1. Scheduling Appointments and Maintaining the Physician’s Schedule2
Scheduling Appointments and Maintaining the Physician’s Schedule

2. Introduction Scheduling systems Scheduling situations Appointment book
Types
How each is used
Scheduling situations
Appointment book
Legal aspects
Documentation
Learning Outcomes:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
12.3 Identify different types of appointment scheduling systems.

3. The Appointment Book A well-managed appointment book
Unexpected events that occur
Creates an efficient patient flow
Shows respect for everyone’s time by preventing excessive wait time
Early and late arrivals
No-show patients
Emergencies
Physicians spend extra time with patients
Learning Outcome:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
Good planning and scheduling can help a medical practice run smoothly in spite of unexpected obstacles.

4. The Appointment Book (cont.)
Preparing the appointment book
Create the matrix, or basic format
Block off times the doctor is unavailable
Examples of when time should be blocked off
Hospital rounds
Surgery
Vacation and holidays
Scheduled meetings
Learning Outcome:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
The procedure for creating the matrix is the same whether the schedule is kept in an appointment book or an electronic scheduler.

5. The Appointment Book (cont.)
Computer or traditional paper appointment book
Obtain patient information
Patient’s full name
Home and work telephone numbers
Purpose of the visit
Use only approved abbreviations
Learning Outcomes:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
12.2 Identify common scheduling abbreviations.
Some offices use both a traditional appointment book and a computerized system; then if the computer fails to work, the appointment book has all the necessary information.

6. Determining Standard Procedure Times
Create a standard list of procedure times
Indicate how much time to allow for the tests
Use only as a guide
Helps identify appointment openings appropriate for the patient visit
Learning Outcomes:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
12.4 Discuss ways to arrange appointments for patients.

7. Determining Standard Procedure Times (cont.)
How Long Will Each Take?
5-10 min
Complete physical examination
30–60 min
10-20 min
Minor in-office surgery
30 min
15 min
Emergency office visit
15–20 min
15-20 min
New patient visit
30 min or >
Learning Outcome:
12.4 Discuss ways to arrange appointments for patients.
Suture removal
10–20 min
15-30 min
Prenatal examination
15 min
30 min
Follow-up office visit
5–10 min
30 min or >
Pap smear and pelvic exam
15–30 min
30-60 min

8. A Legal Record General Tips...
Keep appointment books for at least 3 years
Entries must be clear and easy to read
General Tips...
Never erase a name or use liquid paper
Use blue ink and never pencil
Draw a single line through the name
Write the date, time, and reason for cancellations
Document cancellations and no-shows in patient’s record
Learning Outcomes:
12.1 Explain the importance of the appointment book in maintaining the schedule in the medical office.
12.6 Explain how to properly document no-shows and late patients.

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

10. Appointment Scheduling Systems
Goals
Smooth flow of patients
Minimal waiting time
Open-hours scheduling
No appointments
Patients arrive at their own convenience
Seen on a first-come, first-served basis
Rural practices and urgent care centers
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.
Open-hours scheduling
Appointment book or electronic scheduling system is still needed to record patients as they arrive
Establish a matrix so you will know when a doctor is out of the office

11. Appointment Scheduling Systems (cont.)
Time-specified scheduling
Stream scheduling
Patients are scheduled for specific times
At regular intervals
Time based on reason for the appointment
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.
When a patient requires more than the standard time allotment, assign the patient additional back-to-back slots.

12. Appointment Scheduling Systems (cont.)
Wave scheduling
Large offices
See several patients at the same time
Seen in the order of their actual arrival
Flexibility for appointments that run longer than planned
Uses an hourly target
Number of patients to be seen hourly determined by dividing 60 minutes by the average estimated length of visits
Multiple patients at the same time can result in
Patient dissatisfaction
Annoyance
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.

