SCHEDULING APPOINTMENTS

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• How can the medical assistant contribute to an effi cient daily

routine?

• How does the medical assistant contribute to keeping the daily

schedule on track?

• How can the schedule be put back on track when emergencies disrupt

the day?

• How does the fl exibility of the medical assistant contribute to offi ce

effi ciency?

While studying this chapter, think about the following questions:

1. Defi ne, spell, and pronounce the terms listed in the vocabulary.

2. Describe scheduling guidelines.

3. Discuss the advantages of computerized appointment scheduling.

4. Explain the features that should be considered when choosing an

appointment book.

5. Explain how self-scheduling can reduce the number of calls to the

medical offi ce.

6. Discuss pros and cons of various types of appointment management

systems.

7. Explain the importance of legible writing in the appointment book.

8. Explain the basic procedure to follow when the offi ce is behind

schedule.

9. Discuss the benefi ts of offering choices to patients when scheduling

appointments.

10. Identify critical information required for scheduling patient admissions

and/or procedures.

11. Discuss several methods of dealing with patients who consistently

arrive late.

12. Name several reasons for failed appointments.

13. Recognize offi ce policies and protocols for handling appointments.

L E A R N I N G O B J E C T I V E S

SCHEDULING APPOINTMENTS

SCENARIO

Ramona West is the medical assistant in

charge of scheduling appointments for Dr.

Charlotte Brown. Ramona is an extremely organized

person who thinks quickly and creatively. One of her professional goals is to

ensure that the offi ce remains on schedule throughout the day and that patient ’ s

waiting time is kept to an absolute minimum. She is fortunate that Dr. Brown

is cooperative and time oriented, and they work well together to reach this

common goal.

Ramona usually arrives at work at least 15 minutes early to begin her

preparations for the day. She reviews the electronic medical record for each

patient to make sure test results from previous visits are available to the

physi-cian and that the medical record is complete. She pays special attention to the

patients who arrive in the offi ce as she completes her daily tasks, remembering

the importance of providing patients with good customer service. Ramona greets

each patient by name and carries on a brief but cordial conversation. Patients

appreciate that she goes the extra mile to remember something about them,

and this promotes excellent patient relations.

Ramona leaves a little time in the morning and afternoon for emergency

appointments. The offi ce uses an automatic call routing system to contact

patients and confi rm appointments in advance, which increases her show

rate. Her friendly, caring attitude makes her a favorite among the patients,

and Dr. Brown is pleased with the relationship-building skills Ramona has

developed.

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V O C A B U L A R Y

precertifi cation A process required by some insurance carriers in

which the provider must prove medical necessity before per-forming a procedure.

prerequisite (pre-re ′ -kwe-zut) Something that is necessary to an

end or to carry out a function.

profi ciency (pruh-fi ′ -shun-se) Competency as a result of training

or practice.

reimbursement Payment of benefi ts to the physician for

services rendered according to the guidelines of the third-party payer.

screening A system for examining and separating into diff erent

groups; in the medical offi ce, determining the severity of illness that patients experience and prioritizing appointments based on that severity.

socioeconomic Relating to a combination of social and

eco-nomic factors.

template A predeveloped page layout used to make new pages

with a similar design, pattern, or style; a standardized fi le type used in computer software as a preformatted example on which to base other fi les.

automatic call routing A software system that answers phones

automatically and routes calls to staff after the caller responds to prompts; also used to call a large number of patients to remind them of appointments or make announcements.

disruption An unexpected event that throws a plan into disorder;

an interruption that prevents a system or process from continu-ing as usual or as expected.

established patients Patients who are returning to the offi ce who have previously been seen by the physician.

expediency (ik-spe ′ -de-un-se) A means of achieving a particular

end, as in a situation requiring haste or caution.

integral (in ′ -ti-grul) Essential; being an indispensable part of a

whole.

interaction A two-way communication; mutual or reciprocal

action or infl uence.

intermittent Coming and going at intervals; not continuous.

interval Space of time between events.

matrix Something in which a thing originates, develops, takes

shape, or is contained; a base on which to build.

no-show A person who fails to keep an appointment without

giving advance notice.

preauthorization A process required by some insurance carriers

in which the provider obtains permission to perform certain procedures or services or refers a patient to a specialist.

T

he physician ’ s time is the most valuable asset of a medical practice. Th e person responsible for scheduling this time must understand the practice, be familiar with the working habits and preferences of the physician (or physicians), and have clear guidelines for time management in the practice.

Appointment scheduling is the process that determines which patients the physician sees, the dates and times of appointments, and how much time is allotted to each patient based on the complaint and the physician ’ s availability. Time management involves the real-ization that unforeseen interruptions and delays always occur. Most medical care providers fi nd that effi cient appointment scheduling is one of the most important factors in the success of the practice. Scheduling can be done in a number of ways, and each facility must fi nd the way that suits it best.

USING ESTABLISHED PRIORITIES FOR

APPOINTMENT SCHEDULING

Patients often complain that the amount of money they pay to see the physician does not correspond with the amount of time the physician spends with the patient. A patient may say, “I only saw the doctor for 5 minutes and could not even remember all the questions I wanted to ask!” Th e patient must feel confi dent that the physician will take enough time to understand his or her concerns. Well-planned scheduling and adherence to that schedule allow the physician to do more than run in and out of examination rooms with little time for the patient to talk with the physician.

Th e person scheduling appointments must learn the physician ’ s habits and desires. If the physician suggests scheduling patients every 15 minutes but always spends 20 to 25 minutes with a patient, the schedule must be adjusted. Talk with the physician and/or offi ce manager and compromise so that the schedule is workable. Some physicians need prompting to end the patient visit and move to the next patient. Th e medical assistant assisting in the examination room can help the physician remain on schedule, because he or she teams with the scheduler and they work together for an effi cient fl ow of patients through the offi ce.

Th e scheduling system must be individualized to the specifi c practice. Th e following general guidelines can be applied to any practice, whether computer or paper based. Four factors must be considered in scheduling: the patient ’ s needs, the physician ’ s preferences and habits, the facilities available, and the duration of offi ce visits.

