Learning Objectives Define, spell & pronounce the terms listed in vocabulary. Identify & explain the features of a multiple-line telephone system, & also.

Learning Objectives Define, spell & pronounce the terms listed in vocabulary. Identify & explain the features of a multiple-line telephone system, & also explain how each can be used effectively in a healthcare facility Do the following related to effective use of the telephone: Discuss the telephone equipment needed by a healthcare facility. Summarize active listening skills Demonstrate effective & professional telephone techniques Consider the importance of tone of voice & enunciation Explain the importance of thinking ahead when managing telephone calls; also, describe the correct way to answer the telephone in the office. Discuss the screening of incoming calls, & list several questions to ask when handling an emergency call Do the following related to taking a message: Document telephone messages accurately List the seven elements of a correctly handled telephone message Report relevant information concisely & accurately Discuss various types of common incoming calls & how to deal with each. Discuss how the medical assistant should handle various types of difficult calls Discuss typical outgoing calls, including why knowledge of time zones & long distance calling is necessary Discuss the use of a telephone directory, & describe how answering services & automatic call routing systems are used in a healthcare facility. Discuss the legal & ethical issues related to telephone techniques.

Telephone Techniques Page 113 - 130
The telephone is one of the most important pieces of equipment used in a healthcare facility. It is used to communicate with patients, other healthcare organizations, & suppliers. It would be difficult to run an office without a telephone. It is often the first point of contact with patients, & this is an opportunity to make an outstanding first impression. Developing good telephone techniques will make you a valuable asset to your employer. Page

Telephone Equipment Page 114 Multiple-Line Telephone
Familiarity with multiple-line telephone systems is a must. These telephones have a button for each line, & the buttons flash when a call comes in on the line. The button will also flash, in a different rhythm, when a caller is on hold on the line; this can serve as a reminder for you to check back with the caller to see whether they would like to remain on hold or leave a message. It also allows you to transfer calls You should familiarize yourself with the multiple-line telephone system used in your healthcare practice.

Telephone Equipment: Cont.
Page 114 Telephone Equipment: Cont. Headset Most business telephones have a handset that can be used to answer the telephone. However, since you are most frequently responsible for answering the phone & may want to consider using a headset. Use of a headset can improve your ergonomics & help prevent neck strain. Also, having a headset frees you hands to use the computer or take a message. A headset is a combination earphone & microphone that is attached to the telephone by a cord or is wireless. You can adjust the volume in the earpiece, & you may be able to adjust the volume of your voice through the microphone for callers who may have difficulty hearing. Bluetooth, a type of short-range wireless technology, allows you to be more mobile while on the telephone. Because this type of headset is not as visible, people may not be aware that you are on the phone & may start a conversation with you. You should respond politely indicate that you are on the telephone & you will respond to the person when you can. Some healthcare facilities have a light system that indicates to a patient that you are one the phone & will be with them when the call is complete. Many headsets can be muted so that you can speak with someone without the caller hearing you.

Pages 114 – 115 Telephone Equipment: Cont. Features Most multiple-line business telephones have many features that allow you to perform a number of different tasks in the healthcare facility. Speakerphone This function allows you to hear & speak to the caller without using the handset or a headset. Always inform the caller that you will be putting them on speakerphone, & let the person know who else will be listening in. Be careful when using a speakerphone because the sound can travel farther than you might think Speakerphone - Generally, a button on the telephone is labeled “speaker” (or is indicated with an icon), and once you push it, you can hand up the handset. This can be useful if you need to have more than two people on the call using the same phone. The speakerphone function should not be used in areas such as the patient check-in area or anywhere a conversation can be overheard. The door or reception window should be closed so that no one just walking by can overhear the conversation. If someone overhears private medical information – this is a violation of the law specifically the Health Insurance Portability & Accountability Act (HIPAA)

Page 115 Telephone Equipment: Cont. Conference Calls Many multiple-line telephones allow you to set up a conference call, in which you can have multiple people on the call from different locations. The person initiating the call calls one person, puts them on hold, & continues the sequence until all parties are on the call. Conference calls can be used when the healthcare facility has more than one location & people from all locations must be involved in a conversation. For example, a committee may want to discuss policies & procedures for the practice. It is a much better use of time to set up a conference call that to have many people travel to one location.

Page 115 Telephone Equipment: Cont. Caller ID Caller ID allows the user to see who is calling before they pick up the handset to answer the telephone. The caller’s telephone number & name appear on a screen, & the user can decide whether to take the call. If the user subscribes to call-waiting services, another benefit, called call-waiting caller ID, is often available. This function allows the user to see who is calling even when the user is already on the telephone.

Page 115 Telephone Equipment: Cont. Voice Mail Voice mail is widely used in business offices because it affords an around-the-clock method for receiving messages. It allows the caller to hear a recorded message that may also provide information about what to do in case of an emergency. It allows special temporary greetings when the user is away from the office. You can keep patients happy answering voice mail messages promptly. It can be frustrating to those who find themselves speaking to an electronic device more often than a human being.

