Chapter 12 Notes: Patient Scheduling

What are the guidelines for scheduling inpatient and outpatient admissions and procedures?

1) Gather all your necessary supplies/equipment and make sure that they are in good working order before beginning any procedure. For this particular procedure, you will need to have a calendar, black ink pen, computerized practice management system and/or electronic medical record (EMR), telephones, referral slip, patient's calendar or schedule, and provider requests/orders regarding procedures/admissions being scheduled. 2) In a private and quiet location, discuss with the patient the inpatient admission or outpatient procedure ordered by the provider. This helps the patient identify the time necessary for this appointment and the reason for it. 3) If required, seek permission from the patient's insurance company for the procedure or admission. This clearly identifies for the patient who is responsible for the bill and how it is to be paid. 4) Produce a large, easily read calendar and check to see if the patient has one also. Visualization of the calendar is easier for determining available time for the appointment. Patient's calendar further identifies available days and times for the appointments. 5) Place telephone call to the facility where the appointment is to be scheduled. Identify yourself, your provider, the clinic from where you are calling, and the reason for the call. This alerts the receiver of the call that a provider's office is calling to schedule an appointment. **Note: The more familiar the medical assistant is with the specific procedure to be scheduled or a specific type of hospital admission, the easier it is to make certain the patient has all the information necessary. It can be helpful for medical assistants to discuss such arrangements with speciality clinics and hospitals** 6) Displaying sound judgement, identify any urgency. Request the next available appointment for the particular type of appointment to be scheduled and provide the patient's diagnosis. Identify any time that is not possible for the patient. This tells the receiver how quickly an appointment is to be made, for what reason, and if any dates or times are not possible. 7) As a time is suggested, confer with the patient for an immediate response. 8) Once the appointment has been scheduled, provide receiver pertinent information related to the patient (ex: full name, insurance information, social security number, telephone number). This provides essential information to secure the appointment for the proper patient. 9) Request any special instructions or advanced data necessary for the patient. This helps to ensure that a smooth transition is made from the provider's clinic to the facility where the referral is made and provides the patient with any special instructions. 10) Complete a manual referral slip, or use the practice management or electronic medical record system to enter the referral for the patient; send or fax a copy to the referral facility. This ensures that the patient, the referral facility, and the patient's chart have a copy of the reason for the appointment, any specific instructions, and the date and time of the appointment. 11) If an immediate hospital admission is to be made, attend to the special needs of the patient by providing him or her time on the telephone to call family members to make arrangements to receive personal items and any other arrangements necessitated by the appointment. This provides patients with a little time to notify family members and make necessary arrangements. 12) Place a reminder notice to yourself on the calendar or in a tickler file. This helps you ensure that the appointment was completed and a report is received from the appointment facility. 13) Document the referral in the patient's chart. A copy of the referral slip and all pertinent data are to be included. Document in the chart when the appointment is completed and a report is received from the referral facility. Date and initial.

What are the seven scheduling styles? What are the pros and cons of each?

