97190 ch 06 - Lippincott Williams & Wilkinsdownloads.lww.com/wolterskluwer_vitalstream_com/sample-content/... · 97190_ch 06 11/14/07 12:04 PM Page 112. ... HOUR Dr. Jones Dr. Smith

Appointment SchedulingSystems

Manual AppointmentScheduling

Computerized AppointmentScheduling

Types of SchedulingStructured AppointmentsFlexible HoursOpen Hours

Factors That Affect SchedulingPatients NeedsProviders Preferences and

Needs

Physical FacilitiesScheduling Guidelines

New PatientsEstablished Patients

Preparing a Daily or WeeklySchedule

Patient RemindersAppointment CardsTelephone RemindersMailed Reminder Cards

Adapting the ScheduleEmergenciesPatients Who Are Acutely IllWalk-in Patients

Late PatientsPhysician DelaysMissed Appointments

CancellationsCancellations by the OfficeCancellations by the Patient

Making Appointments forPatients in Other Facilities

Referrals and ConsultationsDiagnostic TestingSurgery

When the AppointmentSchedule Does Not Work

Upon successfully completing this chapter, youwill be able to:

1. Spell and define the key terms

2. Describe the various systems for schedul-ing patient office visits, including manualand computerized scheduling

3. Identify the factors that affect appointmentscheduling

4. Explain guidelines for scheduling appoint-ments for new patients, return visits, inpa-tient admissions, and outpatient proce-dures

5. List three ways to remind patients aboutappointments

6. Describe how to triage patient emergen-cies, acutely ill patients, and walk-in pa-tients

7. Describe how to handle late patients

8. Explain what to do if the physician is de-layed

9. Describe how to handle patients who misstheir appointments

10. Describe how to handle appointment can-cellations made by the office or by the pa-tient

Outline

112

LearningObjectives

Managing Appointments

C H A P T E R

6

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Responsibility for scheduling and managing the flow ofpatient care in a medical office or clinic is one of themost important duties assigned to a medical assistant.As appointment manager, you make the first, last, andmost durable impression on the patient and providers.Depending on your demeanor and actions, that impres-sion can be favorable or unfavorable. A properly usedappointment system helps maintain an efficient office. Ifimproperly used, it can mean confusion and chaos;more important, it can waste precious time for the pa-tient, the provider, and the staff.

To use the office facilities and the physicians avail-ability most efficiently, determine which patients will beseen, when they will be seen, and how much time toallot to each of them, depending on their problems. Ofcourse, every practice will have occasional delays and

emergencies. Your responsibility is to manage all of thiswhile maintaining a calm, efficient, and polite attitude.

Appointment SchedulingSystemsThere are two systems of appointment scheduling foroutpatient medical facilities: the manual system, whichuses an appointment book, and a computerized sched-uling system. The choice of systems will depend on thesize of the practice, how many providers schedulesmust be managed, and the preferences of the staff re-sponsible for the daily schedule. Whether a medical of-fice uses a manual or computerized system, many of theguidelines for effectively scheduling the workday dis-cussed in this chapter are the same.

113

Key Terms

acutebufferchronicclusteringconstellation of

symptoms

consultationdouble bookingmatrixprecertificationproviders

referralSTATstreaming

tickler filewave scheduling

system

CAAHEP

Schedule and manage appointments Schedule inpatient and outpatient admissions

and procedures Apply third-party guidelines Apply managed care policies and procedures

ABHES

Schedule and monitor appointments Schedule inpatient and outpatient admissions

Competencies

Upon successfully completing this chapter, youwill be able to:

1. Schedule an appointment for a new patient(Procedure 6-1)

2. Schedule an appointment for a return visit(Procedure 6-2)

3. Schedule an appointment for a referral to anoutpatient facility (Procedure 6-3)

4. Arrange for admission to an inpatient facility(Procedure 6-4)

PerformanceObjectives

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Manual Appointment SchedulingMedical offices may choose to use a manual appoint-ment scheduling system even if the other administrativefunctions in the office are computerized.

The Appointment Book

If your medical office uses a manual system of sched-uled appointments for patient office visits, you will needan appointment book. An appointment book providesspace for noting appointments for an entire year. It mayhave a single sheet for each day and a separate page foreach provider or show an entire week on two facingpages. Some offices prefer an appointment book withpages showing only one day at a time; others may wantto see a whole week at a glance. A different color pagefor each day may also be desired.

The more information required for scheduling, thelarger the pages should be. Make sure the book hasenough space for all pertinent information (e.g., pa-tients name, telephone number, reason for visit), is di-vided into time units appropriate for your practice (e.g.,10- or 15-minute intervals), can open flat on the deskwhere it will be used, and fits easily into its storageplace when not in use.

Establishing a Matrix

Before you begin using the appointment book, you willhave to set up a matrix. A matrix is established by cross-ing out times that providers are unavailable for patientvisits (Fig. 6-1). For example, the physician may have abreakfast meeting and not be in the office until 10:00AM This is indicated by crossing out the blocks from8:00 to 10:00 AM. Write in the reason for crossing offthe space (e.g., vacation, meeting, hospital rounds).Some practices reserve specific times or even days forcertain activities, such as physical examinations andsurgery. Also, it is advisable to block off 15 to 30 min-utes each morning and afternoon to accommodateemergencies, late arrivals, and other delays. Some physi-cians want their professional or personal obligationsnoted on the appointment schedule so that patients arenot booked immediately before these times.

Once you have acquired and prepared an appoint-ment book, it is not enough to schedule a time and datefor a patient visit and hope everything will runsmoothly. Before actually making an appointment, youshould review the schedule carefully, evaluating theneeds of each patient and considering the physicianspreferences and availability of the office facilities. At thebeginning of each day, copies of the schedule should bedistributed to all staff members. Along with the nota-tions in a patients chart, the pages of the appointmentbook provide documentation of a patients visits and

any changes, such as cancellations and rescheduled ap-pointments. This provides further legal documentationto protect the physician and the patient in case of a dis-pute, as discussed in Chapter 2.

Computerized AppointmentSchedulingMedical management software designed to assist withadministrative functions includes systems for appoint-ment scheduling. Computerized scheduling often savestime. Information used to establish a matrix (e.g., hos-pital rounds 7:308:30, lunch 12:301:30) has to be en-tered only once.

Any medical office software will have an appoint-ment toolbar that requires one click to add a patient,add to the waiting list, see a calendar, or search foravailable times. Many software packages offer an ad-vanced search that defines the resources required for acertain type of appointment.

