INTRODUCTION - Norm



“Practice Name”Policies, Procedures & ProtocolsRevised January 2010ContentsIntroductions 1Organization Charts 2Philosophy & Mission of Practice 3Disclaimer 4Introduction 5Objective 5 Functions of This Handbook 5Equal Employment Opportunity 6 Americans with Disabilities Act 6Policy and Prohibition against Harassment 6 Sexual Harassment 8 Teamwork and Job Duties 9 Practice Administrator 10 Confidential Information 10 Electronic Media and Communication 12Personal Appearance and Habits 13 Telephone 14Office Hours 14Time Clocks 15Employee Classifications 15FLSA Exempt Employees – Salary Basis Policy 16Orientation 18Evaluations 18Employee Benefits 18Holidays 18 Paid Time Off 19 Employee Responsibilities 20Bereavement Leave 20Leave of Absence for Maternity Purposes 20Jury Duty 21Military Leave 21 Standards of Conduct 22Substance Abuse Policy and Testing Program 24 Non-Employee Solicitation/Distribution 26Solicitation/Distribution 26Termination/Resignation of Employment 27Medical Care 28Personal Records 28 Payroll Deductions 28Employee Performance Evaluation 29 Continuing Education 31Clothing Allowance 31Suggestions 31Employee Discipline & Grievance 31 Safety & Solicitations 32Requirements on Record Keeping ………………………………… 33Registration/Appointment Scheduling & Patient Flow 34 Steps for Scheduling Appointments 39Procedure for Cancellations, Bumped and No-Show Appointments ……………………………………………………...… 40 Steps for Preparing a Patient in the Medical Office 41Medical Records 42Release of Medical Information …………………………………… 45 Authorization for Release/Request of Medical Information ……47Prescriptions 48Narcotic Prescriptions………………………………………………. 50 Red Flags Rules ..................................................................…..... 52Telephone 53Research Laboratory 54X-ray/DEXA 56OSHA & ADA 58General Filing 61Processing Mail & Correspondence 62Purchasing 62Furniture & Equipment 63Business Expenses & Travel 64Patient Relations 64Billing & Collecting 65Hardship Cases 69 Standards of Patient Service 69 Profit Sharing/Pension/Savings 71 Accidents & Emergencies 72 Job Descriptions …………………………………………………….. 73Practice Administrator 73Front Office Check Out 74Billing Office Manager 75Front Office Check In 76Insurance Secretary 77File Clerk 78 Infusion RN 79Medical Assistant 80X-ray Technician 82Security 83HIPAA Policies & Procedures 84IntroductionsThis employee manual has been prepared to help you become acquainted with the policies and procedures of “Practice Name”. The office reserves the right to change its policies from time to time.We are an equal opportunity employer. We do not discriminate based on race, religion, sex or political affiliation.Employment at this practice is based solely on the employment at will concept as applied in the State of South Carolina. This means that no contract exists between employer and employee. Either party may terminate employment status without prior notice or cause. The main purpose of our work can be stated in two words: HELPING PEOPLE. Service to the sick, the troubled and the infirm must be provided when it is needed. A medical office must have operating policies and rules to aid in reaching that objective. Every member of the practice is a part of the health care team and must understand that the OBJECTIVE is more important than the rules themselves. A vital principle governing policies is that the physician’s time is the practice’s most valuable resource. This resource must be used carefully if medical care is to be made available to all who need it. For this reason, the most serious employee failing is one which wastes the physician’s time. Regular attendance, punctuality, and cooperation among employees are absolutely necessary. The employee must do everything possible to help the physician effectively utilize time. Every employee receives a copy of the personnel policy with a signed receipt put into the personnel file. The office will maintain a personnel file for all staff members, which includes offer of employment, acceptance, annual evaluation and other pertinent information. Access to each employee’s file is limited to the employee, by request, and the Practice Administrator, except as in unusual circumstances as judged by the Practice Administrator. Each employee will be expected to keep the Practice Administrator informed of any changes in his/her status such as address, dependents, telephone numbers, etc. The falsification of personnel records is just cause for employment anizational Chart for “Practice Name”PHYSICIANSBILLING OFFICE MANAGERPRACTICE ADMINISTRATORINSURANCE &BILLING CLERKSITDEPARTMENTMEDICAL RECORDS FRONT OFFICE STAFFLAB & X-RAYTECHNICIANSMEDICALASSISTANTSREGISTEREDNURSESPhilosophy & Mission of PracticeThe primary purposes of announcing this personnel policy are:To promote an atmosphere and attitude of harmony, cooperation and understanding among all personnel.To establish the duties, responsibilities, rights and obligations of each person in order to minimize misunderstandings between employer and employee.The development of harmonious relations among personnel in our office is essential to the effective operation of our health care facility. It is also vital to making our office a pleasant and enjoyable environment in which to work. Further, your appearance and conduct is instrumental in how our patients judge the quality of our health service.For all these reasons, each employee is required to conform at all times to the following general code of conduct:Never conduct any information regarding our office, its patients, the doctors, oryour co-workers to anybody not authorized to receive such information, or to anybody for whom the information is unnecessary. Remember that no one can repeat or attribute something to you that you did not say.Be kind, sympathetic and understanding to all patients, no matter how adverse the circumstances may be. Always keep in mind that our patients have come to have their problems heard and treated, not to listen to our problems.Always be courteous and polite. Remember that it is a source of satisfaction to retain your composure under difficult circumstances.Support the policies and reputation of our office. Be loyal to your fellow employees and bring any complaint, which you may have about them to the person involved, or your immediate supervisor.EMPLOYEE HANDBOOKFOR“PRACTICE NAME”I have received a copy of the “Practice Name” Employee Handbook and agree to read, understand and abide by its policies and procedures.DisclaimerI UNDERSTAND THAT All employees of ___________________________ (tHE “pRACTICE”) are employees-at-will. MY EMPLOYMENT IS NOT FOR A FIXED TERM OR FOR A DEFINITE PERIOD. tHIS Handbook nor any of its specific provisions are to be considered a contract of employment with THE PRACTICE. I HAVE the right to terminate MY employment at any time with or without cause, and THE PRACTICE reserves the right to terminate MY EMPLOYMENT at any time with or without cause, and with or without prior notice. nothing in this employee handbook in any way creates an express or implied contract of employment. this employee handbook may be amended, modified, or terminated at any time._______________________________________________________Employee SignatureDate_____________________________________Print SignatureEmployee Copy: Please sign, date and maintain for your personal records.IntroductionThis Handbook is intended to inform you of the primary personnel policies and procedures for employees of “Practice Name” (hereinafter “Practice”). For current employees, this Handbook should remind you of our common goals and the general policies under which we work together in the most effective manner for our patients. First, you are expected to master and maintain your own work with a high degree of efficiency. This will result from a desire to do the best possible job of which you are capable. Second, you are expected to become a member of the team and be able to get along peacefully, professionally, and respectfully with your fellow employees. Third, we hope you will take a personal interest in and obtain a personal satisfaction from serving our patients. Remember that all of us are here to serve our patients either directly or indirectly. The personnel policies in this Handbook supersede and replace all prior policies. The Practice maintains flexibility in the administration of policies and procedures and reserves the right to change or revise policies and procedures without notice. Guidelines and benefits are only summaries and may not be all-inclusive. If you have any questions on the material in this Handbook, please discuss them with the Practice Administrator. Objective The ultimate purpose of all work in the medical field can be stated in just three words: To Help People. Service to the sick, the troubled, and the infirm must be provided when it is needed. We consider the patient as a person with an illness and respect how that particular illness affects his or her interpersonal life. It is the Practice’s objective to comply with governmental and industry regulations to ensure appropriate practices. All employees are responsible for compliance with all State and Federal laws and generally accepted standards of patient care, documentation, and billing for delivery of services. The Practice will not tolerate fraud, abuse, or violation of any law or regulation. Employees are encouraged to bring forth any suspicions or complaints to the Practice Administrator without fear of retribution or retaliation.Functions Of This HandbookThis Employee Handbook is an outline of the basic personnel policies, practices, and procedures and is applicable to all employees. It contains general statements of policy and it should not be read as including the fine details of each policy, nor is it forming an express or implied contract or promise that the policies discussed in it will be applied without regard to individual facts and circumstances. The Handbook does not alter the employment-at-will relationship in any way. The Practice may add, revoke, or modify the policies and procedures from time to time with or without prior notice.Equal Employment OpportunityThe Practice is an Equal Employment Opportunity Employer. We are committed to working towards and maintaining a diverse workforce. It is our policy to provide equal employment opportunity to all individuals without regard to race, color, religion, sex, national origin, age, disability or any other protected classification.We are committed to ensuring that all phases of employment including, but not limited to, recruiting, employment, job assignment or placement, promotion, demotion, transfer, lay-off, recall, termination, compensation, training and any other employment related programs are administered reasonably and consistently to similarly situated individuals on an equal opportunity basis and without regard to any characteristic protected by federal, state and/or local law.The Practice prohibits harassment, intimidation, threats, retaliation, coercion or discrimination against employees who have exercised any right protected by law. All employees are responsible for supporting the concept of equal opportunity and diversity and assisting the Practice in meeting its objectives.Americans With Disabilities ActThe Americans with Disabilities Act (“ADA”) prohibits discrimination on the basis of an applicant’s or employee’s disability (as defined by the ADA), in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions and privileges of employment.Qualified disabled individuals (both applicants and employees) may request reasonable accommodations to perform the essential functions of the job. The Practice will consider and may grant requests for accommodations, provided that such requests are determined to be reasonable and unless doing so would result in an undue hardship or direct threat to the Practice. Examples of reasonable accommodation may include flexible working hours, modified office furniture and/or equipment, and short-term leaves of absence.Policy And Prohibition Against HarassmentEmployees are expected to maintain a productive work environment free from harassing or disruptive activity. No form of harassment will be tolerated, including, but not limited to, harassment for the following reasons: race, color, religion, sex, national origin, age, disability, pregnancy, or military status.The Practice is committed to preventing such conduct, to investigating complaints of inappropriate conduct, and to remedying violations of this policy. If you reasonably believe that you have been subjected to any form of prohibited conduct, as defined herein, you are required to (1) affirmatively inform the harasser that such conduct is unwelcome; and (2) report the incident immediately to your supervisor, the Practice Administrator, or one of the shareholder physicians. Further, if you witness harassing behavior, you are required to report it immediately to your supervisor, the Practice Administrator, or one of the shareholder physicians. Employees should not allow any inappropriate situation to continue by not reporting it, regardless of who is creating that situation. No employee is exempt from the requirement to report any conduct that may be in violation of this policy. The Practice will investigate complaints of harassment and will be mindful of an employee’s requests for discretion. Notwithstanding, the Practice cannot promise confidentiality. The Practice is required to investigate promptly and thoroughly, and this includes interviewing relevant parties. Should an investigation disclose a violation of this policy, we will undertake appropriate corrective action designed to rectify the conduct and prevent any recurrence. Under no circumstances will the Practice tolerate any retaliation against an individual for making a complaint, in good faith, under this policy. Any employee who engages in any prohibited conduct may be subject to discipline up to and including termination, in the sole discretion of the Practice. “Harassment” is defined as verbal or physical conduct that denigrates or shows hostility or aversion toward an individual because of his or her race, color, religion, sex, national origin, age, disability, pregnancy, or military status and that:Has the purpose or effect of creating an intimidating, hostile, or offensive working environment.Has the purpose or effect of unreasonably interfering with an individual’s work performance.Otherwise adversely affects an individual’s employment opportunities.Examples of harassing conduct include, but are not limited to the following:Epithets, slurs, negative stereotyping, or threatening, intimidating, or hostile acts that relates to race, color, age, religion, national origin, sex, or disability.Written or graphic material that denigrates or shows hostility or aversion toward an individual or group because of race, color, age, religion, national origin, sex, or disability and that is placed on walls, bulletin boards, or elsewhere on our premises or is circulated in the workplace. Unwelcome requests for sexual favors or sexual advances;Verbal harassment, such as sexual innuendoes, suggestive comments, jokes of a sexual nature, sexual propositions or threats.Because of our strong disapproval of offensive or inappropriate behavior at work, all employees must avoid any action or conduct which could be viewed as harassment of any kind.Sexual HarassmentSexual harassment is a form of sex discrimination, which is a violation of Title VII of the Civil Rights Act of 1964. The Equal Employment Opportunity Commission (EEOC) has defined sexual harassment as:Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when:Submission to such conduct is made explicitly or implicitly a term or condition of an individual’s employment.Submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting an individual.Such conduct has the purpose or effect of substantially interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.Examples of sexual harassment include but are not limited to the following:Unwanted physical contact or conduct including flirting, touching, brushing the body, sexual advances or propositions.Verbal harassment of a sexual nature, such as lewd comments, sexual jokes or innuendo, jokes about gender-specific traits, or references to appearances.Insulting or sexually suggestive written, recorded or electronically transmitted messages.Display in the workplace of demeaning, insulting, intimidating, or sexually suggestive objects, pictures or photographs.Each employee, supervisor and Practice Administrator has a responsibility to keep the workplace free from any from of harassment, especially sexual harassment. All sexually harassing or offensive conduct in the workplace, whether committed by supervisors, Practice Administrators, non-supervisory employees, or non-employees, is prohibited. Any employee, supervisor, or Practice Administrator who is found to have violated the harassment policy may be subject to disciplinary action, up to and including termination, in the sole discretion of the Practice. Reporting HarassmentIf at any time you feel that you have been subjected to harassment of any nature, you are expected to (1) expressly inform the harasser that such conduct is unwelcome and inappropriate; and (2) report the incident immediately to your supervisor, the Practice Administrator or one of the shareholder physicians. Notification must occur immediately so that an investigation can be conducted and appropriate action taken. If, for any reason you does not feel comfortable contacting your immediate supervisor about the matter or if your supervisor is the harassing party, you may contact the Practice Administrator. If this action seems inappropriate due to the source of this harassment, you may take the complaint directly to a shareholder. You should request an investigation and that and that the Practice take the action it deems to be appropriate. All complaints of harassment will be treated with discretion and as confidentially as possible, except as necessary to investigate the complaint or as required by law. The Practice will investigate and resolve complaints of sexual harassment in a discrete manner. However, confidentiality cannot be guaranteed. When a supervisor or any other member of management is notified of alleged harassment, an investigation will promptly take place by the Practice Administrator and other involved parties, which may involve interviewing relevant parties. Refusal to participate in an investigation may lead to disciplinary action up to and including discharge.No RetaliationThe Practice prohibits any form of retaliation against an employee who reports a suspected incident of harassment or who cooperates in an investigation. Any individual who violates this policy or retaliates against an employee in any way may be subject to disciplinary action, up to and including termination, in the sole discretion of the Practice. False AccusationsRetaliation or discrimination against an employee for reporting or complaining about harassment is prohibited. Conversely, false accusations will not be tolerated either. False accusations of harassment may have serious effects on innocent individuals and will not be tolerated. Making false accusations is a form of misconduct and may result in serious impairment of our efforts to administer this policy properly and effectively for the benefit of all employees. Accordingly, such misconduct may result in disciplinary action, up to, and including termination, in the sole discretion of the Practice.InvestigationThe Practice will take the necessary steps to promptly and impartially initiate an investigation of a harassment claim and will conduct its investigation in as confidential and timely manner as possible. Once a resolution of each complaint is reached, the Practice will then communicate its findings to the employee and any the other parties involved.Supervisory employees should not allow personal friendships or social relationships, on and off the job, to influence their treatment of fellow employees or their employment decisions.Teamwork And Job DutiesTeamwork is an essential element of a smoothly operating medical practice. It goes without saying that personal problems should be left outside the office. Small talk, especially in the clinical areas and business office keeps other employees from doing their job smoothly and should be limited. Any suggestions, complaints, or problems should be brought to the attention of your immediate supervisor as soon as possible. It is only through open communication that small problems can be prevented from becoming larger ones. At the time of hire, you are informed of your job duties. A copy of your job description is found in this manual. Your job description outlines your basic responsibilities and you should understand that other duties and responsibilities can be additionally assigned to you that are not listed in your job description. All other duties and responsibilities are assigned by an employee’s immediate supervisor and it is required and expected that all employees remain employed during working hours and accomplish their job duties and assignments. You must be able to perform all of the essential job functions for your job, with or without reasonable accommodation. The job descriptions should not be viewed as a limitation on the duties assigned. In order to deliver quality services, there may be requirements to perform duties outside those outlined in the job description. Practice AdministratorThe Practice Administrator has the authority and responsibility to administer all staff related functions including hiring, firing, job assignments, vacation, and disciplinary actions. All supervisors and Practice Administrators report to the Practice Administrator, who reports to the shareholders of the Practice. Problems within the office should be addressed to your direct supervisor who in turn will address the issue with the Practice Administrator. If you are unable to follow the chain of command, the Practice does operate on an open door policy. If you have any questions regarding the reporting structure, please contact the Practice Administrator. Confidential InformationAll employees are responsible for safeguarding the confidential and private information regarding our patients and other employees. It is also each employee’s responsibility to ensure uniform enforcement of the Practice’s Privacy Policy and to remain HIPAA compliant at all times. All information concerning our patients and employees is confidential and will be available only to authorized users for approved purposes. Access to confidential information is only permitted for direct patient care, approved administrative/supervisory functions, or with other management approval.Confidential information obtained either during assigned duties or by accident shall not be released to any person or entity except in accordance with policies. No person shall have access to confidential information out of curiosity, for malicious purposes, or for financial gain. Discussion or consultation involving a patient's care or an employee’s confidential information should be conducted in private. When supplying information you must have a HIPAA-compliant, written release signed by the patient or a personal representative. Violation of this policy may result in immediate termination. All Practice Information received or developed by employee while employed by the Practice will remain the sole and exclusive property of the Practice. Practice Information means Confidential Information and Trade Secrets.Confidential Information means data and information relating to the business of the Practice (which does not rise to the