Chapter - Patient Appointments.docx

Patient Appointments ==================== Medical assistant (MA) responsibilities include numerous interactions with patients. This includes helping to schedule, cancel, and reschedule appointments. Appointments can be managed both electronically and on paper. Electronic scheduling can be done usin...

Patient Appointments ==================== Medical assistant (MA) responsibilities include numerous interactions with patients. This includes helping to schedule, cancel, and reschedule appointments. Appointments can be managed both electronically and on paper. Electronic scheduling can be done using a computer, kiosk, or tablet. Paper scheduling necessitates handwritten schedule information in a book or on a form. When there is downtime due to power outages or technology issues, the electronic method may be replaced by the paper format. Patients can schedule appointments online through the healthcare organization\'s website or their own patient portal. Scheduling requires meeting the patient\'s needs while managing the provider\'s time. Allow for interruptions and urgent medical issues that may arise on a daily basis when scheduling and managing the time of a healthcare organization. The schedule must also account for any times that must be excluded from the schedule matrix, such as hospital rounds, vacation days, regular days off, lunch hours, or conferences. Find and maintain the appropriate balance for the organization, providers, and patients. Each health care organization also decides how to schedule appointments. Effective and accurate scheduling will improve the organization\'s workflow and success, resulting in staff, patient, and provider satisfaction. Schedule Methods ---------------- - **Specific time** - A specific time gives each patient an individual time for their appointment. - **Wave scheduling** - allows multiple patients to be seen at the same time, such as at the top of the hour or within the first 30 minutes. Patients are prioritized based on their arrival time. This provides greater flexibility within each hour. - **Double-booking** - allows providers to schedule appointments for two patients at the same time and provide medical services concurrently. This is useful when one patient requires labs or tests, allowing for alternate care. - **Clustering** - Patients are scheduled in groups with common medical needs (schedule all new patients on Tuesdays or all wellness exams on Fridays). Types of Office Visits and Requirements --------------------------------------- There are numerous reasons why a patient will seek medical treatment. This includes everything from emergency situations to scheduled wellness visits. It also includes in-person and virtual visits (telehealth). Appointments can include the following: - **New patients** - are those who have not received services from the same provider or group within three years and have a known complaint or condition. - **Established patient status** - (e.g., follow-up, illness, or consultation). - Received services from the same provider or group (and same specialty) within three years, including a known complaint/condition. - **Comprehensive -** New or established patient with multiple complaints, injuries, or worsening chronic conditions at the highest coding level. - **Preventive care** - including physical exams, annual wellness checks, and chronic care management. - Comprehensive evaluation of body systems, including preventive care and screenings. - **Urgent** - Medically necessary within 24 hours - **Other entities** - non-patient related (e.g. depositions, sales, representatives, staff meetings, training). ### Determining the Type of Appointment To determine the type of appointment required (to ensure that the appropriate amount of time is scheduled for the patient visit) consider the medical resources required to complete the appointment. When a patient calls to schedule an appointment, always ask about the reason for the visit to determine the type and length of the appointment. Review the patient record to learn more about the appointment. Is the patient coming in for chronic care management, a wellness exam, or a follow-up on an existing condition? Once the reason for the visit is determined, ask the patient for their preferred time and day for the appointment, and then provide them with a few options for availability. Another factor to consider when scheduling is whether they prefer a virtual (telehealth) or in-person visit. Telehealth (virtual) visits can save patients time and money by eliminating travel time and transportation issues. Telehealth visits allow you to determine their level of technology access and comfort. Telehealth encounters can be classified based on the type of medical specialty, the type of service needed to treat the patient, provider preference, patient preference, or third-party payer guidelines. ### Screening Methods Screening is the process of asking questions to determine the patient\'s signs and symptoms, as well as the history of their current condition, in order to prioritize medical services. Screening is an especially important process for determining the appropriate type of appointment. The health care organization will have written policies and protocols in place for asking questions during screening calls. Questions may include the patient\'s name and contact information, the reason for the visit, the nature of the current condition, and other health-related questions pertaining to the current condition. Screening procedures are also used to determine whether the call should be routed to clinical staff or another department, such as billing. Screening policies should clearly define urgent matters and how to handle calls. The policy can include a decision tree with questions that direct the appropriate action based on the responses. The MA should actively listen for key words to determine the next step, such as scheduling an appointment or leaving a detailed message for a return call. After the screening questions have been answered, confirm the third-party payer (insurance) information and eligibility. Inform the patient about policies governing patient financial responsibility, such as copayments due at the time of service. It is also recommended that patients arrive at least 15 minutes before their appointment time to complete or update any required paperwork. ### Requirements for Visit Duration Many factors influence the amount of time needed for the appointment. The provider\'s habits and preferences can also influence the duration of the visit; they may take longer or shorter depending on the situation. The MA must consider office processes, provider preferences, and the type of appointment being scheduled. Schedules are frequently divided into 15-minute intervals. The MA will reserve the necessary number of appointment slots. The type of appointment and the approximate time required are determined by factors such as provider type and preference. Examples include the following: - New patient - 60 min - Established patient (could include follow-up, sick, or consultation) - 15 min - Comprehensive - 45 to 60 min - Preventive care (complete physical exam, annual wellness exam, chronic care management) - 45 to 60 min - Urgent - 20 min - Other entities - 30 min ### Prioritize Appointment Needs Based on Urgency The MA is trained to ask the appropriate questions to determine appointment priority. A patient who calls in to request an urgent visit for minor injuries or acute conditions that do not require emergency care will be prioritized. This is not an appointment that should be scheduled for the next available time slot; rather, schedule them as soon as possible. The organization\'s screening process determines whether the situation is life-threatening and requires referral to an emergency