chap 7 appointments

long waiting times

"Waiting times of 30 minutes or longer sharply reduced the likelihood that men would visit a doctor again."

choosing an appointment book

(1)size, (2)available desktop area, (3)style requirements (taking into consideration how far in advance the appointments are to be made), (4)number of physicians in the group, and (5)medical specialty.

unexpected patients or interruptions

allow 15-30free periods during the day to fix a delayed schedule, perhaps just before the lunch hour and in midafternoon. It is also wise to schedule lightly during the first hour of the day, leaving heavier scheduling, if necessary, for hours later in the afternoon.

specialty and consulting

also use this technique because it allows the physician time to prepare for each office visit with the knowledge that the day will begin and end on schedule if patients adhere to their assigned times. The disadvantage is that there can be little deviation from the schedule for late arrivals, emergencies, walk-ins, or patients who need more or less time than scheduled. *stream schedule

contacting patients about delays

if there is a 20 min delay in the schedule patient will try and be contacted

a check mark

is a patient worked into the schedule

physicians wishes

to be reminded of personal or professional appointments and to have regularly occurring events scheduled in the appointment calendar, time for all these should be blocked off. If the physician wants personal reminders kept off the appointment calendar but wants to be reminded of such things as outside appointments and scheduled meetings, these may be noted on a monthly desk calendar. Calendars with large squares provide room for physician and office staff reminder notations.

first time patients

usually assigned 45- to 60-minute appointments

internet appointments

As more people use the Internet on a daily basis and more medical practices use Web-based software, more offices are communicating with patients online. Cloud-based software now includes electronic health record (EHR) management as well as electronic claims processing, e-prescribing, customized reporting, collection management, storing documents, and scheduling appointments. Patients can access the schedule via their cell phone and like the convenience of making their own appointments.

appointment software can record

a patient's appointment on the computer's scheduling calendar, in the patient's electronic medical record (EMR), and in an electronic tickler file, so the medical assistant can send a reminder notice or telephone the patient before the appointment. If a patient calls to find out when the appointment is scheduled, the system can search by name or account number to find the time and date. From the electronic appointment schedule, a daily list of appointments can be printed for each physician

schedule tracking

a period of 6 to 12 weeks can help determine these factors and aid in the choice of a scheduling system

computer program can manage

all appointments, free times, days off, and search for available openings in the schedule. For instance, if a patient can come in only on Thursdays at 2:00 p.m., you can insert that criteria and search for the next available time that meets the patient's needs. Such systems can also be used to coordinate and schedule specific treatment rooms and equipment.

importance of writing all appts down

annot be overemphasized; the physician's presence in the office is often determined solely by the appointments scheduled. If an appointment is made and the assistant fails to record it, embarrassing problems can result. If possible, schedule appointments one after the other to prevent gaps in the physician's time while awaiting the next patient. When a patient is to have a series of office visits, try to schedule them at the same time and day of the week to help establish them in the patient's mind.

paper based cancel

if a patient cancels an appointment and does not set up an alternative time, the name should be listed on a cancelation sheet for tracking purposes or remain on the appointment page with a line drawn through it and a notation in the margin to indicate a cancelation was requested by the patient. At the end of the day, the date, time, and reason for the cancelation or missed appointment are then written in the patient's medical record. If the physician thinks the missed appointment will jeopardize the patient's physical condition, the assistant or physician should telephone the patient to suggest making another appointment.

unscheduled patient

in order for an appointment determination to be made, it is advisable to obtain the most precise assessment of the patient's medical problem and ask the physician whether you should work the patient into the day's schedule, send the patient to the emergency room, or make an appointment for another day

patient flow techniques

is to stay on schedule because if the appointment system fails, he or she must deal with irate patients and frustrated physicians. The choice of scheduling methods depends on the size and specialty of the practice, the number of physicians in the practice, and the doctors' preferences, so consider these factors and the goal of maintaining smooth patient flow with a minimum of waiting time as you evaluate the following scheduling systems.

Managing appointments

midday: older adults late afternoon: people who work during the day toddlers: morning school kids: after school or during lunch new patients: early patients who need bloodwork while fasting: early

electronic scheduling system

offer the availability to have patient portals in various locations where patients can schedule their own appointments and quickly fill out forms using templates. Medical applications (apps) are also becoming available for mobile devices such as smartphones and tablets that can be used to make appointments, complete questionnaires, access medical records, and allow providers to securely message patients

group practice appt book

one medical assistant may schedule all the physicians' appointments on a large, multiple-column sheet, often color-coded with a different color for each day of the week and with a physician's name heading each column (Figure 7-4). If standardized columns contain too much or too little space devoted to particular items, self-designed, custom-made appointment sheets may be printed for a three-ring binder at reasonable cost.

