Opening the Office: Checklist, Safety and Office Procedures - PDF

NOTES CHAPTER 21- Opening the Office -​ A well-prepared, organized, and tidy office environment is immediately noticed by patients, providers, and visitors. The surroundings set the tone of the office and the first impression and level of professionalism anticipated. -​ Pre...

NOTES CHAPTER 21- Opening the Office -​ A well-prepared, organized, and tidy office environment is immediately noticed by patients, providers, and visitors. The surroundings set the tone of the office and the first impression and level of professionalism anticipated. -​ Preparation procedures can differ according to the type of practice, number of providers, weekly schedules, and many other variables. ★​ A checklist specific to your office should be created and followed to ensure that you cover all daily functions of opening, operating, and closing the office. Arrive at the office in time to open the office and make preparations for receiving patients. Steps of opening the office for the workday. 1.​ Unlock the reception room door. 2.​ Evaluate and prepare the reception room for cleanliness, comfort, and safety. 3.​ Prepare the front desk area. 4.​ Working in an EHR office: Review the patient schedule, check for previously ordered studies, and scan the chart. (Provide original copy to provider for review and validation before scanning) 5.​ If it is the policy of the office, prepare a list/schedule (or print from the practice management system) of the patients to be seen by the provider and the times of their appointments. Place copies in designated areas. 6.​ Inspect and prepare exams and lab rooms for cleanliness and safety. The U.S. Department of Justice, Civil Rights Division-National Task Force on Violence Against Health Care Providers, has recommended that medical facilities “install deadbolt locks on office doors leading to hallways and other public areas, consider installing a ‘buzzer’ entry door system (on the door between waiting room or reception area and examination rooms or office areas) [and] managers should issue and control keys, conduct semi-annual inventories, and have locks changed when keys are missing.” These types of locks provide a degree of security. Any opening between two areas, such as a window, should also be fitted with a security device to prevent unauthorized access. If there are private entry doors, be certain they are kept locked at all times. If you must enter or leave the office at night, be especially alert. The outside area should be well-lit. If building security personnel are available, ask for an escort. If you are the first staff member to arrive at work, it will be necessary to enter the code before opening the door or enter the code on an internal keypad before the entrance delay period expires. Both these systems lend a feeling of safety and security, but be aware: It takes only a few seconds for someone to grab your purse or wallet or force you to hand over office money or drugs. Never enter the office if you see evidence of forced entry or if it appears that someone might be inside or has been inside. Leave at once and call building security or the police. The reception room requires a safety check every morning to ensure that it presents no hazards for patients and visitors: ​ Observe the physical environment of the reception room. Studies have shown that the reception room atmosphere can reflect how patients perceive the office and their expectations. The atmosphere affects how people experience their environment and can affect their response to treatment. ​ Check the temperature. The room temperature should ensure the patient’s comfort. ​ Look at the room’s appearance- Large plants, paintings, color, lighting, background music, aquariums, flat-screen televisions, and various programming options in medical and dental offices can create a calming environment. It's important to be conscious of the sights, sounds and smells in the reception room. ​ Observe the condition of the furniture. Pay attention to the legs of chairs and tables—they must be stable and able to support appropriate weight. ​ Perform a safety check- Daily visual checks of electrical devices, furniture, floors, and lighting before patients arrive are crucial. Ensure bulbs and cords are in good condition, lighting is adequate, and floor surfaces are free of wrinkles or rugs. ​ Check the reading material- Maintain a clean and organized library by arranging reading materials, sanitizing shared materials, and removing outdated ones. Providers may have brochures, health-related pamphlets, or display racks, but professional medical journals are not suitable for general display. ​ Check the toys and books.- To ensure children's safety, provide washable, safe toys and books that are regularly cleaned and sanitized. Place play areas in controlled areas to prevent falls. Pediatricians' offices should have separate "well" and "sick" areas for children with different health conditions, separating well children from those with disease. Regular inspections and cleaning are essential for maintaining a safe environment. ​ Display the smoking policy. Confirm that the Smoke-Free sign is displayed and policy is enforced. When preparing the front desk at the beginning of the day: ​ Turn on computers, scanners, printers (and other electronic equipment). Offices with electronic health records (EHR) must have all computers and tablets operational before the first patient can be checked in and the encounter starts.  ​ Retrieve telephone messages. Retrieve and record all messages from the answering machine. If an outside service is used, call and obtain the messages. ​ Retrieve faxes. Sort per office protocol. ​ Retrieve printed lab and hospital reports. Sort per office protocol. ​ For offices using paper charts, place charts for check-in. At least one day before, pull charts and look at the appointment book or run a copy of the schedule from the computer of all patients who have appointments that day. You will need to attach reports of any previously ordered studies (labs, consults) to the chart. Have materials (registration package documents) ready to create charts for scheduled new patients. This process should be done at least the day before to reduce morning preparation duties. Many offices like to post a copy of the day’s schedule and place it on the provider’s desk for his or her personal use and reference. ​ The workflow of offices using an EHR will vary, but schedules are generated electronically, lab orders and results are placed and received electronically, and there are no paper charts. All non-electronic documents (faxed hospital reports, consults, etc.) will need to be viewed by the provider, validated, and then scanned into the patient’s electronic chart. ​ Prepare sign-in sheet, cash balance forms, and so on. Have daily forms available along with pens and other basic equipment. ​ If using an electronic check-in kiosk, make sure that it is powered up and online. Inspecting Examination Rooms and Lab Areas At the beginning of the day, visually inspect all exam rooms for cleanliness, even if they were cleaned the previous day, as the provider might have seen a patient after hours. Replace table paper if warranted, and be certain waste receptacles are emptied. Observe room temperature and plug in any disconnected electrical equipment. Confirm everything is in working condition. Restock supplies so that needed materials are available. Maintain an inventory control sheet (checklist) and select a set day of the week as a restocking day. Of course, you will restock as necessary daily. Check common areas and ensure they are clean and everything is in order. Check the water level in the autoclave and turn it on. Be sure hazardous waste disposal containers are available for use in all areas where needed. Children and some adults are naturally curious about things in the examination room, cabinets, or counters. Anything that might be hazardous or could become contaminated should be kept out of sight. -​ Prescription pads, if used, should not be left lying around; they should be kept in a secure, locked area. Secure all electrical cords in the examination rooms so they will not interfere with movement or walking in the room. Chemicals kept in the office for laboratory work must be properly labeled and stored. Chemicals that could become volatile when kept beyond their expiration date must be monitored carefully. Testing patients’ urine, blood, and other specimens requires special procedures. -​ Containers for the disposal of used equipment and biohazardous waste receptacles must be readily accessible. A strict adherence to standard precautions is essential to the maintenance of a safe and healthy lab environment. Good inventory control and cost comparison are essential in your position. Be sure to coordinate your activities with the provider to avoid duplication, and be aware of any updates or changes to items or medications. Some of your duties include inventory and ordering office (clerical) supplies, clinic supplies (exam room orders), and medication orders. Careful monitoring of inventory is vital. You do not want to run out of needed supplies, yet you also do not want to over-order items, especially since many can have an expiration date and are often quite costly. A minimum amount of supplies to be maintained should be determined and will depend on the type of practice and the number of patients seen on an average day. This is known as a threshold (sometimes referred to as par level). Maintain a binder with current information and create an electronic file system using spreadsheets (e.g., Microsoft Excel) to track your inventory and purchases. Keep a current list of all the suppliers (vendors) of goods and services compiled by category, such as administrative, laboratory, clinical, and general. By using a spreadsheet, you can sort this information and create an alphabetical list as well. Document each vendor (business) with the name of the company, the address and phone number(s), email address, website information, and a contact person if possible. A list of what products or services they provide should be entered for each vendor. Special storage for narcotics or laboratory items requires regular inventory and counting. Time-sensitive items should be stored in order of expiration, and expired items should be properly disposed of. Factor in turnaround time for laundering linens After the workday, restock and clean examination rooms and dispose of discarded material. If using paper charts, collect, check, and file them in a locked cabinet. Some physicians dictate notes, which must be transcribed and filed. EHR eliminates the need to refile paper charts but requires scans for non-electronic documents. To ensure patient privacy and HIPAA compliance, all electrical appliances and autoclaves must be turned off, including computers. Office managers must develop IT policies and enforce compliance, while staff members must follow these guidelines. Providers and staff must log off applications and software programs at day's end, and some computers may be left powered for updates. Ensure daily receipts are deposited in the bank or office safe and the reception area is sanitized. If using paper charts, place consultations, lab reports, and reports with them. For offices with electronic health records (EHR), review patient charts for outstanding orders or documents and provide original documents for review and validation before scanning. Activate your answering system, securely lock all the doors and windows, close blinds, activate the alarm system, and turn off the lights. Be aware of your surroundings as you leave the office. Try always to leave with a coworker, rather than leave alone, for safety reasons. If you must leave the office after dark or alone, ask a building attendant for assistance if available. Computers in medical offices offer numerous advantages, including efficient claims processing, quick identification of patients with specific diagnoses, and easy reporting through the EHR application. They eliminate paperwork, improve reimbursement speed, and aid in research and drug-related warnings, making them essential for efficient patient care. Computer