977 and the Telephone Consumer Protection Act of 1991 regulate debt collections, forbidding unfair practices, such as making threats, and the use of any form of deception or violence to collect a debt. Guidelines Under the FDCPA: If an attorney is used by the patient, the practice may only contact the attorney; other individuals may be contacted to find out where the patient lives and/or works. If the patient is contacted, within five days after the patient is first contacted, a written notice called a validation notice must be sent to the patient stating the amount and to whom the money is owed and what action the patient may take if he or she does not believe the money is owed; it is recommended to send the letter via Certified Mail, Return Receipt requested. If the patient sends the practice a letter within 30 days after receiving the validation notice stating the money is not owed by them, do not contact the patient again about the debt; however, the patient may be contacted again to send written verification of the medical debt, such as a copy of the bill or insurance EOB/ERA. Harassing a patient, or making false statements are illegal. Medical practices cannot threaten to arrest a patient for non-payment of a debt or garnish wages; collect interest, fees, or other charges in addition to the amount owed unless an original written/signed agreement allows such charges; or contact the patient using a post card. DELINQUENT ACCOUNTS (CONT’D) Techniques of phone collection Identify yourself, the practice, and the purpose of the call. Be sure you are talking to the person who is responsible for payment of the account; avoid disclosure of PHI by following HIPAA regulations. Make the collection call in the evening, especially if the person who is responsible for payment is out during the day, but no later than 9 p.m.; collection calls may be placed after 8 a.m. but no later than 9 p.m. and not on Sunday or another day the patient recognizes as a Sabbath day. Never call a patient at a place of employment to inquire about an unpaid bill. If the patient has requested not to be called at their workplace. Always use a pleasant manner and positive wording (such as “May I process your payment today using your credit or debit card?”). Ask to discuss the bill to determine whether the patient has any questions. Listen carefully and take accurate notes of the conversation. Do not show irritation in your voice or appear to be scolding the patient. DELINQUENT ACCOUNTS (CONT’D) Techniques of phone collection (cont’d) Inform the person that you need to know why the bill has not been paid or why inquiries about the unpaid bill have not been answered. If the patient promises to pay, ask when you can expect a payment, the method of payment (cash, debit card, etc.), and the amount; then make a note about the conversation. If the patient would prefer that you call his or her attorney, do not contact the patient directly again, unless asked to do so by the attorney. DELINQUENT ACCOUNTS (CONT’D) Collection by Letter Terminated Accounts Collection by Agency Collection letters should be When a physician finds it Once an account has been turned personal letters, not form letters. impossible to extract payment over for collection, the office will The letters should show that you from a patient, he or she may have no further contact with the are sincerely interested in the decide to terminate the patient concerning billing. patient’s problem and want to physician-patient relationship. work out a solution. A letter documenting the Collection letters should be brief, dismissal should be sent to the with short sentences. patient by Certified Mail, Return The letters should appeal to the Receipt requested. patient’s sense of pride and fair play, as well as a desire for a good credit rating. DELINQUENT ACCOUNTS (CONT’D) Statute of Limitations If the physician fails to collect a fee within a certain period of time, the collection becomes illegal under the statute of limitations and no further claim on the debt is possible. Each state sets its own time limitation, which varies from three to eight years. The physician should obtain legal counsel for advice concerning these statutes. Credit Arrangements and the Truth in Lending Act When credit agreements are made, patients and the practice agree to divide the bill into smaller payments over a period of months; if no finance charges are applied to unpaid balances, this type of arrangement is between the practice and the patient, and no legal regulations apply. If, however, the practice adds finance or late charges and the number of payments is more than four installments, the arrangement is governed by the federal Truth in Lending Act, which became law on July 1, 1968, and is part of the Consumer Credit Card Protection Act. Regulation Z requires that a disclosure form be completed and signed. DELINQUENT ACCOUNTS (CONT’D) Writing off Uncollectible Accounts If no payment has been made after the collection process, the administrative medical assistant follows the office policy on bills it does not expect to collect. Usually, if all collection attempts have been exhausted and it would cost more to continue than the amount to be collected, the process is ended. In this case, the amount is called an uncollectible account or bad debt and is written off from the expected revenues. REVENUE CYCLE FIRST STEPS: SCHEDULING THE APPOINTMENT. SEE PATIENT – ENTER PAYMENT (CHARGE LAG) SHOULD BE SUBMITTED WITHIN 1-5 DAYS. CLEAN CLAIMS: NUMBER OF ACCEPTED CLAIMS/NUMBER OF CLAIMS DAYS IN AR: DATE OF SERVICE TO PAYMENT 35 DAYS