This quick method allows you to search for avail-able appointment times. Typically, you enter the desireddate, and the computer displays the schedule for thatday, showing any available time slots. Another featureallows you to search the appointment database for thenext available time slot. For example, a patient is in-structed to return in 3 months and has a preference for

114 PART II The Administrative Medical Assistant

THURSDAY, APRIL 11

8

HOUR Dr. Jones Dr. Smith Dr. Stowe Lab

008 158 308 459 009 159 309 45

10 0010 1510 3010 4511 0011 1511 3011 4512 0012 1512 3012 45

1 001 151 301 452 002 152 302 453 003 153 303 454 004 154 304 455 005 155 305 456 006 156 306 457 00

NOTES

Sue Dalton Hospital RoundsRecheck Jim Hunt - FBS

Tony BaySally TaylorShirley TeagueJennifer Gibson

Don StephensRecheck

Mandy MeltonRecheck

Diana HarrisRecheck

Ray Ware - sutureremoval

Stan GrayRecheck

Alice Cook

Susan HillWork injury555-1111ref by Prime Care

Recheck

John BiggsRecheck

Tony DisherKindergarten PE

Joe SouthRecheck

Sam Johnson555-2222

CPE

Jewel Cherry555-4444

CPE

Lunch

Lunch

off

Figure 6-1 Sample page from manual appointment book.

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the time of day. You can search for the first available af-ternoon appointment with that particular provider.

Depending on the specific software, you can alsoprint numerous documents, such as the daily or weeklyappointment schedule, appointment reminders, orbilling slips. Once the daily schedule is printed, this im-portant document is referred to as the daily activitysheet or the day sheet and is the guide for everyone in-volved in the flow of patient care. Figure 6-2 shows acomputer-generated daily activity sheet.

An important advantage to computerized appoint-ment scheduling is the easy access to billing informa-tion. For example, a patient may call for an appoint-ment, and the medical assistant can inform the patientthat he needs to pay his balance due of $32 when hecomes in to be seen. Credit and collections are discussedin Chapter 12.

C H E C K P O I N T Q U E S T I O N

1. What is the purpose of a matrix?

Types of Scheduling

Structured AppointmentsMost medical offices use a system of structured orscheduled appointments for office visits. Each patient isassigned a time on the schedule and allotted a specificperiod for examination and treatment. Box 6-1 showsexamples of time allotment. The advantages of this sys-tem include good time management and optimum use ofthe office facility. Additionally, a daily schedule may bedeveloped and charts may be prepared in advance of pa-tient arrival.

A disadvantage of this system is that a patient mayneed more of the physicians time than you have sched-uled. Therefore, it is important that you ask the properquestions at the time the appointment is made to antic-ipate the time needed. Such questions might includeWhy do you need to see the doctor? The patientsreply will tell you how many issues will be addressed.Do you have a form to be completed for your physi-cal? The answer to this question will tell you whetherthis is a school physical or a complete physical.

The practice of adding buffer time to the schedulegives extra time to accommodate emergencies, walk-ins,and other demands on the providers daily time sched-ule that are not considered direct patient care. Suchtasks include returning phone calls, reviewing records,and transcribing reports. For example, you may crossoff 30 minutes at the beginning and end of the dailyschedule to be used as a buffer.

Methods of scheduling patients include clustering,wave, modified wave, stream, and double booking.

115CHAPTER 6 Managing Appointments

Figure 6-2 A computer-generated appointment schedule withspace for all providers of care. (Courtesy of MICA Infor-mation Systems, Winston-Salem, North Carolina.)

B O X 6 - 1

HOW MUCH TIME DO I ALLOT?

Every outpatient medical facility has variablesthat determine the time allotted for each service.Factors like the number of providers, the numberof examination rooms, and the size of the officemust be considered when establishing the ap-pointment scheduling guidelines. This partial listof typical outpatient services shows an estimateof the time needed for each.

Complete physical examination 1 hour

School physical 30 minutesRecheck 15 minutesDressing change 10 minutesBlood pressure check 5 minutesPatient teaching 30 minutes1 hour

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Clustering

Clustering is grouping patients with similar problems orneeds. For example, an obstetrics and gynecology prac-tice may see all pregnant patients in the morning andother patients in the afternoon. A pediatrician mayschedule vaccinations on certain days of the week.Special tests like sigmoidoscopies may be scheduled onemorning a week. Advantages to clustering include max-imum use of special equipment, ease in maintainingcontrol of the schedule, the ability to provide many pa-tients with information about their particular situationat the same time, and efficient use of employees time.

Wave and Modified Wave

Outpatient medical facilities may use the wave schedul-ing system or modify the wave system in ways that workfor their particular specialty. With the wave system, sev-eral patients are scheduled the first 30 minutes of eachhour. They are seen in the order that they arrive at the of-fice. The second half of each hour is left open. This tech-nique works well in large facilities with several depart-ments giving medical care. For example, several patientsmay arrive for a 9:00 appointment, be seen by the physi-cian, be sent to the laboratory for blood work, and re-turn to the physician 20 minutes later. The physician hasthe second part of the hour to see these patients aftertheir testing. That second half of each hour is used as abuffer or extra time that can be used for emergencies,walk-ins, returning phone calls, and tasks other than di-rect patient care. Modifications to this system may in-clude seeing new patients who will have complete physi-cal examinations on the hour with three or four rechecksscheduled on the half hour. For example, a 75-year-oldman being seen for a complete physical would be sched-uled at 9:00 AM, with a 22-year-old being seen for a fol-low-up of strep throat and a 6-year-old being seen forrecheck of an ear infection scheduled at 9:30 AM.

Fixed Scheduling

Fixed scheduling is the most commonly used method. Itdivides each hour into increments of 15, 30, 45, or 60minutes. The reason for each patients visit will deter-mine the length of time assigned. Patients who are lateor do not report for their appointment can cause majorproblems in the flow of the day. It is helpful to schedulechronically late patients at the end of the day. Anothertactic is to tell the patient to arrive 30 minutes prior tothe time you schedule.

Streaming

Streaming is a method that helps minimize gaps in timeand backups. Appointments are given based on the needs

of the individual patient. If a patient is being seen for acomplete physical, 1 hour may be allotted. The next pa-tient seen may need a blood pressure recheck, whichwould be allotted a 15-minute slot. Although this methodensures a smooth work flow, the medical assistant sched-uling the appointment must understand the proceduresand guidelines for deciding the time that should be al-lotted. Box 6-1 outlines examples of services and theirprobable time allotments.

Double Booking

With double booking, two patients are scheduled forthe same period with the same physician. This workswell when patients are being sent for diagnostic testingbecause it leaves time to see both patients without keep-ing either one waiting unnecessarily.