status of a Trade Secret) which is or has been disclosed to an employee or of which an employee became aware as a consequence of or through his or her relationship to the Practice and which has value to the Practice and is not generally known to its competitors. Confidential Information shall not include any data or information that has been voluntarily disclosed to the public by the Practice (except where such public disclosure has been made by an employee without authorization) or that has been independently developed and disclosed by others, or that otherwise enters the public domain through lawful means.Trade Secrets shall mean the Practice’s information including, but not limited to, patient lists, technical or non-technical data, medical technology, treatment protocols, contractual relations, compilations, programs, devices, methods, techniques, processes, financial data, and financial plans:Which derive economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by other persons who can obtain economic value from its disclosure or use; andOf which the Practice takes commercially reasonable efforts to maintain its secrecy.As a condition of employment, each employee agrees:To hold Practice Information in strictest confidence;Not to use, duplicate, reproduce, distribute, disclose or otherwise disseminate Practice Information or any physical embodiments of Practice Information; andIn any event, not to take any action causing or fail to take any action necessary in order to prevent the Practice Information from losing its character or ceasing to qualify as Practice Information. Your access to Practice Information and continued employment is contingent upon your continuous observance of the confidentiality obligations described herein. Any actual or threatened unauthorized use or disclosures of Confidential Information may result in the immediate termination of employment, in the sole discretion of the Practice. Any actual or threatened unauthorized use or disclosures of Practice Information will result in irreparable harm for which there is no adequate remedy at law. In the event of any such breach, the Practice may be entitled to equitable relief, including injunctive relief, in addition to all other remedies available at law or in equity, including but not limited to those provided pursuant to the South Carolina Uniform Trade Secrets Act (South Carolina Trade Secrets Act §§39-8-10, et. seq.), and attorneys’ fees.Your confidentiality obligations hereunder shall continue and survive after termination of your relationship with the Practice, for any reason or for no reason.Electronic Media And CommunicationVarious electronic media systems and services are provided by the Practice to ensure patient communications, to assist with research of information, and to promote Practice resources. These may include mail, electronic mail (e-mail), courier services, facsimiles, telephone systems, personal computers, computer network, on-line service, Internet connections, computer files, video equipment and tapes, tape recorder and recordings, pagers, and cellular phones. The Practice has established a policy with regard to access and disclosure of Internet, e-mail, faxes, telephone, and voice mail usage including any accessed information and any messages created, sent, or received by employees through the Practice electronic media equipment and systems. All communications, services, and equipment, including the messages transmitted or stored by them, are the sole property of the Practice. The Practice may access and monitor employee communications and files as it considers appropriate. There is no right of privacy with respect to the usage, messages, information, and data accessed, composed, sent, or received on any the Practice property. No employee has any property right on any information utilized or contained on electronic media or communications. The Practice maintains electronic media systems, equipment, and services. These systems and services are provided by the Practice to assist in the conduct of business within the Practice. All electronic media communications should be for professional reasons only. Usage of any electronic media should be effective, ethical, and lawful.The electronic media systems and equipment, including hardware and software, are property of the Practice. Additionally, all information accessed, and all messages composed, sent, or received on these systems are and remain the property of the Practice. They are not the private property of any employee or agent of the Practice. The use of the electronic media systems equipment and services is reserved solely for the conduct of business at the Practice. You may not use them to conduct personal business or affairs or for personal gain or advancement of individual views. The electronic media equipment and systems may not be used to solicit for commercial ventures, religious or political causes, outside organizations, or other non-job related solicitations. The electronic media systems are not to be used to access or create any fraudulent, harassing, obscene, offensive, or disruptive information or messages. Examples of items considered offensive are any information or messages which contain sexual implications, racial slurs, gender-specific comments, any type of profanity and any comments that offensively address someone’s age, sexual orientation, religious or political beliefs, national origin, race, or disability. You are responsible for the contents of all messages, whether text, audio or images, that you place, send, or receive over electronic media systems. You must attach and transmit under their own names. You shall not use a code, access a file, or retrieve any stored information unless authorized to do so. You may not attempt to gain access to another employee’s files or data or to retrieve stored information by using their log-on or pass code. Only employees specifically authorized by the Practice may access online services and the Internet. Authorized employees must disclose all passwords to Human Resources. Your online use should be limited to work-related activities. In addition, you should not duplicate or download from the Internet or from any e-mail any software or materials that are copyrighted, patented, trademarked, or otherwise identified as intellectual property without express permission from the owner of the material. When appropriate Internet material or e-mail files are downloaded, they should be scanned using anti-virus software.To prevent computer viruses from being transmitted through the system, there will be no unauthorized downloading of any software. All software downloads will be done in coordination with the Practice Administrator and IT vendor. The Practice reserves and intends to exercise the right to review, audit, intercept, access, and disclose all employee actions on the Practice’s electronic media systems and services as deemed necessary and appropriate. This includes information accessed or messages created, received, or sent over electronic media systems for any purpose. The contents of electronic media messages are public communications and are not private. All communications including voice messages, text, and images can be disclosed to law enforcement or other third parties without prior consent. Any employee who violates this policy or uses the electronic media systems for improper or unauthorized purposes may be subjected to discipline, up to and including discharge, in the sole discretion of the Practice. Personal Appearance And HabitsGood grooming and an attractive appearance are especially important for health care professionals. You must dress and groom conservatively for a medical office in the best business and professional standards in order to project a good image to the public. Jewelry should be kept to a minimum. All uniforms must be clean and wrinkle-free. Only appropriate earrings and no facial jewelry, including jewelry worn in the mouth, may be worn. At no time are denim jeans, pants, shorts or skirts appropriate including blue denim as well as colored or white denim. All clinical staff including nurses, medical assistants, pharmacy and lab techs, as well as front office receptionists, should wear scrubs. When wearing scrubs, scrub/lab jackets may be worn for additional warmth versus casual sweatshirts or sweaters. Administrative personnel and physicians may wear business casual attire. No flip-flops, shorts, tank tops, t-shirts with logos or revealing clothing is allowed. Perfume and cologne should be used in moderation, as they can be an irritant to our patients and fellow employees. You must wear your name badge while at work to enhance safety and communications with our patients. You may not eat in any clinical areas as well the front office area or other locations that are in patient view.Smoking is a poor health habit and is only allowed in the designated smoking areas outside. Smoke breaks are only allowed during the two allotted 10 minute break times or lunch. Employees must clock out for any other breaks, errands or non-working times using the appropriate means. Employees are responsible for keeping their work and assigned areas organized and clean. TelephoneThe proper use of the telephone can be one of the most valuable assets of a medical practice. The response that a patient gets over the telephone is quite frequently the first encounter and impression of the office. We prefer that the telephone be answered with some variation of the following: “Good morning/afternoon, thank you for calling “Practice Name”, this is (your name), how may I help you?” Always say “please” and “thank you” and use a helpful and pleasant tone of voice at all times. Calls should be handled promptly and pleasantly with no interruption to the physician. All calls from a physician who wishes to speak with our physician and those calls of extreme urgency should by relayed to the physician or their nurse/assistant immediately. A message should be taken for other calls.Since all telephone calls may be monitored for quality assurance, there exists no right of privacy in the use of any telephone at the Practice. Wireless telephones or other personal communication devices must be used at minimum and kept out of sight of any clinical/patient areas. If personal telephone calls are necessary, please make them during your lunch break and keep them to a minimum. No personal long distance call may be charged to the office. Incoming calls are discouraged and need to be extremely brief since they will normally come at a time when you are busy. Office HoursDepending on the office location, the routine office hours are Monday through Friday from 8:00 am to 5:00 pm with a mandatory ? hour non-paid lunch break. Working overtime is strictly prohibited for all hourly employees except for those situations as described below. Full time employees work a regularly scheduled workweek of 32 to 40 hours. Certain selected employees may work separate hours as necessitated by the Practice schedule and arranged by the Practice Administrator. Full-time employees receive two 10 minute breaks per day.Occasionally, a supervisor may request extended time in addition to 40 hours during periods of heavy office flow. All overtime must be requested and approved in writing in advance by management. In this event you must turn in a time sheet that is signed by your supervisor so that the time clock may be overridden, thus allowing for overtime to be paid.Failure to obtain prior written approval may result in disciplinary action up to and including termination, in the sole discretion of the Practice.For the purpose of this Handbook, one week is equivalent to five working days. A year worked is based on date of employment and not on the calendar year unless otherwise stated, e.g. 401k eligibility.Time ClocksIt is important that you make every effort to be on time and ready to work. You must clock in when you arrive to work. If you are tardy, (6 minutes or more), three times in a 30-day period, you may be subject to disciplinary actions. Each time you leave the work premises for personal matters, you must clock out. When you return to work, you must clock back in. Schedules for employees will be entered into the time clock system which only allows payment for those hours worked within the designated time frame. Any fluctuations from your regular schedule must be approved in advance in writing by your Practice Administrator/supervisor and a time slip must be submitted so that the system may be overridden to allow for payment of those hours worked outside of your regular schedule. All employees are paid on a bi-weekly basis.You are required to take a thirty (30) minute lunch break and may not perform any work-related function during that lunch break. Our time clock system automatically deducts thirty minutes daily for a mandatory lunch break for those employees working five hours or more. As an hourly employee, if you work during your lunch break, you must first notify your supervisor of your inability to take a lunch break to assure being compensated. A time slip must be submitted so that you will receive compensation for the lunch break not taken. Supervisors and Practice Administrators should make every effort for employees to be able to take a thirty minute lunch. In cases where employees work less than five hours and also take a lunch break during that time, it is necessary to submit a time slip so that we may deduct the break. Full-time employees also receive two 10 minute breaks per day, one morning and one afternoon.For all hourly employees you must obtain written approval in advance from your supervisor before working overtime. Never allow someone else to clock in or out for you and never clock in or out for another employee, as this may result in termination. Never falsify your time records and never work off the clock. Employee ClassificationsFull-time employees are considered to be those who regularly work 36 to 40 hours per week.Part-time employees are those who regularly work less than 36, but at least 25 hours per weekTemporary employees are those hired temporarily for a specific purpose.PRN employees are those who work less than 25 hours per week.Note: Temporary, Part-time and PRN employees are not eligible for benefits. Positions are also classified as salaried exempt or hourly non-exempt. Salaried employees are not entitled to overtime pay. Hourly employees are entitled to overtime pay for work in excess of forty (40) hours per workweek. An employee must obtain prior written approval from his/her Practice Administrator before working any overtime Failure to obtain prior written approval may result in disciplinary action, up to and including termination, in the sole discretion of the Practice. If you have questions regarding your classification, contact your supervisor or Human Resources. Non-Exempt employees shall receive one and one half (1?) times the employee’s hourly rate for all hours actually worked over 40 hours in any standard workweek. Hours compensated for benefits such as sick time, holidays, or vacations are not considered as actual time worked for purposes of computing overtime.Overtime compensation is paid to all Non-Exempt employees in accordance with federal and state wage and hour requirements. Hourly EmployeesThere are 7 levels of pay per position, L-1 thru L-7. Grades are determined by several factors. Initiative, rapport with patients and co-workers, attendance, dependability, leadership, acceptance of responsibility, work habits and job knowledge. These skills along with experience and education will determine your pay grade. The following pay grade levels relate to the typical experience and education level and are provided as examples only. Performance and experience may determine the pay grade level to which you are assigned.L-1 Entry level. Less than 6 months experience.L-2 6 months – 24 months experience. Certificate of professional training.L-3 2 – 5 years experience or recent bachelors degree.L-4 5 – 10 years professional experience with continuing education or bachelors degree with more than 2 years experience and continuing education.L-5 10 – 15 years professional experience with continuing education or bachelors degree with 5 plus years or graduate degree with less than 5 years experience.L-6 15 or more years professional experience with continuing education or bachelors degree with 10 plus years or graduate degree with more than 5 years experience.L-7 Expert in their field levelFlsa Exempt Employees – Salary Basis PolicyThe Fair Labor Standards Act (“FLSA”) is a federal law that requires that most employees in the United States be paid at least the federal minimum wage for all hours worked and overtime pay at time and one-half the regular rate of pay for all hours worked over 40 hours in a workweek.However, Section 13(a)(1) of the FLSA provides an exemption from both minimum wage and overtime pay for employees employed as bona fide executive, administrative, professional and outside sales employees. Section 13(a)(1) and Section 13(a)(17) also exempt certain computer employees. To qualify for exemption, employees generally must meet certain tests regarding their job duties and be paid on a salary basis at not less than $455 per week. Job titles do not determine exempt status. In order for an exemption to apply, an employee’s specific job duties and salary must meet all the requirements of the Department of Labor’s regulations.Salary Basis RequirementTo qualify for exemption, employees generally must be paid at not less than $455 per week on a salary basis. These salary requirements do not apply to physicians. Being paid on a “salary basis” means an employee regularly receives a predetermined amount of compensation each pay period on a weekly, or less frequent, basis. The predetermined amount cannot be reduced because of variations in the quality or quantity of the employee’s work. Subject to exceptions listed below, an exempt employee must receive the full salary for any workweek in which the employee performs any work, regardless of the number of days or hours worked. Exempt employees do not need to be paid for any workweek in which they perform no work. If the employer makes deductions from an employee’s predetermined salary, i.e., because of the operating requirements of the business, that employee is not paid on a “salary basis.” If the employee is ready, willing and able to work, deductions may not be made for time when work is not available.Deductions from pay, including partial or full day deductions, are permissible only in the following circumstances:Exempt employee is absent from work for one or more full days for personal reasons other than sickness or disability; Exempt employee is absent from work one or more full days due to sickness or disability, but only if the deduction is made in accordance with a bona fide plan, policy or practice of providing compensation for salary lost due to illness; To offset amounts employees receives as jury or witness fees, or for military pay;For unpaid disciplinary suspensions of one or more full days imposed in good faith for workplace conduct rule infractions;For the initial or terminal week of employment; For penalties imposed in good faith for infractions of safety rules of major significance; orFor amounts owed to the Practice.It is our policy to comply with the salary basis requirements of the FLSA. Therefore, we prohibit Practice Administrators from making any improper deductions from the salaries of exempt employees. We want employees to be aware of this policy and we do not allow deductions that violate the FLSA.If you believe that an improper deduction has been made to your salary, you should immediately report this information to your direct supervisor, or to the Practice Administrator.Reports of improper deductions will be promptly investigated. If it is determined that an improper deduction has occurred, you will be promptly reimbursed for any improper deduction made.Orientation/EvaluationsNew employees are required to complete a general orientation program to acquaint them with the Practice and their responsibilities. Newly hired or re-hired employees will be oriented and provided general and job specific orientation for a 90-day orientation period. The employee’s performance will be monitored and the supervisor may complete a performance evaluation. Eligibility of benefits may be determined at this time. Continuation of employment after the expiration of the 90-day orientation period does not alter your employment-at-will with the Practice.You may receive periodic in-service education to perform current responsibilities and to comply with all regulations. Attendance at a mandatory in service is required and you will be compensated for your attendance if you are paid on an hourly basis. An annual performance evaluation (based on the anniversary date of hire or date of promotion) also may be conducted in conjunction with wage and salary reviews. Employee BenefitsThe following benefits may be currently available to you depending upon your eligibility: life insurance, medical insurance, paid time off, and retirement plans.Generally, you will become eligible for employee benefits following your 90-day orientation period. Currently, the benefit program is funded with the Practice and employee contributions. The Practice group insurance program is summarized in separate benefit brochures. Any questions regarding insurance programs may be directed to the Practice Administrator. HolidaysThe office will be closed on the following holidays and all full-time employees will receive up to 8 hours of their regular pay, but no more than what they would have received during a regularly scheduled workweek (e.g., if an employee regularly works 36 hours per week, her holiday pay may be less than 8 hours).New Years DayThanksgiving DayIndependence DayDay after ThanksgivingMemorial DayChristmas DayLabor DayHoliday pay will not be paid to those employees who do not work the day before or the day after a recognized holiday, unless the employee obtains prior written approval to schedule PTO.Paid Time OffPaid time off (hereinafter referred to as “PTO”) is earned by all full-time employees of the Practice. PTO may be used for approved time off such as vacations or personal appointments (e.g. medical, attorney, etc). This time may also be used for unscheduled sick requests and bereavement leave. PTO may be requested in no less than one hour increments. Upon completion of the ninety (90) day orientation period with all scheduled hours having been worked, you will begin accruing PTO. PTO will continue to accrue at the rate of .0192 per hour for 1 year of service, .0384 for 2 years service, .0576 for 4 years service and .0769 for more than 6 years service. The Practice does not advance PTO or allow employees to have a “negative” balance nor do we allow PTO to be paid prior to being earned. If PTO has been accrued, PTO must be used and exhausted for time off before taking any approved unpaid leave. PTO will be dispersed January 1st of the following year for the accumulated amount worked the previous year. New hires cannot use their PTO until after 6 months of service or after January 1st of the following year. No PTO can be carried over to the next year. Unused PTO will be paid as a bonus and not overtime at the end of the year. Exceptions for jury duty are detailed below. Scheduled time off may be taken at any time during the calendar year with the written approval of your supervisor. The Practice will make reasonable efforts to permit you to take PTO at the time desired. You may not take more than one week of PTO at any one time without prior written approval from the Practice Administrator. In case of conflict, the Practice will consider factors such as the employee with (A) the earliest PTO request, and (B) the longest period of service in determining PTO approval. The period desired for PTO should be made known in writing using the appropriate form to your immediate supervisor at least thirty (30) days in advance. Under no circumstances may a Practice Administrator or supervisor sign off on his or her own PTO request or leave of absence form. Forms must be signed off by immediate supervisor. If you are requesting unscheduled PTO due to illness, please notify your immediate supervisor immediately (or the Practice Administrator if your supervisor is not available). You must speak directly with someone, leaving a message on voice mail is not acceptable. All PTO shall be used before any request for time off without pay may be considered. All requests for time off without pay shall be presented to the Practice Administrator or shareholders of the Practice for approval. If unpaid leave is granted, you may have a prorated deduction from your paycheck for benefits, (e.g. insurance).Upon the first day of returning to work after an illness, you must turn in a time slip for sick leave to your immediate supervisor. The Practice reserves the right to request a medical excuse from a physician upon your return to work.PTO is not appropriate or available for tardiness or unexcused or unapproved absences. In addition, if you have exhausted your PTO, time off without pay is prohibited except in extraordinary situations. Unless approved by the Practice Administrator in writing, time off without pay shall be treated as an unexcused absence and may be grounds for disciplinary action, up to and including termination.Employee Responsibilities1.All employees who come in regular contact with patients are required to wear name badges at all times. The first name badge will be supplied by the Practice. In the event of a loss of a badge, replacement badges will be ordered on your behalf and the cost will be deducted from your paycheck. 