1) Open hours: In open hours scheduling, patients are seen throughout a particular time frame, for example, 9:00am to 11:00am or 1:00pm to 3:00pm. Patients are seen on a first-come, first-serve basis. Many clinics frequently choose this method because they are able, by their nature, to maintain a steady flow of patients. A sign-in sheet is often helpful with open hours scheduling, because patients are seen on a first-come, first-serve basis. It is important to remember that a sign-in sheet can never replace a warm, welcoming greeting from the administrative medical assistant to set the tone for care given that day. 2) Double booking: When the double booking method is used, two or more patients are given a particular appointment time. This method is limited to a practice that can attend to more than one patient at a time. For instance, Maria Jover and Jim Marshal are both given a 9:30am appointment. Ms. Jover requires a complete checkup including lab tests, vitals, and provider visit. Mr. Marshal is being seen for suture removal. While the staff conducts the lab tests on Ms. Jover, the primary care provider can see Mr. Marshal. Obviously, this method requires a precise accounting for time, rooms, and adequate staff. A good rule to remember is that if patients consistently have to wait for staff to attend to them, double booking is not a wise choice of scheduling method. 3) Clustering: The cluster scheduling method involves grouping or categorizing similar types of visits or procedures on particular days or blocks of time. Cluster scheduling is sometimes referred to as specialty scheduling, or practice-based scheduling. It is popular in clinics where groups of patients require similar visit types and are scheduled during these predetermined times. Examples would include an OB/GYN clinic, where all prenatal checks are scheduled so that two to three patients come in every 15 or 30 minutes. The medical assistant generally will handle the vital signs, weight, and other pertinent information, and the provider can check in on patients and focus on those that turn out not to be routine, have problems, or are more complex cases that require attention. Another example would be a day or time block set aside by surgeons for postoperative checks. Most of these follow-up visits involve making sure incision sites are clean and healing well, and that the patient is following all medication and therapy orders and progressing as expected. Again, these visits are normally quick and routine. Clustering allows a higher volume of patients to be seen comfortably. This can be very convenient for the patient, taking away long wait times for what might be a 5- or 10-minute post-op check. There are many creative ways for certain specialties to utilize cluster scheduling. Having similar patients together also offers opportunities for patient education. Presenting videos or information sessions on particular procedures or conditions can optimize everyone's time. This could include initial visits for bariatric surgery, where patients will be evaluated and need to complete a battery of required assessments or meetings before surgery can be approved or scheduled. It is important for the clinic to maintain an atmosphere of individualized care, and avoid an assembly-line feel. Staff, rooms, and resources will need to be carefully planned to keep the larger volume of patients flowing efficiently. 4) Wave scheduling: This is another method that can be used effectively in medical facilities that have several procedure rooms and adequate personnel to staff them. Using the wave scheduling system, patients are scheduled only in the first half hour of each hour. Fir example, three patients may be given the time of 11am. Generally, the first one to arrive is seen first. If they all arrive on time, the one who is most ill is usually seen first, and there will be a waiting time for the other two patients. Depending on the practice, some administrative medical assistants will be instructed to schedule three patients at the top of the hour and another two or three patients at the bottom of the hour (ex: 11:30am). Patients who do not understand this system of scheduling may become irritated if they discover that another patient has the same appointed time with the same provider. This method takes into account that there will be no-shows and late arrivals. It can also accommodate work-in appointments. However, it does require personnel who are able to prioritize patient problems precisely when establishing the appointments 5) Modified wave scheduling: This is a variation of the wave method where patients are scheduled in "waves". In this method, two or three patients are scheduled at the beginning of each hour, followed by single appointments every 10 to 20 minutes the rest of the hour. A variation of this method assesses major and minor problems. Major time-consuming problems are seen at the beginning of the hour (ex: new patients). Minor problems are seen from 20 minutes past the hour to half past the hour (ex: follow-ups, bandage changes, and other minor procedures), and walk-ins (ex: a child with a 103 degree Fahrenheit temperature) are accommodated at the end of the hour. Again, good screening will determine the success of this method. With both the clustering and wave methods, empty or unscheduled periods can be used to catch up on other responsibilities. 6) Stream scheduling: This is perhaps the best known and most widely used scheduling system. When this system works as it should, there is a steady stream of patients at set appointment throughout the workday. There could be, for example, a 30-minute appointment at 9:00am; a 15-minute appointment at 9:30am; and a 15-minute appointment at 9:45am. Each patient is assigned a specific time. This can be best accomplished by establishing realistic time guidelines for particular types of appointments, such as 45 minutes for consultations, 15 minutes for immunizations, and 30 minutes for hearing tests. 7) Online scheduling: As technology advances in healthcare, so does the concept of self-scheduling patient appointments. New self-scheduling software that integrates with electronic health record software is available, and not just for smaller or specialized practices with small or no staff. Larger practices are realizing higher efficiency, decreased phone calls, and happier patients by allowing do-it-yourself (DIY) appointments. Currently, many clinics are using patient portals, which may include either appointment requests or self-scheduling modules. A patient portal is a secure website that provides a patient with 24-hour access to his or her health care information for a particular practice. Popular functions include communicating via email with the healthcare team, obtaining test results, requesting medication refills, and many other capabilities, such as requesting or scheduling appointments. Some portals will allow a patient to request an appointment, and a staff member will schedule it and send a confirmation back to the patient. Others enable the patient to select a date, or the next available date and time, and self-schedule an appointment.

How can medical assistants establish the appointment matrix?

