1. Today's Medical Assistant
Chapter 42
Scheduling Appointments

2. Introduction to Appointment Scheduling
It is important to create a schedule with minimal waiting for the patient
It is important to facilitate the smooth function of the office
How can conflict arise between the needs of the office and the desire of the patient to be seen as soon as possible after arriving at the medical office?

3. Guidelines for Appointment Scheduling
Maintain confidentiality of the patient
Speak clearly and do not appear to be rushed
Concentrate on the person to whom you are speaking
Why is it important for the medical assistant to concentrate fully when scheduling an appointment by telephone? In person?

4. Guidelines for Appointment Scheduling
Obtain necessary and complete information
Repeat information for accuracy
Schedule the proper amount of time for the type of appointment
Document all necessary information
Why should the medical assistant get in the habit of repeating information back to a patient when collecting demographic data? When making an appointment?
Why do medical offices usually allow more time for some appointments than other appointments?

5. Appointment Book Scheduling
Appointment book is usually spiral-bound so that it will lie flat
Each physician usually has his or her own book
Choose a book that suits the practice
What factors might be considered when choosing an appointment book?
If your practice had two physicians, would you prefer to use one appointment book for both physicians or a separate appointment book for each physician? Why?

6. Appointment Book Scheduling
Pages may be set up in 10- or 15-minute intervals
Appointment books usually kept in pencil
Changes can be made easily in the appointment book
Daily schedule is typed and used for permanent record
What are the advantages of basing the appointment schedule on 10-minute intervals versus 15-minute intervals?
What are the implications if a manual appointment book is kept in pencil? In pen?
How is a daily schedule created if the office uses a manual appointment book?

7. Computer Scheduling Appointment intervals can be adjusted
Each physician has a screen for each day
Easier to change appointments or set up repeating appointments
Daily appointment schedules can be printed
Why is it important to set up the basic appointment interval in a computer scheduling program before beginning to make appointments?
What are advantages and disadvantages of using a computer appointment scheduling program?

8. Daily Appointment Schedule
Used to pull medical records for patients
Used as a list of patients who will visit the office
Official schedule is a legal document
Additions in black ink
No-shows and cancellations on the day of the appointment marked in red ink
Posted in area inaccessible to patients or covered with a sheet of paper
To protect patient confidentiality
What is the daily appointment schedule used for?
When should the daily appointment schedule be created if using a manual appointment book? A computer scheduling program?
What are the implications if the daily appointment schedule is a legal document?
How is the daily appointment schedule posted so that staff have access to it but patient confidentiality is protected?

9. Time-Specified (Stream) Scheduling
Most common way to handle appointments
Steady flow of patients (like a stream)
The length of time scheduled for the appointment depends on the patient’s needs
30-45 minutes for a new patient
10-20 minutes for an established patient
30-45 minutes for a physical examination
Why do some offices schedule more time for individual appointments than other offices?
What are the advantages and disadvantages of patients arriving in a steady stream for appointments?

10. Wave Scheduling
Patients arrive in “waves” so that there is always a patient waiting
Three or four patients are scheduled every half-hour
Patients are seen in the order in which they arrive
Sometimes ill patients are taken before those with routine appointments
How do patients react if they realize that one or more other patients may have been given the same appointment time?
If three patients have the same appointment time, which patient is seen first?
What are the advantages and disadvantages of patients arriving in “waves” for appointments?

11. Modified Wave Scheduling
Patients given appointments at specific times during the first half of each hour
Several appointments
One long appointment, such as physical examination
Second half-hour used for wave
Work in patients
Finish appointments from the first half-hour
Schedule several rechecks on the half-hour
What are advantages of the modified wave appointment scheduling compared to wave scheduling?
Why is it often very helpful to have two or three patients who may not need a long time for appointments scheduled for the same appointment time?

12. Double Booking Two patients are given the same appointment time
One patient may be seen by physician while the other is having diagnostic tests performed
It is a way to work in urgent patients
Why do many offices double book patients?
If the medical office uses double booking as a method to add patients with urgent problems to the schedule on the day of the appointment, how will this affect the flow of appointments?

13. Types of Scheduling
Which of these types scheduling is the most precise?
Which of these types of scheduling is the least precise?.
Which of these types of scheduling would you prefer and why if you are the medical assistant? If you are the patient?

