Medical Office Policies & Procedures

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The level of efficiency and responsibility a medical office maintains is a direct indication of its success in patient care and health-care management. Whether it's a new office or an existing one, a review of policies and procedures should be a regular occurrence. While some components may vary according to the type of practice or specialty, there are basic elements that each office must address.

Affecting Direct Patient Care

Patient and staff safety should be the primary concern. It is imperative that policies exist around the cleanliness of examination rooms; procedures for sterility, such as sanitizing instruments and hand washing; availability of protective gear for staff, such as booties, plastic gloves, masks and gowns to prevent the spread of infectious diseases; and the maintenance and processing of medications on site. The federal Occupational Safety and Health Administration is an expansive resource on guidelines for health and safety, and its website contains guidance on what safety measures to implement for your medical office.

Affecting Patient Information

By law, medical practitioners must keep patient information confidential. The Health Insurance Portability and Accountability Act, known as HIPAA, protects the privacy and confidentiality of patient information. If your office has not been trained regarding HIPAA policies, consult the U.S. Department of Health & Human Services for information on how to implement HIPAA policies in your office. In addition to discussing privacy, there should be a policy that governs file management to ensure that all information is kept in secure areas of the practice.

Affecting Billing and Other Business Matters

A medical office is a business. Whether it's inpatient or outpatient visits, there are charges and billings associated with them. Each office should have a policy for patients that communicates how the billing process works; the relationship between the provider and a patient's insurance company; and a patient's responsibility for payment at the time of service as well as any available remedies for discrepancies in billing issues. Staff should be trained on procedures for processing billing, contacting insurance companies for needed information, working with medical coding or billing staff on billing issues, and closing out any residual billing or account issues. Developing and implementing an account management program for your office will reduce the amount of unclaimed revenue as well as enable you to maintain a good relationship with patients when issues arise.