Medical Assistant Exam: Administrative Procedures - Data Entry & Communications

The medical assistant is involved in many of the most important administrative practices of a medical office. These wide-ranging responsibilities can include data entry, basic communications, operation and management of equipment, maintenance of records, mail screening and processing, appointment scheduling and monitoring, efficient operation of the office, and basic functions in the practice’s finances. These responsibilities are outlined on the following pages.

Data Entry
Data entry, or data processing, is the conversion of data into electronic form—that is, entering, updating, and maintaining information on a computer system, including data contained in archives. Data entry needs to be accurate and able to be understood by anyone in the office in order for the material to be reliable and usable.

Correspondence
Accurate, professionally written correspondence is a must in any medical office because these documents reflect the professionalism of the office. Correct spelling is an essential aspect of professional documents, and although the computer has a spell-check function, it does not always have the ability to check the spelling of medical terms or to highlight homophones (words that sound alike but have different meanings, such as their, there, and they’re) that may have been used incorrectly.

Business Letters
Composing a business letter can be accomplished using four basic letter formatting styles: full-block, modified-block, indented modified-block, and simplified.
- Full-block is the most commonly used format for letter writing in an office because it is professional looking and easy to use. In full-block format, all lines are aligned with the left margin of the paper.
- When using modified-block, all lines are aligned with the left margin of the paper except the date line, complimentary closing line, and signature line, which are all centered on the page.
- Indented modified-block follows the directions for modified-block use, but allows the first line of each paragraph to be indented five spaces.
- The simplified format aligns all lines flush with the left margin of the paper and omits the salutation and the complimentary closing. Simplified style is the easiest format to use, but some medical offices feel that it is too casual for formal letter writing.

Business Letter Components
Although different formats of letter writing can be used to produce business letters, most formats have basic components in common.
- The date of the letter should be written out in full (for example, November 15, 2010 instead of 11/15/10).
- The inside address should contain the name, title, and address of the person or company receiving the letter and should be typed approximately five lines below the date line.
- The salutation, or greeting, of the letter is placed at the left margin of the letter, two lines below the inside address.
- The subject line is keyed two lines below the salutation and contains the topic of the letter.
- A complimentary closing, typed two lines below the body of the letter, ends or closes the letter using such terms as Best regards, Sincerely, or Respectfully yours.
- The keyed signature on a letter is typed four lines below the complimentary closing and includes the name and title of the person writing the letter. A handwritten signature is entered directly above the keyed signature.
- Reference initials, included at the lower left-hand margin of the letter, are used to indicate who is responsible for the letter. The initials of the person who composed the letter are entered in uppercase letters and the initials of the person who typed the letter are entered in lowercase letters (for example, 'TK:ef'). If the person who wrote the letter also typed the letter, only one set of initials would be recorded in the reference initials section (for example, 'TK').
- When other documents will be sent with the letter, enclosure notations are added to the bottom left-hand margin of letters, one to two lines below the reference initials. Examples of enclosures are laboratory reports and medical records.
- Copy notations are used when a copy of the letter will be sent to someone in addition to the addressee. A lowercase 'cc' followed by a colon is entered at the lower left-hand margin of the letter, and the name of the person to whom the letter will be copied appears after the colon (for example, 'cc: John Smith').
- A blind copy notation is used when the letter will be sent to other individuals without the knowledge of the person to whom the letter was written. The notation is entered at the lower left-hand margin of the letter using the initials 'bcc.'

Memos
A memo, or memorandum (the plural of memorandum is memoranda), is usually used for interoffice messages written and sent to other personnel to speed up the communication process. Memos can be used to notify personnel about meetings, updates, or changes in the workplace that pertain to everyone. They are written without a salutation or a complimentary closing. Many times a memo format is programmed into the computer for easier and faster use. A common memo format includes four lines, typed in capital letters and listing the date the memo was sent, the name of the person it was sent to, the name of the person sending the memo, and the subject matter of the memo.

DATE: June 8, 2011
TO: Staff of Family Health Center
FROM: Sue Jenkins, Office Manager
SUBJECT: Insurance Changes
As of January 1, 2012, the medical facility will be offering a new insurance plan to employees. Please contact Sue Jenkins at extension 2243 to set up an appointment.

Other Written Material
Transcription is the process of preparing accurate, formatted reports by converting dictated physician notes into written documents. Although medical assistants are trained in transcription, many facilities outsource patient information that needs to be transcribed because it lowers costs, allows faster turnaround times, and enables the facility to receive these documents seven days a week, which can be advantageous, especially for larger facilities. A busy medical assistant can have difficulty keeping up with the volume of transcription needed, and therefore, many facilities find that transcription is not the best use of the medical assistant’s time and skills. The medical assistant’s role has changed from transcriptionist to editor and quality assurance manager, monitoring all incoming reports for accuracy.

