Kinn’s The Medical Assistant, 14th Edition - Chapter 9 Study Notes

Scheduling Appointments and Patient Processing

Learning Objectives

Objective 1: Describe guidelines for establishing an appointment schedule and creating an appointment matrix.
Objective 2: Discuss the advantages of computerized appointment scheduling.
Objective 3: Discuss appointment book scheduling and explain how self-scheduling can reduce the number of calls to the healthcare facility.
Objective 4: Discuss the legality of the appointment scheduling system.
Objective 5: Discuss pros and cons of various types of appointment management systems.
Objective 6: Discuss telephone scheduling and identify critical information required for scheduling appointments for new patients.
Objective 7: Discuss scheduling appointments for established patients.
Objective 8: Discuss how the medical assistant should handle scheduling of other types of appointments.

Establishing the Appointment Schedule

Effective Scheduling Importance: Allows providers adequate time with patients.
Factors for Scheduling:
- Patient's needs
- Provider preferences and habits

Patient Needs

Consider demographics when determining office hours and appointment times.
Allot visit time based on patient needs for each individual visit.
Ensure a balance between meeting patient needs and provider preferences with available facilities.

Provider Preferences and Habits

All preferences and habits play a vital role in scheduling.
Providers have additional responsibilities including making phone calls, examining and dictating reports, attending meetings, and answering mail.

Creating the Appointment Matrix

Matrix Creation Steps:
- Block out times when providers are unavailable.
- In a paper-based system, the matrix is typically established for six months; in computerized systems, it can be set up indefinitely.

Establishing Guidelines for Appointment Scheduling

Scheduler must know the duration of various office visits and procedures.
Use the office policies and procedures manual for time requirements.
Note that provider reimbursement from insurance companies often depends on the time required for procedures.

Available Facilities

Medical assistants need to match patient needs with available facilities during scheduling.
As proficiency increases, matching patient needs with available facilities becomes easier.

Methods of Scheduling Appointments

Common Methods:
- Computerized systems
- Appointment book/paper-based systems

Computerized Scheduling

Characteristics:
  - Ranges from simple to sophisticated practice management software.
  - Can select optimal appointment times based on entered information.
  - Keeps track of future appointments and provides printouts of schedules.
  - Multiple access for staff allowing everyone to stay informed.

Appointment Book Scheduling

Various styles are available, some color-coded and offering multiple columns for multiple doctors in a group practice.

Self-Scheduling

Benefits:
  - Patients can view schedules online and select their own appointment times.
  - Reduces call volume to the office, available 24/7.
  - E-mail reminders can be sent to request appointment confirmation.
  - Phone-in appointments should still be offered.

Legality of the Appointment Scheduling System

Must maintain accuracy as it can be used as a legal record.
Missed appointments should be noted in the medical record.
Pencil is recommended in appointment books for easy changes.
Keep patient names and phone numbers documented.
Appointment books should be retained per state statute limitations and shredded afterward to maintain privacy.

Types of Appointment Scheduling

Different types must meet the needs of facilities, providers, and patients.
Some offices combine various methods to ensure smooth operations throughout the day.
Medical assistants must be proficient in managing appointments.

Appointment Scheduling Types

Time-Specified (Stream) Scheduling

Allows practitioners to see more patients while reducing pressure on scheduling.
Requires multitasking skills and efficiency.
Important to understand how long each procedure takes and to prepare any pre-visit paperwork.

Wave Scheduling

Provides flexibility within each hour.
Typically does not schedule patients at exact intervals; rather, several patients arrive at once and are seen in order of arrival.

Modified Wave Scheduling

Example:
- Two patients scheduled at 10 AM and one at 10:30 AM, repeating throughout the day.
- Patients arrive during the first half of the hour with none scheduled in the second half.

Double-Booking

Not recommended as a practice to book two patients at the same time unless one will take significantly less time.
Use double-booking with caution and reflect accordingly on the schedule.

Open Office Hours

Patients can come in at various times, seen in the order of arrival.
Commonly used in labs, imaging facilities, urgent care clinics, and emergency departments.
Disadvantages include potential overcrowding, long waits, and inconsistencies in staff workload.

Grouping Procedures

Categorizing procedures can facilitate scheduling.
Medical offices may experiment with different grouping methods to find what works best.
Consider using color-coding for different appointment types.

Telephone Scheduling

Guidelines

Be pleasant and helpful while scheduling.
Strive to accommodate patient requests for appointment times, offering alternatives if not possible.
Encourage offering two choices for time slots, empowering patients in their scheduling.

Confirmation

Always repeat the appointment time and date at the end of the call.
Ensure patients have resources to jot it down (pen/paper).
Check entries in the appointment book or computerized system for accuracy.
Record details legibly in appointment systems and obtain a daytime contact number.

Scheduling Appointments for New Patients

Careful Attention Needed

Requires tact, courtesy, and professionalism.
Request preliminary information to estimate appropriate appointment duration.

Steps to Follow

Offer the first available appointment and provide a choice between two times.
Provide directions and parking information if relevant.
Discuss payment options as needed.
Repeat appointment details back to the patient for clarity and thank them for calling.

Information Packets

Some offices send out information packets to new patients.
If it’s a referral, check with the referring provider for additional information before the appointment.
Provide referral information to the attending provider beforehand when required.

Scheduling Appointments for Established Patients

In Person

Arrange for most return appointments when patients are leaving.
Ensure all patients check in at the front desk for scheduling needs and updates.

