Medical Assistant Exam: Administrative Procedures - Mail

Mail Screening and Processing
Medical assistants are responsible for processing and screening the mail that comes to the medical office through the United States Postal Service (USPS) or via courier services such as FedEx or UPS. The medical assistant should be familiar with the various types of mail that are sent to and from a medical office.

Mail Classification
Mail delivery is classified according to weight, type, and destination of the item to be mailed. Classifications of mail that are often sent to and from the medical office include:
- First-class mail is used for handwritten or typed letters, bills, postcards, and personal correspondence. It is sealed and closed against inspection. Rates are based on size and weight, regardless of the distance traveled. Most of the mail sent to and from the medical office is first-class mail. The current postage rate is $0.44 per letter for letters weighing 12 ounces or less. Mail weighing 13 ounces, but not more than 70 pounds is automatically considered priority mail. First-class mail includes forwarding and return services with no additional fee. For a small additional fee, first-class mail can be upgraded to provide special services and security such as certified mail and registered mail.
- Priority mail is used when mail needs to get to a destination anywhere in the United States within two to three days. It includes all first-class mail weighing more than 13 ounces but not more than 70 pounds.
- Periodical mail, formerly known as second-class mail, is used to mail items usually prepared by printers and publishers, such as newspapers, magazines, and periodicals. Only authorized items may be sent using this class.
- Standard mail A, previously known as third-class mail, is used for mailing material weighing less than 16 ounces and is not eligible for first-class rates. Large amounts of printed material, such as quickly copied announcements or letters, containing nonpersonalized material and a duplicated signature may be sent by this class. This class cannot be used for personal correspondence.
- Standard mail B, or nonprofit mail, formerly known as fourth-class mail, includes both parcel post (that is, the mailing of packages weighing more than 16 ounces) and library rate (an economical rate intended for library use when mailing books on loan). Standard mail B is commonly used when mailing at least 200 or more identical items. The items must include a complete return address and be mailed to United States addresses only. All mail in this category needs to be separated by ZIP code and bundled with elastic bands. A business may be charged an annual fee to use this type of mailing.
- Bulk mail is used mainly by businesses that send large quantities of mail that meet specific criteria. An annual fee is charged for bulk mail, but the postage rates for this type of mail are discounted. Bulk mail can include a variety of mail classifications such as first-class, standard, and parcel post.
- Media mail is used to send books, DVDs, CDs, or any other types of media. Rates are based on weight. Delivery takes approximately one to two weeks.
- Express mail offers the fastest service of any type of mail offered by the USPS. Mail sent by express mail may reach its destination overnight or by the second day of mail service. Express mail is offered 365 days a year and can be delivered to most locations in the Unites States.
- Certified mail provides both proof of mailing and proof of delivery. Certified mail can be used to notify patients when they have been discharged from the medical practice (usually due to noncompliance with the physician’s treatment advice). It can also be used to notify patients of overdue accounts.
- Registered mail is used to send valuable or irreplaceable items or letters. Registered mail is more expensive than certified mail, but can be delivered only to the person listed on the envelope.
- A certificate of mailing is used when the sender needs proof that an item was mailed, but is not necessarily concerned about when or if the item was received. For example, a certificate of mailing may be used to send a legal contract that needs to be postmarked by a certain date.
- Special delivery mail is charged at a special rate and ensures that the mail will be delivered as soon as it reaches the post office of its destination. The special delivery mark does not speed up the delivery between cities. Special delivery mail can include first-class, registered, or insured mail.
- Special handling is used to send third- and fourth-class mail by the fastest ground service. Mail labeled special handling will be delivered in about the same amount of time it would take first-class mail to reach its destination.
- International mail sent by offices to a location outside of the United States is classified according to weight, size, and destination. Information about rates and location sites can be obtained from the post office.
Mail may also be sent using private delivery services such as FedEx, Airborne Express, and UPS. Many of these services offer overnight delivery, operate at a competitive rate with the USPS, and have locations throughout the United States where items to be mailed may be dropped off. (In addition, some private delivery services offer pickup service.)