13. Appointment Scheduling Systems (cont.)
Modified-wave scheduling
Options
Patients scheduled in 15-minute increments
Four patients scheduled during the first half hour and the second half hour is left free for catch-up
Double-booking
Two or more patients scheduled for the same time
Both patients will see the doctor within the scheduled period
One may be seen by NP or PA
Used when patient with no appointment needs to be seen
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.

14. Appointment Scheduling Systems (cont.)
Cluster scheduling (categorization)
Groups similar appointments together
Useful if specialized equipment has limited availability
Advance scheduling
Scheduling patients weeks or months in advance, such as with annual exams
Leave a few slots open for patients with unexpected problems
Combination scheduling – Using two scheduling methods
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.

15. Appointment Scheduling Systems (cont.)
Computerized scheduling – advantages
Can “lock out” selected appointment times
Information can be accessed from all office terminals
Help identify patients who are late, miss appointments, cancel, or require more time with the physician
Reports to help improve efficiency
Online scheduling – patients make own appointments via the Internet
Learning Outcome:
12.3 Identify different types of appointment scheduling systems.
Computerized scheduling also allows the use of color coding for scheduling certain appointments.
Online scheduling
Not yet widely implemented because of security issues and learning curve
New security measures have been put in place to make online scheduling feasible
Before adopting e-scheduler
Assess needs of practice
Survey patients for access to the Web
Find out about privacy issues

16. Apply Your Knowledge Right!
A large pediatrician office commonly must “squeeze in” 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?
ANSWER: Combination scheduling consisting of cluster and a form of wave scheduling would be recommended to allow for the needed flexibility.
Right!

17. Arranging Appointments
Offer choices
Dates
Times
Accommodate patient’s needs whenever possible
Confirm choice with patient
Learning Outcome:
12.4 Discuss ways to arrange appointments for patients.

18. Arranging Appointments (cont.)
New patients
Those not established at the medical office
Obtain all necessary information
Name
Address and phone number
Date of birth
Insurance information
Have patient arrive 15–30 minutes early to fill out forms
Return appointments
Ask patients if they need another appointment before they leave
Learning Outcome:
12.4 Discuss ways to arrange appointments for patients.
Patients who have not been seen by the practice in three or more years are considered new patients.

19. Arranging Appointments (cont.)
Appointment cards
After appointment time is entered in the book, it is recorded and given to the patient
Reminder mailings
A postcard addressed to the patient that is mailed one week before the appointment
Appointment
Reminders
Reminder calls
1–2 days before the scheduled appointment, the office calls the patient
Learning Outcome:
12.4 Discuss ways to arrange appointments for patients.
Appointment cards
Enter the information into the appointment book first, then fill out the card
This practice prevents you from working from memory after handing the card to the patient.
Reminder mailings
Serve as backup in case patient loses appointment card
Useful for appointments made many months in advance and for geriatric patients
Reminder calls: Useful for patients with history of late arrivals or no-shows
Recall notices
Form letter sent to remind patients to call for an appointment

20. TERRIFIC! Apply Your Knowledge
The doctor wants Mr. Lincoln to return to the office for a follow-up appointment in two weeks. What should the medical assistant do?
ANSWER: The medical assistant should offer Mr. Lincoln a choice of dates and times available to accommodate Mr. Lincoln’s needs. After entering the appointment in the book or into the computer, confirm the date and time with the patient and give him a appointment card.
TERRIFIC!

21. Special Scheduling Situations: Patient
Emergencies
Seen immediately upon arrival at the office
Explain to waiting patients without details
Provide opportunity to reschedule
Referrals
Referred patients should be seen as soon as possible
When arranging referrals for a patient
Provide choices
Be sure the facility accepts the patient’s insurance
Document in patient record
Learning Outcome:
12.5 Explain how to handle special scheduling situations.

22. Special Scheduling Situations: Patient (cont.)
Fasting patients
Refrain from eating or drinking – usually beginning the night before the appointment
Schedule as early as possible in the day
Instruct patient about the need to fast and when to start
Learning Outcome:
12.5 Explain how to handle special scheduling situations.

