1. Chapter 9: Appointment Scheduling Lesson 1: Scheduling Systems

2. Chapter Objectives
Lesson Objectives
Upon completion of this chapter, students should be able to …
Define, spell and use key terms
List and describe four pieces of equipment used in scheduling process.
Name and describe six scheduling systems.
Identify ten conditions that qualify as emergencies. 2

3. Objectives
Explain the importance of correct documentation when a patient does not keep an appointment.
Describe the appointment scheduling process.
Describe and arrange the process for scheduling a hospital admission and surgery.
Summarize the ethical implications related to scheduling. 3

4. Key Terms Acuity New pt Matrix Specific Time
Acute
Exacerbation
Chronic
Remission
Urgent
Emergency
Advance booking
Archived
Cycle Time
Time patterns
Catch-up time
Double booking
Established pt
New pt
Matrix
Specific Time
Wave, Modified wave Open-ended questions
Close-ended questions
Real time
Referral
Scheduling system
Surgery scheduler
Privacy screen
Screen Saver
Subpoena
Tickler file

5. Critical Thinking Question
What factors do you think need to be considered when selecting scheduling system for medical office?

6. Factors to Selecting Scheduling System
Physician’s preference
Type and size of practice
Availability of equipment
Staff availability
Amount of required flexibility
Insurance coverage
Pt needs 6

7. Two Basic Appointment Scheduling Systems
Scheduled appointments
Open office hours 7

8. Purpose of Scheduling System
Assists in flow of office
Provides time management
Increases efficiency
Helps to ensure quality of pt care 8

9. Variations of Appointment Schedules
Specified time scheduling
Wave scheduling
Modified wave scheduling
Scheduling by grouping procedures
Double booking pts
Open office hours system
Lets take closer look at each one of these! 9

10. Specified Time Scheduling
Length of appointment determined by pt need
Up to each staff member to reduce cycle time
Problems in scheduling occur when pt does not indicate full extent of problem and not enough time provided on schedule
Important for office to build in time patterns, allow for
“Catch up” time
Unscheduled emergencies 10

11. Wave Scheduling Provides flexibility for unforeseen events
Purpose to begin and end each hour on time
Each hour is divided into equal parts of time
Three 20-minute or four 15-minute appointments could be seen in 1 hr
3-4 pts told to come in all together at beginning of ea. hr
Pts seen in order in which they arrive
Actual time used by pts averages out over hr 11

12. Modified Wave Scheduling
Built on hr as base of each block of time
Many variations
One example:
Have 3-4 pts scheduled at 10 min intervals during 1st half hr with none scheduled for 2nd half hr
All pts seen during entire hr, but not waiting for late arriving pt
Physician can still spend 20 min with each pt without having to wait for any pts to arrive

13. Comparison

14. Scheduling by Grouping Procedures
Scheduling similar procedures and examinations during block of time
Examples:
Well-baby checkups, sports physicals
New pts
Vaccines

15. Example of scheduling by grouping
Example of scheduling by grouping. All immunizations scheduled for morning appointments.

16. Example of Manual Appointment book

17. Appointment Schedule with Completed Matrix

18. Example of Computerized Scheduling Format

19. Table 9-2 Time Estimates

20. Acuity Need to know, ask open-ended questions! Acute Chronic
Sudden unexpected, severe; usually short term,
Chronic
Long term illness, longer than 6 months
Exacerbation
Sudden flare-up or severe worsening of chronic condition
Remission
Stable period in condition; period of decrease or subsidence of manifestations of disease (temporary vs. permanent)

24. Double Booking Pts
Practice of scheduling two pts during same time slot without allowing for any additional time in schedule
Not efficient type of scheduling system
Same as overbooking
Disadvantage:
If each pt needs 20-minute appointment, and both are scheduled from 1:00 to 1:20, then entire afternoon’s schedule will be at least 20 minutes late

25. Open Office Hours System
Least structured of all systems
Pts may arrive at any time during business hours
Pts seen in order they arrive
Due to disruption of missed appointments, this method preferred by some
Disadvantages to this system include:
Too many pts arriving at same time producing longer pt cycle time
Overworked physician and staff members during peak times 25

26. Reminder card completed and handed to pt after appointment scheduled.

27. Critical Thinking Question
Why might office choose to stay with manual scheduling system rather than invest in computerized system?

