Admin Protocol Manual updated 2024.docx

About us ======== Capital Podiatry Associates, PC is located on Hinson Farm Rd, Alexandria, VA 22306, suite 301. Our goal is to develop teamwork within our clinic, in order to make a safe place for all staff and patients. We pride ourselves on setting up our staff for success in medical clinic flow...

About us ======== Capital Podiatry Associates, PC is located on Hinson Farm Rd, Alexandria, VA 22306, suite 301. Our goal is to develop teamwork within our clinic, in order to make a safe place for all staff and patients. We pride ourselves on setting up our staff for success in medical clinic flow. Ph: (703) 560 - 3773 Fax: (703) 799 - 0050 Table of Contents ================= Introduction 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. Introduction ============ WHAT TO EXPECT -------------- Capital Podiatry Associates is accountable for all workforce development and requires its physicians and their managers to be responsible for training and development activities. All employees have a duty to inform their line manager of any training needs and continued professional development. All employees must apply the learning received toward their daily roles and responsibilities. At Capital Podiatry Associates we have a check-in, check-out, patient liaison, and an admin assistant for chart prep. All of these roles are crucial to the stability and flow of the front office to the back office. These roles all work together as a unit to make sure all patient charts are up to date before the end of each business day. EMERGENCY PROTOCOLS ------------------- Regardless of what is happening around you, it is important that you **REMAIN CALM**. 1. a. 2. b. 3. c. [Tebra Log in] -------------------------- - ### Tebra - - - - - - ### Tebra - - ##### How to send a message to other personnel in the office - - - - - - - - [Tebra] ------------------- - ### LOGIN  - - - ### PRINTING PATIENT STATEMENT - - - - - - - - - - ### CHECKING PATIENT BALANCES - - - - - - -  [NEW PATIENT] ------------------------- When a new patient calls, please obtain the following: - - - - - - - - - - - - - - - - - - - - - - - - - - [OPENING/CLOSING PROTOCOL] -------------------------------------- - ### Opening - - - - - - - - ### CLOSING - - - - - - - - - - - - [CHECK - IN] ------------------------ Check-in is the first person the patient interacts with when coming to their appointment. It is good to remember great customer service and a smile!! - ### CHECKING IN THE PATIENT - - - - - - - - [CHECK - OUT] ------------------------- Check - out is the last person the patient interacts with at this practice. It is important to schedule the patient\'s follow-up appointment to make sure treatment is continuing. - ### CHECKING OUT THE PATIENT - - - - - - - - - - - - - - [CHART PREP] ------------------------ Chart prep is an important role when it comes to patient charts and the next day\'s appointments. This role is primarily to prep superbills, update COB that new patient packets are with the year of signing, financial forms, and insurance/ ID cards. - ### PREPPING SUPERBILLS - - - - - - - - - - - ### FILLING OUT COB - - - ### FILING/ PULLING CHARTS - - - - - - - - - - - - - ### VERIFICATION - - - - - - - - - - 1. 2. 3. 4. 5. 6. [FLAG COLORS] ------------------------- - - - - - - [CANCELLATION POLICY] --------------------------------- CPA cancellation policy is very straightforward. It is our belief that our time is as valuable as ours. If patients do not show up for their appointment, cancel within the 24 hour window, or arrive more than 15 minutes late, they will be charged a **\$150 fee.** It will be up to higher management (Dr. Gilmore) if the patient will be charged. Surgery cancellation will be a **\$350** **fee**. We request patients to cancel their appointment before the 24 hour time frame of their appointment. It is the patient\'s responsibility to follow-up with our office. We do send courtesy reminders for the patient a couple days beforehand. The front desk is responsible for relaying the message to the doctor via EMR if there is a same-day cancellation, missed appointment, or no show. It is important to ask the patient the reason for cancellation because this is the deciding factor for the doctor in regards to charging a fee. Some emergency cases are waived. **\*HOWEVER, if a patient asks if there will be a fee charged, the best answer you can give is that it is up to higher management\*** [INSURANCE VERIFICATIONS] ------------------------------------- The patient liaison or office manager should have access and are able to edit COB by verifying insurances. - ### AVAILITY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - [CASH SHEET] ------------------------ - ### CASH SHEET FORMAT - -  - Patient balance will be under each patient\'s account. IF the patient has a credit, it will be in parenthesis. Make sure to notate that on the cash sheet. Ex.  - - - ### CO-INSURANCE (COINS) - - - - - - - - - - - - - - - - - - - - - [PRE-AUTHORIZATION] ------------------------------- - ### LOGIN TO AVAILITY - - -  - - -  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - - - - - - - - - - - -  - - - - - - -  - - - - - - - - - - - - - - - - [FAX AGENT] ----------------------- - ### LOGIN Weave desktop application - - - - - - ### UPLOAD FAX/PDF'S INTO TEBRA - - - - - - - - - - - - - - [POST TO BILLING] ----------------------------- - - - - - - - - - - - - - - - [SCHEDULE BLOCKS] ----------------------------- - ### COLORS - - - - - - - - - [TELEPHONE HANDBOOK] -------------------------------- The front receptionist must give his/her full attention to answering and handling telephone communications. The salutation for answering the phone is "Good morning/Good afternoon, this is (insert name here) at Capital Podiatry, how may I help you?" As the patient explains what the nature of their call is or whom the patient would like to talk with, record (Handwritten) the time of the call, who is calling, the message, and who it is for in an EMR. If the call is for the Financial Administrator, or the financial assistant, then ask for the reason they are calling (whether it is a bill/statement or financial discussion) if applicable. If it is in regards to a financial statement, transfer to the office manager or \_\_\_\_\_\_\_\_. If both parties are busy, send an EMR (regardless) to the correct personnel in the office and have them address the issue. (Include, name, reason, and call back number). If you cannot get a hold of either of these parties, ask the patient politely if you are able to place them on hold or ask the patient if the appropriate personnel from our office can call them back and that you will send a message. The office manager and \_\_\_\_\_\_ may be on the line with another patient, insurance company, or in a room with a patient discussing financials. It is vital to obtain the reason the patient is calling, verifying a good call back number, and letting the patient know that the office will call them back quickly and that you (Front Receptionist) will get the information to the appropriate person. State in an EMR if there needs to be a call back the same day. The receptionist is responsible for answering incoming calls if the Patient Liaison Supervisor is unavailable. **URGENT Messages** Ascertain whether the call is URGENT. Urgent messages would be patients in dire need of seeing the doctor, allergic reactions, or unhappy patients. Billing and financials should not be labeled as URGENT unless told otherwise by the doctor or office manager. To mark a message as URGENT, press the button on the top left hand side of the EMR saying "High" as in a high priority message. Once you send the EMR, wait for an acknowledgement and instructions moving ahead by the office doctor, office manager, or \_\_\_\_\_\_\_\_. If it is a serious emergency, put the caller on hold while you get the person needed for this call. In both instances, you can and should send an EMR. **General Questions** If the caller is requesting general information about our office such as office hours, type of practice (Podiatric Specialist), the Doctor's name, office location (8101 Hinson Farm Rd. Suite 301 Alexandria, VA 22306), then answer the question fully. If a caller requests technical information, do not attempt to answer his/her questions. This includes diagnoses, advice on treatment, anything to do on the patient's care (these all have to be discussed by the doctor), billing/statements, authorizations, or pharmacies requesting substitutions for a RX (prescription) If a person calls to speak to the Doctor, ask for the patient's name, the purpose of the call, and the phone number. Let the patient know since they are calling during clinic hours that the Doctor is currently unavailable due to treating patients at this time and that you will send a message promptly. If it is a solicitor, tell them that