By Telephone

When scheduling, know only when the patient is expected to return.
Recap any necessary information and check on what previous instructions were provided.

Scheduling Other Types of Appointments

Include scheduling for:
  - Inpatient surgeries
  - Outpatient and inpatient procedures
  - Outside visits
  - Providers and representatives from the pharmaceutical industry
  - Sales personnel

Inpatient Surgeries

Contact the facility to schedule as soon as the surgery is planned.
Provide all necessary information, including any special provider requests and insurance details.

Outpatient and Inpatient Procedure Appointments

Arrange laboratory and radiography appointments as necessary.
Ensure pertinent information is accessible before making the appointment.
Include MRI, CT scans, x-ray evaluations, ultrasonography, and basic blood tests, along with providing the patient with all contacts for the facilities.

Outside Visits

When providers conduct house calls or visit skilled nursing facilities, establish regular time slots in the appointment schedule.
It is essential to prepare the medical bag before such visits for adequate ready resources.

Pharmaceutical Representatives and Salespeople

Screen pharmaceutical representatives entering the office.
Specialists often limit representatives to those specific to their field.
Be cautious with unsolicited sales personnel.

Special Scheduling Appointments and Patient Processing

Special Circumstances

Methods for dealing with patients who arrive consistently late need to be established.
Office protocols for rescheduling appointments must be clear.
Procedures to handle emergencies, provider referrals, and patients presenting without appointments are critical.
Strategies to manage failed appointments and no-shows are necessary to increase attendance.

Addressing Late Patients

For patients who are habitually late, consider scheduling them last for the day.
Some may need to be asked to arrive 30 minutes early to their appointment.
Develop fallback plans for accommodating those with occasional issues arriving on time.

Rescheduling Patients

Account for unexpected conflicts that cause rescheduling.
Remove previous appointment details from the schedule and establish a new appointment as well.

Emergency Situations

Implement a screening protocol to prioritize emergencies, ensuring they’re seen first.
To recognize urgency, prepare a set of questions for systematic reference.
Patient emergencies should prompt immediate action, and information like name and location should be gathered quickly.
Avoid putting emergency calls on hold.

Patients Without Appointments

Establish a clear policy regarding patients presenting without prior appointments.
Accommodate patients needing immediate attention.
If not urgent, brief visits can help set appointments for later.

Handling Failed Appointments

Identify reasons for missed appointments, such as forgetfulness, financial issues, or denial about health conditions.
Understanding these reasons is essential to rectify recurrences.
If health is jeopardized, certified letters should be sent to address missed appointments, with a copy retained in the medical record.

Managing No-Shows

A defined policy addressing no-shows must be established and enforced.
Keep track of first-time no-shows in patient records; escalate with warnings and potential drop-off of the patient with repeated offenses.
Providers can consider charging for missed appointments—especially if the time cannot be filled—while maintaining an understanding stance.

Automated Reminders

Utilize automated call routing to remind patients of their appointments.
Appointment cards serve as reminders, and utilize e-mail functionalities within scheduling programs for reminders.

When Patients Cancel

Maintain a list of patients willing to fill in for openings caused by cancellations.
Log each cancellation in the patient record, stating a reason if obtainable.

When Provider Delays Occur

If aware of an impending delay, proactively call patients to suggest a later arrival.
Keep arriving patients informed about delays, especially if they result from emergencies.

Ensuring Provider Availability

Establish communication procedures for when providers encounter emergencies.
Verify that rescheduling is performed if appointments get affected and if quick cancellations are necessitated.

Patient Processing Tasks

Screening Arrivals

Medical assistants must screen patients upon arrival for varying conditions:
  - Emergent conditions
  - Pharmaceutical representatives
  - Sales visitors

Patients’ Arrival Protocol

Professional treatment upon arrival is essential.
Always use the patient’s name and greet them promptly.

Check-in Procedures

Verify eligibility and scan/copy insurance cards.
Collect copays prior to the office visit where applicable.

Special Needs Assistance

Acknowledge that some patients may require additional accommodations.
Be sensitive towards physical challenges, illness, and any possible language or cultural barriers.

Patient Consideration

Place signs in the reception area assuring patients to inform staff if they’ve waited longer than 15-20 minutes.
Notify patients of delays to keep them informed and reduce frustration.

Escorting Patients

Patients generally prefer to be escorted to examination rooms.
Understanding office policy on supplementary individuals in the room is vital for comfort.

Managing Unique Patient Scenarios

Talkative Patients: Identify tendencies in initial interviews and manage history accordingly. Schedule for the end of the day if required.
Children: Parents should be responsible for child conduct in the office environment. Avoid disciplinary actions toward children by medical staff.
Angry Patients: De-escalation techniques and preventive measures should be in place to address potential aggressiveness from patients.

Patient Checkout Procedures

Welcome patients back with a smile and use their names.
Check the health record for follow-up instructions and schedule return appointments as directed.

Patient Information Booklets

Provide informative resources regarding office policies and procedures, helping to prepare patients for engagement in scheduling systems.

Legal and Ethical Considerations

Appointment schedules are legal records and may be subpoenaed.
Ensuring legible handwriting and consistent information entry is crucial.
All no-shows must be documented and appointments retained in line with statutes of limitations.

Final Notes

Be prepared to discuss any questions or clarifications regarding patient scheduling or processing.