Flexible HoursOffices that operate with flexible hours are open at dif-ferent times throughout the week. For example,Monday, Wednesday, and Friday office hours might befrom 8 AM to 5 PM, and Tuesday and Thursday officehours might be from 8 AM to 8 PM. Some offices mayalso be open on Saturdays for all or part of the day.Patients still have scheduled appointments, but thisgreater range of available appointment times better ac-commodates work and family schedules. Your mainchallenge with flexible hours is to determine which pa-tients really need to be scheduled for these special times.For example, Saturday appointments may be reservedonly for patients whose work schedules do not permitweekday appointments. Flexible hours are most oftenused by clinics, group practices, and family physicians.

Open HoursA medical office that operates with open hours for pa-tient visits is open for specified hours during the day orevening. Patients may arrive at any time during thosehours to be seen by the physician in the order of theirarrival; there are no scheduled appointments. This sys-tem is commonly seen in emergency walk-in clinics andeliminates patient complaints such as I had an appoint-ment at 2 PM but had to wait until 3 PM to be seen.Open-hour scheduling, however, has some clear disad-vantages:

Effective time management is almost impossible. The facilities may be overloaded at some times and

empty at other times. Charts must be pulled and prepared as each patient

arrives.

So that patients are seen in the order in which theyarrive, some offices use sign-in sheets. Some sign-in


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sheets require that patients record the reason for theirvisit. The use of sign-in sheets is discouraged under theHealth Insurance Portability and Accountability Act of1996 regulations, as discussed in Chapter 8. Sign-insheets are considered a breach of confidentiality, sincepatients signing the sheet can see the names and medicalconditions of other patients.


2. What are the three systems that can be used forscheduling patient office visits?

Factors That Affect Scheduling

Patients NeedsPeople express their needs in varied ways. A patientmight be feeling uncertainty, embarrassment, shyness,or fear. With a patient in an emotional state, even theslightest real or imagined miscommunication can leadto negative response from the patient. Be courteous andmaintain your professionalism.

Before scheduling an appointment, you should de-termine:

Why the patient wishes to see the physician How long the patient has had the symptoms Whether the problem is acute (abrupt onset) or

chronic (longstanding) The most convenient time for the patient to come in

(e.g., early morning or evenings) Any special transportation services the patient re-

quires (community or hospital van services operateonly during certain hours)

Whether the patient needs to see other office staff Any third-party payers constraints Receipt of necessary documentation for referrals

when the patient is enrolled in a program that re-quires such documentation (third-party payers arediscussed further in Chapter 14)

Control of the appointment schedule is your re-sponsibility. Strive to accommodate a patients re-quests whenever possible but not if it will overload theschedule. For example, if a patient requests a 2 PM ap-pointment this Tuesday and you already have patientsin that time slot, politely explain that you cannotschedule the appointment then unless you have a can-cellation. You might offer a later time on Tuesday oron another day at 2 PM. You can also ask if the pa-tient wishes to be put on a move-up list to be notifiedif an earlier appointment opens up. In other words,you control the schedule. Do not let it control you.The entire medical office team depends on a well-man-aged schedule.

Providers Preferences and NeedsThe management of the practice depends on the desiresand requirements of the providers working in it.Providers in a medical practice may include the physi-cian, nurse practitioner, or physicians assistant. Someproviders often run behind schedule; others are ex-tremely punctual. Recognize your providers habits andcommunicate any problems to a supervisor. The physi-cian may allow you to adjust the schedule to accommo-date his or her habits. If you are employed to assist thephysician with clinical duties (e.g., removing sutures,performing electrocardiograms, giving injections), theschedule can be adjusted to accommodate a larger num-ber of patients while still allowing the provider enoughtime to give each patient personal attention.

As discussed earlier, the physician also needs time toreceive and return telephone calls, review laboratoryand pathology reports, dictate chart notes or correspon-dence, and so on. If your physician is on the staff of ateaching hospital, you may also have to block off timefor clinic conferences and other teaching duties.

The physician will need time to meet with unsched-uled office visitors other than patients. Such visitorsmight include other physicians and sales representativesfrom medical supply or pharmaceutical companies. Youshould determine in advance how the physician wantsyou to handle these visitors. For example, the physicianmay want to be notified immediately if another physi-


E T H I C A L T I P

Think Before You Speak

As discussed throughout the text, it is illegal and uneth-ical to release patient information without the patientsconsent. You may be breaching confidentiality withouteven realizing it. Consider this: You are a receptionist ina busy OB/GYN practice. A former classmate comes infor a pregnancy test. While you are making her returnappointment, she tells you that the test was positive.Later, while having lunch at a nearby restaurant, yousee her mother. You congratulate her on her new grand-child and quickly realize that she doesnt know yet. Youhave just breached the patients confidentiality.

What if the scenario had been like this: Hi, Mrs.Roberts. What a conicidence; I just saw Susie thismorning. Mrs. Roberts says, Where did you see her?You reply, At work. You have just told Mrs. Roberts thather daughter was at an OB/GYN office. This innocentexchange is a serious violation of the Privacy Rule ofHIPAA. Most employers consider this to be reason forimmediate dismissal. Be careful.

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cian comes to the office. With salespersons or pharma-ceutical representatives, however, the physician mayhave another staff member meet with them or may re-quest that an appointment be scheduled for a more con-venient time.

Physical FacilitiesThe physical facilities available in the medical office willaffect the management of the appointment schedule.Consider these points: How many providers use the fa-cility? How many examination rooms are there? Is itnecessary to resterilize instruments between procedures,or is more than one set of instruments available? Youwould not want to schedule two sigmoidoscopies at thesame time, for example, if the office has only one appro-priately equipped examination room. You must thor-oughly understand the requirements for procedures tobe performed in the office to schedule appointments ac-curately.


3. What are three factors that can affect appointmentscheduling?

Scheduling GuidelinesWhether the patient is making an appointment by tele-phone or in person, be pleasant and maintain a helpfulattitude. Always write the patients telephone numberon the schedule when making appointments. Emergenciesand delays are unavoidable, and schedule correctionscan be made quickly if the telephone number is handy.Leave some time slots open during each day, perhaps 15to 20 minutes in the morning and in the afternoon.Invariably, problems will arise (e.g., late patients, emer-gencies) and disrupt the regular appointment schedule.These open blocks can allow the schedule to catch up.Also, patients calling for appointments will not appreci-ate being told that no time is available for 2 or 3 weeks.Open slots can be used to schedule brief appointmentsas needed. Procedure 6-1 describes the steps for sched-uling appointments for new patients.

New PatientsMost appointments for new patients are made by tele-phone. The information you exchange at this encounteris crucial, and entering the patients data accurately isimperative. The first encounter with a new patient isdiscussed in Procedure 6-1.