Chart Notes (Progress Notes)
Documentation of patient care should be accurate, complete, and up-to-date. The date and time of the entry and the initials of the person making the entry should be recorded in black ink. Care should be taken to make entries into the medical record correctly, and if an error is made, then corrections should be made following the proper procedure. (See the following sections later in this chapter: 'Medical Records Management,' and 'Making Corrections to Medical Records.')
Progress notes can be informal, but should always have correct spelling and be legibly written, using only accepted medical abbreviations. The medical record is a legal document, and therefore, information entered into it can be used in a court of law. All pertinent information should be recorded, since any treatment or procedures not charted in the medical record are considered not done. Progress notes are a permanent part of the medical record and offer guidance in providing quality care to the patient.

Proofreading
Proofreading every document carefully and checking its spelling, grammar, and punctuation helps to produce an accurate document. It is important to reread the document to be sure the message is clearly stated. Proofreader’s marks include a group of symbols used to indicate changes needed in a document. Medical assistants using proofreading symbols will be able to edit and prepare accurate documents more quickly. For reference, use the Chicago Manual of Style chart found here: http://www.chicagomanualofstyle.org/tools_proof.html

Tips on Setting up and Maintaining Computers in a Medical Office
- When setting up a computer system or moving the computer system to a new location in the office, the medical assistant must take care to place it in a well-ventilated area to prevent overheating.
- A surge protector is used to protect equipment from a sudden rise in voltage, such as an electrical storm, which could cause damage to the equipment.
- Routine maintenance should also include keeping the keyboard of the computer clean, since it harbors many types of harmful organisms. Wiping the keyboard with a disinfectant will help destroy the organisms.
- Screen savers, which appear on the computer monitor when no activity has been detected for a time, are used to protect the computer screen from burn-in, the burning of an image into the cathode ray tubes of the computer.

Equipment
Equipment used to perform routine business tasks in the medical office includes:
- calculators
- photocopiers
- computers
- fax or facsimile machine. These are commonly used in medical offices to send and receive information. Patient reports, test results, referrals to and from other physicians, prescription requests from pharmacies, consent forms, and inquiries from insurance companies are a few of the various types of fax messages sent and received by the medical office.
- scanners. Used to scan or input photos or other paper documents into the computer.
- paper shredders. Used to destroy unwanted written material, such as documents with confidential patient information that are no longer needed.

Maintenance and Repairs
Keeping the office equipment in good working condition is the responsibility of all personnel using the equipment, but it is usually the administrative medical assistant who is responsible for maintaining the equipment and arranging for repairs when needed.
Newly purchased equipment often comes with a warranty, a guarantee from the manufacturer of the equipment stating that the equipment is free of any known defects. If the equipment breaks down due to faulty parts within a specified time frame, the warranty from the manufacturer states that the defective parts will be replaced and the equipment will be repaired without charge.
An instruction manual is enclosed with newly purchased equipment to explain how the equipment operates. Agreements are similar to warranties but add extended time to the warranty for an additional price.
Warranties, instruction manuals, and agreements for equipment used in the medical office should be filed and kept in a safe place. After the expiration date, warranties and agreements can be purged from the file, but the instructional manual for each piece of equipment should be kept as long as the equipment is being used.
Routine maintenance should be performed on all equipment following the directions and suggestions listed in the instruction manual. Routine maintenance will prolong the life of the equipment and allow it to function properly. If repair services are needed for equipment, the instruction manual will usually list the names of repair services. Noting important information about each piece of equipment such as the serial number, the model number, and the name of the company that made the piece of equipment will help the medical assistant arrange for speedy repairs. General policies will help protect against damage and should be posted for all employees to see.

Telephone Techniques
The telephone is one of the most important pieces of equipment used in the medical office to provide doctors, medical assistants, and other medical personnel with vital information about patients. Most patients have their first contact with the medical office by making a first appointment or rescheduling an appointment. The telephone personality of the medical assistant should make a favorable first impression on the patient.

