Chapter 6: Managing Appointments. Chapter Objectives Cognitive Domain Note: AAMA/CAAHEP 2008 Standards are italicized. 1. Spell and define the key

Chapter 6: Chapter 6:

Managing Managing AppointmentsAppointments

Chapter ObjectivesChapter Objectives

Cognitive Domain

Note: AAMA/CAAHEP 2008 Standards are italicized.

1. Spell and define the key terms 2. Describe the pros and cons of various types of

appointment management systems for scheduling patient office visits, including manual and computerized scheduling

3. Describe scheduling guidelines 4. Explain guidelines for scheduling appointments for new

patients, return visits, inpatient admissions, and outpatient procedures

5. Recognize office policies and protocols for handling appointments

Chapter Objectives (cont’d)Chapter Objectives (cont’d)

6. Identify critical information required for scheduling patient admissions and/or procedures

7. Discuss referral process for patients in a managed care program

8. List three ways to remind patients about appointments 9. Describe how to triage patient emergencies, acutely ill

patients, and walk-in patients 10. Describe how to handle late patients 11. Explain what to do if the physician is delayed 12. Describe how to handle patients who miss their

appointments 13. Describe how to handle appointment cancellations

made by the office or by the patient


Psychomotor Domain


1. Manage appointment schedule, using established priorities a. Schedule an appointment for a new patient b. Schedule an appointment for a return visit

2. Schedule patient admissions and/or procedures a. Schedule an appointment for a referral to an

outpatient facility


b. Arrange for admission to an inpatient facilityo Verify eligibility for managed care serviceso Obtain precertification, including documentationo Apply third-party managed care policies and

procedureso Apply third-party guidelines

3. Use office hardware and software to maintain office systems


Affective Domain


1. Implement time management principles to maintain effective office functions

2. Demonstrate empathy in communicating with patients, family and staff

3. Demonstrate sensitivity in communicating with both providers and patients

4. Communicate in language the patient can understand regarding managed care and insurance plans

5. Demonstrate recognition of the patient’s level of understanding in communications


ABHES Competencies

1. Schedule and manage appointments 2. Schedule inpatient and outpatient admissions 3. Be impartial and show empathy when dealing with patients 4. Apply third party guidelines 5. Obtain managed care referrals and precertification


6. Apply computer application skills using a variety of different electronic programs including both practice management software and EMR software 7. Communicate on the recipient’s level of comprehension 8. Serve as liaison between physician and others

Responsibility for scheduling and managing the flow of patient care in a medical office or clinic is one of the most important duties assigned to a medical assistant. As appointment manager, you make the first, last, and most durable impression on the patient and providers.

providers: health care workers who deliver medical care

Back to chapter objectives

IntroductionIntroduction

Appointment Scheduling SystemsAppointment Scheduling Systems

Manual Appointment Scheduling The Appointment Book

Should have enough space for all pertinent information (e.g., patient’s name, telephone number, reason for visit)

Should be divided into time units appropriate for your practice (e.g., 10- or 15-minute intervals)

Should open flat on the desk where it will be used

Should fit easily into its storage place when not in use

Figure 6-1 Sample page from manual appointment book.


Appointment Scheduling Systems (cont’d.)Appointment Scheduling Systems (cont’d.)

Establishing a Matrix Cross out times physician is

unavailable Include reason for unavailability Block off 15–30 minutes morning

and afternoon to accommodate emergencies and delays

Give copies to staff each day A legal document

matrix: a system for blocking off unavailable patient appointment times

Along with the notations in a patient’s chart, the pages of the appointment book provide documentation of a patient’s visits and any changes, such as cancellations and rescheduled appointments.


Appointment Scheduling Systems (cont’d.)Appointment Scheduling Systems (cont’d.)

Computerized Appointment Scheduling Software varies Easy access to billing

information Prints out schedule easily

Figure 6-2 A computer-generated appointment schedule. Courtesy of Ingenix® CareTracker.TM

Once the daily schedule is printed, this important document is referred to as the daily activity sheet or the daysheet and is the guide for everyone involved inthe flow of patient care.


Checkpoint QuestionCheckpoint Question

What is the purpose of a matrix?