14. Open Booking Patients told a range of hours for their visit
Used in clinics
Used for urgent care before or after office hours
Works best where there is a constant stream of patients
Patients seen in the order in which they arrive
What experience have you had with open booking? Did it increase your waiting time?
When is open booking usually used?

15. Clustering or Categorization
Scheduling patients with similar problems or conditions together
Physical examinations
Prenatal patients in an OB/GYN practice
Patients having the same diagnostic procedure
Can be an entire day or part of day
Do physicians like to do several physical examinations or examine several new patients back to back? Why or why not?
Why are pregnant patients often clustered at a different time from patients with infertility problems?
How might a pediatric office cluster patients?

16. Multiple Offices Physicians may see patients in different offices
Appointments may be booked through a central system or at each individual office
If booking centrally, it is important to clarify with patient which office he or she wishes to visit
Paper medical record will need to move from office to office
What special concerns arise related to appointment scheduling if there is more than one office belonging to the same practice?
Why might a medical practice schedule appointments for multiple offices from a central office? From each office independently?
Why are patients encouraged to select one office if a practice has more than one location, and make most appointments at that office?

17. Setting Up the Appointment Schedule
Appointment matrix usually set up for 6 months in advance
Appointment matrix shows available appointment times
Times when a physician is not available to see patients are blocked
Why is the appointment matrix usually only prepared six months in advance?
What are typical reasons to block times from the physician’s appointment schedule?

18. Setting Up the Appointment Schedule
In a computer system, blocked times are usually a different color from available appointments
Several factors influence the appointment matrix
Scheduling system
Physician preferences and needs
Facilities and equipment
What are examples of the effect of facilities and equipment on the appointment matrix?

19. Appointment Intervals
Appointment interval is minimum time unit allotted for one appointment
10-minute interval
15-minute interval
20-minute interval
Patient may be given more than one block of time depending on type of appointment
All appointments are multiples of the basic appointment interval
How does the time interval for a basic appointment affect the appointment matrix?
Which type of appointments requires the least time? The most time? Why?

20. Physician’s Preference and Needs
Times are blocked from the schedule when the physician has other obligations or is not available
Hospital rounds
Nursing home visits
Times are blocked for lunch, meetings, and catch-up
Days are blocked for vacation, conferences, lectures, etc.
Which physician obligations are likely to be the same or similar every day?
Which physician obligations are likely to occur regularly but not every day?
Which physician obligations may change after the schedule has been established?

21. Facilities and Equipment Requirements
Physicians may have special needs for equipment or treatment rooms
Schedules may have to be coordinated
If possible, one or more physicians should be scheduled whenever the office is open
Physicians like to have at least two examination rooms available to see patients
Improves efficiency and time management
Why is it important to coordinate physician use of special equipment or treatment rooms?
Why is it preferable to have at least one physician scheduled whenever the office is open (assuming there are at least three physicians in the practice)?
How does it improve a physician’s efficiency to see patients in at least two different exam rooms?

22. Established Patients
Insurance billing defines an established patient as one seen in the medical office within the past 3 years
Has a current medical record
Record patient name, physician, date of birth, and telephone number
Written in appointment book for manual system
Appear automatically when correct patient is chosen in computer appointment system
Why do insurance companies differentiate between new patients and established patients when setting up reimbursement schedules?
What are possible reasons that a patient who has not been seen for more than 3 years is treated as a new patient for billing purposes?
If a computer system is used, how does the medical assistant identify that he or she has located the correct patient before making the appointment?

23. Established Patients
If a return appointment, the interval was usually indicated by the physician at the previous visit
Patient given the time interval preferred by the physician for return appointments (often called follow-up visits)
Schedule as close as possible to date specified by the physician
Ask patient for day of the week and time of day that is convenient, then offer open times
If patient is in the office, write patient name, date, and time of appointment on an appointment reminder card for the patient
What is the physician’s reason for asking the patient to return for follow-up at a certain interval?
If the patient has no active medical problems, when will the physician most likely recommend that he or she returns?
What types of intervals do insurance companies set up to reimburse physical examinations?
What happens if a patient is scheduled for a physical examination at a shorter interval than that allowed by his or her insurance?
Why are patients given appointment reminder cards?

