“After graduating as a Medical Assistant/
Medical Administrative Assistant, you landed the perfect job at a
clinic that just opened. After working there for 1 ½ years, all of the
staff is called in for a meeting with the Administrator and are told
that the clinic has to downsize. This means you are losing your job, as
the bills are not getting paid because not enough money is coming in.
But you know this to be wrong because the schedules are filled every day
and insurance companies are being billed. What happened? How can this
be happening? Look up the statistics on how many medical facilities
open and have to close within a short time frame due to lack of money
Answer the following in your discussion. Be creative in your posting as well as in your responses to your team members.
- Speculate on what you think the series of events and deficiencies may have been in this office to cause the lack of funds.
- Was it not filing claims timely or at all?
- Was it filing claims on paper and not electronically?
- Did this office use a Practice Management System like Medisoft?
- If insurance was being filed timely, was there any follow-up on those claims, i.e. calling insurance companies on their status?
- Were claims being filed according to the guidelines of the third-party payers?
- Were the physician reimbursement fee schedules high enough to pay
for the services being provided to the patients and to cover overhead?
- Were services being pre-authorized?
- After entering data and completing other tasks within the Medisoft Practice Management System,
do you think that if the reports were more closely monitored and shared
with all office staff that the downsizing could have been prevented?
- What role did you play as an employee? If you were aware of the situation, how did you handle this knowledge?
- What would have been different if claims were filed electronically
instead of paper? Do you think this could have been a problem?