Chapter 7; Written Communications

Capitalization

it is important to know when to capitalize and when to use lowercase letters. Following standard guidelines for using capital letters applies to most correspondence, but there are some exceptions and additional rules when typing medical documents. Never change how a word is capitalized unless directed to do so. Ask for clarification and mark the proof letter with a ? for the physician to assist. • Capitalize the first word in a sentence, proper nouns, the pronoun "I", book titles, and known geographical names. • Names of persons, holidays, and trademark items should be capitalized. • Expressions of time should not be capitalized.

Proofread

the part of editing a document in which the writer reads the draft for accuracy and clarity and corrects errors

Annotation

the process of reading, highlighting, and summarizing a document for another person

United States Postal Service

Written communication is commonly sent via United States Postal Service. Envelopes must be correctly prepared so that the Optical Character Reader used by the USPS can sort the mail quickly and efficiently. The OCR reads the envelope, scanning for information. The OCR scans all envelopes using these margins: 1/2 inch on either side and 5/8 inch from the top or bottom of the envelope. Addresses or notations outside of these margins will not be read.

Block

a type of letter format in which the date, subject line, closing, and signature are justified to the right margin; all other lines are justified left

Semiblock

a type of letter format that is styled the same as block, except the first sentence of each paragraph is indented five spaces

Plural and Possessive

Converting words to plural or possessive form can be tricky. Most medical terms have a Latin or Greek origin and have their own set of rules for pluralization. You should be accurate because mistakes can cause confusion.

Opening and Sorting Mail

Each physician will have an individual policy on which mail you should open and how you should process it. Any mail marked urgent should be handled first, followed by mail about patient-related issues. Promotional material should be handled last. Some physicians will have you sort, file, and respond to mail without their review. In some practices, however, all mail is place in a special file folder and handled only by the physician or office manager. Most physicians will open and handle their own mail. If the physician is on vacation, he or she will apply an auto reply response to his or her email address. When the physician is away, personal mail is placed on his or her desk and left for the physician to handle when they return. Mail that pertains to patient care issues should be opened and handled appropriately. Ask your supervisor if you are unsure which pieces of mail you should open. If the mail requires an urgent response, the covering physician should be contacted unless otherwise directed. Mail should never be allowed to accumulate inside mailboxes because patient information is confidential.

Electronic Mail

Electronic mail, or email, allows computer to computer communications, weather within the same facility or anywhere throughout the world. The communication occurs through a modem. Each computer must be linked to an online service provider. Here are a few things you should remember about sending letters via electronic mail: • Confidentiality cannot be guarantee. • Follow the usual steps of prrparation, composition, and editing. • You can attached letters to an email by clicking on the file attachment icon, locating the letter, and inserting it. It is always a good idea to open the attachment to make sure that you are attaching the correct letter or version.

Facsimile Machines

Fax machines allow the medical office to send and receive printed material over a phone line. These machines offer a convenient and cost-effective way to transmit records, orders, prescriptions, test results, and other materials that require quick receipt. Always use a cover sheet when sending papers through a fax machine. At minimum, a cover sheet should have the following information: • Name, address, telephone number, and fax number of the physicians practice. • Name of the intended receiver of the fax. • Number of pages being sent, counting the cover sheet. • Telephone number of the fax machine of the intended recipient. • Date and time the fax was sent. • Confidentiality statement. When you receive a fax, forward it to the appropriate person. The fax machine should be checked regularly throughout the day, and all items should be sorted quickly. Sometimes when you fax a given letter, the fax machine may be busy, or the number dialed may be busy. If the number is busy, it is not acceptable to leave the fax paper in the machine for redial unless you are sure that no one else will have access to that document. Never leave documents unattended.

Basic Spelling Guidelines

Good spelling skills take time to acquire. Many words sound exactly alike but are spelled differently and have different meanings. Spell check in word processing programs can be a great asset, but they have limitations. Medical terminology spell check software should be added to your computer and be updated frequently. You can add medical terms into your computer's spell check dictionary, but make sure that any word you add is spelled correctly!s Spell checks can never be 100% stocked with all the needed terms, especially in the medical profession, as new technologies, medications, and treatments arise daily. Remember, spell check will not recognize words that are spelled correctly but misused. Even if you use spell check, you should proofread your document for other errors.

