Discuss the obligation a medical office specialist has to uphold a standard of ethics.

Why this

is important? Explain.

Medical office specialists are vital professionals in the health care delivery systems as

they share some important areas in our health care matters. Medical office specialists oversee

non-clinical activities in a health care facility, which include staffing, budgeting, customer

service and inventories. Their duties are ordering supplies, managing marketing operations,

recruiting, and supervising staff, and managing patient admission procedures. Familiarity with

medical institutions is paramount as well. Some essential descriptions of the job include

answering telephone calls from patients, schedules and confirms appointments between them and

their health care providers. They also electronically enter patient’s information into Waiting

Room Solutions medical software. In addition, they have to verify insurance online and via

telephones to make sure medical bills are going to be paid and addressed to proper medical

billing facilities. They are in charge as well in making up follow up calls with medical insurance

for claims and bill patients their dues (JobHero, n.d.).

Ethics are the rules or standards governing conduct of a person or the members of a

profession. A medical office specialist has an obligation to uphold a standard of ethics. They

can and will be held liable for fraudulent billing (Vines, Braceland, Rollins & Miller, 2018).

Before, all the legal burdens fell on the health care provider, but in the recent times, the

medical office specialist can be prosecuted as well and can be in grave consequences when

ethical standards are not observed. In addition, according to Vines, Braceland, Rollins and

Miller (2018), the medical office specialist should always keep in mind when discussing

claims issues with a patient that the patient may not be familiar with these terms, so

layperson’s terms may be needed. They should always document, sign, and date all
conversations regarding any patient’s account whether the conversation is with the provider,

patient, or carrier to have better transparency in all transactions.

Reference:

JobHero. (n.d.). Medical office specialist. Retrieved from

[Link]

Vines, D., Braceland, A., Rollins, E., & Miller, S. (2018). Comprehensive health insurance

(3rd ed.). Pearson Education p62-65.

What should you take into consideration when deciding which plan to enroll in?

In the recent times, a lot of employees have better benefits than before that they have

insurance coverages for mostly everything. Most of the institutions offer Managed Care Plans

that covers for their health needs when they seek medical advices, treatment, and

hospitalizations. Since there are three major types of Managed Care Plans, this gives some

people options to be enrolled in their own health insurances for a variety of coverages. Health

maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-

service plans (POSs) are the major types of managed care plans. HMO is regulated by federal

and state law and has various rules for copayment, coinsurance, and deductible amounts.

PPOs on the other hand, unlike an HMO, the members do not have a primary care provider

(PCP) or gatekeeper nor do they have to use an in-network provider for their care. However,

PPOs offer members higher benefits as financial incentives to use network providers. The
incentives may include lower deductibles, lower copayments, and higher reimbursements

(Vines, Braceland, Rollins & Miller, 2018). This is one of my benefits before being an

employee in the hospital in New Jersey. This really covered me so much on my dental

services, eye services and even when I get sick and seek medical advices from my health care

providers. I used to pay low deductibles and really saves me a headache when my finances are

rough. This comes also with an option to have a health savings account (HSAs) to allow us to

contribute to our accounts be deducting it from our paychecks and that is before taxes.

Meanwhile, POS plan has a contracted provider network. POS plans encourage, but do not

require, members to choose a primary care physician. As in a traditional HMO, the PCP acts

as a gatekeeper when making referrals. POS members also may opt at their discretion to visit

an out-of-network provider. If that happens, the member’s copayments, coinsurance, and

deductibles will be substantially higher (Vines [Link], 2018).

In my case, I make sure that I look into the plans offered by employers when opting

for a health insurance coverage. It is necessary for me to be covered mostly as I am a head

provider for my family and that I make sure they would not suffer for any financial burdens in

case something happens to me unexpectedly. I do also put into consideration about my other

health needs such as my dental and vision services as these are important factors for me to

work effectively. The lower the deductible is and less payments deducted from my check, the

better as long as it could cover any means for my health. If in some case that I do not get a

cheaper health insurance coverage from my employer, I try to evaluate those premium plans

or any outside health care coverages for comparisons and see which could give me better

coverages without any hassles. In addition, I also like to put some savings towards my health

finances in the future. It does save me a lot of money when I use my HSAs for my health
needs. I do not feel much of a deduction from my paycheck and I do not seem to recognize

that I am putting something even a little amount towards my health so that in case of

emergency, I have something to pull out from this account when health care matters arise.

Reference:

Vines, D., Braceland, A., Rollins, E., & Miller, S. (2018). Comprehensive health insurance

(3rd ed.). Pearson Education p34-37.