1) Gather all necessary equipment/supplies and make sure that they are all in working order before beginning any procedure. For this particular procedure, you will need to have a paper appointment scheduling system or a computerized practice management system and a schedule for provider and other medical office staff. 2) Block off times in the appointment scheduler when patients are not to be scheduled. Ideally, the whole year can be mapped out to avoid scheduling patients when the provider has other commitments or when the clinic is closed. 2a) In a paper system, make an "X" through these time slots. This establishes the matrix. 2b) In a computerized practice management system, open the scheduling module and block the time slots patients are not to be scheduled by date and time. This identifies visually when patients cannot be scheduled for an appointment. 3) Indicate all vacations, holidays, and other clinic closures as soon as they are known. It may be helpful to indicate absences that might affect patient scheduling; for example, the vascular laboratory technician is gone April 20-23, so no Doppler procedures will be scheduled. This informs all staff members of absences from the facility and indicates when these members are not available to see patients. 4) Pay attention to detail, note all provider meetings, Hospital rounds, appointments, conferences, vacations, and other prescheduled provider commitments. If the provider has routine items, such as a Medical Society meeting that is always held on the first Thursday of the month at 7:00pm or daily hospital rounds at 8:00am, write these in. This informs all staff members of prescheduled commitments when a provider is unavailable to see patients. 5) If the clinic has a scheduling system for certain examinations or procedures (e.g., all cast removals are done in the morning before 10:30am), these can be color-coded with highlighters in a paper system. In a computerized practice management system, use the method specific to the software to assign either color, room assignment, or staff assignment for special procedures and equipment. By utilizing these methods, it is easily and quickly evident where particular types of appointments are available to be scheduled. This allows all staff members to see at a glance where certain examinations or procedures can be scheduled. The color-coded highlighting helps prevent errors in establishing such specific times for certain procedures. The complete matrix provides proof of the completed task.

What are the guidelines for making telephone appointments?

1) Gather all of your necessary equipment or supplies and make sure that they are in good working order before beginning any procedure. For this particular procedure, you will need to have a telephone and either a paper appointment scheduling system or computerized scheduling practice management system. 2) In a private and quiet location, answer the ringing telephone before the third ring. Identify the facility and yourself. This assures the patient calling that he or she has the correct number; sets the tone for the conversation. The private location ensures that others will not hear any information said during the telephone call. 3) As the patient begins to speak, make notes on your personal log sheet of the patient's name and reason for the call. This makes certain you are focusing on the call and will not have to ask the patient to repeat something you missed. 4) Apply active listening skills, determine whether the patient is new or established, the provider to be seen, and the reason for the appointment. This provides necessary information to determine when the patient should be seen and how much time will likely be necessary. 5) Discuss with the patient any special appointment needs, and search your appointment schedule (using appointment book or the appointment search feature in the computerized practice management system) for an available time. This tells the patient that his or her needs and the needs of the clinic are essential to this conversation. 5) Once that patient has agreed to an appropriate time, enter the patient's name in the schedule. 5a) In a paper system, enter last name first, followed by the first name, telephone number (home, work, or cell) and the chief complaint (reason for the visit) 5b) In a computerized practice management system, use the patient selection feature and select the patient to be scheduled. Select the date, time, and provider using the software, and enter the reason for visit where indicated. This provides necessary information for staff to pull a record or to make a chart; chief complaint helps identify the length of time to allot for the appointment. The telephone number provides immediate information without having to pull the chart should there be a need to change the appointment. 6) Repeat the date and time for the appointment, using the patient's name. Provide any necessary instructions about coming to the facility. This confirms the appointment date and time with the patient and gives information about how to get to the facility. 7) End the call politely, perhaps saying, "Thank you for calling. We will see you at 3:45pm Monday. Goodbye." 8) Make certain you transferred all necessary information from your telephone log to the appropriate appointment schedule. Draw a diagonal line through your notes on the log. This indicates you have completed the task.

What are the guidelines for checking-in patients?