Page 115 Telephone Equipment: Cont. Call Forwarding Call forwarding allows the user to forward calls to another designated number, such as an answering service. Usually a code is entered, then the telephone number to which the call should be forwarded. If you are going to be busy with a patient, the calls can be forwarded to another employee until the task is completed. This prevents the user from missing important calls when away from the main telephone.

Page 116 Telephone Equipment: Cont. Intercom This feature allows two-way communication, but it does not require you to pick up the handset or use a headset. This type of communication is not confidential, but it can be used to notify staff members of an emergency or to ask the provider to come out of an exam room.

Page 116 Telephone Equipment: Cont. Call Hold This is often used when you have answered an incoming call & then another line rings. Interrupt the call you on by asking if you can place the person on hold for a moment; wait for an answer before pushing the hold button Never answer with “Please hold.” Always find out the nature of the call before placing the person on hold. If it is an emergency, handled the second call before you return to the first call. It is very important to be courteous & respectful of the caller.

Page 116 Telephone Equipment: Cont. If it is not an emergency, ask if you can place the person on hold & wait for an answer before pushing the hold button. If the person refuses to be placed on hold, determine the reason why & assure them that you will return to their call quickly. Use this function if you need to retrieve information or speak to someone else.

Page 116 Telephone Equipment: Cont. Speed Dialing Speed dialing allows you to program keys on the telephone keypad to automatically call a stored telephone number by just pressing one key. It can be a time-saver; however, all staff members must know which telephone numbers have been programed into particular keypad numbers. For example, if the healthcare facility uses a particular laboratory for specimen testing, the telephone number for that laboratory can be programmed for the number 1 on the telephone keypad: then, when you want to call that laboratory, you only need to press 1 & the call will be made.

Page 116 Telephone Equipment: Cont. Cell Phones Personal cell phones can present issues particularly in regard to patient confidentially. Pictures can be taken of confidential information, & that information can be transmitted quickly to someone else or put on the Internet. Calls can be made or taken at inopportune times & may affect the care of patients. Most healthcare facilities have a policy that prohibits employees from having their personal cell phones with them during working hours.

Telephone Equipment Needs of a Healthcare Facility
Page 116 Telephone Equipment Needs of a Healthcare Facility Number & Placement of Telephones Telephones should be placed where they are accessible but private. Each provider, in addition to the office manager, requires a telephone at their desk. A telephone should be available in the laboratory area & the clinical area, & multiple phones should be present in reception & business office areas. Many healthcare facilities also have a telephone available for patients to use. This telephone often has a separate line so that patients use does not interfere with the staff members’ work. Few healthcare facilities can get along with just one telephone line. Two incoming lines, along with a private outgoing line with a separate number for the provider’s exclusive use, is the minimum recommended number of lines. You can handle no more than two incoming lines; therefore, the addition of more lines may involve additional staffing. If a staff member is assigned solely to dealing with insurance & billing, a separate line & listing in the telephone directory for this service may considerably lessen the load on the main incoming lines.

Effective Use of the Telephone
Pages 116 – 117 Effective Use of the Telephone Active Listening When you are on the telephone, you have fewer nonverbal cues to help you determine the message; therefore, it is very important that you use good listening skills. When you use active listening skills, your patients realize that you think they are important & that you respect the message they are communicating to you, whether you are on the telephone or face-to-face.

Active Listening Page 116 Be present in the moment
Focus solely on the conversation Don’t interrupt Don’t start forming your response before the person has finished speaking Confirm what the speaker has said, & ask if your interpretation is correct. Always be respectful & professional.

Effective Use of the Telephone: Cont.
Page 117 Effective Use of the Telephone: Cont. Developing a Pleasing Telephone Personality Each time you answers the telephone, you are representing the healthcare practice. The manner in which the telephone is answered can influence the caller’s impression of the whole office & whether the person wants to be seen there. When patients call the healthcare facility, they should hear a friendly yet professional voice. A pleasing telephone personality facilitates the sending of the message.

Page 117 Effective Use of the Telephone: Cont. Nonverbal communication occurs during a telephone conversation Tone of voice – Be aware of your tone of voice. smile when you answer the phone Speed of Speech – speak at a moderate rate of speed Pitch – vary the pitch of your voice & avoid speaking in a monotone. Volume – Use a normal volume & tone of voice, & speak directly into the mouthpiece Enunciation – speak very clearly & distinctly Pausing or hesitation – give the caller your full attention Tone of voice –The physical act of smiling affects how your words sound. It is as if your caller can hear you smile, & you have created a positive impression. Enunciation – Enunciation is crucial when speaking on the telephone. Many letters of the alphabet sound very similar on the telephone, such as B, P, T, F & S. You may need to clarify with the caller by saying, “That is B as in bravo.” Speed of Speech – speaking too quickly makes it difficult for the caller to understand you Pausing or hesitation – Do not become distracted by other things going on around you. In addition, you should never eat, chew gum, or drink when on the telephone.

