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Lippincott Williams & Wilkins’ Comprehensive Medical Assisting (Third Edition)

Lesson Plans

Chapter 6 — Managing Appointments

Goals of the Lesson:

Cognitive: The student will become familiar with aspects of patient visit scheduling and management. Motor: The student will learn to schedule patient appointments and referrals/consultations.

Learning Objectives:

The lesson plans for each learning objective and the related procedures start on the pages noted below.Learning Objective 6-1: Spell and define the key terms. 3Learning Objective 6-2: Describe various systems for scheduling patient office visits, including manual and computerized scheduling. 3Learning Objective 6-3: Identify the factors that affect appointment scheduling. 3Learning Objective 6-4: Explain guidelines for scheduling appointments for new patients, return visits, inpatient admissions and outpatient procedures. 3

Procedure 6-1: Making an Appointment for a New Patient 3Procedure 6-2: Making an Appointment for an Established Patient 3Procedure 6-3: Schedule an Appointment for a referral to outpatient facility 3Procedure 6-4: Arrange for Admission to an inpatient facility. 3

Learning Objective 6-5: List three ways to remind patients about appointments. 3Learning Objective 6-6: Describe how to triage patient emergencies, acutely ill patients, and walk-in patients. 3Learning Objective 6-7: Describe how to handle late patients and patients who miss their appointments. 3Learning Objective 6-8: Explain what to do if the physician is delayed. 3Learning Objective 6-9: Describe how to handle appointment cancellations made by the office or by the patient. 3

Performance Objectives:

The performance objectives are incorporated into the learning objective lesson plans on the pages shown below.Performance Objective 6-1: Schedule an appointment for a new patient (Procedure 6-1)...............................................................................Performance Objective 6-2: Schedule a return appointment (Procedure 6-2)..................................................................................................

Page 6-1Copyright © 2008 Lippincott Williams & Wilkins

Selected Key Terms

acutebufferchronicclusteringconstellation of symptomsconsultationdouble bookingmatrixprecertificationprovidersreferralSTATstreamingtickler filewave scheduling system

Comprehensive Medical Assisting Chapter 6 — Managing Appointments

Performance Objective 6-3: Schedule a referral following third-party guidelines (Procedure 6-3).................................................................Performance Objective 6-4: Arrange for admission to an inpatient facility (Procedure 6-4)

You Will Need:

Gather the following materials for the following lessons:6-2 Twenty cards with patient information that would be provided during scheduling.6-10 Chart, preferred provider list, telephone, pen or pencil

Instructor’s Note:

The Premium Online Course for Comprehensive Medical Assisting is not automatic with course adoption. Instructors must request that students purchase the online course. However, reference to online course content is included within these Lesson Plans for those Instructors who have directed their students to purchase the Premium Online Course.

A complete DVD of 45 videos showing procedures and techniques described in Comprehensive Medical Assisting is available for purchase from Lippincott Williams & Wilkins. Go to thePoint.lww.com/Kronenberger3e to order the DVD. A selection of these video clips are available free on the Student CD and on the Instructors Resource Center on LWW’s thePoint Course and Content Manager. Free videos are denoted by an asterisk (*) in the Lesson Plans.

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint Course&Content Manager; PPt: PowerPoint; SG: Study Guide; DVD: DVD available for purchase. (*) Denotes free video available on the Student CD and on the Instructors Resource Center on thePoint Course& Content Manager.



Date:

Learning Objective 6-1: Spell and define the key terms.

Lecture Outline — Objective 6-1 Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation Instructor’s Notes

Content Text PPt

Key terms appear on the first page of this chapter lesson plan and in the beginning of chapter 6.

113 Outside Assignments




Date:

Learning Objective 6-2: Describe various systems for scheduling patient office visits, including manual and computerized scheduling.




Content Text PPt

Scheduling methods Manualo The

appointment book (Fig. 6-1)

o Creating the matrix 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 Computerized (Fig. 6-2)o Software

varieso Easy

access to billing information

o Prints out schedule easily

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Fig. 6-1: Sample page from manual appointment book

Fig. 6-2: Computer-generated appointment schedule

In-Class Activities Outside Assignments

EvaluationCheckpoint Question 1: What is the purpose of a matrix?

Structured appointments 115–117 4, 5 Box 6-1: How much time do I allot?

In-Class ActivitiesWrite out 20 cards with

Outside Assignments






Content Text PPt

Advantage — promotes efficiency and good time management

Disadvantage — does not allow for unexpected patient needs or emergencies

o Obtain patient information to schedule adequate time

o Add buffer to schedule — empty time slots that allow for schedule disruptions

Clusteringo Group

patients with similar problems or needs

o Daily or weekly

o Allows good use of specialized equipment or staff

Wave and modified wave

o Schedule several patients in first half or each hour, second half left open for rechecks, emergencies, and other tasks

o Patients are seen in order of arrival

o Good for

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5

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patient information that would be provided during scheduling (identifier, returning or new status, chief complaint, hours of availability, etc.) Divide students into groups and assign one of the scheduling systems to each group. Each group should determine the best scheduling of these 20 patients in their scheduling system. Discuss the differences in the systems.






