Scheduling & Records Management

Efficient appointment scheduling and accurate medical records management are core competencies for medical assistants. These skills directly impact patient satisfaction, provider productivity, and practice revenue.

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Appointment Scheduling Methods

Typical Appointment Durations

Scheduling Best Practices

• Buffer time: Leave open slots for emergencies and same-day appointments
• No-show management: Track no-show rates, implement reminder calls/texts 24-48 hours before appointments
• Wait time: Aim to keep patient wait time under 15 minutes
• Cancellations: Have a waitlist to fill cancelled appointments quickly
• Provider preferences: Learn each provider's scheduling preferences and typical visit lengths

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Medical Records Management

Types of Medical Records

EHR vs. EMR

• EMR (Electronic Medical Record): Digital chart used within a single practice — does not easily share data
• EHR (Electronic Health Record): Comprehensive digital record designed to share across healthcare settings — follows the patient
• Key distinction: EHRs are interoperable; EMRs are not

Meaningful Use / Promoting Interoperability

The federal government incentivized EHR adoption through the HITECH Act and Meaningful Use criteria (now called Promoting Interoperability):

• Stage 1: Data capture and sharing
• Stage 2: Advanced clinical processes
• Stage 3: Improved outcomes
• Goal: Improve healthcare quality, safety, and efficiency through health IT

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SOAP Note Documentation

The SOAP note is the standard format for documenting patient encounters:

Documentation Best Practices

• Document at the time of service or as soon as possible after
• Use black ink for paper records (permanent, legible, copies well)
• Never use white-out or erase entries — draw a single line through errors, initial, and date
• All entries must be dated, timed, and signed with credentials
• Document only what you observe and what the patient states — no opinions
• Late entries should be clearly labeled as "late entry" with the current date

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Filing and Organization

Filing Systems

Indexing Rules (ARMA)

1. Last name first, then first name, then middle name/initial
2. Prefixes (Mc, Mac, De, Van) filed as written
3. Titles (Dr., Mrs.) are not used for filing; placed in parentheses after the name
4. Business names are filed as written (articles like "The" moved to end)

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Medical Records Retention

Key Retention Principles

• Follow state law for minimum retention periods (state law overrides general guidelines if more restrictive)
• Records may be needed for malpractice claims — statute of limitations varies
• Never destroy records if litigation is pending or anticipated
• Records should be destroyed by shredding, burning, or secure electronic deletion
• Maintain a destruction log documenting what was destroyed and when

Correspondence and Mail Processing

Incoming Mail Handling

1. Sort mail by category: urgent, routine, personal, financial
2. Date-stamp all incoming mail
3. Annotate or attach relevant patient records if applicable
4. Distribute to the appropriate person or department
5. Handle confidential mail per HIPAA — do not open mail marked "Personal" or "Confidential" unless authorized

Outgoing Mail

• USPS options: First class, priority, certified (proof of mailing), registered (proof of delivery), express
• Certified mail with return receipt is used for important legal documents (termination letters, collection notices)
• Electronic communication: Email, patient portals, and fax must comply with HIPAA
• Faxing PHI: Use a cover sheet with a confidentiality statement, verify fax number before sending

Medical Records Release

• Requires patient written authorization (signed release form)
• Authorization must include: patient name, date, description of information to be released, recipient, expiration date, patient signature
• Exceptions to authorization requirement: Treatment, payment, operations (TPO), court orders, public health reporting, mandatory reporting
• Respond to requests within the time frame specified by state law (typically 30 days)
• A reasonable copy fee may be charged

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Professional Fee Schedules

Fee Setting

• Usual fee: The fee a provider typically charges for a service
• Customary fee: The range of fees charged by providers of similar training and experience in the same geographic area
• Reasonable fee: The fee determined to be appropriate for the specific circumstances (unusual complexity, time, etc.)
• UCR (Usual, Customary, and Reasonable): The basis for determining reimbursement amounts

Adjustments and Write-offs

• Contractual adjustment: Difference between the provider's charge and the allowed amount per insurance contract — written off
• Professional courtesy: Discounted or free care for healthcare colleagues
• Hardship/charity write-off: Reduced fees for patients with financial hardship
• Bad debt: Uncollectible amounts after reasonable collection efforts
• All adjustments must be documented in the patient's financial record

Collection Procedures

Patient Collection Timeline

Collection Letter Series

1. First letter: Friendly reminder of outstanding balance
2. Second letter: Firmer tone, request for prompt payment
3. Third letter: Final notice — warns of potential collection agency referral
4. Collection agency referral: Only after all internal efforts have been exhausted

Fair Debt Collection Practices Act (FDCPA)

• Prohibits harassment, false statements, and unfair practices in debt collection
• Cannot call before 8 AM or after 9 PM
• Cannot call at the patient's workplace if asked not to
• Cannot discuss the debt with third parties (except the patient, their attorney, or credit bureaus)
• Patient can request in writing that all contact cease
• Violations can result in damages to the patient

Credit and Payment Arrangements

• Offer payment plans for large balances
• Document payment agreements in writing
• Accept multiple payment methods (cash, check, credit card, online portal)
• Truth in Lending Act (Regulation Z): If payments extend beyond 4 installments or a finance charge is assessed, a written disclosure is required
• Post fees conspicuously in the office and provide fee information upon request

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Banking Procedures

Types of Checks

• Personal check: Written by an individual from their bank account
• Cashier's check: Issued by the bank — guaranteed funds
• Certified check: Personal check verified by the bank — guaranteed funds
• Traveler's check: Pre-printed fixed-amount checks for travel use
• Third-party check: Written to one party and signed over to another — generally not accepted

Endorsement Types

• Blank endorsement: Signature only — risky, anyone can cash it
• Restrictive endorsement: "For deposit only to account #___" — most secure for medical offices
• Special endorsement: Transfers check to a specific person — "Pay to the order of..."

Bank Deposits

• Prepare a deposit slip listing all checks and cash
• Use restrictive endorsement on all checks immediately upon receipt
• Make deposits daily to ensure timely cash flow
• Keep a copy of the deposit slip for practice records
• Reconcile bank statements monthly to detect errors or discrepancies

Petty Cash

• Maintained for small office expenses (postage, parking, small supplies)
• Typically $50-$200
• Require a voucher/receipt for every disbursement
• Reconcile regularly — cash plus vouchers should equal the original amount
• Replenish when low by writing a check to "Cash" or "Petty Cash"