no show patients

or example, the patient who misses a first appointment might be called at the end of the day to suggest rescheduling the visit; after a second missed appointment, an immediate call might be made to find out the reason and to remind the patient that a third no-show would result in dismissal by the physician; after a third appointment is missed, a certified letter should be sent to release the patient. Each time an appointment is missed, the assistant should note the occurrence in the patient's medical record along with the action taken, as further explained in Chapter 9. No-shows may also be highlighted on the appointment sheet, indicated by NS or N/S with a colored pen, or noted in a computer system.

hospital

physician may visit the ICU or new babies. they take their phone. hospital tracking form.

brief form

reasons why they need an appt

affordable act care

requires all insurance policies to cover a broad range of benefits including preventive medicine services such as screening for breast and colon cancer, cholesterol, depression, diabetes, and substance abuse. Appointment time slots for such services need to be determined and made available for patients.

computer program

same thing as software

follow up exams

scheduled every 10 to 15 to 20 mins

5 goals for scheduling an appt

Filling all available time slots Reducing appointment handling, that is rescheduling Decreasing no-show rates Enhancing providers' schedule and flexibility Increasing patient satisfaction

matrix

Template indicating times to establish an appointment schedule including times allocated for new patients, established patients, brief visits, in-office surgery, specific conditions, and times blocked off when the physician is out of the office

Hostpitalist

A trend that has evolved to reduce hospital costs and shorten hospital stays is the hospitalist. These physicians take over when a patient is admitted to the hospital and provide inpatient care in place of primary care physicians (PCPs). They oversee tests and results, monitor changes in the patient's condition, consult with families, and discharge patients back to their regular doctor.

Five things to consider regarding patients satisfaction include the patient's:

Ability to get an appointment when needed Convenience regarding the appointment time Being seen by their own provider Respectful treatment by office personnel Receiving regular reminder notices, as appropriate

Clustering

Act of scheduling patients with similar ailments in group sequence.Physicians have determined that this system speeds up each case

long time consuming patients

Do not schedule long or time-consuming patients in the last appointment hour of the day, and speak to the physician about when he or she wants a talkative patient to be brought in. Offering patients a brief form (Figure 7-7) may help talkative patients to curtail their discussion and focus on the reason for the visit; it also helps prompt forgetful patients

Double booking

Double booking is a scheduling technique that allows two or more patients to have an appointment for a particular time, depending on the proper combination of patient complaints; for example, checking a strep throat and changing a dressing take a brief time. This system is used to work in emergencies and book in an already full schedule but involves risking the goodwill of patients if they must always wait to see the doctor.

house call vista

Fewer house calls are made today because most physicians do not have the time. However, they do occur on occasion especially in oncology and internal medicine. A portable device, similar to those used for hospital visits, or a list is prepared in advance indicating each patient's name, address, and telephone number (home, work, cell). As the physician makes each call, he or she records the pertinent information about the visit. It is the medical assistant's responsibility to record financial charges for each visit to individual patient accounts in the computer system or on the patient's ledger card and daysheet.

release of medical information

Generally, it is not necessary to obtain a signed authorization for release of medical information from a patient who is being referred to another physician for the same condition. If the patient agrees to the referral, continuity of care applies and medical records regarding that specific condition may be forwarded.

pre op and post op

The medical assistant usually sets up the preoperative appointment the week of surgery and makes appointments for laboratory tests and x-rays. He or she should exercise careful judgment in scheduling a sick person for numerous tests in sequence because too many appointments in one day may be tiring. The assistant must also have knowledge of the patient's insurance requirements that dictate in-network facilities and may require preauthorization. The postoperative appointment is typically scheduled at the time surgery arrangements are made. The time interval after surgery would be specified by the surgeon and would depend on the type of procedure

software

Computer instructions permanently stored in or temporarily programmed into hardware

appointment book

Segment of time set aside in the appointment schedule for a specific patient type or procedure

modified open access schedule

A modified open access schedule is a patient-centered model which focuses on established patients who support the practice—therefore, there is a limit on new patient bookings. An "open access" time limit is set, usually around 11:00 a.m. so that established patients can have priority access up until that time and are encouraged to make same-day appointments. After 11:00 a.m., the remaining two-thirds of the day is left open and new and established patients are scheduled giving each equal access. The time can be adjusted to provide for trends in the practice and patient care demands. Established patients cannot schedule beyond 7 days and at no point are new patients offered appointments beyond that day. As the schedule opens up, however, callbacks are often made to accommodate new patients.