1) Gather all your necessary equipment or supplies and make sure they are in good working order before beginning any procedure. For this particular procedure, you will need to have a patient chart, black ink pen, the required forms, a check-in list or appointment book, and a computerized scheduling practice management system 2) On the previous evening or before opening the ambulatory care setting, prepare a list of patients to be seen. 2a) In a paper system, either type the names of the patients and scheduled times with provider name and photocopy for each area of the clinic that requires it, or photocopy the page of the appointment book for references purposes. Charts for patients are then pulled and prepared for visits. 2b) In a computerized practice management system, create a schedule or reference sheet using the appointment scheduler. Each practice management system will have a feature for producing this sheet. Distribute the reference sheet to each area of the clinic that requires it. If charts are used in the clinic, they are pulled and prepared for visits. This provides a patient list to use as a guide through the day's schedule; charts are ready before patient arrival. If the task is left to the last minute, it may not get done. 3) Check charts or electronic patient records to see that everything is up to date, paying attention to detail. Gather necessary letters, test results, and other data that will be needed during the patient's visit. This ensures that providers and staff have all the necessary data before seeing a patient. 4) When patients arrive, acknowledge their presence. If you cannot assist them immediately, gesture toward a chair, thank them for waiting as soon as you are available. Patients feel welcomed, their time is valued, and their presence is noted. 5) Check in the patient and review vital information, such as address, telephone number, insurance, and reason for visit. Be certain to protect the patient's privacy by reviewing this information where doing so cannot be overheard by others. This ensures that you have the latest personal information regarding your patient; provides patients with the privacy and confidentiality to which they are entitled. 6) Use a pen to check off the patient's name from the reference sheet if one is used for the permanent record. If the computerized practice management system has a check-in feature, input the patient's arrival. This ensures that there is permanent record of the patient's arrival in the facility for an appointment. This also provides documentation for later referral if necessary. 7) Politely ask the patient to be seated and indicate the appropriate wait time, if any. This provides direction to the patient and indicates how long a wait might be 8) Following clinic policy, place the chart where it can be picked up to route the patient to the appropriate location for the visit. The patient's chart is in readiness when the clinical medical assistant, laboratory personnel, or provider is ready for the patient.

What are the guidelines for cancelling and rescheduling procedures?

1) Gather all your necessary equipment/supplies and make sure that they are in good working order before beginning any procedure. For this particular procedure, you will need to have an appointment sheet, a red ink pen, the patient's chart, and a computerized practice management system and/or electronic medical record (EMR). 2) Use the clinic system for marking changes, cancellations, and no-shows so that time that is now open for the other appointments is evident to the staff. 3) Indicate on the appointment sheet all appointments that were changed, canceled, or no-shows: 3a) Changes- In a paper system, note rescheduling in the appointment sheet margin and directly in the patient's chart; indicate new appointment time. In a computerized practice management system, use the appointment scheduler's feature to document changes to the patient's record. This notifies all staff of a schedule change as well as documents the same information in the patient's chart or electronic medical record (EMR). 3b) Cancellations- In a paper system, enter a note on both the appointment sheet and the patient's chart. Draw a single red line through canceled appointments. Date and initial cancellation in the patient chart. In a computerized practice management system, use the appointment scheduler's feature to cancel (and if applicable, reschedule) the appointment to document the cancellation in the patient's record. This notifies staff of a schedule change and documents cancellation in the patient's chart or electronic medical record (EMR), thus identifying a change in the patient's plans. A cancellation may initiate a follow-up call from a staff member to determine the reason for the cancellation. 3c) No-shows: In a paper system, enter a note on both the appointment sheet and the patient's chart. Date and initial notations in the chart. No-shows can be indicated with a red "X" on the appointment sheet. In a computerized practice management system, use the appointment scheduler's feature to indicate a no-show to document the missed appointment in the patient's electronic medical record (EMR). This notifies the staff of a schedule change and documents the no-show in the patient's chart or electronic medical record (EMR) as well as provides a reminder to a staff member to follow up on the reason for the no-show.

What are the legal issues associated with patient scheduling?

1) Information provided in any patient scheduling system may be used for legal purposes. A case of malpractice or questions regarding a provider's availability may require a copy of the daily schedule. It might become necessary to identify how many times a particular patient was a no-show or canceled an appointment, never calling to reschedule. The appointment schedule could verify that a patient was seen and treated on a particular day, thus affirming the information in the patient's record. A patient's sign-in sheet may serve this purpose, also. 2) All computerized systems provide a permanent record of patients seen, and any alterations to that schedule are saved and are shown when a printout is produced. If an appointment book is still used, the staff will have to make certain there is a permanent record or daily appointment sheet that indicates cancellations, work-ins, urgent care needs, and no-shows. Any changes to the daily appointment sheet are to be made in pen; therefore, there will be no question regarding accuracy. 3) Taking the time to accurately and consistently document all aspects of patient care makes a statement about the providers in the practice and their staff and reflects positively on the presumed quality of patient care

Why is it important for medical assistants to have good interpersonal skills when it comes to scheduling appointments? How can medical assistants develop good interpersonal skills when scheduling patient appointments?