Page 117 Effective Use of the Telephone: Cont. It is important to always be courteous & tactful. Think about the words you will be using before actually speaking them. For those of us working in a healthcare facility, it is easy to integrate medical terminology into our conversation. However, we must be careful not to use medical jargon when speaking with patients because this makes the message more difficult for them to understand. For example, if you are giving a male patient preprocedural instructions, advise him that he must not eat or drink anything for 12 hours before the procedure; do not tell him he should “stay NPO” (nothing by mouth).

Managing Telephone Calls
Page 118 Managing Telephone Calls Thinking Ahead Be prepared before you start: Answering calls – have supplies for taking messages a computer or a paper message form working pens a watch or clock to record the time a list of commonly used telephone numbers. For outgoing calls – have the information you need patient’s health record telephone number of the person you will be calling a list of questions a pad & a pen to make notes during the conversation A computer if your office documents telephone messages electronically Commonly used phone numbers list – Such a list includes poison control, other emergency numbers, community resources to which the patients can be referred, & so on.

Managing Telephone Calls: Cont.
Page 118 Managing Telephone Calls: Cont. Confidentiality All communication in a healthcare facility must maintain patient confidentiality. When using the telephone, you must be aware of what is going on around you & who may be able to overhear your conversation. If patient-sensitive information will be discussed, place the call in an area where others can not hear, especially other patients.

Page 118 Managing Telephone Calls: Cont. Answering Promptly Telephone contact is often the first interaction with a patient. If the person's call is not answered promptly, this creates a negative impression before they even talk to someone. It is important that a call be answer within three rings.

Page 119 Managing Telephone Calls: Cont. If you routinely answer the telephone know how to activate emergency medical services (EMS). You may need to make this call for a patient who has called the healthcare facility & is now unable to contact EMS on their own. If your phone system allows it, you can set up a conference call that includes the patient, EMS, & yourself. Get a telephone number where the caller can be reached if you get disconnected. Keep the patient &/or caregivers on the line while contacting EMS. Generally, this means dialing 911

Page 119 Managing Telephone Calls: Cont. Identifying the Facility When answering incoming telephone calls, you should identify the facility first, state your name, & then follow with an offer of help. “Good morning, Walden-Martin Family Medical Clinic. This is Ana. How may I help you?” Always follow the policy of the healthcare facility when answering calls. Speaking slowly & smoothly, with good enunciation, ensures that your callers understand whom they have reached.

Page 119 Managing Telephone Calls: Cont. Identifying the Caller If the caller does not offer a name, you should ask, “May I ask who is calling?” It can be helpful to write down the caller’s name & try to use it at least three times during the conversation, if it does not compromise patient confidentiality. This helps make a strong connection with the patient & assures the person that they have been identified correctly.

Page 119 Managing Telephone Calls: Cont. Occasionally callers refuse to identify themselves to you & insist that they speak with the provider. You must be clear, in a professional manner, that you can not connect the caller to the provider without knowing who the caller is. The caller may be a sales representative who knows that if they identify themselves, they will not get the opportunity to talk with the provider.

Page 119 Managing Telephone Calls: Cont. When it becomes clear that the caller will not give a name but still insists on speaking with the provider, you can tell the person that the provider is busy with patients & has asked that messages be taken; if the caller cannot leave a name for the message, then they may want to write a letter & mark it Personal. Most people do not want to wait for the response to a letter & will then give you their names so that a message can be taken.

Pages 119 – 220 Managing Telephone Calls: Cont. Screening Incoming Calls You will be expected to screen calls. To do this you must determine who the caller is & the nature of the call. This makes it so you can routed the calls correctly. Either: to the billing office to the triage area directly to the provider The provider, office manager, & staff members who will be answering the telephone should work together to develop polices for screening calls. If the call is from a patient with a question about a statement they’ve just received in the mail, the call can be transferred to the appropriated area. If the call involves determining whether a patient should be seen that day, it can be transferred to the triage area. If the caller asks to speak directly to the provider, the situation can become more complicated, & healthcare facility policies should be created to address these cases. Screening polices also should address how calls should be handled when the provider is out of the office.

Page 220 Managing Telephone Calls: Cont. Screening Guidelines In a facility with multiple employees, the provider may designate one individual, such as a nurse or an experienced & trained MA, as the telephone screener. A special sheet of instructions listing specific medical emergencies (e.g., chest pain, heavy bleeding, fainting, seizure, & poisoning) should be posted by each telephone. The telephone numbers for the nearest poison control center, hospital, & ambulance should be listed.