SCENARIOS You are the manager of a dermatology practice. Your patient You are the manager of a large practice. You have a billing comes in for a skin check but also decides to have a few department a few employees dedicated to collecting cosmetic procedures. What should the office do regarding outstanding balances.You overhear one of your employees billing for the patient? on the phone with the patient getting agitated and unprofessional. What do you do? Congratulations, you have made it halfway through!! Have a fabulous week!! HSM 210 Module 3: HIPAA and Digital Technology Dr. Dana Rozeboom This Week Discussion Post – HIPAA violation: choose one of the three articles given and answer questions. Lesson 1 HIPAA Violations Lesson 2 Exploring Digital Technologies Two Knowledge Checks Case Study – Read 2 articles and 6 Quiz Questions 2  HIPAA Health Insurance Portability and Accountability Act of 1996 ▪ HIPAA Electronic Transaction and Code Set Standards Requirements – using the same electronic transactions, code sets, and identifiers ▪ HIPAA Privacy Requirements – limits the release of PHI without patient knowledge or consent ▪ HIPAA Security Requirements – outlines the maximum administrative, technical, and physical safeguards required to protect e-PHI 3  What is a covered entity? Department of Health and Human Services sets standards for transmitting health information. Health providers, health plans, and clearinghouses are covered entities. If they transmit health information, they must comply with HIPAA standards. Healthcare Providers: furnish, bill, and accept payment for health services. They conduct HIPAA-standard transactions electronically. Health Plans: Provides or pays for the cost of medical care. Healthcare Clearinghouses: translates or facilitates electronic data transactions between providers and health plans. Business Associates (BA): includes software vendors, lawyers, accounting firms, etc. Healthcare providers are responsible for making sure these entities are HIPAA complaint. It is not a covered entity if it does not send electronic claims and does not employ a third party, such as a clearinghouse, to do so. Once PHI leaves a covered entity and is given to a noncovered entity, the information is outside the HIPAA scope of legal protection. (Example: a work note from doctor given to an employer) 4 Transaction and Code Set Standards Set transaction standards A set of codes such as between providers and diagnoses or procedure codes is used. HIPAA standard code payers. HIPAA-approved sets include: standards include: Disease, impairment, or other Claims and encounters health-related conditions ICD- 10 (medical diagnoses) Claim status, eligibility Inpatient hospital services Enrollment and ICD-10 ICD-10: Internation Classification of disenrollment Dental services CDT Disease 10th ed Procedural Coding Payment and remittance System Physician services CPT (medical procedures/services) Coordination of benefits CDT: Code on Dental Procedures and Nomenclature Other hospital-related services HCPCS CPT: Current Procedural Terminology HCPCS: Healthcare Common Procedural Drug code NDC Coding System NDC: National Drug Code 5  HIPAA Privacy Rule: Created a national set of standards to protect medical records and patient-protected information Protected Health Information (PHI) Provider Responsibilities Individual identifying health information Three situations where PHI can be shared without permission: Electronic, verbal, or paper Treatment: Providing and coordinating medical care. Names, addresses, etc. Physicians can discuss your treatment with other doctors How many can you list? Payment: Exchange of information with health plans Healthcare Operations: General business management functions needed to run an office 6  Acknowledgement of Receipt Offices must give an explanation of privacy practices. This must be visible for the patient to see. It must include: How a covered entity will use and disclose PHI How a covered entity will protect PHI Privacy rights of patients, including the right to file a complaint with HHS How can the patient contact the covered entity to make a complaint Minimum Necessity What is the least PHI necessary to accomplish the intended purpose? Know your state laws. In some cases, state laws can be stricter than national You must limit who can see PHI, under what conditions and job responsibilities EMR admin can generally restrict use 7 Patient Rights Under HIPAA Patients have rights under HIPAA regarding their medical information. Be careful and train staff! ▪ The right to access, copy, and inspect their health information ▪ The right to request an amendment to their health care information ▪ The right to obtain an accounting of certain disclosures of their health information ▪ The right to alternative means of receiving communications from providers ▪ The right to complain about alleged violations of the regulations and the provider’s information policies There are exceptions to the privacy rule, which include: ▪ Court Orders ▪ HIV and AIDS ▪ Workers Compensation Cases 8  EIN – Employer Identification Number – 9-digit number assigned by the IRS NPI – National Provider Identifiers. Individual and Group. 10-digit number. NPI lookup: https://npiregistry.cms.hhs.gov/search 9  Data Input Transcriptions Technology is moving into new roles SOAP Note in a medical office. Subjective – patient complain Transcriptions can edit Objective – factual info (appearance, test results) Assessment – physician interpretation of the findings documentation, proofread, and act Plan – plan to treat the illness as a scribe. Common voice recognition technology DRAGON. POMR Database – complete medical history Wireless technology allows Master Problem List – running list of patient problems physicians to make medical decisions Initial Plan – master list named and described about patients without being present Notes – includes progress notes in the office. 