Patient Needs

Consider the socioeconomic status of the area being served when

determining offi ce hours and appointment times. Th e offi ce staff should answer the following questions:

• Is the offi ce in a busy metropolitan area or a rural agricultural community?

• Are the patients young, middle aged, or retirement age? • Is the area more industrial or residential?

• What type of patients are seen? Are they of a specifi c age or gender? Do they have common diagnoses? Is the physician a general practitioner?

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• Are evening and weekend appointments essential for most of the patients served?

After these elements have been considered, the scheduler must allot time based on the patient ’ s needs for each individual offi ce visit. Th ese needs can be assessed by determining the following:

• What is the purpose of this visit? • What is the patient ’ s age?

• Will the patient require the physician ’ s time for the entire visit or will another staff member perform all or part of the service? • Is the patient a parent who prefers to schedule appointments

while the children are at school?

• Does the patient object to traveling after dark?

• Is the patient a day worker who cannot take time off from a job?

• Is the patient a child whose parents both work during the day? Th e offi ce should make every attempt to meet the patient ’ s needs while balancing the physician ’ s preferences and the available facilities.

Physician Preferences and Habits

Consider the preferences and habits of the physicians in the practice before establishing and implementing a scheduling plan. Ask the following questions:

• Does the physician become restless if the reception room is not packed with waiting patients?

• Does the physician worry if even one patient is kept waiting? • Is the physician methodic and careful about being in the

facil-ity when patient appointments are scheduled to begin? • Is the physician habitually late?

• Does the physician move easily from one patient to another? • Does the physician require a “break time” after a few patients? • Would the physician rather see fewer patients and spend more

time with each one or schedule more patients each day? All of these preferences and habits become an integral part of

the scheduling process ( Figure 10-1 ). Keep in mind that the physi-cian cannot spend every moment of the day with patients. Th e physician also has telephone calls to make and receive, reports to examine and dictate, meetings to attend, mail to answer, and many other business responsibilities. An experienced staff can handle many but not all of these tasks.

FIGURE 10-1 The habits and preferences of the physician must be considered when appoint-ments are scheduled for patients.

CRITICAL THINKING APPLICATION

■

_{Ramona has noticed that Dr. Brown is taking a little longer with}

patients than normal and that she is running consistently behind

schedule by approximately 5 to 15 minutes. How can Ramona help

rectify this situation?

■

_{Discuss ways of approaching the physician when he or she is the cause}

of the delays in the schedule. What opening remarks can the medical

assistant use to start the discussion in a positive way?

10-1

Available Facilities

Getting a patient into the offi ce at a time when no facilities are available for the services needed is pointless. For example, suppose that an offi ce with two physicians has only one room that can be used for minor surgery. Do not schedule two patients requiring

minor surgery for the same time block, even if both doctors could be available. If the offi ce has only one electrocardiograph, do not book two electrocardiographic procedures at the same time. As the medical assistant gains profi ciency in scheduling, it becomes easier

to pair patient needs with the available facilities according to the physician ’ s preference. Major equipment frequently used or a certain room with such equipment may need its own scheduling column in the appointment book or software system.

Duration of Offi ce Visits

Th e medical assistant who performs scheduling duties must know the amount of time required for various offi ce visits and procedures. Th e offi ce policy and procedure manual should have a list of the proce-dures performed in the physician ’ s offi ce with a notation of the time required for the procedure using established priorities. Th e time blocks are important, because the physician ’ s reimbursement from

insurance companies is based partly on the time requirements of the procedure or offi ce visit. When scheduling, make sure to allow enough time to complete a procedure; for example, never schedule a Pap smear or minor surgery in a 10- or 15-minute time slot.

METHODS OF SCHEDULING APPOINTMENTS

Th e two most common methods of appointment scheduling are computerized scheduling and appointment book scheduling. Each has advantages and disadvantages, and the physician ’ s offi ce should weigh the benefi ts and choose the method that best suits the physi-cian and the staff .

Computer Scheduling

Th e computer has replaced the appointment book in many practices. Software for appointment scheduling ranges from relatively simple

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view a facility ’ s schedule, then select his or her own appointment time and make the appointment right then. Th e system should allow for patient confi dentiality by showing only available times. Other patients ’ names should never be visible on an online system.

Software is available that allows the patient to self-schedule through secure links to the physician ’ s appointment book. Th e soft-ware or Internet site for the physician ’ s offi ce should give the patient guidelines as to the amount of time needed for certain appointments or should allow only a certain length of time to be self-scheduled, such as 15 minutes. Th ese systems will reduce the number of calls to the offi ce and are available to the patient 24 hours a day. Some of these systems also send an automatic e-mail reminder to the patient the day before the appointment, requesting a reply to confi rm. Th ese systems are less frustrating to patients, who do not have to wait on hold to speak to the person who does scheduling for the offi ce. Lengthy or complicated appointments should be scheduled through the offi ce staff .

Although this type of system for making appointments appeals to most technologically savvy people, some patients stringently reject online scheduling because it requires at least minimal computer skills, which the patient may not have or be comfortable performing. If this method is used, some allowance must be made for patients who do not have computers. Other patients may object to online scheduling because they do not want their name anywhere on the Internet. Th is is a valid issue, and the offi ce should allow these patients to schedule over the phone.

programs that merely display available and scheduled times to more sophisticated systems that perform several other functions. Many programs can display such information as the length and type of appointment required and day or time preferences. Th e computer then can select the best appointment time based on the information entered into the computer.

Th e computer also can be used to keep track of future appoint-ments. For example, when a patient calls and inquires about an appointment, the system can search by his or her name to fi nd the time and date. Printouts also can be run to show the physician ’ s daily schedule, including the patients ’ names and telephone numbers and the reason for the visit. Multiple copies of these schedules can be made, according to the needs of the practice.

Computer scheduling allows more than one person to access the system at once, and the information is available to all operators. Th e medical assistant can generate a hard copy of the next day ’ s appoint-ments before leaving each evening. In some facilities, employees keep an appointment book as a backup to computer scheduling.

