chapter 22: scheduling appts & receiving pts

How is most scheduling done and what does it require?

Scheduling is done over the phone and requires good communication & organization skills. Also need to be able to triage (who goes first) over the phone

Acute condition

Sudden onset, severe; appendix burst

Someone bends over and can’t get back up; subluxation of vertebrae

Chronic condition

Long term; diabetes, hypertension

Office hours

When the office is occupied, but isn’t seeing patients (doing administrative work like answering phones, restock exam rooms, ordering meds, etc)

Patient hours

AKA Flex Time. Treating patients. Time slots that are blocked off

Slack time

Open appointment times to accommodate walk-in’s or longer appointments

Interpersonal skills

People skills/soft skills

Hard skills

EKG, vital signs, ultrasound skills

Matrix

An outline of all available appointments and blocked off unavailable appointments for the day, week, month, year

Practice Management (PM) system

Does the admin side of practice → front end

MR/EMR

Electronic medical record

EHR

The EMR & PM put together

Vendor

Seller. Who is selling the syringes, copy paper, computers, maintenance of copiers

Force or fine

Look for a small time slot where a patient could fit in

CPE/CPX

Complete physical exam

NS

No show (never appear, no idea why)

Screenshots

What you’d see if the computer program was open in front of you

Recall tab

To bring back

• ex, Patient comes in with respiratory. On the way out, MD says “recall them in 10 days”, meaning bring them back in

Forced appointment

Trying to find some little time frame to bring patient in that would imply that the patient’s necessity of care immediately is great

The type of practice may dictate the _____

Scheduling

• ex. OB/GYN- OB mon/wed/fri & GYN tues/thurs

Clustering

everyone getting the same procedure

Double booking

Scheduling 2 patients for same time slot. It’s a problem if the provider is to see 2 patients at the same time, not a problem if the patients are to see 2 different providers.

Walk in/urgent care

Don’t know what types of care will be required. Need to triage

Single booking scheduling

One appointment at a time

Streamin scheduling

Most widely used form of scheduling, keeps a steady flow of patients

Wave scheduling

Schedule patients only for the first 30 minutes of the house

Modified wave scheduling

Schedule patients only for the last 30 minutes of the hour

What is the scheduling method that makes the most efficient use of staff and facilities?

Clustering

Is a patient is habitually late, when do you schedule them?

At the end of the day

Obliterated

To cover up (use of white out). After discharge if patient, any obliteration will be questioned.

What proof do you need that the patient was at the office?

Drivers license and insurance card

Statute of limitations

Governed by discovery rule. How long you have to sue, you don’t have unlimited time; changes from state to state & reason to reason.

How are corrections made in a medical record?

A single thin line, initials, credential, and correction

When should the patient be informed about a wait time?

When the wait is longer than 30 minutes. Offering the patient solutions (grab a coffee, run an errand, new appointment) is good patient relations

Audit trail

Paper trail. Able to look and see how something developed. Every conversation, text, email

Informed consent

Patient has been told the risks & benefits of a drug/procedure. It is a responsibility of the MD to get informed consent → called non-delegated duty (can’t give it to someone else to do)

H&P

History & Physical Exam. 2 main parts of the chart

ROS

Review of systems. Can be the physical exam or depends on the MD & what’s being done

HPI

History of the present illness. When did it start? What are your symptoms? What allows the MD to zone in on what may be wrong with you?

Alternative hours

Off hours/late hours/saturdays

After how many no shows does the provider determine if they want to withdraw?

3

How to schedule over the phone

Phone #, new patient?, established patient?, why you want to be there, insurance company/plan,referral

Closed chart

Patient is unlikely to return

Paper chart

Patient has been there within last 2-3 years (active)

Tickler systems

Reminder systems, phone calls, emails, texts, etc. They are HIPAA issues so we have to make sure not to violate them.

In managed care, HMO system, who makes the referrals?

PCP makes referrals to a specialist

How late must a patient be for the appointment to be cancelled?

10-15 min. All appointments for which the patient is late, cancels, or is a no-show needs to be noted on the appointment sheet and in the chart.

Bakery receipt

Check in method/sign in form. Some offices require patients to do it electronically in advance.

Encounter form

Charge slip/multipurpose bill/superbill. Has ICD and CPT codes on it (ICD and CPT codes must agree)

Meeting with the doctor is called an _____

Encounter

ICD

international classification of diseases is the diagnoses code. What do I think is wrong with you?

CPT

Current procedural terminology. What did I do for you? Examined? Consult?

What does the PM deal with?

Front end

What does the EMR deal with?

Clinical

Assignment of benefits

Patient will sign off that the MD can be paid directly by insurance. The MD will be paid whatever the patient is entitled to or flip it around. The patient is saying “Whatever you owe me, you give to the MD directly”. Becomes a problem because the MD may take the $ and say “You still owe a balance” ($100 bill, AoB MD gets $50 & tell pt you owe $50)

HIPAA compliant release

Specific as to what you want & why you want it. It expires. The release/records need to be transmitted while release is valid.

Elective procedure

One of choice, insurance does not pay, MD wants $ up front

Patient bill of rights

For ambulatory care & hospital → what can expect from facility & vise versa

The term “payer” is referring to the …..

Insurance company

Who is the best person to discuss payment planning?

Billing service

Truth in lending act

Federal law. Need a writing with the patient to pay the bill in more than FOUR payments. Anything less, don’t need writing.

What should the credit card receipt never reveal?

The treatment