software enhances written communication, eliminates human error, and provides financial status figures. Electronic health records store patient demographics, insurance, and more. They're useful for inventory control, personalizing mailings, and gathering research data. Privacy of stored information is crucial, regulated by HIPAA regulations. The HIPAA “Minimum Necessary” Privacy Rule generally requires covered entities to take reasonable steps to limit the use or disclosure of and requests for protected health information (PHI) to the minimum necessary to accomplish the intended purpose (HHS, 2014). Employees with computer access should be required to have a login and password to safeguard the information and access. Further, protect PHI by installing a privacy screen on the computer monitor to prevent viewing by others. Place fax machines in a secure area so that PHI is not visible. Place privacy sheets over written documentation or paper charts so that PHI cannot be viewed. Hardware refers to the hard disk drive, the CPU, the monitor, and the keyboard. Software refers to the application programs containing instructions to the computer that enable it to perform tasks. A computer, by itself, cannot do anything without software for accessing and inputting data. Be cautious in downloading any programs. Let the I.T. department install or update any programs. When you input data with a software program, the data resides in the computer’s main memory until it is saved in a file on the hard drive or other storage device. The main storage component for a computer is its hard drive, which stores enormous amounts of information that can be retrieved almost immediately. In offices with several workstations, the individual computers or terminals can be networked to a server. The server can contain databases, applications, and stored files to be shared in the office. This arrangement frees up hard drive space on the individual workstations and provides a centralized location from which client applications such as the EHR or email can be accessed. A properly networked system permits input and record updates from all stations and allows the information to be accessed from all stations. In addition, many of the servers can be accessed remotely via a secure login. Application software allows users to interact with the computer to perform specific tasks such as word processing, database management, spreadsheet preparation, and music or video playing. Medical offices might use educational software programs, another type of application software, for patient education, such as Krames StayWell. The medical assistant can access the application and provide written or electronic copies to the patient. -​ Practice management (PM) software is a type of application software that manages the operations of a medical practice and is available from a variety of companies. The transactions entry screen enables users to apply procedure charges to patient accounts, generate insurance forms, and update their running totals, with the account updating immediately after completion.  -​ PM programs send the insurance claim electronically to the insurance clearinghouse, or paper claims can be printed. The claim scrubber allows for accurate submission of claims, a higher percentage of payment, and less rejection of claims. An electronic health record (EHR) captures all patient health information harvested from one or more encounters in any health care delivery system (such as a medical office, hospital, and urgent care center) and refers to the interoperability of electronic medical records or the ability to share medical records with other healthcare facilities. -​ EHR software enables providers to document all care received by the patient—tests performed, treatments prescribed, patient education given, and so on. Sponsored by the U.S. Department of Health and Human Services, the committee detailed a common industry standard for EHR functionality that will guide the efforts of software developers. The eight core functions are: ​ Health information and data ​ Result management ​ Order management ​ Decision support ​ Electronic communication and connectivity ​ Patient support ​ Administrative processes and reporting ​ Reporting and population health EMR refers to clinical functions, and EHR refers to the combined software program that integrates both PM and EMR EMRs give providers a new way to manage tasks, streamline their workflow, and improve the quality of patient care. With EMR, you can: ​ Capture patient visits electronically using Quick Text, dictation, and structured templates ​ Manage and document patient communications quickly and efficiently ​ Generate and process prescription refills ​ Complete office workflow tasks with detailed or summary patient information that includes medications, allergies, and more ​ Attach patient documents, images, X-rays, or other files in electronic format.t ​ Evaluate patient information using graphs and flow sheets ​ Manage medication and allergy interactions ​ Generate patient education information A progress note is everything the provider or hospital professional does for the pt. Medication Reconciliation is the review of medication. The use of EHR software significantly enhances efficiency in the medical office in many ways. Improving workflows, reducing paper usage, and shrinking costs. As you document in an EHR, It is your responsibility to ensure data integrity. Confirm you are documenting in the correct patient’s chart and professionally entering accurate information. -​ The practice will experience times when the computer systems are not operating. This is referred to as downtime. Preparations must be made in advance to be able to convert to paper, using manual scheduling and messaging, billing, and a downtime form to document the patient encounter. According to HealthIT.gov, A patient portal is defined as “a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection.” Accessed via a unique username and password, patients can view health information such as: ​ Recent physician visits ​ Discharge summaries ​ Medications ​ Immunizations ​ Allergies ​ Lab results Demographic information is the patient name, DOB, Address, Emergency Contact, Telephone number Some patient portals also allow you to: ​ Securely message your physician ​ Request prescription refills ​ Schedule non-urgent appointments ​ Check benefits and coverage ​ Update contact information ​ Make payments ​ Download and complete forms ​ View educational materials New technology offers patients faster access to test results, care plan confirmation, and improved engagement through patient portals, but providers worry about potential confusion or misinterpretation. Encoder Software is available as a powerful application for all CPT, HCPCS, and ICD-10 code sets and Medicare coding guidelines. This software will improve coding accuracy and billing performance and reduce rejected claims. Advantages of using encoder software include:  ​ Compliance editing ​ Robust code checking ​ Increase in the rules set ​ Improved compliance and accuracy for accelerated claims payments ​ Fee calculator ​ Color-code edits ​ Modifier crosswalk ​ Cross-coder relationships ​ Medicare CCI edits ​ LMPR/LCD and NCD policies ​ EncoderPro, Harris CareTracker’s partner for online code verification, is a popular supplier of encoder software. The Internet is a system of interconnected computer networks by which to access information from all over the world. -​ The Internet can be a great source of data from health organizations such as the American Cancer Society and the Centers for Disease Control and Prevention (CDC). -​ Patients should be warned about going online to seek medical advice or purchase medications. Self-medication could cause serious problems from drug interactions with the prescribed medications ordered by the provider. Self-diagnosis could cause anxiety to the patient or, conversely, cause the patient to ignore symptoms best evaluated by a provider. To ensure accurate information, it's essential to follow simple website guidelines, as no official agency reviews or evaluates the content posted on the internet, like 1.​ Check the source. Are there links to professional affiliations, or are there professional credentials? 2.​ Be cautious about personal testimonies from users; they often receive monetary compensation for making statements. 3.​ Watch for the dates of the information; the information can be very old and no longer valid. 4.​ Use your analytic and critical thinking skills to interpret scientific studies or reports. Who did the research? How many people were included in the study? Is the amount of time spent appropriate to arrive at the stated conclusions? Is there more than one study on the subject to give its results credibility? Computer Security Regardless of whether your office has EHR software or not, you must employ best practices for safe computer use. There are several security considerations: 1.​ Physical access (computers, screens, printers, fax, copier, etc.): You must take action to protect patient information from being viewed by unauthorized users. Use screen privacy shields and automatic screen savers; place equipment out of high-traffic and visual sight areas. 2.​ Use passwords for each computer and software application, and set applications to log off automatically if inactive for a specified period. 3.​ Catalog (inventory) all information system components: a.​ Hardware: Computer workstation and tablets, printers, PDAs, smartphones, scanners, modems b.​ Software: Operating system, billing software, practice management, email, EHR, database c.​ Network: Routers, hubs, phone and cable lines, wireless, firewall software and hardware d.​ Backup data to ensure integrity from loss, disaster, human error, hard-drive error, virus, or equipment damage. Use the appropriate level of secure backup for the practice: i.​ Tapes ii.​ CDs iii.​ Off-site (examples include the “cloud” and “web-based” applications provided by EHR vendors, such as Harris CareTracker PM and EMR) e.​ Keep network and communication safeguards intact: To defend against attacks and viruses, install firewalls (hardware and software devices that protect an organization’s network from intruders). A firewall denies access to unauthorized users and applications and creates audit trails or logs that identify who accessed the network and when. Firewalls also issue alarms if repeated unsuccessful attempts or abnormal activities occur. f.​ Keep antivirus software up to date: Viruses attach themselves to emails, program files, and data files. Be vigilant in keeping antivirus software current. Operating systems programs they run can be inherently open to attack. g.​ Understand encryption: HIPAA security standards require you to assess whether unencrypted transmissions of health information are at risk of being accessed by unauthorized entities. If they are, some form of encryption should be considered. Examples are: i.​ Patient billing and information exchanged with payers and health plans ii.​ Usage and case management; authorization and referrals iii.​ Patient health information gathered from or displayed on a website or portal iv.​ Lab and other clinical data electronically sent to and received from outside labs v.​ Word processing files used in transcription and transferred electronically  vi.​ Emails between providers and patients or between attending and referring providers and their offices h.​ Vendor and business relationships chain of trust: Demand that all vendors and business partners fully understand and comply with the HIPAA security standards. i.