24. Special Situations
If patient must have laboratory tests, be sure they are scheduled so that results have been received before the next appointment
If patient must be fasting, schedule laboratory tests early in the morning
Office may only be making appointments 6 months ahead, and patient may not need to return until after that time
Ask patient to call later for appointment
Place patient’s name on reminder list
How should laboratory tests be scheduled related to follow-up appointments?
Why does the medical assistant attempt to schedule fasting laboratory tests in the morning?
What are examples of laboratory tests or diagnostic tests that require the patient to be fasting?
How can the medical office remind patients to make appointments for intervals that are longer than the appointment matrix has been created?

25. New Patients Obtain complete information about a new patient
Get patient’s full name, daytime phone number, reason for visit, or type of visit
For referrals, obtain name of referring physician
Obtain referral form if patient has a referral
Office of referring physician usually makes appointment and sends referral form
Patient sometimes brings the form to the appointment
What information must be obtained from a new patient when making an appointment?
What does the medical assistant need to find out if the patient is being seen for something other than primary care?

26. New Patients
Set aside appointment time for new patient, usually minutes
Give patient directions to office
Send information according to office policy
Health history form
New patient brochure
Make appointments for referrals as soon as possible
What information may a new patient need in addition to the appointment time?
Why are appointments for referrals made as soon as possible?
What information might be mailed to a new patient?

27. Same-Day Appointments
Some problems are usually treated the same day the patient calls
Wounds without fracture or dislocation
Sprains and strains
Nausea, vomiting, or diarrhea that persists more than 3-4 days
Fever higher than 101F for children and higher than 103F-104F for adults
Sudden illness or severe pain without bleeding, fainting, or loss of consciousness
Which types of medical offices are most likely to keep a block of appointments in reserve to give to patients who call with urgent medical problems?
What are general criteria that distinguish conditions that should be seen the same day from conditions that can wait for 2-3 days?

28. Same-Day Appointments
Some problems are usually treated the same day the patient calls
Sore throat, especially with fever
Burning, frequency, or urgency on urination
Vaginal bleeding in a pregnant woman (office or emergency department)
If primary physician’s schedule is full, patient may be offered an appointment with another practitioner
Why is a high fever usually an indication that a patient needs a same-day appointment?
What should the medical assistant do if a patient calls with a problem that requires a same-day appointment, but the patient’s physician is not in the office that day?

29. Urgent Care and Emergencies
Give all callers a chance to talk before putting on hold in case it is an emergency
Refer emergency calls to the physician
Urgent calls can be transferred to any licensed professional
If physician is not present, refer caller to emergency medical services (911)
How does the medical assistant know that the caller has a serious medical emergency?
Why do some offices employ a registered nurse to handle calls from patients with medical problems?
Why do patients call the physician’s office when they truly need emergency care?

30. Urgent Care and Emergencies
Conditions that may result in damage to body structures:
Breathing problems, or respiratory arrest
Severe chest pain, or cardiac arrest
Bleeding that cannot be controlled
Large open wounds
Any suspicion of internal bleeding
Potential poisoning or overdose
Bleeding in, or injury to, a pregnant woman
What are general guidelines for medical conditions that are referred to emergency medical services?
What are indications that an individual might have internal bleeding?
What are indications of possible overdose of medication?

31. Urgent Care and Emergencies
Conditions that result in very low blood pressure:
Shock
Serious burns
Severe bleeding
Why is very low blood pressure usually a symptom of a serious emergency?

32. Urgent Care and Emergencies
Conditions that result in a change in the level of consciousness:
Loss of consciousness
Disorientation
Confusion
Loss of alertness
Fractures, possible fractures, dislocations, or large wounds
What questions are asked to assess confusion or disorientation?
Why do most offices refer possible fractures to the hospital emergency room?

33. Walk-In Patients
Patients who come into the office, without an appointment, and ask to be seen
If need is urgent, physician may work patient into the schedule
If need is routine, person may be offered an open appointment and told to return
Why is it generally not recommended to see walk-in patients unless the physician intends to do so regularly?
What factors should determine if a walk-in patient is seen or given an appointment for another day?

