The role of the Medical Office Manager in risk management is to identify and evaluate risks as a means to reduce injury to patients, staff members, and visitors within an organization. They need to make sure office polices are being followed, they need to maintain accurate records, and maintain a good rapport with patients their families. Medical office managers have to make sure that the staff follows policies to ensure that negligence and malpractice does not occur. There are federal laws that the Medical Office Manager should be an expert in knowing and able to educate their staff, and make sure the laws are being followed (Andress, A, 2009).
It is important that the office manager understands all the laws and make sure that all the staff …show more content…
Retrospective is an audit on services that have already been billed to the insurance company. So, if the insurance company paid the practice too much a refund need to be issued to the insurance company. Prospective is an audit on services that have not been billed yet, and is designed to cut back of liabilities. In order to properly audit an E&M service an Office Manager must open the medical record to the date of service that is being reviewed, then look at the patient encounter form from that date, review the documentation, determine the category of service provided, use the documentation guidelines and carefully review the history portion of the visit, then use the guidelines to determine the level of examination and review the medical decision making portion of the note, then determine the medical decision making, using the guidelines and the determination from all three key components then a determination can be made on the level of services that should be billed. Then compare the reviewer’s level and category with the level and category checked on the patient encounter form to see if the two match. Next, verify the medical necessity for the visit and any additional services that were preformed, make sure the diagnosis codes match on the patient encounter form with the codes listed in the medical record, make sure all services were captured for proper billing, The provider of the services has to sign the note …show more content…
The physician might document services that were provided on the super bill but not on the encounter, or accidently mark a service on the super bill that was never provided during the encounter, so it is important that the manager catch these errors and correct them, this will keep both the physician and the office from breaking any laws, or not get reimbursed by any third parties (Andress, A,