Define the Job
There are a number of common ways for a support person to contribute to the practice, which I have grouped into several broad categories:
Handle telephone correspondence. This person should answer all calls to the practice’s main office number. Most practices will have a separate number for billing inquiries, and clinical calls from the hospital’s nursing staff are usually paged directly to the doctor by a nurse. But that still leaves a lot of calls that will go to the support person, such as administrative questions about the practice, calls from former patients (who have been discharged) and families, pharmacies (e.g., asking about refills), funeral homes, and others.
Some practices use a “triage pager” system in which all calls about new referrals to the practice (e.g., from ED doctors, referring PCPs, surgeons requesting consults) always go to the triage pager—day or night. Usually the individual doctors take turns carrying and responding to the triage pager, and after hearing about a referral to the practice they will call the doctor who is up next for new patients and pass the information along. In a large practice, that pager can generate a huge number of daytime calls, making it difficult or impossible for the person holding the triage pager to also care for patients.
Some practices have found that the practice clerical support person can take all those calls during the daytime Monday through Friday and pass them along to the appropriate hospitalist. The clerical person would typically get only the patient name and location and the referring doctor’s name and contact information, then page it to the hospitalist next in line for a new referral. That hospitalist would then call back the referring physician to get more clinical information. That relieves a member of the practice from taking all the calls. And, it puts the referring physician directly in contact with the hospitalist who will see the patient, rather than a triage doctor who won’t be caring for the patient. This should mean a better handoff.
Handle paper correspondence. This person can sort all the faxes, mail, and medical records that come to the practice, and put them in each doctor’s mail box in the office. He/she might initiate work on some forms. For example, upon arrival of a form to certify medical necessity for a piece of equipment (e.g., home oxygen ordered on a patient recently discharged) he might open the envelope, complete as much of the form as possible, attach the relevant records from the hospital stay, and leave all this for the doctor to sign.
Another potentially critical function is to request and pursue outside clinical records requested by one of the hospitalists. For example, a hospitalist admits Ms. Smith at 1 a.m. and realizes it will be helpful to get previous creatinine values from the PCP’s office and the report of a prior cardiac cath from an outside hospital. The hospitalist could simply record a voice mail (at 1 a.m., while seeing the patient) requesting that the practice assistant track down these things the next morning. That might include ensuring an appropriate release-of-information form is signed by the patient and faxed to the outside facility. When the records arrive, the assistant would place them on the patient’s chart (and, if necessary, page the hospitalist to report that the records have arrived).
Support billing functions. Practices use many strategies to ensure good documentation, coding, charge capture, and billing. The assistant might play an important role in this process. For example, the doctors might first report all charge data to the practice assistant who reviews it to make sure there are no conflicting charges (e.g., two doctors bill the same service to a patient on the same day) and no missing charges (e.g., a doctor forgot to submit a charge for one day of a patient’s stay). The assistant can be the principle connection between the doctors and the billing service and might be the first person to troubleshoot problems encountered by the billing service (e.g., getting additional documentation, figuring out which doctor can best address an ICD-9 code that lacks a fifth digit).