Guidelines for Producing Professional and Medical Documents

Good written communication skills are important for success. In the medical office, written communication is generated in several forms, such as reports and letters. Medical assistants commonly compose collection letters, patient reminders, and notifications of test results. You may also have an opportunity to produce memorandum, agendas, and minutes for meetings. Another important form of written communication is the hand written entry in a patient's medical record. No matter which form it takes, your written communication must be clear, concise, and correct. Poorly written documents reflect negatively on the physician's practice and on you. Written communication may be sent or receive through fax machines, electronic mail, delivery services, or U.S. postal service. HIPAA's privacy rule protects the confidentiality of all medical communication. Sending and receiving written communication according to the rules of confidentiality will be further discussed.

Accuracy

Many of the medical documents or letters that you will write contain information that requires precision, accuracy, and careful attention to details. Inaccurate information in some letters can lead to injury of a patient and lawsuits and can harm the physician's practice. some of your letters will be placed in the patient's permanent medical record. Most letters will start with the physician asking you to draft a letter. He or she may or may not give you some notes to follow. He or she may dictate the letter. Either way, your responsibility in typing the letter is to be as accurate as possible and to question anything about which you are unsure.

Other Delivery Options

Many other companies specialize in document and package delivery, particularly with next day or second day delivery services. Examples of these companies include Airborne Express, Federal Express (FedEx), and United Parcel Services (UPS). Use the company with which the physician has an account. Fees vary, so you may have to contact each company for prices and available services. These companies offer services such as tracking, pick-up services, money back guarantees, and proof of delivery. The tracking service can be done through their website.

Types of Incoming Mail

Many types of mail are receive daily in the physician's office. • Advertisements • Bill for office services • Consultation letters • Hospital communications and newsletters • Laboratory and radiographic reports • Office supply magazines • Patient correspondences • Payments from insurance companies and patients • Professional journals • Literature from professional organizations • Samples (drugs, laboratory test kits) • Waiting room magazines

Punctuation

Period (.) - used at the end of sentences and following some abbreviations Comma (,) - used to separate words or phrases that are part of a series of three or more. The final comma before "and" may be omitted. A comma can also be used after a long introductory clause or to separate independent clauses joined by and, but, yet, or, and nor. Semicolon (;) - used to separate a long list of items in a series and to separate independent clauses not joined by a conjunction. Colon (:) - use to introduce a series of items, to follow formal salutations, and to separate hours from minutes indicating time. Apostrophe (') - use to denote emissions of letters and to denote the possessive case of nouns. Quotation marks (" ") - used to set off spoken dialogue, some titles, and words used in a special way. Parentheses [( )] - use to indicate a part of a sentence that is not part of the main sentence but is essential for the meaning of the sentence. Also use to enclose a number, for confirmation, that is spelled out in a sentence. Ellipsis (...) - used in place of a period to indicate a prolonged continuation of a conversation or list. Also used to display individual items or to connect phrases that are loosely connected. Diagonal (/) - used in abbreviations, dates, fractions, and to indicate two or more options.

Basic Grammar and Punctuation Guidelines

Professional writing requires that you follow the appropriate rules of grammar and punctuation.

What is the purpose of proofreading?

Proofreading allows you to check the accuracy and content of the letter.

Affixing Postage

Proper postage must be affixed to the envelope buy a stamp, permit imprint, or a postage meter machine. Postage meter machines are in-house machines that are regulated by the USPS. They contain a prepaid amount of postage and can imprint the postage stamp either directly on the envelope or onto an adhesive tape that is applied to the envelope. Some machines weigh, stuff, and seal the envelope. The date on the postage machine must be change daily, and the ink roller must be kept full. The physician may opt to use the USPS permit imprint program. In this case, you take the mail, sealed and ready to be sent, to the post office. The postal clerk passes the letters through the USPS machine, and a permit stamp is placed on the envelope. The postal clerk deducts the postage charges from your prepaid account. The advantages to this system are that it saves time and does not require the office to care for the postal meter machine.

Minutes

The minutes of a meeting outline the actions of the group. Members may need to refer back to the minutes of a previous meeting. In organizations with officers, the secretary takes notes and/or records the meeting. For other meetings such as committee or board meetings, someone is assigned the task of preparing the minutes. You should type the minutes of a meeting as soon as possible. Record only motions, seconds, and the results of a vote. You may include a brief discussion of the motions, but do not include unrelated items, opinions, or individual members' statements. The minutes of a meeting become an important document in the association's history. Include the following information: • List of members present. • List of members absent. • Date and time the meeting was called to order. • Statement regarding the acceptance of the previous minutes. • Motions made and the name of the person making the motion. • Brief report of discussion. • Results of voting, whether the motion passed or not. • List of reports that are submitted. • Date and time of the next meeting. • Adjournment time. • Signature of the person who prepared the minutes and the Chairman's signature.