Answer: A matrix is established to indicate times of each day that are not available for patient appointments.


Types of SchedulingTypes of Scheduling

Structured Appointments 30 minutes at the beginning

or end of the day is often used as a buffer

Uses for buffer time:o Returning phone callso Reviewing recordso Transcribing reports

buffer: extra time to accommodate emergencies, walk-ins, and other demands on the provider’s daily time schedule that are not considered direct patient care


Types of SchedulingTypes of Scheduling

Clustering Group patients with similar

problems or needs Daily or weekly Allows good use of

specialized equipment or staff

clustering: grouping patients with similar problems or needs


Types of Scheduling (cont’d.)Types of Scheduling (cont’d.)

Wave Schedule several patients in first

half or each hour, second half left open for rechecks, emergencies, and other tasks

Patients are seen in order of arrival

Good for large, multidepartment facility

Modification — full physicals on the hour, rechecks on the half-hour

wave scheduling: a flexible scheduling method that allows time for procedures of varying lengths and the addition of unscheduled patients, as needed



Fixed Most common method Patients allotted time by complexity of problem Schedule disruptions affect entire day Schedule chronically late patients toward end of day Or, tell patients to arrive 30 minutes prior to their

allotted time


Streaming Standard time periods

assigned to different needs

streaming: a method of allotting time for appointments based on the needs of the individual patient to minimize gaps in time and backups.


Double Booking Two patients scheduled for

same time slot with same physician

double booking: the practice of booking two patients for the same period with the same physician


Flexible Hours Office hours vary throughout week Patients are scheduled during open times Greater range of possible appointment times allow patients

with work or family schedule conflicts



Open Hours No scheduled appointments Patients come when they can during open hours Common in walk-in clinics Patient records must be pulled as patients arrive Clear disadvantages:

o Effective time management almost impossibleo Facilities may be overloaded or completely empty at

timeso Charts must be pulled and prepared as each patient

arrives

Sign-in sheets are considered a breach of confidentiality, since patients signing the sheet can see the names and medical conditions of other patients.



What are the three systems that can be used for scheduling patient office visits?



Answer: The three systems that can be used for patient office visits include scheduled appointments, flexible hours, and open hours.


Factors that Affect SchedulingFactors that Affect Scheduling

Patients’ Needs Good communication critical — emotions can make slight

miscommunication into negative experience for patient

With a patient in an emotional state, even the slightest real or imagined miscommunication can lead to negative response from the patient.


Factors that Affect Scheduling (cont’d.)Factors that Affect Scheduling (cont’d.)

Obtain appropriate patient information:o Reason for visito Length of time of symptomo Problem acute or chronico Time of day convenient for

patiento Special needs of patiento Whether patient needs to see

other office staffo Third party payer constraintso Documentation for referrals if

required by third-party payer

acute: abrupt in onset

chronic: long-standing



Strive to accommodate patient’s requests but remember:o You control the schedule—do not let it control youo Entire medical office team depends on a well-managed

schedule



Providers’ Preferences and Needs Become familiar with providers’ habits

o Punctual or often behind? Medical assistant clinical duties should be accommodated Possible provider scheduling needs:

o Nonmedical office visitors o Telephone timeo Teaching duties



Physical Facilities Number of providers using facility Number of examination rooms Need to resterilize instruments between procedures Must thoroughly understand the requirements for

procedures to be performed in the office

You must thoroughly understand the requirements for procedures to be performed in the office to schedule appointments accurately.



What are three factors that can affect appointment scheduling?



Answer: The three factors that can affect scheduling are patients’ needs, physicians’ preferences, and the physical facilities.


Scheduling GuidelinesScheduling Guidelines

Be pleasant and helpful Always include patient phone number on schedule Include buffers each day


Scheduling Guidelines (cont’d.)Scheduling Guidelines (cont’d.) New Patients

Allow adequate time Obtain full name and correct spelling Mailing address Day and evening phone numbers Reason for visit Name of referring physician or individual Responsible party and third party payer (insurance) Explain payment policy


The information you exchange at this encounter is crucial, and entering the patient’s data accurately is imperative.

