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BRIEF CONTENTS
UNIT 1
PROFESSIONAL AND CAREER RESPONSIBILITIES 1
CHAPTER 1 A Career as an Administrative Medical Assistant 2
CHAPTER 2 The Health Care Environment: Past, Present, and Future 26
CHAPTER 3 Medicolegal and Ethical Responsibilities 60
UNIT 2
INTERPERSONAL COMMUNICATIONS 101
CHAPTER 4 The Art of Communication 102
CHAPTER 5 Receptionist and the Medical Office Environment 136
CHAPTER 6 Telephone Procedures 178
CHAPTER 7 Appointments 204
UNIT 3
RECORDS MANAGEMENT 237
CHAPTER 8 Filing Procedures 238
CHAPTER 9 Medical Records 269
CHAPTER 10 Drug and Prescription Records 310
UNIT 4
WRITTEN COMMUNICATION 339
CHAPTER 11 Written Correspondence 340
CHAPTER 12 Processing Mail and Electronic Correspondence 374
vii
viii Brief Contents
UNIT 5
FINANCIAL ADMINISTRATION 409
CHAPTER 13 The Revenue Cycle: Fees, Credit, and Collection 410
CHAPTER 14 Banking 452
CHAPTER 15 Bookkeeping 474
CHAPTER 16 Procedure Coding 500
CHAPTER 17 Diagnostic Coding 533
CHAPTER 18 Health Insurance Systems and Claim Submission 557
UNIT 6
MANAGING THE OFFICE 605
CHAPTER 19 Office Managerial Responsibilities 606
CHAPTER 20 Financial Management of the Medical Practice 647
ONLINE CHAPTER 21 Seeking a Position as an Administrative Medical

Assistant 676
APPENDIX A CMS-1500 Claim Form Field-by-Field Instructions and a

Commercial Insurance Template 678
APPENDIX B Medical Assisting Task List and Competency Tables
Referencing Chapters, Procedures, and Job Skills to Each
Competency 708
Glossary 748
Index 764
CONTENTS
Brief Contents vii

Contents ix
Comprehensive List of Procedures and Job Skills xvii
Preface xxiii
Acknowledgments xxxi
About the Authors xxxiii
1 PROFESSIONAL AND CAREER RESPONSIBILITIES 1
A CAREER AS AN ADMINISTRATIVE MEDICAL ASSISTANT 2

Chapter
Ch 1 Welcome to Administrative Medical Assisting / 3 Customer Service-Oriented
Practice / 4 Career Advantages / 5 Employment Opportunities / 5
Job Outlook / 5 Administrative Medical Assistant / 5 Clinical Medical Assistant / 6
Administrative Medical Assistant Job Responsibilities / 6 Electronic Health Record / 6
Interpersonal Skills / 7 Listen and Observe / 7 Interest and Concern / 7 Respect / 7
Sensitivity to Others / 7 Empathetic and Positive Attitude / 7 Initiative and Motivation / 11
Time Management / 11 Medical Assistant’s Creed / 11 Team Interaction / 11
Understanding Work-Related Emotional and Psychological Problems / 11 Work
Relationships / 11 Aggressive versus Assertive Behavior / 12 Grieving or Distressed Patients / 12
Death and Dying / 12 Stress and the Health Care Worker / 14 Professionalism / 15
Personal Image / 16 Health and Physical Fitness / 17 Licensure, Accreditation, Certification,
and Registration / 17 Externship / 20 Keeping Current / 20 Health Care Reform / 20
Interpret and Accurately Spell Medical Terms and Abbreviations (Procedure 1-1) / 21
THE HEALTH CARE ENVIRONMENT: PAST, PRESENT, AND FUTURE 26

C hapter
Ch 2 History of Medicine / 27 Evolution of the Medical Assisting Career / 28 Global
Influences on Health Care / 28 Changes in Health Care / 31 Current and Future Trends / 32
Today’s Health Care Delivery System / 34 Traditional Care / 34 Consumer-Directed
Health Plan / 34 Managed Care / 34 The Medical Practice Setting / 40 Solo Physician
Practice / 40 Associate Practice / 40 Group Practice / 41 Partnership / 41 Professional
Corporation / 41 Urgent Care Center / 41 Clinic / 42 Hospital / 43 Direct Patients to
Specific Hospital Departments (Procedure 2-1) / 46 Hospital-Owned Physician Practice / 48
Medical Center / 48 Specialized Care Center / 48 Laboratory / 48 Managed Care
Organization / 49 Holistic Health Environment / 49 Telemedicine / 49 The Physician
Specialist / 50 Nonphysician Providers / 50 Refer Patients to The Correct Physician
Specialist (Procedure 2-2) / 51 Health Care Professionals’ Abbreviations / 54
ix
x Contents
MEDICOLEGAL AND ETHICAL RESPONSIBILITIES 60

Chapter
Ch 3 Medical Ethics / 61 Principles of Medical Ethics for the Physician / 62 Principles of
Medical Ethics for the Medical Assistant / 64 Medical Etiquette / 66 Health Insurance
Portability and Accountability Act of 1996 / 67 Protected Health Information / 69 Health
Information Technology for Economic and Clinical Health Act / 70 Compliance Plan / 70
Security Rule / 71 Confidentiality / 71 Release of Medical Information / 71 Release Patient
Information (Procedure 3-1) / 75 Medical Practice Acts / 77 Physician Licensure / 77
Medical Assistants’ Scope of Practice / 77 Medical Professional Liability / 78 Liability
Insurance / 78 Respondeat Superior / 78 Criminal and Civil Law / 79 Administrative
Law / 79 Contract Law / 79 Tort Law / 84 Principal Defenses / 86 Litigation
Prevention / 86 Risk Management / 86 Guidelines to Prevent Medicolegal Claims / 87
Bonding / 88 Patients’ Bill of Rights / 88 Alternatives to the Litigation Process / 88
Screening Panel / 89 Arbitration / 89 Mediation / 89 No-Fault Malpractice Insurance / 89
Medical Records / 89 Informed Consent / 89 Subpoena / 90 Advance Directives / 90
Living Will / 92 Health Care Power of Attorney / 92 Medical Directive / 92 Values History
Form / 92 Health Care Proxy / 93 Do Not Resuscitate Form / 93 Uniform Anatomical
Gift Act / 93 Advance Directive Guidelines / 94
2 INTERPERSONAL COMMUNICATIONS 101
THE ART OF COMMUNICATION 102

Ch
C h ap
p ter 4 Essential Communication / 103 What Is Communication? / 104 Elements and Goals of
Communication / 106 Methods Of Communication / 110 Verbal Communication / 110
Nonverbal Communication / 111 The Receiver / 113 Feedback / 114 Demonstrate Active
Listening by Following Guidelines (Procedure 4-1) / 114 Elements that Influence and
Interfere with Communication / 116 Environmental Elements / 116 Gender / 116 Age / 116
Communicate with Children (Procedure 4-2) / 118 Economic Status / 119 Communicate with
Older Adults (Procedure 4-3) / 119 Language Barriers / 120 Cultural Differences / 120
Patients with Special Needs / 122 Communicate with Hearing-Impaired Patients
(Procedure 4-4) / 123 Communicate with Visually Impaired Patients (Procedure 4-5) / 124
Communicate with Speech-Impaired Patients (Procedure 4-6) / 124 Communicate with
Patients Who Have an Impaired Level of Understanding (Procedure 4-7) / 125 Anxious
Patients / 125 Angry Patients / 125 Communicate with Anxious Patients (Procedure 4-8) / 126
Professional Communication / 126 Communicate with Angry Patients (Procedure 4-9) / 127
Patients and Their Family Members and Friends / 127 Communicate with Patients and Their
Family Members and Friends (Procedure 4-10) / 128 The Health Care Team / 129 Office
Manager / 129 Communicate with the Health Care Team (Procedure 4-11) / 129 Physician /
130 Outside Health Care Professionals / 130
RECEPTIONIST AND THE MEDICAL OFFICE ENVIRONMENT / 136

C ap
Ch a ter 5 Office Receptionist / 137 First Impression / 137 Multitasking / 138 Opening the
Medical Office / 138 Preparing Records / 138 Retrieving Messages / 138 Open the
Medical Office (Procedure 5-1) / 139 Greeting Patients / 139 Patient Visit Log / 140
Processing Patients / 142 Patient Registration / 143 Assist Patients with In-Office
Registration Procedures (Procedure 5-2) / 146 Medical History and Reports / 148
Privacy Notice / 148 Waiting in Reception Area / 149 Escorting Patients / 149 Instructing
Patients / 151 Assist Patients in Preparing an Application Form for a Disabled Person
Placard (Procedure 5-3) / 151 Community Resources / 153 Reception Area / 153
Contents xi
Develop a List of Community Resources (Procedure 5-4) / 154 Features of the Reception
Area / 155 Develop a Patient Education Plan for Diseases or Injuries Related to the
Medical Specialty (Procedure 5-5) / 156 Maintaining the Reception Area / 157 Office
Safety and Emergency Preparedness / 158 Handling a Medical Emergency / 158 Safety
and Health Standards (OSHA Compliance) / 158 Ergonomics / 160 Office Security / 161
Safe Working Environment / 162 Work at a Computer Station and Comply with Ergonomic
Standards (Procedure 5-6) / 163 Prevent and Prepare for Fires in the Workplace
(Procedure 5-7) / 166 Learn How and When to Use a Fire Extinguisher (Procedure 5-8) / 168
Preparing for Environmental and Other Disasters / 168 Develop an Emergency Disaster
Plan (Procedure 5-9) / 170 Closing the Medical Office / 171 Close the Medical Office
(Procedure 5-10) / 172
TELEPHONE PROCEDURES / 178

C ap
Ch a ter 6 Communication by Telephone / 179 Telephone Equipment / 179 Touch-Tone
Telephone / 180 Cellular Telephone / 180 Telephone Services / 180 Speed Dialing / 180
Redialing / 181 Call Forwarding / 181 Caller ID / 181 Speakerphone / 181 Automated
Attendant / 181 Voice Mail / 182 Electronic Messaging / 182 Answering Service / 182
Prepare and Leave a Voice Mail Message (Procedure 6-1) / 183 Answering Machine / 184
Telephone Policies and Procedures / 184 Take Messages from an Answering Service
(Procedure 6-2) / 184 Telephone Guidelines / 185 Answer Incoming Telephone Calls
(Procedure 6-3) / 185 Place Outgoing Telephone Calls (Procedure 6-4) / 187 Telephone
Screening / 187 Telephone Triage / 187 Telephone Policies in Office Procedure
Manual / 188 Screen Telephone Calls (Procedure 6-5) / 189 Responses to Typical
Telephone Calls / 191 Identify and Manage Emergency Calls (Procedure 6-6) / 192
Handle a Complaint from an Angry Caller (Procedure 6-7) / 194 Waiting on Hold / 195
Transferring Calls / 196 Callbacks / 196 Receiving Telephone Calls and Messages / 196
Telephone Message Slips / 197 Telephone Logs / 197 Special Telephone Calls / 197
Long Distance / 198 Conference Calls / 199 International Communications / 199
Telephone Reference Aids / 199 Callback List / 200
APPOINTMENTS / 204
C ap
Ch a ter 7 Appointment Schedule Template / 205 Scheduling Systems / 206 Computerized
Appointments / 207 Appointment Book / 207 Patient Flow Techniques / 207
Appointment and Patient Care Abbreviations / 212 Scheduling Appointments / 217
Managing Appointments / 217 Prepare an Appointment Matrix (Procedure 7-1) / 217
Execute Appointment Procedures (Procedure 7-2) / 218 Schedule Appointments in a
Paper-Based System (Procedure 7-3) / 219 Schedule Electronic Appointments
(Procedure 7-4) / 219 Scheduling Tips and Types of Appointments / 220 Follow-Up
Appointments / 221 Unscheduled Patient and Nonpatient Appointments / 221
Emergency Situations / 222 Referral Appointments / 222 Habitually Late Patients / 222
Reorganize Patients in an Emergency Situation (Procedure 7-5) / 222 No-Show
Patients / 223 Canceled Appointments / 223 Managed Care Appointments / 223
Internet Appointments / 223 Tele-Appointments / 224 Scheduling Surgery / 224
Preoperative and Postoperative Appointments / 224 Schedule Surgery, Complete Form,
and Notify the Patient (Procedure 7-6) / 226 Diagnostic Testing and Therapeutic
Appointments / 227 Hospital Visits / 227 Schedule an Outpatient Diagnostic Test
(Procedure 7-7) / 228 Convalescent Hospital Visits / 229 House Call Visits / 229
Appointment Reminder Systems / 229 Automated Reminder Systems / 230 Appointment
Reference Sheet / 230 Guidelines to Avoid Audits and Improve Scheduling / 232
xii Contents
3 RECORDS MANAGEMENT 237
FILING PROCEDURES / 238