Telephone Personality
Telephone personality includes the tone, pitch, volume, speed of speaking, and the warmth and friendliness the medical assistant expresses when answering the phone and carrying on a conversation with a caller. It is important to listen carefully to the tone of the patient’s voice, as well as to be aware of the tone of one’s own voice. Stressful situations or an overly busy day in the office can affect the warm tone usually spoken by the medical assistant, which can easily be picked up by the caller. If the patient is angry, intimidated by calling the office, or feeling a lot of stress, it can often be heard in the tone of his or her voice. Listening not only to what the patient says, but also to his or her tone, provides the medical assistant with clues about the patient’s feelings and emotions.
Active listening, or restating what a patient has said to be sure it was correctly understood, is one method the medical assistant can use to establish a rapport between the patient and the medical care providers. Active listening shows that the medical assistant is genuinely interested in what a patient has to say. The medical assistant should use terms that can be easily understood by the patient; this is not the time to impress the patient with medical terminology. Even if the office is extremely busy, the medical assistant should answer the phone ideally by the first ring and definitely by the third ring. Also, if the medical assistant speaks too quickly, the patient may miss much of the conversation.
Often when phone is answered, the first words tend to be clipped off and not heard or understood completely by the patient. Buffer words help prevent the loss of important words by filling in the first portion of the conversation with nonessential words. For example, answering the phone using a greeting such as 'Good morning' before identifying the name of the office, 'Dr. Smith’s office,' will ensure that the patient will hear the complete name of the office and have no question that he or she called the correct physician’s office. Before a call is ended, the medical assistant should be sure to restate the important information that was provided during the call for accuracy. The patient should be the one to end the call, so that he or she will not feel rushed or cut off. All conversations with the caller should be handled in the most courteous manner, leaving the patient with a good impression of the medical office and the medical assistant answering the phone.

Screening Incoming Calls
Medical assistants can handle many types of incoming calls and each type of call requires the medical assistant to make judgments based on learned knowledge and patient screening, sometimes referred to as triaging. Screening incoming calls means that the medical assistant tactfully inquires as to the name of the caller, the reason for the call, and the action needed. It is a method of prioritizing incoming calls, used to determine the urgency of the call and the action needed following the call. If the patient is requesting an appointment, then careful screening will help determine how soon the patient needs to be seen and the length of time needed for the appointment. Occasionally a patient may be reluctant to disclose information on the phone, because the information requested may be confidential and the patient may not feel free to discuss it with the medical assistant. Careful and tactful questioning may encourage the patient to respond to the inquiries of the medical assistant. The medical assistant should explain to the patient that a detailed description of his or her problem is not necessary. But a general idea of what the patient needs is helpful and will enable the medical assistant to determine the urgency of the patient’s problem and to be sure sufficient time is allotted for the visit.

Types of Calls Answered by the Medical Assistant
The medical assistant should answer the telephone using an appropriate salutation, giving the name of the office, stating a polite offer to help, and including his or her name. The next important step is to determine whether the call is an emergency. Emergency calls need to be transferred to the physician immediately. If the call isn’t an emergency, it can be directed to one of many departments, such as billing, insurance, or perhaps a registered nurse. The medical assistant can handle certain calls, such as making an appointment for a patient or taking a message from a patient requesting a prescription refill, without assistance. Specific information must be obtained from the patient in order to collect information needed to make appropriate decisions and to see that the best care is given to the patient. Depending on the size of the practice and the responsibilities relegated to the medical assistant, some incoming calls in larger offices may be transferred to other departments. In smaller offices, the medical assistant may be the person responsible for handling all nonmedical and nonemergency calls.
The following list describes the types of incoming calls that can be handled by the medical assistant, as well as the needed patient information for each type of call.

New Patient Appointments
- Name. The patient’s legal name and date of birth are needed when making an appointment. A patient can have the exact same name as another; these patients can be easily identified by using their dates of birth in addition to their names.
- Address. The patient’s address is needed to send patient registration forms and past medical history forms to each new patient. These forms are to be completed and brought to the first appointment.
- Phone number. The daytime phone number and home phone number of each patient is also needed. This information is needed in case the appointment has to be rescheduled or in case there is a question the patient must answer before he or she comes in for the appointment.
- Insurance information. The patient should tell the medical assistant the type of insurance and/or policy number he or she has. (Some offices ask for both primary and secondary insurance.) Insurance information is needed to verify that the physician is participating in the patient’s particular insurance plan; some offices also check whether the insurance is valid and current. If the physician does not participate in the particular type of insurance plan that the patient uses, then the office visit will not be paid by the insurance company. It will therefore be the responsibility of the patient to pay for the visit. (Many patients will opt to be treated only by a participating physician, so it is better for the patient to know whether a medical office accepts his or her insurance plan before he or she shows up for the appointment.) The patient is asked to bring his or her insurance card to the office because a copy of the card is usually made for the medical record. Discussion of payment at the time of service through co-pays can be mentioned to the patient if it is the office policy.
- Employment. Employment information is often requested when a patient is making an appointment. Not all medical offices request employment information on the phone, but because the registration form often asks for employment information, it may be collected at this time by some offices.
- Reason for the appointment. The medical assistant should ask the patient the reason for the appointment. Knowing the reason for the appointment helps to determine the amount of time needed for the appointment and to evaluate the urgency of the appointment.