Appointment Book Scheduling

Offi ce suppliers carry a variety of appointment book styles. Some appointment books show an entire week at a glance, and many are color coded, with a special color used for each day of the week ( Figure 10-2 ). Th is is very helpful when the physician asks the patient to return, for instance, in 2 weeks. If Wednesdays are colored yellow, the medical assistant can fl ip quickly to the correct day 2 weeks later and schedule the appointment. Multiple columns may be available to correspond with the number of doctors in a group practice, and the time can be divided according to their preferences.

Self-Scheduling

Th e future of appointment scheduling includes self-scheduling, which is a method by which a patient can log on to the Internet and

FIGURE 10-2 Color-coded appointment book pages help the medical assistant fl ip to the right day of the right week quickly. Appointments for multiple physicians can be color-coded in the book.

CRITICAL THINKING APPLICATION

The software used in Dr. Brown ’ s offi ce can allow patients to self-schedule.

Ramona has heard about patient self-scheduling and would like to try this

method in her offi ce, but Dr. Brown is concerned that her patients enjoy

personal contact and is not sold on the idea.

■

_{What can Ramona say to convince Dr. Brown to try this new,}

time-saving method of scheduling?

■

_{What challenges might the use of this system bring?}

10-2

ADVANCE PREPARATION

After an appropriate method of setting appointments has been chosen, some advance preparation should be done. Th is is sometimes called establishing the matrix ( Procedure 10-1 ). Block out time slots

when the physician routinely is not available to see patients, such as days off , holidays, lunch or dinner breaks, time for hospital rounds, and meetings. In the space where a patient ’ s name normally would appear, note the reason the time is blocked off . Most electronic scheduling software allows the user to create a template that can be

used repeatedly when new appointment pages are needed. Th e tem-plate can be set to block time slots unavailable for appointments automatically, such as lunch hours and regular meeting times. Always try to account for every time period in each day.

Legality of the Appointment Book

Because the appointment book can be used as a legal record, it must be accurate and maintained so that it provides correct information about the patients at the offi ce. Patients are expected to follow the physician ’ s orders; this includes keeping appointments. If a patient

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PROCEDURE 10-1

Manage Appointment Scheduling Using Established Procedures

GOAL: To establish the matrix of the appointment page and enter information according to offi ce policy.

EQUIPMENT and SUPPLIES

• Appointment book or computer

• Offi ce procedure manual

• Information about physician ’ s offi ce hours and availability

• Clerical supplies

• Calendar

PROCEDURAL STEPS

1. Determine the proper methods for scheduling an appointment by

consulting the offi ce procedure manual; make sure to follow established

priorities when managing appointments.

PURPOSE: To follow prescribed offi ce policy and established priorities for

appointment scheduling.

2. Become familiar with any software used for scheduling appointments.

PURPOSE: To become profi cient with the scheduling software used in

the offi ce.

3. Determine the hours the physician (or physicians) will not be available.

PURPOSE: To make sure patients are not scheduled when the physician

is unavailable and to prevent rescheduling issues.

4. Make a column in the appointment book or program for each provider.

PURPOSE: Some medical facilities have multiple providers who maintain

a schedule of patients. For example, many physicians employ physician

assistants or nurse practitioners who also see patients.

5. Establish the matrix of the appointment book by blocking out the times

the physician is unavailable or the offi ce is closed.

PURPOSE: To leave available only time slots that can be used for patient

appointments.

6. Allow buffer time in the morning and afternoon.

PURPOSE: To allow for emergencies and short rest or catch-up times for

the staff and providers.

7. Determine the number of rooms available for patient examinations,

treatments, and procedures.

PURPOSE: The number of available rooms affects the number of patients

that can be seen during a day.

8. Establish a list of procedures that details the amount of time needed for

an appointment; use established priorities according to the offi ce policy.

PURPOSE: To better gauge how much time the physician will spend with

patients, according to established priorities.

9. Put the appointment book in a convenient place for all employees who

schedule appointments.

PURPOSE: To make sure the appointment book is always readily

available.

does not show up for an appointment or cancels it and does not reschedule, a notation of this fact should be placed in the patient ’ s medical record. If a patient reschedules an appointment and subse-quently keeps it, there is no need to document that it was rescheduled.

Pencil is used in the appointment book so that making changes is easier. Th e information in the book includes the patient ’ s name and a phone number where the patient can be reached. Some offi ces list the reason for the appointment, but most note only the name and phone number. Th e reason for the visit is not necessary if the medical assistant references the time needed for the appointment and blocks off that amount of time. Although the appointment book can be used as a legal record, actual medical records are more likely to be used in matters of litigation. Because progress notes are dated, a copy of the medical record shows all pertinent information about the patient ’ s adherence to the physician ’ s orders, including the appointments with the physician. Pens are permanent, but the book can become illegible if a number of patients change or cancel their appointments. Because the appointment book could be produced in litigation as a legal record, it should be kept for the number of years that constitute the statute of limitations in that individual state. If the appointment book is discarded, its contents should be shredded to protect patient privacy.

TYPES OF APPOINTMENT SCHEDULING

Diff erent types of appointment scheduling are used to meet the various needs of the medical facility, the providers, and the patients. Some offi ces use a combination of methods to create the right mix of activity during the day and to ensure that the day runs smoothly and effi ciently. Th e medical assistant should become profi cient at managing appointments ( Procedure 10-2 ). Th e following section presents several methods of appointment scheduling.

Open Offi ce Hours

With the open offi ce hours method, the facility is open at given hours of the day or evening, and the patients are “scheduled” by the physi-cian, who mentions to the patient that he or she should return “in a couple of weeks” for follow-up. Th e patients come in at intermittent

times, knowing they will be seen in the order of their arrival. Physi-cians who use this method say that it eliminates the annoyance of broken appointments and an offi ce running behind schedule. Th e open offi ce hours method also has been called tidal wave scheduling.

Some of these facilities allow online or telephone check-in, and patients are notifi ed when it is close to their turn with the provider.

Few healthcare facilities in metropolitan areas have open offi ce hours with no scheduled appointments, but this system still is found

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PROCEDURE 10-2

Schedule and Monitor Appointments

GOAL: To manage appointments as they are cancelled, not kept, or rescheduled throughout the business day.

