Chapter 10
Appointment
Scheduling
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Review Tip
Keep energized! This review process, even if it seems grueling, is a
relatively short period of time with an end in sight. Go outside and
enjoy a walk or run or just sit on a park bench and clear your head.
Call someone you can count on to be cheerful. Read some jokes or
inspirational pieces.
To regain your focus and energy, do something that usually makes you
feel good!
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview
The goal of appointment scheduling is to maintain a smooth office flow
while accommodating the needs of the medical practice and the
patient. The type of scheduling used depends on the following:
Nature of practice
■ Patient population needs
■ Doctor’s preferences and habits
■ Available facilities and staff
■
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Types of Scheduling
The exam questions will require you to identify the different types of
scheduling. These types include:
■ Open hours (tidal wave, open booking)—no appointments
needed; first-come, first-served.
• Used primarily in urgent care centers
• Eliminates broken appointments
• Limits medical records and procedures preparation
• Prohibits control of number of patients arriving at one time
• Needs triage system
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Types of Scheduling, cont’d.
Clustering (group procedures, categorizing)—similar procedures
scheduled on predetermined days or in predetermined time
blocks, such as new patient exams, sports physicals, and
immunizations; they are designated when the appointment
book matrix is developed
• Increases efficiency and speed for procedures
• Theoretically, allows better utilization of equipment and staff
■ Select scheduling
• Double booking—two or more patients scheduled at the
same time
- Used by practices with short visits or a high no-show
rate
- Increases patient waiting time
- Reduces physician downtime
■
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Types of Scheduling, cont’d.
• Wave—a specific number of patients, usually four, scheduled
at the beginning of the same hour
- Reduces physician downtime
- Allows specific procedures, such as a routine ECG, to be
performed prior to the physician seeing the patient
- Intended to start and finish each hour on time
- Increases waiting for patients seen later in the hour
- Creates issues of who is seen first if more than one
person arrives at the same time
• Modified wave—hour-long blocks broken down to smaller time
increments (usually 10 or 15 minutes each) and individual
patients scheduled within those increments
- Intended to start and finish each hour on time
- Decreases patient waiting time compared with wave
scheduling
- Avoids issues of who should be seen first
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Types of Scheduling, cont’d.
• Time-specific (streaming)—patient given an appointment based
on length of time needed and on available time; this is the most
common scheduling method
■ Other scheduling considerations
• Physician or office delay—keep patients informed of waiting time;
offer opportunity to reschedule or wait
• Time allotment for visits and procedures—established criteria
indicate the time required for the common procedures and visits
in a practice (e.g., a complete physical exam may be 45 minutes,
suture removal may be 15 minutes); new patients are usually
allotted more time than established patients
• Emergencies—office criteria for handling urgent medical
situations in the office and on the telephone, including
involvement of the emergency medical system and poison control
centers
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Types of Scheduling, cont’d.
• “Walk-ins”—patients who come to the office without an appointment
expecting to be seen; urgency and available appointment time
should be considered
• Referrals—urgency of referrals should be communicated by the
referring physician, and appropriate medical records, including
diagnostic results, should be sent to the consulting physician
• Repeat appointments—schedule patients for a series of
appointments (e.g., dressing changes, antibiotic administration) at
the same time on the same day of the week, if possible; this
reduces the incidence of missed appointments
• Flexible hours—varied hours on certain days; may include
evenings and weekends
• Buffer zone—periods during the day with no appointments
scheduled to accommodate emergencies and to allow the
physician to catch up if running late
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Types of Scheduling, cont’d.
• Sales representatives—the norm has become to give sales
representatives, such as with pharmaceutical companies, a
designated appointment or to have a specific day or time of the
day set aside for these visits
• Other visitors—attorneys, and other nonmedical professionals
may request to meet with the physician to function as expert
witnesses or perform other consulting- type services;
appointments are scheduled to accommodate the physician and
the practice; these services are generally billed
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Types of Scheduling, cont’d.
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Equipment and Materials
■ Appointment
book—specially designed calendar-type book used to
schedule appointments
• Remains open and conforms to desk or counter space size
• Conforms to Health Insurance Portability and Accountability Act
(HIPAA) privacy standards; not able to be seen by
unauthorized people
• Accommodates practice (e.g., it has an adequate number of
lines for the number of physicians)
■ Daily log—separate from the appointment book; a ledger-type book
listing the day’s appointments and used for cross-referencing
financial entries, data collection on types and number of
procedures, and total patients seen
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Equipment and Materials, cont’d.