2.You are responsible for all information, policy changes and any other information that may be discussed in staff meetings. In the event that you are not in attendance during these meetings, you are still responsible for all content discussed.3.All reports of work related injuries, needle sticks, safety issues, etc. must be reported immediately to your supervisor and Practice Administrator as well as the Practice Administrator. Due to workers’ compensation requirements, your care may be directed to specific physicians.5.You are obligated to report any unsafe practices you see or that may be brought to your attention by a patient or fellow coworker. You are also asked to take part in the preservation of our work spaces. (i.e. If a toilet malfunctions, you must first turn off the water valves prior to notifying management of the situation. Should phone or internet service malfunction, you should notify the Practice Administrator immediately.)6.You are responsible for maintaining all required licenses and certifications. Any changes, renewals, etc. must immediately be reported and given to the Practice Administrator. Bereavement LeaveLeave as a result of death in your immediate family may be granted solely at the discretion of the shareholders of the Practice and PTO may be used for bereavement leave.Leave Of Absence For Maternity PurposesThis policy applies to those pregnant employees experiencing a pregnancy-related disability. An employee may take a Leave for Maternity Purposes during any 12-month period (measured backward from the date an employee uses any Leave). The duration of the Leave will be in accordance with the Practice’s short term disability benefit, which provides benefits for 6-8 weeks. Employees are eligible for a Leave for Maternity Purposes following any disability due to pregnancy, miscarriage, abortion, childbirth, and recovery there from.An employee is expected to report to her supervisor the fact that she is pregnant as soon as it becomes known to her, along with a statement from her doctor as to her anticipated delivery date.Leave for Maternity Purposes will be treated the same as any other medical leave, as described herein. The employee's benefits coverage, if any, will continue for the length of the employee's employment. The employee will be required to substitute and exhaust any accrued paid time off during the allotted 6-8 weeks of unpaid leave allowed under this policy.Upon return from a Leave for Maternity Purposes, you will be reinstated to your former position or to a substantially similar position at the same rate of pay as prior to taking the Leave.Failure to report to work at the end of the set expiration of the leave or when the employee's physician releases the employee to return to work will be considered a voluntary resignation.Jury DutyIf you are subpoenaed for jury duty, you will, upon request, be granted a leave of absence to perform this important civic duty. A copy of the actual summons must accompany the request. If dismissed after the scheduled shift for that day, you are expected to report to work that day if time permits. Please call your supervisor upon release to confirm whether or not to report to work. You may choose to either use accrued PTO or you may take leave without pay. Military LeaveAll eligible full-time and part-time employees are granted military leave in accordance with the provisions of the Uniformed Services Employment and Re-Employment Act (USERRA). USERRA applies to persons who perform duty, voluntarily or involuntarily, in the “uniformed services”, which include the Army, Navy, Marines, Air Force, Coast Guard and Public Health Service commissioned corps, as well as the reserve components of each of these services. Uniformed service includes active duty, active duty for training, inactive duty training (such as drills), and initial active duty training. USERRA requires the Practice to reemploy service members returning from a period of service in the uniformed services. The employee must give notice to the Practice that he or she is leaving his or her job for service in the uniformed services, unless providing such notice is precluded by military necessity or is otherwise impossible or unreasonable. The cumulative period of an employee’s service in the uniformed services must not exceed five (5) years. Further, the employee must report back to his position with the Practice within a timely manner, which shall depend on the length of time of such service.If you request military leave, you are required to submit a copy of your orders to the Practice Administrator not less than one week before leave begins, except for military emergencies where such notice is not possible. Subject to the terms, conditions and limitations of the applicable plans for which you are otherwise eligible, the Practice maintains your health insurance coverage by continuing to pay its share of the premium for the initial thirty (30) days of service. Thereafter, provided that you elect to continue such coverage for up to 24 months, you shall be responsible for the full cost of such coverage plus an additional 2% administrative fee (102% of premium).Standards Of ConductIt is the policy of the Practice that certain rules and regulations regarding employee behavior are necessary for efficient business operations and for the benefit and safety of all employees. Conduct that interferes with operations, discredits the Practice, or is offensive to patients or co-workers will not be tolerated. Employees are expected at all times to conduct themselves in a positive manner in order to promote the best interest of the Practice. Failure to comply with these rules will result in disciplinary action ranging from a verbal reprimand to immediate discharge. Under no circumstance will the Practice tolerate retaliation against an individual. NOTE: THE PRACTICE IS AN AT-WILL EMPLOYER. THE PRACTICE RESERVES THE RIGHT TO TAKE ANY FORM OF DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION, AT ANY TIME FOR VIOLATIONS OF THE PRACTICE POLICIES. THIS IS NOT A MANDATORY PROGRESSIVE DISCIPLINARY POLICY.Failure to properly care for or attend to a patient, patient’s family member, persons in attendance with the patient, and the Practice customer, or client. Possession, use, or selling of alcohol, narcotics, drugs, or other controlled substances on Practice property, or reporting to work under the influence of such substances or having consumed alcoholic beverages. Engaging in any type of conduct that is harmful to any persons, including co-employees and patients. Theft or dishonesty in any form. Theft may lead to civil and criminal prosecution. Sleeping on the job.Failure to properly care for or maintain any type of property located in any the Practice facility including personal property of any employee, patient, or any other persons. Insubordination or disobedience of directions and instructions necessary to the Practice operations. Falsification of time cards or other the Practice job related documents.Clocking in or out for another employee or causing his or her own time to be clocked out by another. Negligence that could or does result in personal injury or damage to the Practice property or the property of another individual. Engaging in harassment, sexual or otherwise, to any patient, family member, employee, or other individual. Fighting on the job or on the Practice property, or assault or threats of assault on a fellow employee and/or patient.Unauthorized or excessive absenteeism.Misuse of the Practice funds.Giving or taking a bribe or self-dealing.Walking off the job or leaving the job area without mission of any act against common decency, or indulges in immoral conduct.Engaging in sabotage or espionage. Gambling or engaging in a lottery on the Practice property or on the Practice time.Failure to cooperate in an investigation such as refusing to open any package, desk, purse, briefcase, or other personal container for inspection when requested to do so by any authorized representative of the Practice.Malicious or intentional disclosure of confidential patient or employee information. Retaliation against an employee for reporting inappropriate conduct.Failure to maintain or keep in good standing professional license or certification.Making a false statement during the employment interview process.Not speaking directly to your supervisor or the Practice Administrator when calling in sick. Engaging in conduct, whether on or off the job, which discredits the Practice.Failure to maintain as confidential any information about any patient. Horseplay on the job or on the Practice property.Failure to report immediately a personal injury, however slight, sustained on property or on Practice time. Engaging in obscene, profane, or abusive language or behavior.Disorderly or immoral conduct on the Practice property or the Practice time.Failure to perform work properly or to follow work instructions.Insubordination.Violating other the Practice rules or departmental rules, policies, or procedures.Failure to maintain satisfactory and/or harmonious working relationship with the public or fellow workers. Performance deficiencies, which jeopardizes the operation of the facility, office, or company.Creating or contributing to unsanitary conditions.Use of the Practice time or equipment for personal gain without permission from the Practice Administrator.Inefficiency.Disregard of any the Practice safety rules or common safety practices.Failure to account for the Practice tools, machinery, or equipment.Selling or collecting contributions for any purposes at any time on the Practice property without prior the Practice authorization.Reading any unauthorized materials during work time; this includes, but is not limited to, non-medical material and magazines.Preparing to quit work prior to the specified quitting time or quit work prior to the specified time.Smoking in any Practice areas.Wearing inappropriate attire or having an inappropriate personal appearance.Reporting to work with a contagious illness and/or fever.A pattern of unexcused or unapproved absences and/or tardiness.These Above Rules Are Not All Inclusive And Are Merely Examples Of Conduct that Cannot Be Tolerated. This list in no way limits the Practice’s ability to Discharge Or Discipline An Employee For What The Practice Deems In Its Sole Discretion To Be Inappropriate Conduct. Substance Abuse Policy And Testing ProgramThe unlawful manufacture, distribution, dispensation, presence, or use of illegal drugs or controlled substances by any employee in or on the Practice property is strictly prohibited. Working or reporting to work having consumed, or under the influence of, or impaired by alcohol, illegal drugs, or controlled substances is strictly prohibited. Except for legitimate uses as prescribed by a licensed physician, the use of illegal drugs, and those drugs or substances which law enforcement classify as “controlled substances” by Practice employees is strictly prohibited. In addition, the Practice prohibits the off-premise abuse of alcohol and controlled substances, as well as possession, use, sale of illegal drugs when those activities adversely affect job performance, safety, or the Practice’s reputation in the community. You will be subject to disciplinary action, up to and including termination, for violations of this policy. Violations include, but are not limited to, possessing illegal or non-prescribed drugs and narcotics or alcoholic beverages at work; being under the influence of those substances while working; using them while working; or dispensing, distributing, or illegally manufacturing or selling them on the Practice premises and work sites. Employees, their possessions, and the Practice issued equipment and containers under their control are subject to search and surveillance at all times while on premises or while conducting Practice business. Employees who are convicted of any criminal drug violation occurring in the workplace must report the conviction to the Practice within five (5) days, which will then take appropriate action as required by law. Supervisors should report immediately to the Practice Administrator any action by an employee, which demonstrates an unusual pattern of behavior. The Practice will determine whether the employee should be examined by a physician or clinic and/or tested for drugs and alcohol. Employees believed to be under the influence of drugs, narcotics, or alcohol will be required to leave the premises and may be required to submit to a drug or alcohol test in order to return to work. You must report your use of over-the-counter or prescribed medications to the Practice Administrator if the use might impair your ability to perform your job safely and effectively. A determination will then be made as to whether you are able to perform the essential functions of job safely and properly. Employees may not use samples of prescription drugs without a valid, signed prescription from their physician. Samples of OTC drugs may only be used.To help detect the use and abuse of substances of abuse, the Practice may conduct controlled and monitored urine or blood testing under certain circumstances. The assurance to employees that personal dignity and privacy will be respected in reaching the Practice’s goal of drug-free workplace is as important as attaining this goal. Therefore, it is also the policy of the Practice to handle all matters relating to an employee’s involvement in Substance Abuse Program with the utmost confidentiality and privacy. The Substance Abuse Policy and Testing Program includes random testing, reasonable cause testing, and post-accident and unsafe practice testing. In random testing, you may be directed to submit to a drug test for no reason other than you were randomly chosen by a system designed to select employees for periodic testing.You may be asked to submit to a substance abuse test if reasonable cause exists to indicate (i) the use of alcohol, illegal drugs, or controlled substances, (ii) danger to the health or safety of the employee, another employee, or the public, or (iii) impairment of the employee’s ability to perform his work. Reasonable cause may be based upon, among other things observable phenomena, such as direct observation of drug or alcohol use or possession, physical symptoms of being under the influence of a drugs, or alcohol; a pattern of abnormal conduct, erratic behavior, or sudden changes in work performance; arrest or conviction for drug-related offense; or information provided either by reliable and credible sources or independently corroborated. The Practice is committed to providing a safe and secure work environment. For this reason, if you are involved in an on-the-job accident or have engaged in unsafe on-duty, job-related activities that pose a danger to others or the overall operation of the Practice, you may be asked to submit to a substance abuse test. The Practice may test for the presence or use of marijuana, cocaine, amphetamines, opiates, and phencyclidine (PCP). the Practice may also test for alcohol and reserves the right to test for the presence or use of any other illegal drugs or controlled substances. If you are requested to submit to a drug test, you must present at the testing location or facility within one hour of the request. Failure to do so may result in immediate termination.In testing its employees, the Practice will generally adhere to the “Procedures of Transportation Workplace Drug Testing Program” promulgated by the Department of Transportation except for the split specimen testing requirements.A laboratory certified by the Department of Health and Human Services or the National Institute on Drug Abuse will conduct all tests. The laboratory assessment will be a test or a series of tests, which are highly accurate and reliable. Positive test results will only be disclosed to the employee, pursuant to State and Federal law. Any employee violating any of the policies set forth in this Program shall be subject to a full range of disciplinary action by the Practice, including termination. The severity of the action chosen will depend on the circumstances of each case. Non-Employee Solicitation/DistributionOutsiders (non-employees) are prohibited from engaging in solicitation of any kind or distribution of literature at any time while on any of the Practice premises.Solicitation/DistributionBecause we believe that work time is for work and that all work areas are to be kept as clean, safe, and litter-free as possible, we ask that you observe the following code of conduct:During working time, you shall not engage in the solicitation of another employee for any purpose, or the distribution of any literature to another employee. For purposes of this rule, your working time does not include meal periods or other periods when you are not engaged in performing work tasks. You shall not engage in the distribution of any literature in any working area at any time without prior the Practice authorization. You shall not engage in the solicitation of any employee for any purpose, or the distribution of any literature to another employee, in any areas of the Practice where, at the time of such solicitation of distribution, guests or patients are likely to be present. At no time while on the Practice premises shall you engage in the solicitation of any non-employee for any purpose, or shall you distribute literature to any non-employee. Termination/Resignation Of EmploymentGiven the nature of the medical industry, the Practice requests (but does not require) that you give a two (2) week prior written notice of resignation. This two (2) week period is oftentimes crucial for multiple reasons including training additional staff in the duties and functions of your particular position and responsibilities, providing adequate staff to perform essential duties, and ensuring a smooth transition of processes and responsibilities for staff and patients alike. This time period also allows for the Practice to begin the process of hiring a replacement to minimize the impact of your absence. At minimum, a ten (10) business day written statement of intent to resign is requested with your reason for leaving and last day of employment. The written resignation should be given to your supervisor as well as a copy to the Practice Administrator. If you resign without both giving and working a ten (10) business day notice you will not be entitled to be paid for any accrued but unused PTO. If you resign with 10 business days notice and you work all scheduled shifts during that ten (10) business day period will receive compensation for any accumulated but unused PTO. In the event of any absence during the resignation period whether due to sickness or previously scheduled time off, you will not be paid, nor may you use PTO. Any such absence may result in forfeiture of accrued PTO. The Practice maintains the right to make an employee’s resignation effective either immediately or earlier than the last day specified by the employee. In this event, the Practice will honor and pay the employee for accrued PTO. Any PTO taken in advance of normal accrual will be deducted from any compensation to be paid to the departing employee. The employee will receive seven (7) days’ prior written notice of the specific amount to be deducted from his or her final compensation. Upon your termination/resignation, you must return all keys and Practice property. If you fail to return any Practice property, the will deduct the value of the property from your final pay check. You will receive seven (7) days’ prior written notice of the specific amount to be deducted from your final compensation. Additional costs in excess of the final paycheck will be your responsibility and will be billed to you. Final paychecks will not be direct deposited. Instead they will be signed by the Practice and mailed to the employee to the most current address on file and issued in accordance to the regularly scheduled payroll.Failure to report to work for a scheduled shift without proper verbal notification or communication with your supervisor or the Practice Administrator is considered job abandonment. Upon your termination or resignation from the Practice, we may request that you participate in an exit interview with the Practice Administrator. Matters such as your vacation pay and health insurance may be discussed in more detail at that time. Medical CareIn order that complete and objective treatment can be given without interference with the employer-employee relationship, you should have a personal physician unaffiliated with this office. You are encouraged to seek medical advice and treatment quite early in the onset of an illness or suspected illness to avoid the development of a more serious problem. Personnel RecordsIn order to keep our personnel records up to date, you must notify the Practice Administrator immediately of any change in name, address, telephone number, whom to notify in case of emergency, insurance beneficiary, numbers of dependents, or information for income tax withholding (i.e. allowances claimed), etc in writing. The Practice maintains individual personnel records for each employee. All employee information is confidential and solely the property of the Practice. Copies of personnel records will not be provided to current or former employees or third parties unless required by law. Payroll DeductionsSocial Security (FICA.): All employees are covered by the Federal Social Security Program with respect to retirement benefits. The office and the employee share equally in the cost of paying taxes to support the Social Security Fund.Federal Income Tax (Withholding): The Federal Revenue