C ap
Ch p ter 8 Commercial Filing Systems / 239 Electronic Filing Systems / 240 Creating Electronic
Documents / 240 Electronic Security / 240 Maintaining Computerized Reports / 241
Maintaining Email Files / 241 Backing Up Computer Files / 241 Set Up an Email Filing
System (Procedure 8-1) / 241 Electronic Confidentiality Guidelines / 242 Electronic
Tickler File / 242 Paper-Based Filing System / 243 Alphabetical Filing System / 243
Subject Filing System / 243 Indirect Filing System / 244 File Using a Subject Filing System
(Procedure 8-2) / 244 Tickler Card Filing System / 245 Organize a Tickler File
(Procedure 8-3) / 246 Alphabetical Filing Rules / 246 General Guidelines / 247
Determine Filing Units and Indexing Order to Alphabetically File a Patient’s Medical
Record (Procedure 8-4) / 251 Filing Equipment / 251 Lateral Files / 251 Full-Suspension
Drawer Files / 252 Filing Supplies and Their Uses / 252 File Guides / 252 File Folders / 253
Color-Coding File Folders / 253 File Tabs / 255 File Labels / 255 Label and Color-Code
Patient Charts (Procedure 8-5) / 257 Charge-Out and Control Systems / 257
Outguide / 257 Outfolder / 258 Filing Documents in Patient Records / 258 Misfiling / 258
Misplaced or Lost Records / 258 Record Retention and Storage / 258 Prepare, Sort, and
File Documents in Patient Records (Procedure 8-6) / 259 Record Retention Schedule / 259
Locate a Misfiled Patient Medical Record File Folder (Procedure 8-7) / 260 Electronic
Storage / 261 Destroying Documents / 263 Purging Computer Files / 263 Recycling and
the Green Team / 264
MEDICAL RECORDS / 269

C ap
Ch p ter 9 Patients’ Medical Records / 270 Prepare and Compile a Medical Record for a New
Patient (Procedure 9-1) / 271 Medical Record Systems / 271 Paper-Based Medical
Record System / 272 Electronic Health Record (EHR) Practice Management System / 275
Medical Record Organization Systems / 279 Recordkeeping / 282 Order Entry / 282
Recordkeepers / 283 Documenters / 283 Authentication of Documents / 284
Documentation Guidelines / 286 Follow Documentation Guidelines to Record
Information in a Medical Record (Procedure 9-2) / 286 Medicare Documentation
Guidelines / 287 Documentation Terminology / 288 Correcting a Medical Record / 289
Correct a Medical Record (Procedure 9-3) / 290 Contents of a Medical Record / 291
Patient Information Form / 291 Patient Medical History / 291 Review of Systems (ROS) / 294
Physical Examination / 295 Complexity of Medical Decision Making / 296 Progress
Notes / 297 Medical Reports / 299 Outside Tests / 299 Abstracting From Medical
Records / 302 Audit of Medical Records / 302 Internal Review / 302 Abstract Data
from a Medical Record (Procedure 9-4) / 303 External Audit / 303
DRUG AND PRESCRIPTION RECORDS / 310

C ap
Ch p ter 10 Introduction / 311 History of Drug Laws / 311 The Harrison Narcotic Act / 311 The
Volstead Act / 311 The Marijuana Tax Act / 312 The Food, Drug, and Cosmetic Act / 312
The Drug Enforcement Administration / 312 The Controlled Substances Act / 312
The Omnibus Budget Reconciliation Act (OBRA) / 315 Drug Names / 315 Chemical Name / 315
Brand Name / 315 Generic Name / 315 Drug References / 316 Physicians’ Desk
Reference / 316 Other Drug Reference Books / 317 Use a Drug Reference Book to Spell
and Locate Drug Information (Procedure 10-1) / 318 Understanding Prescriptions / 319
Routes of Administration / 320 Components of a Prescription / 320 Authorizing
Prescriptions / 322 Prescription Abbreviations / 323 Prescription Drugs and the
Contents xiii
Role of the Medical Assistant / 323 Medication Aides/Assistants / 326 Read and
Interpret a Written Prescription (Procedure 10-2) / 326 Pharmaceutical
Representative / 327 Drug Classifications / 327 Medication Instructions / 327 Medication
Refills / 329 Charting Prescriptions / 331 Record Medication in a Patient’s Medical
Record and on a Medication Log (Procedure 10-3) / 332 Drug Abuse Prevention
Measures / 332 Drug Side Effects and Adverse Reactions / 333 Control and Storage
of Drugs / 333 Drug Waste Disposal / 334
4 WRITTEN COMMUNICATION / 339
WRITTEN CORRESPONDENCE / 340

Chapter 11 Written Communication / 341 The Electronic Health Record and Word Processing
Software / 341 Letter Standards, Styles, and Components / 343 Letter Styles / 343
Parts of a Letter / 346 Composing Letters / 351 Reference Material / 351 Outline
and Tone / 352 Introduction, Body, and Closing / 352 Characteristics of a
Letter / 352 Common Writing Rules / 352 Types of Letters / 355 Compose, Format, Key,
Proofread, and Print Business Correspondence (Procedure 11-1) / 355 Sample
Letters / 357 Corrections in Business Correspondence / 359 Text-Editing
Features / 359 Envelope Enclosures / 361 Folding Enclosures / 361 Proofread a
Business Document (Procedure 11-2) / 362 Medical Transcription / 363 Transcription
Procedures and Equipment / 364 Transcribe a Dictated Document (Procedure 11-3) / 365
Photocopying Procedures / 366 Multifunction Devices / 366 Photocopy Machine / 366
Prepare Documents for Photocopying (Procedure 11-4) / 367
PROCESSING MAIL AND ELECTRONIC CORRESPONDENCE / 374

Chapter 12 United States Postal Service / 375 ZIP Codes / 376 Supplies and Equipment / 376
Postal Scale / 376 Postage Meter / 376 Stamp Services / 376 Operate a Postage Meter
Machine (Procedure 12-1) / 377 Handling Incoming Mail / 378 Mail Security / 378
Opening Mail / 379 Follow Safety Guidelines When Handling Large Volumes of Mail and
Suspicious Mail Pieces (Procedure 12-2) / 379 Annotating Mail / 380 Handling Mail
When the Physician Is Away / 380 Open, Sort, and Annotate Mail (Procedure 12-3) / 381
Handling Outgoing Mail / 382 Mail Classifications / 382 Prepare Outgoing Mail
(Procedure 12-4) / 383 Special Services / 384 Other Delivery Services / 385 Addressing
Envelopes for Computerized Mail / 385 Complete Certified Mail and Return Receipt U.S.
Postal Service Forms (Procedure 12-5) / 387 Envelope Guidelines / 387 Address a Business
Envelope Using U.S. Postal Service Regulations (Procedure 12-6) / 388 Managing Office
Mail / 391 Electronic Mail / 391 Manage Office Mail (Procedure 12-7) / 392
Email Usage / 392 Email Etiquette / 395 Email Format / 395 Basic Guidelines for
Using Email / 396 Compose an Email Message (Procedure 12-8) / 398 Facsimile
Communication / 398 Fax Etiquette / 398 Fax Machine Features / 399 Fax Operating
Guidelines / 399 Faxing Confidential Records / 401 Prepare a Fax Cover Sheet and Send
a Fax (Procedure 12-9) / 402
xiv Contents
5 FINANCIAL ADMINISTRATION / 409
THE REVENUE CYCLE: FEES, CREDIT, AND COLLECTION / 410

C apter
Ch 13 Introduction to Fees, Credit, and Collection / 411 The Revenue Cycle / 412 Obtaining
Billing and Collection Information / 412 Fee Schedules / 413 Physician’s Fee Profile / 413
Usual, Customary, and Reasonable / 413 Relative Value Studies / 414 Capitation / 414
Individual Responsibility Program / 414 Concierge Fees / 414 Medicare Fee Schedule / 414
Value-Based Reimbursement / 416 Discounting Fees / 416 Discussing Fees / 418 Patient
Billing / 420 Payment at Time of Service / 420 Multipurpose Billing Form / 422 Monthly
Itemized Statement / 422 Explain Professional Fees in an Itemized Billing Statement
(Procedure 13-1) / 426 Cycle Billing / 426 Credit Card Billing / 426 Debit Cards / 427
Smart Cards / 427 Separate and Prepare Monthly Itemized Billing Statements
(Procedure 13-2) / 428 Online Payment / 428 Billing Services / 428 Receiving Insurance
Payment / 428 Explanation of Benefits / 429 History of Credit / 429 Credit and
Collection Laws / 429 Fair Debt Collection Practices Act / 432 Equal Credit Opportunity
Act / 432 Federal Truth in Lending Act / 433 Establish a Financial Agreement with a
Patient (Procedure 13-3) / 434 Truth in Lending Consumer Credit Cost Disclosure / 434
Fair Credit Billing Act / 434 Fair Credit Reporting Act / 434 Collections / 435 Aging
Accounts / 435 Office Collection Problem Solving / 436 Telephone Collections / 438
Perform Debt Collection Using a Telephone (Procedure 13-4) / 439 Collection
Letters / 440 Collection Agencies / 441 Select a Collection Agency (Procedure 13-5) / 442
Take Collection Action; Send an Account to a Collection Agency (Procedure 13-6) / 442
Small-Claims Court / 443 Estate Claims / 443 Bankruptcy / 443 File an Uncollectible
Account in Small-Claims Court (Procedure 13-7) / 444 Tracing a Skip / 446 Trace a Skip
BANKING / 452
C apter
Ch 14 Financial Institutions / 453 Accounts / 453 Savings Account / 453 Checking
Account / 454 Checks / 454 Types of Checks / 455 Check Fraud Prevention / 457
Check Endorsements / 457 Bank Deposits / 458 Banking by Mail / 459 Direct
Deposit Program / 459 Prepare a Bank Deposit (Procedure 14-1) / 460 After-Hours
Deposits / 461 Automated Teller Machines / 461 Basic Rules of Precaution / 462
Prepaid Cards / 462 Checkbook Management / 463 Check Writer Machine / 463
Write a Check Using Proper Format and Calculate a Running Balance (Procedure 14-2) / 464
Banking Online / 465 Payment Disputes and Check-Writing Errors / 465 Bank
Statements / 466 Bank Statement Reconciliation / 468 Balance Differences / 468
Reconcile a Bank Statement (Procedure 14-3) / 469
BOOKKEEPING / 474
C apter
Ch 15 Accounting / 475 Bookkeeping Process / 475 Accounting Systems / 476 Patient
Accounts / 480 Patient Account/Ledger Card / 480 Daysheet / 487 Prepare and
Post to a Patient’s Account (Procedure 15-1) / 488 Accounts Receivable Control / 489
Computerized Reports / 489 Prepare the Pegboard; Post Charges, Payments, and
Adjustments; and Balance the Daysheet (Procedure 15-2) / 490 Locating Errors / 492
Cash Funds / 493 Change Drawer / 493 Petty Cash / 493 Setting Up the Petty Cash
Fund / 494 Petty Cash Record / 494 Establish, Record, Balance, and Replenish the Petty
Cash Fund (Procedure 15-3) / 494
Contents xv
PROCEDURE CODING / 500