​ Access and security levels to EHR should be monitored and tracked Electrical surges and power outages can destroy information currently being accessed if it has not yet been saved by the operator or automatically by the program. Loss of data due to electrical surges and power outages can be prevented by the installation of a protective device known as an uninterrupted power supply (UPS), which contains a battery backup system. ​ A UPS is capable of sensing a surge or outage and automatically switches to a backup battery to preserve the data. The size of the battery determines the length of time the electronic equipment can be sustained. The primary purpose is to allow you time to save your document, exit the program, and shut down your system until the power is again stable. Loss of data due to electrical surges and power outages can be prevented by the installation of a protective device known as an uninterrupted power supply (UPS), which contains a battery backup system. A UPS is capable of sensing a surge or outage and automatically switches to a backup battery to preserve the data. The size of the battery determines the length of time the electronic equipment can be sustained. The primary purpose is to allow you time to save your document, exit the program, and shut down your system until the power is again stable. It is very important to establish a backup policy to make copies of office programs and data. Often, this is performed each night. Most online web applications (cloud-based) will back up and refresh continually in real time. Computer hard drives can crash, causing the loss of all programs and stored data. Programs and extensive data can be copied by a peripheral tape backup device, thereby providing a durable copy of the information. All central computer data should be backed up on tape or by way of an external backup system daily, such as an off-site facility, to protect against loss of files from fire or natural disaster. This type of backup service is often included in the EHR vendor support package. Ergonomics and Computer Use Ergonomic- the applied science of being concerned with the nature and characteristics of people as they relate to design and activities to produce more effective results and greater safety. When using computers, it is essential to evaluate the workstation for health and safety considerations by performing an ergonomic assessment. Using proper ergonomics in the work environment promotes wellness and minimizes musculoskeletal disorders. Request a workstation evaluation and appropriate equipment to avoid injury from improper setup or repetitive computer use, including proper lighting, height, keyboard, mouse, and headset. Large multi-provider offices and clinics have more patients and employees and, therefore, require a greater number of machines and larger-capacity equipment. Smaller offices and single-provider practices might have less specialized equipment. Copy Machine A photocopy of correspondence, an insurance form, a patient’s insurance card, a patient’s record, laboratory reports, or account information is often needed. Service representatives can demonstrate how to clean the glass, feed rollers, and surfaces and how to maintain the toner. Large copiers can be programmed to perform several functions, such as enlarging or reducing copy size, stapling, sorting, off-set stacking, one- or two-sided copying, and insertion of cover sheets. Care should be taken to avoid copying material that carries copyright protection because this is considered illegal unless permission to copy is obtained from the writer or publisher. Your duties include routine cleaning and maintenance of the copier, including cleaning glass and rollers, wiping exteriors, picking up discarded paper, filling paper supplies, and checking and replacing toner. Having at least one replacement cartridge in reserve depends on office copying volume. A copy machine can produce copies at a much lower cost than a printer, and the features of speed, collating, offset stacking, and more can be very time-saving. The all-in-one printer, fax, scanner, and copy machine are connected to the computer and replace four individual pieces of equipment. Facsimile machine- Dictation- Transcription- The technology for dictation, transcription, and digital voice recording is constantly improving and changing. Many medical offices and providers are now using speech recognition software. One popular application is Nuance Dragon Medical One, which allows the user to create transcription-free medical records, emails, and correspondence. Many of the newer electronic devices and smartphones have voice recognition capabilities that offer seamless compatibility with Microsoft Office and networks and interface with EHR programs. The use of voice recognition software has been found to reduce cost and turnaround time compared with traditional transcription methods. As with any transcription or voice recognition program, there can be difficulties in setting up the profiles (training the program to your voice) and accuracy. Another error is information that is phonetically correct but inaccurate. Always carefully proofread to eliminate any errors. Printers A printer is required to produce hard copies of computer files. Two types of printers are appropriate for a medical office: inkjet or laser. -​ An inkjet printer can print in different modes. In draft mode, less ink is used, and the page can be printed faster. For a professional-looking finish, the letter-quality mode is used, and, therefore, the printing process is slower. The purpose of the draft setting is to conserve printer toner or ink when printing a large number of pages of a document that is not in its final stages. Inkjet printers cost less than laser printers, but their ink cartridges are more expensive, meaning that the ink cost per printed page is higher. Inkjet printers can be more economical in offices with a lower volume of printing. Laser printers are usually preferred in an office environment with higher printing volume. Additionally, the print quality is much better. Consult with your equipment supplier to see if a multifunctional copier can provide your printer function needs as well. If using a multifunctional machine, it would be best practice to have a backup machine or options available in the event of downtime. Equipment Maintenance The medical assistant might be asked to keep track of equipment maintenance because several administrative offices and clinical equipment pieces must remain operational. Most machines come with a manual for routine maintenance. Daily maintenance includes cleaning various parts (with appropriate materials), checking and resetting consumables, replacing parts, and troubleshooting.