Act requires that the office withhold federal income tax from your wages. The amount withheld is stipulated by law and is based on the number of dependents claimed and the amount of your earnings. By January 31st of each year, a statement (W-2 form) showing the total wages paid to you during the previous year and the amount of tax withheld by the office will be mailed to you.State Income Tax: Certain states require that the office withhold state income tax from employees’ gross pay. As with federal income tax, the amount of state tax withheld is stipulated by law and is based on the number of dependents claimed and the amount of your earnings. If you are subject to such withholding, state tax withheld from your total earnings during the previous year will be included on your W-2 form.Employee Performance EvaluationEmployee Performance Evaluation FormSCALE1234 Outstanding Highly Effective Needs Effective ImprovementRating_____ QUALITY OF WORK: Extent to which work is free from errors, organized, detailed and complete. Meets the ments:_______________________________________________________________________________________________________________________________________________________ TIMELINESS: Degree to which employee is able to meet ments:_______________________________________________________________________________________________________________________________________________________ JOB KNOWLEDGE: Knowledge of techniques, skills, processes, procedures and materials needed to perform work ments:__________________________________________________________________________________________________________________________________________________ _____ DEPENDABILITY: Extent to which employee is reliable and persistent in accomplishing assigned tasks and in meeting ments:_______________________________________________________________________________________________________________________________________________________ INITIATIVE: Degree to which employee seeks out additional work and responsibilities and assumes responsibility for personal growth and ments:_______________________________________________________________________________________________________________________________________________________ CREATIVITY: Extent to which employee suggests new ideas and shows original ments:_______________________________________________________________________________________________________________________________________________________ DECISION-MAKING: Extent to which employee makes decisions which are ments:__________________________________________________________________________________________________________________________________________________Employee Performance Evaluation_____ ORGANIZATION/PLANNING: Extent to which employee organizes work, anticipates problems, sets priorities, and effectively utilizes ments:_______________________________________________________________________________________________________________________________________________________ COMMUNICATION: Ability to listen and respond clearly and directly, describe information or ideas to others, and communicate ments:_______________________________________________________________________________________________________________________________________________________ COOPERATION: Willingness to work with others, including other departments for the overall ments:_______________________________________________________________________________________________________________________________________________________ FLEXIBILITY: Willingness to consider and implement new/different ideas, methods, to modify behavior and attitude to reach a goal; accept ments:_______________________________________________________________________________________________________________________________________________________ PERFORMANCE UNDER STRESS: Ability to carry out job responsibilities under organizational and personal ments:_______________________________________________________________________________________________________________________________________________________ VERSATILITY: Degree to which employee can handle a wide range of tasks/ responsibilities and is capable of turning from one to the other ments:__________________________________________________________________________________________________________________________________________________ADDITIONAL COMMENTS:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I am signing this performance review to indicate that my supervisor and I have met to discuss the above comments and ratings._____________________________________________________________________________ Employee Signature DateContinuing EducationThis practice encourages and provides technical skills training and continuing education in a variety of ways. In order to enhance the skills needed for current employment as well as future career development, this office provides the following support:In-service training programs.Skills training workshops.Management seminars.Job-related seminars and lectures.Clothing AllowanceAfter one year of fulltime employment, employee will receive a $200 clothing allowance to be redeemed at Uniforms Unlimited, Inc. in Summerville. Part-time employees will receive $100 after one year of employment. SuggestionsMany of the good practices now in force in the practice were first suggested by our employees. If you have a suggestion, which you think will be helpful, please submit it to administration.Because a great share of every dollar of practice revenue goes into operating expense it is to everybody’s benefit to find savings, if possible. Your suggestion, even if it is only a small saving, will be appreciated.Your ideas are important. They may not always be accepted or endorsed, but they will certainly be given reasonable consideration. How can we improve? Is there a better way to do something? These are questions about which you should always be thinking. Please present your ideas in writing to the Practice Administrator.Employee Discipline & GrievancesThis office expects all employees to be guided by the following rules of conduct:Maintain a good personal appearance.Refrain from loud noise and unnecessary disturbances.Treat patients, families, doctors, co-workers, supervisors and visitors with respect, courtesy and friendliness.Treat information concerning a patient’s condition or behavior with confidence.Report to work on time as scheduledNo smoking is allowed in the office.Take pride in your work and the contribution you make to the office.Be willing to help a co-workerBe alert to concerns and complaints of patients and families and report it.Remember that our purpose is to meet the total needs of those individuals we serve. Regardless of your specific duties, concern yourself with that service.Avoid all idle or malicious talk about your fellow workers and/or patients. Gossip seldom includes all the facts. It is easy to be unfair or to harm someone unintentionally. Any information regarding a patient’s illness or personal affairs is confidential and should not be discussed at any time. Gossip can be a poisonous thing, and we sincerely hope that no office employee will ever be guilty of repeating any gossip concerning a fellow employee, a patient, a physician, or any other individual in any way connected with the office.We know that people prefer to work in a happy environment where individuals respect each other and work together in peace and harmony; however, rules and regulations have to be established to ensure this atmosphere. The Practice Administrator is responsible to see that these policies are carried out.This practice takes a constructive approach when it comes to discipline. We want to be sure that workers do not continue actions or behaviors that interfere with their performance or the operation of the practice. You have responsibilities to the job and your employer, but you must remember your responsibility to your coworkers, as well.Discipline is meant to correct problems rather than to punish an individual. The employee will be warned, both verbally and in writing. The warning will become a part of the employee’s personnel file. Situations that arise again may receive a second written warning or may require suspension without pay. Dismissal is possible if the employee’s job performance or behavior is not corrected.Safety & SolicitationsYour safety is important to us. You are requested to make every effort and assume your responsibility by using safety equipment and following instructions and rules issued to prevent accidents and ensure safe working conditions. Please report immediately any conditions you feel unsafe: slipping and tripping hazards, inadequate lighting, frayed electrical cords, etc. Report all injuries.Solicitations by salespersons or representatives of outside organizations not associated with the day-to-day operations of the office are prohibited unless approved by the Practice Administrator. No written materials, circulars or petitions are to be circulated. These restrictions apply to religious, fraternal and similar organizations.Requirements On Record KeepingThis office abides by the following requirements:Immigration Reform and Control Act requires INS Form I-9, EmploymentEligibility Verification form.Medical records and related documents - Medicare requires records and progress notes to be kept for a minimum of 10 years. Records shall be retained on all patients in a retrieval storage system until the death of the physician.The Davis-Bacon Act requires that payroll records list the name, address, and correct classification of each employee, rate of pay, daily and weekly number of hours worked, deductions made, and actual wages paid.Title VII of the 1964 Civil Rights Act applies to any personnel record kept byemployer, including application forms and records concerning hiring, promotion, demotion, transfer, layoff or termination, rates of pay or other terms of compensation and selection for training or apprenticeship.Fair Labor Standards Act requires basic records containing employee information, payrolls, individual contracts or collective bargaining agreements, applicable certificates and notices of Wage-Hour administrator, sales and purchase records.Age Discrimination in Employment Act requires payroll or other records containing each employee’s name, address, date of birth, occupation, rate of pay and compensation earned each week.Employment records - Personnel records relating to job applications, resumes, or other replies to job advertisements, including application for temporary positions and records pertaining to failure or refusal to hire; promotion demotion, transfer, selection for training, layoff, recall or discharge; job orders submitted to employment agency or union; test papers in connection with employer-administered aptitude or other employment test; physical examination results considered in connection with personnel action. Job advertisements or notices to the public or employees regarding openings, promotions, training programs, or opportunities for overtime work.Employee Retirement Income Security Act requires records providing the basis for all required plan descriptions or reports or those necessary to certify and information contained therein, including vouchers, worksheets, receipts, and applicable resolutions.Records pertaining to each employee-participant in the plan for determinations of benefits that are due or may become due. Registration, Appointment Scheduling & Patient FlowThe front office, nurses and infusion department will make all appointments.Scheduling appointments for Dr. “Name”.New patients are given a ___ minute time allotment.Infusion follow-up appointments are given a ___ minute time allotment.Regular office revisits are given a ___ minute time allotment.Injections are given a ___ minute time allotment.Scheduling appointments for Dr. “Name”.New patients are given a ___ minute time allotment.Infusion follow-up appointments are given a ___ minute time allotment.Regular office revisits are given a ___ minute time allotment.Injections are given a ___ minute time allotment.Scheduling appointments for Dr. “Name”. New patients are given a ___ minute allotment in the morning and ___ minute afternoon time allotment. Infusion follow-up appointments are given a ___ minute time allotment. Regular office revisits are given a ___ minute time allotment. Injections are given a ___ minute time allotment.Scheduling appointments for Dr. “Name”. New patients are given a ___ minute time allotment. Infusion follow-up appointments are given a ___ minute time allotment. Regular office revisits are given a ___ minute time allotment. Injections are given a ___ minute time allotment.Each evening the front desk will make a copy of the appointments which are scheduled for the next day, print and place in the designated location for each physicians nurse.On Thursday mornings, print out a copy of next week’s schedule, print and place in the designated location for each physicians nurse.If there is a question concerning the urgency of a patient seeing the doctor before an opening is available, take a message, pull the chart and give it directly to the nurse or doctor. If the call reflects an obvious medical emergency, refer the patient to the ER (cardiac arrest, stroke, unresponsiveness). Clinical information is only to be given by the doctor or nurse.Patient charts for the day’s scheduled appointments must be pulled the day before and kept in the front office until the patient arrives.The chart is then tagged with an encounter form and then placed in a designated place for the medical assistant or nurse.Patient charts are to be returned to the physician’s office for review, then the nurse returns them to the front office for filing.Patients will be taken in the order of appointment for Dr’s “ Name” and “ Name” and order of arrival for Dr’s “ Name” and Edwards unless their illness warrants immediate attention.The receptionist greets patients as they arrive. If it is a new patient, a HIPPA brochure is given to them. New Patients complete the new patient forms, Release of records and scan their ID and insurance cards into the system. Assistance to the patient in completing the form should be offered. New and returning patients are to be given the “Rapid III” form to be completed in order for the physician to track the patients progress. Write “REFUSED” on any form which patients decline to complete. Create a “pop-up note” in the system if the patient refuses or is unable to complete the rm patients of long delays. Patients already in the waiting room and those who show up afterwards deserve to be told what’s going on and given the option to reschedule. For new patients, the following information must be noted on the charts:Full name of the patient.Age.Sex.Date of birth.Occupation.Race. (option to report as “unreported” or “refused in the system)Marital status.Full mailing address.Telephone number.Sponsor, DOB and SS# must be entered.Sponsor’s full address.Sponsor’s telephone number.If patient does not have a telephone, enter the telephone of contact person.Insurance: Indicate type (e.g. Medicare, Medicaid, or private insurance), and policy number and group number if available.Enter any allergies in RED INK. (by the nurse in the chart)At the time of registration, it must be determined if the patient has a valid Insurance card, Medicare, Medicaid, Tri-Care, Champus-VA or is a self-pay patient. We do not accept workman’s compensationIn the case of a cash patient, inform the patient that the office visit is as follows:New patient - $250.00 depositEstablished patient - $50.00 deposit The following information should be obtained on insurance:Name of insured.Relationship of insured to the patient.Name and complete mailing address of insurance company.Special claim forms, if any.Call the insurance company or use I-verify to verify the coverage and find out the amount of deductible and co-insurance.The claim form must be signed by the patient or insured to allow the office to provide information to insurance company and for direct payment by the insurance company to the practice.The patient should be informed that if the insurance company does not pay, then he/she will be responsible for payment and patient will also be responsible for the deductible and co-insurance.If the patient has private insurance and is willing to pay cash for the service, then the patient will be charged as a cash patient and the insurance form will be completed so that the patient may be paid by the insurance company.If the patient wants to be billed for the office visit or other services, specific arrangements have to be made with the patient for payment:The date of expected payment.Correct address and telephone number.Responsible party for the payment.Instructions to the patient to either mail or bring in the payment.Instruct the patient that he/she is expected to pay for the services prior to a certain date and we generally do not send monthly statements.For Medicaid, determine if the card is current and valid and note the correct name and address. First Choice, PCP managed plans, Amerigroup And Carolina Crescent all need authorizations. All Medicaid must have an eligibility check to verify the number of ambulatory visits remaining. If Medicaid is out of network and authorization isn’t given, the patient is self pay. We do not accept Medicaid as a secondary insurance. For cash patients, the patient must be asked to make payment on any previous balance and to pay for the present visit.If the patient has only Medicare, collect for the first $100.00 as deductible at $28.00 for the first office visit and $20.00 for follow-up office visits. Also collect 20% as patient’s share of co-insurance after the deductible is met on the following services:Office visits.DEXA.Infusions.Injections.X-rays.Hospital admissions.If the patient has Medicare and supplementary insurance, the Practice Administrator’s permission has to be obtained for accepting the supplementary insurance. A complete record of all claims submitted to Medicare with supplementary insurance must be kept. All of these claims are to be submitted to the private supplementary insurance. After payment by Medicaid, forms must be filled out for supplementary insurance on the same day of service with signatures from the patient. These claims are submitted to private insurance companies with a copy of Medicare EOB after payment from Medicare. Patients should pay deductible and co-insurance and receive payment directly from the insurance company. If the patient agrees to pay for the deductible and co-insurance, assist him/her with the forms for the insurance company. The patient receives the EOB from Medicare. Write the policy number and insurance company on the EOB from Medicare and the patient sends it to the insurance company for payment.If the patient has Medicare and Medicaid, no payment is to be received from the patient, unless indicated by the Practice Administrator. We do not accept Medicaid as a secondary insurance.If the patient has Medicare only and is paying for the deductible and co-insurance, a complete record of the payments made by the patient, amount due patient and current balance must be maintained on file reflecting all office care, hospital ER, and in-patient care and all procedures. If the patient has Medicare, Medicaid, and private insurance the claim will be sent to Medicare first, then to private insurance. If the private insurance did not pay for the service, the claim then must be submitted to Medicaid with a copy of notice of non-payment from the private insurance and copy of EOB from Medicare.If the patient has Champus insurance submit the claim on Medicare insurance form and mark Champus. The patient is responsible for the deductible and 20% co-insurance. The claim must have the Champus provider number and be signed by the patient authorizing payments directly to the practice.If the patient has Blue Cross, enter my Blue Cross provider number on the claim form.All account records must be current at all times. Charges posted at the time of service and all payments posted at the time of payment for cash patients.The daily record sheet must be completed every day before the office is closed. This sheet must reflect all patients who entered the office during the hours of 8:00 a.m. to 5:00 p.m. All Medicare, Medicaid, private insurance, VA and workmen’s compensation claims must be completed before the office closes for the day. No claim submissions should be left incomplete at the end of the day.This office is not subsidized by any entity including city, parish, state, or federal government and it depends upon the payments for provided services to pay the expenses. We are unable to provide free medical care to any individual, unless approved by both the physician and the practice administrator.Steps For Scheduling Appointments:Take the full name, address, DOB, SS# and telephone number of patient.Find out patient’s main complaint or problem and when symptoms first occurred.Ask patient if he/she was referred by another doctor or facility and record.Review scheduler for an appointment time based on the description of the patient’s problem.Offer patient date and time. Ask if convenient; if not give alternate date choice.Enter patient name and complaint on scheduler.Make notation “NP” if a new patient on scheduler.Offer directions to office if patient needs them.Always mail new patient packet prior to visit with an appointment card. Make a note to the patient to arrive 15 minutes early.Make brief statement regarding payment policies and request patient bring insurance verification.Repeat the date and time of appointment and ask if there are any questions.Print “New Patient for Chart Creation” sheet.Note:Appointment time and date.Date when paperwork is mailed.Specify why the patient is being seen at the bottom of the sheet.If notes were requested.Is the referral being sent by the referring physician?Procedure For Cancellations, Bumped And No-Show AppointmentsFor cancellations, type a note in the comment section stating why and who cancelled the appointment.For bumped appointments, reschedule them by using the “Rescheduled Bumped Appointment” feature so the appointment history is properly logged.Thirty minutes after patient has failed to keep an appointment, call him/her to ask why.Notify referring physician (if applicable).Record as “no-show” in patient’s chart and computer.Have physician review patient’s chart.Discharge chronic no-show patients by sending the attached letter certified mail:Dear (Patient Name)Because you have consistently failed to keep your scheduled appointments, I find it necessary to inform you that I am withdrawing from further professional attendance upon you.Since your condition requires medical attention, I suggest that you place yourself under the care of another physician without delay.If you so desire, I shall be available to attend you for a reasonable time after you have received this letter, but in no event for more than ninety (90) days.This should give you ample time to select a physician of your choice from the many competent practitioners in this area.With your written approval, I will make available to this physician your case history and information regarding the diagnosis and treatment.Yours truly,_________________________, M.D Steps In Preparing A Patient In The Medical Office Are:Exam room is checked for cleanliness and proper supplies and instruments. Table paper and clean patient gown provided.Medical assistant prepares room for anything additionally required based on purpose of patient visit.Medical assistant escorts patient from waiting room to exam room (or vitals room, if applicable).Medical assistant