C ap
Ch apter 16 Introduction to Procedure Coding / 501 Coding for Professional Services / 501 Standard
Code Set / 502 CPT Codebook / 502 HCPCS Level II Codebook / 503 RVS Codebook / 503
ABC Codebook / 504 Coding Terminology / 504 CPT Codebook Terms / 504
Codebook Symbols / 505 Reimbursement Terminology / 505 Codebook Sections / 507
Evaluation and Management Section / 507 Anesthesia Section / 511 Surgery Section / 512
Select Correct Procedure Codes (Procedure 16-1) / 514 Determine Code Selections from
an Operative Report (Procedure 16-2) / 515 Radiology Section / 519 Pathology and
Laboratory Section / 519 Medicine Section / 519 Code Modifiers / 520
Add-On Codes / 520 Codebook Appendices / 521 Unlisted Procedures / 521
DIAGNOSTIC CODING / 533

Ch
C h apter 17 Diagnostic Coding Using Icd-10-Cm / 534 Diagnostic Coding History / 534 ICD-9-CM
versus ICD-10-CM: Comparisons and Advantages / 535 The Icd-10-Cm Codebook / 535
The Encounter Form / 535 Encoders and Computer-Assisted Coding / 536 Codebook
Official Guidelines / 536 Coding Terminology / 536 Codebook Organization / 541
Chapter-Specific Coding Guidelines / 543 Human Immunodeficiency Virus (HIV) / 543
Select Correct Diagnostic Codes Using ICD-10-CM (Procedure 17-1) / 544 Neoplasms / 545
Diabetes Mellitus (DM / 546 Pain / 546 Hypertension / 546 Myocardial Infarction / 546
Influenza / 547 Pregnancy and Childbirth / 547 Sprains, Strains, and Fractures / 547
Burns and Corrosions / 548 Poisoning and Adverse Effects / 549 Select Burn and Corrosion
Codes (Procedure 17-2) / 549 External Causes / 550 Select Diagnostic Codes from the
Table of Drugs and Chemicals (Procedure 17-3) / 551 Factors Influencing Health Status
and Contact with Health Services / 551 Summary / 552
HEALTH INSURANCE SYSTEMS AND CLAIM SUBMISSION / 557

Ch
C h apter 18 Introduction to Insurance / 558 Insurance Terminology / 559 Third-Party Payers / 559
Types of Insurance / 559 Health Insurance Identification Card / 561 Insurance Benefits / 562
The Insurance Policy / 562 Verify Insurance Coverage (Procedure 18-1) / 564 Provider
Contracts / 564 Insurance Plans and Programs / 564 Managed Care Plans / 565
Medicaid / 565 Medicare / 566 TRICARE / 572 CHAMPVA / 577 State Disability
Insurance / 577 Workers’ Compensation / 578 General Guidelines for Handling
Insurance Claims / 579 Patient Registration Process / 579 Assignment and Consent / 579
The Health Insurance Claim / 579 The CMS-1500 Claim Form / 582 Completing the
Claim / 583 Complete the CMS-1500 Health Insurance Claim Form Using OCR Guidelines
(Procedure 18-2) / 584 Claims Submission and Time Limits / 585 Paper Submission / 586
Electronic Submission / 586 Medicaid Claim Completion and Submission / 587 Medicare
Claim Completion and Submission / 587 Complete an Advance Beneficiary Notice (ABN)
Form (Procedure 18-3) / 591 TRICARE Claim Completion and Submission / 591
CHAMPVA Claims Submission and Time Limit / 593 State Disability Claim Completion
and Submission / 593 Workers’ Compensation Claim Completion and Submission / 595
Claim Status / 596 Claim Adjudication and Payment / 596 Claim Follow-Up / 596
Tracing Insurance Claims / 597 False Claim Act / 598 Appeals / 598
xvi Contents
6 MANAGING THE OFFICE / 605
OFFICE MANAGERIAL RESPONSIBILITIES / 606

Chapter 19 Office Manager / 607 The Work Environment / 608 Promoting Patient Satisfaction and
Communication / 608 Develop a Complaint Protocol (Procedure 19-1) / 609 Increasing
Office Productivity / 611 Staff Meetings / 612 Set Up a Staff Meeting (Procedure 19-2) / 613
Prepare a Staff Meeting Agenda (Procedure 19-3) / 614 Office Guidebooks / 615
Employee Handbook / 615 Office Policies and Procedures Manual / 615 Develop and
Maintain an Employee Handbook (Procedure 19-4) / 617 Employment Laws and
Management Plans / 617 Compile and Maintain an Office Policies and Procedures Manual
(Procedure 19-5) / 619 Employer Responsibilities / 622 Prepare an Injury and Illness
Incident Report (Procedure 19-6) / 622 Recruitment and Hiring / 623 Recruit an Employee
(Procedure 19-7) / 623 Employment Verification / 624 Orient a New Employee
(Procedure 19-8) / 625 Employee File / 625 Orientation and Training / 625 Staff
Development / 625 Working with Various Personality Types / 626 Evaluation of Performance
and Salary Review / 627 Termination of Employees / 627 Facility Oversight / 629
Going Green / 629 Building Maintenance / 629 Equipment / 630 Office Supplies / 631
Reducing Supply Expenses / 631 Manage Equipment Maintenance (Procedure 19-9) / 631
Ordering Supplies / 632 Payment of Invoices / 632 Types of Systems for Controlling Inventory / 633
Prepare an Order Form (Procedure 19-10) / 634 Pay an Invoice (Procedure 19-11) / 635
Storing Office Supplies / 637 Business Travel / 638 Travel Arrangements / 638 Establish and
Maintain Inventory (Procedure 19-12) / 639 Travel Help on the Internet / 641 Medical Meeting
Expenses / 641 Prepare a Travel Expense Report (Procedure 19-13) / 642
FINANCIAL MANAGEMENT OF THE MEDICAL PRACTICE / 647

Chapter 20 Computerized Financial Management / 648 Accounting Systems / 648 Financial Status
Reports / 649 Analyzing Practice Productivity / 650 Overhead Expenses / 650 Cost
of Procedures and Services / 650 Accounts Payable / 655 Check Controls / 657
Overpayments and Refunds / 658 Create Headings and Post Entries in an Accounts
Payable System; Write Checks (Procedure 20-1) / 659 Payroll / 660 Wages and Hours of
Work / 660 Payroll Procedures / 661 Employer Identification Number / 661 Social
Security Number / 662 Employee Withholding Allowance Certificate / 662 Payroll
Deductions / 662 Unemployment Taxes / 666 Tax Reports / 666 Create Category
Headings, Determine Deductions, Calculate Payroll, and Make Entries to a Payroll Register
Online SEEKING A POSITION AS AN ADMINISTRATIVE MEDICAL

Chapter 21 ASSISTANT / 676
APPENDIX A CMS-1500 Claim Form Field-by-Field Instructions and a