Established Patient Appointments
- Name or address changes. The patient should inform the medical office of any name or address changes as a result of moving, marriage, or divorce. In order to keep the medical record current, this information should be updated at every visit.
- A patient’s insurance coverage needs frequent updating because of changes in employers, employer-offered insurance plans, or retirement. The patient may call to let the medical assistant know of such a change.
- Reasons for appointment. The medical assistant should ask the reason for the appointment. Knowing the reason for the appointment helps to determine the amount of time needed for the appointment and to evaluate the urgency of the appointment. If a patient needs to be rescheduled, knowing the reason for the visit will help the medical assistant meet the health needs of the patient.
- Phone number. A daytime phone number is needed in case the appointment needs to be changed or canceled.

Referrals from Other Physicians
- Referring physician’s name. The medical assistant should ask the name of the physician making the referral. (The medical assistant can take the patient information. If the referring physician asks to be put through to the attending physician, then the medical assistant should transfer the call to the attending physician.)
- Patient’s name. The medical assistant should ask the name of the patient, and then ask for the patient’s address and daytime phone number.
- Insurance information. The medical assistant should ask for information on the patient’s insurance, including the type of insurance, insurance company, and policy number.
- Reason for and urgency of referral. The medical assistant should ask the referring physician the purpose of the appointment and should assess the urgency of the referral. Pre-op clearance, which most insurance companies demand, needs to be made within a special time limit prior to the surgery. Many physicians will try to accommodate referrals from other physicians as soon as possible—often even on the same day.

Insurance and Billing Questions
- Calls from insurance companies. Insurance carriers and HMOs will call to verify patient treatment and procedures. No patient information should be given out until the caller is positively identified as the insurance company and until the medical assistant has proof that the patient has signed a release form giving the medical office permission to release the patient’s information.
- Billing questions. If the office has a billing department, then patient inquiries about billing should be transferred to that department. Before transferring the call, the medical assistant should take down the patient’s name and phone number, just in case the call is disconnected. Providing the patient with the extension number of the requested department can be helpful if the call is terminated prematurely.

General Patient Inquiries
Patients may also call to ask about general policies of the office, to ask for directions, or to ask which insurance carriers are accepted by the facility. Patients may ask what the office’s policies are concerning co-pays and methods of payment accepted, or to ask what hours the office is open. Patients may also ask about the protocol for getting medical attention during unopened hours, weekends, and holidays. The medical assistant should have access to the general policies and information about the office, which are usually located in the office policy manual. By keeping this manual within easy reach, the medical assistant can correctly answer questions about the office.

Prescription Information
Specific information is needed in order to process prescription refills or renewals. The information needed includes the full name of the patient, the patient’s date of birth, the pharmacy’s name and phone number, the name of the medication, the dosage, and the prescription number. A call-back number for the patient should be recorded in case there is a problem. The medical assistant should obtain this information from the patient. After the physician approves the refill, the medical assistant will call in the prescription to the pharmacy.

Test and Lab Results
Accepting normal test and lab reports is another responsibility of the medical assistant. The medical assistant can take normal reports over the phone, but most offices prefer that abnormal reports are given directly to the physician. Receiving a fax of the test or lab report is safer than receiving the result by phone because there will be a hard copy of the information, which will be more legible and accurate and take less time to obtain. Medical assistants can usually notify patients of normal lab results after the physician has read the results and given his or her approval.

Patient Progress Reports
Medical assistants also accept routine progress reports from patients. Many times, a patient leaves after an office visit with directions to call the next day and report an improvement or worsening in his or her condition. If the report from the patient is a favorable one, then the medical assistant should make a note of the patient’s condition, give it to the physician, and document it in the patient’s medical record. If the patient’s report is not favorable and the patient is doing poorly, then a message stating that fact should be taken and given to the physician with the patient’s medical record and phone number so that the physician may call the patient.

Sales Calls
In addition, medical offices receive calls from many salespeople trying to sell their items to the physician. The individual office policy manual should state how these situations are handled. Some offices may set up 15-minute appointments at certain times of the day for pharmaceutical sales representatives, while other offices will see sales representatives only if time permits; some offices may not wish to see sales representatives at all.

Deciding on What Calls to Refer to the Physician
The medical assistant needs to know which calls should be referred to the physician. Medical assistants do not give medical advice because it is not within the scope of their training. Following are examples of the types of calls that the medical assistant should refer to the physician:
- calls about abnormal lab or test reports
- calls from patients who have medical questions
- calls from other physicians
- emergency calls
- calls from the physician’s family members

The office policy manual should list the various types of incoming calls, stating how they should be handled. Although the goal of the medical assistant is to be helpful to patients, medical assistants should not give out medical advice under any conditions.