takes weight, blood pressure, pulse rate and determines if other tests are required.Obtain patient information on chief complaint, when condition or symptoms began and what care has patient given self. Also reviews patient medication list with patient.Nurse/medical assistant follows procedure alerting physician that patient is ready for exam use the appropriate color door flag.The medical chart and documentation of vitals is stationed for physician’s review.Prepares Patient and supplies for injections and procedures.After physician’s exam, nurse/medical assistant:Advises patient to get dressed.Makes arrangements for future visits, tests or referrals.Obtains the pre-cert for any medications or procedures as required by the patients insurance. Escorts patient to check out area.Checks for completeness of medical chart documentation.Checks for completion of encounter form for billing.If labs are order, verifies that the router is accurate and pletes any prescription refills and verifies that physician completed any/all new prescription.Medical RecordsThis office recognizes the need for a clear well-organized system of written medical records to achieve quality and comprehensiveness. A Problem Oriented Medical Records System is utilized. A medical chart is prepared for each patient.Registration forms completed by patient or responsible party on the initial visit:Patient’s name, address, and phone numberAge, sex, and date of birth of the patientInformation on the responsible partyMedical insurance, Medicare, or Medicaid information and numbersAuthorization for medical careReferral informationPatient’s chart number – this is assigned to the patient numerically by the order in which the patient arrives at the office.Yearly sticker – the year in which the initial visit is made.3. Patient’s name – typed on label in capital letters (first name first, then last name).Inside the chart – DocumentsMedical History Sheet. To be completed on each new patient.Progress Sheet Notes. To be kept in numeric order.Nurses Notes. Completed at the time of each office visit to include:DateVitalsCurrent medicationBrief historyPhysician notes. To be completed by the doctor at the time of the office visit, phone conversation, or other consultation. Painful Areas: Severity, location and factors associated with signs and symptoms.Past and Social History: Information told by the patient or family about the problem.Physical Exam: Information from the physician exam and laboratory tests.A-Assessment: Interpretation by the provider of the subjective and objective data; identification of problem and patient’s current medical and functional status; discussion of diagnostic questions to be answered.P-Plans: specific course of action for the problem described including:DX – Diagnosis: Plans for further investigation to establish a diagnosis.RX – Treatment: Plans for patient care and problem management.ED – Patient Education: Information given to the patient and/or family.FU – Follow-up: Schedule of return visits.Laboratory ReportsOn-site laboratory testing results placed in chart when a lab test is reported for the first time.Outside lab testing. Original report to be placed with the chart and placed on the appropriate doctor’s desk, in which he/she will initial after reviewing.Medication sheet.Operative notes.Hospital admission and discharge documents.Miscellaneous reports and correspondence (EKG’s, outside reports from referring physicians).Referral information is to be maintained by the office staff through the aid of the physicians. Referrals should be entered as soon as notified by the doctor that they have occurred. The referrals should be checked on a monthly basis to follow-up on overdue reports or acknowledgements.Patients coming into the practiceThis entry consists of patients which have been referred to the office from another provider. The staff person should complete the entry by noting:Date which referral is madePatient’s nameName of physician who will see the patientDoctor who referred the patient or other referral sourceReason for referralDate of patient’s office visitDate and initial by whom acknowledgement is madePatients referred out The referral form book consists of patients who the physicians are referring to another physician, hospital, or institution. Each front office staff person is assigned to a physician to manage their outgoing referrals and maintains an up-to date log book which contains some of the following information;Date the referral is made.Patient’s name.Doctor which is referring the patient.Who the referral is made to.Reason for the referral.Date of patient’s appointment.The report has been received from the referral doctor.Medical records are dictated by the physician. The transcriptionist types and dictation is filed in medical charts. Other Medical Record forms:Records release authorizationPhysician report to referring physicianPhysician introduction of patient to referred physicianDisability certification letterMedicare consent formHospitalization logReferral logRelease of Medical InformationThere must be consent of the patient before requests from insurance companies for records are handled.The physician shall review records for completion before transferring to requesting party.If litigation matters are pending, a subpoena should accompany request for release unless patient gives written consent.Non-medical persons are not allowed to examine medical records in this practice.Any situations where release of records is questionable, the physician is consulted.Attorney requests for patient medical information must have authorization from the patient. This should be a part of the practice’s medical ernment agencies can access medical records only if authorized by law.Release of medical information shall adhere to all HIPAA regulations on privacy.AUTHORIZATION FOR RELEASE/REQUEST OF MEDICAL INFORMATION FORMTEXT “Practice Name” FORMTEXT “ Address”, FORMTEXT “ City”, SC 12345 FORMTEXT “123-456-7890” phone * “123-456-7890” faxAUTHORIZATION FOR RELEASE/REQUEST OF MEDICAL INFORMATIONPatient’s Full Name: __________________________________ Phone: __________________________________Street Address: __________________________________ Email: __________________________________City/State/Zip: __________________________________ Date of Birth: ____________________________Request Information From:_________________________________________Name of Company/Agency/Facility/Person_________________________________________Street Address_________________________________________City/State/Zip_________________________________________Phone / FaxRelease Information To:_________________________________________Name of Company/Agency/Facility/Person_________________________________________Street Address_________________________________________City/State/Zip_________________________________________Phone / Fax‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐Authorize Release of Information related to AIDS (Acquired Immunodeficiency Syndrome) or HIV (Human ImmunodeficiencyVirus) Infection, psychiatric care and/or psychological assessment and treatment for alcohol and/or drug abuse. Yes___ No__Information Needed For: Attorney_____ Insurance Company_____ Self_____ Other_________________Complete Record _____Partial Record _____________________________________________________________________(Indicate info needed and date range…for example, MRI reports 2006, Op Note from 06‐13‐07…etc.)‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐PLEASE NOTE THERE IS A FEE FOR REPRODUCING PATIENT RECORDS. THESE FEES ARE IN ACCORDANCEWITH SC ST SEC 44‐115‐80 AND ARE AS FOLLOWS:Authorization will expire in 12 months from date of signature below:Signature: _____________________________________ Witness: ________________________________ Date: _________________________PrescriptionsInformation required from caller:Patient NameDOBPatient’s DoctorPharmacy NamePharmacy NumberDrug Requested, Strength and DosePull the chartWrite up request, time called and initial it!If the patient’s doctor is not in the office that day, verify all narcotic refills with the doctor in house that day.“PRACTICE NAME”, P.A.“ Address”REET“ CITY”, S.C. 12345 “ Name”, M.D. (123)456-7890“ Name”, M.D. FAX(123)456-7890“ Name”, M.D.“Name”, M.D.STEPS TO GETTING YOUR PRESCRIPTION REFILLEDAs part of our attempt to operate an efficient and patient centered practice, we strive to renew prescriptions the day we receive the request for refill. However, prescription refills may as long as take 3-5 days due to holidays, weekends, or issues of coverage.YOU NEED TO CALL FOR YOUR PRESCRIPTION REFILL 3-5 DAYS BEFORE YOU ARE OUT OF MEDICATION!!!!A good way to remember this is to write it on your calendar at home as a reminder.If you need a prescription refilled please call “123-456-7890”When leaving your message you will need to leave this informationYour name (first and last name) with correct spellingYour home telephone numberYour date of birthThe name of the medication and how you take it.Your pharmacy’s name and phone number.(We are unable to call information to obtain pharmacy phone numbers)The nurse will give your prescription to the doctor and he will write you prescription. Please remember that this process may take 3-5 days. After the doctor writes your prescription we will contact you to pick up your prescription. There is no reason for you to call us. We cannot and will not fill prescriptions early for any controlled drugs.________________________________ ___________Signature Date________________________________ ___________Witness DateNarcotic Prescriptions“PRACTICE NAME”, P.A.“ Address”“ CITY”, “State” 12345 “ Name”, M.D. ”123-456-7890”“ Name”, M.D. FAX(123)456-7890 “Name”, M.D.“Name”, M.D.I understand that Dr.________________ and “Practice Name” P.A. will prescribe only if I agree to the following conditions. These conditions are needed because of potential for abuse of narcotics and because the use of these medicines MUST be strictly monitored and regulated. I understand that these conditions are needed to protect myself and the doctor who prescribes the medicine.ConditionsI agree to try other treatments along with narcotic therapy such as injections, physical therapy, occupational therapy, and psychological counseling. I understand that these other therapies will be needed in addition to narcotics to provide me pain relief. ____I realize that it is my responsibility to keep others and myself from harm, including the safety of my driving. I will not be involved in any activity that may be dangerous to me or someone else if I feel drowsy or am not thinking clearly. If there is any question of impairment of my ability to safely perform any activity, I agree that I will not attempt to perform that activity unit my ability to perform the activity has been evaluated or I have not used the medications for at least four days. ____“Practice Name”, P.A. will prescribe ALL of my narcotic medications. No other physician is to prescribe narcotics except as allowed in this contract. I understand that breaking this contact and receiving narcotics from other physicians is a violation of South Carolina Law and I may be arrested for this. ____All narcotic prescriptions MUST be filled at the same pharmacy. ____I will not use any illegal drugs, including marijuana, cocaine, etc. ____I will not share, sell, or trade my medicine for money, goods, or services. I will not use other patient’s medication for my own use. ____I will not attempt to get pain medication from any other source without telling them that I have a medication agreement with “Practice Name”, P.A. I may receive medications while hospitalized, or during treatment in an emergency room, but I will not accept prescriptions for narcotics upon discharge._____I agree that I will take medicines EXACTLY as prescribed. I will never increase the medicine dose myself and I will insure that medicine will last until my next scheduled refill. ____No medicines doses will be changed between visits to the doctor’s office. ____Any narcotic medication or prescriptions lost or stolen MUST be reported to the police and a copy of the police report will be placed in my chart at the time of my next visit. I will place my medications in a safe place and protect them from being lost or stolen. I will not carry all medications with me to prevent all of the medications from being lost or stolen. ____I understand if my narcotics prescription or medications is lost or stolen, NO replacement medications or prescriptions will be given. I will have to wait until the next scheduled refill to get any further narcotics. ____I agree to ongoing psychological evaluation and counseling while I am taking narcotic medications. ____I will not request to start or change narcotics over the phone. ____I will never alter a prescription. ____I understand that my primary care physician must agree that narcotics are required to treat my condition before I will be given a narcotics prescription. ____I agree to have any lab studies, including random drug screening by blood or urine to ensure the medication is being taken correctly and to ensure that illicit drugs are not being used. If I refuse to be tested, I will not receive any further medication prescriptions from “Practice Name”, P.A. and may be discharged from this practice. I understand my insurance may not cover the cost of this testing and I may be responsible to the lab for theses fees. _____I agree not to harass or threaten any “Practice Name” personnel. This will not be tolerated and will result in discharge from this practice. This includes family members as well. _____I understand that Chronic Pain is not an emergency. I will contact “Practice Name” personnel during regular business hours and will not call any personnel at home to request a refill or change in medication. _____When I need a refill on medication, I will call Four business days before the refill is due. This is to ensure that the prescription will be available by the day it is due. _____I agree to all of the above conditions. I understand that I may have all medications discontinued and may be discharged from “Practice Name”, P.A. if all the conditions are not met. I also understand that “Practice Name”, P.A. may discontinue prescribing these medications at any time and that compliance with this agreement is not a promise that these medicines will be prescribed. ____Patients Signature: _____________________________Signing for patient: ____________________________ (relationship)Witness: _____________________________Date: ______________________Red Flag RulesI. Mission Statement“Practice Name” is committed to providing its patients with the highest level of privacy protection and to protecting its patients against the harms of identity theft. “Practice Name”’s mission is to demonstrate respect and compassion for each patient and Staff member and to promote a culture that encourages full disclosure by patients. “Practice Name” understands that this culture cannot be cultivated without ensuring patients that their privacy is a priority to “Practice Name” and that “Practice Name” will take all reasonable steps to protect patients against the detrimental effects of a breach in their privacy. This Program is intended to serve as the cornerstone of “Practice Name”’s commitment to the patient’s privacy and protection against identity theft. II. Need for and Purpose for Program“Practice Name” recognizes that identity thieves are increasingly targeting medical records because they provide an abundance of financial information including billing addresses, birthdates, Social Security Numbers (“SSNs”), credit information and health insurance account numbers. “Practice Name” further recognizes that medical identity theft subjects its victims to devastating and life-threatening consequences as it may result in victims finding their medical benefits exhausted or face potential deadly consequences due to inaccuracies in their medical records. For these reasons, and in response to the Federal Trade Commission’s (“FTC’s”) implementation of the Red Flags Rules, “Practice Name” has developed this Program.The Red Flags Rules require Creditors with Covered Accounts to define, detect and respond to Red Flags to prevent and mitigate identity theft. “Practice Name” has reviewed its billing and payment procedures and has determined that it may be subject to the Red Flags Rules.The Program is designed to provide “Practice Name” with a comprehensive strategy to ensure that it consistently complies with the Red Flags Rules and to be consistent with other applicable privacy and security laws. “Practice Name” intends to use this Program to define, detect, and respond to Red Flags to prevent and mitigate identity theft. As such, the Program will promote continuous evaluation and improvement of identity theft prevention policies and procedures, as well as Staff understanding of applicable duties and responsibilities related to the prevention of identity theft. The Program was developed with the full support of the Board of Directors (“Board”) and was adopted by the Board on July 1, 2009.III.Program TrainingAll employees are to review the Red Flag Rules Policies and Procedures manual located in the Practice Administrators office. After reviewing the manual, employees are to complete the training section and sign the training completion log.TelephoneThe office telephone is strictly for professional use and making or receiving personal calls except emergencies is not allowed.All the calls must be answered promptly, politely, and professionally. To answer any call, start with good morning/good afternoon, “Practice Name”, first name of person answering the call, speaking, may I help you? Be precise and professional. Before hanging up, always say goodbye!If the patient calls to renew a prescription and the patient was not seen for 21 days or longer, ask the patient to come in to be examined and the medication will be renewed after examination and determining the necessity of the medication.If the patient calls about renewing the medication and the patient has been seen within a week, get the patient’s chart and advise nurse or doctor and the doctor will inform you. If the doctor decides to renew medication, you will need to call the drug store and renew the medicine for a specified time as ordered by the doctor.If the patient calls about any medical problem, explain to the patient that it will be in the best interest of the patient to come into the office to be examined, so that proper diagnosis can be made and treatment started.All the front office employees are strictly prohibited to give any medical advice to any patient on the phone. If the patient has any medical condition that the patient is worried about, take a message, pull the chart and give it to the doctor or doctors nurse.If the patient calls and wants to talk to the doctor, take a message and inform them that the doctors nurse will return the call before the end of the day.If the pharmacist calls regarding prescriptions, take a message for the corresponding doctors nurse. If any person calls and wants to talk to the doctor find out his/her name, reason for calling, ask for specific, if it is regarding patient, get the patient’s chart and give to the doctors nurse. If it is a business call, give it to the Practice Administrator.When the doctor is in the exam room and you need to give him a telephone message, knock on the door, wait a few seconds, and if you do no hear any response, open the door, give the doctor the chart and tell the doctor who is calling regarding what. As soon as you give the message to the doctor, leave the room.If there are any messages for the doctor, give him/her these before you leave the office. Long distance calls are to be kept to a minimum.Obtain numbers form the telephone directory or internet and avoid calling directory assistance, except under unusual circumstances. No personal long distance calls are allowed.Research LaboratoryGeneral Lab Rules:All equipment must be kept clean and in an orderly fashion.Pour any stains directly into drain and flush with water.If any acid or alkaline solution comes in contact with skin, flush with water.Use extreme care when handling laboratory instruments and specimens.Clean up work area after activity.Collection of specimen:Make sure orders for tests match the correct patient.Be certain there is sufficient quantity of the specimen.See that all specimens are labeled correctly.Prepare all specimens to be sent out.Report accurate results in the patient’s chart.Keep all logs accurate and up to date.Perform quality control as necessary.Store supplies at the proper temperature and appropriate place.Check for adequate supplies and reagents for future tests.Clean Up and Maintenance:Put reagents away.Dispose of specimens.Incubator: Check temperature and record each day.Keep incubator level and free from drafts.Wipe clean as necessary.Handle all bacteriological specimens with care.Specimens, culture plates, etc., should be disposed of in plastic bags before placing in waste receptacle.Microscope:Do not remove oculars.Keep oculars clean and free of lint.Keep cover slips and slides free from fingerprints.Clean surface of lens before and after use with lens paper.Always turn light off after use and cover with dust cover.Perform quality control as necessary.Store supplies at the proper temperature and appropriate place.Check for adequate supplies and reagents for future tests.X-ray/DEXAGeneral Policies of X-ray in this Office:The policy of this office to provide quality x-ray service appropriate to the medical needs of the patients we serve.Radiology services are supervised by a staff physician.3. A sign is prominently displayed inside the x-ray room which says, “If you are pregnant, please let the technician know.” Always inquire whether a female patient (of appropriate age) is pregnant. Patients are referred to x-ray services of hospitals and other facilities, as needed.Radiographic procedures will be performed at this office within the capacity of the radiographic equipment.X-ray charges are a part of the office fees schedule which are available to patients who may inquire about them.If consultation is needed, referrals are made to outside radiographic specialists.An accurate daily log should be maintained at all times relating to time, procedure and physician involved.Only the trained x-ray technician operates the x-ray equipment. The x-ray technician only performs the exam(s) requested by the physician.Positioning X-ray Tube and Selection of the Cassette:The patients’ information is directly typed into the CR unit. The patients’ information contains the name, account number, gender, DOB and ordering physician. Select the ordered exam(s) and proceed.The tube unit should be placed directly over the body, at the proper distance from the cassette.The shutter must be adjusted to focus on the exact film size.The anatomy must be identified using left or right markers appropriately.Cassette selection is according to the size of the body part to be exposed.Routine sizes are 10x12 and 14x17.Procedure for Taking an X-ray:Turn on the wall breaker, then the monitor and processor.Identify the patient and explain procedure.Provide gown, if necessary.Type patients info into the CR unit and select exam..Position patient and place cassette accordingly.Make sure room doors are closed.Shield patient with protective lead shield.Center x-ray tube directly over the body part to be x-rayed.Cone shutter to focus on the cassette size.Measure the body part through the densest area to be penetrated.Check technique chart for variables. Adjust the variables.Position yourself near the machine behind the shield. Instruct patient to remain motionless