Chapter 6:
Managing
Appointments
Chapter Objectives
 Cognitive Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
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1. Spell and define the key terms
2. Describe the pros and cons of various types of
appointment management systems for scheduling patient
office visits, including manual and computerized scheduling
3. Describe scheduling guidelines
4. Explain guidelines for scheduling appointments for new
patients, return visits, inpatient admissions, and outpatient
procedures
5. Recognize office policies and protocols for handling
appointments
Chapter Objectives (cont’d)
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6. Identify critical information required for scheduling
patient admissions and/or procedures
7. Discuss referral process for patients in a managed care
program
8. List three ways to remind patients about appointments
9. Describe how to triage patient emergencies, acutely ill
patients, and walk-in patients
10. Describe how to handle late patients
11. Explain what to do if the physician is delayed
12. Describe how to handle patients who miss their
appointments
13. Describe how to handle appointment cancellations
made by the office or by the patient
Chapter Objectives (cont’d)
 Psychomotor Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
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1. Manage appointment schedule, using established
priorities
 a. Schedule an appointment for a new patient
 b. Schedule an appointment for a return visit
2. Schedule patient admissions and/or procedures
 a. Schedule an appointment for a referral to an
outpatient facility
Chapter Objectives (cont’d)
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 b. Arrange for admission to an inpatient facility
o Verify eligibility for managed care services
o Obtain precertification, including documentation
o Apply third-party managed care policies and
procedures
o Apply third-party guidelines
3. Use office hardware and software to maintain office
systems
Chapter Objectives (cont’d)
 Affective Domain
Note: AAMA/CAAHEP 2008 Standards are italicized.
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1. Implement time management principles to maintain
effective office functions
2. Demonstrate empathy in communicating with patients,
family and staff
3. Demonstrate sensitivity in communicating with both
providers and patients
4. Communicate in language the patient can understand
regarding managed care and insurance plans
5. Demonstrate recognition of the patient’s level of
understanding in communications
Chapter Objectives (cont’d)
 ABHES Competencies
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1. Schedule and manage appointments
2. Schedule inpatient and outpatient admissions
3. Be impartial and show empathy when dealing
with patients
4. Apply third party guidelines
5. Obtain managed care referrals and precertification
Chapter Objectives (cont’d)
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6. Apply computer application skills using a variety
of different electronic programs including
both practice management software and EMR
software
7. Communicate on the recipient’s level of comprehension
8. Serve as liaison between physician and others
Introduction
Responsibility for scheduling and
managing the flow of patient care in a
medical office or clinic is one of the most
important duties assigned to a medical
assistant. As appointment manager, you
make the first, last, and most durable
impression on the patient and providers.
providers: health
care workers who
deliver medical
care
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Appointment Scheduling Systems
 Manual Appointment Scheduling
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The Appointment Book
 Should have enough space for
all pertinent information (e.g.,
patient’s name, telephone
number, reason for visit)
 Should be divided into time
units appropriate for your
practice (e.g., 10- or 15-minute
intervals)
 Should open flat on the desk
where it will be used
 Should fit easily into its storage
place when not in use
Figure 6-1 Sample page from
manual appointment book.
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Appointment Scheduling Systems (cont’d.)
 Establishing a Matrix
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Cross out times physician is
unavailable
Include reason for
unavailability
Block off 15–30 minutes
morning and afternoon to
accommodate emergencies
and delays
Give copies to staff each day
A legal document
matrix: a system for
blocking off unavailable
patient appointment times
Along with the notations in a patient’s chart, the pages of the appointment
book provide documentation of a patient’s visits and any changes, such
as cancellations and rescheduled appointments.
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Appointment Scheduling Systems (cont’d.)
 Computerized Appointment
Scheduling
 Software varies
 Easy access to billing
information
 Prints out schedule easily
Once the daily schedule is printed,
this important document is referred to as
the daily activity sheet or the daysheet
and is the guide for everyone involved in
the flow of patient care.
Figure 6-2 A computer-generated
appointment schedule. Courtesy of
Ingenix® CareTracker.TM
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Checkpoint Question
 What is the purpose of a matrix?
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Checkpoint Question
 Answer: A matrix is established to indicate times of each
day that are not available for patient appointments.
