1. TEACH Lesson Plan Manual for Kinn’s The Medical Assistant: An Applied Learning Approach
12th edition
Chapter 9
Telephone Techniques

2. Telephone Use in the Medical Office
Lesson 9.1
Telephone Use in the Medical Office
Define, spell, and pronounce the terms listed in the vocabulary.
Determine and discuss the source of incoming and outgoing calls to a physician’s office.
Describe how to develop a pleasing telephone voice.
Explain why courtesy is so important when speaking on the telephone.
Demonstrate the correct way to hold a telephone handset.

3. Telephone Use in the Medical Office
Lesson 9.1
Telephone Use in the Medical Office
Demonstrate the correct way to answer the telephone in the office.
Discuss different ways to handle callers who want to speak to the physician.
List the seven elements of a correctly handled telephone message.
Demonstrate the correct way to record a message accurately and take a request for action.
Demonstrate the most efficient way to call in a prescription or a prescription refill to a pharmacy.

4. Introduction Sources of most calls Established patients New patients
Reports of treatment results or emergencies
Physician referrals
Laboratory results
Pharmacies and patients for prescription refills
Telephone is the lifeline of a medical practice.
Treat all phone calls with respect and courtesy.

5. Active Listening
Practice focusing on the call at hand while juggling several tasks at once.

6. Pleasing Telephone Voice
Use proper enunciation, diction, pitch, and clarity
Use pleasant inflection with friendly, warm tone
Use courtesy and tact
Avoid medical jargon and use correct grammar
Never answer the telephone while eating, drinking, or chewing gum.
Give the caller your full attention and present a professional, friendly image of the office.

7. Telephone Handset
Handset mouthpiece should be 1 inch from lips and directly in front of teeth
Speak directly into mouthpiece of headset, same distance as handset
How do you check the proper distance from a mouthpiece to your mouth? (You should be able to fit two finger widths between your lips and the mouthpiece.)
A person who speaks too quickly, enunciates poorly, or fails to speak directly into the transmitter may not be easily understood by the person on the other end of the line.

8. Maintaining Confidentiality
All communications are confidential
Use discretion when mentioning names, symptoms, or other information
Never use speaker phone
Another individual may hear private medical information, which is a violation of regulations established by the Health Insurance Portability and Accountability Act (HIPAA). 

9. Thinking Ahead Before a call, have all necessary information ready
Have pen and pad ready to take notes
Write down list of questions or goals for conversation
List of frequently called numbers saves time
Keep the call short and simple to free the line for other calls.

10. Answering Promptly Answer quickly and always by third ring
With multiple lines, place first call on hold long enough to ask second caller to hold
If emergency, let others on hold know they may have to wait or be called back
Do not multitask while on a phone call
If the call is an emergency, prompt attention to it could save a life.
You must know how to activate emergency medical services (EMS) in your area.
Treat the phone call just as if the patient were standing in the office.
Procedure 9-1 on p. 143 outlines how to answer the phone in a professional manner using proper telephone techniques.

11. Identifying the Facility
Identify facility first
Say your name
Choose a greeting and practice saying it
Why do some physicians avoid using the title "Dr." when calling a patient? (To protect their patient’s confidentiality, particularly when calling a shared line or place of work.)
Never rush. All callers should be able to clearly understand exactly what is said.

12. Identifying the Caller
If caller does not identify self, ask who is calling
Write name down immediately
Try to use caller’s name at least three times during conversation
Handle callers who will not identify selves according to office policy
Unidentified callers could be a patient; therefore, every attempt to identify the patient and assist him or her should be made.
Such callers may also be salespersons who are fully aware that if their identity is revealed, they will never get the opportunity to speak to the physician.

13. Screening Incoming Calls
Learn physician's preferences for receiving calls or returning later
Explain that physician will return calls as soon as possible
Provide approximate time frame for when caller can expect to hear back
Ask for phone number of caller
Record messages accurately and document calls
Find out exactly how calls are to be handled when the physician is out of the office and under what circumstances he or she can be interrupted when on the premises.

14. Minimizing Wait Time Keep callers on hold as short a time as possible
Once per minute, check back in with patient holding for physician
Offer to have call returned, rather than wait on hold
Always thank caller for waiting
Requests that might require pulling the patient's chart from the files are best handled with a call back to the patient.
Remember that leaving a person on hold ties up one of the physician's telephone lines, and an emergency call could be coming through or new patients might be attempting to call.

15. Transferring a Call
Ask permission when placing caller on hold and to transfer calls
Identify caller to person receiving transferred call
If unavailable, ask caller if he or she would prefer to leave a voice mail or take a message
Know how to direct calls to appropriate staff member
Any person who refuses to give a name should not be put through unless the medical assistant has been specifically instructed to do so.
Because the physician's office often is a hectic place, most require that a message be taken so that the medical record can be reviewed, the patient's request considered, and the patient called back with questions or instructions from the doctor.