1) Scheduling appointments requires interpersonal skills. Medical assistants convey a great deal to patients through attitude and actions as well as empathy. A hurried or disinterested manner communicates that the patient is not a priority. Because patients are often distraught or anxious when making appointments, it is extremely important to reduce rather than to increase anxiety. Also, the medical assistant who schedules appointments may be the first contact a patient has with the clinic; patients do not easily forget rude or insensitive staff. A hurried, disinterested manner towards patients is just as often the basis for legal action as is a negligent act 2) If any form of online scheduling is used, be certain that it is user friendly, has a rapid response time of no more than 24 hours, and provides patients an option if the online scheduling proves unsatisfactory for any reason. Make certain that staff are ready for online scheduling and that those responsible for assignments and backups are carefully prepared. It is important that patients not be made to feel inadequate if they choose not to use online scheduling 3) The patient should always be made to feel worthy of attention. This validates his or her reason for calling. If you are scheduling a patient in the clinic and the phone rings, answer the call but excuse yourself first. Ask the caller to please hold for a moment. If you are on the telephone scheduling a patient and another patient walks in, acknowledge with a nod or signal that you will be right there—never let the person feel ignored. Today, patients have a variety of options for healthcare and tend to be much more consumer conscious of the treatment they receive

What are the guidelines for reminding patients about their upcoming medical appointments?

1) When patients are reminded of their scheduled appointments, it results in a greater rate of fulfilled appointments. Give patients appointment card reminders when appointments are made at the medical facility. Those cards may easily be tucked in a wallet and forgotten, however. Many clinics notify patients the day before the appointment with a reminder via their choice for the communication—telephone, text message, or email. 2) Keep in mind that the reminder is confidential information and should not be left on a recording device without the patient's express permission to do so. (When initially seeing the patient, obtain a number where a personal message could be left.) Finally, reminders can be mailed. This would be most appropriate for patients who come in on a regular basis (ex: once every 6 months)

Why is it important for medical assistants to analyze patient flow? How can this be done?

1) When reviewing the current scheduling practice, a simple analysis can maximize a clinic's scheduling practices. This entails looking at appointment times, patient arrival times, the actual time a patient is seen, and the time a visit is completed. A simple grid chart can be produced for a given period, for example, 1 to 2 weeks. In addition, monitor and chart the number of no-shows and cancellations. An electronic scheduling system can automatically provide the detail necessary to analyze the effectiveness of patient scheduling. It has the capability of indicating the scheduled time for specific procedures, for each provider, and for each service given to the patient. 2) This analysis will provide a clear picture of patient flow and whether personnel are being used efficiently. The data will assist in estimating how many patients to schedule and realistic time frames for particular problems or procedures. If the staff is scheduling return patients every 15 minutes yet the analysis shows these visits average 24 minutes, then the scheduling method needs adjustment. This may mean either allowing more minutes for follow-up visits or building slack time when no appointments are made. 3) Develop a simple list of commonly scheduled visits with time estimates for each. This procedural sheet will be particularly useful when training new employees or when temporary help is used for scheduling. A list of commonly scheduled visit types with set duration times can also be set up when using an electronic scheduling system

What are the guidelines for using scheduling software and materials?

