1. Managing Appointments
Chapter 6:
Managing Appointments

2. Chapter Objectives Cognitive Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
1. Spell and define the key terms
2. Describe the pros and cons of various types of appointment management systems for scheduling patient office visits, including manual and computerized scheduling
3. Describe scheduling guidelines
4. Explain guidelines for scheduling appointments for new patients, return visits, inpatient admissions, and outpatient procedures
5. Recognize office policies and protocols for handling appointments

3. Chapter Objectives (cont’d)
6. Identify critical information required for scheduling patient admissions and/or procedures
7. Discuss referral process for patients in a managed care program
8. List three ways to remind patients about appointments
9. Describe how to triage patient emergencies, acutely ill patients, and walk-in patients
10. Describe how to handle late patients
11. Explain what to do if the physician is delayed
12. Describe how to handle patients who miss their appointments
13. Describe how to handle appointment cancellations made by the office or by the patient

4. Chapter Objectives (cont’d)
Psychomotor Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
1. Manage appointment schedule, using established priorities
a. Schedule an appointment for a new patient
b. Schedule an appointment for a return visit
2. Schedule patient admissions and/or procedures
a. Schedule an appointment for a referral to an outpatient facility

5. Chapter Objectives (cont’d)
b. Arrange for admission to an inpatient facility
Verify eligibility for managed care services
Obtain precertification, including documentation
Apply third-party managed care policies and procedures
Apply third-party guidelines
3. Use office hardware and software to maintain office systems

6. Chapter Objectives (cont’d)
Affective Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
1. Implement time management principles to maintain effective office functions
2. Demonstrate empathy in communicating with patients, family and staff
3. Demonstrate sensitivity in communicating with both providers and patients
4. Communicate in language the patient can understand regarding managed care and insurance plans
5. Demonstrate recognition of the patient’s level of understanding in communications

7. Chapter Objectives (cont’d)
ABHES Competencies
1. Schedule and manage appointments
2. Schedule inpatient and outpatient admissions
3. Be impartial and show empathy when dealing
with patients
4. Apply third party guidelines
5. Obtain managed care referrals and precertification

8. Chapter Objectives (cont’d)
6. Apply computer application skills using a variety
of different electronic programs including
both practice management software and EMR
software
7. Communicate on the recipient’s level of comprehension
8. Serve as liaison between physician and others

9. Introduction
Responsibility for scheduling and managing the flow of patient care in a medical office or clinic is one of the most important duties assigned to a medical assistant. As appointment manager, you make the first, last, and most durable impression on the patient and providers.
providers: health care workers who deliver medical care
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10. Appointment Scheduling Systems
Manual Appointment Scheduling
The Appointment Book
Should have enough space for all pertinent information (e.g., patient’s name, telephone number, reason for visit)
Should be divided into time units appropriate for your practice (e.g., 10- or 15-minute intervals)
Should open flat on the desk where it will be used
Should fit easily into its storage place when not in use
Figure 6-1 Sample page from manual appointment book.
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11. Appointment Scheduling Systems (cont’d.)
Establishing a Matrix
Cross out times physician is unavailable
Include reason for unavailability
Block off 15–30 minutes morning and afternoon to accommodate emergencies and delays
Give copies to staff each day
A legal document
matrix: a system for blocking off unavailable patient appointment times
Along with the notations in a patient’s chart, the pages of the appointment book provide documentation of a patient’s visits and any changes, such as cancellations and rescheduled appointments.
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12. Appointment Scheduling Systems (cont’d.)
Computerized Appointment Scheduling
Software varies
Easy access to billing information
Prints out schedule easily
Figure 6-2 A computer-generated appointment schedule. Courtesy of Ingenix® CareTracker.TM
Once the daily schedule is printed, this important document is referred to as the daily activity sheet or the daysheet and is the guide for everyone involved in
the flow of patient care.
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13. Checkpoint Question What is the purpose of a matrix?
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14. Checkpoint Question
Answer: A matrix is established to indicate times of each day that are not available for patient appointments.
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15. Types of Scheduling Structured Appointments
30 minutes at the beginning or end of the day is often used as a buffer
Uses for buffer time:
Returning phone calls
Reviewing records
Transcribing reports
buffer: extra time to accommodate emergencies, walk-ins, and other demands on the provider’s daily time schedule that are not considered direct patient care
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16. Types of Scheduling Clustering
Group patients with similar problems or needs
Daily or weekly
Allows good use of specialized equipment or staff
clustering: grouping patients with similar problems or needs
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17. Types of Scheduling (cont’d.)
Wave
Schedule several patients in first half or each hour, second half left open for rechecks, emergencies, and other tasks
Patients are seen in order of arrival
Good for large, multidepartment facility
Modification — full physicals on the hour, rechecks on the half-hour
wave scheduling: a flexible scheduling method that allows time for procedures of varying lengths and the addition of unscheduled patients, as needed
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18. Types of Scheduling (cont’d.)
Fixed
Most common method
Patients allotted time by complexity of problem
Schedule disruptions affect entire day
Schedule chronically late patients toward end of day
Or, tell patients to arrive 30 minutes prior to their allotted time