Why should all numbers in a sentence be written in the same way regardless of the rule?

This practice ensures consistency, a mark of professional writing.

Proofreading

Whenever possible, have a colleague proof read your letter and provide constructive criticism. Be sure to maintain confidentiality. If you are using a computer, consider printing out a hard copy of your document for proofreading, some individuals find it difficult to proof read a document on the computer screen. Checking for the following items: • Accuracy of all information • Clarity and conciseness • Grammar • Spelling • Punctuation • Paragraph appropriate in length and limited to one subject • Capitalization • Logical organization and flow. Use proofreader's marks to speed up the editing process. These are standard marks used to indicate corrections. You should become familiar with these basic marks.

Types of Business Letters

You will be asked create an type various letters. Letters that you write will be sent to patients, insurance companies, other healthcare providers, pharmaceutical company, and various businesses. here are some common type of letters that you may write: • Letters welcoming new patients to the practice. • Letters to patients regarding their test results. • Consultation reports to other healthcare professionals. • Workers' Compensation letters verifying the patient's injury or treatment. • Justification or explanation of treatments to insurance companies. • Cover letters for transferring patients' records to another practice. • Clarification or explanation to patients regarding fees or billing concerns. • Thank you letters to sales representatives. • Physician changes for on-call schedules (generally sent to the hospital and covering physicians) • Announcements of new services, hours, or office location changes

Margin

a blank space around the edges of a piece of paper, such as a letter or page of a book

Memorandum

a type of written documentation used for interoffice communication

Agenda

a brief outline of the topics to be discussed at a meeting

Template

a skeleton of a letter or document with preset and prespaced elements

Full Block

a type of letter format in which all letter components are justified left

Font

a typeface; affects the way written messages look

Salutation

an introductory phrase that greets the reader of a letter

Enclosure

indication for the reader that an item is accompanying the letter

BiCaps

words or phrases with unusual capitalization

Intercaps

words or phrases with unusual capitalization

Sentence Structure

• Avoid long, run-on sentences • A verb must always agree with its subject in number and person. • Ensure the proper pronoun (he or she) is used. • Adjectives should be used when they add an important message. Don't over use adjectives or adverbs. Remember, double negatives use in one sentence make the sentence positive.

USPS Special Services

A certificate of mailing is used to prove that a document was mailed. No record is kept at the post office. It does not provide proof that the letter was received by the addressee. Certified mail provides a mailing receipt and a record of the mailing at the local post office. This service is available for First-Class and Priority Mail. Return receipts can be purchased in conjunction with this. Return receipts are used to prove that the recipient received the document. Registered mail provides the most protection for valuables. It is available only for Priority and First-Class mail. The maximum insurance that can be obtained is $25,000. This service can be combined with return receipts. International rates are available from your local post office. Type the address as discussed earlier, and type the name of the country on the last line without abbreviations. All physician's offices should have a supply of Express and Priority Mail envelopes along with a current fee schedule.

Memorandum Development

A memorandum (often called a memo) is for communication within the office or with another department only; it is never sent to patients. It is less formal than a letter and is generally used for brief announcements.

Components of a Memorandum

A memorandum contains the standard elements in the following list 1. Heading The word memorandum is typed across the top of the page. 2. Date Use the same rules for letters when typing the date for memorandum. 3. To: List the names of all recipients in either alphabetical order hierarchy order. If the memorandum is going to a particular group, it can be addressed to that group. 4. From: List the name and title of the person sending the memorandum. 5. Subject Insert a brief phrase describing the purpose of the memorandum. 6. Body Write the message of the memorandum here. 7. Copy (c) Use the same rules as for letters when sending duplicate copies of memorandums. Salutations and closings are not use in memorandums. All lines in the memorandum are justified left, and 1 inch margins are used. Writing a memorandum entails the same steps (preparation, composition, editing) as writing a business letter. The memorandum should be read and initial by the physician before it is distributed. Your computer software will have a memorandum template.

Components of a Letter

A typical business letter has 11 components.