Postage Meter
A postage meter, used by many offices, may be purchased or leased from an office equipment dealer. A postage meter is used for faster mail delivery at the most efficient cost. Once purchased or leased, the postage meter is brought to the post office to purchase a designated amount of postage. The meter will be set for the amount of postage bought and can be refilled periodically, as needed. In the medical office, each item to be sent is weighed on an electronic scale or on a manual scale. The correct postage needed is printed out onto envelopes or onto adhesive strips that can be easily attached for mailing. Because mail that has been prepared using a postage meter does not need to be canceled or postmarked at the post office, it may reach its destination sooner. Also, using a postage meter will ensure that the exact amount of postage needed is used.

Processing Incoming Mail
The medical office receives a variety of incoming mail that needs to be processed in an efficient manner. Examples of incoming mail that may come to a medical office may include:
- laboratory reports
- certified or registered letters
- telegrams
- faxes
- payment from patients for services
- payments from third-party payers
- bills for services provided to the office
- information from pharmaceutical companies
- medical journals, magazines, and newspapers
- catalogs and advertising from office equipment suppliers
- insurance carrier updates
- correspondence and personal letters

Sorting Incoming Mail
Mail should be sorted according to importance. Telegrams, registered and certified letters, and letters marked 'personal' are considered important mail and should be placed on the top of sorted mail. Once sorted, mail can be directed to the appropriate person or department.
The medical assistant should be familiar with the office policy regarding opening various types of incoming mail. Any mail addressed to the physician that is clearly marked 'confidential' should not be opened by the medical assistant; rather, it should be delivered to the physician as soon as possible. Many physicians prefer that mail, even if not marked personal, sent from the Internal Revenue Service, accountants, or attorneys not be opened by the medical assistant.

Opening Mail
Opening and processing the mail should be done when the medical assistant can devote sufficient time to this duty. Each piece of mail opened should be stamped with the date it was received. Before the letter’s envelope is discarded, the medical assistant should locate a return address on the letter, and the envelope should be checked to be sure it is empty. While reading the letter, the medical assistant may jot down notes in the margin of the letter noting any action that he or she needs to take. This process of annotating the mail acts as a reminder of the action needed. For example, if the patient’s medical record were needed for the physician to complete an insurance form received, the medical assistant may note this in the margin, pull the record from the file, and attach the letter to the record with a paper clip so that the needed information would be easily accessible. If no action were needed, then the letter would be coded for filing.

Preparing Outgoing Mail

Envelope Selection and Letter Folding
Envelopes should be of high quality and should be heavy enough to protect the contents of the envelope from being viewed. The letter should be folded correctly so that it fits into the envelope properly and may be easily removed and read. A properly folded letter can create and impression of professional competency. Common envelope types used in a medical office include
- No. 10 envelope (measures 91/2 inches long by 41/8 inches wide). Standard size letters are folded by bringing up the bottom edge of the letter about third of the length of the paper and forming a crease. The top third of the letter is then folded down to within a quarter inch of the first crease. The letter is then placed in the envelope with the last crease going into the envelope first.
- No. 63/4 envelope (measures 61/2 inches long by 35/8 inches wide). Standard sized letters are first folded bringing up the bottom edge to within a quarter inch of the top edge. The right edge is then folded about one third of the letter width toward the center, making a crease, and the left edge is then folded toward the right edge crease to within a quarter inch. The left creased edge—the last crease made—goes into the envelope first.
- Window envelope (measures 71/2 inches long by 37/8 inches wide). Letters to be sent in this type of envelope are fan folded by folding the bottom edge of the letter up one third of the length of the paper. The letter is then turned over, and the top of the letter is folded down to the crease. The letter is then placed in the envelope so that the address shows in the window.

