Chapter 40
Scheduling Appointments
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Pretest
True or False
1.
2.
3.
4.
5.
For legal purposes, a daily schedule is usually the
official record of appointments.
Corrections or changes to the official daily
schedule are usually made in pencil.
Most medical offices use some type of timespecified appointment system.
In the stream method of appointment scheduling,
each patient is given a different appointment time.
An example of clustering patient appointments is
making appointments for new patients.
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Pretest, cont.
True or False
6.
In the appointment matrix, times when physicians
are available to see patients are blocked.
7. Demographic data for new patients are usually
obtained when scheduling the first appointment.
8. Many medical offices call patients a few days
before an appointment as a reminder.
9. The physician can usually admit a patient to the
hospital without insurance preauthorization.
10. Patients usually call the hospital to schedule their
own surgery.
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Introduction to Appointment
Scheduling
1. It is important to create a schedule with
minimal waiting for the patient
2. It is important to facilitate the smooth
function of the office
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Guidelines for Appointment
Scheduling
1. Maintain confidentiality of the patient
2. Speak clearly and do not appear to be
rushed
3. Concentrate on the person to whom you are
speaking
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Guidelines for Appointment
Scheduling, cont.
4. Obtain necessary and complete information
5. Repeat information for accuracy
6. Schedule the proper amount of time for the
type of appointment
7. Document all necessary information
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Methods of Scheduling
Appointment Books
1. Appointment book is usually spiral-bound so
that it will lie flat
2. Each physician usually has his or her own
book
3. Choose a book that suits the practice
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Methods of Scheduling, cont.
4. Pages may be set up in 10- or 15-minute
intervals
5. Appointment books usually kept in pencil
a. Changes can be made easily in the
appointment book
b. Daily schedule is typed and used for
permanent record
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Methods of Scheduling, cont.
Computer Scheduling
1. Appointment intervals can be adjusted
2. Each physician has a screen for each day
3. Easier to change appointments or set up
repeating appointments
4. Daily appointment schedules can be printed
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Methods of Scheduling, cont.
Daily Appointment Schedule
1. Used to pull medical records for patients
2. Used as a list of patients who will visit the
office
3. Official schedule is a legal document
a. Additions in black ink
b. No-shows and cancellations on the day of the
appointment marked in red ink
4. Posted in area inaccessible to patients or
covered with a sheet of paper
a. To protect patient confidentiality
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Types of Scheduling
Time-Specified (Stream) Scheduling
1. Most common way to handle appointments
2. Steady flow of patients (like a stream)
3. The length of time scheduled for the
appointment depends on the patient’s needs
a. 30-45 minutes for a new patient
b. 10-20 minutes for an established patient
c. 30-45 minutes for a physical examination
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Types of Scheduling, cont.
Wave Scheduling
1. Patients arrive in “waves” so that there is
always a patient waiting
2. Three or four patients are scheduled every
half-hour
3. Patients are seen in the order in which they
arrive
4. Sometimes ill patients are taken before
those with routine appointments
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Types of Scheduling, cont.
Modified Wave Scheduling
1. Patients given appointments at specific
times during the first half of each hour
a. Several appointments
b. One long appointment, such as physical
examination
2. Second half-hour used for wave
a. Work in patients
b. Finish appointments from the first half-hour
c. Schedule several rechecks on the half-hour
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Types of Scheduling, cont.
Double Booking
1. Two patients are given the same
appointment time
2. One patient may be seen by physician while
the other is having diagnostic tests
performed
3. It is a way to work in urgent patients
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Types of Scheduling, cont.
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Types of Scheduling, cont.
Open Booking
1. Patients told a range of hours for their visit
a. Used in clinics
b. Used for urgent care before or after office
hours
c. Works best where there is a constant stream of
patients
2. Patients seen in the order in which they
arrive
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Types of Scheduling, cont.
