Administrative: Scheduling, Records, Billing, and Insurance
Workflow and the revenue cycle
Administrative items test rules and arithmetic more than memorized lists. Scheduling formats: stream (one patient per slot), wave (several patients arrive together, staggered), modified wave (a blend), and clustering (grouping similar visits, such as all physicals in one block). A scheduling matrix cross-references provider, day, and visit type so conflicts are visible; leave buffers for urgent work-ins and confirm appointments 24–48 hours ahead.
Records: understand the problem-oriented record and SOAP notes (subjective, objective, assessment, plan); CHEDDAR is a charting mnemonic. Correct a paper error with a single line through the entry, the word "error," date, and initials - never erase, backdate, or obliterate. Electronic entries are locked after signing; corrections are addenda. Release information only with a signed authorization, or where permitted for treatment, payment, operations, or legal requirement.
Coding and claims: ICD-10-CM reports diagnoses, CPT reports procedures and services, HCPCS covers supplies and drugs; modifiers clarify circumstances. Professional claims use CMS-1500; institutional claims use UB-04. Learn premium, deductible, copay, coinsurance, allowed amount, EOB/ERA; HMO, PPO, POS, and capitation; Medicare Parts A–D, Medicaid, TRICARE, CHAMPVA, and workers' compensation; coordination of benefits with the birthday rule for dependent children; fraud versus abuse; accounts-receivable aging; trial balance; petty cash; and check endorsements.
Trap: treating the provider's billed charge as the patient balance. Rule of thumb: patient responsibility = copay + coinsurance on the allowed amount + any unmet deductible; the difference between charge and allowed amount is a contractual write-off.