Page 220 Managing Telephone Calls: Cont. Emergency calls should be routed to a provider immediately. Additional instructions should include what action to take if no provider is available (e.g., sending the patient to an emergency department or calling for an ambulance). Most offices have some means of constant contact with the provider, whether by pager, cell phone, or another method. Every healthcare facility would be wise to have a written telephone protocol for handling urgent situations & emergencies. The protocol should state that employees are bound by the written guidelines & that unauthorized personnel may give no advice. If advice is given, it may be grounds for dismissal

Page 220 Managing Telephone Calls: Cont. Getting the Information the Provider Needs As you gain experience you will begin to have a sense of the questions the provider will have for patients who call the facility. One way to learn about questions to ask is to listen to the provider carefully as they question patients about their symptoms. This can help you learn more about signs & symptoms & enables you to be a better assistant to the provider. For example, the provider is interested in how long the patient has had symptoms, what makes the symptoms better or worse, what remedies have been tried, what has worked & not worked, & other specifics about the condition. If the patient complains of painful urination, the MA learns to ask about pain in the back or blood in the urine.

Page 220 Managing Telephone Calls: Cont. If the provider is unavailable for part of the day, take a messages & inform callers that the provider currently is out of the office but will return calls when they return. It is important to give callers the time frame in which the provider will be returning calls so that patients’ time is not wasted waiting for a call. If the caller is unavailable when the provider usually returns calls, ask what would be a convenient time & let the caller know you will try to work with that time frame. It should be stressed that the time frame is approximate because emergencies cannot be predicted.

Page 220 Managing Telephone Calls: Cont. Placing Callers on Hold If the call needs to be transferred to someone else in the healthcare facility & that person is not immediately available you should ask if the caller would like to be put on hold, or if he or she would prefer to be called back. If you know that the person with whom the caller needs to speak may be busy for quite a while, inform the caller of that. The caller may still want to wait. The MA should always ask before place a caller on hold.

Page 220 Managing Telephone Calls: Cont. You should check back with callers on hold periodically to make sure they still want to remain on hold. No longer than 1 minute should pass before you check back. When you return to the call, you can use a statement such as, “Thank you for waiting. Would you like to continue to hold or should I take a message?” Minimizing the wait for the caller shows concern, & freeing up the telephone lines is important for other people trying to contact the healthcare facility. The MA should always ask before place a caller on hold.

Page 220 Managing Telephone Calls: Cont. Transferring a Call You may determine that a call should be transferred to the provider or to another person in the facility. If you answer telephone calls you have to know who does what in the healthcare facility. An organization chart with telephone extensions can be helpful, but it must be kept up to date so that calls can be transferred successfully. For example: Ms. Fields calls your office because of a billing question. You should ask Ms. Field’s permission before placing her on hold, & wait for a response. It is also helpful to give Ms. Fields the name & extension of the person to whom you will be transferring her call (if it is not the provider); this way, if Ms. Fields’ call happens to get disconnected, she will have that information when she calls back. Once you have Ms. Fields’ permission to put her on hold, you should contact the person to whom the call is being transferred; in this case, that is Mr. Lewis in the billing department. Tell Mr. Lewis to be prepared to help Ms. Fields when the connection is made. Mr. Lewis may ask for a moment to pull up the information before you put Ms. Field’s call through. You should stay on the line to introduce Ms. Fields to Mr. Lewis & to make sure the connection is made. If Mr. Lewis is unavailable, you should ask Ms. Fields if she would like to be connected to his voice mail. Some callers may prefer that you take a message in written form & bring it to the proper person.

Pages 220 – 121 Managing Telephone Calls: Cont. Taking a Message Telephone messages, whether handwritten or in electronic format, are important to patient care. Information needed for a complete message: name of the person calling name of the person to whom the call is directed caller’s daytime, evening, &/or cell number reason for the call (phone number of the caller’s pharmacy if a medication is requested) action to be taken date & time of call & your initials The patient relies on the MA to get the message to the appropriate person. Taking messages allows information to be delivered to a provider or an appropriate person, who can make a decision (then or later), which can be communicated back to the patient without interrupting the flow of patients through the healthcare facility. Let the caller know when to expect a call back.

Page 122 Managing Telephone Calls: Cont. Messages Taken on Paper Many types of message pads or books are available. Many are pressure-sensitive, making a copy of the message & serving as a telephone call log. The original is given to the person the message is for & you will have a copy to use for follow-up. Having legible handwriting is a must when taking handwritten messages.

Page 122 Managing Telephone Calls: Cont. Messages Recorded Electronically Most electronic health record (EHR) systems can record telephone messages. The EHR automatically saves a copy of the message to the patient’s health record, sends the message to the provider, who can either call the patient directly or give you directions to respond to the the patient. The electronic system may be able to flag a message, to indicate its urgency, that it requires a call back, or that a prescription refill is requested.

Page 122 Managing Telephone Calls: Cont. Taking Action on Telephone Messages The message process is not complete until the necessary action has been taken. If a handwritten system is used, use an identifying mark to indicate a message that requires action. If an electronic system is used, check periodically during the day to be sure you do not have to complete the response to the message, such as calling the patient back or contacting the pharmacy. For risk management purposes, the healthcare facility should have a policy on the documentation of telephone messages & the specific information that must be included. MA should become familiar with that policy.