Clustering or Categorization
1. Scheduling patients with similar problems or
conditions together
a. Physical examinations
b. Prenatal patients in an OB/GYN practice
c. Patients having the same diagnostic procedure
2. Can be an entire day or part of day
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Multiple Offices
1. Physicians may see patients in different
offices
2. Appointments may be booked through a
central system or at each individual office
3. If booking centrally, it is important to clarify
with patient which office he or she wishes to
visit
4. Paper medical record will need to move from
office to office
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Setting Up the Appointment
Matrix
1. Appointment matrix usually set up for 6
months in advance
2. Appointment matrix shows available
appointment times
3. Times when a physician is not available to
see patients are blocked
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Setting Up the Appointment
Matrix, cont.
4. In a computer system, blocked times are
usually a different color than available
appointments
5. Several factors influence the appointment
matrix
a. Scheduling system
b. Physician preferences and needs
c. Facilities and equipment
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Appointment Intervals
1. Appointment interval is minimum time unit
allotted for one appointment
a. 10-minute interval
b. 15-minute interval
c. 20-minute interval
2. Patient may be given more than one block of
time depending on type of appointment
3. All appointments are multiples of the basic
appointment interval
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Physician’s Preference and Needs
1. Times are blocked from the schedule when
the physician has other obligations or is not
available
a. Hospital rounds
b. Nursing home visits
2. Times are blocked for lunch, meetings, and
catch-up
3. Days are blocked for vacation, conferences,
lectures, etc.
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Facilities and Equipment Requirements
1. Physicians may have special needs for
equipment or treatment rooms
a. Schedules may have to be coordinated
2. If possible, one or more physicians should
be scheduled whenever the office is open
3. Physicians like to have at least two
examination rooms available to see patients
a. Improves efficiency and time management
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Guidelines for Scheduling
Established Patients
1. Insurance billing defines an established
patient as one seen in the medical office
within the past 3 years
2. Has a current medical record
3. Record patient name, physician, date of
birth, and telephone number
a. Written in appointment book for manual
system
b. Appear automatically when correct patient is
chosen in computer appointment system
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Guidelines for Scheduling, cont.
4. If a return appointment, the interval was
usually indicated by the physician at the
previous visit
a. Patient given the time interval preferred by the
physician for return appointments (often called
follow-up visits)
b. Schedule as close as possible to date specified
by the physician
c. Ask patient for day of the week and time of day
that is convenient, then offer open times
5. If patient is in the office, write patient name,
date, and time of appointment on an
appointment reminder card for the patient
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Guidelines for Scheduling, cont.
Appointment Reminder Card
From Young AP, Proctor DB: Kinn’s the
medical assistant, ed 10, St. Louis, 2007,
Saunders
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Guidelines for Scheduling, cont.
Special Situations
1. If patient must have laboratory tests, be sure
they are scheduled so that results have
been received before the next appointment
2. If patient must be fasting, schedule
laboratory tests early in the morning
3. Office may only be making appointments 6
months ahead and patient may not need to
return until after that time
a. Ask patient to call later for appointment
b. Place patient’s name on reminder list
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Guidelines for Scheduling, cont.
New Patients and Referrals
1. Obtain complete information about a new
patient
a. Get patient’s full name, daytime phone number,
reason for visit, or type of visit
b. For referrals, obtain name of referring
physician
2. Obtain referral form if patient has a referral
a. Office of referring physician usually makes
appointment and sends referral form
b. Patient sometimes brings the form to the
appointment
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Guidelines for Scheduling, cont.
3. Set aside appointment time for new patient,
usually 30-45 minutes
4. Give patient directions to office
5. Send information according to office policy
a. Health history form
b. New patient brochure
6. Make appointments for referrals as soon as
possible
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Guidelines for Scheduling, cont.
Same-Day Appointments
1. Some problems are usually treated the
same day the patient calls
a. Wounds without fracture or dislocation
b. Sprains and strains
c. Nausea, vomiting, or diarrhea that persists
more than 3-4 days
d. Fever higher than 101F for children and
higher than 103F-104F for adults
e. Sudden illness or severe pain without bleeding,
fainting, or loss of consciousness
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Guidelines for Scheduling, cont.
f. Sore throat, especially with fever
g. Burning, frequency, or urgency on urination
h. Vaginal bleeding in a pregnant woman (office or
emergency department)
2. If primary physician’s schedule is full, patient
may be offered an appointment with another
practitioner
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Guidelines for Scheduling, cont.
