43

Mail

Key Terms

annotate (ANN-oh-tate)

barcode clear zone

metered mail

postage meter

postal bar code

ZIP code

ZIP+4 code

LEARNING OBJECTIVES	PROCEDURES
U.S. Mail
1. Identify the function of the U.S. Postal Service (USPS). 2. State the purpose of the ZIP and ZIP+4 systems. 3. Describe the use of the following USPS mail classifications: Express Mail, Priority Mail, First-Class Mail, Standard Mail, and classifications used for packages. 4. Correlate available insurance and delivery confirmation services to their appropriate use in the medical office.
Other Package Delivery Services
5. Compare and contrast the use of private package delivery services with the use of the USPS.
Processing Incoming Mail
6. List and describe the steps for processing incoming mail.	Process incoming mail.
Preparing Envelopes for Mailing
7. List and describe the USPS addressing standards that must be followed to prepare mail.	Look up a ZIP code for automated processing.
8. List and describe the equipment used to prepare envelopes for mailing.	Prepare envelopes for mailing.
9. Compare and contrast postage meters and online postage services.

Introduction to Mail and Shipping

Mail communication is an important aspect of the efficient operation of the medical office. Every day the medical assistant processes incoming mail to facilitate delivery to physicians and other employees in the medical office. Preparing outgoing mail is also important. Most of this chapter is devoted to the services and postal addressing standards of the U.S. Postal Service (USPS), which is used to send the bulk of outgoing mail.

U.S. Postal System

The USPS is an independent agency with an official monopoly on the delivery of mail within the United States. It is financed primarily through the sale of postage and postage stamps. The postal service processes more than 563 million pieces of mail daily and is one of the largest employers in the United States. The USPS provides a variety of ways for mail to be transported from sender to receiver. The cost of these various services depends on the urgency with which mail must be received, as well as any special handling services provided.

ZIP Code and Bar Code Systems

In 1963 the USPS introduced the Zone Improvement Plan (ZIP) code system. This system enables the postal service to process mail more accurately, quickly, and economically with automated equipment. A ZIP code consists of a five-digit code that identifies the post office to which a piece of mail is to be delivered. In 1967 it became mandatory to use the ZIP code for second- and third-class bulk mailing.

The ZIP+4 code, which was introduced in 1983, consists of the original five-digit code followed by a hyphen and four additional digits. These digits identify a specific geographic segment within the five-digit delivery area, such as a city block, an office building, or a group of post office boxes. The plus-four code is required for certain presorted mailings. The USPS maintains a ZIP code lookup service that makes it easy to use the Internet to look up the ZIP+4 code for any address in the United States.

For bulk mailing, the ZIP code is translated into a postal bar code that is printed on the piece of mail by the sender. A computer program is used to add the bar code to pieces of mail, mailing labels, and mailing lists. For ordinary letters, the postal service may add the postal bar code because it makes the mail easier to sort. Unlike supermarket bar codes, which consist of wide and narrow bars, the postal bar code consists of long and short bars. Each individual digit in the ZIP code is represented by five bars, and a check digit is used after the ZIP code or ZIP+4 code. The postal bar code may be printed in the address block above or below the mailing address. When not included in the address block, the postal bar code is placed in the barcode clear zone, a blank rectangular area at the lower right of the card or envelope (Figure 43-1).

Classifications of Domestic Mail

Domestic mail includes mail that is collected and distributed within, among, and between the United States, its territories and possession, the military service, and the United Nations. Classifications are based on speed of delivery, weight of individual pieces of mail, and number of pieces of mail in the mailing.

Express Mail

Express Mail received by the post office before 5 PM is delivered within 24 hours, and by noon to most major cities, including on weekends and holidays. It includes letters and packages weighing up to 70 pounds. Envelopes and packing materials are available from the post office. Medical offices may use Express Mail to send laboratory specimens to an outside laboratory for testing. The postage rates for Express Mail are considerably higher than other rates, but they do include insurance against loss or damage.

First-Class Mail

First-Class Mail is used for letters or other lightweight items up to 13 ounces. The postage is based on weight, with a base rate for one ounce and additional postage for each additional ounce. The medical office uses this mail classification to send letters, postcards, patient statements, and some insurance claim forms.

Sending an item First Class usually results in overnight service to local cities and second-day service nationwide. Delivery by the third day can be anticipated for some outlying areas. All First-Class Mail should be sealed, and it may not be opened for postal inspection without a federal search warrant.

Additional extra mailing services can be purchased for First-Class Mail, such as Certificates of Mailing, Certified Mail, Registered Mail, Collect on Delivery (COD), and Restricted Delivery. If the item that is being sent First Class is letter size, no additional designation is required on the letter. However, if the item is not letter size, it must be clearly marked “First Class.”

Priority Mail

Priority Mail is used for mail weighing more than 13 ounces that is to be treated as First-Class Mail. It will be delivered anywhere in the United States within 2 to 3 days. The USPS has a set rate for items up to 1 pound, and flat rate envelopes and boxes are available. For an item over 1 pound in ordinary packaging, the rate depends on both the weight of the item and the distance it must be transported. For an additional charge Priority Mail can be combined with Insured Mail, Registered Mail, or Certified Mail or sent COD. Some examples of items that might be sent from the medical office using Priority Mail include copies of medical records.