you will give the message to the Doctor. **New Patients** New patients often inquire about fees, and for second opinions; do not "treat" the patient over the phone or in person. If a new patient is a self-pay patient then let them know that the evaluation will be \$125 for a new patient visit. However, there may be fees depending on treatment by the Doctor and that the patient will be responsible for those fees post appointment. Explain to the caller "I am unable to discuss treatment options or diagnose over the phone without seeing the patient. The office offers an examination and evaluation at the first visit. The office will explain any costs to the patient before treatment is rendered." Please refer to the phone scenario regarding this offer. **Referring Doctor** When a referring doctor is calling about a patient, ask who the patient is (Last name, First name, D.O.B. (Date of birth)), verify patients in Wisdom and pull their chart in Powerchart, then send a message to the doctor via EMR. If the doctor is in the middle of a procedure, tell the referring doctor this and ask the doctor if this is an emergency. If it is not an emergency, send an EMR. If it is an emergency, transfer to the office manager and ask if the doctor is available. If not, then send a high priority EMR to the doctor and add the correct personnel to the message. **Outgoing Calls** The front receptionists are responsible for placing any outgoing calls requested by the staff or doctor. When placing a call for a doctor, use the dialogue "Good morning/Good afternoon, this is (insert name) at Dr. Gilmore's office. Dr. Gilmore would like to speak with (Doctor), is he/she available?" Or when appropriate, "Good morning/Good afternoon, this is Dana. Dr. Gilmore is returning (Patient Name)'s call, is he/she available?" Depending on the nature of the treatment, the Doctor may request the front receptionist to make an outgoing call to a patient, lab, doctor's office, drug representative, or pharmacy. If the doctor wants you to call any of these options, he will send an EMR directed to the front. When you call the any one of these options, use the following dialogue: **Staff:** "That is great to hear. The doctor also wanted me to ask if you have any and to confirm that you are following the post-operative instructions we gave you at your last appointment including (reiterate whatever point the doctor wanted to stress)." **Patient:** "No, I don't have any questions. I am following the instructions given to me." OR **Patient:** "Yes, I would like to ask if......" - **Patient:** "Thank you." Send an EMR to the doctor with the patient's response. Write in the subject line "Follow up call", then in the message include "Patient has a question in regards to their treatment or post-op instructions." **Rescheduling An Appointment** **Staff:** "Good morning/Good afternoon, this is (insert name) at Capital Podiatry, how may I help you?" **Patient:** "Hi, I would like to reschedule my appointment for (Date) and (Time)?" **Staff:** "Of course, when would you like to reschedule your appointment?" **Patient:** "I would like to reschedule it to (Date)." **Staff:** "Let me look at the schedule for you. It looks like we have an opening for that (date) at this (time)." **Patient:** "Perfect, I'll take it." **Staff:** "Just to confirm, we will cancel your upcoming appointment and reschedule to (Date) and (Time). May I ask the reason for the cancellation?" **Patient:** "I unfortunately have a work conflict." **Staff:** "No problem, I will just note it for the cancellation. Thank you and we will see you then. Have a great day." **Patient:** "Thank you, you as well." \*IMPORTANT NOTE FOR APPOINTMENTS\* When scheduling remember, patients cannot see your schedule. Fill in the schedule as best as you can and follow the opening slots. Scheduling appointments is like a game of Tetris. All appointments should fit corresponding to their duration. Do not schedule a patient at the end of the day if there are no patients scheduled beforehand. **PATIENT MISSED THEIR APPOINTMENT SCENARIO** **Staff:** "Good morning/Good afternoon, this is (insert name) at Capital Podiatry, may I speak with (insert patient name)?" "Hello (insert patient name) how are you doing today?" "I am calling to reschedule your appointment from mm/dd." "Are you able to do mm/dd at hh:mm AM/PM?" "Amazing, we will see you on mm/dd at hh/mm AM/PM! Have a great rest of your day!" -If patients