• Appointment book or computer

• Offi ce procedure manual

• Appointment cards

• Clerical supplies

• Telephone

1. Determine the names of patients who have appointments either the day

before or the morning of the appointment.

PURPOSE: To prepare the medical records for the patients who have

appointments.

2. Confi rm the appointments if required.

PURPOSE: To make sure the patient plans to keep the appointment

and to provide an opportunity to reschedule or to call in a patient on

the waiting list.

3. Make note of any patient arriving late in the appointment book. If this

behavior has become a pattern, also note it in the medical record.

PURPOSE: Repeated behavior that disrupts the clinic schedule should be

documented.

4. Document failure to arrive for an appointment in the appointment book

or scheduling program and in the patient ’ s medical record.

5. Call the patient to attempt to reschedule the appointment and obtain a

reason for the no-show.

PURPOSE: To document failure to comply with physician ’ s

recommendation to return.

6. Reschedule missed appointments, if possible, after talking with the

patient.

PURPOSE: To keep the patient on schedule for medical care.

7. Write the new appointment time, date, and day on an appointment

card or give the information to the patient over the telephone.

PURPOSE: To ensure that the patient is aware of the new appointment

time.

8. If the physician is running more than 15 minutes late, inform patients

of the delay.

PURPOSE: To offer the patients the opportunity to reschedule if

necessary.

9. As patients arrive, place a check next to the name in the

appointment book.

10. Offer the sign-in sheet to the patient for his or her signature.

PURPOSE: To verify that the patient arrived in the clinic.

in some rural areas, where the way of life is governed not so much by the clock as by the needs of the people in the area. Open offi ce hours scheduling is most commonly used at laboratories, imaging facilities, urgent care clinics, and emergency departments. Many emergency departments are open 24 hours a day. Although called

emergency departments, many of these facilities deal with general

practice cases.

Th e open offi ce hours system can have many disadvantages. Th e offi ce may already be crowded when the physician arrives, resulting in an extremely long wait for some patients. Patients may arrive in waves throughout the day, which causes parts of the day to be very busy and parts to be slow. Th is makes getting other offi ce duties accomplished diffi cult. Without planning, the facilities and staff can be overburdened.

Scheduled Appointments

Studies have shown that practitioners can see more patients with less pressure when their appointments are scheduled. Unfortunately, the skill required for scheduling appointments often is not fully appreci-ated by the practitioner or offi ce manager, and the responsibility is delegated to the least-qualifi ed medical assistant. An effi cient, bright individual profi cient at multitasking should be assigned to the sched-uling of duties. Although the skill and attitude of the assistant who manages the appointment schedule are very important, the ultimate success of the system lies in the cooperation of the physicians.

Diff erent procedures require diff erent amounts of time; the scheduler must understand how long it takes to draw blood, fi ll out new patient paperwork, and weigh and check the patient in; all procedures, even the simplest, must have an associated amount of time needed to complete the task. If the patient needs an average of 15 minutes to do new patient paperwork, this time must be included in the schedule. (Th is is why many offi ces ask new patients to arrive 15 minutes early for their appointment.) If an allergy shot takes only 20 minutes from check-in to checkout and does not require the patient to see the physician, the scheduler knows that other patients can see the physician while the medical assistant gives the allergy shot. Th e scheduler cannot effi ciently set appointments without developing the skill of accurately assessing how long an offi ce pro-cedure takes.

Flexible Offi ce Hours

Most scheduling practices are carryovers from the days when expectant mothers of families with young children relied on one wage earner. Today families commonly have two working parents. As a result, many healthcare providers are turning to extended day and fl exible offi ce hours. Staff hours are aff ected by these schedules, but this fl exibility works to the advantage of the patient and the staff at the physician ’ s offi ce. Patients appreciate fl exible offi ce hours, because they can schedule an appointment after work or after children ’ s school hours. Evening and weekend hours may

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and given to the patient. All appointment cards should mention that patients must give 24 hours ’ notice if they are unable to keep the time reserved for them. Most offi ces have some type of confi rmation procedure by which patients are called the day before to verify that they intend to keep the appointment.

TIME PATTERNS

When booking appointments, a medical assistant should make it a policy to leave some open time during each day ’ s schedule so that if a patient calls with a special problem that is not an immediate emergency, time will be available to book the patient for at least a brief visit. Mondays and Fridays generally are the most hectic days of the week. Keeping one time slot available in the morning and the afternoon specifi cally for emergencies also is a wise practice. A busy physician always fi lls these open slots, and having them in the sched-ule causes the least disruption during the day. If possible, set aside

time in the morning and afternoon for a break. Even 15 minutes can give the physician time to return calls from patients, verify prescription calls, or answer questions.

PATIENT WAIT TIME

Be aware of the amount of time the patient sits in the reception area. Ideally, the patient ’ s name is called to go to the examination room precisely at the scheduled appointment time ( Figure 10-3 ). However, the scheduling process has failed if the patient then waits in the back offi ce for 30 minutes to see the physician. Make it clear to the patient whether he or she is free to leave the offi ce after the physician has fi nished the examination. Some patients mistakenly wait in the examination room until told they are free to leave. Always make sure the patient knows when to go where.

If a patient has waited longer than 15 minutes in the reception area, the medical assistant should briefl y explain the delay and off er to reschedule the appointment. Th e longer patients sit and wait, the more anxious and frustrated they become. Remember, some patients are there to see the physician for test results or may be expecting a negative diagnosis. Do not make their visit more stressful by forcing them to wait for a long time. Briefl y explain the situation and allow the patient to decide whether to wait or reschedule. If a delay is forthcoming, attempt to call patients who may be en route to the increase the size of the practice because of the convenience off ered

to patients.

CRITICAL THINKING APPLICATION

Dr. Brown would like to implement evening appointments 1 night each

week and open the offi ce every other Saturday morning. She feels this

will better serve her patients with children who have diffi culty making

daytime appointments. If this is her primary goal, should other types of

patients be seen during these time slots? Why or why not?