Worksheet—copy of daily patients by list or medical assistant
assignment; used to prepare rooms and equipment; it is shredded
at the end of the day in compliance with HIPAA privacy standards
■ Computer appointment scheduling—software that replaces the
hard-copy appointment book
• Commercial or custom software can be used (it may also
incorporate financial and claims procedures)
• Legal, HIPAA, and other standard appointment guidelines must
be met
■
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Procedure
■
Developing the matrix—preparing the appointment book or
computer to show what times are available and unavailable for
appointments
• Block off times when appointments are not routinely scheduled,
such as lunch or monthly staff meetings
• Fill in physician’s time away from the office, such as for hospital
rounds, out-of-office procedures, or meetings
• If the cluster method of scheduling is used, mark days and times
that are reserved for special procedures (e.g., if Mondays are
reserved for sports physicals, the top of the day’s matrix would
be marked “sports physicals” and times would be blocked in
the increments designated by the practice for each physical)
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Procedure, cont’d.
■
Scheduling
• Begin with the first appointment available that has the time
required for the specific visit
• Consider patient and practice needs, such as fasting for blood
work, preparation for procedures, or who does specific
procedure
• Obtain patient’s full name and telephone number
• Note reason for visit, using standard abbreviations
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Procedure, cont’d.
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Patient Preparation
At the time the appointment is made:
Verify that the office accepts the patient’s insurance
■ Inform the patient of any copay and other office financial policies
■ Instruct the patient to bring his or her insurance card and any
necessary insurance forms, medical records, and immunization
records
■ Request that a new patient allow time before an appointment to
complete registration material in the office
■ Provide directions to office
■ Mail preregistration material if it is office policy to do so
■ Obtain prior approval from the insurance company if required
■ Explain any necessary preparations for procedures both verbally
and in writing
■ Confirm date and time of appointment at the end of conversation
■
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Procedures Outside of the
Practice
Depending on the type of practice, it may be necessary to schedule
hospitalizations and procedures to be performed outside of the
medical office. The following are guidelines:
■
Inpatient scheduling for an illness or procedure that requires a
hospital stay:
• Ensure insurance requirements, such as prior authorization,
are met
• Check patient’s availability for expected length of stay (LOS)
• Check physician’s availability for procedure
• Know appropriate diagnosis (ICD-9 code) and procedure
(CPT code)
• If surgery or procedure, schedule with appropriate
department within the hospital
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Procedures Outside of the
Practice, cont’d.
• Schedule the admission or reservation with the hospital Admissions
Department (separate from scheduling the procedure to assure a bed is
available on the appropriate unit afterward)
• Provide patient preparation information and materials if appropriate
■ Outpatient scheduling for a procedure that does not require a hospital stay:
• Ensure insurance requirements, such as prior authorization, are met
• Check patient’s availability
• Check physician’s availability for procedure
• Know appropriate diagnosis (ICD-9 code) and procedure (CPT code)
• Schedule with appropriate facility
• Provide patient preparation information and materials if appropriate
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Appointment Reminders
■ Appointment
cards—given at the time the appointment is established
■ Tickler file—an index system with cards placed in chronologic order, usually
by week or month; used as reminders for items that need attention in the
future, such as immunizations
■ Reminder mailings—cards or computer-generated forms mailed to the
patient informing him or her that an appointment is coming up or to remind
the patient to call and schedule an appointment if the patient is due for a
procedure (e.g., annual well-woman check)
■ Telephone calls—made by the office the day before the appointment is
scheduled; leave messages only with prior patient permission (usually
obtained during initial registration)
■ E-mail—sent with patient’s permission
■ Recall notices—cards or computer-generated forms sent to inform the
patient that he or she missed a scheduled appointment or that he or she is
overdue for a procedure (e.g., immunizations)
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Patient Flow Analysis
Patient flow analysis is a periodic study conducted by the medical
practice to assess the efficiency of scheduling and staff and, ideally,
resolve identified problems. It generally measures the following
times:
Sign in
■ Scheduled appointment
■ Placement in treatment room
■ Physician presentation
■ Discharge
■
The times are then evaluated and compared with established norms
and benchmarks. Some insurance companies require or
recommend a patient flow analysis at intervals or may conduct one
as a follow-up to member complaints or other issues.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Legal Issues
■ Treat the appointment book and daily log as legal documents;
they may be subpoenaed
■ Maintain HIPAA standards by ensuring confidentiality with
appointment information; if the system is computerized,
screens should be protected from view, passwords changed
frequently, and required firewalls in place if the system is part
of a network
■ Document no-shows and cancellations that are not rescheduled
in the patient’s medical record and in the appointment book
and log
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