16. Taking a Telephone Message
Use message pad or computer system to record the following:
Name of call recipient
Name of caller
All contact numbers for caller
Reason for call
Action to be taken
Date and time of call
Initials of person taking call 
Never use small scraps of paper for messages; they are too easily lost.
Impression-sensitive message pads, which provide a copy of each page, ensure that no message is forgotten and are the best way to keep track of handwritten messages.
Electronic software systems usually populate the name, address, phone number, date, and time of a message; therefore, you only need to type in the reason for the call and what the patient would like the physician to do.

17. Taking Action on Messages
Message procedure incomplete until necessary action is taken
Add notation to carry over to next day, if necessary
Note patients’ attitudes if significant, to help physician when returning call
Do not trust to memory messages that were not attended to from previous days; always carry them forward either electronically or in writing.
Procedure 9-2 on p. 145 outlines how to take a telephone message.

18. Ending a Call End calls promptly
Thank caller, close conversation with a form of goodbye
Allow caller to hang up first
Do not encourage inappropriate chatting or permit the call to monopolize your time unnecessarily.

19. Retaining Records of Telephone Messages
Office should have policy on retention of message records
Electronic systems should send directly to medical record
Keep handwritten message pads for period of statute of limitations
Make sure accurate telephone records are kept to ensure good patient care and customer service.

20. Directions
Clear set of directions written out to read to caller, if requested
Prepare directions from various points in the area
Place map on office Web site for patients to print
Do not refer to Internet mapping site
Place these directions close to the telephone so that all employees can access them easily.

21. Inquiries about Bills
If patient calls with billing question, obtain ledger from computer or files
If routine, ask if you can help answer the question
Arrange payment plan and note call in medical record
Refer to billing office if necessary
What practice can reduce the number of calls relating to bills? (Properly advising patients about charges at the time services are rendered)

22. Inquiries about Fees
Give estimates of fees before patient sees physician
Follow estimates by stating that fees vary depending on patient’s condition and tests ordered
Have schedule of fees available
If fees are regularly discussed on the telephone, write a suggested script in the policy manual.

23. Participating Provider
Patients call to inquire if physician is a participating provider with their insurance plan or managed care organization
Keep updated list of valid plans by phone
Insurance benefits vary for participating and nonparticipating providers, and a claim will be denied or reimbursement lessened if the physician is not a provider for the patient's insurance company.

24. Requests for Assistance with Insurance
Medical facility typically files insurance claims
Patients may call to require about claim status
Answer inquiries patiently and provide help
Insurance is a difficult subject to understand, even for trained individuals familiar with the various forms and procedures.

25. Radiology and Laboratory Reports
Urgent reports may be faxed, telephoned, or ed to physician’s office
Relay reports to physician
If marked STAT, physician wants results immediately
Original reports usually are delivered by mail for the medical record.
Some facilities receive laboratory results directly from the laboratory by computer.

26. Satisfactory Progress Reports
Physician may ask patient to report on condition a few days after visit
Take calls and relay information to physician if report is satisfactory
Immediately inform physician if report is unsatisfactory
The doctor should provide instructions for the patient to follow in case of an unsatisfactory report.

27. Routine Reports from Hospitals
Hospitals and other sources may call to report a patient’s progress
Take message carefully and give to physician
What should you do after giving the message to the physician? (After physician sees message report, file it in patient’s medical record.)

28. Office Administration Matters
Calls may not refer to patients
Accountant, auditor, office suppliers, office maintenance, etc.
Handle calls or refer to appropriate person
For some of these calls, you may need to gather additional information and return the call.

29. Requests for Referrals
May be handled without consulting physician, if a list of referral practitioners is provided
If insurance plan requires a written referral, physician must handle
Most physicians require office visit to discuss referral
Then call referral physician and notify of referral
Document all referrals in medical record
Handle these calls as quickly as possible so that the patient may make an appointment to see the referral physician.

30. Prescription Refills
Pharmacies call to obtain approval for patient’s refill
Any refills should be authorized only with physician's approval
Check with physician and call back
Some medications require written prescription
Make sure state regulations and procedures are followed any time you deal with prescription refills or calls.
Procedure 9-3 on p. 148 outlines the procedures for calling the pharmacy with new or refill prescriptions.

31. Patients Refusing to Discuss Symptoms
Some patients may insist on only discussing symptoms with physician over phone
If patient refuses, suggest he or she make appointment to discuss in person with physician
The physician cannot be expected to take numerous calls from patients who do not want to speak to the medical assistant.