10-3

Wave Scheduling

Wave scheduling is an attempt to create short-term fl exibility within each hour. Wave scheduling assumes that the actual time needed for all the patients seen will average out over the course of the day. Instead of scheduling patients at each 20-minute interval , wave

scheduling places three patients in the offi ce at the same time, and they are seen in the order of their arrival. Th is way, one person ’ s late arrival does not disrupt the entire schedule.

Modifi ed Wave Scheduling

Th e wave schedule can be modifi ed in several ways. For example, one method is to have two patients scheduled to come in at 10 AM

and a third at 10:30 AM . Th is hourly cycle is repeated throughout

the day. In another version, patients are scheduled to arrive at given intervals during the fi rst half of the hour, and none are scheduled to arrive during the second half of the hour.

Double-Booking

Booking two patients to come in at the same time, both of whom are to be seen by the physician, is poor practice. Of course, if each appointment is expected to take only 5 minutes, no harm is done by telling both to come at the same time and reserving a 15-minute period for the two. Th is is simply one method of wave scheduling. However, if each patient requires 15 minutes, two require 30 minutes. Th is must be refl ected in the scheduling. It is not consid-ered double-booking if a patient comes to the offi ce to receive a treatment by someone other than the physician, such as a patient receiving physical therapy or an antiallergy injection.

Grouping Procedures

Grouping or categorizing of procedures is another method of sched-uling that appeals to many practitioners. For instance, an internist might reserve all morning appointments for complete physical exam-inations, or a pediatrician might keep that time for well-baby visits. A surgeon might devote one day each week to seeing only referral patients. Obstetricians often schedule pregnant patients on diff erent days from gynecology patients. Th e physician and staff can experi-ment with diff erent groupings until the plan that works best for the practice eventually becomes evident. In applying a grouping system of appointments, the medical assistant may fi nd it helpful to color-code the sections of the appointment book reserved for designated procedures.

Advance Booking

Often appointments are made months in advance. When any appointment is made, an appointment card should be completed

FIGURE 10-3 One of the most common patient complaints is the time spent in the reception area.

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the telephone number is handy. Cell phone numbers also are quite useful for tracking down a patient quickly.

SCHEDULING APPOINTMENTS FOR NEW PATIENTS

Arranging the fi rst appointment for a new patient requires time and attention to detail ( Procedure 10-3 ). Th is fi rst encounter pro-vides the fi rst impression of the offi ce and may set the tone for all subsequent visits. Tact, courtesy, and professionalism are extremely important. During the conversation with the new patient, request preliminary information to help determine how much time to allot for the visit on the appointment schedule. Th e physician may also expect the medical assistant to give general instructions to patients seeking care for specifi c complaints. For example, the patient may be required to bring a urine specimen or to make sure laboratory tests are completed before the appointment. Some offi ces obtain enough information to build a patient medical record before the offi ce visit; others wait until the patient actually arrives to construct the medical record.

After the necessary information has been recorded, off er the patient the fi rst available appointment. Whenever possible, off er a choice between two dates and times. Ask the patient whether he or she knows the directions to the offi ce or off er the physical address for those who want to obtain exact directions from one of the many Internet directions sites, such as MapQuest. Tell the patient whether any special parking conveniences are available and whether the offi ce provides a token or parking validation. Th e patient ’ s options for the fi rst payment should also be discussed. If payment is expected imme-diately, inform the patient. Th e offi ce staff should expect patient concerns about the amount of the fi rst bill and should address this issue before the appointment so that there are no surprises or mis-understandings. Before ending the conversation, repeat the appoint-ment date and time and then thank the patient for calling.

Some medical offi ces mail an information packet about their facility to new patients, especially if the appointment is several days away. With today ’ s technology and the patient ’ s e-mail address, such information can also be sent via the Internet. Th is information should inform the patient about the nature of the practice, introduce the medical staff , and explain appointment policies and fi nancial arrangements.

If another physician has referred the patient, the medical assistant may need to call the referring physician ’ s offi ce to obtain additional information before the patient ’ s appointment. Th is information should be printed out and given to the attending physician before the patient arrives. Remember to send a thank you note to anyone who refers a patient to the facility.

Many offi ces call each patient the day before the appointment as a reminder and a courtesy. Th is can be a time-consuming procedure, but most patients appreciate this service, and it may open appoint-ments for others if the original patient cannot keep the scheduled time slot. E-mail and automatic dialers also can be programmed to call or send electronic reminders to patients about their appoint-ments. Th is procedure can run automatically if the offi ce has access to the proper equipment, which takes no time away from the medical assistant ’ s other duties. Often, the medical assistant will need to conduct preauthorization or precertifi cation to determine whether

a patient is eligible for treatment or for certain procedures. Th e offi ce offi ce and inform them that there will be a delay. Always ask for the

patient ’ s cell phone number for just such events.

CRITICAL THINKING APPLICATION

Ramona offers to reschedule patient appointments if the schedule ever

falls more than 15 minutes behind. If a patient becomes belligerent about

the delays, how can Ramona handle the situation in a professional

manner?

10-4

TELEPHONE SCHEDULING

A pleasant manner and expressing a willingness to help are just as important on the telephone as when meeting patients face to face. Th is is especially true when making appointments, because the tele-phone contact may be the patient ’ s fi rst impression of the facility. Often the manner in which the booking is made makes more of an impact than the convenience of the appointment time.

Be especially considerate if the time requested for an appoint-ment must be refused. Briefl y explain why the time is not available and off er a substitute date and time. Comply with the patient ’ s desires as much as possible, and do not show annoyance if the patient does not understand the scheduling process. Most people, however, understand the need for a well-managed offi ce and are willing to cooperate.

Many offi ces off er the patient a choice when scheduling the appointment and let the patient decide which option is best for him or her. For example, the following dialog might take place during the scheduling call:

Medical assistant: “Mrs. Th omas, Dr. Stern is available to see

you in the offi ce next Tuesday or Wednesday,

January 6 or 7. Which day is better for you?”

Patient: “I will be working on Wednesday, so I would

like to come in on Tuesday.”

Medical assistant: “Do you prefer a morning or afternoon

appointment?”