Pages 122 – 123 Managing Telephone Calls: Cont. Retaining Records of Telephone Messages If a handwritten system: Message relates to patient care? A copy of the message should be added to the patient’s health record. If the health record is electronic, this may mean scanning in a copy of the paper message & attaching it to the EHR. The copy in the message book usually is retained for the same period that the statute of limitations runs for medical professional liability cases. Policy should be in place to deal with this

Pages 122 – 123 Managing Telephone Calls: Cont. Electronic system is used? The message is automatically saved to the patient’s record, along with the response to the message. These are key points if a medical professional liability case is brought against the provider. Accurate telephone records can ensure quality patient care & customer service. The message record can show whether the patient contacted the office, if the office responded to that contact, & what the response was.

Typical Incoming Calls
Page 123 Typical Incoming Calls Handling incoming calls is often your responsibility as a medical assistant. You can handle many calls directly, but some will require the assistance of others. Knowing how to respond to the different types of calls will make you a valuable asset to the healthcare facility.

Typical Incoming Calls: Cont.
Page 123 Typical Incoming Calls: Cont. Requests for Directions Each office should have a clear set of written directions that can be read to a caller who wants to know how to get to the office. Prepare the directions from various points in the area. Place these directions close to the telephone so that all employees can find them. Put a map on the office website & direct patients there for printable directions. Never simply suggest that callers refer to an Internet map when they ask for directions.

Page 123 Typical Incoming Calls: Cont. Inquires About Bills A patient may have questions about a statement that came in the mail. If you are responsible for billing, politely ask the patient to hold the line while you obtain the patient ledger. On returning to the line, thank the patient for waiting & explain the charges carefully. If an error has occurred, apologize & say that a corrected statement will be sent out at once. Always remember to thank the patient for calling. If billing matters are handled by another employee, tell the patient that the call will be transferred to the billing office. If the healthcare facility uses an external billing service, you may need to provide the caller with that agency’s telephone number. If patients are properly advised about charges at the time services are rendered, the number of these calls can be reduced considerably. When an external billing service is used, that telephone number is often shown on the patient’s statement. When necessary, post a note in the EHR or to the physical ledger card about the patient’s call, such as a promise to pay on a certain date.

Page 123 Typical Incoming Calls: Cont. Inquiries About Fees A good estimate should be given to patients as to what they can expect to pay, especially on the first visit. Asking a patient to just appear at the office without having any idea of the cost is unreasonable. Discuss with the provider or office manager what range should be quoted to the patient, & then follow your quote with the statement that the fees vary, depending on the patient’s condition & tests the provider orders. Fees vary widely in each healthcare facility, & quoting an exact fee before the provider sees the patient can be difficult.

Page 123 Typical Incoming Calls: Cont. Most healthcare facilities require patients to pay the health insurance co-payment (or co-pay) on the day service is provided, & the caller should be informed of this. If fees are regularly discussed on the telephone, a suggested script should be included in the polices & procedures manual. Do not be evasive; have a list of fees available you can discuss with patients.

Page 123 Typical Incoming Calls: Cont. Questions About Participating Providers Patients call the office to inquire whether the provider is a participating provider with their particular insurance plan. A list of the insurance plans with which the provider has a contract should be readily available to you. This is important because insurance benefits vary widely for patients based on whether they see a participating provider or a nonparticipating provider.

Page 123 Typical Incoming Calls: Cont. Requests for Assistance with Insurance In the ever-changing world of health insurance, patients often are confused about their coverage, how payment is determined, & what they are actually financially responsible for when it comes to their bill from the healthcare facility. A solid understanding of the basics of health insurance, including managed care, allows you to answer patient questions about insurance. If the question is beyond your knowledge, you should know to whom to transfer the call so that the patient can get an answer.

Pages 123 Typical Incoming Calls: Cont. Radiology & Laboratory Reports Because of the increased use of EHRs, radiology & laboratory results often are available to providers as soon as the technician has completed the test. When the patient calls for those results, a message is taken, & the provider decides whether the MA can relay the results or the provider needs to speak to the patient directly. When tests are done at a facility that is not linked to the healthcare facility’s EHR, the findings usually are delivered by mail to the provider’s office. If the test has been marked STAT, which means the provider wants the results immediately, reports may be telephoned, faxed, or ed to the provider’s office & an original report delivered by mail. It is helpful to have blank laboratory results form available that list the various tests, with their normal values, so that you can easily & accurately document results telephoned to the healthcare facility. This can save time, & you can be assured that the test name is spelled correctly. You should repeat the results you have been given to make sure you have written them down correctly. This report must be documented in the patient’s health record & sent to the provider for review.

Page 124 Typical Incoming Calls: Cont. Satisfactory Progress Reports from Patients Providers sometimes ask patients to phone the office to report on their condition a few days after the office visit. You can take such calls & relay the information to the provider if the report is satisfactory. Assure the patient that you will inform the provider of the call. The report should be documented in the health record.

