The U.S. Health Care System (MCAA Training Manual)

The Healthcare system of the United States of America is the world’s largest health care system in terms of expenditure. However, much about the US healthcare system relates to the system’s controversial inability to be at par with the healthcare systems of other countries that belong to the developed world. However, the US healthcare system boasts of many other things that include freely available medical technologies and state-of-the-art facilities that are the envy of all other countries in the world. A distinguishing feature of the US healthcare system is its domineering private sector that makes the country different from many countries in the world (Ric, Rosenau, Unruh, & Barnes, 2013).

The US healthcare system can be regarded as a multiple-based system whose operations include collaborating and independent stakeholders. In this case, there are two major players in the system, namely the federal government and state governments. Here, the state governments are in charge of many public health functions, cover the costs of part of the Medicaid, and dictate its operations within their respective states. At the same time, healthcare aspects such as the supply of pharmaceuticals and medical devices are under the supervision of the federal government.

Despite these confusing elements of the healthcare system, the country boasts of a large and well-trained workforce that has a high level of specialization within its ranks. For instance, the healthcare industry has various organizations that advocate the perpetuation of the interests of the various professionals working in the sector. Consequently, many of the professionals adhere to very high standards of personal as well as professional conduct when they are in duty. The Certified Medical Administrative Assistant (CMAA) is an example of one occupation in the US healthcare that is very critical to upholding the standards of the sector. Therefore, this paper is going to lay out a training manual for the certification of the American Medical Administrative Assistant.

The Organization Structure

The National Health Association approved CMA (AAMA) is the only recognized medical assisting body that requires formal training and education for one to gain acceptance into the sector (Balasa, 2011). Secondary school graduates qualify to enroll into the certification program. The running and accreditation of the CMA (AAMA) program is under the Accrediting Bureau of Health Education Schools (ABHES) or the Accreditation of Allied Health Education Programs (CAAHEP). Candidates for this certification are given a fair chance of attempting three exams in order to qualify as professionals in the field. Furthermore, the CMAs undergo recertification in the field by either passing the CMA (AAMA) Certification Examination or having 60 hours of continuing education in the mandatory categories that run for over five years.

The American Medical Technologists offer five distinct eligibility pathways for one to graduate and become a CMAA. These five distinct pathways provide the graduates with the opportunity to work in the various divisions of the US health sector.

A typical US health sector is composed of the following specialists. First, there is the Physicians, who can be medical doctors (MDs) or doctors of osteopathy (DOs). The Physicians are served by the Physician Assistants, who have the qualifications to diagnose and treat patients under the supervision of the physicians. A registered nurse (RN) is a medical professional limited to the nursing functions in the health care sector. On the other hand, the nurse practitioner is a registered nurse that has an advanced training. Consequently, the nurse practitioner can diagnose and prescribe medications to patients with an emphasis on the prevention of diseases. Medical assistants are expected to work under the physicians but cannot take part in clinical and treatment procedures.

Patient Check-In and Checkout

Typically, an MCAA should record particular information about the patients who visit the physicians’ office. The MCAA is supposed to demand some information politely from any new patient that visits the clinic (NHA Certified Medical Administrative Assistant (CMAA), 2010). The information includes aspects such as the patient’s general information, chief complaints, and the general information about the patient’s referrals. In addition, the MCAA should inform the patients about the various dates and times that the doctor could see them.

On the other hand, the check-in procedures of the established patients give the patients multiple options. In this case, the MCAA will properly identify, question the patient on the reason of making an appointment, and provide a person with two dates that the patient could see a doctor. The MCAA will enter the appropriate data for the appointment, verify the information, and provide the patient with an appointment card if it is needed (County-Based Medica lAdministrative Activities Manual, 2011).

Scheduling Patients

Medical appointments are scheduled in specially designated books that should be of the right size to allow comfortable writing, accommodate all the relevant information, and be able to fit on the desk as required.

There are three types of scheduling patients, namely wave, modified wave, and double booking. In wave scheduling, a number of patients arrive at the same time, and each patient sees a doctor in accordance to the order of arrival. In the modified wave scheduling, small groups of patients see a doctor at scheduled intervals throughout an hour. Double booking involves two patients seeing a doctor at the same time.

Various Community and Patient Resources

The MCAA should be the connecting agent between the clinic and the community at arranging public affairs and liaison meetings.

Processes for Patient Interactions

There are instances in the clinic where the MCAA needs to handle the patients tactfully. First, patient lateness can be avoided by advising them to arrive thirty minutes before their scheduled appointment. Secondly, unscheduled patients should be accommodated as much as the MCAA can. However, the MCAA should inform the patient that the booking of an appointment is much better. Thirdly, the MCAA should tactfully contact the patient who failed to honor the appointment and know the reasons for the absence. If possible, the MCAA should try to reschedule the appointment. Fourthly, the MCAA should calm the patients in the cases where the doctor has not appeared. The MCAA will briefly explain the reason for the delay and suggest rescheduling options.