No matter what materials and which methods are used, the proper tools will enable patient scheduling to be a smoothly functioning, easily documented process. Materials needed for scheduling should be customized to the ambulatory care setting. For instance, a smaller practice may refer a manual method involving appointment books; a large urgent care-type setting will use a computer program for patient scheduling that may be part of a practice management (PM) software program. 1) Appointment schedule: An appropriate appointment schedule system is essential to any medical practice in the ambulatory care setting. Each clinic has unique needs in its physical facility and for its staff. The physical arrangement of the scheduler, including the various combinations of time allotments, must be determined. Some have major headings for hours with minor spaces for 15-minute intervals, others have 10-minute intervals, and still others have only hour intervals. An appointment sheet is necessary for both legal risk management and quality management purposes. Copies of the daily appointment sheet, also known as a reference sheet, are made available to doctors, medical assistants, and any other staff members. Using the daily appointment sheet, it is easy to check in patients as they arrive and to indicate no-shows and cancellations. Indicating the check-in and check-out times can be useful for quality management purposes. More importantly, the daily appointment sheet enables all staff members to see the total scheme of the day's patient flow. If a provider works between two clinics or a hospital and clinic, it is helpful to have this appointment schedule transferred to a handheld computer device for immediate referral. If a handheld device is not used by the provider, reduce the dimensions of the appointment schedule sheet to pocket size for the provider's easy access. Generally, if the provider makes hospital visits before coming to the clinic in the morning, this schedule is printed the previous evening before closing. These daily appointment sheets can also be used to include other provider commitments such as meetings and visits from pharmaceutical company representatives. Such a complete record of your ensures that no patient appointments will be booked when, in fact, the provider is not available. 2) Computer scheduling software: Even the smallest of medical facilities today will benefit from the use of information technology. Numerous software programs for the ambulatory care setting require only basic computer hardware that can save time for providers and their staff members. Other programs are more sophisticated and may require on-site technical support. Some scheduling software programs will schedule resources, equipment, examination rooms, and specialty staff, as well as patients and providers. Some will show copayments due, authorization expiration dates, and insurance expiration dates. They can select the next available appointment, search for appointments by provider, copy and paste appointments, and specify minimum time increments between appointments. The staff can view multiple schedules daily, weekly, monthly, or even yearly. Reminder notes can be created for both providers and patients. Computerized scheduling systems that are a component of a complete practice management facility, including medical records, are able to indicate no-shows and cancellations in the system and the patient's chart at the same time. Facilities that are partially computerized will still want to indicate patients who do not keep their appointments on the daily worksheet and in the patient's medical records. Online systems can handle prescription refill requests, patient-provider email messages, and laboratory results. Some will allow patients to update insurance data and complete registration forms. All of the online systems are done within the provider's website, which includes security measures and sophisticated encryption technology. Therefore, security is less of a concern. With America's ongoing goal of giving patients increased access to their electronic health record (EHR) and congress pushing to have prescriptions transferred electronically, electronic scheduling has become the "entry" to the entire field of computerized medical information. Employers in ambulatory care settings who make certain that patients understand computerized scheduling, who have put time and effort into determining the best program for their use, and who have trained their staff well will not be disappointed with the outcome. Whatever system is chosen, keep in mind that the patient's time, the staff's time, and the provider's time are extremely valuable. The goal is to manage that time as efficiently as possible.

How can medical assistants help patients deal with wait times?

One of patients' frequently voiced frustrations with medical clinics is excessive waiting time. Obviously, emergencies and other unexpected interruptions cannot be anticipated. However, there are certain measures the medical assistant can take when attempting to keep the schedule on target. If patients are kept waiting, it is a good strategy to explain the reason for the delay and give patients an estimate of how long the delay will be. Never ignore the delay hoping patients will not notice; doing so may even increase perceived waiting time. Find ways to make patients comfortable while they wait; for example, provide an appropriate choice of reading materials (or in case of children, activities). If a delay can be anticipated—for example, if the provider is called away for a baby delivery or surgery—attempt to contact patients before they leave home to reschedule the appointments. If the delay is likely to be a half hour or longer, provide patients with options, for example: 1) Offer patients the opportunity to run an errand, having them return at a specified time 2) Offer to reschedule appointments for another day, or later that day, or to see another provider in the practice if possible In any case, remember that good customer relations dictate your willingness to acknowledge the inconvenience to the patients, and do attempt to provide an acceptable solution. Remember also that some patients simply will not appreciate any efforts to apologize for a delay, in which case you must continue to act professionally toward them.

What are the guidelines for scheduling meetings with pharmaceutical and medical supply company representatives?

Some medical facilities schedule time with representatives of pharmaceutical and medical supply companies. On the other hand, there are some medical clinics that refuse to see any pharmaceutical representatives. When representatives are seen, however, they can provide a valuable service to providers and staff, and with clear guidelines regarding when and how often representatives can visit, a working partnership can develop. Providers may set aside a specific time during the week to meet with these representatives; generally, a time allotment of 15 to 20 minutes is sufficient for these appointments. Some representatives try to establish a standard appointment once a month. If this is a representative your provider desires to see on a regular basis, that policy can be helpful to both the provider and the representative.