19. Types of Scheduling (cont’d.)
Streaming
Standard time periods assigned to different needs
streaming: a method of allotting time for appointments based on the needs of the individual patient to minimize gaps in time and backups.

20. Types of Scheduling (cont’d.)
Double Booking
Two patients scheduled for same time slot with same physician
double booking: the practice of booking two patients for the same period with the same physician

21. Types of Scheduling (cont’d.)
Flexible Hours
Office hours vary throughout week
Patients are scheduled during open times
Greater range of possible appointment times allow patients with work or family schedule conflicts
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22. Types of Scheduling (cont’d.)
Open Hours
No scheduled appointments
Patients come when they can during open hours
Common in walk-in clinics
Patient records must be pulled as patients arrive
Clear disadvantages:
Effective time management almost impossible
Facilities may be overloaded or completely empty at times
Charts must be pulled and prepared as each patient arrives
Sign-in sheets are considered a breach of confidentiality, since patients signing the sheet can see the names and medical conditions of other patients.
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23. Checkpoint Question
What are the three systems that can be used for scheduling patient office visits?
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24. Checkpoint Question
Answer: The three systems that can be used for patient office visits include scheduled appointments, flexible hours, and open hours.
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25. Factors that Affect Scheduling
Patients’ Needs
Good communication critical — emotions can make slight miscommunication into negative experience for patient
With a patient in an emotional state, even the slightest real or imagined miscommunication can lead to negative response from the patient.
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26. Factors that Affect Scheduling (cont’d.)
Obtain appropriate patient information:
Reason for visit
Length of time of symptom
Problem acute or chronic
Time of day convenient for patient
Special needs of patient
Whether patient needs to see other office staff
Third party payer constraints
Documentation for referrals if required by third-party payer
acute: abrupt in onset
chronic: long-standing
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27. Factors that Affect Scheduling (cont’d.)
Strive to accommodate patient’s requests but remember:
You control the schedule—do not let it control you
Entire medical office team depends on a well-managed schedule
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28. Factors that Affect Scheduling (cont’d.)
Providers’ Preferences and Needs
Become familiar with providers’ habits
Punctual or often behind?
Medical assistant clinical duties should be accommodated
Possible provider scheduling needs:
Nonmedical office visitors
Telephone time
Teaching duties
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29. Factors that Affect Scheduling (cont’d.)
Physical Facilities
Number of providers using facility
Number of examination rooms
Need to resterilize instruments between procedures
Must thoroughly understand the requirements for procedures to be performed in the office
You must thoroughly understand the requirements for procedures to be performed in the office to schedule appointments accurately.
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30. Checkpoint Question
What are three factors that can affect appointment scheduling?
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31. Checkpoint Question
Answer: The three factors that can affect scheduling are patients’ needs, physicians’ preferences, and the physical facilities.
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32. Scheduling Guidelines
Be pleasant and helpful
Always include patient phone number on schedule
Include buffers each day
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33. Scheduling Guidelines (cont’d.)
New Patients
Allow adequate time
Obtain full name and correct spelling
Mailing address
Day and evening phone numbers
Reason for visit
Name of referring physician or individual
Responsible party and third party payer (insurance)
Explain payment policy
The information you exchange at this encounter is crucial, and entering the patient’s data accurately is imperative.
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34. Scheduling Guidelines (cont’d.)
Request pertinent insurance information
Ensure that patient knows office location and directions
Ask patient if messages can be left at home or work — note in chart
Reconfirm date and time of appointment before ending call
Recheck that appointment is correctly entered in book
Note if referral — obtain relevant patient information from source of referral
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35. Scheduling Guidelines (cont’d.)
Established Patients
Carefully check appointment book or screen before offering appointment time
Offer patient specific date and time
Enter information in appointment book (or enter in the appointment screen)
If patient is present, fill out appointment card
Figure 6-3 An appointment card will help the patient remember his or her appointment and reduce no shows.
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36. Scheduling Guidelines (cont’d.)