Commercial Insurance Template 678
APPENDIX B Medical Assisting Task List and Competency Tables
Referencing Chapters, Procedures, and Job Skills to Each
Competency 708
Glossary 748
Index 764
COMPREHENSIVE LIST OF PROCEDURES AND JOB SKILLS
The following Procedures appear in the textbook and Performance Objectives (Job Skills) in the Workbook
Job Skills appear in the Workbook: t Job Skill 2-1 Use the Internet to research and write
an essay about a medical pioneer
t Job Skill 2-2 Direct patients to specific hospital
CHAPTER 1 departments
A CAREER AS AN ADMINISTRATIVE t Job Skill 2-3 Refer patients to the correct physician
MEDICAL ASSISTANT specialist
t Job Skill 2-4 Define abbreviations for health care
Performance Objectives (Procedures) in This Textbook professionals
t Procedure 1-1 Interpret and accurately spell medical t Job Skill 2-5 Determine basic skills needed by the
terms and abbreviations administrative medical assistant
Performance Objectives (Job Skills) in the Workbook
t Job Skill 1-1 Interpret and accurately spell medical CHAPTER 3
terms and abbreviations
t Job Skill 1-2 Use the Internet to look up key terms MEDICOLEGAL AND ETHICAL
and hear pronunciations RESPONSIBILITIES
t Job Skill 1-3 Prioritize a task list to practice time Performance Objectives (Procedures) in This Textbook
management skills
t Procedure 3-1 Release patient information
t Job Skill 1-4 Use the Internet to obtain information
on certification or registration Performance Objectives (Job Skills) in the Workbook
t Job Skill 1-5 Use the Internet to test your knowledge t Job Skill 3-1 List personal ethics and set professional
of anatomy and physiology or medical terminology ethical goals
t Job Skill 1-6 Develop a medical practice survey t Job Skill 3-2 Complete an authorization form to
release medical records
t Job Skill 3-3 Download state-specific scope of prac-
CHAPTER 2 tice laws and determine parameters for a medical
THE HEALTH CARE ENVIRONMENT: PAST, assistant
PRESENT, AND FUTURE t Job Skill 3-4 Compose a letter of withdrawal
t Job Skill 3-5 View a MedWatch online form and
Performance Objectives (Procedures) in This Textbook learn submitting requirements
t Procedure 2-1 Direct patients to specific hospital t Job Skill 3-6 Print the Patient Care Partnership online
departments brochure and apply it to the medical office setting
t Procedure 2-2 Refer patients to the correct physician t Job Skill 3-7 Download and compare state-specific
specialist advance directives
xvii
xviii Comprehensive List of Procedures and Job Skills
CHAPTER 4 CHAPTER 5
The Art of Communication RECEPTIONIST AND THE MEDICAL OFFICE
ENVIRONMENT
Performance Objectives (Procedures) in This Textbook
t Procedure 4-1 Demonstrate active listening by Performance Objectives (Procedures) in This Textbook
following guidelines t Procedure 5-1 Open the medical office
t Procedure 4-2 Communicate with children t Procedure 5-2 Assist patients with in-office registra-
t Procedure 4-3 Communicate with older adults tion procedures
t Procedure 4-4 Communicate with hearing-impaired t Procedure 5-3 Assist patient in preparing an applica-
patients tion form for a disabled person placard
t Procedure 4-5 Communicate with visually impaired t Procedure 5-4 Develop a list of community resources
patients t Procedure 5-5 Develop a patient education plan for
t Procedure 4-6 Communicate with speech-impaired diseases or injuries related to the medical specialty
patients t Procedure 5-6 Work at a computer station and com-
t Procedure 4-7 Communicate with patients who ply with ergonomic standards
have an impaired level of understanding t Procedure 5-7 Prevent and prepare for fires in the
t Procedure 4-8 Communicate with anxious patients workplace
t Procedure 4-9 Communicate with angry patients t Procedure 5-8 Learn how and when to use a fire
t Procedure 4-10 Communicate with patients and extinguisher
their family members and friends t Procedure 5-9 Develop an emergency disaster plan
t Procedure 4-11 Communicate with the health care t Procedure 5-10 Close the medical office
team
Performance Objectives (Job Skills) in the Workbook t Job Skill 5-1 Prepare a patient registration form
t Job Skill 4-1 Demonstrate body language t Job Skill 5-2 Prepare an application form for a dis-
t Job Skill 4-2 Use the Internet to research active lis- abled person placard
tening skills and write a report t Job Skill 5-3 Research community resources for
t Job Skill 4-3 Communicate with a child via role- patient referrals and patient education
playing t Job Skill 5-4 Assess and use proper body mechanics
t Job Skill 4-4 Communicate with an older adult via t Job Skill 5-5 Evaluate the work or school environ-
role-playing ment and develop a safety plan
t Job Skill 4-5 Name unique qualities of other cultures t Job Skill 5-6 Take steps to prevent and prepare for
t Job Skill 4-6 Communicate with a hearing-impaired fires in a health care setting
patient via role-playing t Job Skill 5-7 Demonstrate proper use of a fire extin-
t Job Skill 4-7 Communicate with a visually impaired guisher
patient via role-playing t Job Skill 5-8 Determine potential disaster hazards in
t Job Skill 4-8 Communicate with a speech-impaired your local community
patient via role-playing t Job Skill 5-9 Develop an emergency response tem-
t Job Skill 4-9 Communicate with a patient who has plate with an evacuation plan
an impaired level of understanding via role-playing
t Job Skill 4-10 Communicate with an anxious patient
via role-playing CHAPTER 6
t Job Skill 4-11 Communicate with an angry patient TELEPHONE PROCEDURES
via role-playing
t Job Skill 4-12 Communicate with a patient and his Performance Objectives (Procedures) in This Textbook
or her family members and friends via role-playing t Procedure 6-1 Prepare and leave a voice mail message
t Job Skill 4-13 Communicate with a coworker on the t Procedure 6-2 Take messages from an answering
health care team via role-playing service
Comprehensive List of Procedures and Job Skills xix
t Procedure 6-3 Answer incoming telephone calls t Procedure 8-4 Determine filing units and indexing
t Procedure 6-4 Place outgoing telephone calls order to alphabetically file a patient’s medical record
t Procedure 6-5 Screen telephone calls t Procedure 8-5 Label and color-code patient charts
t Procedure 6-6 Identify and manage emergency calls t Procedure 8-6 Prepare, sort, and file documents in
t Procedure 6-7 Handle a complaint from an angry patient records
caller t Procedure 8-7 Locate a misfiled medical record file
folder
t Job Skill 6-1 Screen incoming telephone calls Performance Objectives (Job Skills) in the Workbook
t Job Skill 6-2 Prepare telephone message forms t Job Skill 8-1 Determine filing units
t Job Skill 6-3 Document telephone messages and t Job Skill 8-2 Index and file names alphabetically
physician responses t Job Skill 8-3 File patient and business names alpha-
t Job Skill 6-4 Role-play emergency telephone betically
scenario(s) t Job Skill 8-4 Index names on file folder labels and
arrange file cards in alphabetical order
t Job Skill 8-5 Color-code file cards
CHAPTER 7
APPOINTMENTS
CHAPTER 9
MEDICAL RECORDS
t Procedure 7-1 Prepare an appointment matrix
t Procedure 7-2 Execute appointment procedures Performance Objectives (Procedures) in This Textbook
t Procedure 7-3 Schedule appointments in a paper- t Procedure 9-1 Prepare and compile a medical record
based system for a new patient
t Procedure 7-4 Schedule electronic appointments t Procedure 9-2 Follow documentation guidelines to
t Procedure 7-5 Reorganize patients in an emergency record information in a medical record
situation t Procedure 9-3 Correct a medical record
t Procedure 7-6 Schedule surgery, complete form, and t Procedure 9-4 Abstract data from a medical record
notify the patient
t Procedure 7-7 Schedule an outpatient diagnostic test
t Job Skill 9-1 Prepare a patient record and insert
Performance Objectives (Job Skills) in the Workbook progress notes
t Job Skill 7-1 Set up appointment matrix t Job Skill 9-2 Prepare a patient record and format
t Job Skill 7-2 Schedule appointments chart notes
t Job Skill 7-3 Prepare an appointment reference sheet t Job Skill 9-3 Correct a medical record
t Job Skill 7-4 Complete appointment cards t Job Skill 9-4 Abstract from a medical record
t Job Skill 7-5 Abstract information and complete a t Job Skill 9-5 Prepare a history and physical (H & P)
hospital/surgery scheduling form report
t Job Skill 7-6 Transfer surgery scheduling informa- t Job Skill 9-6 Record test results on a flow sheet
tion to a form letter
t Job Skill 7-7 Complete requisition forms to sched-
ule outpatient diagnostic tests CHAPTER 10
DRUG AND PRESCRIPTION RECORDS
CHAPTER 8 Performance Objectives (Procedures) in This Textbook
FILING PROCEDURES t Procedure 10-1 Use a drug reference book to spell

