Medical Assistant Exam: Administrative Procedures - Scheduling and Monitoring Appointments

Scheduling appointments for patient visits is one of the primary responsibilities of the administrative medical assistant. Appointments can be made by telephone or in person. Appointments can be recorded either in a manual appointment book or with a computer scheduling system. Regardless of the scheduling system used, skillful appointment scheduling can make patient flow run smoothly, which decreases waiting time and better accommodates the needs of the patient. The medical assistant must be familiar with the office policy regarding the time allotment for appointments and the preferred scheduling styles of the facility.

Appointment Book
The first step in manual scheduling is to select an appropriate appointment book. Considerations in this selection should meet the following requirements of the individual office. Appropriate time slot selection allows the office to schedule patients at specific intervals, for example, every 15 minutes or every 20 minutes. Adequate space for entering patient information should be available. Most offices record the patient’s full name, daytime telephone number, the reason for the visit, a note about whether the patient is new or established, and the type of insurance.
The appointment book should also lie flat when opened (so that it is easier to use) and should be large enough to accommodate the number of physicians in the practice. Because appointments often need to be changed or cancelled, entries should be done in pencil to prevent the appointment book from becoming difficult to read. Some appointment books could include color coding for different days of the week or for different months. Also, some appointment books allow viewing of more than one day at a time. One disadvantage of the manual appointment book system is that it doesn’t provide a permanent record of the day’s appointments because it is written in pencil. A typed list of patients should therefore be kept for legal reference.
Computer systems for scheduling are quite popular in many offices and often come as part of the office management software package. Regardless of the type of appointment book used—either manual or computerized—problems with patient flow will occur if careful attention to the time needs of the patient, the work habits of the physician, and the best use of the facility resources and staff are not considered in the scheduling process.

Matrix
The next step after selecting the appointment book is setting up the matrix. The medical assistant should block off times that the physician is unavailable to treat patients and times the office is not open, such as during weekends, vacation, medical meetings, or holidays, so that patients are not scheduled during those times. The matrix should be done in pencil to accommodate changes.
The medical assistant must set up a matrix whether the office uses a computerized scheduling system or a manual scheduling system.

Common Scheduling Styles
There are different styles or methods of scheduling patients. Each style has its advantages and disadvantages—for both the patient and the medical staff. The facility can use any combination of the scheduling styles in order to accommodate the flow of the patients and to allow flexibility in the schedule in case of emergencies.

Stream scheduling is one of the most common types of scheduling styles used in physicians’ offices. Each patient is given a specific time for the appointment and the time allowed for the appointment depends upon the reason for the visit. For example, a physical examination for a new patient would take more time than a three-month blood pressure check for an established patient would take. An advantage of this scheduling style for patients would be minimized wait time, so that the patients would not have to wait too long to receive care. An advantage for the medical staff is that the patient load would be spread out throughout the day. Certain periods in the day could be marked off to allow for emergency appointments or to allow the physician to catch up if he or she runs behind due to unforeseen problems. These marked-off times are referred to as 'catch-up times.'
Wave scheduling schedules three patients per hour. For example, three patients would be scheduled at ten a.m., three patients scheduled at eleven a.m., and so forth, allowing for 20-minute visits. The main idea behind this style of scheduling is to start and finish each hour on time, treating three patients per hour. All three patients would be scheduled at the same time, and the first patient to arrive would be seen first, followed by the second patient to arrive, and then the third patient to arrive. The theory behind this style is that not every patient takes the same amount of time, and most of the time the differences work out by the end of the hour. There is a disadvantage to the patient, however, with this style. If all patients arrived at the same time, one patient would have to wait approximately 40 minutes before he or she could be seen. However, most references on scheduling state that the waiting period for a patient should not exceed 15 to 20 minutes. If there will be a delay longer than 20 minutes before the patient is seen, many offices will inform the patient of the delay and offer to reschedule, or even call the patient to inform him or her that the office is running late and ask the patient to come in a bit later in order to decrease the waiting time.
Modified wave scheduling aims to address these potential issues with wait time. Only two patients are scheduled on the hour and the third patient is scheduled at half past the hour. This style allows more flexibility within the hour depending on the needs of the patient and minimizes the waiting time for patients.
Clustering, sometimes referred to as grouping, allows the facility to schedule similar procedures together in a specific time slot or day. Performing school physicals one morning or having a routine immunization clinic one morning, for instance, makes for more efficient use of time and staff members.
Open hours is a style for treating walk-in patients. No specific times are set for each appointment, but rather the hours of operation are listed and patients are seen usually on a first-come, first-served basis. With this scheduling system, patients are triaged, or screened, when they arrive, meaning that the most seriously injured or the sickest patient is seen first, regardless of the order of arrival. One of the advantages of this style is that the patients don’t have to wait weeks or even months to get an appointment with their physician. There are disadvantages, too: patients may need to wait a long time to be seen, and the medical staff may have no patients, or too many, to treat at any given time.
Double-booking is a style that schedules two patients for the exact same time. It should be used very carefully and only if the office can accommodate more than one patient at a time. If two patients are going to be scheduled for a physical examination and both are scheduled for the same time, one patient could be taken to the lab for blood work or be seen by the physician, while the other patient is having an electrocardiogram (EKG) performed. Neither patient would be sitting and waiting for his or her appointment. Some physicians use this way of scheduling to ensure that there will not be any empty times during office hours caused by missed appointments or last-minute cancellations; however, this can result in long wait times for patients.
Practice-based scheduling refers to any method that works for the individual office. No one type of scheduling works for every facility; therefore, a practice-based style consists of scheduling techniques that are the best fit for a specific facility. For instance, a pediatrician’s schedule may be set up for well-baby visits two mornings a week (clustering style) and have set appointment times the rest of the day (stream style). Another afternoon could be dedicated to immunization appointments (clustering style).
No matter what scheduling style is used, many problems with scheduling can be solved by making reminder calls to patients the day before their appointments and being sure to give each returning patient a reminder card for his or her next appointment.