Reconfirm date and time
Recheck appointment book
End with pleasant word and smile
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37. Preparing a Daily or Weekly Schedule
Most offices—medical assistant responsible
Make copy for staff—ensure corrections are made on all copies
Place next day’s schedule on physicians desk before he or she leaves—next week’s on Friday
Should include patient appointments and all other commitments
Important to make manual changes to computer schedules as day progresses
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38. Patient Reminders Appointment Cards Give out one at a time
Regular appointments should be scheduled at same day and time
Telephone Reminders
New and already-scheduled patients should receive phone call day before appointment
Check chart to ensure that patient has agreed to allow messages to be left
If patient must cancel, use move-up list to schedule another patient in slot
All new patients and patients with appointments scheduled in advance should receive a telephone reminder the day before their appointment.
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39. Patient Reminders (cont’d.)
Mailed Reminder Cards
Alternative to phone calls
Mail at least 1 week before appointment
Can be used to remind patients to make appointments for regular examinations
Keep a supply of preprinted postcards in the office
Most medical management software packages can alert you that it’s time for patient reminders
Figure 6-4 Sample reminder postcard.
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40. Checkpoint Question What are the three types of patient reminders?
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41. Checkpoint Question
Answer: The three types of reminders are appointment cards, telephone reminders, and mailed reminder cards.
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42. Adapting the Schedule Emergencies
Figure 6-5 When a patient calls from home with a possible heart attack, you will call 911.
Emergencies
Must determine if problem can be treated in office or whether to call EMS
“STAT” = Latin statim, or immediately
When a patient calls with an emergency, your first responsibility is to determine whether the problem can be treated in the office.
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43. Adapting the Schedule (cont’d.)
Ask questions to elicit crucial information:
Possible heart attack
Possible poisoning
Life-threatening bleeding
Shock
Burns
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44. Adapting the Schedule (cont’d.)
Constellation of symptoms can indicate particular condition:
Shortness of breath, chest pain, arm/neck pain, nausea/vomiting can indicate heart attack
Severe right lower quadrant pain, nausea, and fever often points to appendicitis
If life-threatening emergency:
Keep patient on phone
Call EMS for transport
Do not advise patient to drive to hospital
constellation of
symptoms: a group of clinical signs indicating a particular disease process
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45. Adapting the Schedule (cont’d.)
Patients Who Are Acutely Ill
Severe but not life-threatening
Obtain as much information as possible
Place note on chart for physician review
Tell patient you will call back as soon as physician makes decision
Obtain as much information about the patient’s medical problem as you can so
your message to the physician will allow him or her to decide how soon the patient
should be seen.
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46. Adapting the Schedule (cont’d.)
Walk-in Patients
Office policy should be in place
Emergencies must be handled immediately
Ask patient to wait — work in to schedule as possible
Late Patients
Explain to patient that they are late and must wait until physician is available
Chronically late patients can be told that lateness of more than 15 minutes mandates rescheduling
Schedule chronically late patients in afternoon/evening to avoid schedule disruption
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47. Adapting the Schedule (cont’d.)
Physician Delays
Call patients with appointments later in the day to alert them and allow the option of rescheduling
Patients in waiting room should be notified immediately
Allow to wait or reschedule
If rescheduling, note reason in patient record
Continue to offer updates
Always keep patients informed
Most will understand if they know they are not ignored or forgotten
If patients are waiting in the office, inform them immediately if the physician will be delayed.
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48. Adapting the Schedule (cont’d.)
Missed Appointments
No-show = patient fails to show up for appointment and does not call to notify
Call patient to determine reason and to reschedule
If unable to reach by phone, sent reminder card — place copy in patient’s chart
Note missed appointment and follow-up steps in chart
Continued failure to keep appointments should be handled by physician
May decide to terminate relationship
Continued failure to keep appointments should be brought to the attention of the physician, who may want to call the patient personally (particularly if the patient is seriously ill) or send a letter expressing concern for the patient’s welfare.
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49. Cancellations Cancellations by the Office
