2. 1 PowerPoint ® to accompany Second Edition Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Chapter 12 Medical Assisting Chapter 12 Ramutkowski Booth Pugh Thompson Whicker

3. 2 Objectives 12-1 Explain the importance of the appointment book in maintaining the schedule in the medical office. 12-2 Identify common scheduling abbreviations. 12-3 Identify and describe different types of appointment scheduling systems. 12-4 Discuss ways to arrange appointments for patients. 12-5 Explain how to handle special scheduling situations. Scheduling Appointments and Maintaining the Physician’s Schedule

4. 3 Objectives (cont.) 12-6 Explain how to handle no-show and late patients with proper documentation. 12-7 Describe how to schedule appointments that are outside the medical office. 12-8 Discuss ways to keep an accurate and efficient physician schedule. Scheduling Appointments and Maintaining the Physician’s Schedule

5. 4 The Appointment Book A well managed appointment book: Creates an efficient patient flow Shows respect for everyone’s time by preventing excessive wait time Unexpected events that occur: Early & late arrivals No-show patients Emergencies Physicians spend extra time with patients

6. 5 Preparing the Appointment Book  First a matrix must be created by blocking off times the doctor is unavailable.  Examples of when time should be blocked off: Hospital Rounds Surgery Vacation & Holidays Scheduled Meetings The Appointment Book

7. 6   Patient’s full name  Home and work telephone numbers  Purpose of the visit  Estimated length of visit

8. 7 The Appointment Book (cont.) AbbreviationMeaning BPblood pressure check cancancellation consconsultation CPEcomplete physical examination ECGelectrocardiogram FUfollow-up appointment I&Dincision and drainage

9. 8 AbbreviationMeaning injinjection N&Vnausea and vomiting NPnew patient P&PPap smear (Papanicolaou smear) and pelvic examination PapPap smear PTphysical therapy re recheck The Appointment Book (cont.)

10. 9 AbbreviationMeaning refreferral RSreschedule sigsigmoidoscopy S/Rsuture removal surgsurgery USultrasound CPchest pain C&Ccalled and canceled The Appointment Book (cont.)

11. 10 AbbreviationMeaning Ccanceled LabLaboratory studies RxPrescription SOBShortness of Breath c/oComplains of ptPatient GIGastrointestinal PMSPremenstrual Syndrome STDSexually Transmitted Disease The Appointment Book (cont.)

12. 11 30 min or > Determining Standard Procedure Times  30-60 min 5-10 min 15-20 min 15 min 15-30 min 10-20 min 30 min 5-10 min 10-20 min 15 min 15-20 min 15-30 min 30 min 30 min or > 30-60 min

13. 12 A Legal Record  The appointment book is considered to be a legal record.  Some offices keep appointment books on- hand for at least 3 years.  Use ink and never pencil.  Never erase a name or use liquid paper to blot names out.  Write the date, time, and reason for cancellations.  It can be used as evidence, so entries must be easy to read.

14. 13 Use your knowledge of abbreviations and scheduling to order these patients from least time required to most time required. S/R CPE FU can P&P Apply Your Knowledge

15. 14 Use your knowledge of abbreviations and scheduling to order these patients from least time required to most time required.( 1= least time & 5= most time required) S/R suture removal 10-20 min. CPE complete physical examination 30-60 min. FU follow-up appointment 5-10 min. can cancellation 0 min. P&P Pap smear (Papanicolaou smear) and pelvic examination 15-30 min. 1 2 3 4 5 Answer Apply Your Knowledge- Answer

16. 15 Appointment Scheduling Systems  Open-Hours Scheduling Patients arrive at their own convenience Patients are seen on a first-come, first-served basis  Time Specified Scheduling Patients are scheduled for specific times Longer appointment times are given as needed

17. 16  Wave Scheduling Uses an hourly target by determining the number of patients to be seen hourly and dividing by the average estimated length of the visits Works well in large offices that can see several patients at the same time Several patients are scheduled for the same appointment time, and they are seen in the order of their actual arrival Appointment Scheduling Systems (cont.)

18. 17  Modified-Wave Scheduling One modification is to schedule patients in 15- minute increments Another option is to schedule four patients during the first half hour and leave the second half hour free for catch up  Double Booking Scheduling two or more patients for the same time with the plan that both will see the doctor within the scheduled period Appointment Scheduling Systems (cont.)

19. 18  Cluster Scheduling Groups similar appointments together during the day or week Useful if specialized equipment has limited availability  Advance Scheduling Scheduling patients weeks or months in advance such as with annual gynecologic examinations Appointment Scheduling Systems (cont.)

20. 19  Combination Scheduling Using two scheduling methods  Computerized Scheduling Affords the following advantages:  Can “lock out” selected appointment times  Information can be accessed from all terminals in the office  Help identify patients who are late, canceled, or those requiring more time with the physician Appointment Scheduling Systems (cont.)