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Types of Scheduling
 Structured Appointments
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30 minutes at the beginning
or end of the day is often
used as a buffer
Uses for buffer time:
o Returning phone calls
o Reviewing records
o Transcribing reports
buffer: extra time to
accommodate
emergencies, walk-ins, and
other demands on the
provider’s daily time
schedule that are not
considered direct patient
care
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Types of Scheduling
 Clustering
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Group patients with similar
problems or needs
Daily or weekly
Allows good use of
specialized equipment or
staff
clustering:
grouping patients
with similar problems
or needs
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Types of Scheduling (cont’d.)
 Wave
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Schedule several patients in first
half or each hour, second half left
open for rechecks, emergencies,
and other tasks
Patients are seen in order of
arrival
Good for large, multidepartment
facility
Modification — full physicals on
the hour, rechecks on the halfhour
wave scheduling: a
flexible scheduling
method that allows time
for procedures of varying
lengths and the addition
of unscheduled patients,
as needed
Back to chapter objectives
Types of Scheduling (cont’d.)
 Fixed
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Most common method
Patients allotted time by complexity of problem
Schedule disruptions affect entire day
Schedule chronically late patients toward end of day
Or, tell patients to arrive 30 minutes prior to their
allotted time
Types of Scheduling (cont’d.)
 Streaming
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Standard time periods
assigned to different needs
streaming: a method of
allotting time for
appointments based on the
needs of the individual
patient to minimize gaps in
time and backups.
Types of Scheduling (cont’d.)
 Double Booking
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Two patients scheduled for
same time slot with same
physician
double booking: the
practice of booking two
patients for the same period
with the same physician
Types of Scheduling (cont’d.)
 Flexible Hours
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Office hours vary throughout week
Patients are scheduled during open times
Greater range of possible appointment times allow patients
with work or family schedule conflicts
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Types of Scheduling (cont’d.)
 Open Hours
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No scheduled appointments
Patients come when they can during open hours
Common in walk-in clinics
Patient records must be pulled as patients arrive
Clear disadvantages:
o Effective time management almost impossible
o Facilities may be overloaded or completely empty at
times
o Charts must be pulled and prepared as each patient
arrives
Sign-in sheets are considered a breach of confidentiality, since patients
signing the sheet can see the names and medical conditions of other patients.
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Checkpoint Question
 What are the three systems that can be used for
scheduling patient office visits?
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Checkpoint Question
 Answer: The three systems that can be used for
patient office visits include scheduled appointments,
flexible hours, and open hours.
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Factors that Affect Scheduling
 Patients’ Needs
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Good communication critical — emotions can make slight
miscommunication into negative experience for patient
With a patient in an emotional state, even the slightest real or imagined
miscommunication can lead to negative response from the patient.
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Factors that Affect Scheduling (cont’d.)
 Obtain appropriate patient
information:
o Reason for visit
o Length of time of symptom
o Problem acute or chronic
o Time of day convenient for
patient
o Special needs of patient
o Whether patient needs to see
other office staff
o Third party payer constraints
o Documentation for referrals if
required by third-party payer
acute: abrupt in onset
chronic: long-standing
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Factors that Affect Scheduling (cont’d.)
 Strive to accommodate patient’s requests but remember:
o
o
You control the schedule—do not let it control you
Entire medical office team depends on a well-managed
schedule
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Factors that Affect Scheduling (cont’d.)
 Providers’ Preferences and Needs
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Become familiar with providers’ habits
o Punctual or often behind?
Medical assistant clinical duties should be accommodated
Possible provider scheduling needs:
o Nonmedical office visitors
o Telephone time
o Teaching duties
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Factors that Affect Scheduling (cont’d.)
 Physical Facilities
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Number of providers using facility
Number of examination rooms
Need to resterilize instruments between procedures
Must thoroughly understand the requirements for
procedures to be performed in the office
You must thoroughly understand the requirements for procedures to be performed
in the office to schedule appointments accurately.
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Checkpoint Question
 What are three factors that can affect appointment
scheduling?
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Checkpoint Question
 Answer: The three factors that can affect scheduling are
patients’ needs, physicians’ preferences, and the
physical facilities.
Back to chapter objectives
Scheduling Guidelines
 Be pleasant and helpful
 Always include patient phone number on schedule
 Include buffers each day
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Scheduling Guidelines (cont’d.)
 New Patients
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Allow adequate time
Obtain full name and correct spelling
Mailing address
Day and evening phone numbers
Reason for visit
Name of referring physician or individual
Responsible party and third party payer (insurance)
Explain payment policy
The information you exchange at this encounter is crucial, and entering the
patient’s data accurately is imperative.