An office brochure can be mailed to the patient inadvance of the appointment. Some offices send new-pa-tient forms to be filled out and brought in at the ap-

pointment. When scheduling an appointment for a newpatient, follow these guidelines:

1. Allow an adequate amount of time for the appoint-ment. To do so, obtain as much information as pos-sible from the patient: Full name and correct spelling Mailing address Day and evening telephone numbers Reason for the visit Name of the referring physician or individual Responsible party and third-party payer (insur-

ance plan)2. Explain the offices payment policy. Most offices re-

quire full or partial payment at the time of an initialvisit, and patients must understand this policy.Instruct patients to bring all pertinent insurance in-formation.

3. Be sure patients know your office location; if needed,give them concise directions. You may also want totell patients how long they can expect to be at the of-fice.

4. Some patients are sensitive about messages left on ananswering machine or given to a co-worker. Toavoid violating confidentiality, ask the patient if it ispermissible to call at home or at work and includethis information in the patients chart.

5. Before ending the call, confirm the time and date ofthe appointment. You might say, Thank you forcalling Mr. Brown. We look forward to seeing youon Tuesday, December 10, at 2 PM.

6. Always check your appointment system or book tobe sure that you have placed the appointment on thecorrect day in the right time slot.

7. If the patient was referred by another physician, youmay need to call that physicians office in advance ofthe appointment for copies of laboratory work, radi-ology and pathology reports, and so on. Remember,the patient must give authorization to release med-ical documents (see Chapter 9). Give these reports tothe physician prior to the patients appointment.

Established PatientsEstablished patients will be given return appointmentswhen necessary. Most return appointments are madebefore the patient leaves the office. Procedure 6-2 de-scribes the steps for scheduling a return appointment.

When making a return appointment, follow theseguidelines:

1. Carefully check your appointment book or screenbefore offering an appointment time. If a specific ex-amination, test, or x-ray is to be performed on thereturn visit, avoid scheduling two patients for thesame examination at the same time.


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2. Offer the patient a specific time and date. For exam-ple, you might say, Mrs. Hernandez, I have nextTuesday, the 15th, available at 3:30 PM (Avoid ask-ing the patient when he or she would like to return, asthis can elicit indecision.) If the offered appointment isnot convenient, offer another specific time and date.

3. Write the patients name and telephone number inthe appointment book, or enter in the informationon the appointment screen.

4. Transfer the pertinent information to an appoint-ment card and give it to the patient. Computerizedsystems print an appointment card. Repeat aloud theappointment day, date, and time to the patient asyou hand over the card (Fig. 6-3).

5. Double-check your book or screen to be sure youhave not made an error.

6. End your conversation with a pleasant word and asmile.

Preparing a Daily or WeeklyScheduleIn most offices, as medical assistant, you are responsiblefor preparing a daily and weekly schedule of appoint-ments. Make a copy for the providers and other officestaff members. When there are changes in the schedule,ensure that corrections are made on all copies. Place thenext days schedule on the physicians desk before he orshe leaves for the day. Give the next weeks schedule tothe physician before he or she leaves on Friday. Schedulesshould include not only patients appointments but alsohospital rounds, surgeries, meetings, and any personalengagements on the schedule. Computer systems print adaily or weekly schedule, but you must remember tomake changes manually as the day progresses.

Patient RemindersOffices use various kinds of reminders to tell a patientabout an appointment that should be made or to re-mind them that an appointment has been made on aspecific date and time. These reminders are the appoint-ment card, the telephone call, and the mailed card.

Appointment CardsAn appointment card is given to the patient when he orshe leaves the office. It should have the following infor-mation:

Patients name Day, date, and time of the return visit Physicians name and telephone number

If the patient requires a series of appointments, tryto make them on the same day of the week and at thesame time of day. This will make it easier for the patientto remember the appointments. Unless your appoint-ment card allows you to list the complete series of ap-pointments, however, give the patient a card for thenext appointment only and repeat this procedure aftereach subsequent visit. When the patient has to save sev-eral cards, they can easily be lost or cause confusion. Ifusing a manual system, write on the card with ink sothat it cannot be altered. Computer appointment sched-uling software provides appointment cards that can beprinted on special perforated paper.

Telephone RemindersAll new patients and patients with appointments sched-uled in advance should receive a telephone reminder theday before their appointment. Computer systems canplace the call to the programmed number and remindthe patient of the appointment with a prerecorded mes-sage. Remember, do not call a patient at work or leave


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

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a message unless you have been given permission to doso. Make the telephone reminder simple. Identify youroffice and yourself, and state the date and time of theappointment. For example, you might say, This is Ms.Sprinkle from Dr. Yokleys office. Im calling to confirmyour appointment for tomorrow, Thursday, February10, at 3:30 PM. Unless the patient has a question, thensay, Thank you and goodbye. This reminder helps jogthe patients memory, and if the patient must cancel orreschedule an appointment, you will have time to fill theslot. Keep a list with the names and phone numbers ofpatients who have asked to be called or who need to beseen sooner than their next appointment. This list maybe called a cancellation list, a waiting list, or a move-uplist. Make a notation on the appointment schedule, suchas confirmed, left message, or no answer.

Mailed Reminder CardsSome offices send reminder cards instead of makingphone calls. Reminder cards are also used to remind pa-tients who could not be reached by phone that it is timeto keep an upcoming scheduled appointment. Theseshould be mailed at least a week before the date of theappointment. In addition, reminder cards are sent aftera set period since a patients last appointment. Remindercards are often used to alert patients to the need for an-nual examinations (e.g., Pap smears, mammograms,prostate examinations).

To handle this kind of reminder, keep a supply ofpreprinted postcards in the office (Fig. 6-4). The cardsshould have a simple one- or two-sentence message,such as, According to our records, you are due foryour annual physical. If you would kindly call the of-fice, we will be glad to arrange an appointment foryou. The physicians name, address, and telephonenumber should be printed on the card. Place the card ina tickler file (Box 6-2) and mail it at the appropriate

time. Some medical management software packagesproduce a list that can be used to alert patients of nec-essary services.


4. What are the three types of patient reminders?

ADAPTING THE SCHEDULE

EmergenciesWhen a patient calls with an emergency (Fig. 6-5), yourfirst responsibility is to determine whether the problemcan be treated in the office. The office should have apolicy for evaluation of the situation. The word STATis used in the medical field to indicate that somethingshould be done immediately (Box 6-3). You also shouldhave a list of appropriate questions to ask the patient,such as Are you having chest pain? Are you having dif-ficulty breathing? How long have you had the symp-toms? (Box 6-4). When several symptoms occur to-gether, they may indicate a particular problem. Thisgroup of complaints is referred to as a constellation ofsymptoms. One group of symptoms found to indicate acertain disorder is severe right lower quadrant pain,nausea, and fever. A physician who sees this constella-tion of symptoms considers appendicitis.


has an appointment with

time weekday month date

DONALD L. MYERS, M.D.NEUROLOGICAL SURGERY

233 SOUTH SIXTH STREET, FIRST FLOORPHILADELPHIA, PENNSYLVANIA 19106

(215) 627-4380on

, , 200,

If your plans change please notify the office at least 24 hours in advance

Laila Hudson

2:00 Tues. April 8 8

Figure 6-4 Sample reminder postcard.