Content Text PPt

large, multidepartment facility

o Modification — full physicals on the hour, rechecks on the half-hour

Fixed schedulingo Most

common methodo Patients

allotted time by complexity of problem

o Schedule disruptions affect entire day

o Schedule chronically late patients toward end of day

Streamingo Standard

time periods assigned to different needs (Box 6-1)

Double bookingo Two

patients scheduled for same time slot with same physician

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5

Flexible and open hours Flexibleo Office

hours vary throughout week

116 6 In-Class Activities Outside Assignments

EvaluationCheckpoint Question 2: What are the three systems that can be used for

-6Copyright © 2008 Lippincott Williams & Wilkins





Content Text PPt

o Patients are scheduled during open times

o Greater range of possible appointment times allow patients with work or family schedule conflicts

Open hours No scheduled

appointments Patients come when

they can during open hours

Common in walk-in clinics

Sign-in sheets no longer allowed — breach of confidentiality

Patient records must be pulled as patients arrive

Clear disadvantages Effective time

management almost impossible

Facilities may be overloaded or completely empty at times

Charts must be pulled an prepared s each patient arrives

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scheduling patient office visits?




WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS Assume that you are the office manager in a physician’s office. Create a policy and procedure for scheduling patients. ►You can allow students to use the sample in the text and the procedures for making appointments.

WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS Sign-in sheets can cause a breach in patient confidentiality. What other methods could you use that would limit the potential for invasion of patient privacy? ►This exercise is effective as a group discussion. Students can compare sign-in procedures in their own medical offices, pharmacies, and other facilities. Have students identify any HIPAA violations in each suggested procedure.



Date:

Learning Objective 6-3: Identify the factors that affect appointment scheduling.




Content Text PPt

Patients’ needs Good communication

critical — emotions can make slight miscommunication into negative experience for patient

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

Strive to accommodate patient’s requests but remember:

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7 In-Class ActivitiesRead the Ethical Tip “Think Before You Speak,” and discuss with class

Outside Assignments

EvaluationCheckpoint Question 3: What are three factors that can affect appointment scheduling?






Content Text PPt

You control the schedule—do not let it control you

Entire medical office team depends on a well-managed schedule

Providers’ preferences and needs Become familiar with

providers’ habitso 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

Physical facilities Number of providers

using facility Number of examination

rooms Need to resterilize

instruments between procedures

Must thoroughly understand the requirements for

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9






Content Text PPt

procedures to be performed in the office




Date:

Learning Objective 6-4: Explain guidelines for scheduling appointments for new patients, return visits, inpatient admissions and outpatient procedures.

Procedure 6-1: Making an Appointment for a New Patient

Procedure 6-2: Making an Appointment for an Established Patient

Procedure 6-3: Schedule an Appointment for a Referral to Outpatient Facility.

Procedure 6-4: Arrange for Admission to an Inpatient Facility.




Content Text PPt

Making appointments Be pleasant and helpful Always include patient

phone number on schedule

Include buffers each day New patients

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 Request pertinent

insurance information

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Fig. 6-3: Give patient an appointment card

Box6-6: explanation of terms referral or consultation

In-Class ActivitiesLecture Notes, SG p. 291Competency Evaluation Form Procedure 6-1, Making an Appointment for a New Patient. Competency Evaluation Form for Procedure 6-2, Making an Appointment for an Established Patient. Competency Evaluation Form for Procedure 6-3, Schedule an appointment for a referral to an outpatient facility.Competency Evaluation Form for Procedure 6-4, Arrange for admission to an inpatient facility.Video Clip 6-1: Making an Appointment for a New Patient*Video Clip 6-2: Making

Outside Assignments

Evaluation:Checkpoint Question.5: What information should be readily available when calling to schedule a patient for surgery in another facility?






Content Text PPt

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

Established patients 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 (Fig. 6-3)

Reconfirm date and time Recheck appointment

book End with pleasant word

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an Appointment for a Return PatientVideo Clip 6-3: Making a Referral to an Outpatient FacilityVideo Clip 6-4: Arranging for Admission to an Inpatient Facility






Content Text PPt

and smile When the provider requests

assistance from another physician—consultation—or referral:

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 (figure 6-6)

Give patients choice of specialist

When calling another physician’s office for patient appointment provide the following:

Physicians name and telephone number

Patients name, address, and telephone number

Reason for referral Degree of urgency Whether patient is being

sent for consultation or referral (Box 6-6)

Record in patients chart Time and date of call Who received your call

Inform person that you wish to be notified if patient does not

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19Fig. 6-6: Sample referral formBox 6.6: Referral or Consultation?