32. Unsatisfactory Progress Reports
Do not give medical advice to patients
Make detailed notes about patient’s unsatisfactory progress
Present notes to physician
Follow up with patient with physician’s instructions
The physician may make a medication change or may decide that the patient should return to the office.

33. Requests for Test Results
Patients call for test results
Physician must see results and give permission to share results with patient
Only provide abnormal test results if authorized, and give further instructions
Refer any questions to physician
Patients do not always understand that the medical assistant does not have the privilege of giving out information without the permission of the physician.
If the result is unfavorable, the physician should be the one to inform the patient and give further instructions.

34. Requests for Test Results, cont’d
Schedule appointment with physician for serious abnormal results
These types of results best relayed in person
Identify patient properly before giving results
Patient must give written permission before any information may be given to third-party callers
Staff members may breach HIPAA regulations if they do not identify the patient accurately.
Third-party callers include insurance companies, attorneys, relatives, neighbors, employers, and any other third party.

35. Complaints about Care or Fees
Explain charges by reviewing bill with patient
If patient is angry, offer to pull chart, research problem, and discuss with physician
Reassure patient you want to help
What four magic words often calm the angry patient? (“Let me help you.”)
If you are unable to appease the patient easily, the physician or office manager may prefer to talk directly to the patient.

36. Personal Calls Personal calls to physician Personal calls to staff
Handle according to physician’s instructions and be tactful
Personal calls to staff
Only take personal calls in case of emergency
Emergency calls could be coming through, and the lines must be clear.

37. Specialty Calls, Telephone Services, and Equipment
Lesson 9.2
Specialty Calls, Telephone Services, and Equipment
Explain how angry callers might be handled.
Discuss how the medical assistant should handle callers who have a complaint.
List several questions to ask when handling an emergency call.
Discuss several useful sections of the introductory pages of the phone directory.

38. Angry Callers Take required action
Acknowledge importance of call and reassure caller of your assistance
Lower tone of voice and volume to encourage calm manner
Avoid getting angry and try to get to root of real problem
Express interest, take careful notes, and follow through
Never "pass the buck" by saying, "That isn't my job," or "I am not the person who filed that insurance claim."
No matter whose fault the problem is, it is best to deal with it and find a solution instead of placing blame.

39. Aggressive Callers
Insist they receive whatever action they feel necessary immediately
Treat them with calm, poised attitude
Do not let aggression force you to take inappropriate action
Explain when caller can expect a response from office
Follow up that appropriate action was taken
Reassure the caller that the concern being shared is valid and will receive the full attention of the right person.

40. Unauthorized Inquiry and Sales Calls
Callers requesting information to which they are not entitled should be politely denied
Keep sales calls quick
Know which companies and reps office works with
Developing a good rapport with representatives ("reps") from the companies whose products are frequently used in the practice may result in discounted prices and first news of sales and promotions.

41. Physician Shopping
Prospective patients call seeking information about medical office
May want to know physician’s background before selecting the office
Be polite and answer questions respectfully
Even if the caller does not become a patient, he or she may share his or her impressions of the practice with another prospective patient.

42. Complaints
Find source of problem and present options to caller for resolution
Treat callers in same way you would wish to be treated
Complaint may seem small to you, but is paramount to patient
Good customer service remedies many complaints
When callers complain, use an approach similar to the one used with angry callers.

43. Callers with Difficulty Communicating
If callers are not primarily English speakers, they may be difficult to understand
Use listening skills to understand
Ask questions to be sure you understand
If a certain language is predominant in the area, the physician should consider hiring a medical assistant who is bilingual.

44. Emergency Calls Require good judgment from person answering calls
Know what constitutes a real emergency and how to handle it
Never hang up on emergency until help arrives
Urgent calls require prompt attention but are not life-threatening
Policies and procedures manual should dictate what to do
What are some examples of true emergencies? (Chest pain, profuse bleeding, severe allergic reactions, cessation of breathing, loss of consciousness, and broken bones)
What are some examples of urgent calls? (Adult with fever over 102°F, an animal bite, or increasingly painful ear infection)

45. Emergency Calls, cont’d
Emergency calls may need to be transferred to physician if possible
Written plan of action in case physician is not available to handle call
Develop typical questions to ask caller to determine nature of emergency
What types of questions may be asked to determine the validity and disposition of the emergency? (Answers will vary, but a list of examples is available on p. 151.)

46. Screening Guidelines One person may be designated to screen calls
Written telephone protocol should dictate how to handle urgent and emergency situations
Emergencies should be transferred to physician
The protocol should state that the employees are bound by the written guidelines and that any giving of advice by unauthorized personnel may be grounds for dismissal.
Additional instructions should include what action to take if no physician is available, such as sending the patient to an emergency department or calling an ambulance.