Urgent Care and Emergencies
1. Give all callers a chance to talk before
putting on hold in case it is an emergency
2. Refer emergency calls to the physician
3. Urgent calls can be transferred to any
licensed professional
4. If physician is not present, refer caller to
emergency medical services (911)
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Guidelines for Scheduling, cont.
Medical Conditions Referred to Emergency
Medical Services
1. Conditions that may result in damage to
body structures:
a.
b.
c.
d.
e.
f.
g.
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
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Guidelines for Scheduling, cont.
2. Conditions that result in very low blood
pressure:
a. Shock
b. Serious burns
c. Severe bleeding
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Guidelines for Scheduling, cont.
3. Conditions that result in a change in the
level of consciousness:
a.
b.
c.
d.
Loss of consciousness
Disorientation
Confusion
Loss of alertness
4. Fractures, possible fractures, dislocations,
or large wounds
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Guidelines for Scheduling, cont.
Individuals Who Are Not Patients
1.
2.
3.
4.
Pharmaceutical representatives
Salespeople
Usually given specific appointment times
Often during lunch or another time period
that has been blocked from the schedule
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Guidelines for Scheduling, cont.
Walk-in Patients
1. Patients who come into the office, without an
appointment, and ask to be seen
2. If need is urgent, physician may work patient
into the schedule
3. If need is routine, person may be offered an
open appointment and told to return
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Guidelines for Scheduling, cont.
Changing Appointments
1. If using appointment book, erase original
appointment and enter all information in new
slot
2. If using computer schedule, use “move
appointment” feature
a. Moves all information to new slot
b. Deletes original appointment
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Guidelines for Scheduling, cont.
3. Appointments may be changed because of
change in physician’s schedule
a. If physician must leave the office, offer to
reschedule or indicate how long before
physician likely to return
b. If physician is running behind schedule, some
patients may wish to reschedule
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Guidelines for Scheduling, cont.
4. No-shows are patients who do not keep
appointments and do not call to cancel
a. Marked in red on the appointment schedule
b. Failure to keep the appointment documented in
the medical record
c. No-shows usually reviewed after three
occurrences
d. May be asked to find another physician
because they do not adhere to treatment plan
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Managing the Appointment
Schedule
Late Patients
1. Office usually has a policy regarding late
patients
2. If the patient telephones, he or she may be
worked in on arrival
3. Habitual latecomers may be given the last
appointment of the day or told a time earlier
than they are scheduled
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Managing the Appointment
Schedule, cont.
Appointment Reminders
1. Patients usually given appointment reminder
cards for future appointments
2. Most offices call 1 or 2 days ahead to
remind patient of appointment
a. Ask new patients for permission to leave a
message
b. May send letters or e-mails to patients who
need periodic examinations
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Managing the Appointment
Schedule, cont.
Storing Appointment Books and Daily
Schedules
1. Some appointment books used as the office
record of appointments
a. Must be in ink
b. Store in secure area
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Managing the Appointment
Schedule, cont.
2. The official daily schedule should be
updated and stored in a secure place
a. Add all patients who receive appointments that
day in ink
b. Mark “no-shows” and cancellations from that
day
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Managing the Appointment
Schedule, cont.
Marking Changes and/or No Shows
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions
Referrals and Preauthorizations
1. Referral is an authorization to another
physician or health professional, usually a
specialist
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions, cont.
2. Under managed care, a referral is made by
the patient’s primary care physician
a. It is an authorization for a specific number of
visits
b. Usually the primary care provider can initiate a
referral to a physician who participates in the
patient’s managed care plan without
preauthorization
c. Medicaid always preauthorizes all referrals
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions, cont.
3. Preauthorization may be required for some
treatments or providers
a. Therapy (physical therapy, occupational therapy,
speech therapy)
b. Certain diagnostic tests or procedures
c. Consultations by a physician who does not
participate in the insurance plan
d. Surgery and hospitalization
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions, cont.
4. If preauthorization is required, medical
assistant (MA) usually calls the insurance
company and sends a written referral
request to follow up
5. Three common types of referrals
a. Specialist physician for consultation
b. Provider of therapy
c. Provider of community-based services (visiting
nurse, Meals on Wheels)
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions, cont.