28. Computerized Scheduling Systems
Advantages:
Completed in real-time environment
Provides ability to view appointment information with ease
Maximizes office process flow and pt cycle time
Provides ability to track patterns of medical practice
Disadvantages:
Privacy and security issues
Technological factors 28

29. Manual Scheduling Systems
Still used in some small practices and specialties
Consists of hard-copy schedule book
Schedule books come in various styles, sizes, and features
Book selected based on practice needs and preferences
As with computerized system, use of manual system must be in compliance with HIPAA 29

30. Requirements for both Computerized and Manual Systems
Appointment book legal document that can be subpoenaed by court
Record of physician’s day and time spent in contact with pts
Appointment books should be archived for future reference
Kept for several years in event of court case that may subpoena information

31. Requirements for both Computerized and Manual Systems
Files archived by placing appointment book or back-up disks in storage container or facility and keeping then for predetermined number of years
If any changes from scheduled pts in appointment book, noted both in appointment book and in pt’s medical record
If appointment rescheduled, should be appropriately documented as well
NS or Cx

32. Scheduling Pts
For video on scheduling pts go to MyHealthProfessionsKit.com, or insert DVD-ROM at back of your book. 32

33. Chapter 9 Appt Scheduling Lesson 2: Pt Scheduling Process

34. Critical Thinking Question
When scheduling pt, what is critical for success?
Being organized and efficient!
TIME MANAGEMENT

35. Steps to Scheduling Pt Step 4: Use office criteria requirements
Step 2: Gather all information (pt name, tel#, DOB, cc,
MD, office location).
Step 1: Ensure appt book has been
matrixed.
Step 3: Listen to pt’s information and
requests to determine type of appt that
is actually needed.
Step 4: Use office criteria requirements
checklist to help determine type of and time
needed for appt. 35

36. Steps to Scheduling Pt Step 8: Repeat back to pt date and
Step 5: Determine facility, equipment, and staff
availability to meet pt’s needs.
Step 6: Discuss available dates and times with pt. Try to schedule first available that meets pt needs.
Step 7: Enter agreed upon date and time into computer or manual schedule book.
Step 8: Repeat back to pt date and
time of appt. 36

37. Critical Thinking Question
Why is it important to understand difference between definition of established pt vs. new pt?

38. Established Pt
One who has previously seen physician within past three years
Existing medical record/chart that accessed each time pt contacts physician for appt

39. Steps to Manually Scheduling Established Pts
Set up matrix by blocking out all time periods when physician not available for appts
DEMO
Use pencil so that appts can be erased to make changes as needed
Begin with 1st Available appt. in morning or early in afternoon that meets pt needs, and then fill in day whenever possible
Print pt’s full first and last name next to appropriate time on schedule, reason for appt, phone # and DOB
Add Jr. or Sr. if two pts with same name in family

40. Steps to Manually Scheduling Established Pts
Block off required amount of time for appt
Once appt recorded, repeat date and time along with any special instructions back to pt and provide reminder card if pt is in office
Reminder or phone call hr prior
Document appt in pt chart

41. Additional Steps Related to Scheduling Pts Electronically
Be sure scheduling system open
Search for correct pt – this sometimes done by using pt’s Social Security number or chart number
Verify telephone numbers, s, address, insurance, correct; if incorrect, take time to update

42. Definition of New Pt
Has been more than 3 years since physician within practice has seen pt OR
They have never been seen by physician in practice

43. Steps to Scheduling New Pts
Assemble necessary appt scheduling equipment
Obtain pt’s full legal name and correct spelling, birth date, full address, telephone contacts (home, office, cell), and address, DOB
Record pt’s cc and symptoms, ask questions to determine acuity
Request name of pt’s insurance carrier and policy number, verify if accepted