Abbreviations and Symbols

Abbreviations and symbols can save time in long handwriting and with typing. When you use abbreviations in medical documents, your reader must be able to recognize or translate the abbreviation. Abbreviations are not used as often as they once were. The possibility of confusion is not worth the time saved by using an abbreviation. When in doubt, spell it out.

Corrections

After making corrections, print a final copy of the letter. Remember, a computer spell check should be used with caution because it highlights misspelled words but not incorrectly used words.

Sending Written Communication

After the document has been written, proofread, and signed, it is ready for you to send it to its receiver. Fold the letter in thirds, and place it in an envelope. Most professional letters are sent through the postal service. Other types of written communication are sent through fax machines or by email. Here are two key steps to remember when sending any type of written communication: • All attempts must be made to ensure patient confidentiality. The outside of envelopes should be marked confidential when the correspondence contains information about a patient. Send letters only to known or confirmed addresses. • Return addresses must be use so that mail can be returned if the recipient is no longer at the given address.

Editing

After you have composed the letter, edit it for both grammatical errors and factual information. Editing is a key step in making your letter a success. Editing entails two steps; proofreading and corrections.

Enclosure

An enclosure is something that is included with the letter. It is abbreviated Enc. and is placed two spaces down from the identification line. The number of documents included is placed in parentheses; if only one document is included, just the abbreviation Enc. is used.

Numbers

In general, numbers 1 through 10 should be spelled out, except when used with units of measurement, and numbers over 10 may be expressed as a numeral. When several numbers are used in a sentence, this rule is ignored in order to maintain consistency. All numbers in a sentence should be written in the same form.

What are three consequences that could arise from inaccurate information in a business letter?

Inaccurate information in a business letter can lead to injuries to the patient and lawsuits and can harm the physician's practice.

USPS Mailing Options

Mail can be sent in a variety of ways based on its urgency and value. The following is a brief description of the services offered by the USPS: • Express Mail, the fastest service, ensures delivery of your package by the next day. Express Mail is delivered 7 days a week. Express Mail is automatically insured for $500. Additional insurance is available. • Priority Mail, the second fastest service, offers 2-day delivery to most destinations. The maximum weight is 70 pounds, and the maximum size is 108 inches combined length and girth. The rate is based on the weight of the package. You can purchase up to $5,000 of insurance for packages. • First-Class Mail is the service used for sending standard mail (letters and postcards) weighing up to 13 ounces. Mail weighing more than 13 ounces will be considered Priority Mail. • Standard Mail (A) is used by companies to mail books and catalogs. Standard Mail (B) is used to mail packages weighing more than one pound. The maximum weight is 70 pounds, and the maximum measurement is 130 inches combined length and girth. • Postal rates, fees, and services are subject to change. You must stay abreast of the latest information. Use the USPS website for additional information and updates.

What are memorandums used for?

Memorandums are used for communication within the office and with other departments.

Receiving and Handling Incoming Mail

Part of the daily routine for a medical assistant is handling the incoming mail. Sort the mail quickly and promptly to ensure efficient functioning of the office.

Professional Letter Development

Professional writing is different from writing letters to your friends or family members. The goal of professional writing is to get information communicated in a concise, accurate, and comprehensible manner. Slang or idiomatic terms that are commonly used in writing letters to friends are not appropriate for business letters. Writing effective business letters is a skill that requires practice and careful attention to detail. To write a professional business letter, you must: • Understand the components of a letter. • Use the correct letter format. • Ensure that the message is clear, concise, and accurate.

Be Careful What You Report in the Minutes

Remember, you are recording the happenings of a meeting that will stay on record for years. The minutes of a meeting should not include personal opinions or any information that is not relevant to the business of the group. The purpose of minutes is to record the actions that took place at the meeting.

Annotation

Some physicians request that letters be annotated. Annotation involves reading a document and highlighting the key points. If the letter is very detailed, a summary of the key points should be written in the margins. The summary should be factual and not editorialized.

What does an Pptical Character Reader do?

The USPS uses Optical Character Readers to quickly and efficiently sort the mail electronically.

Copy

The abbreviation c: is used to indicate that a duplicate letter has been sent. It is typed two spaces below the enclosure line. Usually, letters are copied to managers, supervisors, or to the physician who requested that the given information be dispersed.

Body of the Letter

The body of the letter contains the message. It should be single-spaced with double spacing between the paragraphs.

Closing

The closing concludes the letter. Some common closings are Sincerely, Yours truly, Regards, Respectfully, and Cordially yours. Only the first word is capitalized, and a comma follows the phrase. Closing are placed two spaces down from the end of the letter. Never put the closing alone on a page.