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Scheduling Guidelines (cont’d.)
 Request pertinent insurance information
 Ensure that patient knows office location and directions
 Ask patient if messages can be left at home or work — note in
chart
 Reconfirm date and time of appointment before ending call
 Recheck that appointment is correctly entered in book
 Note if referral — obtain relevant patient information from
source of referral
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Scheduling Guidelines (cont’d.)
 Established Patients
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Carefully check
appointment book or
screen before offering
appointment time
Offer patient specific date
and time
Enter information in
appointment book (or
enter in the appointment
screen)
If patient is present, fill out
appointment card
Figure 6-3 An appointment card will
help the patient remember his or
her appointment and reduce no
shows.
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Scheduling Guidelines (cont’d.)
 Reconfirm date and time
 Recheck appointment book
 End with pleasant word and smile
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Preparing a Daily or Weekly Schedule
 Most offices—medical assistant responsible
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Make copy for staff—ensure corrections are made on all
copies
Place next day’s schedule on physicians desk before he or
she leaves—next week’s on Friday
Should include patient appointments and all other
commitments
Important to make manual changes to computer schedules
as day progresses
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Patient Reminders
 Appointment Cards
Give out one at a time
 Regular appointments should be scheduled at same day
and time
 Telephone Reminders
 New and already-scheduled patients should receive phone
call day before appointment
 Check chart to ensure that patient has agreed to allow
messages to be left
 If patient must cancel, use move-up list to schedule another
patient in slot
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All new patients and patients with appointments scheduled in advance
should receive a telephone reminder the day before their appointment.
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Patient Reminders (cont’d.)
 Mailed Reminder Cards
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Alternative to phone calls
Mail at least 1 week before
appointment
Can be used to remind
patients to make
appointments for regular
examinations
Keep a supply of preprinted
postcards in the office
Most medical management
software packages can alert
you that it’s time for patient
reminders
Figure 6-4 Sample reminder postcard.
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Checkpoint Question
 What are the three types of patient reminders?
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Checkpoint Question
 Answer: The three types of reminders are appointment
cards, telephone reminders, and mailed reminder cards.
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Adapting the Schedule
 Emergencies
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Must determine if
problem can be treated in
office or whether to call
EMS
“STAT” = Latin statim, or
immediately
Figure 6-5 When a patient calls from
home with a possible heart attack,
you will call 911.
When a patient calls with an emergency, your first responsibility is
to determine whether the problem can be treated in the office.
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Adapting the Schedule (cont’d.)
 Ask questions to elicit crucial information:
o
o
o
o
o
Possible heart attack
Possible poisoning
Life-threatening bleeding
Shock
Burns
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Adapting the Schedule (cont’d.)
 Constellation of symptoms can
indicate particular condition:
o Shortness of breath, chest pain,
arm/neck pain, nausea/vomiting
can indicate heart attack
o Severe right lower quadrant
pain, nausea, and fever often
points to appendicitis
 If life-threatening emergency:
o Keep patient on phone
o Call EMS for transport
o Do not advise patient to drive to
hospital
constellation of
symptoms: a group of
clinical signs indicating a
particular disease process
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Adapting the Schedule (cont’d.)
 Patients Who Are Acutely Ill
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Severe but not life-threatening
Obtain as much information as possible
Place note on chart for physician review
Tell patient you will call back as soon as physician makes
decision
Obtain as much information about the patient’s medical problem as you can so
your message to the physician will allow him or her to decide how soon the patient
should be seen.
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Adapting the Schedule (cont’d.)
 Walk-in Patients
Office policy should be in place
 Emergencies must be handled immediately
 Ask patient to wait — work in to schedule as possible
 Late Patients
 Explain to patient that they are late and must wait until
physician is available
 Chronically late patients can be told that lateness of more
than 15 minutes mandates rescheduling
 Schedule chronically late patients in afternoon/evening to
avoid schedule disruption
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Adapting the Schedule (cont’d.)
 Physician Delays
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Call patients with appointments later in the day to alert
them and allow the option of rescheduling
Patients in waiting room should be notified immediately
Allow to wait or reschedule
If rescheduling, note reason in patient record
Continue to offer updates
Always keep patients informed
Most will understand if they know they are not ignored or
forgotten
If patients are waiting in the office, inform them immediately if the
physician will be delayed.
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Adapting the Schedule (cont’d.)