Health Insurance Plans

A CMAA should verify the patient’s insurance details on the first day of contact. In this case, the patient’s insurance type is recorded. In addition, copies of the patient’s identity cards are made so that they can enable the CMAA contact the insurance to determine the kind of insurance policies and services that the patient rightly qualifies.

The information about the patient that is obtained from the insurance carrier is recorded on the patient’s medical record, and the verification benefits form. Thereafter, the patient is provided with a list of their requirements and plan restrictions that they are supposed to read and sign if agree. There are three types of insurance policies. There are the individual policies, which caters for people ineligible to receive government plans. There are also the Group policies, which caters for an organization’s employees. Lastly, there is a government plan, which caters for a large group of people that meet a particular criteria.

Financial Procedures Related to the Policies of the Organization

The CMAA should accurately enter all the data that relate to payments at the facility into the disbursement journal. Other functions include the keeping of pad of vouchers, keeping track of the debts that the patients owe the clinic, and maintain the fee schedule of the practice. In addition to these, the CMAA will process and verify all credit card transactions, arrange payment options, process the financial forms/agreements, and reconcile the financial transactions of the practice.

Clean Claims

The CMAA will fill and submit the appropriate insurance forms that concern the practice, abstract from the medical and financial records the data that is relevant for clean claim submissions, and correct any errors of claims that had been made.

Billing Policy and Procedures

The CMAA is to inform the patients on the correct procedure and requirements when they are filling their invoices or hospital bills. In this case, the CMAA informs the patients about the various methods or means that the facility employs to facilitate payments.

Protecting Patients’ Privacy

The MCAA will be responsible for availing any copies of the clinic’s privacy policies to patients that visit the facility. The legal terms discussed in the copy of the clinic’s privacy policy include items such as the arbitration, battery, negligence, statutes, and abandonment. All these terms refer to the various ways in which legal proceedings can be imposed on doctors should they fail to fulfil their duties.

Accounting and Bookkeeping Procedures and Processes

The CMAA will follow up bad debt, mail patients the unpaid bills, handle the clinic’s bank and cash transactions, and secure all cash or cheque collections that are obtained at the practice counter.

Office Procedures for various Forms of Documentation

The CMAA is expected to construct medical records, create clinical databases, database management, perform data entry, data coding and validation, practice medical business procedures and quality control.

Health Insurance Portability and Accountability Act (HIPAA) Rules and Regulations

The CMAA will train and orient new staff in matters that relate to the compliance to the regulatory agency guidelines. In addition, the CMAA will monitor the compliance of the employees and patients to the policies and procedures of the practice. The CMAA will also witness the signing of documents and inform consents between the doctors and patients. Any audit, whether internal or external, that scrutinize the medical records and business records of the practice will need testimonials from the CMAA.

HIPAA Forms

The CMAA is expected to ensure that the HIPAA forms are filled with the due diligence they deserve. Therefore, both the patient and the doctor are obligated by the CMAA to ensure that the information they provide on the forms are honest and comply with all the requirements.

Advance Directives

A CMAA should comply with rules and regulations of the facility in regards to the implementation of directives from the medical staff. In this case, the CMAA should seek written clarification on directives that involve patient treatments.

Medical Record Responsibilities

It is the duty of the CMAA to ensure that the medical records in the facility where one is serving are updated and accurate. Therefore, the CMAA ensures that anyone authorized to access the information gets the information that is accurate, recent, and has access permission.

Obtaining Patient Demographics and Insurance Information

The CMAA should record the following information about the patient. The information includes the patient’s personal and medical history, family history, social history like smoking, drinking among others. In addition, the CMAA should record the patient’s chief symptoms and diagnosis.

Receive, Triage, and Route Phone Calls

An MCAA should observe proper telephone etiquette. Therefore, MCAAs should answer the telephone in a kind and prompt manner. They should give the caller undivided attention in addition to being clear and distinct in their talking. An MCAA should always ask for permission from the other person before putting the telephone on hold.

Review Records for Medical Necessity

All the medical records should be evaluated by the MCAA for their accuracy in terms of filing and compliance with medical terminologies. For instance, the filing review will analyze whether the medical files have been indexed properly, have an alphabetical, numerical, subject, and tickler filing. The last filing type is exclusively used to store time-sensitive data or confidential information.

Release of Information Guidelines

The CMAA will schedule the archiving and destruction of expired medical records and other correspondences. The CMAA will also monitor the original documents or any piece of information that leaves the premises of the practice to ensure that the identity and location of the audience of the information are disclosed. In addition, the CMAA will follow up all outsourcing activities that may compromise the confidentiality of the information found within the premises of the practice.

References

Balasa, D. A. (2011). How the CMA (AAMA) stands apart: A comparison of four medical assisting certifications. CMA Today, 1 – 4.
County-Based Medical Administrative Activities Manual. (2011)..Los Angeles, CA: State of California.
NHA Certified Medical Administrative Assistant (CMAA). (2010). Detailed test plan based on the 2010 job analysis study. Washington, DC: NHA.
Rice, T., Rosenau, P., Unruh, L., & Barnes, A. (2013). United States of America: Health system review. Health Systems in Transition, 1 – 467.