44. Steps to Scheduling New Pts
Ask how pt was referred to medical office
Ask pt if they have preference for morning or afternoon appts
Attempt to accommodate new pt’s request for preferred appt time
Inform new pt of all materials to bring with him/her for first visit
Insurance card, id, medication list
Confirm day, date, and time of appt
Have new pt repeat information for verification
Provide new pt with directions to office

45. Steps to Scheduling New pt
Welcome and thank new pt by name for selecting your medical office
May send registration forms ahead by mail or
, call for appt reminder
If enough time available prior to appt, send all information as discussed with new pt via mail
Document new pt information in new medical record (must create)

46. Addressing Missed appts and No-Shows
Charge pt according to office policy
Contact pt and reschedule
Document missed appt and rescheduled date
Write NS or Cx on appt schedule and in pt chart
Make every attempt to fill void in schedule caused by cancellation 46

47. Advance Bookings and Follow-up
Done for regularly scheduled appts
Ensure pt receives appt card 47

48. Advance Bookings and Follow-up
Tickler file used to remind pts of appts
Information should include day, date, and time of appt
Follow-ups can be made in writing, by telephone, or 48

49. Referrals
When physician sends patient to specialist or other facility for treatment
Requires paperwork be sent to referred physician
Referral recommendation must be in writing
Documentation must be placed in patient’s chart
Preauthorization from insurance carrier must be obtained 49

50. Regular Referrals When primary care physician requests specialist
Authorization can take up to week to obtain
Preauthorization can be obtained by sending information to carrier by fax or , or by calling company 50

51. Urgent and STAT Referrals
Urgent referrals:
Granted for non-life threatening situations
Authorization can take up to 48 hours
STAT referrals:
Approval obtained immediately for life-threatening situation 51

52. Arranging Referral appt
Schedule referral appt as soon as possible
Information required for outgoing or incoming referral includes
pt’s name, contact number, insurance, and referral needs
Referral physician’s name, address, and contact number
Depending on insurance, preauthorization/precertification may be necessary before scheduling appt

53. Steps to Arranging Referral appt
Gather supplies
Open pt chart for insurance information and physician request for referral
Place call to physician’s office to which pt being referred
Identify yourself and physician for whom you are calling
Let office know calling to schedule referral appt

54. Steps to Arranging Referral appt
Before providing pt’s name and other information, verify that practice accepts pt’s medical insurance
Provide pt’s name, address, telephone number, and reason for referral
Record referral appt information in pt’s chart as well as on appt reminder card for pt

55. Steps to Arranging Referral appt
Record name of individual with whom you spoke in chart and on reminder card
Notify pt of date and time of appt and provide reminder card
Verify that pt knows location of office
Forward any pertinent information such as lab tests or X-rays to physician’s office and record them in pt’s chart

56. Steps to Arranging Referral appt
If precertification required, contact pt’s insurance company and request authorization
If completing by telephone, document precertification number, name and telephone of individual who provides number
Provide precertification number and pertinent information to physician’s office where pt being referred

57. Considerations for Scheduling Direct Admit to Hospital
Contact pt’s insurance company for pre-admissions approval
Verify spelling of pt’s first and last name
Verify DOB, SS#, address, phone
Find out if pt has hosp, room preference and if covered by pt’s insurance
Give physician’s statement from pt record as to reason for admission
Ask pt for last admission date in any hospital (if known)
Document person’s name at insurance company who gave pre-approval and precert#

58. Critical Thinking Question
What type of considerations should be given for nonscheduled pts who contact office and want immediate appt?

59. Considerations for Handling Nonscheduled Pts
Determine seriousness (acuity) of pt’s condition
Ask pt for telephone number from where he/she calling and determine if pt alone
Follow office policy and protocol regarding handling emergency situations
Inform physician immediately regarding potential emergency

60. Considerations for Handling Nonscheduled Pts
If physician not available, follow office protocol
May require referring pt to nearest emergency center
Call 911 for pt, stay on the line

61. Questions? Paper scheduling Manual Weekly Matrix Dr. Cho
Applied Practice Ch9 #1 & 2
Dr. Cho/Jackon Wed./Thurs Schedule
Competencies
P9-1 to P9-5 61