Patient: “Th e afternoon is best for me.”

Medical assistant: “Great. Would 1:30 or 3:30 be a better

time?”

Patient: “I can be there at 1:30. ”

Medical assistant: “Th en Dr. Stern will see you at 1:30 next

Tuesday, January 6. Th ank you for calling,

Mrs. Th omas. We ’ ll see you then!”

Th ese small courtesies give patients the feeling they control their time. Always repeat the time to reinforce the appointment and do not hesitate to ask the patient if he or she has a pen with which to jot down the time and date. While repeating the information to the patient, check the appointment book or computer screen to ensure that it was posted correctly.

Write legibly when using an appointment book. Th ese records could be called into court, and the medical assistant must be able to read his or her own writing if asked to testify. Form the habit of entering the patient ’ s daytime telephone number after every entry. Th e appointment may need to be canceled or the schedule rearranged in a hurry, and many precious minutes can be saved if

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PROCEDURE 10-3

Schedule Appointments for New Patients

GOAL: To schedule a new patient for a fi rst offi ce visit.

• Appointment book or computer

• Scheduling guidelines

• Appointment card

• Telephone

1. Obtain the patient ’ s full name, birth date, address, and telephone

number.

NOTE: Verify the spelling of the name.

2. Determine whether the patient was referred by another physician.

PURPOSE: You may need to request additional information from the

referring physician, and your physician will want to send a consultation

report.

3. Determine the patient ’ s chief complaint and when the fi rst symptoms

occurred.

PURPOSE: To help gauge the time needed for the appointment and the

degree of urgency.

4. Search the appointment book for the fi rst suitable appointment time and

an alternate time.

5. Offer the patient a choice of these dates and times to demonstrate

sensitivity appropriate to the message being delivered.

PURPOSE: Patients are better satisfi ed if they are given a choice.

6. Enter the mutually agreeable time in the appointment book, followed by

the patient ’ s telephone number.

NOTE: Indicate that the patient is new by adding the letters NP.

7. If new patients are expected to pay at the time of the visit, explain this

fi nancial arrangement when the appointment is made.

PURPOSE: The payment policy is explained to the patient, who can

come prepared to pay.

8. Offer travel directions for reaching the offi ce as well as parking

instructions. E-mail or mail new patient paperwork.

PURPOSE: To relieve any anxiety about being able to fi nd the medical

facility.

9. Analyze communications in providing appropriate responses and feedback

by repeating the day, date, and time of the appointment before saying

goodbye to the patient.

PURPOSE: To verify that the patient understands the date and time of

the appointment.

manager must make certain that these procedures are being done and assign these duties to a specifi c person(s). More about preautho-rization and precertifi cation is included in Chapter 20 .

SCHEDULING APPOINTMENTS FOR

ESTABLISHED PATIENTS

In Person

Most return appointments for established patients are arranged

when the patient is leaving the offi ce. A good policy is to have all patients stop by the front desk before leaving in case any information is needed from the patient or any outside scheduling must be done. Th e patient ’ s medical record can be reviewed to see whether the physician ordered any laboratory tests or procedures, and these can be scheduled and discussed with the patient. When making a return appointment, follow the same procedures as for scheduling any appointment by phone, off ering the patient choices in the day and time slots ( Procedure 10-4 ). If a certain time the patient specifi cally requests is not available, off er two alternatives. Always give the patient an appointment card and any necessary instructions at this time, along with a bright smile ( Procedure 10-5 ). Never forget to provide excellent customer service.

By Telephone

Usually the medical assistant needs only to determine when the patient must return and to fi nd a suitable time in the schedule.

Established patients do not usually need directions and parking information unless the offi ce has recently moved. If some time has passed since the patient ’ s last visit, recheck certain information and enter any changes on the patient ’ s medical record. Be sure to ask whether insurance companies or benefi ts have changed; also, verify-ing the patient ’ s address and phone numbers is always a good idea. If an e-mail address is not on fi le, obtain one so as to have a quick, easy way to notify the patient of appointments and other events.

SCHEDULING OTHER TYPES OF APPOINTMENTS

Th e medical assistant also will make other types of appointments, and these will appear on the appointment schedule. Th ey include surgeries the physician will perform at a hospital or other facility, hospital rounds and consultations, outside appointments and meet-ings, and even house calls if the physician makes them. Th e physician also must have time to get from one location to another, so driving time must be considered when arranging all appointments.

Some critical information is required when scheduling admission or treatments in other facilities. Always provide the scheduler with the patient ’ s name, address, phone numbers (both home and cell), Social Security number, and insurance information and relay the procedures that are to be performed. Patient allergies should be mentioned if the patient is being admitted. Additionally, the facility may have forms that the patient needs to complete, so an e-mail address is helpful in such cases. Always send the admitting diagnosis and orders to the healthcare facility prior to admission time or with

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PROCEDURE 10-4

Schedule Appointments for Established Patients or Visitors

GOAL: To schedule a general appointment either by telephone or in person.

• Appointment book or computer

• Offi ce procedure manual

• Clerical supplies

• Appointment cards

• Telephone

1. Learn the proper methods for scheduling an appointment by consulting

the offi ce procedure manual.

PURPOSE: To follow prescribed offi ce policy for appointment scheduling.

2. Ask the name of the person wanting to make the appointment and

obtain his or her phone number.

PURPOSE: To be able to speak professionally with the individual and to

identify the person in the patient database, if applicable. Ask for the

phone number in case the line is disconnected or the appointment

needs to be changed.

SAY: “To whom am I speaking, please?”

3. Ask the reason for making the appointment.

PURPOSE: To determine the time needed for the appointment.

SAY: “What is the reason for making this appointment?”

4. Determine for whom the appointment is being made, if necessary.

PURPOSE: To schedule the individual with the right provider or person.

SAY: “Mr. Adams, would you like to see Dr. Blake, or would you like to

see our nurse practitioner, Mrs. Jackson?”

5. Analyze communications in providing appropriate responses and

feedback by giving the person a choice between 2 days of the week.

PURPOSE: To allow the individual to choose a convenient time; this

reduces the number of missed appointments. If the suggested days are

not satisfactory, allow the person to suggest an alternate day.