21. 20 A large pediatrician office commonly must “squeeze” patients in that have become ill, so this new office plans to offer immunizations only twice per week. Which scheduling system(s) would you recommend for this medical practice? Apply Your Knowledge Combination scheduling consisting of cluster and a form of wave scheduling would be recommended to allow for the needed flexibility. Answer -Answer

22. 21 Arranging Appointments  New Patients Patients who have not been established at the medical office Get correct information such as spelling and pronunciation of their name, address, telephone number, etc. Requested to arrive 15- 30 minutes early to complete forms  Return Appointments It is a good practice to ask patients that come to the office for visits if they need another appointment before they leave.

23. 22 Appointment Reminders Appointment cards After appointment time is entered in the book, it is recorded and given to the patient Reminder calls 1-2 days before the scheduled appointment a follow- up call is made Reminder mailings Patient addresses a postcard to themselves that the office mails one week before the appointment Recall notices Form letter sent to remind patients that they need to be seen Arranging Appointments (cont.)

24. 23 A new patient is scheduling an appointment over the telephone with the medical assistant. This medical office uses Time Specified Scheduling. The next available appointment is 0930. What time will the medical assistant request that this patient arrive based on this information? Apply Your Knowledge This patient should be scheduled to arrive no later than 0915, so the necessary forms can be completed prior to the scheduled time to see the physician. Answer -Answer

25. 24 Special Scheduling Situations Medical office schedules can be interrupted by: a) Patients b) Physicians c) Both d) Neither

26. 25 Patient Scheduling Situations  Emergencies Patients told to come to the office for emergency appointments are seen before patients already scheduled, once they arrive.  Referrals Patients referred by other physicians should be seen as quickly as possible as a matter of professional courtesy and good business practice.

27. 26  Fasting Patients Patients required to refrain from eating or drinking should be seen as early as possible.  Patients with Diabetes To prevent complications associated with taking insulin these patients require regular meals and snacks Schedule their appointment as early as possible Patient Scheduling Situations (cont.)

28. 27  Repeat Visits Schedule appointments on same day and time for patients needing regular appointments  Late Arrivals Patients that are often late for appointments can be scheduled toward the end of the day to prevent disruption with the office schedule  Walk-Ins If the doctor is fully booked, ask patient to schedule an appointment A sign should be posted in the office if no walk-ins are allowed Patient Scheduling Situations (cont.)

29. 28  Cancellations Be sure to draw a line through the patient’s name in the appointment book and document in his/her medical record the cancellation Attempt to reschedule while the patient is on the phone  Missed Appointments Document no-shows in the appointment book and patient medical record Inform the physician of no-shows Patient Scheduling Situations (cont.)

30. 29 Physician Scheduling Situations  Physicians may throw the schedule off by: Being late to work Returning late from lunch or meetings Being called away for emergencies Delays at the hospital If a physician is late repeatedly, you may want to add some buffer time to the schedule and slot patients accordingly.

31. 30 Scheduling Outside Appointments  Before scheduling ask the doctor for an order that identifies the exact procedures to be done.  Always validate the patient’s insurance before selecting the outside physician or facility.  Common Outside Appointments Include: Consults with other physicians Laboratory work X-rays & other diagnostic tests Hospitalizations & surgeries

32. 31 Apply Your Knowledge A patient calls and cancels his/her 0900 appointment at 0830 but recalls the office at 1030 with a c/o redness at the surgical site. What should the medical assistant do? The patient should certainly be allowed to come due to complaints of incision redness; however, explain to the patient that he/she will be “worked in” the best you can, so you do not throw off the other appointments. Answer - Answer

33. 32 Maintaining the Physician’s Schedule

34. 33  Reserving Operating Rooms Reserve the facility and staff needed Give preferred days and times, types and length of surgeries  Stocking the Medical Bag Some physicians see patients in nursing home facilities Supplies may be needed, so the medical assistant may stock items needed in the medical bag Maintaining the Physician’s Schedule (cont.)

35. 34  Scheduling Pharmaceutical Sales Representatives Representatives from drug manufacturing companies are often called detail persons Some physicians will meet briefly with them so time may be set aside If an unknown, unscheduled representative comes, request a business card and check with the physician before scheduling an appointment Maintaining the Physician’s Schedule (cont.)

36. 35  Making Travel Arrangements Physicians may attend out-of-town meetings and other events. Airline arrangements (get itinerary) may need to be made along with car rentals and lodging. Get confirmations for both travel and room reservations. A locum tenens may be required while the physician is away. Maintaining the Physician’s Schedule (cont.)

37. 36  Planning Meetings Find out number of people, length and purpose of meeting Secure location with adequate room and parking Prepare an agenda if requested Secure equipment like podium and microphones  Scheduling Time with the Physician Meet regularly with the physician to review items such as:  State Medical License  Drug Enforcement Agency Registration  Documentation of Continuing Medical Education (CME) requirements Maintaining the Physician’s Schedule (cont.)

38. 37 Apply Your Knowledge When making travel arrangements for the physician, which of the following would be most important? a) Locum tenens b) Itinerary c) Agenda Answer - Answer

39. 38 End of Chapter