B O X 6 - 2

A TICKLER FILE CAN TICKLE YOUR

MEMORY

A ttiicckklleerr ffiillee helps remind you to do something bya certain time in the future. It can be somethingas simple as a card file box (like a recipe box) oran accordion folder with insert guides in chrono-logical order. The guides may be in weekly ormonthly divisions. Put patient appointment re-minder cards in the appropriate location in thefile. Check the file each week or month, depend-ing on the divisions, then mail the reminders.

Medical office computer software often offershelp with patient reminders. With a search of thedatabase, a report of every female patient overage 50, for example, could be generated. Somesystems even generate patient reminders basedon preprogrammed criteria.

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Patients Who Are Acutely IllPatients who are acutely ill often have serious, althoughnot life-threatening, conditions. These patients need tobe seen as soon as possible but not necessarily on thatsame day. Obtain as much information about the pa-tients medical problem as you can so your message tothe physician will allow him or her to decide how soonthe patient should be seen. Place the chart with a notein the location selected by the physician, and tell the pa-tient you will call back as soon as the physician makesa decision. Walk-in Patients

Walk-in patients are those who arrive at the office with-out a scheduled appointment and expect to see thephysician that day. Typically, the physician will have aset protocol, or prescribed list of steps, for handlingsuch situations. In general, you must first determine thereason for the walk-in. Patients with medical emergen-cies need to be seen immediately. Other patients can beasked to have a seat in the waiting room while you in-form the physician of the patients presence. The physi-cian can then make the decision to see the patient ornot.

If the patient is to be seen, explain that you willwork him or her into the schedule as soon as possiblefor a brief examination. When the patient leaves the of-fice, you might apologize for the delay and then ask thepatient to schedule an appointment for the next visit.

If the physician decides not to see a walk-in patient,you will have to ask the patient to schedule an appoint-ment and to return later.

Late PatientsPatients who are late cause problems in the schedule.You should gently but firmly apologize for any delaybut tell the patient, You were late, and Dr. Wooten isseeing another patient now. The doctor should be able


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

B O X 6 - 3

WHEN DOES THE PATIENT NEED TO

BE SEEN NOW?

When the patient calls with any of the followingcomplaints:

Shortness of breath Severe chest pain Uncontrollable bleeding Large open wounds Potential accidental poisoning Bleeding in a pregnant patient Injury to a pregnant patient Shock Serious burns Severe bleeding Any symptoms of internal bleeding (dark, tarry

stools; discoloration of the skin)

Note: Remember to check with the physician forproper procedures concerning triage.

B O X 6 - 4

WHEN A PATIENT COULD BE HAVING

A HEART ATTACK

When a patient calls complaining of the followingconstellation of symptoms, you should assumethat this is a potential heart attack:

Shortness of breath Chest pain Arm or neck pain Nausea and/or vomiting

Just one of these symptoms alone may not in-dicate a cardiac event, but when there is morethan one, you should be alert to the fact that thismay be a heart attack. Studies have shown that,in women, early symptoms of a heart attack aredifferent from those in men. These symptoms in-clude jaw, neck, and back pain and severe fa-tigue. Keep this in mind when questioning the pa-tient. Call 911 and stay on the line with thepatient. Do not advise the patient to drive to thehospital. Follow office policies for such an emer-gency.

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to see you in about 15 minutes. Patients who are rou-tinely late should be politely advised that According toour office policy, patients who are more than 15 min-utes late will have to be rescheduled. Some offices havefound that scheduling the habitually late patient at theend of the day is helpful. In addition, ask patients to callthe office if they know ahead of time that they are goingto be late.

Physician DelaysOf course, sometimes the physician calls in to say he orshe has been delayed and will be in the office later. If of-fice hours have not yet begun, call patients with ap-pointments scheduled early, and give them the option ofcoming in later in the day or rescheduling the appoint-ment for another day. If patients are waiting in the of-fice, inform them immediately if the physician will bedelayed. For example, you might say, Dr. Franklin hasbeen delayed and will probably be 20 to 30 minuteslate. Would you like to wait, or would you prefer toreschedule for another time? Always keep your pa-tients informed; most people will understand if theyknow you have not ignored or forgotten them. Most pa-tients appreciate the fact that the physician would alsobe available to them in an emergency. If you reschedulean appointment, note in the patients chart the reasonfor the cancellation or rescheduling.

Missed AppointmentsA missed appointment, or no-show, occurs when a pa-tient neglects to keep an appointment and does not no-tify the office. When this happens, call the patient to tryto determine why the appointment was missed and toreschedule for another time. If you are unable to reachthe patient by telephone, send a card asking the patientto call the office to reschedule. Note in the patientschart the missed appointment and that you have eitherrescheduled the appointment or mailed a card to sched-ule another appointment. Even if the facility does notroutinely remind patients of appointments, be sure tocall and remind habitually late patients the day beforethe appointment.

Continued failure to keep appointments should bebrought to the attention of the physician, who maywant to call the patient personally (particularly if thepatient is seriously ill) or send a letter expressing con-cern for the patients welfare. In extreme cases, thephysician may choose to terminate the physicianpa-tient relationship. See Chapter 2 for the proper proce-dure for this action. Notations of all actions and copiesof any letters sent to the patient should become a per-manent part of the individuals medical record. Box 6-5is an example of a chart note.

Cancellations

Cancellations by the OfficeYou may have to cancel a patients appointment if thephysician is ill, has an emergency, or has personal timeoff. Patients who must be rescheduled need not be toldthe specific reason for the physicians absence. Thesecancellations should be noted in the patients medicalrecord.

When you have advance notice, write a letter to pa-tients with appointments you must cancel, indicatingthat the physician will be away from the office but willreturn by a certain date. Patients should be alerted tocancellations a week before their appointments. Ask thepatient to call the office to reschedule. If you have tocancel on the day of the appointment, call the patientand explain. For example, you might say, Dr. Flora hasbeen called out of the office unexpectedly. Would it beconvenient to reschedule your appointment for some-time next week? If the patient arrives at the office be-fore you can contact him or her, apologize and politelyexplain the situation. Most patients will be understand-ing. When a physician is unavailable for an extendedperiod, another physician must cover the practice or beon call. Everyone in the office should have a list ofnames and addresses of on-call physicians, and youshould give this information to your patients, accordingto your office policy. When a locum tenens, or substi-tute physician, is employed, the office appointments willnot be interrupted (see Chapter 2).