Handling Special Calls
Many calls come into the medical office that will need special consideration to be handled successfully. Patience, tact, a calm attitude, and knowledge of the office policies can help diffuse tense situations, prevent frustrations for the caller, maintain patient confidentiality, and help in risk management.

Angry or Dissatisfied Patients
When an angry or dissatisfied patient calls the office, the first thing the medical assistant should do is listen. Giving the patient time to release pent-up anger may help to defuse the situation. Listening closely to what the patient is saying can help identify the problem. Do not interrupt the patient, try to offer an opinion, or try to correct the patient’s view of the problem. Active listening, or restating what the patient has said, is a good way to clarify the problem. Once the problem is identified, the patient can be referred to the proper person or department. Allowing the patient to speak first and then offering to help the patient when he or she gives you a chance to respond can do much to defuse and resolve the patient’s anger. If it is a problem that can be handled by the medical assistant, you may offer a solution or (if it will take time for you to resolve the problem) offer to get back to the patient. Give the patient a definite time for the return call. For example, 'I will call you before the office closes today at five p.m.' Be sure to call the patient back even if the problem can’t be solved until the following day. The patient will become even angrier if the promised call never comes.
If the angry patient is dissatisfied with the care he or she has received, then the caller should be referred to the physician. Tell the patient that the physician will make a return call, giving an approximate time, for example, after five p.m. Many physicians make return calls after office hours so that they will have more time to talk with patients on the phone without interrupting the treatment of scheduled patients. Attach a message to the medical record, alerting the physician that the patient is dissatisfied and with what aspect of care he or she is dissatisfied.
If the patient calls and is dissatisfied about a bill, perhaps the best person to handle this problem would be either someone in the billing department or the office manager. Tell the patient you will contact the appropriate person and have this person return the patient’s call. Notify the billing department or office manager of the situation, and be sure to mention that the patient is angry. Give the billing department or office manager the patient’s name, phone number, and details of the call. Having the appropriate person call the patient back will give this person ample time to retrieve the record, the billing statement, or whatever data is needed in order to help clarify any incorrect information the patient may have or to resolve the problem.

The Unidentified Caller or Unidentified Information
A patient may call the office requesting to speak with the physician or requesting information that the medical assistant feels should not be given out to an unidentified caller. The medical assistant should politely ask for the caller’s name and the reason for the call. If the caller requests to speak to the physician and gives you his or her name, but refuses to give you the reason for the call, take his or her name and phone number and let the physician decide what to do about the call. If the caller refuses to give his or her name and phone number, then the medical assistant can suggest that the caller send a written note to the physician regarding the message or issue he or she wishes to discuss. The medical assistant can politely state that it is the policy of the physician not to return unidentified calls. Knowing the office policies can help the medical assistant make the appropriate decision when handling difficult situations.

HANDLING OF ROUTINE CALLS RECEIVED IN THE MEDICAL OFFICE
Calls Handled by the Medical Assistant
Calls Referred to the Physician
new patient appointments
abnormal lab or test reports
established patient appointments
patients’ medical questions
referrals from other medical offices
calls from other physicians
insurance questions
emergency calls
billing questions
calls from the physician’s family members
prescription renewal information
favorable routine progress reports from patients
calls from sales representatives
general information about the medical office

Hearing-Impaired Callers
Once it is identified that the patient is hearing impaired, the best approach for the medical assistant is to speak clearly, slowly, and loudly. Do not shout at the patient, as this action is disrespectful to the individual.

Non-English-Speaking Callers
Ideally, the office would have a bilingual interpreter who can speak fluently with the non-English-speaking patient. If the office doesn’t have an interpreter, the medical assistant may speak a little more slowly. Speaking louder will not be useful in this situation. If the patient isn’t hearing impaired, speaking louder will not help the patient interpret the message. Repeating the information and having patience will most likely get the information across to the patient. Also, the fact that a patient doesn’t speak English fluently doesn’t mean that he or she does not understand English well. The medical assistant can verify the patient’s understanding by having the patient repeat the information. Many times a patient will bring a family member who speaks fluent English to interpret instructions.

Personal Calls
Staff members should limit personal incoming calls to emergency situations, although you may occasionally take a quick personal call. Too many personal calls for the staff will tie up the phone lines, interfering with patient calls. Personal calls may also interrupt staff members who are caring for patients.

Personal Physician Calls
The physician decides the policy regarding calls from his or her family or friends. The medical assistant should abide by the wishes of the physician.

