Medical assisting Administrative and clinical procedures (5e) Chapter 16 Schedule management

Learning objectives of this chapter include: Describe how the appointment book is key to the continuity of patient care, identify how to properly apply a matrix to an appointment book, compare different types of appointment scheduling systems, identify ways to organize and schedule patient appointments,...

Schedule Management

Learning Outcomes (cont.)

16.1 Describe how the appointment book is key to

the continuity of patient care

16.2 Identify how to properly apply a matrix to an

Learning Outcomes (cont.)

16.5 Model how to handle special scheduling

situations

16.6 Explain how to schedule appointments that

are outside the medical office

16.7 Implement ways to keep an accurate and

efficient physician schedule

The Appointment Book

– Early and late arrivals – Emergencies

– Patient’s who require extra time

• Color-coding feature Screen captures of SpringCharts™ Electronic Health Records

software are reprinted with permission from Spring Medical Systems, Inc All rights reserved.

Online Scheduling

• Not for all office types

• Cost and security have been barriers

• Prior to purchasing an e-scheduler

– Assess practice needs

– Determine potential for use

– Research products

Apply Your Knowledge

What advantages does a computerized scheduler

have over a paper appointment book related to

continuity of care?

ANSWER:

•It enables you to identify possible noncompliant patients

who cancel appointments, often arrive late, or are

no-shows

•It enables you to search for upcoming appointments to

ensure follow-up care is given.

•It allows for access from multiple areas so a physician

could check for a patient in an examination room.

Applying the Matrix

• Block off times the

Required Patient Information

• Obtain patient information

– Patient’s full name

– Home and work telephone

numbers – Purpose of the visit

• Use only approved

abbreviations

Standard Appointment Times

• Create a list

– Standard appointment times

– Time needed for common tests

• This helps in choosing an appropriate

appointment book or scheduler

The Appointment Book as a Legal Record

• Keep appointment books 3 years

• Entries – clear and easy to read

• Corrections or changes

– Draw a single line through the entry

– Add appropriate comment

– Initial the entry

– Document in medical record

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)

Apply Your Knowledge

S/RCPEf/uCANP&P

suture removal 10–20 min.

complete physical examination 30/60 min.

follow-up appointment 5–15 min.

cancellation 0 min.

Pelvic examination and Pap Smear 15–30 min.

ANSWER:

Appointment Scheduling Systems

• Goals

– Smooth flow of patients

– Minimal wait time

– No appointments

– Emergency room, urgent care centers and

some rural practices

Appointment Scheduling Systems (cont.)

Appointment Scheduling Systems (cont.)

– Flexibility to allow for

• Patients who arrive late

• Patients who require more or less time

– Uses an hourly target number of patients

• Arrive at the same time

• Seen in order of arrival

Appointment Scheduling Systems (cont.)

• Modified-wave scheduling

– 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 system

– Two or more patients scheduled for the same time

– Used when patient with no appointment needs to be

seen

Appointment Scheduling Systems (cont.)

• Cluster scheduling

– Groups similar appointments

– Useful if specialized equipment has limited availability

• Advance scheduling

– Scheduling weeks or months in advance

– Leave a few slots open for unexpected needs

• Combination scheduling – using two scheduling

methods

Apply Your Knowledge

A large pediatrician office commonly must “squeeze in”

patients in that have become ill The practice also plans

to begin offering immunizations only two days a week

Which scheduling system(s) would you recommend for

this medical practice?

ANSWER: Combination scheduling system consisting

of cluster scheduling for the immunizations and wave

or modified-wave scheduling to allow for the needed

flexibility of emergency patients.

Organizing and Scheduling Appointments

• Appointment cards

– Enter appointment

in scheduler – Fill out card

• Do not rely on memory to enter

appointment into book or scheduler

Reminders (cont.)

• Encounter forms/superbills

– Receipt for payment

– Information about next appointment

• Reminder mailings

– Postcard with time and date of appointment

– Put in tickler file on date it should be mailed

Reminders (cont.)

• Confirmation Calls

– To confirm a scheduled appointment

– Useful for frequent late arrivals or no-shows

• Recall notices – reminder to call for an

appointment

• E-mail notifications

– Patients enroll and receive a password

– Notifications of up-coming appointment sent

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: Offer Mr Lincoln a choice of dates and times

available 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.

