Medical assistants are key agents in the chain of custody of specimens and evidence. When there is a crime such as rape or battery that requires a physical exam or laboratory specimen, the medical assistant needs to be aware of the importance of verifying that any potential evidence is safeguarded against tampering. That means each person who touches the evidence must record his or her name. Potential evidence is never out of direct sight unless locked in a secure place where those who have access must record their names. This may include routine drug testing as well.
All drug and alcohol treatment information is under federal jurisdiction and must never be disclosed without patient permission. According to the Public Service Act, anyone disclosing this type of information is subject to criminal fines.
Patients receiving mental health treatment require a high degree of confidentiality. Treatment of the mentally ill may be involuntary if the patient is in imminent danger. Laws vary from state to state, but usually involve a petition for involuntary admission by someone who has no direct interest in the case but has observed dangerous behavior. Additionally, two certificates within 24 hours are usually required to keep a patient against his or her will. A formal, legal hearing is usually held within five days. The patient must have legal counsel, if desired. Like any other patient, mentally ill patients have rights to adequate humane care, timely discharge, to be free of mechanical and chemical restraints, to handle their own business and money, to communicate in private, to send and receive mail, and to vote in any election. Depending on the nature of the illness, mentally ill persons may lose a gun permit or not be able to obtain one.
Medical assistants have access to Schedules II through V substances and are responsible for maintaining all regulations required by the Drug Enforcement Agency (DEA). All physicians prescribing these substances must register for a DEA number using form DEA 224. Controlled substances are those with the potential for addiction. The medical assistant may be responsible for making certain the DEA number that identifies the physician is renewed every three years. The office is responsible for having policies established for dispensing, handling, and storing scheduled drugs and keeping current and up-to-date records. See Chapter 14, Medications, for additional information.
Hiring and firing of staff may be a responsibility of the medical assistant. It is essential that no laws are broken in the hiring process. There are strict guidelines designated by the Equal Employment Opportunity Commission (EEOC) to ensure hiring practices remain fair. Questions about age, race, religion, nationality, handicaps, and children are illegal. It is not legal to ask about arrests, but it is acceptable to ask about convictions. Asking about marriage is not illegal, but might be construed as discriminatory and is not advised. Hiring based on ability, training, and certification is the best practice. All new employees should have a clear job description and an employee handbook clearly stating the expectations and disciplinary procedures. Employee records and evaluations should be stored in a secure, locked area. The hiring process includes completion of a W-4 for the Internal Revenue Service (IRS) and I-9 for the U.S. Citizenship and Immigration Services (USCIS). Other business forms that the medical assistant may be responsible for include the W-2 Wage and Tax Statement sent at the end of the year itemizing annual wages and taxes withheld, Form 941 Employer’s Quarterly Federal Tax return, and Form 940 Employer’s Quarterly Federal Unemployment Tax return.
Medical assistants are mandated to report abuse and neglect of children or elderly persons. Abuse to the elderly can be neglect, financial, emotional, physical, or sexual abuse. Child abuse is neglect and abandonment as well as sexual, physical, or psychological abuse. It can manifest itself in physical or emotional ways. Most states have hotlines that can be used for reporting suspected abuse.
A medical assistant may be the person appointed to report communicable illnesses and vital statistics to the public health department. This is one of the public duties performed by physicians. Diseases such as measles, mumps, polio, syphilis, gonorrhea, tuberculosis, and HIV are tracked for trends and epidemics. Births, stillbirths, deaths, rapes, gunshots, knife wounds, and animal bites may be part of the vital statistics recorded in a state. Most counties require the filing of birth and death certificates at the county clerk’s office as well. The medical assistant must know the regulations of the state in order to comply with making certain all information is provided in a timely manner.
Many medical assistants are responsible for billing third-party payers such as insurance, Blue Cross/Blue Shield, Medicaid, and Medicare. Medicare is a federally administrated program in which all persons over a certain age or those who are disabled are entitled to health benefits. Medicaid is a need-based program for health benefits administrated by individual states. It is important to know the correct billing procedures, guidelines, and laws so as to avoid fraud.
Medical assistants help protect patients and the environment by properly disposing of medical waste and biohazardous materials. Medical assistants make sure sharps in puncture proof containers and the items disposed of in biohazard bags are uniformly packaged, labeled, and taken to incinerators by biohazardous waste companies. It is important to conform to federal standards that have been developed by the Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) to protect health care workers. Failure to comply can lead to large fines.