23. Special Scheduling Situations: Patient (cont.)
Patients with diabetes
Require regular meals and snacks to regulate blood glucose
Consider avoiding late morning slots that are close to lunchtime
Keep appropriate snacks on hand in the event a patient develops a low blood sugar
Learning Outcome:
12.5 Explain how to handle special scheduling situations.

24. Special Scheduling Situations: Patient (cont.)
Repeat visits
Schedule regular appointments on same day and time
Late arrivals
Schedule chronically late patients toward the end of the day
Prevents disruption in the office schedule
Document late arrivals or missed appointments in patient record
Learning Outcome:
12.5 Explain how to handle special scheduling situations.

25. Special Scheduling Situations: Patient (cont.)
Walk-ins
If it is an emergency, handle as such
If no openings, offer to schedule an appointment
Post a sign in the office if no walk-ins are allowed
Learning Outcome:
12.5 Explain how to handle special scheduling situations.
If physician is available and willing to see a walk-in patient, ask patient to schedule appointment for future visits.

26. Special Scheduling Situations: Patient (cont.)
Cancellations
Thank patient for calling to cancel
Appropriately mark appointment as canceled
Attempt to reschedule while the patient is on the phone
Document cancellation in the patient’s medical record
S Smith
R Hansen
M Fitz
J. Jones
cancelled
Learning Outcome:
12.5 Explain how to handle special scheduling situations.
To avoid confusion, cancel the first appointment by crossing out patient’s name before entering the patient’s rescheduled appointment.

27. Special Scheduling Situations: Patient (cont.)
Missed appointments
Document no-shows in the appointment book and patient medical record
Inform the physician of no-shows
Wrong day
Reschedule if patient lives locally
Attempt to accommodate if patient required special transportation or traveled far
H Plummer
P. Lexar
No show
Learning Outcome:
12.5 Explain how to handle special scheduling situations.
Physicians may charge for missed appointments.
If your office implements this policy, let patients know in advance before you start charging for missed appointments.
Consider adding statement to appointment cards that patients will be charged for appointments cancelled with less than 24 hours notice.

28. Physician Scheduling Situations
Physicians may throw the schedule off by
Arriving late to the office
Returning late from lunch or meetings
Being called away for emergencies
Being delayed at the hospital
Learning Outcome:
12.5 Explain how to handle special scheduling situations.
If a physician is late repeatedly, you may want to add some buffer time to the schedule and slot patients accordingly.

29. Apply Your Knowledge SUPER!
Mr. Washington needs a follow-up appointment in a week for a fasting blood sugar after the physician changed his medicine for diabetes. How should you handle this appointment?
ANSWER: The appointment should be made for the first or second appointment for that day. Mr. Washington should be reminded he should not eat or drink after midnight, and that he should not take his diabetes medicine prior to the appointment but should bring it with him.
SUPER!

30. Scheduling Outside Appointments
Common outside appointments include
Consults with other physicians
Laboratory work
X-rays and other diagnostic tests
Hospitalizations and surgeries
Be sure to have a doctor’s order specifying
Procedure
When results are needed
Learning Outcome:
12.7 Describe how to schedule appointments that are outside the medical office.

31. Scheduling Outside Appointments (cont.)
Validate the patient’s insurance prior to selecting the outside physician or facility
HMOs often arrange referrals and notify office when approved
Discuss possible appointment times with patient or give patient information to make appointment
Give pre-appointment instructions if necessary
Learning Outcome:
12.7 Describe how to schedule appointments that are outside the medical office.
HMO authorizations
Document the authorization (referral) number in the patient’s financial or insurance file.
Authorization number must appear on all forms related to this appointment in order for the procedure to be paid.

32. Apply Your Knowledge Very Good!
Mr. Anderson calls at 0830 and cancels his 0900 but calls the office again at 1230 c/o redness and discomfort at his surgical site. What should the medical assistant do?
ANSWER: The medical assistant should tell the patient to come right in due his complaints of incision redness and discomfort. However, Mr. Anderson should also be told that he will be “worked in” around other patients’ appointments.
Very Good!