If physician is ill or has emergency
Call patients to reschedule — don’t tell exact reason
Note in medical record
If physician will be out for an extended period, a locum tenens should be arranged
On-call physicians can stand in
These cancellations should be noted in the patient’s medical record.
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50. Cancellations (cont’d.)
Cancellations by the Patient
Note in record
Offer to reschedule
If patient has ongoing problem, emphasize importance of regular care
Notify physician of frequent cancellations
Can schedule move-up list patients if schedule is light
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51. Making Appointments for Patients in Other Facilities
Figure 6-6 Sample referral form.
Referrals and Consultations
Must make sure referral meets requirements of third-party payers.
HMO’s have strict requirements for precertification
Must complete referral form with approval number from insurance company
Give patients choice of specialist
Be sure the physician you are calling is on the preferred provider list
for the patient’s insurance company.
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52. Making Appointments for Patients in Other Facilities (cont’d.)
referral: instruction to transfer a patient’s care to a specialist
consultation: request for assistance from one physician to another
precertification: request for assistance from one physician to another
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53. Making Appointments for Patients in Other Facilities (cont’d.)
When calling another physician’s office for patient appointment provide the following:
Physicians name and telephone number
Patients name, address, and telephone number
Reason for referral
Degree of urgency
Whether patient is being sent for consultation or referral
Record in patients chart:
Time and date of call
Who received your call
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54. Making Appointments for Patients in Other Facilities (cont’d.)
Inform person that you wish to be notified if patient does not keep appointment (if this occurs—enter in to the patients record)
Can write name, address, telephone number of referral doctor on office stationery and include the date and time of appointment
Give or mail to patient
Patient may call referring physician and make appointment—ask patient to notify you with date—document
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55. Making Appointments for Patients in Other Facilities (cont’d.)
Diagnostic Testing
Patient sent to another facility for laboratory test, radiology, computed tomography, Magnetic resonance imaging etc.
Appointments usually made with patient still in office
Prior to scheduling, must determine exact test or test:
How soon results are needed—STAT?
Ask patient about time restrictions
Provide patient’s name, address, telephone number, exact test or test required and other special instructions
Give patient referral slip with name, address, telephone number of facility
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56. Making Appointments for Patients in Other Facilities (cont’d.)
Some laboratory studies or x-ray test require advanced preparation
Give patient written and verbal explanation
Ensure he or she understands
Document in chart and put reminder in tickler file to ensure test results are received.
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57. Making Appointments for Patients in Other Facilities (cont’d.)
Surgery
Determine precertification—call number on back of insurance card
Call facility chosen by patient and specify time and date physician has requested
Operating facility needs to know
Exact procedure
Amount of time needed
Anesthesia required
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58. Making Appointments for Patients in Other Facilities (cont’d.)
Other instructions
Also need all pertinent patient information
Give patient copy of preadmission forms—if available
Follow policies of surgical facility regarding preadmission testing (laboratory studies, autologous blood donation)
Write down all for patients—ensure he or she understands
Note—may need to also arrange for hospital admission with hospital admitting department
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59. Checkpoint Question
What information should be readily available when calling to schedule a patient for surgery in another facility?
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60. Checkpoint Question
Answer: When scheduling a patient for surgery, the following information is needed: demographic and insurance information; the patient’s name, age, address, telephone number, precertification number (if required), and diagnosis; surgery planned; and any special instructions.
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61. When the Appointment Schedule Does Not Work
Regular schedule disruptions require determining cause
Evaluate the schedule over 2 to 3 months by listing:
All patients seen
Arrival times
Amount of time spent with physician
Departure times
Amount of time needed to perform each examination or treatment
Office meetings are ideal way to identify scheduling problems
Adjust schedule to avoid causing frustration for both patients and office personnel
Since the workflow of the office affects every staff member, involve all employees in your study.
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