Content Text PPt

keep appointment (if this occurs—enter in

to the patients record)o Can write

name, address, telephone number of referral doctor on office stationery and include the date and time of appointment

o Give or mail to patient

Patient may call referring physician and make appointment—ask patient to notify you with date—document

Diagnostic testing 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

o Exact test or test

o How soon results are needed—STAT?

o Ask

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Content Text PPt

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

Some laboratory studies or x-ray test require advanced preparation

o Give patient written and verbal explanation

o Ensure he or she understand

o Document in chart and put reminder in tickler file to ensure test results are received.

Surgery 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

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Content Text PPt

Exact procedure Amount of time needed Anesthesia required 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




Date:

Learning Objective 6-5: List three ways to remind patients about appointments.




Content Text PPt

Preparing Daily or weekly schedule

Most offices—medical assistant responsible

o Make copy for staff—ensure corrections are made on all copies

o Place next day’s schedule on physicians desk before he or she leaves—next week’s on Friday

o Should include patient appointments and all other commitments

o Important to make manual changes to computer schedules as day progresses

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

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Fig. 6-4: Sample reminder postcardBox 6-2: A tickler file can tickle your memory

In-Class Activities Outside Assignments

EvaluationCheckpoint Question 4: What are the three types of patient reminders?






Content Text PPt

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

Mailed reminder card (Fig. 6-4) Alternative to phone

calls Mail one week before

appointment Can be used to remind

patients to make appointments for regular examinations

Place filled out cards in tickler file and mail at appropriate time (Box 6-2)

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Date:

Learning Objective 6-6: Describe how to triage patient emergencies, acutely ill patients, and walk-in patients.




Content Text PPt

Schedules often need to be adapted to accommodate unexpected situations

Emergencies (Fig. 6-5) Must determine if

problem can be treated in office or whether to call EMS

STAT = Latin statim, immediately

Ask appropriate questions to elicit crucial information (Box 6-3)

o Possible heart attack

o Possible poisoning

o Life-threatening bleeding

o Shocko Burns Constellation of

symptoms can indicate particular condition

o Shortness of breath, chest pain, arm/neck pain, nausea/vomiting can indicate heart attack (Box

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Fig. 6-5: When a patient calls from home with a possible heart attack, you will call 911

Box 6-3: When does the patient need to be seen now?Box 6-4: When a patient could be having a heart attack?

In-Class Activities

Administrative Medical Assisting Competency Interactive Case Study: Unit 2: Managing a medical office emergency(Student CD; IRCD; IRC)

Outside Assignments






Content Text PPt

6-4)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

Acute illnesses 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

Walk-in patients Office policy should be

in place Emergencies must be

handled immediately Ask patient to wait —

work in to schedule as possible

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Content Text PPt

Legend: Student CD: CD-ROM that accompanies textbook; IRCD: Instructor’s CD-ROM; IRC: Instructor’s Resource Center on thePoint Course&Content Manager; PPt: PowerPoint; SG: Study Guide ; DVD: DVD available for purchase. (*) Denotes free video available on the Student CD and on the Instructors Resource Center on thePoint Course& Content Manager.



Date:

Learning Objective 6-7: Describe how to handle late patients and patients who miss their appointments.




Content Text PPt

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

Missed appointments 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 (Box 6-5)

Continued failure to

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Box 6-5: Charting example

Related ChapterChapter 2 outlines steps taken to terminate physician-patient relationship

In-Class Activities

Read the Legal Tip “Document, Document, Document!” found in the text. Discuss with the class.

Outside Assignments






Content Text PPt

keep appointments should be handled by physician

o May decide to terminate relationship




Date:

Learning Objective 6-8: Explain what to do if the physician is delayed.




Content Text PPt

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

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17 In-Class Activities Outside Assignments




Date:

Learning Objective 6-9: Describe how to handle appointment cancellations made by the office or by the patient.




Content Text PPt

Office cancellations 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

Patient cancellations 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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Figures6-6: Patient making emergency call

Upon completion of all Learning Objectives for Chapter 6:

Instruct students to work through Chapter 6 of the Study Guide.

Have students take the Chapter Self-Assessment Quiz at the end of Study Guide Chapter 6 and submit it at the next class period. You can review the answers as a group in class or grade them individually and return them to the students.

Premium Online Course: Have students work through the exercises in Module 6 of the online course


WARM UPS FOR CRITICAL THINKING – QUESTIONS AND TALKING POINTS



You notice that patients typically wait 30 to 45 minutes past their scheduled appointment times because of the physician. How would you approach a physician who chronically runs late? ►A good way to identify the possible reasons for the delays is to discuss the issue at an office meeting. Be sure you pinpoint the specific problem. The chain of command should always be followed. The office manager should be the one to speak to the physician. He should be told exactly what he needs to change. For example, “Dr. Young, do you think you could get here about 15 minutes earlier? We seem to be getting behind and starting on time would help us stay on schedule.” Remember, physicians want their offices to run smoothly. Most will appreciate being part of the solution instead of the problem.


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