Administrative Procedures
Administrative procedure items focus on the front office and revenue cycle: appointment scheduling, patient registration, medical records, release of information, billing and coding, insurance verification, claims, and supply control. Know scheduling types such as wave, modified wave, and open access; how to prioritize urgent versus routine visits; and how to handle no-shows and cancellations. Medical records must be accurate, timely, legible, and confidential. Corrections use a single line, date, initials, and reason, never obliteration. HIPAA permits disclosures for treatment, payment, and health care operations; otherwise a valid authorization is required, with the minimum-necessary standard. Release-of-information requests need patient authorization, identity verification, and attention to special protections such as mental health, substance use, HIV, and minors. Billing questions test CPT versus ICD-10-CM: CPT describes procedures and services; ICD-10-CM describes diagnoses. Claims require correct patient identifiers, provider NPI, coding linkage, and timely filing. Insurance terms include deductible, copay, coinsurance, allowed amount, and explanation of benefits.
Traps include releasing records to a family member without authorization, assuming a subpoena is always sufficient, billing a diagnosis code as a procedure, confusing copay with coinsurance, or promising insurance coverage before verification. Watch for minimum-necessary and need-to-know wording.
Worked rule: When a patient requests copies of records, verify identity, obtain a signed authorization naming the records and recipient, follow state fee and timeline rules, and document the release. If an attorney requests records, follow organizational policy and legal process rather than an informal letter alone.