Medical Office Procedures - What You Need For Your Office

Some of the highly important medical office procedures that you NEED to have in place...

Whether you run your own medical billing consulting business, code claims for a doctor as a side job, or work full time as a biller or coder in a medical office, it's super-important to have specific policies and procedures in place.

These policies can range from confidentiality and HIPAA related policies to billing or collections policies. What's important is that medical office policies are an explanation of how your business runs in writing.

Medical Billing Basics

Medical Billing Basics
Want to quickly get to grips with the fundamentals of medical billing? We recommend the ebook The Basics of Medical Billing, a guide to the industry written by a mother/daughter team of billers. Learn more about it here.

Policies are important when you or your office is questioned by patients, lawyers (gulp!), or auditors. If your office is under investigation or your patients or customers are mad at having been sent to collections, you can always show the inquirer your policy, in writing, which states how you run your professional business.

Procedures v. Policies

Important medical office procedures

There's an important difference between medical office procedures and policies.

Policies are the official way that your office conducts professional business. An example is a billing policy which states that every balance over 90 days old will be sent to collections.

Procedures, on the other hand, are different. In this case we're not talking about medical procedures like office visits and strep throat swabs, which are services performed for a patient on a specific date of service.

Medical office procedures are more like how each and every strep swab is run, each and every time, for each and every patient.

Example: there's a specific procedure for taking the sample from the patient, testing this sample, recording the results, and giving the results to the doctor who then relays them to the patient.

Other procedures in the medical office revolve around entire office procedures, such as a fire or emergency procedure. This would involve determining a route of evacuation and a safe place to meet.

The purpose of written policies and medical office procedures

In our overly-litigious society it seems like everyone is trying to find some way to sue someone else, or some other way to get ahead of the system. The same goes for medical offices and patients.

Unfortunately many patients have the misunderstanding that doctors can get away with what they want, take vacations every month, and get paid bazillions of dollars. But anyone in the medical industry knows better.

Although there are some doctors who really do make tons of money (and take advantage of it), the truth is that many doctors work very hard and get very little credit for it.

Having written policies and procedures in your practice makes sure that your hard working doctors, nurses, and other staff will be prepared if you get audited or sued.

These written medical office procedures and policies serve as a safeguard against a lawyer or auditor. They may say that there is no policy in place, so your staff members don't know what they're doing.

If you have everything in place, neatly typed out, and signed by your managerial staff, then a lawyer will have little to go on when he or she is trying to find fault with your practice.

Furthermore, written policies and procedures are a good way to practice healthy and sound business practices. These documents inform not only you and your staff, but you can keep them posted in open locations or on the internet so your patients can see them as well.

Written procedures help both your staff and your clinic's patients


Many of the policies that your office should develop are centered on the financial and administrative side of running a medical practice. This is similar to an employee handbook, which is a written set of policies that no office should be without.

Another important set of policies that your office should develop is an in-depth billing and collections policy. This outlines your billing process, including charges for specific non-medical services (such as medical records fees and prescriptions for controlled substances).

This policy should also include the process that your billing office follows in regards to sending patient statements, the age of patient balances, and sending delinquent accounts to collections. If your office also discharges patients who have been sent to collections this should be noted in your policy.

Not only is a written billing and collections policy important to support your billing and collections claims, but it's also a good way to sit down with your staff and figure out how to run your billing department.

One more thing that your office may want to develop is a set of policies regarding the handling of claims.

Some offices don't send secondary claims, whereas other offices have patients bill their insurances. Depending on how your office handles claims, make sure you have it figured out and written down in an official policy.


Having proper procedures protects your patients

Still other written documents that your office needs are official procedures. This ranges from a fire and emergency procedure to lab procedures to be followed by clinical staff.

Here are some important procedures that need to be developed:

  • Confidentiality Procedures: Because of HIPAA and the ensuing confidentiality nightmare faced by medical offices, many offices still don't exactly know what to do and why when it comes to patient confidentiality.

    One requirement is that you must inform patient of their HIPAA rights. But there are other, more vague elements of confidentiality that need to be addressed, for instance:

    • Do you take a copy of each one of your patient's identification cards?
    • Can you fax confidential patient information to a patient without a signed waiver?
    • Can you tell someone over the phone about a person's medical history?

    These types of questions should be answered. You should also create a set of steps to follow in each situation and document these in your confidentiality procedures.

  • Patient Care and Customer Service: You should also have a set of medical office procedures in place for patient care and customer service. This includes rules about how many times to let the phone ring, what to say when you greet a patient both in person and on the phone, and simple check-in, check-out procedures.
  • Emergency Procedures: It may bring you back to elementary school, but we do fire drills for a reason: they work.

    Imagine if your office place were to catch on fire tomorrow, full of patients and staff. Would you know what to do? Would your doctors know what to do? How would you make sure that everyone got out okay?

    These are questions that need to be answered, put into writing, and practiced on a regular basis so that everyone knows what to do in an emergency.

  • Clinical Procedures: If you've ever worked in a clinical setting you know full well the amount of responsibilities and intricacies involved with clinical patient care. It's important for your office to figure out the precise procedures for each type of service, write them down, and train based off those documents. This helps reduce confusion, frustration, and save time.

You may or may not be in a position where you can develop and implement a comprehensive set of policies or procedures for your office. If your upper management is reluctant to do the work, remind them that they'll be covering their own bases by being a fully prepared and professional office.

You may also want to check your state laws and insurance regulations. These may require some specific policies and procedures to be documented.

Either way, written policies and medical office procedures are always a good idea!

Learn all about how a medical office team functions together.

We also recommend the ebook The Basics of Medical Billing for getting a good grasp of the industry.

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