L E G A L T I P

DOCUMENT, DOCUMENT,DOCUMENT!

When a patient does not show up for his appoint-ment, you must make an entry in the chart.Because your physician has a legal contract withthe patient, he has an obligation to treat him aslong and as often as necessary. If the patient doesnot report for his scheduled appointments, the pa-tient is breaking the contract. This would be an im-portant factor in a court cases involving a physi-cian being sued for abandonment. The chart is thephysicians defense. Being diligent with documen-tation is not optional.

Example:

10/07/07. Mr. Quinn did not report for his appoint-ment at 10 AM today. I called him at 11:00 AM, andhe stated that he did not want to reschedule. Hesays he is doing fine and will call next week toreschedule. LM, RMA

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Cancellations by the PatientWhen a patient cancels an appointment, ask the reasonfor the cancellation and mark it on your appointmentschedule and in the patients chart. Offer to rescheduleat another time. If the patient is being seen for a contin-uing problem, be sure he or she understands the neces-sity for the follow-up visit. If the patient wants to callback for an appointment, make a note to yourself tocheck on the call-back in a few days. If a patient cancelsappointments frequently, bring this to the physicians at-tention.

If a patient cancels an appointment and you have afull schedule, no action is needed. If your schedule islight, however, refer to your move-up list to try to fillthe vacancy.

Making Appointments forPatients in Other Facilities

Referrals and ConsultationsWhen the provider requests assistance from anotherphysician in consultation or makes a referral to anotherphysician for the patient, make certain that the referralmeets the requirements of any third-party payers.Managed care companies like HMOs have strict re-quirements regarding precertification and documenta-tion for referrals to specialists and other facilities. If thepatients third-party payer requires a referral form, youwill need to complete it with the referral approval num-ber that you must obtain from the insurance company.Figure 6-6 is a sample referral form. (See Chapter 13.)Be sure the physician you are calling is on the preferredprovider list for the patients insurance company.Patients should be given a choice when being referred toa specialist.

When calling another physicians office for an ap-

pointment for your patient (Procedure 6-3), provide thefollowing information:

Physicians name and telephone number Patients name, address, and telephone number Reason for the referral Degree of urgency Whether the patient is being sent for consultation or

referral (see Box 6-6 for an explanation of the termsreferral and consultation)

Record in the patients chart the time and date of thecall and the person who received your call. Tell the per-son you are calling that you wish to be notified if yourpatient does not keep the appointment. If this occurs, besure to tell the physician and enter this information inthe patients record.

Write the name, address, and telephone number ofthe referral doctor on your office stationery and includethe date and time of the appointment. Give or mail thisinformation to your patient. The patient may call the re-ferring physician to make his or her own appointment.If this is the situation, ask the patient to call you withthe appointment date and document it in the chart.


B O X 6 - 5

CHARTING EXAMPLE

05/12/081530

Mrs. Parrish was called regarding missing sched-uled appointment for today at 9:30 AM Patientsaid she forgot about the appointment.Appointment was rescheduled for 05/14/08 at10:00 AM. Patient was advised of the need tohave regular prenatal checkups. Patient verbal-ized understanding. Dr. Wong was notified thatappointment was missed and rescheduled.Lois Samuels, RMA

REFERRAL FORMThis form must be completed in full or treatment of the patient may be delayed.ALL INFORMATION IS STRICTLY CONFIDENTIAL AND WILL BE HELD BY THE AREA HEALTH SERVICE.

PATIENT DETAILS: Interpreter Required: YES / NO

TITLE

MEDICARE NUMBER

ADDRESS

COUNTRY OF BIRTH

FIRST LANGUAGE SPOKEN

GENERAL MEDICALPRACTITIONER NAME:MEDICAL SPECIALISTNAME:

DOB

POST CODE

HOME TEL

MOBILE

BUS TEL

HEALTH CARD NO

GIVEN NAMESURNAME

CONTACT TEL:

CONTACT TEL:

Referred to: Enclosures Medical Documents: Yes No Specialists Reports: Yes No

Specialty:

History and Reason for referral:

Significant Medical History: (include any relevant access issues or special requirements)

(Signature) (Printed Name) (Date)

REFERRING CLINICIAN:

Provider Name: Provider No:

Address:

Telephone: Fax: Email:

LSW HEALTH

Figure 6-6 Sample referral form.

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Diagnostic TestingSometimes, patients are sent for diagnostic testing ortreatment at another facility. Such testing includes labo-ratory tests, radiology, computed tomography, magneticresonance imaging, and nuclear medicine studies. Theseappointments are usually made while the patient is stillin the office. Before scheduling, determine the exact testor tests the physician requires and how soon the resultsare needed. (Be sure to indicate to the facility if the re-sults are needed immediately, or STAT.) Also, checkwith the patient for any time restrictions he or she mayhave. Give the facility the patients name, address, tele-phone number, the exact test or tests required, and anyother special instructions from the physician. Give thepatient a laboratory or x-ray referral slip with the timeand date of the appointment and the name, address, andtelephone number of the outside facility.

Some laboratory studies or x-ray tests require ad-vance preparation by the patient. Give your patient awritten and verbal explanation of the required prepara-tion, and be sure he or she understands the importanceof following the instructions. On the patients chart, notethe name of the outside facility and the date and time ofthe appointment. Also place a reminder in your ticklerfile or on your appointment schedule to be sure the testresults are received as requested. See Procedure 6-3.

SurgeryYou also assist with the scheduling of procedures in ahospital operating room or an outpatient surgical facil-ity. Determine the patients need for precertificationwith the insurance carrier. You may have to call thenumber on the back of the patients insurance card fora precertification number. Call the participating facilitychosen by the patient and specify the time and date thephysician has requested. The operating facility will needto know the exact procedure, the amount of timeneeded, the type of anesthesia required, and any otherspecial instructions your physician may have. The facil-ity will also need the patients name, age, address, tele-phone number, insurance information, and the precerti-fication number if required.

If the hospital has supplied your office with pread-mission forms, give a copy to the patient and make surehe or she understands the need to complete and returnthe form in a timely manner. Follow the policies of thesurgical facility regarding preadmission testing, whichmay include laboratory studies, x-rays, or autologousblood donation (donation of a persons own blood inadvance). Write down all appointment dates, times, andlocations for the patient and be certain he or she under-stands where to go and when.