and press pressure the exposure switch. Remove cassette from the table as needed.The cassette is then read by the CR unit and is ready to be viewed by the physician.SafetyEquipment and shielding shall meet all local and state requirements and shall be inspected at least every 24 months.Employee exposure is measured by appropriate means.3.Permanent records are kept of employee exposure and this should not exceed the maximum dose equivalent recommended by the National Council of Radiation Protection and Measurement. Always use appropriate equipment and good technique to avoid over-exposure and unnecessary repeats.Check every time after an x-ray to make sure everything is correct before exposing the patient.Prevent exposure of gonads especially in children, adolescents, and the reproductive years by using shields.Maintain strict adherence to all safety precautions. This includes using a lead shield, lead gloves, lead apron, and x-ray badges.OSHA & ADAThis office complies with the requirements of all OSHA regulations that apply to this practice. All employees are trained in proper procedures and are expected to follow the regulations.This office follows procedures to minimize or eliminate exposure to human blood and other infectious materials. It is required that all employees of this office who have contact with or exposure to human blood or other infectious materials read and understand the following plan. Employees should ask the Practice Administrator (designated as the exposure control Practice Administrator) any questions regarding this plan. All employees are to abide by the provisions of the plan as long as employed by this office.Universal Precautions is the preferred method of control to protect employees from exposure to all human blood, certain body fluids and Other Potentially Infectious Materials (OPIM). The term “Universal Precaution” refers to a concept of bloodborne disease control which requires that all human blood and OPIM be treated as if known to be infectious for HBV, HIV, or other bloodborne pathogens regardless of the perceived “low risk” of an individual patient.Employers are required by OSHA to develop and implement engineering and work practice controls as the primary means of eliminating or reducing employee exposure. Employees are required to wear personal protective equipment as an additional precaution to these controls.Employees will wash their hands and any exposed skin areas with at least soap and running water immediately or as soon as feasible upon contact with blood, certain body fluids or OPIM.If an employee’s mucous membranes become exposed, employee will flush affected area thoroughly with running water or equivalent substitute immediately or as soon as feasible.Employees must wash their hands after all patients care procedures.6. Employees must wash their hands after any glove removal including all patient care and all cleaning or decontamination procedures involving items with blood, certain body fluids or other potentially infectious materials.7. Employees will not BEND, RECAP, or REMOVE contaminated needles and other contaminated sharps (i.e. blades) except as indicated below:Note: contaminated needles and other contaminated sharps will not be removed or recapped unless the employer can verify and establish that no other alternative method is practical or that the above guideline is required by a specific medical procedure.8. Employees will place all contaminated sharps in appropriate designated containers until property reprocessed. Designated containers must be: Puncture resistance.Labeled or color coded in regard to standard.Leak proof on the sides and bottom.Sharps’ containers should not be stored or processed in a manner, which would require employee to reach, by hand into the container where sharps have been placed.Sharps’ containers are located in the exam rooms, procedure rooms and laboratory.Filled sharps’ containers will be closed when 2/3 full and disposed of in the following manner: (i.e. placed in medical waste service box, encapsulated)The storage of food or drink is allowed in the refrigerator in employee lounge/ and kitchen only.When performing tasks/procedures involving blood, body fluids or OPIM, employees will perform such procedures in a manner that will minimize splashing, spraying, spattering and generation of droplets by these substances.Employees will not, under any circumstances, utilize mouth pipette to suction blood, body fluids, or OPIM.Specimens of blood, body fluids, or OPIM will be placed in a designated container that prevents leakage during collection, handling, processing, storage, transport, or shipping. This container must be labeled with the International BIOHAZARD SYMBOL or COLOR-CODED IN RED and closed prior to storage, transportation or shipping.Should contamination or breakage of the primary container occur, it must be placed inside a second container that prevents leakage and is also labeled or color coded according to standard requirements (i.e. broken red bag placed inside new red bag).If a specimen could puncture the primary container, the primary container must be placed within a second container that is puncture resistant and labeled or color coded according to standard requirements (i.e. broken glass).Employees will not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in work areas or environments where risk of exposure to blood, other body fluids or other potentially infectious materials may be found or occur.Employees will not store food or drink in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops where blood or other potentially infectious materials (OPIM) are present (within six feet).Eating, drinking is allowed only in the following areas of this office: employee break room, employee lounge, front office and physician office.Equipment which has become contaminated with blood, body fluids, or OPIM must be examined thoroughly before servicing or shipping.If such equipment is contaminated, it should be decontaminated unless there is no feasible procedure that will properly decontaminate the item or portions of the item (i.e. centrifuges, microscopes, and dental equipment).Prior to service or shipping, labels must be attached to the equipment stipulating which portion(s) remain contaminated (i.e. with BIOHAZARD SYMBOL). This information must be communicated to all affected employees of this office of any other companies’ employees, service representatives and manufacturers before handling, servicing or shipping (i.e. placed in properly labeled bag and/or box).Upon removal of gloves or other personal protective equipment, employees will wash their hands with soap and running water immediately.Should hand washing facilities be unavailable, employees will use either an antiseptic cleanser or towelette. However, when antiseptic cleaners or towelettes are utilized, hands will be washed with soap and water as soon as feasible.Hand washing facilities are located the exam rooms, lab and procedure room.This office complies with the regulations pertaining to the Americans with Disability Act.This office does not discriminate in hiring employees based on an applicant’s disability. Every effort is made to accommodate disabled individuals with emphasis on the person’s education, work experience and qualifications to perform essential job functions.General FilingThe file system is to permit orderly document retention and easy, efficient retrieval.File folder designations required for proper file location of documents is the responsibility of each employee.Prior to filing, the employee should:Insure that the document is complete.Assemble for filing with the portion having the latest date of action on top.Remove extraneous material, e.g., envelopes or memo routing slips not containing information of significance.Destroy duplicate copies (unless otherwise instructed). If possible, always retain the original rather than a copy.Insure that parts of another document are not attached.Remove rubber bands, paper clips, etc., reinforce worn or frayed paper.File drawers must be labeled to identify the contents.5. NEVER take a paper from a file folder while the folder is still in the drawer. Remove the file intact, keeping the contents intact.At least annually, active files must be reviewed for materials which can be transferred or become inactive.All legal documents will be kept indefinitely; any other documents will be kept for a minimum of seven years.Processing Mail, Correspondence and FaxesUpon opening envelopes, make sure all materials have been removed.2. Check if there is a return address on correspondence or letters. If not, staple envelope to material.3. For enclosures, paper clip to letter.Checks received should be paper clipped to statements and referred to AP. If a statement or invoice does not include a check, attach envelope to aid in identifying.For time saving, open all envelopes at once with opener rather than laying opener down and pulling materials out of each envelope.Attempt to sort mail in this fashion:Insurance and patient checks together.Personal mail together.Professional correspondence and 1st class letters together.Other professional bulletins, newsletters and announcements.Journals and magazines.Advertising brochures & literature.FacsimilesFaxes are to be removed, date stamped and filed in the patient chart or delivered to the appropriate department in a timely manner.Outgoing faxes are to be date stamped.PostageThe postage meter is for business use only.Items are to be weighed for the proper postage amount.PurchasingThe nurses/medical assistants shall be responsible for presenting medical equipment and supply needs to the Practice Administrator.The Practice Administrator shall serve as Purchasing Officer and be responsible for all procurements and inventory of supplies/equipment with physician approval.All incoming supplies and or equipment will be checked at the time of delivery for condition, quantity delivered, damage, price and verification that what was ordered was the item(s) actually received. This will be verified and forwarded on to the Practice Administrator for comparison with the invoice making certain quantity and prices are accurate.All invoices should be checked against receiving reports.Invoices for payment shall be examined by the Practice Administrator.Purchases for employees are prohibited.Minor items costing less than $25.00 may be purchased using Petty Cash funds. Requests for petty cash are made through the Practice Administrator.Furniture and EquipmentA current inventory will be maintained on each item of office furniture and equipment.Some mechanical equipment requires specialized knowledge of its operation and staff members who have difficulty in using such machines should ask for assistance and instructions to avoid waste of time and materials and possible damage to equipment.A list will be maintained in a file listing each office machine, equipment, and furniture. The list will include the description of item, manufacturer, serial number, date of purchase, estimated cost and location.An inventory will be conducted once a year, of all furniture and equipment, at which time any equipment particularly in need of repair or cleaning will be handled. This inventory should agree with the prior year’s inventory plus the current year’s purchases and disposals. Any discrepancies must be reported and accounted for, if possible.Any equipment which changes from one facility to another requires notification to the Practice Administrator so the inventory sheet can be changed. This should be done in writing, noting condition of the equipment.Depreciation of assets is done according to generally accepted accounting principles and proper depreciation schedules are maintained.Medical office equipment of instruments may not be used by employees for personal reasons for themselves or their families, unless authorized to do so by the Practice Administrator.No equipment, documents, records or other property belonging to the practice shall be removed from the premises by an employee without first obtaining permission from the Practice Administrator or physician. In addition, no work shall be performed at home or other place off the premises by any employee unless permission is first obtained from the Practice Administrator.Business Expenses and TravelTravel involving overnight stays out of the city must have prior approval of the Practice Administrator. Conference expenses must be approved in advance and all expense reports must include receipts from hotel, transportation where reasonable, and other major cost items.If the performance of your job necessitates traveling from the office, either to a hospital or elsewhere, your mileage costs will be reimbursed at fixed rate, currently 50 cents per mile. Any other expenses will have to be discussed with the Practice Administrator prior to your incurring them. No reimbursement will be made for mileage to and from work.Staff members required touse public transportation such as taxis, airlines, or buses for business reasons will be reimbursed for the full cost of the trip.Staff members attending out-of-town meetings relating to medical office business at which meals are not served, will receive reimbursement. Meals are limited to $10 for lunch and $25 for dinner. Total not to exceed $35 per day.The Practice Administrator may authorize membership of staff members in civic, professional and other community organizations for purposes of public relations and/or medical office representation. Individual memberships must be paid by the affected employee.Patient RelationsEvery member of the office staff needs to be courteous, friendly, and helpful in the attention accorded patients and their relatives. If at times their demands seem unreasonable, remember that they are ill or worried and undergoing an experience that may be most trying. What is involved may seem trivial to you but to them it may be of vital concern at the moment.Be tactful in relaying or discussing any information concerning patients. Handle these details in a professional and diplomatic manner so that there will be no embarrassment to the patient. Please keep your voice low especially at reception areas and do not discuss any personal topics within the hearing distance of patients. By all means, avoid thinking of the patients in terms of cases or registration numbers. They are individual human beings who need your help and the help of all of the people in the office. By doing your best for them you will reflect credit on yourself and on the office. Be alert and willing to extend your services at all times.All patients are to be treated with courtesy and respect. Employees are expected to be tactful at all times and to render as much assistance as required to satisfactorily serve the patient. All adult patients are to be addressed as “Mr.,” “Mrs.,” “Miss.” No patient should ever have cause to complain of an employee’s attitude or conduct.Billing and CollectingThe policy of this office is to make every effort possible to obtain payment at the time of service.I. Daily Charges and Cash ReceiptsDaily Transaction SystemThe daily transaction system serves as the permanent record of all financial and patient information of each day and shall consist of three basis components:Billing Encounter SlipThis serves as a bill for any balance due, insurance coverage, receipt for any payment paid, and as a reminder of the patient’s next appointment.This form is attached to the patient’s file, which is given to the doctor.The physician writes down what has been done and gives the file to the receptionist. The medical assistant makes sure all lab and diagnostic procedures are marked on the encounter slip.The billing clerk enters the total charges into the computer or on the day sheet. The original encounter slip is retained by the office and is scanned later as a .pdf file into the main server.Account RecordEach patient shall have a computer account record.It should be maintained in the name of the party responsible for payment and all charges to that party are posted on it. This shall serve as the complete and permanent record of all charges, payments, and adjustments.It includes insurance coverage, telephone number, the names of other family members, and columns or entry lines for posting charges and payments.Daily Record of Charges & ReceiptsThe daily posting to the computer shall serve as the permanent record of daily charges, and cash receipts associated with patient services on a given date.Service codes, payment codes, and adjustment codes will be specified in the computer or in written policy.The daily deposits and computer payment report should agree with the total bank deposit for that day.Instances arise when adjustments have to be made to an individual’s account. The amount of the adjustment must be accomplished by a code describing the adjustment. Explanation of benefits remittances and EFT’s are recorded in the computer with the date the payment is deposited into the bank account.When it is necessary to adjust a patient’s account for an incorrect amount or a check returned by the bank, the adjustment must be made on both the day sheet and the ledger card or computer. The adjustment (entered in the charge adjustment column) will be an increase to the account, or if entered in the credit adjust column it will be a decrease to the account.When all means of collection have been pursued by the office and it is necessary to turn a patient’s account over to a collection agency, the balance due by the patient should be written off. This is recorded in the same manner as a credit adjustment. Any subsequent payments should be entered on the day sheet and ledger card or computer as an adjusted charge and payment on the day received,DepositsDaily payments from patients are recorded on a separate deposit ticket each day. This deposit ticket must always be exactly the same as the amount, which appears in the “received on account” column of the day sheet or receipts on the computer program.Deposit TicketsBank deposit slips are filled out in duplicate.One copy goes to the bank with the money.One copy stays in the deposit slip book for record.Patient StatementsIf the patient account is still open and not paid in full, statements are generated every Monday for patients who have not been billed in the last 28 days and processed electronically.If, at the end of the 60 days, the bill is not paid and there is no response, then a second statement is send with a statement note of (PAST DUE.) At the end of 90 days if bill is not paid:Computer entry is made showing turned over for collection.A warning letter is sent with billing statement giving seven (7) days to respond.If no response or payment then account is sent to collection agency for collection action. No further action is taken by receptionist or billings secretary at the office regarding the account. If determined that collection agency handling and/or alternative letters and communications are unsuccessful then determination is made as to other alternatives - legal action, small claims court, etc. The Practice Administrator and physicians shall be consulted with regard to initiation of such legal action.A copy of each claim submitted is retained by the insurance clerk for follow-up by placing it in a monthly folder.If after 45 days payment has not been received, the insurance clerk sends a statement to the patient informing them that payment has not been received and they should check on the claim.If after 30 days no payment or response has been received, the insurance clerk phones the insurance carrier; giving the patient name, I.D. number, and date claim was filed. If no response after two weeks, a copy of the claim form with a memo requesting status is mailed to insurance carrier.Persons who are able to pay for services and refuse may be denied services.Denial of services may be made only after a careful review has determined a person’s ability to pay all or part of the debt, and only if the individual has received at least two notices of overdue payments and has been given at least 60 days from the second notice to make full or partial payment to the extent the person has been judged capable of paying.All persons, including those with delinquent accounts, will be given emergency and urgent health care. Only care that is not emergency or acute may be denied, and only upon a determination by the physician that the care is not emergency or urgent. It is important that the physician is notified, therefore he/she can send a certified registered letter to the patient notifying them that their care under his/her service is being discontinued and they have two weeks to find another physician.Process insurance claims as follows:Submit insurance claim forms at least three times a week to include all claims 30 days or older that have not been paid. Electronic MedicalClaims processing should be utilized when possible.When insurance payment received, review account to check for correct reimbursement.Pull copy of claim form from filing system and attach to EOB (Explanation of Benefits). File claim copy and EOB in alphabetical order.If secondary insurance applies, attach copy of EOB to secondary insurance original form. Repeat steps 1-5, filing the secondary insurance form under the date the claim form is submitted to the insurance carrier.After 30 days, print an insurance claim status report that gives aging and financial classification.On unpaid claims, contact insurance carrier to determine status. If claim not received, resubmit. Mail copy of claim forms and place in insurance tracer file system labeled “Re-submissions”.When a response is received from the carrier, post a payment or denial.Notify patient if insurance payment denied and request payment from patient. Hardship CasesBy law, all patients are expected to their co-pays, co-insurances, deductibles and amounts approved but not paid by their insurances companies. We recognize that some patients may struggle paying their bills for reasons out of their control. For patients who have lost their jobs, insurance or are at certain income levels, we offer a Hardship Plan to assist patients with paying their bill.In order for patients to qualify for these discounts, they must bring in the following information to be approved by the Practice Administrator. Failure to supply this information will disqualify them for the assistance plan.Recent original copy of all pay, retirement and/or disability check stubs.Last 2 years tax returns with W-2 forms.Last 2 months bank statement.Self-Pay PatientsYearly IncomeDiscount from billed chargesLess than $15,00080%$15,001 to $25,00070%$25,001 to $50,00060%$50,001 to $75,00050%Over $75,00140%Indigent-Low Income PatientsYearly IncomeCo-Pay, Co-Insurance or Deductible DiscountLess than $10,00090%$10,001 to $20,00080%Standards of Patient ServiceAcknowledge patients promptly and courteously with eye contact and a pleasant expression and tone of voice.Use words that express respect, patience, and understanding when talking with patients and/or other employees.Care for people with kindness and gentleness, rather than with roughness and cold professionalism.Address adult patients by their proper title and last name, unless the patient requests otherwise.Display visible identification and introduce yourself by name and title when first meeting a patient.Answer the telephone quickly and courteously and identify yourself by name. Provide callers the opportunity to respond to a request to be placed on hold, and explain if their call is being transferred.Be sensitive to reducing noise levels near patient care areas.Respect patient privacy by knocking before entering a patient room if the door is closed, and by refraining from