SAY: “Would you prefer to come on Monday or Tuesday, Mr. Adams?”

6. Give the person a choice between a morning or an afternoon

appointment.

PURPOSE: To allow the individual to choose a convenient time of day.

SAY: “Would morning or afternoon be better for you?”

7. Give the person a choice between two specifi c times.

PURPOSE: To allow the individual to choose the best time for his or her

needs.

SAY: “Mr. Adams, would you prefer 9

AM

or 11

AM

?”

8. Write the person ’ s name and the phone number on the appropriate

line of the appointment book or enter this information into the

scheduling system.

PURPOSE: To document the appointment and ensure that the time is

reserved.

9. Analyze communications in providing appropriate responses and

feedback by repeating the appointment day, date, and time back to

the person.

PURPOSE: Repeating the appointment time reduces errors and

misunderstandings.

SAY: “I have you scheduled for 9

AM

on Tuesday, March 14, Mr.

Adams. If you are not able to keep your appointment, please let

us know.”

10. If the person scheduling the appointment is in the offi ce instead of on

the phone, give the individual an appointment card.

PURPOSE: Providing appointment cards reduces the number of missed

appointments.

the patient. Some facilities require a history form prior to admission. Th e patient will be required to bring a form of picture identifi cation, such as a state driver ’ s license, and his or her insurance card.

Inpatient Surgeries

When scheduling a surgery, call the facility where the procedure will be performed as soon as the operation is planned. Most surgical departments and centers have a surgical secretary who makes these arrangements. Provide all necessary information and state any special requests the physician may have, such as the amount of blood to have available for the patient. Th e secretary may want all the patient ’ s insurance information and certainly will want a phone number so that the patient can be contacted before the surgery if necessary. Make sure all this information is handy before placing the call.

Outpatient and Inpatient Procedure Appointments

A medical assistant often is asked to arrange laboratory or radiogra-phy appointments for patients. Before calling the facility to schedule the appointment, be sure all necessary information is handy. When the patient is informed of the time and place of the appointment, relay any special instructions, then note these arrangements in the patient ’ s medical record. Some offi ces make a reminder call to the patient or send a reminder e-mail message.

Outpatient testing is common, because most physicians do not have extensive x-ray or laboratory equipment in their offi ces. Mag-netic resonance imaging (MRI), computed tomography (CT) scans, numerous x-ray evaluations, ultrasonography, and simple blood tests all may need to be scheduled ( Procedure 10-6 ). Provide the patient

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PROCEDURE 10-5

Document Appropriately and Accurately

GOAL: To document appropriately and accurately on all patient medical records and other offi ce paperwork that concerns the

patient.

• Any medical document

• Clerical supplies

• Computer or word processor

• Offi ce policy and procedure manual

1. Determine the information that needs to be added to the patient ’ s

medical record, appointment book, telephone message, or other offi ce

paperwork that concerns the patient.

PURPOSE: To place pertinent, accurate information into the document.

2. Make sure the information is factual, timely, and accurate.

PURPOSE: To ensure that the information is usable.

3. Document accurately in the medical record by writing or typing the

information into the document.

4. Reread the information to make sure it is legible.

PURPOSE: To be sure the information can be read even after several

years by anyone who needs to access the information.

5. Date and sign the entry if necessary.

PURPOSE: To authenticate the entry.

6. Make sure the entry meets any local, state, or federal guidelines that

may apply to the information contained in the document.

PURPOSE: To remain in compliance with local, state, and federal rules

and regulations.

7. Make sure the entry is written in compliance with offi ce policies and

procedures.

PURPOSE: To comply with offi ce policy.

8. If the entry needs to be corrected, draw one line through it and make

the new entry below or in the required place in the document.

PURPOSE: To correct the document according to offi ce policy and

procedure guidelines.

9. Make sure the correction has not obliterated any part of the medical

record or documentation that affects the patient.

PURPOSE: No obliteration is acceptable in any part of the medical

record.

10. Place the date and initial the corrected entry.

PURPOSE: To authenticate the correction.

PROCEDURE 10-6

Schedule Outpatient Admissions and Procedures

GOAL: To schedule a patient for outpatient admission or procedure within the time frame needed by the physician, confi rm with

the patient, and issue all required instructions.

• Diagnostic test order from physician

• Name, address, and telephone number of diagnostic facility

• Patient ’ s demographic information

• Patient ’ s medical record

• Test preparation instructions

• Telephone

• Consent form

1. Obtain an oral or written order from the physician for the exact procedure

to be performed.

PURPOSE: To have a documented order for the procedure to be

performed

2. Precertify the procedure with the patient ’ s insurance company if

necessary.

PURPOSE: To make sure expected insurance benefi ts are valid and the

procedure will be covered by the patient ’ s insurance policy.

3. Determine the physician ’ s and patient ’ s availability.

PURPOSE: To make sure the patient will be able to comply with the

arrangements for the test and that the physician is available, if he or she

must be present for the procedure. The urgency of the needed test results

affects the time and date of the appointment needed.

4. Telephone the diagnostic facility and schedule the patient ’ s procedure

or test.

• Order the specifi c test.

• Provide the patient ’ s diagnosis and orders.

• Establish the date and time for the procedure.

• Give the patient ’ s name, age, address, and telephone number.

• Provide the patient ’ s demographic information, including

identifi cation and insurance policy numbers and addresses for

fi ling claims.

• Determine any special instructions for the patient or special anesthesia

requirements.

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has no obligation to wait. Some medical assistants tell the patient to come in 30 minutes before the appointment time actually scheduled. Make an attempt to work with patients who have occasional diffi cul-ties arriving on time, but do not allow the schedule to be constantly disrupted by late patients.

with the name, address, and phone number of the facility where the tests will be done.

Some patients may require a series of appointments (e.g., at weekly intervals). Try to set up these appointments on the same day each week at the same time of day. Th is considerably reduces the risk of the patient forgetting an appointment.