and locate drug information
Performance Objectives (Procedures) in This Textbook t Procedure 10-2 Read and interpret a written pre-
t Procedure 8-1 Set up an email filing system scription
t Procedure 8-2 File using a subject filing system t Procedure 10-3 Record medication in a patient’s
t Procedure 8-3 Organize a tickler file medical record and on a medication log
xx Comprehensive List of Procedures and Job Skills
Performance Objectives (Job Skills) in the Workbook t Procedure 12-3 Open, sort, and annotate mail
t Job Skill 10-1 Spell drug names t Procedure 12-4 Prepare outgoing mail
t Job Skill 10-2 Determine the correct spelling of drug t Procedure 12-5 Complete Certified Mail and Return
names Receipt U.S. Postal Service forms
t Job Skill 10-3 Use a drug reference book to locate t Procedure 12-6 Address a business envelope using
information U. S. Postal Service regulations
t Job Skill 10-4 Translate prescriptions t Procedure 12-7 Manage office mail
t Job Skill 10-5 Record prescription refills in medical t Procedure 12-8 Compose an email message
records t Procedure 12-9 Prepare a fax cover sheet and send
t Job Skill 10-6 Write a prescription a fax
t Job Skill 10-7 Interpret a medication log Performance Objectives (Job Skills) in the Workbook
t Job Skill 10-8 Record on a medication schedule
t Job Skill 12-1 Process incoming mail
t Job Skill 12-2 Annotate mail
t Job Skill 12-3 Classify outgoing mail
CHAPTER 11 t Job Skill 12-4 Address small envelopes for OCR
WRITTEN CORRESPONDENCE scanning
t Job Skill 12-5 Complete a mail-order form for postal
supplies
t Procedure 11-1 Compose, format, key, proofread, t Job Skill 12-6 Compose a letter and prepare an enve-
and print business correspondence lope for Certified Mail
t Procedure 11-2 Proofread a business document t Job Skill 12-7 Key and fold an original letter; address
t Procedure 11-3 Transcribe a dictated document a small envelope for Certified Mail, Return Receipt
t Procedure 11-4 Prepare documents for photocopying requested
Performance Objectives (Job Skills) in the Workbook t Job Skill 12-8 Key and fold an original letter; address
t Job Skill 11-1 Spell medical words a large envelope for Certified Mail, Return Receipt
t Job Skill 11-2 Key a letter of withdrawal requested
t Job Skill 11-3 Edit written communication t Job Skill 12-9 Prepare a cover sheet for fax transmis-
t Job Skill 11-4 Compose and key a letter for a failed sion
appointment
t Job Skill 11-5 Compose and key a letter for an initial
visit CHAPTER 13
t Job Skill 11-6 Compose and key a letter to another THE REVENUE CYCLE: FEES, CREDIT, AND
physician COLLECTION
t Job Skill 11-7 Compose and key a letter requesting
payment Performance Objectives (Procedures) in This Textbook
t Job Skill 11-8 Key two interoffice memorandums t Procedure 13-1 Explain professional fees in an item-
t Job Skill 11-9 Abstract information from a medical ized billing statement
record; compose and key a letter t Procedure 13-2 Separate and prepare monthly item-
t Job Skill 11-10 Key a two-page letter ized billing statements
t Procedure 13-3 Establish a financial agreement with
a patient
CHAPTER 12 t Procedure 13-4 Perform debt collection using a tele-
PROCESSING MAIL AND ELECTRONIC phone
CORRESPONDENCE t Procedure 13-5 Select a collection agency
t Procedure 13-6 Take collection action; send an
Performance Objectives (Procedures) in This Textbook account to a collection agency
t Procedure 12-1 Operate a postage meter machine t Procedure 13-7 File an uncollectible account in
t Procedure 12-2 Follow safety guidelines when han- small-claims court
dling large volumes of mail and suspicious mail pieces t Procedure 13-8 Trace a skip
Comprehensive List of Procedures and Job Skills xxi
Performance Objectives (Job Skills) in the Workbook t Job Skill 15-6 Bookkeeping Day 1—Balance the day
t Job Skill 13-1 Use a physician’s fee schedule to sheet
determine correct fees t Job Skill 15-7 Bookkeeping Day 2—Prepare the
t Job Skill 13-2 Complete cash receipts daily journal
t Job Skill 13-3 Interpret an explanation of benefits t Job Skill 15-8 Bookkeeping Day 2—Post charges,
form payments, and adjustments to patient ledger cards
t Job Skill 13-4 Role-play collection scenarios and to the daily journal; prepare cash receipts and
t Job Skill 13-5 Compose a collection letter and pre- the bank deposit
pare an envelope t Job Skill 15-9 Bookkeeping Day 2—Balance the day
t Job Skill 13-6 Complete a financial agreement sheet
t Job Skill 15-10 Bookkeeping Day 3—Prepare the
daily journal
CHAPTER 14 t Job Skill 15-11 Bookkeeping Day 3—Post charges,
payments, and adjustments to patient ledger cards
BANKING and to the daily journal; prepare cash receipts and
Performance Objectives (Procedures) in This Textbook the bank deposit
t Procedure 14-1 Prepare a bank deposit t Job Skill 15-12 Bookkeeping Day 3—Balance the
t Procedure 14-2 Write a check using proper format day sheet
and calculate a running balance t Job Skill 15-13 Set up the day sheet for a new month
t Procedure 14-3 Reconcile a bank statement
Performance Objectives (Job Skills) in the Workbook CHAPTER 16
t Job Skill 14-1 Prepare a bank deposit PROCEDURE CODING
t Job Skill 14-2 Write checks
t Job Skill 14-3 Endorse a check
t Job Skill 14-4 Inspect a check t Procedure 16-1 Select correct procedure codes
t Job Skill 14-5 Reconcile a bank statement t Procedure 16-2 Determine code selection from an
operative report
CHAPTER 15 t Job Skill 16-1 Review Current Procedural Terminology
BOOKKEEPING codebook sections
t Job Skill 16-2 Code evaluation and management
services
t Procedure 15-1 Prepare and post to a patient’s account t Job Skill 16-3 Code surgical services and procedures
t Procedure 15-2 Prepare the pegboard; post charges, t Job Skill 16-4 Code radiology and laboratory ser-
payments, and adjustments; and balance the day vices and procedures
sheet t Job Skill 16-5 Code procedures and services in the
t Procedure 15-3 Establish, record, balance, and Medicine section
replenish the petty cash fund t Job Skill 16-6 Code clinical examples
t Job Skill 15-1 Post entries to ledger cards and calcu- CHAPTER 17
late balances
DIAGNOSTIC CODING
t Job Skill 15-2 Prepare ledger cards
t Job Skill 15-3 Bookkeeping Day 1—Post to patient Performance Objectives (Procedures) in This Textbook
ledger cards and prepare cash receipts t Procedure 17-1 Select correct diagnostic codes using
t Job Skill 15-4 Bookkeeping Day 1—Prepare the ICD-10-CM
daily journal t Procedure 17-2 Select burn and corrosion codes
t Job Skill 15-5 Bookkeeping Day 1—Post charges, t Procedure 17-3 Select diagnostic codes from the
payments, and adjustments using a daily journal Table of Drugs and Chemicals
xxii Comprehensive List of Procedures and Job Skills
Performance Objectives (Job Skills) in the Workbook t Procedure 19-8 Orient a new employee
t Job Skill 17-1 Code diagnoses from Chapters 1, 2, 3, t Procedure 19-9 Manage equipment maintenance
4, and 5 in ICD-10-CM t Procedure 19-10 Prepare an order form
t Job Skill 17-2 Code diagnoses from Chapters 6, 7, 8, t Procedure 19-11 Pay an invoice
9, and 10 in ICD-10-CM t Procedure 19-12 Establish and maintain inventory
t Job Skill 17-3 Code diagnoses from Chapters 11, 12, t Procedure 19-13 Prepare a travel expense report
13, 14, and 15 in ICD-10-CM Performance Objectives (Job Skills) in the Workbook
t Job Skill 17-4 Code diagnoses from Chapters 16, 17,
t Job Skill 19-1 Document patient complaints and
18, 19, and 20 in ICD-10-CM
determine actions to resolve problems
t Job Skill 17-5 Code diagnoses from Chapter 21 and
t Job Skill 19-2 Write an agenda for an office meeting
the Table of Drugs and Chemicals in ICD-10-CM
t Job Skill 19-3 Prepare material for an office proce-
t Job Skill 17-6 Code diagnoses from chart notes using
dures manual
ICD-10-CM
t Job Skill 19-4 Perform inventory control and keep
an equipment maintenance log
CHAPTER 18 t Job Skill 19-5 Abstract data from a catalogue and
key an order form
HEALTH INSURANCE SYSTEMS AND CLAIM
t Job Skill 19-6 Complete an order form for office
SUBMISSION
supplies
Performance Objectives (Procedures) in This Textbook t Job Skill 19-7 Perform mathematic calculations of
t Procedure 18-1 Verify insurance coverage an office manager
t Procedure 18-2 Complete the CMS-1500 Health t Job Skill 19-8 Prepare two order forms
Insurance Claim Form using OCR guidelines t Job Skill 19-9 Prepare a travel expense report
t Procedure 18-3 Complete an Advance Beneficiary
Notice form (ABN)
CHAPTER 20
FINANCIAL MANAGEMENT OF THE
t Job Skill 18-1 Complete a managed care authoriza-
MEDICAL PRACTICE
tion form
t Job Skill 18-2 Complete a health insurance claim Performance Objectives (Procedures) in This Textbook
form for a commercial case t Procedure 20-1 Create headings and post entries in
t Job Skill 18-3 Complete a health insurance claim an accounts payable system; write checks
form for a Medicare case t Procedure 20-2 Create category headings, determine
t Job Skill 18-4 Complete a health insurance claim deductions, calculate payroll, and make entries to a
form for a TRICARE case payroll register
CHAPTER 19 t Job Skill 20-1 Perform accounts payable functions:
OFFICE MANAGERIAL RESPONSIBILITIES write checks and record disbursements
t Job Skill 20-2 Pay bills and record expenditures
Performance Objectives (Procedures) in This Textbook t Job Skill 20-3 Replenish and balance the petty cash
t Procedure 19-1 Develop a complaint protocol fund
t Procedure 19-2 Setup a staff meeting t Job Skill 20-4 Balance a check register
t Procedure 19-3 Prepare a staff meeting agenda t Job Skill 20-5 Reconcile a bank statement
t Procedure 19-4 Develop and maintain an employee t Job Skill 20-6 Prepare payroll
handbook t Job Skill 20-7 Complete a payroll register
t Procedure 19-5 Prepare an incident report t Job Skill 20-8 Complete an employee earning record
t Procedure 19-6 Compile and maintain an office t Job Skill 20-9 Complete an employee’s withholding
policies and procedures manual allowance certificate
t Procedure 19-7 Recruit an employee t Job Skill 20-10 Complete an employee benefit form
PREFACE
When I started preparations for the revision speaks of the excellence of its founding
of Administrative Medical Assisting, eighth authors, Marilyn T. Fordney and Joan J. Follis,
edition, I adopted the following quote by whose great dedication, perseverance, and
William Arthur Ward: vision for the future role of the medical assis-
tant helped create a working tool out of a
Four Steps to Achievement
classroom syllabus at Ventura College, Cali-
Plan purposefully
fornia. This book has been used to expand
Prepare prayerfully knowledge and understanding, teach practi-
Proceed positively cal skills used by medical assistants all across
Pursue persistently America, as well as increase productivity in
I read this quote every morning and took to medical offices. While being mentored by
heart each step as I worked to make this edi- these two great authors, my role has grown
tion the very best! My goals were to streamline from a contributing author in the fourth edi-
the content in order to simplify the learning tion, to coauthor in the fifth edition, and
path, highlight electronic components that are then becoming a primary author in the sixth,
now a part of the medical office, and include seventh, and eighth editions.
all skills needed by an administrative medical
assistant—all while focusing on the “heart of
the health care professional” who works with COMPETENCY-BASED
compassion and sensitivity while tending to LEARNING
the needs of patients.
In the eighth edition, an emphasis has Curriculum competencies and standards
been placed on the electronic health record define the role and responsibilities of an
(EHR) and a new icon has been added to iden- administrative medical assistant, and certifi-
tify chapter-specific content. The health care cation tasks and test parameters help students
reform (HCR) icon remains throughout the understand topics and areas to study. Educa-
text with updated legislative actions and tional components for each of the following
implementation dates. The continued devel- are presented in Appendix B of the textbook
opment of additional critical thinking pre- where cross-reference tables may be found
sented in real-life scenarios helps cultivate that refer individual competencies to chapters
problem-solving skills. Materials needed and and assignments within the text:
referred to for Job Skills in the Workbook are t American Medical Technologists (AMT)
now presented in a concise easy-to-follow list. Medical Assisting Task List for the Reg-
istered Medical Assistant (RMA)
t Commission on Allied Health Educa-
DEVELOPMENT OF THIS tion Programs (CAAHEP) Educational
Competencies
TEXT t Accrediting Bureau of Health Education
The longevity of this award-winning textbook, Schools (ABHES) Curriculum
which has been in publication for 34 years, Competencies
xxiii
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no related content on Scribd:
but when relieved or cured of this, suddenly a new manifestation
occurs. A new figure appears upon the scene, or perhaps I might
better say a new actor treads the boards. Even in these cases,
however, it would be difficult to say that the phenomena are really
simulated. They are rather induced, and get partly beyond the
patient's will.
A remarkable case of this kind is well known at the Philadelphia

Polyclinic and College for Graduates in Medicine. She is sometimes
facetiously spoken of as the “Polyclinic Case,” because she has
done duty at almost every clinical service connected with the
institution. The case has been reported several times: the fullest
report is that given by Harlan.100 The patient was taken sick in
September with sore throat, and was confined to the house for about
two weeks. She was attended by S. Solis Cohen. There was
difficulty in swallowing, and some regurgitation of food. At the same
time she had weakness of sight in the right eye. Later, huskiness of
voice came on, and soon complete aphonia. Her voice recovered,
and she then had what appeared to be pleuro-pneumonia. During
the attack her arms became partially paralyzed. She complained of
numbness down her legs and in her feet.
100 Transactions of the Amer. Ophthalmological Soc., 20th annual meeting, 1884,
649.
Before these symptoms had disappeared twitchings of the muscles

of the face set in, most marked on the right side. The face improved,
but in two days she had complete spasmodic torticollis of the left
side. One pole of a magnet was placed in front of the ear, and the
other along the face; and under this treatment in a week the spasm
ceased entirely.
In a short time she complained of various troubles of vision and a

fixed dilatation of the pupil. Homonymous diplopia appeared.
Reading power of the right eye was soon lost. The pupil was slightly
dilated, and reacted imperfectly to light. She had distressing
blepharospasm on the right side and slight twitchings on the left. Two
months later a central scotoma appeared, and eventually her right
eye became entirely blind except to light. The pupil was widely
dilated and fixed, and the spasm became more violent and extended
to the face and neck. The sight was tested by Harlan by placing a
weak convex lens in front of the blind eye, and one too strong to
read through in front of the sound eye, when it was found that she
read without any difficulty. The use of the magnet was continued by
Cohen. Blepharospasm and dilatation of the pupil improved. She,
however, had an attack of conjunctivitis in the left eye, and again got
worse in all her eye symptoms. A perfect imitation of the magnet was
made of wood with iron tips. Under this imitation magnet the pupil
recovered its size and twitching of the face and eyelids ceased.
The next campaign was precipitated by a fall. She claimed that she
had dislocated her elbow-joint; she was treated for dislocation by a
physician, and discharged with an arm stiff at the elbow. A wooden
magnet was applied to the arm, the spasm relaxed, and the
dislocation disappeared.
This ends Harlan's report of the case, and I had thought that this
patient's Iliad of woes was also ended; but I have just been informed
by J. Solis Cohen and his brother that she has again come under
their care. The latter was sent for, and found the patient seemingly
choking to death. The right chest was fixed; there was marked
dyspnœa; respiration 76 per minute; her expectoration was profuse;
she had hyperresonance of the apex, and loud mucous râles were
heard. At last accounts she was again recovering.
This patient's train of symptoms began with what appeared to be

diphtheria. The fact that she had some real regurgitation would seem
to be strong evidence that she had some form of throat paralysis
following diphtheria. She was of neurotic temperament. From the
age of seven until ten years she had had fits of some kind about
every four weeks. Because of her sore throat and subsequent real or
seeming paralytic condition she came to the Polyclinic, where she
was an object of interest and considerable attention, having been
talked about and lectured upon to the classes in attendance.
Whether her first symptoms were or were not hysterical, those which
succeeded were demonstrably of this character. Frequently some
real disease is the starting-point of a train of hysterical disorders.
DURATION AND COURSE.—Hysteria is pre-eminently a chronic disease;