Finally, note in the patients record the name of theoperating facility and the date and time the surgery isscheduled. You may also need to arrange for hospitaladmission by providing the same information to thehospital admitting department (Procedure 6-4).


5. What information should be readily available whencalling to schedule a patient for surgery in anotherfacility?

When the Appointment ScheduleDoes Not WorkNo appointment schedule runs smoothly all the time,and an occasional glitch is to be expected. If, however,you find that your schedule is chaotic nearly every day,you should determine the cause. Evaluate the scheduleover time, generally 2 to 3 months. For example, makea list of all patients seen, their arrival times, the amountof time they spent with the physician, the time they left,and the amount of time needed to perform each exami-nation or treatment. Since the work flow of the officeaffects every staff member, involve all employees in yourstudy.

Office meetings are an ideal way to identify schedul-ing problems. Your evaluation may reveal that many ofyour patients are arriving late or that you have not al-lotted enough time for certain procedures. Sometimes, a


B O X 6 - 6

REFERRAL OR CONSULTATION?

It is important to know the difference between areferral and a consultation. According to the cod-ing guidelines in the Current Procedural CodingTerminology, a consultation is a request for theopinion of a colleague. A letter is provided to thereferring physician by the consultant and con-tains the consulting physicians impression andrecommendations for the patient, but the patientreturns to the referring physician for treatment.For example, an orthopedist may send a patientwith rheumatoid arthritis to a rheumatologist formedication management, but the orthopedist willcontinue the patients care based on the rheuma-tologists recommendations.

A referral usually involves a specialist and re-quires that the patients care be transferred tothat specialist. For example, a patient may seehis family physician for an ingrown toenail. Thatphysician refers the patient to a podiatrist forcare. That care will continue simultaneously withany other care by the family physician until theproblem is resolved.

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habitually delayed physician is the problem. You mayfind that too many staff people are making appoint-ments. If this is the case, you can assign only one staffperson to handle all scheduling. Some problems maynever be completely solved. If they are identified, how-ever, you can often make adjustments to avoid causingfrustration for both patients and office personnel.

espaolSPANISH T E R M I N O L O G YA que se debe su visita?

Why do you need to see the doctor?Desde cuando se siente mal?

How long has this been going on?Prefiere la cita en la manana o en la tarde?

Would you prefer morning or afternoon?Llamo para recordarle su cita.

I am calling to remind you of your appointment.Le dare una cita para que vea al Doctor nueva-menta.

I will give you an appointment to return to seethe doctor.

Para su proxima visita, por favor traiga su tarjetadel seguro y todas las medicinas que esta tomando.

Please bring your insurance card and medicinebottles with you for your next appointment.

Dias de las semanaDays of the week

DomingoSunday

LunesMonday

MartesTuesday

MiercolesWednesday

JuevesThursday

ViernesFriday

SabadoSaturday

M E D I A M E N U

Student CD

Case StudyInteractive Administrative Case Study 2:

Managing a Medical Office Emergency

CMA/RMA Certification Exam Review

Video ProceduresProcedure 6-1 video clip

LWWs Medical Assisting Skills DVDProcedures 6-1, 6-2, 6-3, 6-4

Premium Online Coursehttp://thePoint.lww.com/Kronenberger3e

Internet Resources

LiveAdvise Online Tutoring & CompetencyTraining

http://thePoint.lww.com/LiveAdvise

Horas del diaTimes of the day

A la unaOne oclock

El medio pasado uno1:30

Dos en punto2:00

Son las dos y media2:30

Tres en punto3:00

Son las tres y media3:30

Siete en punto7:00

Son las siete y media7:30

Ocho en punto8:00

Son las ocho y media8:30

Nueve en punto9:00

Son las nueve y media9:30

97190_ch 06 12/7/07 1:04 PM Page 125


Purpose: To secure an allotted time for a patient who is new to your facility to see the providerEquipment: Patients demographic information, patients chief complaint, appointment book or computer with appointment software

Steps Reasons

1. Obtain as much information as possible from the To stay on schedule, you must allow enough time patient, such as: for the appointment. This information will help Full name and correct spelling determine appointment needs and save time at Mailing address (not all offices require this) the first visit. Day and evening telephone numbers Reason for the visit Name of the referring person

2. Determine the patients chief complaint or the The reason for the visit will determine the time reason for seeing the physician. allotment, use of special rooms or equipment, etc.

3. Explain the payment policy of the practice. Patients must understand this policy if they are to Most offices require payment at the time of an follow it.initial visit. Instruct patients to bring all pertinent insurance information.

4. Be sure patients know your office location; give Helps patients arrive on time and lets them concise directions if needed. You may also want budget their time.to give patients an idea of how long they can expect to be at the office.

5. To avoid violating confidentiality, ask the patient HIPPAs Privacy Rule prohibits leaving messages if it is permissible to call at home or at work. on an answering machine or giving any

information to another individual who has not beennamed by the patient.

6. Before ending the call, confirm the time and date Repeating the appointment time will ensure that of the appointment. Say, Thank you for calling, effective communication has taken place and Mr. Brown. We look forward to seeing you on increase the likelihood that the patient will be Tuesday, December 10, at 2 PM there on time.

7. Always check your appointment book to be sure Failure to record every appointment in the proper that you have placed the appointment on the location can cause overbooking, frustrated correct day in the right time slot. physicians and staff, and irate patients.

8. If the patient was referred by another physician, Remember, the patient must give authorization to you may need to call that physicians office before release medical documents (see Chapter 9).the appointment for copies of laboratory work, radiology, pathology reports, and so on. Give this information to the physician prior to the patients appointment.

PROCEDURE 6-1: Making an Appointment for a New Patient

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Purpose: To secure an allotted time for a patient who is returning to your office as an established patientEquipment: Appointment book or computer with appointment software, appointment card

Steps Reasons

1. Determine what will be done at the return visit. If a specific examination, test, or scan is to be Check your appointment book or computer performed, you will want to avoid scheduling two system before offering an appointment. patients for the same examination at the same

time.

2. Offer the patient a specific time and date. Avoid Give the patient a choice, and if neither time is asking the patient when he or she would like to convenient, offer another specific time and date. return, as this can cause indecision. Giving a patient a choice is good practice. Mrs.

Chang, we can see you next Tuesday, the 15th, at3:30 PM or Wednesday, the 16th, at 9:00 AM.

3. Write the patients name and telephone Writing the phone number in the appointment number in the appointment book or enter it in book or making a notation in the computer will the computer. give you a quick reference if you need to call the

patient to change the appointment.

4. Transfer the pertinent information to an appoint- Repeating the information reinforces the patients ment card and give it to the patient. Repeat aloud memory and helps ensure that the appointment the appointment day, date, and time to the will be kept.patient as you hand over the card (see Fig. 6-4).