discussing one patient in front of another.Protect the confidentiality of patients, co-workers, and others who use our facilities.Make certain that patient modesty is respected at all times.Be attentive to patients and their families who are kept waiting in waiting areas or treatment rooms for extended periods of time.Consider the effects of what they say and do in the presence of patients. Refrain from conducting personal (not work-related) conversations in front of patients.Refrain from discussing other employees, organizational policies, problems, or medical care in public areas.Maintain and use medical equipment and facilities in an appropriate and cost- effective manner.Profit Sharing/Pension/SavingsIn an effort to provide some financial security at the time of retirement, the practice has a 401K plan, pension plan, deferred compensation plan and a profit sharing plan for eligible employees. If you are a full-time permanent employee and have completed 12 months of continuous full-time employment you are eligible to participate. Out of “net income” or “profits” the practice will contribute a certain percentage of your annual salary. The percentage will be the same for all employees and will be determined by profit performance and applicable federal regulations governing tax-sheltered retirement programs. These contributions are NOT DEDUCTIONS from your salary, but are excess deferred income for your benefit. As a participant you may contribute your own funds to the trust for each fiscal year during which you are a participant in an amount not to exceed ten percent (10%) of your compensation for such fiscal year. This money is kept separate from the employer-contributed funds and a separate accounting of it is presented to you annually. You are not required to contribute any amount during any fiscal year; however, should you contribute, you may discontinue at any time.If you should terminate your employment after you have become an eligible participant the following vesting schedule in employer-contributed funds will prevail:Full Years of Continuous Service Percentage of InterestAs a Participant Vested1 year of service10%2 years of service20%3 years of service30%4 years of service40%5 years of service50%6 years of service60%Any amounts you should forfeit by reason of your failure to vest shall be allocated among the employer-contributed accounts of the remaining participants. An employee-contributed account shall be fully vested in the participant at all times. Withdrawals of employee-contributed funds can be made upon 30 days written notice prior to the annual valuation. In no event shall a participant who has contributed to the Trust Fund withdraw any of the interest, earnings, income or other increments arising with respect to such contribution or contributions prior to the distribution of his employee-contributed account.When you are an eligible participant you will be presented an accounting of the annual contribution made in your behalf and the status of your share at each valuation date. These contributions are entirely separate from the Social Security contributions, which the clinic also makes for you. Accidents & EmergenciesAny accident of any nature, which occurs on the premises, which involves employees or patients, must be reported immediately to the Practice Administrator. A complete written record of the occurrence, including the time, place, circumstances, names of persons involved, and the names of witnesses, if any, should be made.Accidents specifically include:Injuries sustained by an employee or any patient on the premises.2. Occurrences involving the use of an automobile while driven by an employee on the business of the practice.3. Any incident which could remotely be associated with malpractice, including any complaint made by a patient or his representative.It cannot be too greatly emphasized that all accidents must be reported, no matter how slight the injury or damage might seem to be, or who was responsible for the occurrence.In connection with accidents involving employees, the practice is insured under the Workers’ Compensation Act. Under the terms of this insurance, accidents and injuries must be reported promptly to the insurance company in order to benefit from the coverage.All employees must help prevent and eliminate conditions that could cause safety or security problems. Safe practices are essential to the well being of everyone in the office.In the case of fire, call the fire department and direct patients and employees away from the danger area to the nearest exit. Try to extinguish the fire with the available extinguishers located throughout the building.All employees are to be concerned about safeguarding the premises. Outside doors are to be kept locked during non-business hours.Employees must also question people within the office who do not appear to be patients. Personal articles and the money received by the practice must be secured at all times.Job DescriptionsPractice AdministratorDUTIES AND RESPONSIBILITIES:Evaluates and maintains all professional standards, policies and procedures of practice.Analyzes practice expenses and takes corrective action as needed.Prepares financial and operational reports.Prepares budget and outlines plans, goods and objectives for physicians’ review.Oversees financial and accounting policies.Monitors insurance plan participation.Reviews staffing needs, monitors employee performance and all personnel matters.Manages quality control standards established by physicians.Conducts employee and physician meetings.Works with attorney, accountant and other professional services.Reviews all practice contracts and makes recommendations to physicians.Monitors overall facility maintenance.Monitors fee schedule.Evaluates billing, collecting, and reimbursement policies.Monitors patient relations and patient satisfaction.Other responsibilities as assigned by the physicians.QUALIFICATIONS:Thorough knowledge of medical office operations.Knowledge of billing systems.Ability to interpret and supervise business policies of practice.Special ability to communicate well with staff, physicians and general public.PERSONAL QUALITIES:Neatness and friendly appearance.Good organizational and strong communication skills with the ability to interact with a variety of persons.Must be understanding, courteous and professional at all times in contacts with patients, visitors, employees, and medical staff. OTHER SPECIAL CONDITIONS:Must be able to communicate with a variety of persons – physicians, accounts, attorney, clinical staff, business office personnel, insurance companies, office suppliers and patients. 2. Some work times require after hours.SUPERVISORY RELATIONSHIPReports to directors of corporation and/or physicians.Front Office Check OutDUTIES AND RESPONSIBILITIES:Greets patients and visitors in a courteous and friendly manner.Screen calls, arranges appointments and referrals.Prepares new records, re-files, and maintains records.Types correspondence, reports, memos, and forms.Some transcription of medical notes.Performs billing and bookkeeping functions including collecting cash payments, posting and balancing daily sheets of transactions, bank deposits.Prepares and mails statements and third party claims.QUALIFICATIONS:Previous medical receptionist experience or background in general office work preferred.Ability to comprehend established office routines and policies.Learns quickly from oral and written instructions.Ability to keep financial records and performs mathematical tasks.Knowledge of medical terminology.Understand the ethics of confidentiality.Good organization skills and good health.Tact and diplomacy.Previous public contact work.PERSONAL QUALITIES:Able to work well under pressure.Ability to communicate well with people in personal contacts and on the phone.Can be trusted with confidential information.Can effectively act as a liaison between patients and physicians.Must have a neat and friendly appearance.OTHER SPECIAL CONDITIONS:Any other duties relating to the business operation of the medical practice that may be assigned by the physician or Practice Administrator.SUPERVISORY RELATIONSHIP:Reports to Board of Directors.Billing Office ManagerDUTIES AND RESPONSIBILITIES:Submit HCFA claim forms and other carrier forms for insurance reimbursement.Process claims by matching correct procedural and diagnostic codes.Review EOB statements and resubmit as necessary.Review payments of carriers and submit appeals for further claim review when applicable.Handle all matters related to claim rejection.Enter appropriate up to date information in computer billing system.Review in-office encounter forms for listing of all procedures and services performed for patients and clarify with staff as needed.Maintain comprehensive up to date listing of insurance carrier contacts and claims processing persons.Keep all insurance reference materials, manuals and forms organized.Review regularly all bulletins and correspondence from carriers for up to date changes and keep for easy reference.Attend continuing education programs related to coding and reimbursement.Work with carriers through electronics claims processing.Adhere to all billing requirements of Medicare, Medicaid, managed care plans, commercial carriers, worker’s compensation and other government programs.Assist in educating physicians and staff in requirements of documentation for proper reimbursement.QUALIFICATIONS:Experience in medical office working with insurance claims processing involving CPT, HCPCS, ICD-9 CM and HCFA regulations.Familiarity with HCFA 1500 claim form completion.Strong analytical, oral and written communication skill.Accreditation/certification by American Academy of Professional Coders preferred.PERSONAL QUALITIES:Ability to communicate well with people both in personal contacts and on the phone.Can effectively promote feeling of cooperation and concern in dealings with patients, employers and insurance companies.OTHER SPECIAL CONDITIONS:Any other duties relating to the service of patients at “Practice Name” that may be assigned by the physician or Practice Administrator.SUPERVISORY RELATIONSHIP:Reports to Practice Administrator.Front Office Check InDUTIES AND RESPONSIBILITIES:Make patients feel comfortable and welcomed in this office.Obtain necessary information in a courteous manner in order to register a new patient property.Becomes aware of any credit problem involving a new patient and screens in a professional, courteous way.Registers patients and states amount of deposit required.Prepares charts, and encounter form for new patients.Prepares paper work for proper information on all compensation cases and sees that this information is received in the correct department.Checks in Medicaid patients by obtaining their state ID number and other information.Sets up new accounts, changes information, etc. on the master file.Performs any other duties as assigned by supervisor.QUALIFICATIONS:High school graduate.Typing skills.Three months on-the-job training.Previous hospital admitting or medical reception experience and background preferred.Previous public relations work.PERSONAL QUALITIES:Interest in peopleTact and diplomacyPleasant personality.OTHER SPECIAL CONDITIONS:Any other duties relating to the service of patients at “Practice Name” that may be assigned by the physician or Practice Administrator.SUPERVISORY RELATIONSHIP:Reports business matters on office operations and services to Practice Administrator. Receives supervision and specific directions on medical problems from physicians.Insurance SecretaryDUTIES AND RESPONSIBILITIESAccepts insurance claim information from patients and arranges for completion of insurance forms.Mails completed forms to patient or insurance company.Counsels patients on claims processing.Handles phone inquiries from patients and insurance companies and writes letters necessary for collection.May substitute on front reception desk.QUALIFICATIONS:Previous medical insurance processing experience.Ability to comprehend established office routines and policies.Typing skills.Knowledge of medical terminology.PERSONAL QUALITIES:Ability to communicate well with people both in personal contacts and on the phones.Can effectively promote feeling of cooperation and concern in dealings with patients, employers and insurance companies.OTHER SPECIAL CONDITIONS:Any other duties relating to the business operation of the medical practice that may be assigned by the physician or Practice Administrator.SUPERVISORY RELATIONSHIP:Reports to Practice Administrator.File ClerkDUTIES AND RESPONSIBILITIES:Keep medical charts filed in appropriate location.Retrieves medical charts from business and clinical areas as needed.Distributes incoming reports and correspondence and files in patient charts or presents to professional staff.Copies medical information as requested.Pulls charts as requested.Keep charts orderly in accordance with Medical Record Policy.QUALIFICATIONS:Good organization skills.Able to sort and file materials.Must be able to read and understand oral and written directions.PERSONAL QUALITIES:Ability to work with physicians, business and clinical staff.Good eyesight and manual dexterity.OTHER SPECIAL CONDITIONS:May be requested to assist front office employees in miscellaneous administrative tasks.SUPERVISORY RELATIONSHIP:Reports to Practice Administrator.Infusion RNDUTIES AND RESPONSIBILITIES:Assist the physicians with patients.Prepares patients and the examination rooms.Takes initial medical history for the chart.Takes vital signs.Makes lab and x-ray appointments and explains the preparation to the patients.Assist physician in all special procedures, including minor surgery, as required.Remove sutures, clean wounds and applies dressings as directed by physician.May be responsible for notifying patients of lab results.Give allergy shots, immunizations and medications prescribed by the doctor. Lab work consisting of throat cultures, hematocrits, U/A stix, and preparations for microscope. Wash and dry instruments used and prepare sterilization as required. Receive and handle phone calls as directed by physician. Responsible for some patient education, completing physical forms and referral arrangements. Assist in keeping large volume and variety of medical records in accordance to office procedures. File lab reports, check medical supplies, and see drug and other salesmen. Keep exam and treatments room clean and properly locked with supplies.Abides by Policies and Procedures Infusion Department Manual.QUALIFICATIONS:State nursing license.Previous demonstrated nursing experience. PERSONAL QUALITIES:Patient, courteous and tactful with neat and friendly appearance. Ability to communicate and relate well with physicians and other clinical staff.Must be efficient and conscientious in delivering medical car services to patients.Must have awareness of patient confidentiality and be able to follow directions well from physician.OTHER SPECIAL CONDITIONS:Reports to the physician regarding medical problems, treatment and diagnosis, and follows medical directions given by the physician. Must have awareness of patient confidentiality and be able to follow directions well from physicians.SUPERVISORY RELATIONSHIPReports to the physician regarding medical problems, treatment diagnosis, and follows medical directions given by the physician. Reports to Practice Administrator regarding business and administrative matters that deal with the operation of the office.Medical AssistantDUTIES AND RESPONSIBILITIES:When following or filling in for doctorPerforms nursing procedures under supervision of doctor.Assists doctor in examinations.Gives instructions to patients as instructed by doctor.Takes blood pressure, pulse, temperature and respiration.Assists with any procedures that have been taught through formal training or by licensed nurse or physician.Check all medicines on patientWrite prescriptions for doctorsChief complaintFill out labs for doctors if neededAssist doctor when neededReturn ALL calls to patients same dayWhen you are an extra nurse with no doctor to followTry to be here between the hours of 9 and 3AVAILABILITY ON DAYS OFFTake messages for all doctorsHelp with call backs and schedulingGet caught up on prior authorizationsClean and stock roomsHelp with filing of charts and office notesHelp with laundry (wash, dry, fold etc,)Stock medical supply closet downstairsKeep up with ordering supplies upstairs Return ALL calls to patients same dayQUALIFICATIONS:Possesses willingness to accept orders and to perform repetitive tasks.Loyal in matters relating to the office.Has awareness of the need for discretion and keeping confident matters relating to the patients and their problems.Previously demonstrated performance in a medical environment.PERSONAL QUALITIES:Mentally alert, in good physical health.Patient, courteous and tactful with neat and friendly appearance.Ability to communicate and relate well with physicians and other office staff.Must be able to follow direction well from physicians, nurse and Practice Administrator.OTHER SPECIAL CONDITIONS:As required by physician, individual is expected to attend some classes that educate and improve medical service skills.Must be willing to serve emergency situations during off hours if directed by physician. May be requested to substitute for other office responsibilities of receptionist. Any other assigned duties by physician or Practice Administrator.SUPERVISORY RELATIONSHIP:Reports to the physician regarding medical problems. Reports to Practice Administrator regarding business matters.X-ray TechnicianDUTIES AND RESPONSIBILITIES:Responsible for carrying out x-ray and DEXA procedures as ordered by physicians.Helps prepare patient for x-ray and DEXA and reports results on necessary forms.Responsible for processing film, sorting and filing.Checks x-ray supplies and maintains equipment to the best of his/her ability.Advises supervisor and medical staff of any problems with x-ray procedures, efficiency, safety and overall service.QUALIFICATIONS:Skills in x-ray technology.Certified radiology technician.Familiarity with modern diagnostic x-ray systems.PERSONAL QUALITIES:Neat and friendly appearance.Must work well with patients and medical staff.OTHER SPECIAL CONDITIONS:Any other duties relating to the service of patients at medical office that may be assigned by the physician or Practice Administrator.SUPERVISORY RELATIONSHIPReports business matters on office operations and services to Practice Administrator. Receives supervision and specific directions on medical problems from physicians.SecurityThe computer system of the office is protected using a password system. Only employees whose job duties require computer access will be assigned a password and given access to the computer system. Employees are specifically prohibited from providing their password to any other individual or allowing another individual access to the computer system through their password in any manner.When employees with computer access have completed their work on the computer, or when they leave their assigned work area, the terminal must be logged out or closed to prevent unauthorized rmation contained in the computer will be backed up each night. The backup tapes will be stored in an area separate from the computer system to ensure that data are not corrupted, compromised or destroyed in the event of a disaster.All software in the computer system is the property of the practice and will not be copied for individual use. The practice considers all information within its computer software to be a trade secret, and the unauthorized transmission, copying or use of that information is a criminal offense and is a violation of copyright laws. Any employee found to have copied, duplicated or transmitted such software or information will be subject to disciplinary action, up to and including termination or employment and/or criminal or civil prosecution.All monies and checks received via patient or mail transaction by an assigned employee are the responsibility of that employee to ensure they are maintained in a secure place. All monies and checks not pick up by the bank courier are to be placed in the safe before the employee leaves for the day.Avoiding theft is the responsibility of all employees. The practice cannot be responsible for employees’ personal effects. Purses and pocketbooks are not to be left in unlocked cabinets, on desks or in open drawers. Employees are encouraged to lock up their valuable and carry money on their person. The security of patient valuables is the primary responsibility of the patient.Articles of any kind left in treatment rooms or found in or around the office must be turned into the administrator/Practice Administrator, where they can be claimed by the owner upon proper identification. If lost and found items are fully identifiable, all reasonable efforts will be taken to contact the owner and return the items. All items will be kept for a period of six (6) months to allow adequate time for a claim to be made. If no one claims an item after six(6) months, it will be disposed of by the administrator/Practice Administrator.HIPAA Policies & ProceduresCompliance with the Health Insurance Portability and Accountability ActPOLICY: “Practice Name” will comply with the Health Insurance Portability and Accountability Act (HIPAA) in all aspects required of health care providers.PROCEDURE: Section I -- With regard to electronic transmissions of protected health information, “Practice Name” will utilize only software programmed to operate in accord with standards developed to comply with the requirements of HIPAA. The format of these programs will include compliance with the following standards:ASC X12N 837 - Health Care Claim, Professional Version 4010ASC X12N 278 - Health Care Services Review -- Request for Review and Response Version 4010ASC X12N 276 - Health Care Claim Status Requests Version 4010ASC X12N 270 - Health Care Eligibility, Coverage, or Benefit Inquiry Version 4010Software vendors whose products are used in “Practice Name” will be required to sign an affidavit to the effect that their software complies with the stipulations above. Signed affidavits will be kept as an appendix to this manual in Section III: Signed AgreementsSection II - With regard to protection of privacy of protected health information at “Practice Name” , whether stored electronically or on paper, “Practice Name” has enacted a wide range of policies which can be found within the HIPAA Policy and Procedures Manual and which will be used to train staff to understand the limitations placed upon the use and sharing of protected health information. Affidavit(s) attesting to the provision of this training can also be found in the HIPAA Policy and Procedures Manual.The Privacy OfficerPOLICY: A medical office staff member will be appointed Privacy Officer. The Privacy Officer’s duty will be to ensure that no patient’s medical or financial information beyond the minimum amount of information necessary under the circumstances will be disclosed to any person.PROCEDURE: To ensure minimal exposure of patient records, a Privacy Officer has been named to be responsible for oversight of exposure. The Privacy Officer’s name and position in “Practice Name” are: “ Name” and “ Name”To ensure minimal exposure of protected health information (PHI), the Privacy Officer will:Assign levels of access to specific job descriptions that will recognize the need for routine handling of PHI by persons holding those jobs. These levels of access will specify the kinds of PHI to which persons holding those jobs will be allowed access. Unauthorized access to levels beyond those allowed under this authorization will be cause