Co-insurance is a percentage of the allowable charges that the patient is required to pay at the time of service. Typically, the patient’s deductible must be satisfied before the payer will pay on a claim.

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Dear Mary Pat: What is the Difference Between Fixed and Variable Expenses in a Medical Office?


Operating expenses fall into two categories: fixed and variable.  Your fixed expenses are the same from month to month regardless of whether you are seeing patients or not.  Your variable expenses change from month to month based on the volume of business you do and what is needed to support that volume of business.  Purchases that fall under the operating expense category are less than a pre-determined amount – maybe less than $500 in a practice or less than $1000 in a hospital.  Any purchase over that amount will be a capital expense (defined as having a usable life of more than one year) and will appear on your monthly expense statement as depreciation.

Fixed Expenses


Utilities: electricity, water, garbage, cable, alarm system

Janitorial and Groundskeeping

Computer System: monthly maintenance

Phones: monthly maintenance

Leases: copiers, transcription equipment, some medical equipment

Malpractice Insurance

Other Insurance: general, business interruption, directors & officers, umbrella


Variable Expenses – Typically when you are looking at reducing expenses, you will look first at your variable expenses, seeing what you can cut down on or eliminate, or what you can renegotiate.

Payroll: staff wages, tax match, retirement plan match, bonuses, annual raises

Benefits: health insurance, life insurance, dental insurance, vision insurance, disability (long term, short-term), worker’s compensation, unemployment

Computer System: additional licenses, charges for claims, statements, eligibility

Phones: repair, new lines, new jacks, voice mail changes, cell phone plans, pager plans, answering service, Yellow Pages (hopefully minimal),

Inside: pest service, plant service

Medical equipment: small instruments, exam room lamps, Mayo trays

Laundry: gowns, sheets, towels, shorts, lab coats

Consumables: (medical – built-in to the price of the service) table paper, syringes, x-ray film, lab supplies

Consumables: (medical – charged separately to the patient) allergy serum, durable medical equipment

Consumables: (office) copy paper, toner, kitchen and bathroom supplies, pens

Printing: encounter forms, appointment cards, Rx pads

Education: (staff) continuing education, license renewal, CPR, coding updates, dues, subscriptions

Perks: uniform allowance, parking, lunches, holiday parties, birthday gifts

Purchased Services: transcription, radiology over-read, accountant, lawyer, consultant, auditor, inspector, outsourced billing, collection agencies

Marketing: advertising (print, TV, radio, direct), sponsorship of events, meet & greet with referrers, holiday gifts, website

Posted in: Finance

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Pillbox is a website that was developed to aid in the identification of unknown solid dosage pharmaceuticals. The system combines high-resolution images of tablets and capsules with FDA-approved appearance information (imprint, shape, color, etc.) to enable users to visually search for and identify an unknown solid dosage pharmaceutical.

This system is designed for use by emergency physicians, first responders, other health care providers, Poison Control Center staff, and concerned citizens.

Description courtesy of the Pillbox website.  Click here.

Posted in: Definitions

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Who Does What in a Medical Office: Basic Position Descriptions


Front Desk/Check-In

  • Greets patients and visitors to the practice
  • Registers patients in the practice management system which may mean entering information given verbally or on registration forms
  • Collects identification and insurance cards and copies or scans them for the record, may photograph the patient for the record
  • May collect co-pays or other monies
  • Prints encounter form (also called superbill, routing slip, or fee ticket) with updated information, or updates information on the encounter form
  • Has patient sign financial agreement, receipt of privacy policy, benefits assignment, etc.
  • May answer phone calls, take messages and make appointments
  • Directs visitor (drug reps, salespersons, etc.) appropriately

Medical Records

  • Primary responsibility for the integrity and management of the medical record, whether paper or electronic
  • Controls record filing (paper) or indexing (electronic)
  • Fulfills requests by patients, attorneys, insurance companies, and social security for release of records
  • May manage paper faxes and messages by attaching to charts and delivering to provider
  • May prepare paper charts for chart audits by payers or others
  • May be the HIPAA Officer

Medical Assistant, LPN or RN

  • May assist Physician, Nurse Practitioner or Physician Assistant with procedures
  • Depending on state laws, may give injections
  • May perform procedures independently (ear wax removal, staple removal, etc.)
  • Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
  • May perform phlebotomy (draw blood)
  • May collect specimens, perform basic laboratory tests and chart results
  • Provides patient education verbally and by providing written materials
  • May schedule tests or procedures ordered by the provider
  • May schedule surgery and prepare surgery packets for providers (*this may be delegated to a surgery scheduler if this position exists)
  • Calls patients about test or procedure results; returns patients calls with answers after consulting with provider
  • Prepares exam room for procedures (PAP smears, excisions, etc.), marks specimens for lab and pathology
  • Cleans exam room after each patient and stocks exam and procedure rooms with supplies
  • May be responsible for ordering office medications and medical supplies
  • May perform lab controls daily and check and record temperatures on lab refrigerators and freezers

Triage Nurse

  • Takes incoming calls from patients and gives them medical advice according to predetermined nursing protocols
  • Makes decisions about patients needing to be seen urgently, same day or next day
  • May be delegated callbacks from providers or other nurses
  • May see walk-in patients and triage their condition