Scheduling Guidelines
Scheduling guidelines include facility and staff availability, physician preferences and habits, and patient needs.

Facility and Staff Availability
In selecting an appointment style and setting up the matrix, the medical assistant should give attention to the available facilities, such as the available number of patient examining rooms. The type of practice will dictate the needs of the patients. Offices that perform minor surgical procedures may need more time with each patient, plus a recovery room to allow the patient to rest before leaving the office. More treatment rooms may need to be set up for the next surgical procedure so that the physician and patient do not have to wait. The time needed to perform procedures done by other personnel, such as blood tests, EKGs, or X-rays, needs to be considered when setting up appointment times.

Physician Preferences and Habits
The working style and habits of the physician are another consideration for time allotment in the appointment book. Physicians work differently, some preferring to be kept very busy and others preferring a slower, more relaxed environment. The scheduling style selected should fit the needs of the individual office.

Patient Needs
Regardless of the scheduling style chosen, flexibility and concern for patients are the most important factors in successful scheduling. Having some general information about the type of patients coming to the facility can be helpful in arranging the most convenient appointment times for patients. Elderly patients may need transportation. Working patients may appreciate evening or weekend appointments. Working around the individual’s schedule will help ensure that appointments are kept.

New Patient Scheduling
New patients require longer appointment times. One reason for the additional time needed is that information must be gathered from the patient upon his or her arrival. Such information includes the patient’s full name, phone number, reason for the visit, and type of insurance. Some offices ask for more detail before the patient even arrives, including the name of the referring physician and the patient’s address, place of employment, date of birth, and insurance information, while other offices may wait to obtain this information when the new patient arrives for his or her first visit. To get started on organizing the medical record, some offices will send registration and past history forms to the patient and ask that the completed forms be returned when the patient comes in for his or her appointment. Some offices may request that new patients come in 15 minutes before the scheduled appointment to fill out paperwork. The medical assistant should remind the patient to bring his or her insurance card and co-pay, if needed, depending on office policy.

Established Patient Scheduling
Information needed from established patients requesting an appointment should include the patient’s full name, a phone number where he or she may be reached during the day, the reason for the visit, and any changes in insurance information. Often the medical assistant will ask established patients to update information on file, such as addresses and insurance plan details.

Physician Referrals
Patients can be referred by the primary care physician to a specialist for evaluation or treatment of a specific disease or condition. Many types of insurances, such as health maintenance organizations (HMOs), request preauthorization before the patient can be seen by a specialist. There are three primary types of referrals:
- Regular referrals: requested when the primary care physician decides that the patient needs more specialized treatment; usually take about one week to ten days before being approved by the insurance company
- Urgent referrals: requested for more specialized, non-emergency care; can take between 24 to 48 hours for insurance company approval
- STAT referrals: requested for life-threatening conditions; usually faxed to insurance companies and usually approved by telephone
Referrals can be made by the physician, members of the physician’s staff, or the patient needing the referral. If the patient or the staff member of the referring physician is the one calling for the appointment, the information needed for scheduling an appointment is the same as needed for scheduling a new patient. It is essential that the patient provide the reason for the appointment, so that the medical assistant may schedule an appointment for the patient as soon as possible, if needed. If the patient is referred to a medical facility for a presurgical clearance, then the appointment needs to be scheduled within a certain time frame, depending on the policy of the hospital where the surgery will be performed. Many times, if the situation is more urgent, the referring physician may call to request the appointment for the patient. If the situation is urgent, the medical assistant should make every attempt to give the patient an appointment on the day of the call or as soon as possible.