10 RECORDS AND PATIENT DATA DESTRUCTION Records to keep indefinitely: Diagnostic Imaging How do you dispose of Births/Deaths records with PHI? Surgical Procedures Use a shredding service and keep receipts. Master Patient Index Records are the Keep Health Records property of the per CMS: 5 years physician for use and treatment. Records States have different must be given to rules. Know your state! another physician to FL: 5 yrs resume care. Records belong to the patient. GA: 10 yrs 11 Scenarios Patient Records Transferring Care Old Records Change Chart You are the manager of a You are the manager of an You are the new manager of a You are the manager of a medical office. A patient who Orthopedic office. An medical office. The company medical practice. A patient is no longer a patient calls Orthopedic office down the went from paper charts to an comes in and is angry about your front desk and asks for road calls and asks for one of EMR several years before you something written in her their records. Your front desk your patients’ entire medical became manager. A staff SOAP note. She wants it staff said no you are no longer history because they are member wants to get rid of changed. What do you do? our patient. What do you do? transferring care. What do you old paper charts. What do you do? do? 12 Have a great week!! HSM210 Medical Office Administration Module 1 Dr. Dana Rozeboom  How To Reach Me… Email: [email protected] – the best way to reach me Canvas messaging… may be slower in responding Office Hours: Tuesday 6 pm – 7 pm. Email me if you need to schedule outside of those hours During office hours, I will have our Engageli link open so you can join during those hours. 2 Live Lessons Feel free to use the camera or not. My goal is to make this a fun class! Use Chat during lecture. Information in this class you will use in your future career. Each live lesson will review upcoming assignments in detail at I want everyone to do well in this class; my job is to help you the end of class. succeed. Each live lesson will include a Everyone learns differently. Please tell me how I can help scenario for you to practice you individually. thinking like a manager. You can engage in the way you feel most comfortable. Use the Pulse Survey In the first three weeks. I can adjust my lectures, etc, as needed. Or email me! 3 Syllabus, Course Objectives, and Week 1 ▪ Understand the role of digital health in medical office operations. ▪ Week 1 ▪ Understand the key aspects of patient appointment scheduling and registration. ▪ Intro to Digital Health in Medical Office Operations ▪ Understand digital health security. ▪ Chapter 5: Section 5.1 ▪ Understand a general overview of the ▪ Graded Discussion revenue cycle management (RCM) process. ▪ Lesson ▪ Assessing the quality of a medical practice. ▪ Assessment ▪ Case Study ▪ Apply best practices with medical office operations. ▪ Explore the evolving job market in digital health. 4  Lesson 1 Module 1: Lesson 1 – Introduction to Digital Health in Medical Office Operations What will you learn? In this lesson, you will learn the following. 1.How computers are used in a medical office 2.The concept of ergonomics 3.Hardware versus software 4.Various electronic communication tools 5.Electronic scheduling 6.Maintaining patient records and privacy 7.Health care billing, collections, and financial reporting 5  The Areas Computers are Used in a Medical Office: Scheduling Creation and maintenance of patients’ medical records Communications Billing, collections, claims, and financial reporting Clinical work Scheduling Patient Medical Records 6 Communications What is Word Processing? How are computers used Word Processing Emailthink of some Can you in a medical office? examples? Word Processing What is a word processing program? Email Computer Networks Can you think of some examples? The Internet Wireless Communications How can it be used in a medical office? 7 Communications continued… What is Word Processing? Computer Networks Wireless The Internet Can you think of some Communications examples? Networking exchanges What are ways medical offices use How is Wifi used in a medical office? information among a group of the internet? computers. Cloud-based applications and how Do not use public Wifi to share PHI. Provides: might these be used in a medical Access to programs and files office? Is texting PHI HIPAA compliant? Simple backing-up process Office of the National Sharing of computer devices Coordination for Healthcare Information Technology (ONC) Servers certified and HIPAA compliant. Sharing equipment such as printers Cloud based applications 8 Billing, Collections, Claims and Financial Reporting How is billing sent to Electronic Transfer of patients? Insurance Claims Paper statements are becoming Most EMRs can electronically less common, mainly due to the submit claims to insurance cost of printing and postage. Many companies through a clearing EMRs can submit bills to patients house. Funds are generally via text, email, or links on the company’s website. returned to the company via electronic fund transfer (EFT) Many older patients have difficulty into their operating accounts. with this and may need to be sent paper statements. Billing and Collections: Financial Records EMR generally houses patient Most companies use software billing data and balances. Some such as Quick Books to can also accept cc payments. manage accounts. Generally Patient Data: Database containing operating accounts and patient data. payroll accounts are kept separate. Transaction Data: containing information about the patient’s visit. 