Callers Requesting Patient Information
Medical offices receive many incoming calls requesting information about patients. These calls may be from insurance carriers; lawyers; or patients’ family members, friends, and neighbors. The medical assistant has a legal and ethical responsibility to screen these calls, giving out information only to approved persons. In-depth screening needs to be done to protect the privacy of the patient.
Calls from third parties must be carefully handled. The term third party, when used in the context of the medical office, usually refers to someone other than the patient who is responsible for paying the patient’s bill. A third party could be an insurance carrier that is involved in the reimbursement process of an insurance claim, a lawyer hired to handle the finances of a patient, or a family member assuming responsibility for the patient’s bill. Assuming financial responsibility for a patient’s bill does not automatically mean that the third party is permitted access to the patient’s confidential information. The patient must give written permission before any confidential information is released. A patient’s concerned family member, neighbor, or friend is not entitled to any confidential patient information without proper written permission from the patient.
Concerned family members, neighbors, and even employers may try to persuade the medical assistant to disclose patient information, but it is unlawful to do so without written permission from the patient. When in doubt, don’t give it out. It is easier to refuse to give out information than it is to take it back after it has been released. No information can be given to a wife, husband, or concerned adult child of a patient without the patient’s written consent. A call from an attorney requesting patient information may be intimidating to the medical assistant, but the medical assistant should politely refuse to release any information until he or she has verified the patient’s written consent.

Emergency Calls
It is the medical assistant’s responsibility to screen all incoming calls in order to prioritize the calls so that the calls are handled in order of urgency. If a patient calls stating that it is an emergency, the medical assistant should immediately get the patient’s name and phone number and ask if it is a life-threatening emergency. If the call is a life-threatening emergency, the caller should be kept on the line, and the medical assistant should call 911 using another extension. Emergency situations take precedence over all other calls. If the call is not a life-threatening emergency, then the medical assistant should ask questions to determine the urgency of the situation and to make a determination about whether the patient’s problem can best be handled in the office or in the emergency room of the hospital. Good judgment is essential to handling emergencies quickly and correctly. The medical assistant must be very careful not to give the patient any advice outside of his or her training and never to give medical advice. Most offices have a list of questions used in screening calls. Information that may be requested when dealing with emergency calls includes:
- What is the name, phone number, and age of the patient?
- What happened?
- Is the patient breathing or having trouble breathing?
- Is the patient is bleeding? From what part of the body? How severe is the bleeding?
- Is the patient is conscious or unconscious?
- Does the patient feel hot? What is the patient’s temperature?
- Is the patient in pain? Where is the pain? How bad is the pain?
- If the patient swallowed or ate something thought to be poisonous: What was taken? How much was taken? When was it taken? The caller should be told to bring the container of the suspected poison with the patient.

Telephone Technology, Equipment, and Services
The medical assistant should be skilled in using the various types of telephone technology, equipment, and services available for use in the medical office, including:
- automated routing units (ARU)
- multi-line telephones
- caller ID
- call forwarding
- answering services
- answering machines
- voice mail
- pagers/cellular phones
- fax machines
- email

Automated Routing Units
The medical office telephone system can be equipped to handle the many calls received throughout the day by use of an automated routing unit (ARU). The ARU allows the caller to listen to a recorded message that gives the caller the option of selecting specific departments or persons by pressing the specified number given. For example, the patient may be instructed, to 'Press 1 if this call is an emergency; press 2 to reschedule an appointment; or press 3 to make an appointment.' The ARU is set up to allow patients to access the medical assistant immediately in emergency situations.
Other selections on the ARU can include an extension for refilling prescriptions, canceling an appointment, speaking to the billing department, receiving test results, or leaving a message. The ARU options can be individualized to meet the needs of the practice. The ARU system was designed to decrease the waiting time for patients trying to contact the office. By directing calls to the appropriate department or person, an automated system can help decrease the number of busy signals reached by patients. However, some patients find the recorded ARU message difficult to hear and confusing to understand.