6. MA obtains information from the physician,
patient, and medical record
a. Completes the referral form
b. Either makes the appointment or instructs the
patient to make the appointment
7. Referrals to community resources, such as
Meals on Wheels or visiting nurse, may
require additional specific information about
the patient’s needs
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Scheduling Diagnostic Procedures and
Inpatient Admissions
Scheduling a Diagnostic Procedure
1. Compile information about the patient before
scheduling a diagnostic test
a. Patient’s demographic and insurance information
including a preauthorization number (if required)
or written referral
b. Type of test being performed and reason for the
test (diagnosis)
c. Time frame within which the test must be
performed
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Scheduling Diagnostic Procedures and
Inpatient Admissions, cont.
2. Give patient instructions
a. Inform patient when and where the test will be
performed
b. Provide directions to the testing facility
c. Provide the facility’s instructions for preparing
for the test
3. Document instructions and follow-up
4. Document that patients informed of results
of diagnostic tests to avoid lawsuits for
malpractice or abandonment
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Scheduling Diagnostic Procedures and
Inpatient Admissions, cont.
Scheduling an Inpatient Admission
1. Obtain preauthorization from patient’s
insurance
2. Arrange admission with hospital admitting
department
a. Provide patient information
•
•
•
Patient’s name, address, telephone number, and
date of birth
Admitting diagnosis
Patient’s insurance information and preauthorization
number
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Scheduling Referrals, Diagnostic Tests,
Procedures, and Admissions, cont.
b. Say when MD will visit the patient (within first 24
hours)
c. Arrange to send or fax admitting orders
3. If patient is admitted through the emergency
department, hospital obtains the information
from the patient
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Scheduling Surgery
1. Information necessary for scheduling
surgery
a. Patient’s name, address, telephone number,
and date of birth
b. Type of surgery to be performed
c. Time frame within which the surgery is to be
performed
d. Name of surgeon and any assistant surgeons
e. Name of anesthesiologist
f. Name of hospital or day surgery center at
which surgery will be performed
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Scheduling Surgery, cont.
2. Preauthorization is necessary before
scheduling surgery
a. Call the patient’s insurance company to obtain
this prior approval
b. Give preauthorization number when
scheduling surgery
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Scheduling Surgery, cont.
3. Schedule preadmission testing (PAT)
a. Will include blood tests, ECG, and chest x-ray
b. May be done at hospital or surgeon’s office, or
by patient’s primary care physician
c. Patient may be scheduled to donate one or
more units of his or her own blood
d. If a transfusion is necessary, using patient's
own blood is safer
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Scheduling Surgery, cont.
Giving a Patient Instructions before Surgery
1. If surgery will be done under general
anesthesia, patient must be NPO
a. Usually after midnight
b. Surgeon may allow morning medication with a
sip of water
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Scheduling Surgery, cont.
2. Patient may need to wash with antibiotic
soap before surgery
3. Instruct patient not to bring along valuables
to the hospital
4. For day surgery, patient should arrange to
have someone pick up him or her afterward
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Scheduling Surgery, cont.
Documenting an Appointment for Surgery
1. Document all interactions with surgical team
members and facilities
2. Document all instructions to the patient in
the medical record
3. Document any additional interactions with
the patient about the surgery
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Posttest
True or False
1.
2.
3.
4.
5.
A written appointment book must be kept to provide a
legal record of appointments.
If a patient fails to call or keep an appointment, the
appointment is crossed out in red on the official daily
schedule.
In wave scheduling, several patients are given the
same appointment time.
The method of scheduling appointments with the least
waiting time for patients is open hours.
Categorization refers to the practice of scheduling
patients with similar problems back to back.
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Posttest, cont.
True or False
6.
Most medical offices set up the appointment matrix for
only the next 2-3 months.
7. If a patient makes an appointment while in the office, he
or she should be given a written appointment reminder
card.
8. The primary care physician must always obtain
insurance preauthorization before providing a referral for
a patient.
9. If a medical assistant schedules a diagnostic test for a
patient, he or she should also provide any written
instructions about preparation for the test.
10. A patient must almost always be scheduled to have an
ECG and blood work before he or she can have inpatient
or outpatient surgery.
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