for dismissal from employment.Create and enforce policies and procedures designed to control access to PHI by persons and entities outside “Practice Name”.Review all non-routine requests for use and disclosure of PHI which are received from anyone -- other than providers employed by this medical office or referred health care providers needing information for treatment purposes -- to ensure that appropriate consent or authorization is supplied and that staff supply no more than the information necessary to fulfill the request.Develop and store agreements with outside entities performing duties on behalf of “Practice Name” whose duties require that they have access to PHI.Identifying Protected Health InformationPOLICY: All staff of “Practice Name” will be trained to understand the definition of “protected health information” (PHI) and to guard against unauthorized use or disclosure of PHI.PROCEDURE: To be PHI, information must be individually identifiable. This means that a reviewer of the information would be able to tell which patient the information belongs to. Here is the definition of PHI: Protected health information is any “individually identifiable health information” that is transmitted or maintained in any form or medium. Individually identifiable health information includes any information about the health care of an individual including payment information, which is identified as being related to that individual or which provides enough specific information that someone reading the information could identify the individual.To be individually identifiable, health care information must include at least one or a combination of the following:NameGeographic subdivisions including: street address, city, county, precinct, zip code and equivalent geocodes.Dates, other than year, directly related to an individual such as birth date, admission date, discharge date, date of death. (Ages and date elements may be aggregated into a single category of age 90 or older.)Telephone numbersFax numbersElectronic mail addressesSocial Security numbersMedical record numbersHealth plan beneficiary numbersAccount numbersCertificate/license numbersVehicle identifiers and serial numbers including license plate numbersDevice identifiers and serial numbersWeb Universal Resource LocatorsInternet Protocol address numbersBiometric identifiers such as finger and voiceprintsFull-face photographic images, drawings, etc.Any and all other identifying characteristics, numbers, etc.All individually identifiable health care information that relates to a person’s health or payment for health related services is PHI. This includes any information having to do with treatment, payment or health care operations. Health care operations mean administrative actions, which use health care information. This would include quality assessment review of medical records and data compilation for program development.Recognizing Types of Protected Health InformationPOLICY: Types of protected health information (PHI) will be identified to facilitate staff training and adequate control of information.PROCEDURE: Types of information classed as PHI are divided into two general groups:rmation that identifies the patient, including:A.The medical record jacketB.Copies of insurance cardsC.The patient’s registration information whether on paper or stored electronicallyD.All treatment and diagnosis related materials stored in the patient’s medical record which include the patient’s name or identifying number(s)E.The patient’s accounts receivable recordsF.The patient’s billing recordsG.Demographic information such as age, gender, address, zip code, or telephone number H.Patient’s family rmation related to the patient’s health status, includingA.Progress notesB.Reports of diagnostic tests or treatment processesC.Health care problemsD.MedicationsE.Diagnoses F.Time of a specific patient’s presence in “Practice Name” G.PrescriptionsH.Referrals -- dates, name of referring provider, specialty of referring provider, etc.I.Frequency of patient visits to “Practice Name” Common uses of PHI include billing for payment, informing other providers involved in the patient’s care, and disclosing the information to outside entities only when appropriate. The following policy states the circumstances under which PHI must be disclosed and the process by which such disclosure must occur. Appropriate Disclosure of Protected Health InformationPOLICY:“Practice Name” staff will disclose protected health information (PHI) to outside entities only under one or a combination of three specific circumstances: when required by law, when an individual asks for his or her own PHI (except as stipulated below), or when required by the HHS Secretary. Such disclosure is subject to the limitations of Section 164.512(f)(2) of the Privacy Rule.PROCEDURE: No protected health information (PHI) will be released by any staff member unless appropriate authorization is received and on file. Appropriate authorization may include:1.Signed consent or authorization by the patient who is requesting his/her own PHI or that of a person for whom the signer is legally authorized to act as agent. (Such documents must become a part of the patient’s medical record.)2.Disclosure is required by state or federal law. This occurs with regard to required disclosure when a health care provider becomes aware of the probability of the commission of a crime, child abuse or neglect, or domestic violence. (Notice of action must be included in progress notes in the patient’s medical record.) It also occurs regarding requirements for reportable diseases. (Reporting a required reportable disease does not require permission from the patient.)3.Order from a court or administrative tribunal by subpoena, court order, court-ordered warrant, summons issued by a judicial officer, civil or authorized investigative demand or similar process authorized by law. (See attendant form for inclusion in medical record.)4.A law enforcement request for identification and location purposes. Staff members may disclose limited identifying information to help identify a suspect, fugitive, material witness or missing person. Such information may include: name, address, Social Security number, date of birth, place of birth, type of injury or other distinguishing characteristic, as well as date and time of treatment. (See attendant form for inclusion in medical record.)5.A law enforcement request for PHI representing that: a) the information is needed to determine whether a person other than the victim violated the law, or b) immediate action by law enforcement depends on obtaining the information. (See attendant form for inclusion in medical record.)6.A circumstance wherein a staff member treats a patient in a medical emergency in which it appears necessary to alert law enforcement to: a) the commission of a crime, b) the location of the crime or of the victim(s) of the crime, and c) the location, identity and/or description of the perpetrator of the crime.Handling Requests for Disclosure of Protected Health InformationPOLICY: Before disclosing protected health care information in response to a request, staff members will verify the legitimacy of the request.PROCEDURE: When a request for protected health information is received, staff will take reasonable action to ensure that the request for information is valid. When patients request their own PHI, staff fulfilling the request must:1.Already know the patient, or2.Obtain a copy of the patient’s driver’s license or other official identifying information and include that copy in the patient’s medical record, and3.Always include in the patient’s medical record a request form signed by the patient.When a person requests another person’s PHI, staff fulfilling the request must: 1.In the case of a parent requesting a minor child’s PHI, obtain and include in the patient’s medical record a request form signed by the parent, or2.In the case of a legal guardian requesting a patient’s PHI, obtain and include in the patient’s medical record a request form signed by the guardian and some legal documentation of the person’s status as guardian. If no such document is available, staff must have personal knowledge of the guardian’s legal status or verify that status by contacting the entity which the guardian states granted him or her that status and then enter that information into the patient’s medical record in the form of a progress note signed and dated by the staff member.When a law enforcement officer or officer of the court presents a subpoena for or requests protected health information about a patient, staff must:1.Notify the Privacy Officer who will verify the validity of the request before instructing staff whether to fulfill or refuse the request.Staff should always remember that a request for an entire medical record is an extremely rare occurrence. A request for a complete medical record should not be honored until the Privacy Officer has been notified of and reviewed the request, then approved the release.Business AssociatesPOLICY: “Practice Name” recognizes as “business associates” entities outside “Practice Name” with which “Practice Name” does business and who might, from time to time, need access to certain protected health information (PHI) in order to adequately fulfill their role.PROCEDURE: Any time “Practice Name” enters into a business relationship with a new entity whose duties will require them to have access to PHI, the staff member who is working directly with the new business will notify the Privacy Officer. The Privacy Officer will interview the representative of the new business. Upon determining that access to PHI is necessary to performance of duties, the Privacy Officer will give the representative a copy of a Protection of Privacy Agreement and require that the representative sign the agreement on behalf of the entity or obtain the signature of an authorized company representative before granting access to PHI.Business associates entering into a Protection of Privacy Agreement, will also receive an attachment to that agreement which will clearly identify the nature and extent of PHI to which the associate will be granted access. If a written contract for services exists between the two entities, the signed Protection of Privacy Agreement and its attachment will be attached to the contract as an addendum and will be stored in the Privacy Officer’s Privacy Protection file. If no contract exists between the two entities, the agreement and attachment alone will be stored in the Privacy Officer’s Privacy Protection file.Notifying Patients of Disclosure of Protected Health InformationPOLICY: The involved patient must be notified of any disclosure of their health care information except when such disclosure is required by law or as described in the procedure below.PROCEDURE: The involved patient or patient’s guardian must be notified of disclosure of PHI if:1.The patient is the victim of abuse, neglect or domestic violence unlessa) the provider believes that informing the patient would put him/her at risk of serious harm, orb)the provider believes that the patient’s guardian is the source of the abuse, neglect or violence and that informing the guardian would not be in the patient’s best interest.The rule of thumb is -- unless the law requires disclosure, the patient must be aware of disclosure.Authorization for Disclosure of Protected Health InformationPOLICY: No protected health information (PHI) will be disclosed by any staff member to any other person without legal authorization.PROCEDURE: In the case of legally required disclosure, staff will follow verification policies and procedures in the process of releasing or refusing to release PHI. In the case of patient, patient guardian, or other requests for PHI, staff will obtain one of three types of authorization as detailed below.1.Verbal Agreement -- Verbal agreement provides acceptable authorization of PHI for release of PHI to friends or family members involved in the individual’s care. Such agreement should be documented in progress notes.In cases where a provider relates health care information to a patient’s family or friends when the patient is unable to provide verbal agreement, the provider may assume that agreement exists if, in his or her professional judgment, the persons to whom he or she relates the information is validly involved in the well-being of the patient and the disclosure of the information poses no threat to the health or privacy rights of the patient. Such disclosure will be limited to information related to the presenting problem and will not include other, unrelated health care information.Patients may also consent verbally to allowing a third party to handle payment of accounts due. In this case, no interaction may be taken until such verbal authorization is given, but subsequently, the staff may discuss and accept payment arrangements with that person until and unless the patient gives notice that the relationship is no longer valid.Providers also may contact a patient’s family members or friends to notify them of a patient’s location, condition or death if the patient has involved them in prior care in any way.All such disclosures must be documented in the patient’s medical record. A progress note dated and signed is an appropriate means of doing so. Suggested content of such notes include: a) Informed patient’s friend (Name) of his present condition at the request of patient, or b) Informed patient’s friends and family of his condition even though he is unconscious.The patient should be made aware of this disclosure as soon as he or she is capable of understanding.Written Consent -- It is not necessary to obtain consent with regard to the use and disclosure of PHI for the practice’s treatment, payment and operational purposes within the practice. If a written consent form is obtained for any purpose including for the practice’s treatment, payment and operational purposes within the practice or for marketing, research or other purposes within the practice, that consent will suffice for all future contacts with the patient. Another consent form would be needed only if the patient has revoked his/her consent between visits.SPECIAL NOTE: All staff handling consent issues must be aware that the written consent obtained in accord with this policy relates only to uses of PHI inside the practice. If the patient is referred outside the practice, a specific release authorization must be obtained and kept on file related to that referral.For this purpose, one of the following forms will be used in all referrals:1)“Consent to Release Protected Health Information”2)“Authorization to Use or Disclose Protected Health Information” Copies of these forms may be found in the “Forms” section of this manual.3.Authorization -- When an outside organization wants access to PHI for any reason other than the furtherance of the plan for treatment, payment or health care operations, the patient must sign an authorization form stating the specific reason the authorization is being given. Reasons for such request often include, but are not limited to the following: a)Marketing -- This would include having a person not part of the patient’s chosen health care facility communicate with a patient about a product or service that could help with the patient’s health care. This could include health care products such as alternative treatments or even health care insurance coverage. As it would be necessary for the person contacting the patient to know that the patient had a condition which could be helped by the product or service, the patient would have to authorize the practice to disclose that he or she has the condition or more broadly, that he or she uses the health care practice that discloses that fact to the outside marketer.The law identifies three situations where the practice does not need authorization:1.)Giving patients information about other providers participating in a provider network or health plan network, benefits or services available under a health care plan, payment information related to the health care plan, what providers the patient may see under the plan or whether or how much the plan will pay to plan and non-plan providers.2.)When a health care provider contacts a patient as part of treatment for the patient to further the treatment such as referrals, prescriptions, recommendations or information about a product or service and how it might help the patient.3.)When a health care provider or his/her representative contacts a patient as part of managing that patient’s care to recommend sources of care not offered by the primary provider such as alternative therapies, providers or settings.b)Pre-Employment Underwriting -- If an insurer wants to get PHI from the practice to determine whether or not to enroll a patient in the plan, the practice must get written authorization from the patient before releasing the information. In most cases, the insurer should get the authorization and include it in the request. However, if they do not, it is up to “Practice Name” to get the authorization from the patient and have it in the patient’s medical record before any information is copied from the record and supplied to the insurer.c)Employment Determinations -- If “Practice Name” is asked by an employer for health care information about a patient including the results of a pre-employment physical, written authorization must be obtained from the patient before the information is released.d)Fundraising -- Before releasing any PHI about any patient to help with any fundraising effort for any individual or group other than “Practice Name” itself, “Practice Name” must obtain written authorization from the patient.e)Psychotherapy Notes -- Except to defend itself against suit brought by the patient, “Practice Name” must get written authorization to disclose any part of psychotherapy notes to any third party.Written authorization to use or disclose PHI must include the following:Identification of the specific information involvedThe name of the medical office and/or other persons being authorized to use or disclose the informationThe name(s) or kind(s) of persons or entities entitled to receive the informationThe date the authorization expiresThe authorizing person’s signature and the date the authorization was signedNotation of the authority vested in any person signing the authorization who is not the patientA statement of the signer’s right to revoke the authorization A statement that the information involved may no longer be protected by the federal privacy lawInforming Patients about Protected Health InformationPOLICY: All patients will be informed about how the practice uses and protects their health information. Patients will be asked to sign a form documenting the fact that they have received this notice of the privacy practices.PROCEDURE: Every patient will receive a copy of the pamphlet “Your Medical and Financial Records” and a copy of the pamphlet will be posted in the reception area of “Practice Name” . Signatures documenting receipt of this information will be obtained on the patient sign-in sheet.In addition, each patient will be asked to name those persons to whom they wish to grant access to their financial information and their medical information on the registration form they will complete at their initial visit to “Practice Name”.A copy of the pamphlet “Your Medical and Financial Record” is provided in the “Forms” section of this manual.Protecting Information at the Front DeskPOLICY: Every effort will be made to ensure that no protected health information (PHI) about any patient is exposed to the view or hearing of anyone other than the patient or health care providers.PROCEDURE: Front desk personnel and all other personnel when in the front desk area, will guard against inadvertent and inappropriate sharing of PHI in at least the following ways:1.No patient records will be left unattended while accessible to non-staff persons.2.No patient records will be left open when visible to unauthorized persons.3.No announcements or statements which may be overheard by unauthorized persons will be made which identify any patient’s reason(s) for being at “Practice Name”, such as conditions, medications, prescriptions, referrals, treatments, diagnostic tests, or diagnoses.4.When notifying patients that they may move from the reception area to an exam room, persons responsible for doing so should be careful not to reveal the patient’s reason for being there. For instance, an appropriate way to handle this routine situation is to call out only the patient’s name plus a simple instruction such as, “Follow me, please.” or “We are ready to see you now.” Do not identify the room to which you are sending the patient except privately to the patient.5.When discussing payment for services with patients be sure that no other patients or other unauthorized persons can overhear any part of the discussion. 6.If a patient announces his or her reason for being at “Practice Name” or other aspects of PHI, front desk personnel should respond in such a way as to discourage further discussion and to protect the information from being overheard by unauthorized persons. For instance, by saying things like, “I’ll tell the nurse that for you. Please have a seat. I’m sure she’ll be with you soon” or “I’m sorry, but I can’t help you with that, but I’ll inform the nurse and she’ll talk with you about it later”, or simply “Thank you. Please have a seat and we’ll call you as soon as we can.”Guarding Against Inappropriate Use of Protected Health InformationPOLICY: All staff will be instructed in specific ways to avoid inappropriate release of protected health information (PHI).PROCEDURE: All medical office staff will be required to read and sign an affidavit attesting to their understanding of the policies and procedures governing protecting the privacy of PHI. That affidavit will be filed as a part of the Health Information Protection Manual.Additionally, staff will be granted access to varying levels of health care information depending upon their class of employment. The employment classifications include:Housekeeping and Maintenance - Personnel who clean and maintain the facility.Clerical - Personnel whose work primarily has to do with basic compilation and maintenance of records created by others. This class is divided into two sections.Section I positions include file clerk and receptionist.Section II positions include medical records transcriptionist, collections clerk and billing clerk.Administrative - Personnel whose work primarily has to do with business operations of “Practice Name”. The positions included in this class are Practice Administrator, secretary and bookkeeper.Ancillary - Personnel whose work primarily has to do with assisting providers in the provision of health care to patients. The positions included in this class are medical assistant, nurse, laboratory technician, x-ray technician and other technicians.Provider - Personnel whose work primarily has to do with direct provision of health care services including diagnosis, treatment and management of health care processes related both to individuals and to policies, procedures and protocols.All staff regardless of employment classification are hereby notified that it is essential that any and all utterances relative to patient care including the simple fact of the patient’s presence in “Practice Name” and certainly with regard to any reasons for their presence must be guarded to ensure that no more information about the patient is imparted than is absolutely necessary. Any violations of this policy are to be reported to the Practice Administrator. ................
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