What factor determines the best method for scheduling patient appointments? What should be the primary goals in determining the best method for scheduling patient appointments?

The patient population of each medical facility will determine the best method for scheduling appointments. A surgeon's clinic will have a much different flow of patients than a pediatrician's clinic. The key is to customize the system to best accommodate the practice. Primary goals in determining this should include: a) A smooth flow of patients with a minimal amount of waiting time b) Flexibility to accommodate acutely ill, STAT (or emergency) appointments, work-ins, cancellations, and no-shows Medical providers may feel uncomfortable if their days are not busy with patients or they experience idle time. It is also true that patients want access to their medical providers when needed and prefer not to wait several days to be seen. There is no one perfect scheduling style, and some facilities may even be unable to identify their style of scheduling by name. One thing is certain, however; patients, providers, and their staff will know when scheduling is not working successfully.

What are the guidelines for scheduling patient appointments?

Whether completed by manual methods or computer technology, the process of scheduling appointments for patients and other visitors to the clinic involves a number of variables, including (1) the urgency of the need for an appointment; (2) whether the patient is a referral from another provider; (3) recording methods for new and established patients; (4) implementation of check-in, cancellation, and rescheduling policies; (5) use of reminder systems; and (6) accommodating visits from medical supply and pharmaceutical company representatives. 1) Screening calls: Urgent calls will need to be screened or assessed, before they can be scheduled. Screening calls is defined as the person making the appointment determining the actual urgency of that call and how the patient can be best scheduled. This requires both communication skills and medical knowledge, especially details specific to the clinic itself according to the practice speciality. Appropriate questions will be asked to determine the actual urgency. Is the patient in immediate need of medical assistance? Is there any bleeding? If so, where? How profuse is the bleeding? Are there any chest pains? How intense is the pain? Is the pain localized? How long have the symptoms been present? The medical assistant needs to determine whether this is a life-threatening matter, or whether the problem is urgent in the patient's eyes but not a medical emergency. Precise information will help to determine the critical or no critical nature of the call. In screening the patient's urgency of care, be tactful in questioning and avoid making the patient feel that the need is insignificant. If questioning indicates this is a medical emergency, follow the policy for having the patient seen (whether it be an emergency appointment or referral to the emergency department). If referral to the emergency department or a call to 911 is necessary, make the call for the patient, being certain you have the correct address and telephone number available. Such a referral minimizes disruption to patients being seen in the ambulatory care setting. If it is determined that the best method in handling this emergency is to see the patient in the clinic, let scheduled patients know of the emergency and offer them the opportunity of rescheduling or waiting until the emergency has been resolved. A built-in slack time of 30 minutes in the morning and 30 minutes in the afternoon can provide some flexibility in the last-minute emergency scheduling. If it is determined that the situation is not an emergency, work the patient into the schedule as the situation warrants and time allows, and make certain the patient is comfortable with the scheduled time. Be sure to leave the patient with the understanding that you have done your best to address the situation. 2) Referral appointments: One of the primary sources of patients for any provider is referrals from other providers. This is especially true in a managed care climate, where patients usually must have a referral from their primary care provider and where providers are part of an HMO network. It is important that these appointments be given special consideration and that referred patients are given an appointment as soon as possible. Adequate information needs to be obtained to determine the urgency of scheduling. If the referring provider or clinic staff calls directly, the situation can be assessed at that time. However, if the referred patient calls, it is best to obtain necessary records and information from the referring provider's clinic to determine the urgency and appropriateness of an appointment. Often, the referring provider's clinic has initiated a referral authorization from the patient's insurance and this is forwarded to the appropriate provider. The patient also receives a notification that the referral was approved, and to which doctor. The notification may be sent to the patient by regular mail, a patient portal system, or other secure method. If the patient does not know if a referral authorization has been obtained, or the authorization has not been received, it may be necessary to direct the patient to ask the referring provider for authorization. In some cases, the medical assistant will need to call the referring provider's clinic to obtain more information before an appointment is scheduled. Assure the patient that an appointment will be scheduled upon receipt of the authorization, and then follow up as required. 