Page 124 Typical Incoming Calls: Cont. The provider should always be informed immediately about unsatisfactory progress reports, & they should give instructions for the patient to follow in such situations. The provider may discuss this directly with the patient, or you may be instructed to relay the information to the patient. All instructions given should also be documented in the health record.

Page 124 Typical Incoming Calls: Cont. Routine Reports from Hospitals & Other Sources Routine calls may be received from hospitals & other sources reporting a patient’s progress. Take the message carefully & make sure the provider sees it. The message should be placed in the patient’s health record after the provider has reviewed & initialed it.

Page 124 Typical Incoming Calls: Cont. Requests for Referrals Well-respected providers, especially primary care providers, are often asked for recommendations for referrals to specialists. If the provider has furnished you with a list of practitioners for this purpose, these inquires may be handled without consulting the provider (unless the patient’s insurance plan requires a written referral). However, the provider should always be informed of such requests. Referrals should also be documented in the patient’s health record. Afterward, a staff member calls the referral provider & notifies the office staff of the referral. This process may also be done electronically. A managed care organization may offer the option of using its website to enter the referral information & then electronically forwarding the information to the new provider. Handle these calls as quickly as possible so that the patient may make an appointment to see the referral provider.

Page 124 Typical Incoming Calls: Cont. Some managed care organizations require a provider referral before a patient may see a specialist; this referral should come from the provider useless they have authorized automatic referrals. (Most providers require the patient to come in for an office visit to discuss the referral.)

Page 124 Typical Incoming Calls: Cont. Office Administration Matters Not all calls concern patients. Calls may come from the accountant or the auditor or about banking procedures, office supplies, or office maintenance, most of which you can handle or refer to the appropriate person. For some of these calls, you may need to gather additional information & return the call.

Special Incoming Calls
Page 124 Special Incoming Calls Patients Refusing to Discuss Symptoms Sometimes patients call & want to talk with the provider about symptoms they are reluctant to discuss with you. Patients have the right to privacy, but the provider cannot be expected to take numerous calls from patients who do not want to speak to you. If the patient refuses to discuss symptoms, follow the healthcare facility’s procedures, which may include suggesting the patient make an appointment with the provider to discuss the problem in person.

Special Incoming Calls: Cont.
Page 124 Special Incoming Calls: Cont. Unsatisfactory Progress Reports If a patient under treatment reports that they are still not feeling well or that the prescription the provider provided is not helping do NOT practice medicine illegally by giving the patient medical advice. Make detailed notes about the patient’s comments & then give your notes to the provider. They may make a medication change or may decide that the patient should return to the office. Follow up with the patient & convey the provider’s instructions.

Pages 124 – 125 Special Incoming Calls: Cont. Requests for Test Results When the provider orders special tests, the patient may be told to call the office in a couple of days for the results. It is ultimately the responsibility of the provider to notify the patient of test results, especially if they are abnormal. When a patient calls for the results, make sure the provider has seen them & has given permission before sharing the results with the patient.

Pages 124 – 125 Special Incoming Calls: Cont. Patients do not always understand that you cannot give out information without the provider’s permission. If the results are unfavorable, the provider should be the one to inform the patient & give further instructions. This call must be handled tactfully; otherwise, the patient may feel as if the staff is concealing information. Most provider prefer that MAs give only normal test results to patients. However, the MA may give abnormal test results if authorized by the provider. If the patient has any questions about the test result, she must be referred to the provider. The MA needs good communication skills to relay information such as this without crossing the line of practicing medicine without a license.

Pages 124 – 125 Special Incoming Calls: Cont. You must know & follow federal regulations & the laws in their state regarding the release of any information to someone other than the patient; this includes information about a minor. Make sure the right individual is on the line before offering results by verifying name & date of birth. It is considered a breach of confidentially & of the Privacy Rules of the Health Insurance Portability & Accountability Act (HIPAA) if the patient is not identified correctly & information is released to the wrong individual.

Page 125 Special Incoming Calls: Cont. Requests for Information from Third Parties The patient must give permission before any member of the provider’s staff can give information to third-party callers; this includes insurance companies, attorneys, relative, neighbors, employees, & any other third party. HIPAA is very specific about the information that should be included in the release of information form. The patient must specify who can receive the information & exactly what information can be released. The release of information form also must include an expiration date. You must carefully review the patient’s form before releasing any information to third parties.

Page 125 Special Incoming Calls: Cont. Complaints About Care or Fees You may be able to offer a satisfactory explanation to a patient who complains about the care they have received or the fee charged. Often the patient simply does not understand a charge, & you can provide assistance by reviewing the bill. If a patient seems angry, offer to pull the health record, research the problem & if needed, discuss it with the provider.

Page 125 Special Incoming Calls: Cont. Four magic words often calm the angry patient: “Let me help you.” This reassures the patient that someone is willing to talk about the problem. However, if you are unable to appease the patient easily, the provider or office manager may prefer to talk directly to the patient. When callers complain, do not attempt to blame someone else, & never argue with the patient. Find the source of the problem, & then present options to the caller as to how the situation can be resolved. Remember to treat callers in the same manner that you would wish to be treated. A complaint may seem small & insignificant to the office staff, but to the patient it may be a serious issue. Provide good customer service to patients, & complaints will be few & far between.