 Missed Appointments
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No-show = patient fails to show up for appointment and
does not call to notify
Call patient to determine reason and to reschedule
If unable to reach by phone, sent reminder card — place
copy in patient’s chart
Note missed appointment and follow-up steps in chart
Continued failure to keep appointments should be handled
by physician
May decide to terminate relationship
Continued failure to keep appointments should be brought to the attention
of the physician, who may want to call the patient personally (particularly if the
patient is seriously ill) or send a letter expressing concern for the patient’s
welfare.
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Cancellations
 Cancellations by the Office
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If physician is ill or has emergency
Call patients to reschedule — don’t tell exact reason
Note in medical record
If physician will be out for an extended period, a locum
tenens should be arranged
On-call physicians can stand in
These cancellations should be noted in the patient’s medical record.
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Cancellations (cont’d.)
 Cancellations by the Patient
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Note in record
Offer to reschedule
If patient has ongoing problem, emphasize importance of
regular care
Notify physician of frequent cancellations
Can schedule move-up list patients if schedule is light
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Making Appointments for Patients in Other Facilities
 Referrals and Consultations
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Must make sure referral
meets requirements of
third-party payers.
HMO’s have strict
requirements for
precertification
Must complete referral
form with approval number
from insurance company
Give patients choice of
specialist
Figure 6-6 Sample referral form.
Be sure the physician you are calling is on the preferred provider list
for the patient’s insurance company.
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Making Appointments for Patients in Other Facilities
(cont’d.)
referral: instruction to transfer a patient’s care to a specialist
consultation: request for assistance from one physician to another
precertification: request for assistance from one physician to another
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Making Appointments for Patients in Other Facilities
(cont’d.)
 When calling another physician’s office for patient appointment
provide the following:
o Physicians name and telephone number
o Patients name, address, and telephone number
o Reason for referral
o Degree of urgency
o Whether patient is being sent for consultation or referral
 Record in patients chart:
o Time and date of call
o Who received your call
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Making Appointments for Patients in Other Facilities
(cont’d.)
 Inform person that you wish to be notified if patient does not
keep appointment (if this occurs—enter in to the patients
record)
 Can write name, address, telephone number of referral doctor
on office stationery and include the date and time of
appointment
 Give or mail to patient
o Patient may call referring physician and make
appointment—ask patient to notify you with date—
document
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Making Appointments for Patients in Other Facilities
(cont’d.)
 Diagnostic Testing
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Patient sent to another facility for laboratory test, radiology,
computed tomography, Magnetic resonance imaging etc.
Appointments usually made with patient still in office
Prior to scheduling, must determine exact test or test:
o How soon results are needed—STAT?
o Ask patient about time restrictions
o Provide patient’s name, address, telephone number,
exact test or test required and other special instructions
o Give patient referral slip with name, address, telephone
number of facility
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Making Appointments for Patients in Other Facilities
(cont’d.)
 Some laboratory studies or x-ray test require advanced
preparation
o Give patient written and verbal explanation
o Ensure he or she understands
o Document in chart and put reminder in tickler file to ensure
test results are received.
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Making Appointments for Patients in Other Facilities
(cont’d.)
 Surgery
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Determine precertification—call number on back of
insurance card
Call facility chosen by patient and specify time and date
physician has requested
Operating facility needs to know
Exact procedure
Amount of time needed
Anesthesia required
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Making Appointments for Patients in Other Facilities
(cont’d.)
 Other instructions
 Also need all pertinent patient information
 Give patient copy of preadmission forms—if available
 Follow policies of surgical facility regarding preadmission
testing (laboratory studies, autologous blood donation)
 Write down all for patients—ensure he or she understands
 Note—may need to also arrange for hospital admission with
hospital admitting department
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Checkpoint Question
 What information should be readily available when calling
to schedule a patient for surgery in another facility?
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Checkpoint Question
 Answer: When scheduling a patient for surgery, the
following information is needed: demographic and
insurance information; the patient’s name, age, address,
telephone number, precertification number (if required),
and diagnosis; surgery planned; and any special
instructions.
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When the Appointment Schedule Does Not Work
 Regular schedule disruptions require determining cause
 Evaluate the schedule over 2 to 3 months by listing:
All patients seen
o Arrival times
o Amount of time spent with physician
o Departure times
o Amount of time needed to perform each examination or
treatment
 Office meetings are ideal way to identify scheduling problems
 Adjust schedule to avoid causing frustration for both patients
and office personnel
o
Since the workflow of the office affects every staff member, involve all
employees in your study.
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