Addressing Envelopes
Envelopes addressed according to the standards set by the USPS can be read by an optical character reader (OCR), which is a type of scanner that electronically transforms the address information into a bar code placed at the bottom edge of the letter. Letters read by the OCR will go to the bar code sorter and will be delivered faster. Rules to be followed when addressing letters to meet the USPS standards include:
- Use all capital letters.
- Use no punctuation except for the hyphen in the ZIP code.
- Use one space between the city and state.
- Use approved abbreviations for street suffixes and locators.
- Use left justification format, using simple fonts with at least 10-point font size.
- Use dark ink on a light background.
- Use approved two-letter abbreviations for states.

Return Addresses
The medical assistant should make sure that a complete return address is placed in the upper left-hand corner of all letters mailed to ensure a prompt return if the post office is unable to deliver to the address listed on the envelope. Letters without a complete return address go to the dead letter office, where they may be opened in attempt to find the sender. If no information is provided in the opened letter regarding a return address, then the letter is destroyed.

Two-Letter State Abbreviations

AL - Alabama
MT - Montana
AK - Alaska
NE - Nebraska
AZ - Arizona
NV - Nevada
AR - Arkansas
NH - New Hampshire
CA - California
NJ - New Jersey
CO - Colorado
NM - New Mexico
CT - Connecticut
NY - New York
DE - Delaware
NC - North Carolina
DC - District of Columbia
ND - North Dakota
FL - Florida
OH - Ohio
GA - Georgia
OK - Oklahoma
HI - Hawaii
OR - Oregon
ID - Idaho
PA - Pennsylvania
IL - Illinois
RI - Rhode Island
IN - Indiana
SC - South Carolina
IA - Iowa
SD - South Dakota
KS - Kansas
TN - Tennessee
KY - Kentucky
TX - Texas
LA - Louisiana
UT - Utah
ME - Maine
VT - Vermont
MD - Maryland
VA - Virginia
MA - Massachusetts
WA - Washington
MI - Michigan
WV - West Virginia
MN - Minnesota
WI - Wisconsin
MS - Mississippi
WY - Wyoming
MO - Missouri

Envelope Notations
Notations such as 'personal' or 'confidential' should be typed, underlined, and aligned immediately below the return address on the left side of the envelope. Notations to the USPS should be typed in uppercase letters, immediately below the stamp on the right side of the envelope. If the letter needs an attention line, this information is typed on the line immediately above the post office box number or the street address.

ZIP Codes
Zone improvement plan (ZIP) codes are five-digit numbers used by the USPS to expedite mail delivery. In 1983, a nine-digit ZIP code went into effect to identify geographic segments within delivery areas designated by the first five digits, such as a group of apartments, a city block, or any identity that would be helpful to speed up mail sorting and delivery. The nine-digit ZIP code is written using the first five digits separated by a hyphen and then listing the last four digits, and is referred to as a ZIP + 4 code.

Handling Special Mail
Even with careful addressing and record keeping, some mail does not get to the intended destination. Special mailing situations can include:
- Forwarding and obtaining changed addresses. Forwarding and obtaining changed addresses can occur when patients have moved without notifying the medical office of their new address. By writing 'forwarding services requested' on the letter, the medical assistant can instruct the post office to forward the letter to the patient’s new address if the move occurred within 12 months (or if the forwarding address is listed with the post office) at no expense for first-class or priority mail.
- Address correction requested. The notation 'address correction requested' is used when the sender wants to know the patient’s new address. If the letter was sent by first-class mail, then the corrected address will be noted on a sticker and returned to the sender at no additional cost.
- Recalling mail. Recalling mail is needed if a letter was deposited into the mailbox in error. A completed written application, accompanied by an exact duplicate of the envelope mailed, handed in to the post office, can recall the letter mailed in error. If the letter has already left the post office, a notification can be sent to the post office of the letter’s destination requesting the letter’s return, although no guarantee is made that the letter will be returned.
- Tracing lost mail. Letters mailed by certified, registered, or insured mail have a better chance of being located if the medical assistant has kept the mailing receipts until the letter has reached its destination. First-class mail is very difficult to trace. Insuring or certifying a letter is not very expensive and may be worth the expense if it is important for the letter to reach its destination.