say they do not want to reschedule their appointment right now then try and get the reason why. If it is time, money, or fear then try to see if you are able to find out if everything is okay. Our mission at the practice is to care for patients as best as we can. Customer service can go a long way in making sure patients are cared for, whether it is treatment or customer service. Money: Before calling to reschedule, make sure you read all the pop-ups on the patients account in Wisdom. If there are pop-ups then there is a good reason. Some patients are not always able to reschedule their appointment due to a high balance, or constant no-shows. - - Whatever the patient states is the issue, then send an EMR to the respective office personnel so we can go over the account and try to work on getting this patient back in the office. If there are any issues with patients, do not stay on the phone and take the heat. Pass it up to the Patient Liaison Supervisor and let them know what is going on. Always listen to patients on the phone. LISTEN, LISTEN, AND LISTEN. AND THEN ACKNOWLEDGE, ACKNOWLEDGE, AND ACKNOWLEDGE. **LEAVING MESSAGES** If the patient's voicemail does not state their name, due to HIPAA you cannot leave the patient's name in the message. Instead, use this line: "Hello, this is (insert name) from Capital Podiatry Associates calling to confirm your appointment for mm/dd at hh:mm AM/PM with Dr. Gilmore. Please give us a call back to confirm your appointment at (703) 560-3773." If the phone number does not connect: - - - **ANSWERING PHONES** Phones are answered with a smile! Try your best to listen to the patient and comfort them. People know if you are smiling over the phone by the tone of voice. At our office, we should give patients the best experience we can. **RULES** - - - - - - **PRIORITISING CALLS** Calls requiring immediate attention and high priority EMR's: 1. 2. 3. a. Calls that can be returned at a later time by the doctor (sent via EMR): 1. 2. 3. **DO YOU ACCEPT MY INSURANCE?** This is a popular question that we receive everyday. This is a common question that new patients have in order to be seen. It is important that the front desk understand which insurance companies we accept, do not accept, or are out-of-network with. **Patient**: "Do you accept my insurance?" **Staff:** "That's a great question, Let me see how I can help you." First, if you do not know if we accept a specific type of insurance, look at the key we have with a list of insurances we accept and do not accept. Regardless if our office accepts or do not accept the patient's insurance, do not say "yes" or "no". See what we can do to check their verification. The chances of losing a patient by saying no is high. Be sure to do everything we can to help the patient. There are about three ways a patient will ask "Do you take my insurance?" 1. a. 2. b. 3. c. **NEW PATIENT** **Patient:** "Hello, my name is (insert patient name) and I was wondering if I could make an appointment with Dr. Gilmore?" **Staff:** "Of course! Would you be an existing patient or a new patient?" **Patient:** "I would be a new patient. What type of availability do you have open?" **Staff:** "Great, well let me be the first to welcome you! We have it as early as tomorrow. May I ask what type of insurance you have?" **Patient:** " I have (insert insurance we accept)." **Staff:** "Perfect, let's get you set up. Do you have time for me to ask you some questions for your chart?" **Patient:** "Of course." **Staff:** Retrieve information from the new patient. - 1. 2. 3. 4. 5. - 1. 2. - 1. 2. 3. 4. **Staff:** "It looks like we have tomorrow morning available at hh:mm AM." **Patient**: "That would be perfect?" **Staff:** "Great! May I ask what your chief complaint is?" **Patient**: "I think I have \_\_\_\_\_\_." **Staff**: "I see, that can be rather uncomfortable. Well, you have come to the right place! Our doctor takes care of this all the time and gets great results. We will get you all sorted out and help as much as we can." **Patient:** "Thank you! I will see you tomorrow morning." **Staff:** "Perfect! Before you go, do you need directions to our practice?" **Patient:** "That you are great, thank you!" **Staff:** "Our address is 8101 Hinson Farm Rd. Suite 301 Alexandria, VA. Is there anything else I can help you with?" It is important to not rush the call. At the end, always ask "Is there anything else I can help you with?" Then thank the