Template

A preset format or pattern, used as a guide which designates various time frames for specific appointment types.

accurate appointment book

An accurate appointment book serves as a permanent record of all appointments and can be used for documentation in medicolegal cases. Omission of information about a canceled appointment can have serious legal consequences

modified wave

Another example of modified wave is to schedule more than one patient at specific intervals throughout the hour, but the same number is seen during each hour. So if five patients can be seen in 1 hour, two are scheduled at the hour, two at 20 minutes past the hour, and one 20 minutes prior to the next hour. With staggered appointments, the patients do not have to wait unreasonable lengths of time.

electronic mobile device security

Any electronic mobile device used for business should have access controls and employ encryption. Passwords must be used on all mobile devices containing protected health information and should be different from other office computer network passwords, be a minimum of six characters, and incorporate letters and numbers. A mobile device should never be left unattended. Electronic mobile devices, whether employee- or physician-owned, may be subject to audits like any other office electronic device depending on their usage for the medical practice.

open access

Appointment scheduling system that allows patients to call and come in the same day; also referred to as same-day scheduling, same-day access, and advanced access.In order to make this system work, the backlog of current patients must be cleared. After the schedule is freed, open access will lead to a regular flow of patients and visitors who simply call and come in the same day. Many practices, including large clinics such as the Mayo Clinic in Rochester, Minnesota, have adopted open access scheduling.

appointment reference sheet

At the end of the previous day or before the first patients arrive each day, the medical assistant prepares a schedule of patients to be seen by the physician. It can be either a computer printout, a photocopy of the daily appointment sheet, or a typed list of names, times, and procedures

referral appointments

Because physicians depend upon patient referrals from other doctors, it is important that these patients be given appointments as soon as possible. If the referring physician calls the doctor directly, the appointment requirements may be assessed at that time.Depending on the specialty, it may be appropriate to allow a block of time for referral appointments, which often require priority. In the managed care setting, primary care physicians refer patients to specialists when necessary.

automated appointment reminder system

Computer-generated system that retrieves appointment data from the computer's scheduling system and supports integrated phone, email, text, and mobile app messaging. if no answer can call the patient up to 5 times

convalescent hospital visits

Convalescent hospital or nursing home calls are made on a monthly basis and more frequently if a patient becomes unstable. With the input of the physician, blocks of time are set aside for these outside calls, usually after hospital rounds in the morning or after office hours before the physician returns home at the end of the day. Tracking systems similar to those described for hospital visits may be used to record convalescent hospital visits

confirming appts

Dental offices usually confirm all appointments because many are made months in advance; medical facilities typically confirm only new patient, longer appointments, or appointments for in-office procedures. Early morning or late afternoon is usually the best time to reach people at home to remind them of their appointments. Many daytime confirmation calls get "no-answers"; therefore, it might be worth having an assistant make calls in the early evening hours. A flex schedule could accommodate this need. Even if it requires extra pay for the work, the expense will be more than made up if only one long appointment is saved.

do nots wen scheduling

Do not schedule according to the number of rooms available; instead schedule according to the number of health care practitioners who can see patients.

Triage

If the medical assistant is working overtime because of problems in scheduling or because many of the emergency appointments turn out to be false alarms, consideration might be given to more creative appointment scheduling and screening procedures

tele appointments

In some rural areas after the initial appointment, telephone appointments (tele-appointments) can be arranged in a medical practice if no formal office visit is required. Patients are given designated times when they may call and talk to the physician. The physician must document the information in each patient's medical record. A nominal charge may be made for this service and billed to the insurance company using appropriate Current Procedural Terminology (CPT) codes. Refer to Chapter 2 for telemedicine services.

template for scheduling appointments

Indicate each doctor's preferred time frames Cut down on decision making Allow faster access for new patients Provide for urgent and emergent situations Decrease patient waiting times

New Patient

Individual who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.Although the new patient may have been seen before by the physician and a history may be on file, if more than 3 years have passed, the physician will need a longer appointment to review the patient's history and get up to date on the patient's current problems.

established patient

Individual who has received professional health care services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years

appointment schedule

List designating chronological fixed times for patients to meet with the physician and/or receive medical services

which includes a few ways to improve scheduling and avoid an audit:

Make sure the telephone receptionist knows how much time to allow for appointments based upon the physician's determinations and guidelines. Block off several urgent and emergent slots during the day. Notify the supervisor immediately when an urgent appointment cannot be given to an established patient on the same day. Note the time each patient is actually seen using 15 minutes as the maximum waiting time; after a 2-week check, if the waiting time is longer, bring scheduling into line with back-office reality. Notify patients if the physician is running 20 minutes or more behind schedule and offer the option to reschedule or continue to wait. Utilize physician extenders to provide routine care. This gives waiting patients another immediate option. Limit primary care office visits to the national average of six per hour, until it has been determined whether the work pace should be increased or decreased

managed care appointments

One of the important factors managed care organizations (MCOs) use as a measure of the provider's quality of care is how well appointment scheduling is organized and facilitated. This requires maximum cooperation between the front and back office staff. Services must be scheduled correctly according to a specified time frame so that quality of care will not suffer. Poor appointment scheduling may provide an excuse for an MCO to closely monitor a practice's patient relations and medical outcomes. This in turn may lead to increased paperwork, reduced reimbursements, or being dropped from the MCO's network of physicians at the end of the contract period

open hours

Open hours allows patients to walk in anytime within a specified time frame; they sign in with the receptionist and are seen in order of their arrival. Medical laboratories and x-ray facilities often use this scheduling procedure.