34. Individuals Who Are Not Patients
Pharmaceutical representatives
Salespeople
Usually given specific appointment times
Often during lunch or another time period that has been blocked from the schedule
When are physicians willing to make appointments to see pharmaceutical representatives?
What types of equipment might the physician wish to consult with a salesperson about?
What is the advantage to the physician of making a specific appointment with an individual who is not a patient?
If the physician does not make appointments with pharmaceutical representatives, how is the representative handled?

35. Changing Appointments
If using appointment book, erase original appointment and enter all information in new slot
If using computer schedule, use “move appointment” feature
Moves all information to new slot
Deletes original appointment
Do you think it is faster to change an appointment in an appointment book or in a computer scheduling program? Why?
Why is it important to be sure that all information is transferred when changing appointments?

36. Changing Appointments
Appointments may be changed because of change in physician’s schedule
If physician must leave the office, offer to reschedule or indicate how long before physician likely to return
If physician is running behind schedule, some patients may wish to reschedule
When do appointments need to be changed?
If a patient requests an appointment change, what should the medical assistant do?

37. Changing Appointments
No-shows are patients who do not keep appointments and do not call to cancel
Marked in red on the appointment schedule
Failure to keep the appointment documented in the medical record
No-shows usually reviewed after three occurrences
May be asked to find another physician because they do not adhere to treatment plan
Why should all no-show appointments be documented in the medical record?
Why do many offices place a telephone call to patients who fail to keep an appointment?
What are possible legal implications if patients frequently fail to keep appointments?

38. Late Patients Office usually has a policy regarding late patients
If the patient telephones, he or she may be worked in on arrival
Habitual latecomers may be given the last appointment of the day or told a time earlier than they are scheduled
Why are late patients a problem for the smooth process of appointments?
If a late patient is turned away, how might the patient respond?
How late is really late?

39. Appointment Reminders
Patients usually given appointment reminder cards for future appointments
Most offices call 1 or 2 days ahead to remind patient of appointment
Ask new patients for permission to leave a message
May send letters or s to patients who need periodic examinations
Why do most medical offices call patients a few days before an appointment to remind them?
How can the medical office protect patient privacy when leaving messages about appointment reminders?

40. Storing Appointment Books and Daily Schedules
Some appointment books used as the office record of appointments
Must be in ink
Store in secure area
Why is it a legal requirement to maintain an official daily schedule?

41. Storing Appointment Books and Daily Schedules
The official daily schedule should be updated and stored in a secure place
Add all patients who receive appointments that day in ink
Mark “no-shows” and cancellations from that day
Why is it usually preferred to have a printed appointment schedule instead of using the appointment book as a schedule?
How should a no-show be marked on the appointment schedule?
What is the difference in terms of documentation between a no-show and a cancellation on the day of the appointment?

42. Storing Appointment Books and Daily Schedules
Marking Changes and/or No-Shows
Why are no-shows marked in red on the daily appointment schedule?
How should the daily appointment schedule be stored?

43. Referrals
Referral is an authorization to another physician or health professional, usually a specialist
What is the difference between a verbal referral and a written referral?

44. Referrals
Under managed care, a referral is made by the patient’s primary care physician
It is an authorization for a specific number of visits
Usually the primary care provider can initiate a referral to a physician who participates in the patient’s managed care plan without preauthorization
Medicaid always preauthorizes all referrals
When the term referral is used for managed care, does it refer to a verbal or written referral?
What are general guidelines about when managed care insurance requires preauthorization for a referral? When Medicaid requires preauthorization for a referral?

45. Referrals
Preauthorization may be required for some treatments or providers
Therapy (physical therapy, occupational therapy, speech therapy)
Certain diagnostic tests or procedures
Consultations by a physician who does not participate in the insurance plan
Surgery and hospitalization
What kinds of treatments or providers usually require preauthorization?

46. Referrals
If preauthorization is required, medical assistant (MA) usually calls the insurance company and sends a written referral request to follow up
Three common types of referrals
Specialist physician for consultation
Provider of therapy
Provider of community-based services (visiting nurse, Meals on Wheels)
How does the medical assistant obtain preauthorization or determine if preauthorization is required?
When is a written referral often required?