In some cases the medical assistant may be responsible for sched-uling inpatient admissions or inpatient surgical procedures ( Proce-dures 10-7 and 10-8 ). Th is is similar to scheduling outpatient testing, but the medical assistant coordinates with a hospital rather than an outside facility.

Outside Visits

If the physician regularly makes house calls or visits patients in skilled nursing facilities, a special block of time must be reserved in the appointment schedule. Th e physician needs demographic infor-mation, such as addresses, room numbers, and the best route to each home or facility. Remember to allow for travel time. Most physicians do not make house calls, because seeing patients in the offi ce is easier; however, such visits may be necessary in certain situations. Th e physician ’ s medical bag should always be prepared and well stocked before he or she has to make any outside visits.

SPECIAL CIRCUMSTANCES

Late Patients

Probably every medical practice has a few patients who are habitually late for appointments. Th is seems to be a problem for which no cure has been found. Emergencies and small delays can happen to anyone, but a patient who constantly arrives late can put a strain on the practice. Such patients can be booked as the last appointment of the day. Th en, if closing time arrives before the patient does, the staff

PROCEDURE 10-6—cont’d

6. Have the physician review the consent form with the patient. The patient

should sign the consent form, and a copy should be placed in the medical

record. Note the arrangements on the patient ’ s medical record.

PURPOSE: To make sure the patient understands the risks, benefi ts,

and alternatives to the procedure. To ensure follow-up on the diagnosis

and/or treatment.

7. Implement time management principles to maintain effective offi ce

function by placing a reminder on the physician ’ s tickler or desk calendar.

Make sure the information is listed on the offi ce schedule. Check the

patient ’ s postsurgical status. Follow up if results are not received in a

timely manner.

PURPOSE: To check whether the appointment was kept and a report was

received from the testing facility.

PURPOSE: To schedule the procedure or admission and provide needed

information.

5. Notify the patient of the arrangements:

• Give the name, address, and telephone number of the diagnostic

facility.

• Specify the date and time to report for the test.

• Give instructions on preparation for the test (e.g., eating restrictions,

fl uids, medications, enemas).

• Explain any preadmission testing.

• Remind the patient to take a form of picture identifi cation and the

insurance card.

• Explain whether the patient needs to pick up orders or whether they

will be forwarded to the facility in advance.

• Ask the patient to repeat the instructions.

PURPOSE: To make sure the patient understands the necessary

preparations and the importance of keeping the appointment. If time

permits, provide written instructions to the patient.

CRITICAL THINKING APPLICATION

Seth Jones is always late for his appointments. How might Ramona

approach him about this? What can Ramona do to assist Mr. Jones in

arriving for appointments on time?

10-5

Rescheduling Canceled Appointments

Changes sometimes must be made in the appointment schedule. Unexpected confl icts might arise that force a patient to change the appointment time. When rescheduling an appointment, make sure the fi rst appointment day and time is removed from the appoint-ment book or database, then set the new appointappoint-ment. Otherwise, the patient will be expected in the offi ce on 2 days, and time will be wasted with calls and follow-up, only to discover that the appoint-ment was rescheduled.

Emergency Calls

Periodically, emergency or urgent calls come into the offi ce, and an appointment needs to be scheduled. To some extent, all calls that come in go through a screening process, and emergencies are

priori-tized to evaluate the urgency of the need to see the physician. Screen-ing is an extremely important function that requires experience, a knowledge of signs and symptoms, and tact.

Emergencies may involve emotional crises in addition to the more obvious physical problems. Patients with emergencies and those who are acutely ill should be seen the same day. Th e urgency

(13)

PROCEDURE 10-7

Schedule Inpatient Admissions

GOAL: To schedule a patient for inpatient admission within the time frame needed by the physician, confi rm with the patient,

and issue all required instructions.

• Admission orders from physician

• Name, address, and telephone number of inpatient facility

• Patient ’ s demographic information

• Patient ’ s medical record

• Any preparation instructions for the patient

• Telephone

• Admission packet

1. Obtain an oral or written order from the physician for the admission.

PURPOSE: To have a documented order for the admission.

2. Precertify the admission with the patient ’ s insurance company if

necessary.

PURPOSE: To make sure expected insurance benefi ts are valid and the

admission will be covered by the patient ’ s insurance policy.

3. Determine the physician ’ s and patient ’ s availability if the admission is not

an emergency.

PURPOSE: To make sure the patient will be able to comply with the

arrangements for the admission and that the physician is available to care

for the patient during the admission. The urgency of the admission affects

the time and date of the appointment needed.

4. Telephone the diagnostic facility and schedule the patient ’ s admission.

• Order any specifi c tests needed.

• Provide the patient ’ s admitting diagnosis.

• Establish the date and time.

• State the patient ’ s room preferences.

• Give the patient ’ s name, age, address, and telephone number.

• Provide the patient ’ s demographic information, including identifi cation

and insurance policy numbers and addresses for fi ling claims.

• Determine any special instructions for the patient.

• Notify the facility of any urgency for test results.

PURPOSE: To schedule the admission and provide needed information.

5. Notify the patient of the arrangements:

• Give the facility ’ s name, address, and telephone number.

• Specify the date and time to report for admission.

• Provide any necessary instructions on preparation for the procedure

(e.g., eating restrictions, fl uids, medications, enemas).

• Outline any preadmission testing.

• Ask the patient to repeat the instructions.

PURPOSE: To make sure the patient understands the preparation

necessary and the importance of admittance. If it is the offi ce policy, give

the patient an admission packet that contains the orders and basic

instructions for the admission.

6. Note the arrangements and the admission on the patient ’ s medical

record.

PURPOSE: To ensure follow-up on the diagnosis and/or treatment.

7. Implement time management principles to maintain effective offi ce

function by placing a reminder on the physician ’ s tickler or desk calendar.

Make sure the information is listed on the offi ce schedule. If the

physician keeps a list of all inpatients, add the patient ’ s name to that list.

PURPOSE: To keep a record of the number of days the patient was seen

in the hospital by the physician during rounds for insurance billing

purposes.

PROCEDURE 10-8

Schedule Inpatient Procedures

GOAL: To schedule a patient for inpatient surgery within the time frame needed by the physician, confi rm with the patient, and