Medical Assisting - Chapter 9 Appointment Scheduling

Responding to Urgent and Emergency Situations

Physician should always be informed immediately regarding a potential emergency

Appointment matrix

a grid that shows the availability of each physician, as well as periods of time that are not available for appointments* •Formed in advance for three to six months •Identify the patient and the need -Ask open-ended questions that require more than a yes or no answer

Scheduling systems

a tool used to keep track of appointments*

A scheduling system:

facilitates the coordination of appropriate time segments for staff, patients, and the practice's available equipment

Specified time scheduling

format in which each patient given a specific time slot •Benefit: helps prevents a large backlog of waiting patients or a long cycle time •Drawback: some patients may not provide enough information about their medical problems to schedule an appropriate appointment length

Acute conditions

illnesses or injuries that occur suddenly and require treatment but may or may not be life threatening*

Patient scheduling

is similar in both electronic and manual systems

patient status

new or established* •helps determine the appropriate length of appointment •Definitions are established by American Medical Association (AMA) -Definitions are consistent with those required by Current Procedural Terminology (CPT®) codes used for billing

Overbooking

scheduling more than one patient in a time slot*

Triage

sorting or grouping patients according to seriousness of their condition -Inform physician immediately of any patient calling or presenting with an emergency condition -Document phone calls regarding emergency conditions in the patient's medical record*

cycle time

the length of time the average patient spends in the medical office*

office hours

the time span each day that a medical office is open for business

Manual systems

use hard-copy schedule book and a pencil or pen •In accordance with HIPAA compliance, the appointment book and schedule must protect patient privacy at all times •Advantages -Inexpensive -Easy to use •Disadvantages -Can become messy and illegible from frequent changes -Difficulty accessing data and statistics -Can be used by only one person in one location at a time

Future Appointments

•Advance booking -Before leaving office, patient will schedule next appointment -Done for regularly scheduled checkups or required follow-up appointment -Date and time of next appointment can be written on an appointment card

Rescheduled appointment

-Appointment for which patient calls before scheduled time and changes it to another day and time •Verify patient's name; confirm date, time, and purpose of original appointment •Determine how soon appointment must be rescheduled, then follow normal procedures for scheduling an appointment •Confirm both date that was cancelled and new, rescheduled date and time

Patient cancellations

-Appointment for which patient calls office to say he or she cannot make appointment time and does not schedule another appointment •Always ask if patient wants to reschedule •Document the cancellation in patient chart •Physician notified of any cancellations that could endanger patient's health •Computerized system -Select appropriate menu item or check-off box to indicate the cancellation •Manual system Write cancellation (CX) on appointment schedule sheet

No-show

-Appointment for which patient does not attend appointment and does not call to reschedule or cancel •Also called failed or missed appointments; when patient does not show up to keep appointment •Computerized system -Select correct menu item or check-off box to indicate no-show or cancellation •Manual system -Write no-show (NS) or cancellation (CX) •Some medical practices charge patients for no-show appointments

Follow-up

-Automated or manual tickler systems to send patients reminder notices about their next appointment -Follow-up reminders provided in writing, by telephone, or by secure e-mail or messaging -Maintains good customer service -Essential to comply with HIPAA privacy standards when sending reminder postcards or leaving appointment reminder messages

Rescheduling appointments: Computerized system

-Pull up original appointment, and enter new date and time -System will make change and notate the rescheduled status -Keep track of patients who frequently reschedule

Rescheduling appointment: Manual system

-Use a single line to cross out the patient information in the original time slot and enter it in the new time slot -Add a note next to the original entry that it was rescheduled and the date to document that it is a rescheduled appointment -Document the rescheduled appointment in the patient's chart

The appointment book is a legal document and it:

-Verifies services provided Insurance companies: appropriate billing Internal Revenue Service (IRS): physician revenue -Verifies patient cancellations and changes Protects physician against charges of abandonment*

Established patient

One who has previously seen the physician within the past three years* •Has existing medical record accessed each time patient contacts physician for an appointment •Good customer service includes appointment reminders and observing patient cycle time

scheduling by grouping procedures

Patients requiring the same type of examination or procedure are scheduled during a particular block of time

