AMA Review 1

Define Cluster Booking

Cluster or categorization booking is when you book different times of the day for specific kinds of patients. For example, an internal medicine practice may reserve all morning appointments for physical examinations and the afternoon for sick patients.

Arranging Diagnostic Testing and Procedures

-Written order -Referral if needed -Preauthorization, if needed -Notifies insurance that patient needs procedures -Insurance determines necessity -Confirms validity of benefits -Patient availability -Provider availability

Confirming Diagnostic Testing and Procedures

AMA need to confirm that the diagnostic facility participates with the patient's insurance company. Then, call the facility and schedule the patient's procedure or test. Remember to follow these steps. Order the test. Provide the patient's diagnosis and orders. Establish the date and time for the procedure. Give the patient's name, age, address, and telephone number. Provide the patient's demographic information. Give the patient's name, age, address, and telephone number. Provide the patient's demographic information, including identification and insurance policy numbers, plus addresses for filing claims. Determine any special instructions for the patient or special anesthesia requirements. Notify the facility of any urgency for test results.

Strategies for Preventing and Documenting No Shows

Automated Calling Appointment Cards Confirmation Calls Email Reminders Mailed Reminders

Define Double Booking

Double-booking is when two patients come in at the same time to see the same provider. This is not a good form of scheduling. But you can use it if both appointments will only be 5 minutes long, and a 15- minute interval is set for both patients. But if both patients require 15 minutes, you need to set a 30- minute interval. If two patients come to the office at the same time but aren't going to see the same practitioner, this isn't a double-booking.

Policies for No-Shows

First, call the patient to discuss the problem. If you need to address the patient's medical situation, write a letter outlining the medical problem. Send the letter by certified mail with return receipt request. Make sure to keep the letter in the patient's medical record for legal purposes. The Policies for No-Shows is very important for a medical practice to have policies for no-shows in the office manual. Many practices follow these guidelines. For the first no-show, note it in the patient's medical record. Second no-show, warn the patient. Third no-show, consider dismissing the patient from the practice. Make sure you do this in such a way that provides legal protection for the provider. Some providers charge patients fees for no-shows. Because the time slot was assigned to that patient and no time was given to substitute another patient, it's ethical to charge him. In addition, the Centers for Medicare and Medicaid Services allow providers to directly charge Medicare beneficiaries for missed appointments, provided that the providers also charge non-Medicare patients for missed appointments. Many providers choose not to charge patients, but it's an option to consider.

Preventing and Documenting No-shows

For legal reasons, it's important to document these events in the appointment book or in the online scheduling system. Use initials such as "NS" for no-show, or "MA" for missed appointment. Also, make sure the notes are neat and legible. Because a court may need to use an appointment book as evidence, it's very important that all parties can read the documentation.

Arranging Diagnostic Testing and Procedures → Consent Form

Have the provider review the consent form with the patient. The patient should sign it, and a copy needs to be placed in her medical record. This process makes sure the patient understands the risks, benefits, and alternatives to the procedure. Document the information in the patient's chart. Then, check the patient's status after the procedure. Make sure the patient is following the provider's post-procedure instructions. If you don't receive prompt results, follow up with the provider.

Determining Scheduling Needs → Patient Needs→ Knowledge of fees

If the patient needs to pay at the time of the visit, go over financial arrangements.

Scheduling → Following Appointment Protocols → Patients Without Appointment

It's up to providers in your practice to develop a policy about patients who don't have appointments. If patients arrive in need of immediate attention, most providers will see them. If the patient doesn't need immediate care, the provider may visit with the patient briefly and then ask you to schedule an appointment. If the office policy is to turn away the patient, then you'll need to do just that.

Steps on informing the patient know about the diagnostic and procedure arrangements.

Make sure to inform patient about the following: name, address, telephone number of the facility, as well as the name of the referred physician; the date and time that she needs to report for the test; instructions for preparing for the test, including eating restrictions, fluid requirements, and whether she can take medications; information about preadmission testing; the need to bring a form of picture identification and her insurance card to the facility on the day of the procedure; and whether she needs to pick up orders, or whether they'll be sent to the facility in advance. After going through the list, ask the patient to repeat the instructions. Remind her about the importance of keeping the appointment and arriving on time.

A grid with time slots blocked out when the providers are unavailable or the office is closed.

Matrix

Define Open Booking

Practices that use open booking, also called tidal-wave scheduling, don't schedule patients for a specific time. Instead, patients come in at intermittent times. Then, providers see them in the order that they arrive

Scheduling → Following Appointment Protocols → Emergency Calls

The office usually has procedures in place that you can follow. These procedures commonly involve a screening system to prioritize the urgency of the call and when the provider can see the patient. To screen patients, it's helpful to have a list of questions available. The provider should help prepare the list, which should identify what's an emergency or life-threatening, urgent, or serious but not life-threatening. Some of the first questions to ask are a patient's name, phone number, and location. If it is a true emergency, you can recommend that the patient go to the hospital emergency room. If necessary, you may need to call 911 for the patient. Always stay on the phone until the emergency medical technicians (or EMTs) arrive. Never place an emergency call on hold.

When patients come to the doctor, they must bring the correct documentation.

The patient to bring his insurance card and photo ID. If patient needs a referral, make sure he brings that to the appointment, too.

When scheduling appointments, you must keep three sets of needs in mind:

The patients', The providers', and The facility's.

Define Stream/Time-Specific Scheduling

The stream or time-specific scheduling approach involves scheduling patients for specific times at regular intervals. The amount of time for this depends on the reason for the visit.

Define Wave Booking

Wave booking works like this: instead of scheduling patients for 20-minute intervals, patients come at the same time each hour. This creates short-term flexibility each hour. The assumption is that the time necessary for each patient averages out over the course of the day. Providers see patients in the order of their arrival. You can use a sign-in sheet to track this. As a result, if one patient is late, it doesn't disrupt the schedule for the day.

Scheduling → Following Appointment Protocols → Policies for Cancelled Appointments →Patient Cancelled Appointments

When a patient calls to reschedule an appointment, remove the original appointment day and time from the appointment book or database. Then, add the new date and time to the schedule. If the cancellation occurs the same day as the original appointment, try to have a list of patients who want come in as soon as possible. Then, start calling these patients to see if they're available. Note these types of cancellations on the patient's medical record, plus any reason for it. You don't need to document a reason for patients who change their appointment times far enough in advance.

Define Modified Wave Booking

You can modify wave booking in a couple of different ways. One example is to schedule two patients to come at 9 a.m., and one patient at 9:30 a.m. This hourly cycle repeats throughout the day. Another approach is to schedule patients to arrive at intervals during the first half of the hour and none for the second half of the hour. This reserves the second half for patients who need extra time.