9 Clinical Work Most office procedures use computers. Taking vitals, EKGs, Ultrasound, X-ray, etc. Some equipment can automatically transmit data into the EMR. Nurses or providers put in most results. Many lab companies like Quest or Lab Corp can interface with company EMRs to send patient lab results directly into their chart. It helps get information faster and reduces errors. Providers use programs such as Up To Date to access clinical information. Computers also electronically transmit prescriptions and can catch dangerous medication interactions. Acceptable use policy (AUP). Know how equipment is used and company property. 10 Ergonomics Designing a work environment to meet the needs of the human body. Cumulative trauma disorders, repetitive stress disorders The keyboard and monitor are most problematic Take breaks, get proper equipment for staff and suggest stretches Monitor at or above eye level, 2 – 2 ½ feet away Paper holder to look up and should be 1 ½ feet away Lower keyboard – hands at the same level as wrist Hand and wrist supports are recommended Height of chair – both feet on the ground and back properly supported Focus eyes away from screen at regular intervals to avoid strain 11 Computer Software Operating System This is what you see when you turn on Word Processing Programs your computer and runs in the Most common Microsoft Word. You background. Controls basic functions of can create templates and utilize spell the computer. Important management check. has basic knowledge of system to help troubleshoot. Graphics and Spreadsheets PowerPoint and Excel and examples. It is beneficial to know how to use both Database Management as a manager. You may give It helps the user enter information and presentations or need to create patient sort data. These are customized as handouts. Spreadsheets are used often needed. by management for tracking financial information and running reports for the office. 12  Computer Safety and Patient Confidentiality Screen Savers: Set this to a Standard Release of short amount of time. When Information Forms: You employees leave their desks, cannot share or transmit patient information on the patient data without a screen must not be visible. patient signing a release. You must ensure that your Passwords: EHRs are strict with Safeguards for Electronic Claims staff understands these laws Backing up Data: individual passwords. Transmissions: and pays close attention to Protecting PHI is very them. If your EMR is cloud-based, everything Encryption turns data into gibberish. is backed up. However, remember that important. Do not use another every file you keep on your computer Encrypted data is cipher text, and staff member’s login. The unencrypted data is plain text. Full Disclosure Policy: Have a can easily be lost. Ensure your IT system tracks and monitors written policy stating who department creates files so your work individual actions within the Electronic signatures are required on can access patient records. is backed up on a server or the cloud. system. office notes, prescriptions, and imaging Informing patients protects Don’t keep any PHI on files that can be read by a physician and for electronic the office. lost or are not secured. It is best to Virus Checker: Viruses damage claim submissions. The provider must keep all patient information in your lock office notes so the information is EMR. hard drives and destroy data. kept the same once signed. Inspection of Audit Trails: Tell staff not to open any emails Almost everything you do in they do not recognize. Antivirus Firewalls protect outside parties from an EMR can be tracked, software should always be seeing an organization’s files. Firewall from scheduling to looking used. Trojan viruses work in the blocks and antivirus remove malicious at a particular file. background, and worm viruses software. Remember that whatever will “eat their way” through a you do is documented and computer. Both are examples of time-stamped. malware. 13  Scenario 2….. You are the manager of a cardiac unit at a hospital. This unit has several pieces of medical equipment that staff use for cardiac diagnostic purposes. There has been a great deal of employee turnover. What steps would you take to make sure employees know how to properly use this equipment for the safety of patients and the accuracy of results? Scenario 1….. You are the manager of a small primary care practice. One of your employees tells you she has seen one of the medical assistants taking pictures with her cell phone. The medical assistant thinks it is funny to take photos of patients who come into the office and dress funny or look unusual in some way. She shares them with friends and co-workers. The employee insists this is not a violation of any kind. How would you handle this situation with the employee? 14 Assignments Due This Week…… Read Ch 5 Section 5.1 Discussion Post – What Module 1 Knowledge Case Study is Digital Health? Check Remember to do the Pulse First response by Wednesday 2 attempts. Keeps highest Watch the video and answer Survey at the end of the week. midnight. Min 100 words. score. 25 points questions. 50 points It helps me know what I can Reply to 2 classmates two do to help you succeed. separate days—at least 50 words. 15