no show

Patient who does not keep a scheduled appointment and does not notify the office to cancel

Emergency situations

Refer the patient to a hospital emergency facility. Suggest the patient come to the office immediately. Schedule the patient for one of the appointment periods left open for urgent or emergent problems. Work the patient into the schedule and flag the appointment with a colored pen or notation in the computer.

fixed interval

See stream schedule: System of advance appointment scheduling in which patients are allocated specific periods of time for office visits and procedures; also called fixed interval

appointment and patient care abbreviations

Shortened words or coded numbers indicating types of appointments, types of patients, types of insurance, and reasons for appointments

single book

Single booking or time-specific is a scheduling technique used when an appointment may take a great amount of time. Specialty and consulting practices such as psychiatry and physical or occupational therapy use this method because patients are seen for consultations, counseling, patient education, or types of therapy. Appointments may be for 45 to 50 minutes of each hour.

appointment card

Small card preprinted with the physician's name, address, and telephone number showing the day, date, and time of an appointment; given to the patient to serve as a reminder

stream

System of advance appointment scheduling in which patients are allocated specific periods of time for office visits and procedures; also called fixed interval

true wave scheduling

System of appointment scheduling that allows for variables and flexibility and assumes the time allowed for appointments will average out each hour. schedules patients on the hour and takes the ones that arrive first. so they take them in order.

Modified wave scheduling

System used to schedule appointments in which patients are allocated appointment times in the first half of each hour, with the second half of each hour left open for work-ins and emergencies. developed as a compromise to minimize patient waiting and to maximize use of physicians' office hours to keep the patient flow smooth. The number of patients seen is affected by the number of examination rooms available. This system works best if there is no overscheduling and if it is used consistently by both the physician and the staff.

inform patients about surgery

The physician and the medical assistant often share the responsibilities of informing the patient about a surgical procedure including what to expect before, during, and after surgery. The physician usually explains the details about the procedure, why it is needed, how it will correct the problem, how long it will take, and so forth. The medical assistant may be the one asking the patient to sign the surgical consent form, explaining when to go for preoperative testing, directing the patient to the hospital admissions office, explaining postoperative care (dietary restrictions or activity levels), and advising when a postoperative appointment should be made. The medical assistant witnesses the correct signature on the form and is not actually witnessing the consent. This is an important issue in the event the patient claims he or she did not understand or was not fully informed when verifying consent for a procedure. Special care should be taken to show awareness of the patient's concerns, answer all questions, and provide a telephone number should additional questions arise.

diagnostic testing and therapy appts

The type of medical specialty will determine the type of diagnostic tests that are typically scheduled. Some examples are laboratory tests (blood chemistry, microbiology, pathology, cultures), radiology (x-ray, MRI, CT), physiology (ECG, treadmill, echocardiogram), and nuclear medicine (bone scan, IVP, thyroid uptake). Examples of therapeutic appointments include physical therapy, occupational therapy, speech therapy, and nutritional counseling.Logo of "Electronic Health Record" shows an open folder icon with white and red circles enclosing it. Laboratory tests and diagnostic images can be ordered electronically and test results sent directly to the health care provider's office; some EHRs link results directly to patients' EMR. Electronic prompts can be setup to remind health care providers of a test or procedure that is due. Procedure 7-7 gives step-by-step directions for scheduling outpatient diagnostic tests

follow-up appointment

Usually a patient's need for a follow-up appointment will be decided by the physician and the patient at the close of a visit. If the patient is to return, the appointment should be made at the reception desk, with the date and time made mutually clear. While the patient is determining the best time for the appointment, the assistant can guide him or her to a convenient time slot to hasten the decision.

Habitually late patients

When a patient is habitually late for appointments, schedule him or her either 15 minutes before the real appointment time or at the end of the day. This can prevent the patient's tardiness from disrupting the day's schedule. A coded notation could be written on the patient record as a reminder if the problem continues.

cancelled appointments

When using an electronic scheduling system, enter the Appointment Schedule, select the physician's calendar and date, and then clink on the time slot where the patient is scheduled. Depending on the software, you can either double-click on the time slot you want canceled or click "cancel." Scheduling software programs usually track canceled appointments so that another record is not necessary.