Scheduling Guidelines (cont’d.)Scheduling Guidelines (cont’d.)

Request pertinent insurance information Ensure that patient knows office location and directions Ask patient if messages can be left at home or work — note in

chart Reconfirm date and time of appointment before ending call Recheck that appointment is correctly entered in book Note if referral — obtain relevant patient information from

source of referral


Scheduling Guidelines (cont’d.)Scheduling Guidelines (cont’d.) Established Patients

Carefully check appointment book or screen before offering appointment time

Offer patient specific date and time

Enter information in appointment book (or enter in the appointment screen)

If patient is present, fill out appointment card


Figure 6-3 An appointment card will help the patient remember his or her appointment and reduce no shows.

Scheduling Guidelines (cont’d.)Scheduling Guidelines (cont’d.)

Reconfirm date and time Recheck appointment book End with pleasant word and smile


Preparing a Daily or Weekly SchedulePreparing a Daily or Weekly Schedule

Most offices—medical assistant responsible o Make copy for staff—ensure corrections are made on all

copieso Place next day’s schedule on physicians desk before he or

she leaves—next week’s on Fridayo Should include patient appointments and all other

commitmentso Important to make manual changes to computer schedules

as day progresses


Patient RemindersPatient Reminders Appointment Cards

Give out one at a time Regular appointments should be scheduled at same day

and time Telephone Reminders

New and already-scheduled patients should receive phone call day before appointment

Check chart to ensure that patient has agreed to allow messages to be left

If patient must cancel, use move-up list to schedule another patient in slot


All new patients and patients with appointments scheduled in advance should receive a telephone reminder the day before their appointment.

Patient Reminders (cont’d.)Patient Reminders (cont’d.) Mailed Reminder Cards

Alternative to phone calls Mail at least 1 week before

appointment Can be used to remind

patients to make appointments for regular examinations

Keep a supply of preprinted postcards in the office

Most medical management software packages can alert you that it’s time for patient reminders


Figure 6-4 Sample reminder postcard.


What are the three types of patient reminders?



Answer: The three types of reminders are appointment cards, telephone reminders, and mailed reminder cards.


Adapting the ScheduleAdapting the Schedule

Emergencies Must determine if

problem can be treated in office or whether to call EMS

“STAT” = Latin statim, or immediately

When a patient calls with an emergency, your first responsibility is to determine whether the problem can be treated in the office.

Figure 6-5 When a patient calls from home with a possible heart attack, you will call 911.


Adapting the Schedule (cont’d.)Adapting the Schedule (cont’d.)

Ask questions to elicit crucial information:o Possible heart attacko Possible poisoningo Life-threatening bleedingo Shocko Burns


Adapting the Schedule (cont’d.)Adapting the Schedule (cont’d.) Constellation of symptoms can

indicate particular condition:o Shortness of breath, chest pain,

arm/neck pain, nausea/vomiting can indicate heart attack

o Severe right lower quadrant pain, nausea, and fever often points to appendicitis

If life-threatening emergency:o Keep patient on phoneo Call EMS for transporto Do not advise patient to drive to

hospital


constellation of symptoms: a group of clinical signs indicating a particular disease process


Patients Who Are Acutely Ill Severe but not life-threatening Obtain as much information as possible Place note on chart for physician review Tell patient you will call back as soon as physician makes

decision


Obtain as much information about the patient’s medical problem as you can so your message to the physician will allow him or her to decide how soon the patientshould be seen.


Walk-in Patients Office policy should be in place Emergencies must be handled immediately Ask patient to wait — work in to schedule as possible

Late Patients Explain to patient that they are late and must wait until

physician is available Chronically late patients can be told that lateness of more

than 15 minutes mandates rescheduling Schedule chronically late patients in afternoon/evening to

avoid schedule disruption



Physician Delays Call patients with appointments later in the day to alert

them and allow the option of rescheduling Patients in waiting room should be notified immediately Allow to wait or reschedule If rescheduling, note reason in patient record Continue to offer updates Always keep patients informed Most will understand if they know they are not ignored or

forgotten


If patients are waiting in the office, inform them immediately if the physician will be delayed.