3) Recording Information: Patients can be sensitive to the amount of information they are required to provide to make an initial appointment. Keep the information as simple as possible and obtain only essential information. It should be tailored to fit the practice; for example, an obstetrician and a pediatrician will have different questions for the first-time patient. When patients schedule an appointment online via the clinic's website, they are directed to a patient preregistration and health history that can be completed online prior to coming to the facility. The information provided in this format is often more detailed than what is obtained over the telephone. Nevertheless, the following basic items should be obtained from a new patient: 3a) The patient's full legal name (with the correct spelling) 3b) A daytime telephone number 3c) The reason for the visit 3d) The referring provider, and when relevant, if a referral authorization has been obtained 3e) Date of birth 3f) Type of insurance 3g) Insurance identification and group numbers In privacy, repeat this information back to the patient to ensure accuracy. The critical determination is whether the information is essential to the first contact or whether it can no brained at the time of the visit. An established patient, someone who has already been seen in the clinic, should be required to provide only the following information: 3a) Full legal name 3b) Chief complaint or reason for the visit 3c) A daytime telephone number 3d) If the patient has not been to the office in more than six months, or if it's the first quarter of the year, confirm whether address or insurance information have changed and update where needed. When the information is needed, print legibly and accurately if using a manual system and key in the information if using a computer system. Check for accuracy in either system. Record the appointment as soon as it is made—never rely on memory. When scheduling an appointment time, ask the patient what day and time is most convenient and then make the appointment for the first available time stated. If possible, provide the patient with a choice of appointment times. Finally, confirm that the patient clearly understands the date and time of the appointment; be sure to repeat the date and time to ensure that both of you have recorded the same information. If the patient is making the appointment in person, provide an appointment reminder. Scheduling an appointment for the clinic's available times for anyone with an extremely busy schedule can require a great deal of patience. If the patient requests a particular appointment that is not possible, courteously offer an explanation. Many ambulatory care settings, especially those specializing in family practice and pediatrics, provide alternative hours for scheduling appointments. Having evening appointments at least one day a week or Saturday morning appointments can be helpful for individuals whose work schedule does not permit weekday appointments 4) Appointment matrix: Before appointments can be scheduled, the times a provider is not available will need to be blocked out. This is called establishing the matrix. The matrix provides a current and accurate record of appointment times available for scheduling patient visits. Clinic hours are noted with times blocked when the facility is closed. Provider's schedules, vacations, holidays, hospital rounds, and any responsibilities that make providers unavailable for appointments are recorded. The matrix of the scheduling plan might include slots for patients who need to see only staff members for their appointment; therefore, times when they are unavailable are important for the matrix. Any evening or weekend appointment slots available also are noted. Typically, when using an electronic system for scheduling, the program will search through a database of appointments, find an open appointment, and allocate an appointment time according to your instructions. These instructions can include finding an open appointment with a specific time length, on a specific day, or within a specified time frame. Once the appointment time is confirmed with the patient, patient data are keyed in, and the appointment is automatically scheduled. 5) Telephone appointments: More appointments are made by telephone than by any other method. Remember the guidelines for appointment scheduling and appropriate screening of all calls to determine urgency and need, and to follow your provider-employer's instructions regarding patient referrals for appointments. 6) Patient check-in: Records of patient appointments serve a legal purpose. Establishing a procedure for checking in appointments simplifies tracking the arrival of patients. This is particularly true in multi provider settings where patients are attended by a number of staff before, or instead of, seeing the primary care provider. As mentioned earlier, more than one method can be used to check in patients. A sign-in sheet might be used, especially in a facility with open hours scheduling. The administrative medical assistant can place a check mark (usually in red) by the patient's name in the appointment book or make an indication electronically in scheduling software. The check-in procedure serves the additional purpose of alerting the staff when a patient has arrived and is available to be seen. Communication among the administrative medical assistants and the clinical medical assistants is important for a smooth patient flow and to save time for both patients and providers. Computer scheduling systems include a space to indicate when a patient arrives for an appointment. Some clinics use the printed activity schedule to check when patients arrive. Other clinics rely upon a copy of the day's schedule and the patient's chart indicating a consultation or visit to legally verify the patient's presence in the clinic. Unfortunately, even the best of electronic systems may fail temporarily. In that case, the manual system is used as a backup. If the day's schedule has already been printed, it can be used to monitor the patient flow and to check in patients. It may also serve as adequate information for any work-in patients to be accommodated that day. However, for appointments to be made in the future, the administrative medical assistant may have to return a call to the patient when the computer is back up and running properly.