47. Obtaining Information for Physician
Duration of symptoms
Remedies tried at home
Specifics about symptoms
One way to learn about questions to ask is to listen to the physician carefully as he or she questions patients about their symptoms.
Remember to always be "patient with your patients."

48. Typical Outgoing Calls
Most are responses to incoming calls
Plan outgoing calls in advance
Organizing calls increases efficiency
Remember to treat those on the other end of the phone as you would wish to be treated.

49. Voice Mail Around-the-clock method to receive patient messages
Answer voice mails messages promptly
Voice mail allows the caller to hear a recorded message that may also provide information about what to do in case of an emergency.

50. Answering Services
Provide an operator to answer calls when office is closed
May also answer when office is open, but staff cannot answer a call
Check in with answering service each evening and morning
An answering service can act as a buffer for the physician and help eliminate too-frequent, unnecessary calls during the late evening or night hours.

51. Automatic Routing and Call Forwarding
Automatic call routing has automated message with list of options to route calls
Call forwarding allows user to forward calls to another number to prevent missing important calls while away
The impersonal nature of automation does not lend itself well to answering the telephone in a small to medium-sized physician's office.

52. Caller ID and Blocking
Caller ID allows user to see who is calling before picking up
Caller ID blocking blocks calls from unknown numbers
Some physicians often use a blocker (e.g., *67) before calling patients so that the patient will not have access to the physician's personal phone numbers.
Patients may need to be educated about this procedure so that the physician can reach them easily when calling after established office hours.

53. Fax Machines
Allow user to send and receive copies of printed documents over telephone lines
Protect confidentiality by using cover sheets and alerting recipient fax is coming
A fax machine can be a great time and labor saver in conveying patient information from physician to physician or from physician to hospital.

54. Headsets Keep hands free while talking on phone
Many are lightweight and made for mobility
Some also have a quick-disconnect feature that allows the user to separate the headset even during a call without breaking the connection.

55. Long-Distance and Special Services
Efficient way to get information quickly
Directory assistance can provide numbers
Internet searches are a free way to obtain numbers
Consider the different time zones before placing calls
Often a fee is charged for using directory assistance, so look for the phone number using free sources whenever possible.
If you reach a wrong long-distance number, be sure to obtain the name of the city and state that was called, and report this information promptly to the local operator so that the facility will not be charged for the call.

56. International Service
International Direct Distance Dialing (IDDD)
International code 011
Country code
City code
Local telephone number
The pound sign (#) button if the telephone is touchtone
After dialing any international code, allow at least 45 seconds for the ringing to start.

57. Conference Calls Connect numerous points for a conference
Each person can hear or talk to all others participating
Set up by a normal long distance operator or through conference call services
Schedule a call by relaying pertinent information about time, date, and the individuals included
It has exceptional value in family conferences when a quick decision by the entire family regarding a patient's condition is required.

58. Operator-Assisted Calls and Services
Person to person
Billing to a third party
Collect calls
Requests for time and charges
Certain calls placed from hotels
Credit for wrong numbers
Conference calls
Some international calls
Operator-assisted calls through most phone service providers have an initial charge and a service charge.
Try other alternatives before making an operator-assisted call.

59. Number and Placement of Telephones
Know how to use multiple-line systems
Place phones where accessible but private
Courtesy phone for patients to use upon request
Two incoming lines, along with a private outgoing line with a separate number for the physician's exclusive use, is the minimum recommended number of lines.

60. Using a Telephone Directory
Primary purpose is to provide lists of those who have telephones, their telephone numbers, and in most cases their addresses
Aid in checking spelling of names and in locating certain businesses
Introductory pages
Alphabetic pages (white pages)
Yellow pages
Take a few moments to become familiar with the local directory, then use it frequently for getting information quickly.

61. Personal Phone Directory
Include all numbers frequently called
Emergency numbers might be typed on a colored card or flagged with a colored tab
Organize telephone numbers in a tabbed 3- × 5-inch desktop file or a rotary file.

62. Identifying Community Resources
Keep a list of community resources that might be of assistance to patients
Information can be found in first few sections of telephone book
Patients often call the physician's office looking for information on various community resources.

63. Patient Education
Recordings that offer health information can play while patients wait on hold
Messages about special events can be announced
Phone directories can offer listings of health information
Such features help address the needs of today's more information-oriented healthcare consumers, who are interested in healthy lifestyles and in gaining useful information immediately.

64. Legal and Ethical Issues
Take care that no one overhears sensitive information while on the phone
Do not place or receive personal phone calls during work hours
Telephone and message records may be brought into court as evidence
Make sure all messages are complete and legible
The telephone is a business line and should be reserved for patients and others conducting business with the office.

65. Questions?