Date

The date includes the month, day, and year. It should be position two to four spaces below the letterhead. The date must be typed on only one line, and abbreviations should not be used.

Composition

The goal of composition is to ensure that your message is transmitted clearly, concisely, and accurately to your reader. As you did during preparation, focus on the message, not on the mechanics. A clear message ensures that your reader knows precisely what is expected, an unclear message leaves room for doubt. A concise message is short and to the point. Wordy phrases with many adjectives should not be used. An accurate message includes the correct date, time, figures, and information. Inaccurate messages cause delays and confusion and can lead to poor public relations.

Identification Line

The identification line, an optional component, indicates who dictated the letter and who wrote it. It consists of abbreviations only. The initials of the person who dictated the letter are capitalized (generally the physician); the initials of the writer of the letter are in lowercase (generally these will be yours). The identification line can also be called the reference line.

Whose address is typed as the inside address? What is the purpose of the salutation? What is the purpose of the identification line?

The inside address is the address of the person to whom the letter is going. The salutation is the greeting. The identification line shows the initials of the person who dictated the letter and the initials of the person who typed the letter.

Inside Address

The inside address refers to the name and address of the person to whom the letter is being sent. A 9-digit zip code should be used if available. The inside address is placed two spaces down from the date unless the letter is being mailed with a window envelope and it will not be aligned correctly. Never abbreviate city or town names. States can be abbreviated.

Letterhead

The letterhead consist of the name of the practice or physician, address, telephone number, fax number, and sometimes the company logo. The letterhead is oftrn embossed in color and centered on the top of the page. The letterhead may also be preset into a template.

Signature and Typed Name

The name of the person sending the document is typed four spaces below the closing, with the person's title typed directly below. The physician will read and sign the letter above the typed name. If you are instructed to sign the letter, sign the physician's name followed by a slash mark with your name. Example: Susan James, MD / Reyna Smith, CCMA

Agendas

The purpose of an agenda is to outline briefly but topics to be discussed at a meeting. It allows the meeting participants to prepare any necessary reports before the meeting and to anticipate questions. Agendas usually begin with a call to order, followed by a review of previous meeting minutes, old business updates, and then new business. Adjournment is the last item on the agenda. The format and amount of detail included in an agenda is determined by the type of group that is meeting.

Salutation

The salutation is the greeting of the letter. It is placed two spaces down from the inside address or the subject line. Capitalize the first letter of each word in the phrase, and end the phrase with a colon. It is permissible to eliminate the saltation if the letter is formal or if a subject line has been used. When writing to a physician, write out the word doctor.

Addressing Envelopes

The standard business envelope is no. 10. USPS regulations state that the minimum size of an envelope is 3 1/2 by 5 inches. It must be rectangular and no less than 0.007 inches thick. The standard no. 10 business envelope is 4 1/8 by 9 1/2 inches. The requirements for addressing an envelope are necessary because the Postal Service uses Optical Character Reader, which quickly and efficiently sorts the mail. As the mail travels through the scanning devices, it is sorted electronically. The return address is placed in the upper left hand corner. It should not exceed 5 lines. The return address is typed with the same guidelines as for letters and is single spaced. Often, medical offices have the return address preprinted on the envelope. The recipient's address is typed 12 spaces down from the top and centered on the face of the envelope. All words of the address should be capitalized. Only postal abbreviations for States should be used, and no punctuation is used between the postal abbreviation and the zip code. All addresses must include the 5-digit zip code whenever possible, the 4-digit expanded zip code should also be used. The expanded zip code allows the USPS to sort and route mail faster and more accurately. Envelopes should not be handwritten, as this does not portray a professional image. The entire address should not exceed five lines. Your software may allow you to insert a USPS PostNet ba rcode. This is generally inserted two to three lines below the address. This bar code accelerates USPS sorting. Always check your software to make sure it is certified by the USPS.

Subject Line

The subject line, an optional component, is used to state the intent of a letter or to indicate what the letter is regarding. It is placed on the third line below the inside address and is written as Re:

Letter Formats

There are three basic types of letter formats: full block, semiblock, and block. Office policy or the physician preferences will dictate which format you use.

Composing a Business Letter

To create a professional business letter, follow these three steps: preparation, composition, and editing.

Composing Agendas and Minutes

Two other forms of written communication are agendas and minutes.