Page 125 Special Incoming Calls: Cont. Calls from Staff Member’s Families or Friends Telephone lines should never be burdened with an excess of personal calls to the staff. A call is necessary in emergencies, but staff members should never monopolize the telephone for personal business & conversations. Emergency calls could be coming through, & the lines must be clear. Keep personal calls & texting to an absolute minimum.

Handling Difficult Calls
Page 125 Handling Difficult Calls Angry Callers No matter how efficient you are on the telephone or how well liked the provider might be, sooner or later an angry caller will be on the line. You may find that lowering your tone of voice & the volume of speech may force the angry caller to do the same. This method does not always work, but it usually is true that when dealing with an angry person, calm promotes calm. Some patients may misread this method & become even angrier, thinking that their complaint is not being taken seriously.

Page 125 Handling Difficult Calls Interpersonal skills are critical when dealing with other individuals because the more skilled you become, the better able you are to deal with multiple type of personalities. Always avoid getting angry or defensive in response to an angry caller, & try to get to the root of the real problem. Express interest & understanding, take careful notes, & follow through with the problem to the most appropriate resolution.

Page 125 Handling Difficult Calls Never “pass the buck” by saying, “That’s not may job,” or “I am not the person who filed that insurance claim.” No matter whose fault the problem is, it is best to deal with it & find a solution instead of placing blame. It is important to respond to the patient when you said you would, even if the call is to tell them that you need a bit more time to work on the problem. Keeping the patient in the loop shows that you want to come up with a solution.

Handling Difficult Calls: Cont.
Page 125 Handling Difficult Calls: Cont. Aggressive Callers Aggressive callers insist that they receive whatever action they feel is necessary, & they insist on that action happening now! Treat these callers with a calm, poised attitude, but do not allow the caller to goad you into an inappropriate action. Reassure the caller that their concern is valid & will receive the full attention of the right person. Explain when the caller can expect a response from the office, & be sure to follow up.

Page 125 Handling Difficult Calls: Cont. Unauthorized Inquiry Calls Some individuals call the provider’s office requesting information to which they are not entitled. These callers must be told politely but firmly that such information cannot be provided to them because of privacy laws. Insistent callers should be referred to the office manager or provider.

Pages 125 – 126 Handling Difficult Calls: Cont. Sales Calls Sales calls often are thought of as an interruption to the provider’s busy day, but some salespersons may have important information on products, equipment, or services the office uses regularly. Do not completely disregard salespeople, but do not allow them to monopolize time or telephone lines, either. Keep these calls quick & to the point. Developing a rapport with representative of the companies whose products the practice uses frequently may result in a discounted price & first news of sales & promotions. In turn, these professionals rarely waste the time of office personnel. It may be the healthcare facility policy to give the salesperson an appointment, possibly over the lunch hour, to discuss the new product or service with the provider &/or office manager.

Page 126 Handling Difficult Calls: Cont. Callers with Difficulty Communicating Calls from patients who have difficulty with the English language. Some patients may speak English but have a heavy accent, so you should listen carefully & ask questions to be sure you understand the person correctly. Resources are available to assist with translation: a contract with a translator who would be available to help with telephone calls & patient visits in the office online services offer translation If a certain language is predominant in the area, the healthcare facility should consider hiring a MA who is bilingual. In some cases English is not the caller’s primary language, so you must use listening skills to ensure understanding.

Page 126 Handling Difficult Calls: Cont. deaf or hard or hearing: These patients may use a relay system to communicate with healthcare facilities over the telephone. They can use a translation app You should be familiar with the way this system works so that you can engage in these conversations in a professional manner. Some relay systems have the patient use a keyboard to enter the information to an operator, who calls the office & reads the information to you; your response is then typed back to the patient

Typical Outgoing Calls
Page 126 Typical Outgoing Calls Most outgoing calls in the healthcare facility are response to incoming coming calls. The same rules for courtesy & diction apply to calls made from the office to patient, other individuals, & businesses. It is helpful to plan outgoing calls in advance. Never be rude to an individual on the telephone. Remember to treat those on the other end of the telephone as you would wish to be treated. Do not forget that you are a representative of the provider & that you must behave in a professional manner at all times. For instance, if the MA is placing an order for office supplies, a list should be made that includes the product, the price, the quantity needed, & a catalog page number, if applicable. Questions about the various products ordered should be noted so that they can be asked while the sales representative is on the telephone. Some MAs find it helpful to make all outgoing calls at once, when possible. This way the calls can be made one after another, & if a call back is necessary, the MA is likely to still be by the telephone. Organizing calls helps increase office efficiency.