in the majority of cases it lasts at least for years. Its symptoms may
be prolonged in various ways. Sometimes one grave hysterical
disorder, as hysterical paralysis, persists for years. In other cases
one set of symptoms will be supplanted by others, and these by still
others, and so on until the whole round of hysterical phenomena
appears in succession.
Deceptive remissions in hysterical symptoms often mislead the

unwary practitioner. Cures are sometimes claimed where simply a
change in the character of the phenomena has taken place. Without
doubt, some cases of hysteria are curable; equally, without doubt,
many cases are not permanently cured. It is a disease in which it is
unsafe to claim a conquest too soon. In uncomplicated cases of
hysteria the disorder often abates slowly but surely as age
advances. As a rule, the longevity of hysterical patients is not much
affected by the disorder.
COMPLICATIONS.—We should not treat a nervous case occurring in a

woman or a man as hysterical simply because it is obscure and
mysterious. Unless, after the most careful examination, we are able
by exclusion or by the presence of certain positive symptoms to
arrive at the diagnosis of hysteria, it is far better to withhold an
opinion or to continue probing for organic disease. I can recall five
cases in which the diagnosis of hysteria was made, and in which
death resulted in a short time. One of these was a case of uræmia
with convulsions, two were cases of acute mania, another proved to
be a brain abscess, and the fifth a brain tumor. Hughes Bennett101
has reported a case of cerebral tumor with symptoms simulating
hysteria in which the diagnosis of the true nature of the disease was
not made out during life. The patient was a young lady of sixteen at
the time of her death. Her family history was decidedly neurotic. She
was precocious both mentally and physically, was mischievous and
destructive, sentimental and romantic; she had abnormal sexual
passions. She had a sudden attack of total blindness, with equally
sudden recovery of sight some ten days afterward. Sudden loss of
sight occurred a second time, and deafness with restoration of
hearing, loss of power in her lower limbs, and total blindness,
deafness, and paraplegia. Severe constant headaches were absent,
as were also ptosis, diplopia, facial or lingual paralysis, convulsions
with unconsciousness, vomiting, wasting, and abnormal
ophthalmoscopic appearances. She had attacks of laughing, crying,
and throwing herself about. Her appearance and character were
eminently suggestive of hysteria. The patient died, and on post-
mortem examination a tumor about the size and shape of a hen's
egg was found in the medullary substance of the middle lobe of the
right hemisphere.
101 Brain, April, 1878.
The association of hysteria with real and very severe spinal

traumatism partially misled me in the case of a middle-aged man
who had been injured in a runaway accident, and who sustained a
fracture of one of the upper dorsal vertebræ, probably of the spines
or posterior arch. This was followed by paralysis, atrophy of the
muscles, contractures, changed reactions, bladder symptoms, bed-
sores, and anæsthesia. The upper extremities were also affected.
Marked mental changes were present, the man being almost
insanely hysterical. The diagnosis was fracture, followed by
compression myelitis, with descending motor and ascending sensory
degeneration. An unfavorable prognosis was given. He left the
hospital and went to another, and finally went home, where he was
treated with a faradic battery. He gradually improved, and is now on
his feet, although not well. In this case there was organic disease
and also much hysteria.
Seguin102 holds that (1) many hysterical symptoms may occur in

diseases of the spinal cord and brain; (2) in diseases of the spinal
cord these diseases appear merely as a matter of coincidence; (3) in
cases of cerebral disease the hysterical symptoms have a deeper
significance, being in relation to the hemisphere injured. He collects,
as illustrative of the propositions that hysterical symptoms will
present themselves in persons suffering from organic disease of the
nervous system, the following cases of organic spinal disease: One
case of left hemiplegia with paresis of the right limbs, which proved
after death to be extensive central myelitis, with formation of cavities
in the cord; two cases of posterior spinal sclerosis, two of
disseminated sclerosis, and one of sclerosis of the lateral column. In
some of these cases the organic disease was wholly overlooked.
Sixteen cases of organic disease of the brain accompanied by
marked hysterical manifestations are also given: 9 of left hemiplegia;
2 of right hemiplegia with aphasia; 1 of left alternating with right
hemiplegia; 1 of hemichorea with paresis; 1 of double hemiplegia;
and 2 of general paresis. It is remarkable and of interest, in
connection with other unilateral phenomena of hysteria, that
emotional symptoms were present in 14 cases of left hemiplegia and
in only 2 of right.
102 Op. cit.
Among the important conclusions of this paper are the following: “1.
In typical hysteria the emotional symptoms are the most prominent,
and according to many authors the most characteristic. In all the
cases of cerebral disease related there were undue emotional
manifestations or emotional movements not duly controlled. 2. In
typical hysteria many of the objective phenomena are almost always
shown on the left side of the body, and we may consequently feel
sure that in these cases the right hemisphere is disordered. In nearly
all of the above sixteen cases the right hemisphere was the seat of
organic disease, and the symptoms were on the left side of the
body.”
The possibility of the occurrence of hysteria in the course of acute

diseases, particularly fevers, is often overlooked. Its occurrence
sometimes misleads the doctor with reference to prognosis. Such
manifestations are particularly apt to occur in emotional children. A
young girl suffering from a moderately severe attack of follicular
tonsillitis, with high fever, suddenly awoke during the night and
passed into an hysterical convulsion which greatly alarmed her
parents. Her fingers, hands, and arms twitched and worked
convulsively. She had fits of laughing and shouting, and was for a
short time in a state of ecstasy or trance. Once before this she had
had a similar but slighter seizure, during the course of an ephemeral
fever.
Among other complications of hysteria which have been noted by

different observers are apoplexy, disease of the spleen, mania-a-
potu, heart disease, and spinal caries, and among affections alluded
to by competent observers as simulated by hysteria are secondary
syphilis, phthisis, tetanus, strychnia-poisoning, peritonitis, angina
pectoris, and cardiac dyspnœa.
DIAGNOSIS.—Buzzard103 significantly remarks that you cannot cure a

case of hysteria as long as you have any serious doubt about its
nature; and, on the other hand, if you are able to be quite sure on
this point, and are prepared to act with sufficient energy, there are
few cases that will not yield to treatment. The importance of a correct
diagnosis is a trite topic, but in no affection is it of more consequence
than in hysteria, that disorder which, although itself curable, may, as
has been abundantly shown, imitate the most incurable and fatal of
diseases.
103 Clinical Lectures on Diseases of the Nervous System, by Thomas Buzzard, M.D.,
Philada., 1882.
A few remarks with reference to the methods of examining hysterical

patients will be here in place. Success on the part of the physician
will often depend upon his quickness of perception and ability to
seize passing symptoms. It is often extremely difficult to determine
whether hysterical patients are or are not shamming or how far they
are shamming. The shrewdness and watchfulness which such
patients sometimes exercise in resisting the physician's attempts to
arrive at a diagnosis should be borne in mind. A consistent method
of procedure, one which never betrays any lack of confidence,
should be adopted. “Trifles light as air” will sometimes decide, a
single expression or a trivial sign clinching the diagnosis. On the
other hand, the most elaborate and painstaking investigation will be
frequently required.
The physician should carefully guard against making a diagnosis

according to preconceived views. On the whole, the general
practitioner is more likely to err on the side of diagnosticating organic
disease where it does not exist; the specialist in too quickly
assigning hysteria where organic disease is present, or in failing to
determine the association of hysteria and organic disease in the
same case.
Special expedients may sometimes be resorted to in the course of

an examination. Not a few hysterical symptoms require for their
continuance that the patient's mind shall be centred on the
manifestations. If, therefore, the attention can, without arousing
suspicions, be directed to something else during the examination,
the disappearance of the particular hysterical symptom may clear
away all obscurity. In a case reported by Seguin,104 in which
staggering was a prominent symptom, the patient was placed in the
middle of the room and directed to look at the ceiling to see if he
could make out certain fine marks; he stood perfectly well without
any unsteadiness. In the case of a boy eleven years old whose chief
symptoms were hysterical paralysis with contracture of the lower
extremities, great hyperæsthesia of the feet, and a tremor involving
both the upper and lower extremities, and sometimes the head, I
directed him, as if to bring out some point, to hold one arm above his
head and at the same time fix his attention on the foot of the
opposite side. The tremor in the upper extremities, which had been
most marked, entirely disappeared. This experiment was varied, the
result being the same.
104 Op. cit.
The method adopted in the cases supposed to be phthisis, but which

proved to be hysterical, which has already been alluded to under the
head of hysterical or nervous breathing, is worthy of note. The
patients, it will be recalled, could not be induced to draw a long
breath until the plan was adopted of having them count twenty
without stopping, when the lungs expanded and the diagnosis was
clear.
It is important to know whether or not children are of this hysterical

tendency or are likely, sooner or later in life, to develop some forms
of this disorder. In children as well as in adults the hysterical
diathesis will be indicated by that peculiar mobility of the nervous
system, which has been referred to under Etiology. It is chiefly by
psychical manifestations that the determination will be made. These
are often of mild degree and of irregular appearance. Undue
emotionality under slight exciting cause, a tendency to simulation
and to exaggeration of real conditions, inconsistency in likes and
dislikes, and great sensibility to passing impressions, are among
these indications. Children of hysterical diathesis are sometimes,
although by no means always, precocious mentally, but not a few
cases of apparent precocity are rather examples of an effort to
attract attention, which is always present in individuals of this
temperament.
It is also important, as urged by Allbutt,105 to make a distinction

between hysterical patients and neurotic subjects, often incorrectly
classed as hysterical. Many cases of genuine malady and suffering
are contemptuously thrown aside as hysteric. Allbutt regards some
of these neurotic patients as almost the best people in this wicked
world. Although, however, this author's righteous wrath against the
too frequent diagnosis of hysteria, hysterical pain, hysterical spine,
etc. is entirely justifiable, he errs a little on the other side.
105 On Visceral Neuroses, being the Gulstonian Lectures on Neuralgia of the
Stomach and Allied Disorders, delivered at Royal College of Physicians, March, 1884,
by T. Clifford Allbutt, M.A., M.D. Cantab., F. R. S., Philada., 1884.
Hysteria and neurasthenia are often confounded, and, while both

conditions may exist in the same case, just as certainly one may be
present without the other. The points of differential diagnosis as
given by Beard106 are sufficient for practical purposes. They are the
following: In neurasthenia convulsions or paroxysms are absent; in
hysteria they are among the most common features. In neurasthenia
globus hystericus and anæsthesia of the epiglottis are absent,
ovarian tenderness is not common, and attacks of anæsthesia are
not frequent and have little permanency; in hysteria globus
hystericus, anæsthesia of the epiglottis, ovarian tenderness, and
attacks of general or local anæsthesia are all marked phenomena.
The symptoms of neurasthenia are moderate, quiet, subdued,
passive; those of hysteria are acute, intense, violent, positive.
Neurasthenia may occur in well-balanced intellectual organizations;
hysteria is usually associated with great emotional activity and
unbalanced mental organization. Neurasthenia is common in males,
although more common in females; hysteria is rare in males.
Neurasthenia is always associated with physical debility; hysteria in
the mental or psychical form occurs in those who are in perfect
physical health. Neurasthenia never recovers suddenly, but always
gradually and under the combined influences of hygiene and
objective treatment; hysteria may recover suddenly and under purely
emotional treatment.
106 Op. cit.
An affection termed general nervousness has been described by