Maintaining the schedule

Schedule changes and updates are a daily occurrence in medical offices

Computerized Systems

These systems help to maximize workflow and ensure scheduling policies followed •Advantages -Ability to access and view patient appointments with click or touch of button -Ability to track regular patterns within medical practice

Computerized scheduling systems

•Advantages -Allow patients to schedule their own appointments online -Provide option for patients to request appointment via secure e-mail or inquiry system •Disadvantages -Cost of equipment and staff training -Potential for electronic security breeches -Cost of power -Potential for failure because of power outage or computer system breakdown

Wave scheduling

•All patients told to come in at beginning of the hour in which they are to be seen •Patients seen in order in which they arrive •Each hour divided into equal segments of time depending on how many patients can be seen within an hour •Goal: to begin and end each hour on time •Benefit: balances out patient lateness •Drawback: many patients arrive at the same time, so some will have to wait longer

Scheduling Outpatient Surgery and Outpatient Procedures

•Based on patient's need and diagnosis, type of procedure, insurance carrier, physician, anesthesia requirements, facility availability •Medical assistant contacts surgery scheduling department and makes arrangements with surgery scheduler •Surgery scheduler may request all patient information, including legal name, telephone contacts, insurance information, advance directives, or other pre-admittance information

Modified wave scheduling

•Built on the hour as the base of each block of time •Many variations of this type of scheduling -Example: Schedule patients to arrive every 10-15 minutes during the first half of the hour rather than all at the beginning of the hour •Goal: smooths patient flow for busy offices with many appointments of similar length •Benefit: patients not kept waiting as long as they may be under wave scheduling method •Drawback: patients with complicated times might need to scheduled during separate time periods

Scheduling inpatient admissions

•Contact patient's insurance company for preadmissions approval •Provide patient with detailed explanation of day, date, time, and preparation needed for the admission •Always better to place details in writing •Medical assistant should provide complete, concise, verbal explanations of important points

Communication Skills for Scheduling

•Determine if you are speaking directly with the patient or to a third party •Use patient's name while addressing him or her on the telephone and in e-mail •On the telephone, confirm appointment by asking patient to repeat day, date, time, and location of appointment •E-mailed appointment requests should be initiated by the patient, not the office •Communicate with patient the desire to meet requested appointment time •Be specific and inform patient of office policies for cancellations and missed appointments •Gather all pertinent information from patient •Always be aware of HIPAA regulations, and take every measure possible to protect patient's identity and verify that the individual the caller claims to be is indeed the patient

Cancellation policies

•Important to make patients aware of cancellation policies •Careful, legible documentation of missed appointments necessary in order to legally protect physician from a claim of patient abandonment

Open hours scheduling

•Least structured of all the systems •Patients may arrive at any time during those hours and are generally seen in order of their arrival •Commonly used in urgent care clinics •Benefit: schedule is not disrupted by late or missing patients •Drawback: longer cycle time if too many patients arrive at once; can lead to irregular workload throughout day

Arranging outside appointments

•MAs facilitate appointments at other facilities -Testing or treatment -Inpatient admission: overnight hospital -Outpatient procedure: patient goes in for the procedure then returns home

New patient

•More than three years since patient saw a physician of the same specialty and subspecialty within the practice;* or •If patient has never been seen by a physician in the practice*

Patient scheduling process

•Offer appointment time -Provide patient with two or three options -Establish appointment time per office policy Option 1: The time patient needs to arrive to complete check-in process Option 2: The time the patient will be taken back to the exam room. Instruct patient on desired arrival time to check in. •Confirm appointment details -Date, time, and arrival time

Double booking scheduling

•Practice of scheduling two patients to be seen during the same time slot without allowing for any additional time in the schedule •Considered to be an ineffective but sometimes unavoidable method •Using a modified form of wave scheduling eliminates this problem

Patient referral appointments

•Schedule _______________________________ as soon as possible* •Exchange pertinent information regarding patient's name, contact number, insurance, referral needs, referral physician's name, address, contact number •Depending on the insurance, precertification may be necessary before scheduling appointment

Scheduling Non-Patient Appointments

•They should never take priority over patient appointments* •These appointments may be for sales representatives from various organizations or community service leaders

Time patterns

•similar to matrixing off time within the schedule to allow for catch-up time or unscheduled appointments* •Open time often scheduled at end of the morning and at the end of the day