47. Referrals
MA obtains information from the physician, patient, and medical record
Completes the referral form
Either makes the appointment or instructs the patient to make the appointment
Referrals to community resources, such as Meals on Wheels or visiting nurse, may require additional specific information about the patient’s needs
What is the role of the medical assistant in completing a referral form?
When should the referral form be completed related to the appointment it covers?

48. Scheduling a Diagnostic Procedure
Compile information about the patient before scheduling a diagnostic test
Patient’s demographic and insurance information including a preauthorization number (if required) or written referral
Type of test being performed and reason for the test (diagnosis)
Time frame within which the test must be performed
Why do medical assistants often schedule diagnostic tests for patients?
What information must be prepared before scheduling a diagnostic test?

49. Scheduling a Diagnostic Procedure
Give patient instructions
Inform patient when and where the test will be performed
Provide directions to the testing facility
Provide the facility’s instructions for preparing for the test
Document instructions and follow-up
Document that patients informed of results of diagnostic tests to avoid lawsuits for malpractice or abandonment
What is the medical assistant’s responsibility related to instructing patients about diagnostic tests?
How can the medical assistant get written instruction sheets if patients will be sent to a hospital or other facility for diagnostic tests?
What should the medical assistant include in the patient’s medical record if a diagnostic test is scheduled for a patient?
Why is it important for patients to receive adequate instruction before diagnostic tests?

50. Scheduling an Inpatient Admission
Obtain preauthorization from patient’s insurance
Arrange admission with hospital admitting department
Provide patient information
Patient’s name, address, telephone number, and date of birth
Admitting diagnosis
Patient’s insurance information and preauthorization number
What are specific examples of occasions when a medical assistant might schedule an inpatient admission?

51. Scheduling an Inpatient Admission
Arrange admission with hospital admitting department
Say when MD will visit the patient (within first 24 hours)
Arrange to send or fax admitting orders
If patient is admitted through the emergency department, hospital obtains the information from the patient
What are differences if a patient will be sent to the hospital by ambulance instead of being admitted from home?

52. Scheduling Surgery Information necessary for scheduling surgery
Patient’s name, address, telephone number, and date of birth
Type of surgery to be performed
Time frame within which the surgery is to be performed
Name of surgeon and any assistant surgeons
Name of anesthesiologist
Name of hospital or day surgery center at which surgery will be performed
What information is necessary before scheduling surgery?
What types of surgery might a medical assistant schedule if he or she works for a general surgeon, plastic surgeon, dermatologist, ophthalmologist, gynecologist, orthopedic surgeon?
In what types of facilities is surgery performed?
What types of surgical procedures may be performed in the medical office? Are they usually scheduled?

53. Scheduling Surgery
Preauthorization is necessary before scheduling surgery
Call the patient’s insurance company to obtain this prior approval
Give preauthorization number when scheduling surgery
How does the medical assistant obtain preauthorization to schedule surgery?

54. Scheduling Surgery Schedule preadmission testing (PAT)
Will include blood tests, ECG, and chest x-ray
May be done at hospital or surgeon’s office, or by patient’s primary care physician
Patient may be scheduled to donate one or more units of his or her own blood
If a transfusion is necessary, using patient's own blood is safer
Why are diagnostic tests usually done before surgery?
What diagnostic tests are commonly included in preadmission testing?
Why are patients sometimes encouraged to donate their own blood before surgery?

55. Giving a Patient Instructions Before Surgery
If surgery will be done under general anesthesia, patient must be NPO
Usually after midnight
Surgeon may allow morning medication with a sip of water
What are common dietary restrictions before surgery?
How do physicians usually instruct patients regarding morning medications on the day of surgery?

56. Giving a Patient Instructions Before Surgery
Patient may need to wash with antibiotic soap before surgery
Instruct patient not to bring along valuables to the hospital
For day surgery, patient should arrange to have someone pick up him or her afterward
Why are patients encouraged to leave any valuables with a family member instead of bringing them to the hospital?
What arrangements should patients make following day surgery?

57. Documenting an Appointment for Surgery
Document all interactions with surgical team members and facilities
Document all instructions to the patient in the medical record
Document any additional interactions with the patient about the surgery
What should the medical assistant include in the patient’s medical record after scheduling surgery?