Mitchell. It does not seem to be strictly a neurasthenia, nor does it
always occur in hysterical individuals. These cases are sometimes
“more or less neurasthenic people, easily tired in brain or body; but
others are merely tremulous, nervous folks, easily agitated, over-
sensitive, emotional, and timid.” It is sometimes an inheritance;
sometimes it results from the misuse of alcohol, tobacco, tea or
coffee. Usually, it is developed slowly; occasionally, however, it
arises in a moment. Thus, Mitchell mentions the case of a healthy
girl who fell suddenly into a state of general nervousness owing to
the fall of a house-wall. General nervousness is to be distinguished
from hysteria, into which it sometimes merges, only by the absence
of the mental perversions and the special motor, sensory, vaso-
motor, and visceral disorders peculiar to the latter.
The differential diagnosis of hysteria and hypochondria, or what is

better termed hypochondriacal melancholia, is often, apparently at
least, somewhat difficult. Formerly, it was somewhat the fashion to
regard hysteria in the male as hypochondria; but this view has
nothing to support it. Hypochondria and hysteria, as neurasthenia
and hysteria, are sometimes united in the same subject; one
sometimes begets the other, but they have certain points of
distinction. Hypochondria more frequently passes into real organic
disease than does hysteria; it is more frequently associated with
organic disease than is hysteria. Hypochondria is in the majority of
cases a true insanity, while hysteria can only be regarded as such in
the special instances which have been discussed. In hypochondria
the individual's thoughts are centred upon some supposed disease
until a true delusional condition is developed; this does not often
occur in hysteria. Hypochondria is seen with as great a frequency in
the male as in the female, while hysteria prevails much more largely
in the female sex. In typical hypochondria more readily than in
hysteria the patient may be led from one set of symptoms to another,
the particulars of which he will detail in obedience to questions that
are put to him, these symptoms not unusually partaking of the
absurd and impossible. In hypochondria are absent those distinctive
symptoms which in nearly all cases of hysteria appear in greater or
less number, such as convulsions, paralysis, contracture, aphonia,
hysterical joints, and the like. In hypochondria is present the
groundless fear of disease without these outward manifestations of
disease. The symptoms of hypochondria, as a rule, but not
invariably, are less likely to change or abate than those of hysteria.
It is often of moment to be able to distinguish between two such well-

marked affections as common acute mania and hysterical mania. In
acute mania the disorder usually comes on gradually; in hysterical
mania the outbreak of excitement is generally sudden, although
prodromic manifestations are sometimes present. This point of
difference is not one to be absolutely depended upon. In acute
mania incoherence and delusions or delusional states are genuine
phenomena; in hysterical mania delusional conditions, often of an
hallucinatory character, may be present, but they are likely to be of a
peculiar character. Frequently, for instance, such patients see, or say
that they see, rats, toads, spiders, and strange beasts. These
delusions have the appearance of being affected in many cases;
very often they are fantastical, and sometimes at least they are
spurious or simulated. In hysterical mania such phenomena as
obstinate mutism, aphonia, pseudo-coma, ecstasy, catalepsy, and
trance often occur, but they are usually absent in the history of cases
of acute mania. In acute mania under the influence of excitement or
delusion the patients may take their own lives: they may starve or kill
themselves violently; in hysterical mania suicide will be threatened or
apparently attempted, but the attempts are not genuine as a rule;
they are rather acts of deception. In acute mania the patients often
become much reduced and emaciated; in hysterical mania in
general, considering the amount of mental and motor excitement
through which the individuals pass, their nutrition remains good. In
acute mania sleeplessness is common, persistent, and depressing;
in hysterical mania usually a fair amount of sleep will be obtained in
twenty-four hours. In many cases of hysterical mania the patients
have their worst attacks early in the morning after a good night's
rest. Acute mania under judicious treatment and management may
gradually recover; sometimes, however, it ends fatally: this is
especially likely to occur if the physician supposes the case to be
simply hysterical and acts accordingly. Hysterical mania seldom has
a serious termination unless through accident or complication.
In order to make the diagnosis of purposive hysterical attacks

watchfulness on the part of the physician will often suffice. Such
patients can frequently be detected slyly watching the physician or
others. Threats or the actual use of harsh measures will sometimes
serve for diagnostic ends, although the greatest care should be
exercised in using such methods in order that injustice be not done.
In uræmia, as in true epilepsy, the convulsion is marked and the

condition of unconsciousness is usually profound. An examination of
the urine for albumen, and the presence of symptoms, such as
dropsical effusion, which point to disorder of the kidneys, will also
assist.
Hysterical paralysis in the form of monoplegia or hemiplegia must
sometimes be distinguished from such organic conditions as
cerebral hemorrhage, embolism or thrombosis, tumor, abscess, or
meningitis (cerebral syphilis).
When the question is between hysteria and paralysis from coarse
brain disease, as hemorrhage, embolism, etc., the history is of great
importance. The hysterical case usually has had previous special
hysterical manifestations. The palsy may be the last of several
attacks, the patient having entirely recovered from other attacks. In
an organic case, if previously attacked, the patient has usually made
an incomplete recovery; the history is of a succession of attacks,
each of which leaves the patient worse. In cerebral syphilis it
happens sometimes that coming and going paralyses occur; but the
improvement in these cases is generally directly traceable to specific
treatment. Partial recoveries take place in embolism, thrombosis,
hemorrhage, etc. when the lesion has been of a limited character,
but the improvement is scarcely ever sufficient to enable the patient
to be classed as recovered. The exciting cause of hysterical and
organic cases of paralysis is different. While in hysterical paralysis
sudden fright, anxiety, anger, or great emotion is frequently the
exciting cause, such psychical cause is most commonly not to be
traced as the factor immediately concerned in the production of the
organic paralysis. In the organic paralysis an apoplectic or
apoplectiform attack of a peculiar kind has usually occurred. In
cerebral hemorrhage or embolism the patient suddenly loses
consciousness, and certain peculiar pulse, temperature, and
respiration phenomena occur. The patient usually remains in a state
of complete unconsciousness for a greater or less period. In hysteria
the conditions are different. A state of pseudo-coma may sometimes
be present, but the temperature, pulse, and respiration will not be
affected as in the organic case.
Hysterical monoplegia or hemiplegia, as a rule, is not as complete as

that of organic origin, and is nearly always accompanied by some
loss of sensation. The face usually escapes entirely. In organic palsy
the face is generally less severely and less permanently affected
than the limbs, but paresis is commonly present in some degree.
Hysterical palsies are more likely to occur upon the left than upon
the right side. Embolism is well known to occur most frequently in the
left middle cerebral artery, thus giving the palsies upon the right. In
hemorrhage and thrombosis the tendency is perhaps almost equal
for the two sides. Some of these and other points of distinction
between organic and hysterical palsies have been given incidentally
under Symptomatology.
In organic hemiplegia aphasia is more likely to occur than in

hysterical cases; and acute bed-sores and wasting of the limbs, with
contractures, are conditions frequently present as distressing
sequelæ. Such is not the rule in hysterical cases, for while there may
be wasting of the limbs from disuse and hysterical contractures, bed-
sores are seldom present, and the wasting and contractures do not
appear so insidiously, nor progressively advance to painful
permanent conditions, as in the organic cases. Mitchell mentions the
fact that in palsies from nerve wounds feeling is apt to come back
first, motion last; while in the hysterical the gain in the power of
motion may go on to full recovery, while the sense of feeling remains
as it was at the beginning of treatment. This point of course would
help only in cases where both sensory and motor loss are present.
The examination of an hysterically palsied limb, if conducted with

care, may often bring out the suppressed power of the patient.
Practising the duplicated, active Swedish movements on such a limb
will sometimes coax resistance from the patient. As already stated,
electro-contractility is retained in hysterical cases.
The disorders from which it may be necessary to diagnosticate

hysterical paraplegia are spinal congestion, subacute generalized
myelitis of the anterior horns (chronic atrophic spinal paralysis of
Duchenne), diffused myelitis, acute ascending paralysis, spinal
hemorrhage, spinal tumor, posterior spinal sclerosis or locomotor
ataxy, lateral sclerosis or spasmodic tabes, multiple cerebro-spinal
sclerosis, and spinal caries.
In spinal congestion the patients come with a history that after

exposure they have lost the use of their lower limbs, and sometimes
of the upper. Heaviness and pain in the back are complained of, and
also more or less pain from lying on the back. Numbness in the legs
and other disturbances of sensation are also present. The paralysis
may be almost altogether complete. Such patients exhibit evidences
of the involvement of the whole cord, but not a complete destructive
involvement. A colored woman, age unknown, had been in her
ordinary health until Nov. 24, 1884. At this time, while washing, she
noticed swelling of the feet, which soon became painful, and finally
associated with loss of power. She had also a girdling sensation
about the abdomen and pain in the back. She was admitted to the
hospital one week later, at which time there was retention of the
urine and feces. She had some soreness and tenderness of the
epigastrium. She complained of dyspnœa, which was apparently
independent of any pulmonary trouble. It was necessary to use the
catheter for one week, by which time control of the bladder had been
regained. The bowels were regulated by purgatives. She was given
large doses of ergot and bromide and iodide of potassium, and
slowly improved, and after a time was able to get out of bed and
walk with the aid of a chair. An examination at the time showed that
the girdling pain had disappeared. There was distinct loss of
sensation. Testing the farado-contractility, it was found that in the
right leg the flexors only responded to the slowly-interrupted current,
while in the left both flexors and extensors responded to the
interrupted current. In both limbs with the galvanic current the flexors
responded to twenty cells, while the extensors responded to fifty
cells. She gradually improved, and was able to leave after having
been in the hospital three months.
The diagnosis of subacute myelitis of the anterior horns from

hysterical paraplegia is often of vital importance. “A young woman,”
says Bennett,107 “suddenly or gradually becomes paralyzed in the
lower extremities. This may in a few days, weeks, or months become
complete or may remain partial. There is no loss of sensation, no
muscular rigidity, no cerebral disturbances, nor any general affection
of the bladder or rectum. The patient's general health may be robust
or it may be delicate. She may be of emotional and hysterical
temperament, or, on the contrary, of a calm and well-balanced
disposition. At first there is no muscular wasting, but as the disease
becomes chronic the limbs may or may not diminish in size. The
entire extremity may be affected or only certain groups of muscles.
Finally, the disease may partially or entirely recover, or remain
almost unchanged for years.” This is a fair general picture of either
disease.
107 Lancet, vol. ii. p. 842, November, 1882.
Two facts are often overlooked in this connection: first, that

poliomyelitis is just as liable to occur in the hysterical as in the other
class; and, secondly, that the symptoms of hysterical paraplegia and
poliomyelitis may go hand in hand.
The history is different in the two affections. Frequent attacks of