Multi-line Telephones
The multi-line telephone in the office allows the medical assistant to receive more than one call at a time. However, because only one call can be handled at a time, one of the callers must be put on hold. Specific protocol, as listed in the office policy manual, should be followed to ensure that emergency calls are not put on hold, and all other calls are answered in a prompt manner. Before placing a caller on hold, certain information should be gathered. All callers should be asked if it is an emergency call. If it is not an emergency, permission to put the caller on hold should be requested. For example, the medical assistant may ask the patient, 'Would you please hold for a minute?' or 'Is it all right if I put you on hold for a minute?' The caller should not wait more than a few minutes before getting through to the requested party. The medical assistant should check back on the waiting caller at least every two minutes and offer to take a phone number to return his or her call, or to put the caller through to the requested party’s voice mail so that he or she may leave a message. Both of these options will prevent undue waiting time for the caller.
Whether the phone is answered by the ARU message or the medical assistant, proper telephone use is important. The telephone is an essential piece of equipment in the medical setting, and the voice answering the phone needs to be clearly understood by the caller. The medical assistant should hold the receiver of the phone approximately one inch from his or her mouth, never holding it in the crook of the neck, because this position can easily muffle the sound, making the conversation hard to understand. The patient on the phone should receive 100% of the medical assistant’s concentration and attention. The medical assistant should not spend time doing other paperwork or engaging in other activities while handling a call. Better communication between the medical office personnel and the patient can contribute to a more satisfied patient. When questions are better understood by the healthcare givers and patients are answered in a friendly manner, using terms that are easy to understand, communication between the patient and the medical assistant can better meet each patient’s needs.

Caller ID
Caller ID is another technology advancement used in some offices to identify the caller and phone number before answering the phone, and can be applied when the phone is in use. If the medical assistant were waiting for an important call, the caller ID would alert the medical assistant to the name and phone number of the caller.

Call Forwarding
Call forwarding gives the medical office the option of transferring or forwarding calls to another phone number, such as a cell phone. The advantage of call forwarding is that important calls and messages are not missed. If calls are forwarded to the physician’s cell phone, for example, he or she will receive important messages without having to wait around in the office for the call. Please note that many physicians will not want all the calls coming into the medical office to be be forwarded to their cell phones, so this feature should be handled with great caution.

Answering Services, Answering Machines, and Voice Mail
Medical offices monitor after-hours calls in several ways. Each office selects the method that works best for notifying the physician and office of missed calls.
Because voice mail is part of the telephone system, there is no additional cost to the office to set up this option. An answering machine, on the other hand, does have an additional cost because it is a separate piece of equipment that must be purchased and attached to the telephone.
The information provided to the caller by either voice mail or an answering machine is the same. The recording will give the patient a number to call in case of an emergency situation. This type of after-hours message system is used primarily for smaller practices that rarely experience emergency situations.
Answering services—whereby an outside firm is hired by the medical office to take calls, record messages, and make contacts and referrals in case of emergencies—can also be used for after-hours calls. This service allows patients to talk to a person, as opposed to leaving a message on an answering machine or in a voice mailbox, and may leave the patient with more confidence that the message will get through.
There are disadvantages to all these options. Many patients don’t feel comfortable leaving a message on the phone, in a voice mailbox, or even with a person other than the doctor or medical assistant, whom they know and trust. Also, answering machine and voice mail messages must be retrieved often to be sure critical situations are not missed. If there are a high number of calls, then the voice mailbox or the answering machine may become full, preventing messages from being recorded. In addition, sorting a lengthy list of messages would take time, preventing patients from receiving a prompt call back from the office.

Pagers and Cell Phones
Pagers, sometimes referred to as beepers, were once carried almost exclusively by physicians to receive notice that they had a message after hours. The pager provided the physician with one-way communication, listing a number for the physician to call. Cell phones are another common and more modern device medical personnel use to receive messages when the office is closed. Cell phones are small, lightweight, and convenient to use. Because cellular connections are not secure, the use of this method to relay private information should be considered carefully in order to ensure patient privacy. Cell phones can also be used to send and receive text messages.

Facsimile (Fax) Machines
Fax machines are commonly used in medical offices to send and receive information. Patient reports, test results, referrals to and from other physicians, prescription requests from pharmacies, and consent forms and inquiries from insurance companies are a few of the various types of fax messages sent and received by the staff in a medical office. The fax machine works by sending the message from one fax machine to another (or from a modem to a fax machine) using telephone lines.
Sending information using a fax machine has several advantages over using the postal system. A fax is faster, more convenient, provides a hard copy to the office receiving the fax, and is lower in cost compared to purchasing postage stamps and waiting a few days before the information reaches the other office. Up-to-date patient information can be obtained immediately, which helps provide improved care to patients.
However, confidentiality can be a problem when sending a fax if it is sent to an unsecure location such as, for example, a mailroom. Before a fax is sent, the medical assistant should call ahead to be sure that the appropriate person will be available to receive the fax or to be sure that the fax is going to a secure location, such as a private office. A cover letter should be sent with the fax stating that the enclosed information is confidential and that it is against state and federal laws to disclose this information; however, a fax that contains sensitive or confidential information should not be sent at all, if possible. After typing in the fax number, the medical assistant should recheck the information for correctness and, after sending the fax, should call the recipient to be sure that it arrived. A fax confirmation, which is a receipt for the message successfully faxed, can be requested by pressing the appropriate button on the fax machine. The receipt should be placed in the patient’s medical record for documentation.