Lead Nurse, Charge Nurse, or Nurse Supervisor

  • Assigns clinical staff specific responsibilities
  • Manages clinical staff schedules, using agency or temporary staff as needed
  • Performs annual competency exams on staff
  • Ensures all staff are current on licenses, continuing education and CPR
  • Problem-solves patient issues
  • May be responsible for ordering office medications and medical supplies
  • Has responsibility for medication sample closet upkeep
  • May perform annual evaluations fro clinical staff
  • Responsible for equipment maintenance and makes recommendations for medical equipment as needed
  • May be the Patient Safety Officer and the Worker’s Compensation Coordinator

Referral Clerk

  • Reviews orders written by providers and determines where test and procedures may be performed based on patient’s insurance
  • May provide the patient with information about the test or procedure cost and what the patient’s financial responsibility is estimated to be
  • Pre-authorizes, pre-certifies, or pre-notifies the test or procedure if required by the patient’s insurance company
  • Schedules the test or procedure
  • Provides the patient with information about preparation for the test or procedure

Lab Technologist/ Phlebotomist

  • Receives laboratory requisitions from provider and collects specimens according to provider order
  • Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
  • Performs tests or packages specimens to be transported to reference lab
  • Receives results back from the labs and matches them to charts
  • Performs lab controls daily and checks and records temperatures on lab refrigerators and freezers

Check-out Desk

  • Reviews services received by patients, checking to make sure that all services received were checked on the encounter form
  • Enters charges in the computer system for services received
  • Tells patient if any additional monies are owed if co-pay was collected at check-in
  • May sign patient on to a payment plan if needed
  • Takes monies owed, posts monies and produces a receipt for the patient
  • Makes return appointment for the patient if needed, or enters recall into the practice management system

Biller or Collector

  • Corrects claims that are rejected from the claims scrubber, clearinghouse or payer
  • Files secondary and tertiary claims as needed, electronically or via paper
  • Posts receipts from insurance companies and patients and edits any electronic remittance advice; may post from lockbox account on the web
  • May prepare deposits and/or make deposits
  • Generates patient statements
  • May check eligibility on patients with appointments and call patients whose insurance is not active (*may be delegated to a financial counselor if this position exists)
  • Calls patients who have not made payments in response to statements
  • May turn patients over to third-party collectors
  • Takes phone calls from payers or patients about billing issues and resolves issues


  • Reviews notes from inpatient or outpatient encounters and codes them according to the documentation
  • May post charges for services rendered
  • Audits chart documentation for quality purposes to ensure that provider coding and documentation is synchronous
  • Introduces changes in procedure (HCPCS) and diagnosis (ICD-9) codes and educates staff on the use of new codes
  • Ensures encounter forms and practice management software is updated appropriately with new and deleted codes
  • May be delegated the Compliance Officer

Billing Supervisor

  • Reviews the work of coders, billers and collectors and performs quality audits to benchmark acceptable error rates
  • Prepares or reviews deposits and tracks daily charge, collection, write-off and deposit information, watching for monthly abberations by payer or date
  • Reviews Accounts Receivable (A/R) reports, looking for trending or specific problems to be addressed with staff or payers
  • Brings to the attention of the Office Manager or Administrator any issues with non-standard payment trends, denials or non-covered services.
  • Performs evaluations for billing department staff
  • Takes escalated patient complaints
  • May credential providers with new payers or recredential providers with payers or hospitals

Office Manager, Practice Administrator, or Practice Manager (see the Library tab for job descriptions) see my posts on what an administrator does here, and a day in the life of an administrator here

  • Performs all human resource functions for the practice
  • Has ultimate responsibility for all money flowing in and out of the practice – makes deposits, pays bills, etc.
  • Contact person for all computer system, equipment and phone system issues
  • Responsible for day-to-day operations, advises supervisors on issues and problems
  • Resolves escalated patient complaints
  • Meets with vendors and researches possible practice purchases
  • Negotiates all practice contracts
  • Meets with staff and providers on a regular basis

These descriptions will not perfectly fit most practices, this is just a generalization.  Each practice divides duties based on the number and skills of the staff in their office, and their specialty.  These descriptions should help to define what the basic tasks are in most practices.

Posted in: Day-to-Day Operations, Human Resources

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Smartphones in Healthcare


A smartphone is a mobile phone with PC-like functionality and advanced capabilities ”“ essentially a miniature computer that combines phone, email, texting, and Inter-
net service.

According to a study by Manhattan Research, 64 percent of U.S. physicians own smartphones and analysts predict penetrationwill increase to 81 percent by 2012. Since most nurses and physicians have either used a smartphone or a mobile phone, the learning curve that usually occurs when new devices or equipment is introduced to a workplace would prove minimal.  Smartphones, such as the iPhone, natively support the latest network security protocols and standards that are essential to protect confidential patient data. (courtesy of voalte)

Other resources:

Posted in: Definitions

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MAUDE (Manufacturer and User Facility Device Experience)


MAUDE stands for Manufacturer and User Facility Device Experience and is the FDA’s database of voluntary reports of adverse events caused by medical devices.  EMRs can fall under the category of medical devices and there are some reports about deficits in EMR CPOE (Computer Physician/Provider Order Entry) related to their ability to choose specific drug dosages for prescribing.  You can find MAUDE here.

Posted in: Definitions

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