paralysis in connection with hysterical symptoms are very
suggestive, although not always positive. In poliomyelitis the disease
may come on with diarrhœa and fever; often it comes on with
vomiting and pain. The patellar reflex is retained, often exaggerated,
and rarely lost, in hysteria, while it is usually lost in poliomyelitis.
Electro-muscular contractility is often normal in hysterical paralysis,
although it is sometimes slightly diminished quantitatively to both
faradism and galvanism: the various muscles of one limb respond
about equally to electricity: there are no reactions of degeneration in
hysterical paralysis as in poliomyelitis. In poliomyelitis reactions of
degeneration are one of the most striking features. The cutaneous
plantar reflex is impaired in hysterical paraplegia; bed-sores are
usually absent, as are also acute trophic eschars and the nail-
markings present both in generalized subacute myelitis and diffused
myelitis. True muscular atrophy is also wanting in hysterical
paraplegia, although the limbs may be lean and wasted from the
original thinness of the patient or from disuse. The temperature of
the limbs is usually good. There is no blueness nor redness of the
limbs, nor are the bowels or bladder uncomfortably affected.
Buzzard108 gives two diagrams (Figs. 16 and 17), which I have

reproduced. They are drawn from photographs. They show two pairs
of feet, which have a certain superficial resemblance. In each the
inner border is drawn up into the position of a not severe varus. They
are the feet of two young women who were in the hospital at the
same time. A (Fig. 16), really a case of acute myelitis, had been
treated as a case of hysteria; and B (Fig. 17), really a case of
hysteria, came in as a paralytic. In these cases the results of
examination into the state of the electrical response and of the
patellar-tendon reflex was sufficient to make a diagnosis clear. In the
organic case the electrical reactions were abnormal and the patellar-
tendon reflex was abolished. These conditions were not present in
the hysterical case.
FIG. 16. FIG. 17.
108 Clin. Lectures on Diseases of the Nervous System, London, 1882.
The diagnosis of hysterical paraplegia from diffused myelitis is

governed practically by the same rules which serve in subacute
myelitis of the anterior horns, with some additional points. In diffused
myelitis, in addition to the motor, trophic, vaso-motor, electrical, and
reflex disorders of myelitis of the anterior horns, affections of
sensibility from involvement of the sensory regions of the cord will
also be present. Anæsthesia and paræsthesia will be present.
Acute ascending paralysis, the so-called Landry's paralysis,

particularly when it runs a variable course, might be mistaken
sometimes for hysterical paralysis. In one instance I saw a fatal case
of Landry's paralysis which had been supposed to be hysterical until
a few hours before death. In Landry's paralysis, however, the swiftly
ascending character of the disorder is usually so well marked as to
lead easily to the diagnosis. In Landry's paralysis the loss of power
begins first in the legs, but soon becomes more pronounced, and
passes to the arms, and in the worst cases swallowing and
respiration become affected.
Spinal hemorrhage and spinal tumors, giving rise to paralysis, may

be mistaken for hysterical paralysis, partly because of the
contractures. Reactions of degenerations are usually features of this
form of organic paralysis. The contractures of hysterical paralysis
can be promptly relieved by deep, strong pressure along supplying
nerve-trunks; this cannot be accomplished in the organic cases.
Severe localized pains in the limbs, sometimes radiating from the
spinal column, are present in the organic cases. Pain may be
complained of by the hysterical patient, but close examination will
show that it is not of the same character, either as regards severity
or duration.
Hysterical locomotor ataxy is usually readily distinguished from

posterior spinal sclerosis, although the phenomena are apparently
more marked and more peculiar than those exhibited as the result of
organic changes. Hysterical ataxic patients often show an
extraordinary inability to balance their movements, this want of co-
ordinating power being observed even in the neck and trunk, as well
as the limbs. In hysterical cases a certain amount of palsy, often of
an irregular type, is more likely to be associated with the ataxia than
in the structural cases. The knee-jerk, so commonly absent in true
posterior spinal sclerosis that its absence has come to be regarded
as almost a pathognomonic symptom of this affection, in hysterical
motor ataxy is present and exaggerated. In hysterical locomotor
ataxy other well-marked symptoms of general hysteria, such as
hysterical convulsions, aphonia, etc., are present.
In the diagnosis of spastic spinal paralysis from hysterical paraplegia

great difficulties will sometimes arise. A complete history of the case
is of the utmost importance in coming to a conclusion. If the case be
hysterical, usually some account of decided hysterical manifestation,
such as aphonia, sudden loss and return of sight, hysterical
seizures, etc., can be had. Althaus holds that a dynamometer which
he has had constructed for measuring the force of the lower
extremities will, at least in a certain number of cases, enable us to
distinguish between the functional and spinal form of spastic
paralysis. In the former, although the patient may be unable to walk,
the dynamometer often exhibits a considerable degree of muscular
power; while in the latter, more especially where the disease is
somewhat advanced, the index of the instrument will only indicate
20° or 30° in place of 140° or 160°, and occasionally will make no
excursion at all.
The diagnosis of multiple cerebro-spinal sclerosis from hysteria

occasionally offers some difficulties. Jolly goes so far as to say that it
can only with certainty be diagnosticated in some cases in its later
stages and by the final issue—cases in which the paralytic
phenomena frequently alter their position, in which paroxysmal
exacerbations and as sudden ameliorations take place, and
convulsive attacks and disturbances of consciousness of a like
complicated nature as in hysteria are met with. Disorders of
deglutition and articulation, also characteristic of multiple cerebro-
spinal sclerosis, are now and again observed in the hysterical.
Recently, through the kindness of J. Solis Cohen, I saw at the
German Hospital in Philadelphia a patient about whom there was for
a time some doubt as to whether the peculiar tremor from which he
suffered was hysterical or sclerotic. At rest and unobserved, he was
usually quiet, but as soon as attention was directed to him the tremor
would begin, at first in the limbs, but soon also in the head and trunk.
If while under observation he attempted any movement with his
hands or feet, the tremor would become violent, and if the effort was
persisted in it would become convulsive in character. The effort to
take a glass of water threw him into such violent spasms as to cause
the water to be splashed in all directions. The fact that this patient
was a quiet, phlegmatic man of middle age, that his troubles had
come on slowly and had progressively increased, that tremor of the
head and trunk was present, that cramps or tonic spasms of the
limbs came and went, indicated the existence of disseminated
sclerosis. The knee-jerk was much exaggerated, taps upon the
patellar tendon causing decided movement; when continued, the leg
would be thrown into violent spasm.
Spondylitis, or caries of the vertebræ, is sometimes difficult to

distinguish from hysterical paraplegia or hysterical paraplegia from it,
or both may be present in the same case. Likewise, painful
paraplegia from cancer or sarcoma of the vertebræ may offer some
difficulties. A woman aged forty-four when two years old had a fall,
which was followed by disease of the spine, and has resulted in the
characteristic deformity of Pott's disease. She was apparently well,
able to do ordinary work, until about five years before she came
under observation, when her legs began to feel heavy and numb,
and with this were some pain and slight loss of power. These
symptoms increased, and in three months were followed by a total
loss of power in the lower extremity. She was admitted to the
hospital, and for about three years was unable to move the legs. She
went round the wards in a wheeled chair. The diagnosis was made
of spondylitis, curvature, and paralysis and sensory disorders
depending on compression myelitis, and it was supposed she was
beyond the reach of remedies. One day one of the resident
physicians gave her a simple digestant or carminative, soon after
which she got up and walked, and has been walking ever since. She
attributes her cure entirely to this medicine.
What is the lesson to be learned from this case? It is, in the first
place, not to consider a patient doomed until you have made a
careful examination. There can be much incurvation of the spine
without sufficient compression to cause complete paralysis. In this
patient organic disease was associated with an hysterical or
neuromimetic condition. This woman had disease of the vertebræ,
the active symptoms of which had subsided. The vertebral column
had assumed a certain shape, and the cord had adjusted itself to this
new position, yet for a long time she was considered incurable from
the fact that the conjunction of a real and a mimetic disorder was
overlooked.

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ONLINE CHAPTER 21 Seeking a Position as an Administrative Medical

APPENDIX A CMS-1500 Claim Form Field-by-Field Instructions and a

Brief Contents vii

1 PROFESSIONAL AND CAREER RESPONSIBILITIES 1

A CAREER AS AN ADMINISTRATIVE MEDICAL ASSISTANT 2

THE HEALTH CARE ENVIRONMENT: PAST, PRESENT, AND FUTURE 26

MEDICOLEGAL AND ETHICAL RESPONSIBILITIES 60

2 INTERPERSONAL COMMUNICATIONS 101

THE ART OF COMMUNICATION 102

RECEPTIONIST AND THE MEDICAL OFFICE ENVIRONMENT / 136

TELEPHONE PROCEDURES / 178

3 RECORDS MANAGEMENT 237

FILING PROCEDURES / 238

MEDICAL RECORDS / 269

DRUG AND PRESCRIPTION RECORDS / 310

4 WRITTEN COMMUNICATION / 339

WRITTEN CORRESPONDENCE / 340

PROCESSING MAIL AND ELECTRONIC CORRESPONDENCE / 374

5 FINANCIAL ADMINISTRATION / 409

THE REVENUE CYCLE: FEES, CREDIT, AND COLLECTION / 410

PROCEDURE CODING / 500

DIAGNOSTIC CODING / 533

HEALTH INSURANCE SYSTEMS AND CLAIM SUBMISSION / 557

6 MANAGING THE OFFICE / 605

OFFICE MANAGERIAL RESPONSIBILITIES / 606

FINANCIAL MANAGEMENT OF THE MEDICAL PRACTICE / 647

Online SEEKING A POSITION AS AN ADMINISTRATIVE MEDICAL

APPENDIX A CMS-1500 Claim Form Field-by-Field Instructions and a

CHAPTER 8 Performance Objectives (Procedures) in This Textbook

FILING PROCEDURES t Procedure 10-1 Use a drug reference book to spell

A remarkable case of this kind is well known at the Philadelphia

Before these symptoms had disappeared twitchings of the muscles

In a short time she complained of various troubles of vision and a

This patient's train of symptoms began with what appeared to be

DURATION AND COURSE.—Hysteria is pre-eminently a chronic disease;

Deceptive remissions in hysterical symptoms often mislead the

COMPLICATIONS.—We should not treat a nervous case occurring in a

The association of hysteria with real and very severe spinal

Seguin102 holds that (1) many hysterical symptoms may occur in

The possibility of the occurrence of hysteria in the course of acute

Among other complications of hysteria which have been noted by

DIAGNOSIS.—Buzzard103 significantly remarks that you cannot cure a

A few remarks with reference to the methods of examining hysterical

The physician should carefully guard against making a diagnosis

Special expedients may sometimes be resorted to in the course of

The method adopted in the cases supposed to be phthisis, but which

It is important to know whether or not children are of this hysterical

It is also important, as urged by Allbutt,105 to make a distinction

Hysteria and neurasthenia are often confounded, and, while both

An affection termed general nervousness has been described by

The differential diagnosis of hysteria and hypochondria, or what is

It is often of moment to be able to distinguish between two such well-

In order to make the diagnosis of purposive hysterical attacks

In uræmia, as in true epilepsy, the convulsion is marked and the

Hysterical monoplegia or hemiplegia, as a rule, is not as complete as

In organic hemiplegia aphasia is more likely to occur than in

The examination of an hysterically palsied limb, if conducted with

The disorders from which it may be necessary to diagnosticate

In spinal congestion the patients come with a history that after

The diagnosis of subacute myelitis of the anterior horns from