Standard Mail

The Standard Mail classification is used by newspapers and periodical publishers to send newspapers, journals, magazines, and other periodicals. Periodical mailings must not be sealed, and handwritten messages are not permitted. Standard Mail is also used to send large mailings of newsletters and bulletins. The medical office usually does not obtain the special permit to send items at this rate, but it may receive newspapers, magazines for the waiting room, and medical journals. Standard Mail requires a minimum of 200 pieces or 50 pounds per mailing.

Parcel Post and Other Packages

If time is not a significant factor, packages may be sent using one of the ground mail classifications. Parcel Post is used to send merchandise and other items that weigh up to 70 pounds and measure up to 108 inches in length and girth. Instruction slips, packing slips, sales slips, or invoices can be enclosed in a package sent Parcel Post without additional postage. However, in order to send a letter with a package, the letter must be attached to the outside of the package and paid for at the First-Class rate. The medical office rarely sends items by Parcel Post, although it may receive supplies sent by this method. Media Mail is a special classification for packages containing books, sound recordings, film, manuscripts, and computer media but not advertising. Bound Printed Matter is a classification for packages containing permanently bound catalogs and other volumes containing advertising (e.g., telephone books).

Insurance and Delivery Confirmation Services

The USPS offers a number of extra mailing services. These services must be purchased in addition to the regular postage required to send an item. The medical assistant must understand these extra services, particularly those that are used most frequently in the medical office, such as Certified Mail and Return Receipt.

Certified Mail

Certified Mail is available for First-Class Mail and Priority Mail. It serves as legal evidence that an item was mailed by providing the sender with a mailing receipt. In addition, a record of delivery of the certified item is maintained for 2 years. A green certified mail sticker affixed to the envelope identifies the envelope as Certified Mail. The recipient must sign on delivery of a piece of Certified Mail. This service can also be combined with a Return Receipt for an additional fee (Figure 43-2).

Putting It All into Practice

My name is Diane Waters, and I am a certified medical assistant. I have been working for a group practice with three general surgeons for the past 6 years. Our physicians usually have office hours three times a week, either in the morning or the afternoon. They usually operate two or three times a week, and they have to make hospital rounds every day. Two of them also work with residents at a large hospital located near our practice. In the past, each surgeon received an operative report and discharge summary for each patient he or she had operated on in hard copy. When I opened the mail, I had to date stamp each report, find the patient’s medical record, and place it for the physician to review before it could be filed. A few years ago the hospital went to an electronic medical record. The operative reports and discharge summaries are now entered into the electronic medical record automatically, and the physicians review them online. That means that we get significantly less mail because not only those reports but also laboratory reports, pathology reports, and other types of reports no longer come to the office. Of course, we don’t have as much filing, either. Our office still gets piles of journals, magazines, and other printed matter, however. Every day when I am sorting the mail, I have to separate the professional journals that our physicians want to read from magazines, catalogs, circulars, and other items that they would only look at if we found some item of special interest to them. One physician likes to look through this material if it comes with his name on it, but the others don’t even want it to show up on their desks. 

Return Receipt

A Return Receipt provides the sender with proof of delivery of a piece of mail and the signature of the person receiving the mail. This may be done through a postcard signed by the recipient and returned to the sender or by an e-mail with an attachment containing the recipient’s signature. The sender then has a copy of the signature of the person who signed for the piece of mail. This service can be combined with other services. It is often used with Certified Mail to establish proof of mailing, as well as proof of receipt (Figure 43-3).

Signature Confirmation

Signature Confirmation provides a record of the date and time an item was delivered, as well as the name of the person who signed for the item. A delivery record, including the signature of the recipient, is available by fax or mail on request. The medical office usually uses Return Receipt instead of Signature Confirmation for evidence of delivery because the return postcard or e-mail will be sent automatically.

Certificate of Mailing

A Certificate of Mailing provides evidence of the date and time an item was mailed, but there is no legal proof that the item was actually delivered to the recipient. A certificate of mailing might be used when proof of timely mailing is required, such as a tax return. No record is maintained at the post office, so the sender is responsible for keeping the form.

Restricted Delivery

If an item is strictly confidential, Restricted Delivery limits delivery to the addressee, the individual authorized in writing to sign for the addressee, or a parent or guardian. It is not generally necessary to use this service for letters from the medical office, but if a legal case is pending, it might be advisable.

Registered Mail

Registered Mail is available for First-Class and Priority Mail, to insure the contents up to $25,000.00. Registered Mail is used when the contents of the item mailed are valuable. The items are tracked, and the date and time of delivery or delivery attempts can be verified online. The cost depends on the value of the item being sent. The sender receives a receipt that is kept until the recipient receives the item. The recipient must sign a form acknowledging receipt. For an additional fee, the sender can receive a Return Receipt.

Insured Mail

Insurance can be purchased on the contents of mail up to $5000.00. The cost depends on the declared value of the contents. If the mail is lost or damaged, the sender presents the receipt to make a claim for reimbursement of the declared value.

