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6 Current Issues for Medical Office Managers

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The medical office is constantly facing many challenges. The medical office manager's job is to identify them and understand the necessary steps to implement successful strategies.

1. Preparing for Change

Whether it is welcome or not, change is inevitable especially in the health care industry. It is important to be prepared for changes that may come which could be technology, compliance or in order to meet the demands of your patients. No matter what changes your medical office experiences, the main importance regarding those changes is how you respond to it.

Medical Office Managers must be ready and able to identify opportunities for change that will enhance office efficiency and effectiveness. It is important to stay up-to-date on healthcare trends for financial, compliance and future planning.

2. Transition to 5010

Althought the date has passed for all providers, hospitals, and payers to convert from Version 4010 standards for electronic health transactions to Version 5010 for electronic claims, the transition is far from over. Facilities all over the country are experiencing many challenges in getting back to the "norms" of billing and coding. Getting clean claims billed out will take time because simply put - none of us knew exactly what we were facing.

The most important step you can make is to identify each problem as it arises. Whether you have your own IT department or you have to contact your billing software provider, be ready with examples of what your billers are experienceing to get things fixed. Unfortunately there is no quick solution but staying on top of these "bugs" will serve you well in the long run.

3. Protecting Patient Privacy

All healthcare providers have a responsibility to keep their staff trained and informed regarding HIPAA compliance. Whether intentional or accidental, unauthorized disclosure of PHI is considered a violation of HIPAA. Here are 5 tips to avoid violating HIPAA:

  1. Healthcare professionals should be very careful to refrain from disclosing information through routine conversation. This can easily be done by mentioning to a third party something seemingly insignificant as saying that John Smith had an office visit today.
  2. Discussing patient information in waiting areas, hallways or elevators should be strictly off limits. Sensitive information can be overheard by visitors or other patients. Also be sure to keep patient records out of areas that are accessible to the public.
  3. PHI should never be disposed of in the trash can. Any document thrown in the trash is open to the public and therefore a breach of information. Use an outside service that specializes in the proper disposal of PHI.
  4. Gossip is particularly hard to control. That is why it is important that access to information be strictly limited to employees whose jobs require that information. This type of violation can be particularly damaging to the reputation of your organization especially in small communities where "everybody knows everybody".
  5. Selling patient lists or disclosing PHI to third parties for marketing purposes is strictly prohibited without prior authorization from the patient. Remember that disclosure of patient information should only be accessed for the purpose of providing quality care.

4. Infection Control

Preventing the spread of infectious diseases is the main goal of infection control in the medical office. As we all know, proper hand washing is the most effective way of preventing the spread of infections, however, hand washing alone cannot do the job. Patients and staff can help by:

  • Staying up-to-date on immunizations including the flu shot
  • Using proper hygiene when coughing and sneezing
  • Following proper guidelines when handling blood and other bodily fluids
  • Wearing appropriate personal protective equipment (PPE) when appropriate

The most important step the medical office can take to prevent the spread of infectious diseases is by adding touchless, or hands-free products that promote patient safety and ensure the protection of patients and staff.

5. Outstanding Claims

Whether your medical claims are billed electronically or paper billed by mail, it is imperative that your medical office staff follow-up with the insurance carriers to obtain claim status. Once the bill has been received by the insurance company, you do not have to be at their mercy to get paid in a timely manner.

Depending on your billing method, you should expect to receive payment in as little as 15 days. If your insurance payments are averaging a turnaround time longer than 30 days from the time your bills are sent out until you receive payment, your office needs to develop a process for claim follow-up. Following up on the status of your claims can definitely improve your accounts receivable days.

6. Internal Control

Internal controls are defined as a process designed to discourage fraud, safeguard company resources, and ensure compliance with laws and regulations. Internal controls are only effective if they are determined by the specific needs of the medical office, implemented, monitored, and measured to make sure they are functioning as planned.

The medical office must take a proactive approach to prevent and detect employee misconduct by having a policy in place regarding internal controls. Prevention and detection play a very important role in any internal control process by minimizing a certain level of risk.

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