Electronic Mail (Email)
Email sends messages in digital form over a computer network. Many medical offices use email to remind patients of their upcoming appointments or to receive notices of appointment cancellations from patients. Because email messages can be sent to a group of people at the click of a button, email is a fast, efficient, and inexpensive way to send interoffice information. Hard copies of the sent information can be printed and saved as necessary. For example, an email printout of a patient cancellation can easily be kept in the medical record to document the cancellation. Another example would be an emailed schedule of staff in-service meetings that can be printed and placed on the bulletin board. All email messages should be written using a professional tone and accurate, concise sentences. Time-sensitive material should not be sent by email because there is no guarantee when the message will be read by the receiver.

Placing Outgoing Calls
The medical assistant also places outgoing calls. The supplies needed to make outgoing calls will depend on the nature of the call. Examples of the types of outgoing calls made by the medical assistant include:
- Appointment reminders. An appointment book, the patients’ names and phone numbers, a calendar, and a pen or pencil are the supplies needed for appointment reminders.
- Calls about prescriptions. To call in approved prescription refills, the medical assistant needs the name and date of birth of the patient, the name and phone number of the pharmacy, pertinent information about the medication, the pharmacy medication number, and a phone number at which the patient may be reached in case of any questions or problems.
- Scheduling outpatient tests and procedures. It is beneficial to have the patient available when making calls to the needed facilities to better coordinate scheduling outpatient tests and procedures. The medical assistant should place the call from a quiet area away from activity and have a calendar available for reference, along with the patient’s medical record and a copy of the requisition for the test or procedure ordered. Having the patient present to agree to the scheduled times and ask questions to clarify the preparation for the treatment or procedure will help to minimize confusion and ensure that the patient will show up on the correct date and time, properly prepared for the procedure. The medical assistant may need to call the patient’s insurance company for preapproval of the test or procedure and the facility used if the insurance company is to cover the expenses.
- Scheduling inpatient tests and procedures. Most scheduling for inpatient procedures and tests is confined to the departments in the hospital, and preapproval from the patient’s insurance company may be needed before expenses will be covered.
- Calling to reschedule patient appointments. The medical assistant will need the appointment book, manual, or computer; a list of the available time slots; and patient information such as name, phone number, and the reason for the visit.
- Collection calls for overdue patient balances. Collection calls should be made in a private area to ensure confidentiality. The medical assistant should speak only to the person responsible for the bill. Early hour and late evening calls should be avoided, and no calls should be made to the patient’s place of employment. A friendly, matter-of-fact, nonthreatening tone should be used, and the patient should be treated with respect. Often, medical offices are willing to work out a payment schedule with the patient. Check with your office manager or billing department about the policy regarding payment schedules for patients.
- Ordering supplies and requesting equipment service. When ordering supplies, the medical assistant should have a list of the needed supplies, the name and phone number of the supplier, and a purchase order for the needed supplies. When requesting service for equipment, the medical assistant should have the name and phone number of the repair service to be used and any relevant information about the type of office equipment to be repaired. For example, any serial numbers or information about warranties should be easily available when requesting service.

Long-Distance Calls
The medical assistant may be arranging conference calls from individuals in different time zones in the United States or making a call to the patient’s family out of state. It is beneficial for the medical assistant to know the various time zones so that he or she may better coordinate calls within reasonable hours for all parties. International direct dialing is also an option when calling out of the country.
There are six time zones in the United States. The contiguous United States has four time zones: Eastern, Central, Mountain, and Pacific. Most of Alaska is located in the Alaska time zone (which is four hours before Eastern Standard Time [EST]) and the westernmost Aleutian Islands, St. Lawrence Island, and Hawaii are in the Hawaii-Aleutian time zone (which is five hours before EST). Going from east to west, time is one hour earlier for each time zone. For example, if it is nine a.m. in Boston, Massachusetts, it would be eight a.m. in Milwaukee, Wisconsin; seven a.m. in Denver, Colorado; six a.m. in Sacramento, California; five a.m. in Anchorage, Alaska; and four a.m. in Honolulu, Hawaii. This information is important because if the medical assistant has to make a call to a physician’s office in California, this call should not be made at nine a.m. EST because it would be six a.m. in California, and most offices do not open that early.

Outgoing Calls Made by the Physician
Outgoing calls that should be made by the physician (rather than by the medical assistant) include calls to patients who have medical questions, patients who have poor test results, and patients who are dissatisfied with their care or treatment. The physician should also directly contact the pharmacy about questions he or she may have concerning a prescription that was written or requested. The patient’s medical record, along with messages from the patient, should be given to the physician so that when the physician calls the patient, he or she will have adequate information when handling these calls.