Special Handling

Special Handling is used for unusual items that require special treatment, such as a shipment of live bees. Ordinary packages with breakable items can be marked “FRAGILE” and do not require Special Handling provided they are packed with adequate packing material to protect the contents. This service is not usually used by the medical office.

Collect on Delivery

COD is a special mailing service that allows a sender to collect for merchandise and postage on delivery. The amount due is collected by the postal carrier and returned to the sender by a postal money order. This service is rarely used by the medical office.

Postal Money Orders

Postal money orders are a safe way to send money through the mail within the United States. They may be purchased in an amount up to $1000.00. The sender is given a customer receipt. If the money order is lost or stolen, the sender presents the receipt to the post office for replacement. Some patients may pay bills with postal money orders.

Other Package Delivery Services

Private carriers compete with the USPS to provide delivery service of letters and packages. Many companies use DHL, FedEx, or United Parcel Service (UPS) for next-day and 2-day delivery service. Larger packages that are not time sensitive can be shipped via UPS or FedEx Ground service. A shipping service company will pick items up from an office and offer continuous item tracking over the company’s website. Each company also provides mailing envelopes and small boxes at no cost to the customer. Once an account has been established, shipping can be arranged and paid for using the Internet.

Private carriers often deliver packages to the medical office. Examples include business supplies and laboratory reagents requiring refrigeration. The medical office may use a private delivery service to send some laboratory specimens to a laboratory for testing if the specimen must go to a special laboratory or cannot wait for the regular laboratory pickup service.

What Would You Do? What Would You Not Do?

Case Study 1

Jerome Stone, a 68-year-old man who has had two laparoscopic surgeries in the past, has called the office and asked to have a copy of his medical record sent to his new surgeon in another state because he needs to have another surgery for the same condition. He tells Diane that the surgery is scheduled for the following week and asks if she can send the copy of the record immediately. He states that he can come into the office the following day to sign the form giving permission to release the record. He gives her the name, address, and telephone number of the new physician. 

Processing Incoming Mail

Mail is delivered to the medical office in various ways. The postal carrier may deliver the mail directly to the office, or it may be placed in an outside mailbox. Some medical offices use a post office box. In this case the medical assistant must go to the post office to collect the mail each day. In a large clinic the mail may be delivered to a central mailroom, where it is sorted and distributed to each department or individual mailbox.

Once the mail is received by the medical office, it must be processed according to the preferences of individual physicians. One physician may want to see all the incoming mail, whereas another physician may want the medical assistant to screen the mail and remove circulars, patient and insurance payments, and magazines for the waiting room (Procedure 43-1).

 Procedure 43-1   Processing Incoming Mail

Outcome

Process incoming mail.

Equipment/Supplies

• Letter opener

• Date stamp

• Paper clips

• Stapler

• Pen or highlighter

• Transparent tape

1. Procedural Step. Assemble supplies in a work area large enough to make several piles of mail.

2. Procedural Step. Stack all the envelopes so that they face in the same direction. Place any envelopes marked “personal” or confidential” to the side.

    Principle. Letters marked “personal” or “confidential” should be opened only by the person to whom they are addressed.

3. Procedural Step. Tap the lower edge of the first envelope on the desk so that the contents fall to the bottom.

    Principle. Tapping the envelope prevents cutting the contents when the envelope is opened.

4. Procedural Step. Using a letter opener, open the envelope along its top edge.

    Principle. Using a letter opener makes it easier to open the envelope neatly and preserves the return address should it be needed.

5. Procedural Step. Remove the contents of the envelope. Check to be sure the envelope is empty.

6. Procedural Step. Unfold and flatten letters. Date stamp each letter, preferably in the upper right-hand corner of the letter.

    Principle. A date stamp provides a record of when the letter was received.

7. Procedural Step. Check to make sure that the letter contains an inside address. If not, staple the envelope to the letter. Discard the envelope if it is not needed, unless office policy states otherwise.

8. Procedural Step. Fasten enclosures to the letter with a paper clip. If a letter indicates an enclosure, but it is missing, write “No” next to the enclosure notation and circle or highlight it.

9. Procedural Step. Mend any torn paper with transparent tape to prevent further damage.

10. Procedural Step. If directed by the physician, annotate the correspondence by underlining or highlighting important words and phrases in the correspondence. Attach a sticky note indicating any action that should be taken in response to the correspondence.

    Principle. Annotating saves the physician time in reading and responding to incoming mail.

11. Procedural Step. Follow the same steps to open each piece of mail as described earlier, and separate the pieces of mail into categories: urgent or very important, other letters, letters or reports containing patient information or results, medical journals, and circulars or advertising.

12. Procedural Step. Arrange letters and reports containing patient information in alphabetic order. If the office uses paper medical records, find the appropriate medical record, and attach each letter or report to the medical record with a paper clip.

13. Procedural Step. Arrange the mail for each physician with the most important mail on top and the least important on the bottom.

14. Procedural Step. Distribute each stack of mail to the appropriate individual.

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