33. Maintaining the Physician’s Schedule
Do Not Overbook
Maintain a Balance
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.
Do Not Underbook

34. Maintaining the Physician’s Schedule (cont.)
Overbooking
Scheduling too many patients
Office schedule falls behind
Stressful for staff
Underbooking
Gaps in schedule
Try to schedule another appointment in cancelled time slot
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.

35. Maintaining the Physician’s Schedule (cont.)
Emergencies or delays
Apologize to waiting patients and give an estimated waiting time
Offer choice
Leave and return at agreed-upon time
Reschedule appointment for another day
Reserving operating rooms
Give preferred days and times
Provide type and approximate length of procedure
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.
Rescheduling due to emergencies or delays
Document in patients’ charts that appointment had to be rescheduled due to an emergency in the office. Write the date of the rescheduled appointment in the chart.
Always make sure patients who need immediate attention are seen by another physician.
If physician makes house calls and nursing home visits, the medical assistant may be responsible for keeping medical bag well stocked.
Adhesive tape/bandages, scissors, dressing forceps
Biohazard container
BP cuff and stethoscope, ophthalmoscope, otoscope, thermometer, penlight
Specimen containers and sterile swabs
Medications (antibiotics, epinephrine, digitalis)
PPE
Sterile syringes and needles

36. Maintaining the Physician’s Schedule (cont.)
Scheduling pharmaceutical sales representatives
Block time for this purpose
New representatives
Request a business card
Check with the physician before scheduling an appointment
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.

37. Maintaining the Physician’s Schedule (cont.)
Making travel arrangements for out-of-town meetings or events
Medical assistant may be responsible for
Airline arrangements (get itinerary)
Car rentals and lodging
Get confirmations for all reservations
A locum tenens or substitute physician may cover practice while regular physician is away
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.
Itinerary: A detailed travel plan. Listing dates and times of flights and events, locations of meetings and lodgings, and telephone numbers.

38. Maintaining the Physician’s Schedule (cont.)
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 such as podium and microphones
Take minutes as needed
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.
Agenda: List of topics to be discussed or presented at a meeting.
Minutes: Report of what was discussed and decided at the meeting.

39. Maintaining the Physician’s Schedule (cont.)
Schedule regular time with the physician
Review schedule
Other items
State medical license
Drug Enforcement Agency registration
Documentation of continuing medical education (CME) requirements
Learning Outcome:
12.8 Discuss ways to keep an accurate and efficient physician schedule.

40. Right! Apply Your Knowledge Locum tenens Itinerary Agenda
When making travel arrangements for the physician, which of the following would be the responsibility of the medical assistant?
Locum tenens
Itinerary
Agenda
ANSWER:
Right!

41. In Summary
12.1 The appointment book is important in a medical office because it shows respect for the physician’s time and creates an orderly and efficient patient flow.
12.2 Commonly used abbreviations save space and time when entering information into an appointment book.
12.3 There are several different types of appointment scheduling systems. They range from open-hours scheduling to computerized scheduling.

42. In Summary (cont.)
12.4 When arranging appointments for patients, be courteous and polite. Offer different dates and times; always confirm the appointment by repeating it to the patient.
12.5 Special scheduling requires creativity and flexibility.
12.6 Document late arrivals and no-show patients. Call to discuss reasons for lateness or no- show.

43. In Summary (cont.)
12.7 Before scheduling outside appointments, ask the doctor for exact procedures that need to be performed, and which results will be needed Your job as a medical assistant is to keep the physician’s schedule accurate and efficient. Do not overbook or underbook.

44. End of Chapter 12
Taking a few extra minutes, going that extra mile, and giving that added special touch can make a world of difference in a very difficult situation.
~ Lisa Lockhart
(From A Daybook for Nurses: Making a Difference Each Day)