Special Scheduling Situations

• Emergencies

– Seen immediately upon arrival at the office

– Explain situation to waiting patients

• Referrals

– See referred patients as soon as possible

– When arranging referrals

• Provide choices

• Be sure the facility accepts the patient’s insurance

• Document in patient record

Special Scheduling Situations (cont.)

• Fasting patients

– Schedule as early

as possible in the day

– Instruct patient

about the need to fast and when to start

• Patients with diabetes

– Require regular meals and snacks – Avoid late morning slots

• Late arrivals

– Schedule chronically late patients toward the

end of the day

– Document late arrivals

or missed appointments

in patient record

Special Scheduling Situations (cont.)

• Walk-ins

– If it is an emergency, handle as such

– If no openings, offer to schedule an

Special Scheduling Situations (cont.)

• Patient came a long distance

• Made special travel arrangements

Physician Scheduling Situations

• Physicians may throw the schedule off by

– Arriving late to the office

– Being called away for emergencies

– Being delayed at the hospital

If a physician is repeatedly late, you may want

to add some buffer time to the schedule

Apply Your Knowledge

Mr Washington needs a follow-up appointment in a week for a fasting lab tests 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.

Scheduling Outside Appointments

• Verify insurance coverage

• Obtain referral or approval if needed

• Make appointment

• Instruct patient

• Document in medical

record

Reserving an Operating Room

• Call OR scheduler to reserve space

– Preferred date and time

– Type of surgery

– Relevant patient information

• Insurance requirements

• Patient instructions

Apply Your Knowledge

What is the first thing you should do before scheduling

an appointment for a referral to a specialty physician?

ANSWER: The first thing you need to do is to verify that the

physician will be covered by the patient’s insurance.

Maintaining the Physician’s Schedule

Maintain a Balance

Visits Outside the Office

• House calls – check on home-bound

• Hospital rounds

• Nursing home visits

• “Mouse calls”

– Request a business card

– Check with the physician

before scheduling an appointment

Making Travel Arrangements

• Travel and lodging arrangements

• Itinerary – several copies for physician and one

for the office

• A locum tenens or substitute physician may

cover practice while regular physician is away

Planning Meetings

• Find out number of people, length and purpose

of meeting

• Secure location with adequate room, parking,

and food services

• Secure AV equipment

• Send invitations

• Create agenda

Scheduling Time with the Physician

• Irregularities or changes in the schedule

• Other items for discussion

Apply Your Knowledge

Why is it important to maintain a balance in the

physician’s schedule?

ANSWER: To help the physicians use their

time efficiently

Right!

In Summary

16.1 The appointment book or electronic

allow the office staff to respect the time of both the

day

In Summary (cont.)

16.2 To create a matrix you must know the usual

schedule of physician availability to see

practice) will not be open to see patients

The latter times should be X’d out with a short reason given as to why the time is unavailable

Follow the instructions for the electronic scheduler to block out the appropriate time

frames

In Summary (cont.)

16.3 The most commonly used types of

scheduling systems are open-hours,

time-specified, wave, modified wave, double booking,

cluster, and advance scheduling

It is also common for offices to use any combination of the above as best suits each

practice

In Summary (cont.)

16.4 When organizing and scheduling patient

appointments, always maintain a positive, professional image

The patient’s status should be considered as well as patient preference

The goal is to accommodate the patient, while still maintaining an efficient schedule

Appointments should be confirmed through appointment cards, phone calls, email

notification and mailing recall notices

In Summary (cont.)

16.5 Handling special scheduling situations

requires critical thinking skills and creativity

Scheduling situations can arise if the physician is running late or if a patient requires

an emergency appointment

Other scheduling problems may also include

a patient who does not show, arrives late, or arrives on the wrong day

Document any patient-related appointment issues the patient’s medical record for legal purposes

In Summary (cont.)

16.6 In order to schedule outside appointments

you will require the patient’s demographic and health insurance information along with the procedure or service to be performed and the reason for the service

Preferred dates and times should also be noted

If referrals or prior authorizations are required, you may also be required to obtain

these

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)

End of Chapter 16