5. Double-check your book or computer to be sure Errors in appointments waste the patients, staffs, you have not made an error. and physicians time.

6. Whether in person or on the phone, end your A smile always feels good to a patient who may conversation with a pleasant word and a smile. be apprehensive about needing to return to the

doctor.

PROCEDURE 6-2: Making an Appointment for an EstablishedPatient

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Purpose: To secure an allotted time for a patient who needs to be seen in another facilityEquipment: Patients chart with demographic information; physicians order for services needed by the pa-tient and reason for the services; patients insurance card with referral information, referral form, and direc-tions to offce

Steps Reasons

1. Make certain that the requirements of any third- Some third-party payers require that referrals be party payers are met. precertified. Pre-existing conditions may not be

covered for referral. Most companies require thatonly the patients primary care physician (PCP) orgatekeeper make referrals. It is important to re-search each situation. Telephone numbers for pre-certification and questions will be printed on theback of the insurance card.

2. Refer to the preferred provider list for the patients Managed care companies have strict require-insurance company. Allow the patient to choose ments for precertification and documentation for a provider from the list. referrals (see Chapter 13). If there is more than

one provider with the same qualifications, the pa-tient should always be given a choice.

3. Have the following information available when The referred or consulting physicians office needsyou make the call: to know these things to serve the patient well. Physicians name and telephone number Patients name, address, and telephone number Reason for the call Degree of urgency Whether the patient is being sent for

consultation or referral

4. Record in the patients chart the time and date This is necessary for proper documentation of the of the call and the name of the person who patients care.received your call.

5. Tell the person you are calling that you wish to be Anyone in the office who needs this information notified if your patient does not keep the will have it.appointment. If this occurs, be sure to tell your physician and enter this information in the patients record.

6. Write down the name, address, and telephone It is important that the patient keep their appoint-number of the doctor you are referring your ment. The physician is responsible for the patient to and include the date and time of the patients care and should know if the appointment appointment. Give or mail this information to is not kept.your patient. Be certain that the information is complete, accurate, and easy to read.

7. If the patient is to call the referring physician to Recording the appointment information in the make the appointment, ask the patient to call patients chart completes the transaction and you with the appointment date, and then proves that the physicians order was carried out.document this in the chart.

PROCEDURE 6-3: Making an Appointment for a Referral to anOupatient Facility

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PROCEDURE 6-4: Arranging for Admission to an InpatientFacility

Steps Reasons1. Determine the place that the patient and/or Physicians may have privileges at one hospital or

physician wants the admission arranged. several hospitals. The patients insurance carriermay have a preferred facility list as well.

2. Gather information for the other facility, including Having the patients demographic and insurance demographic and insurance information. information handy avoids delays.

3. Determine any precertification requirements. Most insurance carriers must be notified in If needed, locate contact information on the back advance of an admission to an inpatient facility. of the insurance card and call the insurance You will be given a precertification number that carrier to obtain a precertification number. must be given to the hospital admissions depart-

ment. This number will follow the patient throughthe claims later filed for that admission.

4. Obtain from the physician the diagnosis and The hospital admissions department will need the exact needs of the patient for an admission. patients exact diagnosis. They will also need to

know of any special requirements, such as a pri-vate room, isolation, etc.

5. Call the admissions department of the inpatient The admissions department handles all prelimi-facility and give information from Step 2. nary information, insurance information, etc. be-

fore assigning the patient a room.

6. Obtain instructions for the patient and call or give Patients should be given complete information in the patient instructions and information. writing if possible. Patients may be afraid and

emotional when they are being admitted to a hos-pital. Be sure they understand their instructions.

7. Provide the patient with the physicians orders for If the patient is not at your office, the physician their hospital stay, including diet, medications, must call in this information. Most hospitals prefer bed rest, etc. that patients bring this information.

8. Document time, place, etc. in patients chart, Any appointments made for the patient must be including any precertification requirements documented in the patients chart. This provides completed. the information to anyone in the office who needs

it.

Purpose: To arrange admission to an inpatient facility providing all necessary information and to provide instructions to the patientEquipment: Physicians order with diagnosis, patients chart with demographic information, contact infor-mation for inpatient facility

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ChapterSummary

when establishing an appointment scheduling system. Sick patients calling to make appointments should be

given priority, and there are established guidelines fordetermining the urgency of a patients problem.Other functions, such as phone calls, reviewingrecords, and lunch breaks, are also scheduled into thedaily activities of the office.

An established protocol or list of steps should be inplace to handle pharmaceutical representatives andother visitors to the office. As the medical assistant atthe front desk, you will be one of the most importantfactors in the daily operation of the outpatient med-ical facility.

As a medical assistant, you will make appointments,document encounters with patients that deal with ap-pointments, and make referrals to other health carefacilities. Learning the issues involved in successfulappointment scheduling will help you make sure yourfacility runs smoothly.

The outpatient medical facility can be chaotic with-out an efficient appointment system. Moving patientsthrough the facility while treating each personequally and thoroughly is one of the biggest chal-lenges in the medical office.

It is difficult for a busy practice to run smoothly all ofthe time. You need structure, but you must be flexible.Available times, equipment and room usage, and per-sonnel coverage must be considered when finding justthe right formula for a well-run and efficient office.

The goals of the outpatient medical facility are toprovide quality patient care and maintain financialstability. To reach those goals, an office must have aplan for the efficient scheduling and carrying out ofthe daily activities.

Appointment scheduling systems include manual sys-tems using appointment books and computerized sys-tems that render helpful reports and daily activitysheets. The size of a practice, the number of physi-cians, the types of services, and so on are considered

Warm Ups for Critical Thinking

Answers to Checkpoint Questions

1. Assume that you are the office manager in a physi-cians office. Create a policy and procedure forscheduling patients.

2. Sign-in sheets can cause a breach in patient confi-dentiality. What other methods could you use thatwould limit the potential for invasion of patientprivacy?

3. You notice that patients typically wait 30 to 45minutes past their scheduled appointment times be-cause of the physician. How would you approacha physician who chronically runs late?

1. A matrix is established to indicate times of eachday that are not available for patient appoint-ments.

2. The three systems that can be used for patient of-fice visits include scheduled appointments, flexiblehours, and open hours.

3. The three factors that can affect scheduling are pa-tients needs, physicians preferences, and the phys-ical facilities.

4. The three types of reminders are appointmentcards, telephone reminders, and mailed remindercards.

5. When scheduling a patient for surgery, the follow-ing information is needed: demographic and insur-ance information; the patients name, age, address,telephone number, precertification number (if re-quired), and diagnosis; surgery planned; and anyspecial instructions.

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