RMA Medical Office Procedures 2 — Questions and Answers

Question 1: Which of the following best defines 'petty cash' management in a medical office?

A fund for physician personal expenses
A small reserve of cash for minor, everyday office expenses that are impractical to pay by check (Correct answer)
The daily patient co-payment collection total
A security deposit held for new employees

Correct answer: A small reserve of cash for minor, everyday office expenses that are impractical to pay by check

Petty cash is a small, fixed amount of money kept on hand for minor incidental expenses (postage, office supplies, refreshments) that are too small to process through formal accounts payable.

Petty cash is a standard cash management tool in any business office, including medical practices. A fixed sum (commonly $50–$200) is established and replenished periodically. Each disbursement is documented with a petty cash voucher recording the date, amount, recipient, purpose, and receipt when available. When the fund runs low, the vouchers are totaled and a replenishment check is written to bring the fund back to its fixed amount. The medical assistant responsible for petty cash must maintain accurate records for every transaction, reconcile the cash and vouchers regularly (total cash + total vouchers should always equal the fund amount), and store the fund in a locked location. Discrepancies must be investigated and reported to the office manager. Proper petty cash management prevents internal theft and ensures accurate financial records. The petty cash fund is separate from the patient co-payment collection, which is managed through the practice management system and deposited daily. Understanding both is part of the medical assistant's administrative competency.

Question 2: A medical assistant is opening mail and finds a check made out to the practice. What should she do with the check before recording it?

Deposit it immediately in the night deposit box
Restrictively endorse it 'For Deposit Only' with the practice account number (Correct answer)
Hold it until the office manager is available
Make a photocopy only and give the original to the physician

Correct answer: Restrictively endorse it 'For Deposit Only' with the practice account number

A restrictive endorsement 'For Deposit Only' with the practice name and account number written on the back of the check prevents it from being cashed by anyone else if lost or stolen.

A restrictive endorsement limits what can be done with a check. Writing 'For Deposit Only — [Practice Name] — Account #XXXXXXXX' on the endorsement line restricts the check so that it can only be deposited into the specified account. This is a critical internal control measure because checks that are lost or stolen after a restrictive endorsement cannot be cashed by a thief. Many practices use a rubber stamp for this purpose to ensure consistency and efficiency. The medical assistant should endorse incoming checks immediately upon opening the mail, before the checks are separated from their documentation. All endorsed checks should be logged in the daily receipts record. After endorsement and recording, checks are typically held for the daily deposit, which should be made promptly (same day when possible) rather than allowing funds to accumulate. Accurate reconciliation of deposits against the day sheet or accounts receivable system is part of sound financial management in a medical practice.

Question 3: Which of the following best describes an 'explanation of benefits' (EOB) form sent by an insurance company?

A prescription authorization form
A document explaining what services were billed, what the insurer paid, and any amount remaining as patient responsibility (Correct answer)
A summary of the patient's insurance coverage and deductible
An appeal form for denied claims

Correct answer: A document explaining what services were billed, what the insurer paid, and any amount remaining as patient responsibility

An EOB is a summary statement sent by the insurer to the provider and patient after processing a claim, showing billed amounts, allowed amounts, insurer payments, adjustments, and patient balance due.

An Explanation of Benefits (EOB) is not a bill — it is an informational statement generated by the insurance company after processing a claim. It details: the dates of service, procedure codes, and billed amounts; the allowed amount (the contracted rate); adjustments (write-offs per contract); the amount the insurer paid; and the remaining patient responsibility (deductible, copay, coinsurance, or non-covered amounts). For medical office billing staff (including medical assistants with billing responsibilities), reviewing EOBs is essential for: posting payments accurately to patient accounts; identifying claim denials or partial payments; determining correct patient balances to bill; and identifying patterns in claim rejections that may indicate coding or documentation issues. Patients also receive an EOB (or Summary of Payment) to help them understand their responsibility. Many patients confuse EOBs with bills, so medical assistants should be prepared to explain the difference. When the payment on the EOB differs from expected, the medical assistant should consult the insurance contract or refer to a billing supervisor.

Question 4: When scheduling a new patient appointment, which of the following pieces of information is MOST important to obtain first?