caller. Make sure to personalize your service. Mention your name, and leave a positive impression for the patient. Always positively explain information. This means that do not say no right away. See what we can do to help the patient. No matter what kind of insurance a patient has, every caller is a potential patient. Give them the best customer service we can. It is important to note: If the patient asks for medical advice, DO NOT treat the patient, that is the job for the doctor. Let the patient know that you can write down the questions for the doctor but cannot diagnose over the phone politely. **TELEPHONE SHOPPERS** Telephone shoppers are people that call the practice to get an estimate on how much it will cost for an appointment, as well as treatment. The doctor is the only one who can treat a patient. Try your best not to give estimates over the phone. This can lead to patients not wanting to come for an appointment OR they will state that someone in the office told them it was exactly this price. Depending on what the patient is coming in for, you are not able to advise patients on financials because it depends on their insurance. More than likely, the patient will shop for another practice once they hear the amount of money it will be. Follow the script below: **Patient:** "How much does it cost to have an ingrown toenail removed? **Staff:** "You have an ingrown toenail?" **Patient:** "Yes." **Patient:** "Okay." **APPOINTMENT CONFIRMATIONS** **Staff:** "Hello, this is (insert name) from Capital Podiatry, Dr. Gilmore's/Dr. Panchigar's office, how are you today?" **Patient:** "Doing well, thank you." **Staff:** "I was just calling to confirm your appointment for (day of the week) mm/dd at hh:mm Am/PM" **Patient:** "Okay, thank you, I will be there! Thank you." **Staff:** "You're welcome, I hope you have a great day!" Or **Patients**: "I'm glad you called, I need to reschedule my appointment." **Staff:** "Of course, I can definitely help you with that." Or **Patient:** "I actually need to cancel that appointment," **Staff:** "No problem, is there a better day we can reschedule your appointment?" **Patient:** "I'm actually going out of town next week." **Staff:** "Is there a way we can place you in the schedule? We want to make sure the doctor sees you for a follow-up appointment." **Patient:** "That would be perfect actually. Thank you." Leaving a voicemail: "Hi, this is \_\_\_ at Capital Podiatry. I was calling to confirm your appointment for (Date) and at (time). Please give us a call back at 703-560-3773 to confirm your appointment. Thank you and have a great day." At this time, you can look in Wisdom to see what that patient is usually coming in for. This would be beneficial to understand why it is important for the patient to come in to see the doctor. If patients go for long periods of time ignoring their problem it could turn into an emergency appointment. However, some patients will not want to reschedule their appointments. All you can do at this point is to state that you understand and say you will call in a couple of weeks to follow up. Some patients will state "I feel fine and I don't see why I have to come in anymore." **Staff:** "Well, it is important that the doctor follow-up just to make sure you are fully healed/that the orthotics are doing fine." **CANCELING APPOINTMENTS** Intended outcome: All cancellations should be handled professionally. Our goal at Capital Podiatry is to treat and help as many people as we can. We need to make sure that we reschedule appointments if they are canceled or missed. If a patient calls more than 24 hours in advance, it is important to reschedule their appointment and acquire the reasoning for the cancellation. If a patient calls within the 24 hours or same day cancellation, acquire the reasoning and send an EMR to the doctor and corresponding office personnel. Include if it is an emergency or non-emergency reason. If a patient asks if there will be a cancellation fee, let them know that it is up to higher management in regards to a missed appointment fee. We try not to let the patient know about the fee because they may not want to come back to the practice. Unless specified by the doctor, we do not tell the patient about the \$75 fee of a missed appointment or no show fee. All cancellations, missed appointments, no-shows should be recorded on the CX List excel sheet on google drive. **23. Sending SuperBills** 1. 2. 3. 4. 5. 6. 7. 8.