Typical Outgoing Calls: Cont.
Page 126 Typical Outgoing Calls: Cont. Time Zones When making outgoing calls, it is important to keep time zones in mind, especially when calling patients. If you are trying to contact a patient who is spending the winter somewhere else, you should place that call at an appropriate time for the patient. If you are trying to get information from an insurance company, you should call when someone is available to answer your questions. The continental US is divided into four standard time zones: Pacific, Mountain, Central, & Eastern. When it is noon Pacific time, it is 3 pm Eastern time. If you will be calling from San Francisco to a business or professional office in New York, plan to make the call no later than 1 pm. When it is 2 pm on the West Coast, it is 5 pm on the East Coast.

Typical Outgoing Calls: Cont.
Page 126 Typical Outgoing Calls: Cont. Long Distance Calling Long distance calls are simple to place, usually inexpensive, & efficient. When information is needed in a hurry, telephoning is much more expedient than written communication. Before placing a long distance call, have the correct number ready. Some Internet services, such as Skype, Jajah, or magicJack, allow the user to call long distance, & sometimes even internationally, through the computer with no long distance charges. If you do not have the number, you may access directory assistance by dialing 1, then the area code of the party you want to call, followed by In some areas, numbers are available by calling Directory assistance is now an automated service in many regions, & you will be asked for the name of the city & person you are calling. Often a fee is charged for using directory assistance, so look for the telephone number using free sources whenever possible.

Using a Telephone Directory
Pages 126 – 127 Using a Telephone Directory The primary purpose of a telephone directory is to provide lists of those who have telephones, their telephone numbers &, in most cases, their addresses. In addition, the directory is an aid in checking the spelling of names & in locating certain types of businesses through the Yellow Pages. Directories are found on the Internet & in print format. The Internet makes searching for telephone numbers much easier. Try to find telephone numbers through websites such as or or use a printed telephone book to avoid directory assistance charges on the monthly phone bill. A Web search for the business or provider needed may yield the information. Companies with websites usually have a “Contact Us” page that directs the user to the individual departments. In a print telephone directory, color coding is often used to differentiate between residence listings & business listing. Governmental offices usually have their own section (commonly blue). Some directories include ZIP code maps for the local area.

Telephone Services Page 127 Answering Services
With an answering service, an actual person answers calls, which can be comforting for patients. The staff at the answering service acts as a buffer for the provider after hours by screening calls. By following the criteria given to them by the healthcare facility, they can determine whether the provider (or on call person) should be contacted or the patient directed to the hospital emergency department, or whether a message can be taken & relayed to the healthcare facility in the morning. Patients expect to be able to contact their provider if an emergency arises. This means that the telephone in the healthcare facility must be answered at all times, day & night, weekends & holidays. During normal office hours, you are available to answer the telephone. After office hours, most healthcare facilities use an answering service or an answering machine that directs the caller to the answering service if there is an urgent issue.

Telephone Services Page 127
It is common courtesy to call the answering service in the morning to let them know that you will be answering the calls & also to retrieve any messages taken overnight or over the weekend. You should also call the answering service when you are leaving for the day. Answering services also can be used to cover the telephone if all staff members need to be away from the telephone at the same time.

Telephone Services: Cont.
Page 127 Telephone Services: Cont. Automatic Call Routing Many healthcare facilities have started using an automatic call routing system. The caller is given a menu of choices; they then press a number on the telephone keypad to direct the call to the correct department. This can be an efficient way to handle a large volume of calls, but it can also be frustrating for some patients, especially elderly adults who may have trouble hearing & remembering the options. Some of the frustration can be minimized by providing a number option that connects the caller with a person (e.g., “Press 0”), who can then transfer the call to the appropriate department.

Closing Comments Page 127 Patient Education
Today’s telephone systems allow providers to educate patients while they are on hold; recordings may be played that offer health information on subjects from A to Z. These messages can be professionally recorded &/or custom designed by the provider & staff. Special events may be announced, with the option to press a certain number for more information about the event.

Closing Comments: Cont.
Page 128 Closing Comments: Cont. Legal & Ethical Issues The guidelines for medical confidentiality apply equally to telephone conversations; therefore, take care that no one overhears sensitive information. Use discretion when mentioning the name of the caller or patient. Telephone message records may be brought into court as evidence; make sure all messages are complete & legible. Most offices should keep these records for at least the same period as the statute of limitations in that state. Do not place or receive personal calls during work hours. Time limitations of personal phone use should be described in the office policies & procedure manual. The telephone is a business line & should be reserved for patients & others conducting business with the office. Personal cell phones also should not be used during working hours; this takes the MA’s time & attention away from patient care.

Learning Objectives Define, spell & pronounce the terms listed in vocabulary. Identify & explain the features of a multiple-line telephone system, & also.

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Learning Objectives Define, spell & pronounce the terms listed in vocabulary. Identify & explain the features of a multiple-line telephone system, & also.

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Presentation on theme: "Learning Objectives Define, spell & pronounce the terms listed in vocabulary. Identify & explain the features of a multiple-line telephone system, & also."— Presentation transcript:

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