Missed Appointments No-show = patient fails to show up for appointment and

does not call to notify Call patient to determine reason and to reschedule If unable to reach by phone, sent reminder card — place

copy in patient’s chart Note missed appointment and follow-up steps in chart Continued failure to keep appointments should be handled

by physician May decide to terminate relationship


Continued failure to keep appointments should be brought to the attention of the physician, who may want to call the patient personally (particularly if the patient is seriously ill) or send a letter expressing concern for the patient’s welfare.

CancellationsCancellations

Cancellations by the Office If physician is ill or has emergency Call patients to reschedule — don’t tell exact reason Note in medical record If physician will be out for an extended period, a locum

tenens should be arranged On-call physicians can stand in


These cancellations should be noted in the patient’s medical record.

Cancellations (cont’d.)Cancellations (cont’d.)

Cancellations by the Patient Note in record Offer to reschedule If patient has ongoing problem, emphasize importance of

regular care Notify physician of frequent cancellations Can schedule move-up list patients if schedule is light


Making Appointments for Patients in Other FacilitiesMaking Appointments for Patients in Other Facilities

Referrals and Consultations Must make sure referral

meets requirements of third-party payers.

HMO’s have strict requirements for precertification

Must complete referral form with approval number from insurance company

Give patients choice of specialist


Figure 6-6 Sample referral form.

Be sure the physician you are calling is on the preferred provider listfor the patient’s insurance company.

referral: instruction to transfer a patient’s care to a specialist

consultation: request for assistance from one physician to another

precertification: request for assistance from one physician to another

Making Appointments for Patients in Other Facilities Making Appointments for Patients in Other Facilities (cont’d.)(cont’d.)



When calling another physician’s office for patient appointment provide the following:o Physicians name and telephone numbero Patients name, address, and telephone numbero Reason for referralo Degree of urgencyo Whether patient is being sent for consultation or referral

Record in patients chart:o Time and date of callo Who received your call



Inform person that you wish to be notified if patient does not keep appointment (if this occurs—enter in to the patients record)

Can write name, address, telephone number of referral doctor on office stationery and include the date and time of appointment

Give or mail to patiento Patient may call referring physician and make appointment

—ask patient to notify you with date—document



Diagnostic Testing Patient sent to another facility for laboratory test, radiology,

computed tomography, Magnetic resonance imaging etc. Appointments usually made with patient still in office Prior to scheduling, must determine exact test or test:

o How soon results are needed—STAT?o Ask patient about time restrictionso Provide patient’s name, address, telephone number,

exact test or test required and other special instructionsoGive patient referral slip with name, address, telephone

number of facility



Some laboratory studies or x-ray test require advanced preparationo Give patient written and verbal explanationo Ensure he or she understandso Document in chart and put reminder in tickler file to ensure

test results are received.



Surgery Determine precertification—call number on back of

insurance card Call facility chosen by patient and specify time and date

physician has requested Operating facility needs to know Exact procedure Amount of time needed Anesthesia required



Other instructions Also need all pertinent patient information Give patient copy of preadmission forms—if available Follow policies of surgical facility regarding preadmission

testing (laboratory studies, autologous blood donation) Write down all for patients—ensure he or she understands Note—may need to also arrange for hospital admission with

hospital admitting department



What information should be readily available when calling to schedule a patient for surgery in another facility?



Answer: When scheduling a patient for surgery, the following information is needed: demographic and insurance information; the patient’s name, age, address, telephone number, precertification number (if required), and diagnosis; surgery planned; and any special instructions.


When the Appointment Schedule Does Not WorkWhen the Appointment Schedule Does Not Work

Regular schedule disruptions require determining cause Evaluate the schedule over 2 to 3 months by listing:

o All patients seeno Arrival timeso Amount of time spent with physiciano Departure timeso Amount of time needed to perform each examination or

treatment Office meetings are ideal way to identify scheduling problems Adjust schedule to avoid causing frustration for both patients

and office personnel


Since the workflow of the office affects every staff member, involve all employees in your study.

Documents

Chapter 6: Managing Appointments. Chapter Objectives Cognitive Domain Note: AAMA/CAAHEP 2008 Standards are italicized. 1. Spell and define the key