The patient's insurance information and policy number
The reason for the visit and the urgency of the concern (Correct answer)
The patient's preferred appointment time
Whether the patient needs a referral

Correct answer: The reason for the visit and the urgency of the concern

The reason for the visit and its urgency must be established first to ensure the patient is scheduled appropriately — an acute problem may require same-day care while a routine visit can wait weeks.

Effective appointment scheduling begins with triaging the patient's needs. Before discussing times, availability, or insurance, the medical assistant must determine: what is the patient's chief complaint or reason for visiting, and is it urgent, semi-urgent, or routine? This information determines the appointment type, length, and appropriate timing. For example, a patient calling with chest pain or shortness of breath needs immediate guidance (possibly to call 911 or go to an emergency room) — scheduling a routine appointment would be inappropriate and potentially dangerous. A patient with a new mole that has changed shape should be seen within days, not weeks. A patient requesting an annual wellness exam can be scheduled at the next convenient time. Insurance information, demographics, and preferences are important but secondary to clinical urgency assessment. Many practices use standardized triage scripts or protocols to guide this assessment. Medical assistants should also know which symptoms require emergency referral rather than office scheduling, and should escalate these calls to the nurse or physician on duty when uncertain.

Question 5: Which filing method is MOST appropriate for a large practice that wants to distribute filing workload evenly and prevent one section of the files from becoming overcrowded?

Straight alphabetic filing
Alphabetic-numeric combination filing
Terminal-digit (reverse numeric) filing (Correct answer)
Geographic filing

Correct answer: Terminal-digit (reverse numeric) filing

Terminal-digit filing arranges records by reading the assigned number in groups from right to left (last digits first), which distributes new records randomly throughout all filing sections, preventing crowding and balancing workload.

Terminal-digit filing is a numeric filing system in which the patient record number is divided into groups (typically pairs or triplets) and filed according to the final digits (the terminal digits) first, then the middle digits, then the primary (first) digits. For example, patient number 12-34-56 would be filed in section 56, subsection 34, record 12. Because new patients are assigned sequential numbers and filed by terminal digits, new records are distributed randomly and evenly throughout all sections of the filing system, preventing the formation of crowded sections. This also distributes filing and retrieval workload evenly among staff assigned to different sections. Straight numeric filing (sequential) concentrates all new records in the highest-number section, creating crowding and bottlenecks. Straight alphabetic filing can be uneven (some letters — like S and M — are heavily populated). Terminal-digit filing is preferred in large hospitals, health systems, and practices with high volumes where even distribution of work and prevention of crowding are priorities. Medical assistants in these settings must learn the terminal-digit method to locate and file records efficiently.

Question 6: A medical assistant answers the phone and a caller identifies himself as a physician at the local hospital asking for a patient's complete records to be faxed immediately for emergency care. What should the medical assistant do?

Fax the records immediately since it is an emergency involving patient care
Verify the request through a callback to the hospital's main number and confirm the receiving fax number is secure before transmitting (Correct answer)
Decline to fax any records without written authorization from the patient
Transfer the call to the physician immediately without further action

Correct answer: Verify the request through a callback to the hospital's main number and confirm the receiving fax number is secure before transmitting

Even in urgent situations, the identity of the requester and the security of the receiving fax must be verified through an independent callback — 'emergency' requests are a common social engineering technique for unauthorized PHI disclosure.

While emergency treatment exceptions under HIPAA do permit disclosures without patient authorization when necessary for emergency care, this does not eliminate the need for basic verification steps. The medical assistant must exercise judgment and follow established protocols to prevent social engineering attacks — where someone falsely claims to be a physician or emergency contact to obtain PHI. The correct approach for an urgent fax request is: ask the calling physician to hold briefly, look up the hospital's main published telephone number independently (do not use a number the caller provides), call the hospital and ask to be connected to the requesting physician or their unit to confirm the request, and use only a verified, secure fax number for transmission. Document the verification steps taken. For truly life-threatening emergencies where even a brief delay could cause harm, the provider should be consulted to make the disclosure decision. HIPAA's minimum necessary standard also applies — only the information actually needed for the emergency treatment should be transmitted, not necessarily the complete record. Fax cover sheets must always include the confidentiality notice.

RMA Medical Office Procedures 2

Which of the following best defines 'petty cash' management in a medical office?