department, or if it is urgent and can be accommodated within the office schedule. This supports the need to ask the patient\'s name, phone number, and location at the start of the call. The MA lacks the necessary qualifications and training to diagnose and treat medical conditions. General recommendations for nonprescription treatments can be provided as part of patient education under the organization\'s direction and policy. In emergency situations, the patient can be asked to call 911, or the MA can call 911 and request that personnel come to the patient\'s location, remaining on the phone with the patient until EMS personnel arrive. ### Identify and check. Patients In/Out Patient check-in begins when the patient arrives for their appointment. It should be polite and professional. The MA will confirm the patient\'s identity, eligibility, and insurance details. Request a photo identification, such as a valid state identification card or driver\'s license, to ensure that the name and birth date match those on the insurance card and patient medical record. The MA will ask the patient to confirm their demographics and ask if anything has changed so that information can be updated as needed. Missing, incomplete, or inaccurate demographic information is a common cause of claim denials, and the check-in process is an opportunity to ensure accuracy. Patient registration forms will be checked to ensure they have been signed and uploaded to the patient\'s account. The insurance card and valid state photo identification will be scanned into the system. Some health-care facilities will photograph the patient and upload it to their medical records. This helps to verify the patient\'s identity and reduces the possibility of identity fraud. Patients have the option of agreeing or declining to have their picture or photo ID scanned. When determining the patient\'s insurance eligibility, the MA will also determine any copayments or patient financial responsibilities that must be collected before medical services are provided. It is far more efficient to collect the balance due up front rather than after the appointment or when the patient has left. When the appointment was scheduled, the patient should have been informed of any amounts due at the time of service. Provide any assistance that patients require while being escorted to the exam room. The patient should be asked if they require any accommodations or assistance; this should never be assumed. The patient check-out process takes place after the medical encounter is completed. It is critical to review the after-visit summary (AVS) and inquire whether the patient has any questions or concerns. Any necessary follow-up should be noted and highlighted for the patient, such as scheduling follow-up appointments or assisting in the scheduling of diagnostic tests or lab work. If a patient has additional financial responsibility, such as a deductible or coinsurance, it will be collected at check-out. The patient check-out should be as courteous and professional as the greeting before the appointment. ### Required Documentation for Patient Review and Signature. When patients come in for medical services, make sure that all necessary paperwork is reviewed, completed, and signed by the patient. New patients have more paperwork than established patients because they have signed documents on file. This documentation may include the patient\'s demographics and medical history, the organization\'s Notice of Privacy Practices (NPP), the Patient\'s Bill of Rights, the Assignment of Benefits, and any medical record release forms. These forms inform patients about office policies and procedures, as well as collect information for the medical record and billing. ### Follow-up on Patient Calls and Appointment Confirmations The majority of outgoing calls to patients are in response to appointment requests or confirmations, laboratory and imaging results, post-procedure follow-up calls, or returning patient inquiries. Patients frequently express anxiety and eagerness to receive laboratory and diagnostic test results. Many patients now have immediate access to their results through their patient portal. Health care providers notify patients about the findings via the patient portal, phone, or mail. The provider\'s organization may have a policy in place to contact patients by phone if they have abnormal results, or to instruct the patient to call the office after a certain amount of time to follow up on the results. This may be done to reduce staff workload while prioritizing contact with patients who require follow-up. The ordering provider must always review the results and provide direction on how to communicate test results. Confirming and reminding patients of their scheduled appointments can help to reduce no-show rates. Reminders can be sent in a variety of ways, including automated calls or patient portal messages, appointment cards, email or text messages, or a combination of the above. Inform patients of the practice\'s no-show and late cancellation policy. When returning phone calls from patients, it is beneficial to plan ahead of time. Only leave the name of the practice if it does not reveal the reason for the call. All patient interactions and follow-ups must be recorded in the patient record. Always maintain confidentiality by not disclosing unauthorized protected health information (PHI) and follow confidentiality guidelines when speaking with patients over the phone. Tips when placing outgoing calls to patients include the following: - Open the patient\'s medical record. - Have all the information needed available prior to placing the call. - Allow enough time and double-check the telephone number. - The MA should identify themselves and confirm if this call time is convenient. - Only provide information to the patient or authorized individuals who are identified on the patient\'s signed privacy agreement. Tips when reaching a voicemail include the following. - The MA should state only the name of the individual the message is intended for, date and time of the call, their name and the name of the practice, return call back number, and hours for returned calls. - Follow any office policy and procedure guidelines regarding office privacy agreements signed by the patient. Manage Electronic and Paper-Based Medical Records. -------------------------------------------------- Some healthcare providers continue to use paper-based filing systems (charts) for medical records. Paper charting can be inconvenient because it only allows one user to access data at a time and lacks real-time adjudication (RTA) interoperability among healthcare providers. Furthermore, looking for and finding charts can be time-consuming. There are several methods for storing and filing documents, but alphabetical filing (by the patient\'s last name) is the most common. Inside the chart, paper records are arranged in reverse chronological order, with the most recent medical services at the top. Most organizations and medical providers have switched to electronic records for a variety of reasons, including accuracy, efficiency, and government requirements and incentives from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). ### Sections of the Medical Record #### The administrative section includes the following: - Patient\'s demographic information (name, address, phone number, birthdate, sex (assigned at birth), insurance information, place of employment) - Notice of Privacy Practices (NPP) - Advance directive - Consent forms - Medical release forms - Correspondence and messages - Appointments and billing information #### The clinical section includes the following. - Health history - Physical examinations - Allergies - Medication record - Problem list - Progress notes - Laboratory data - Diagnostic procedures (electrocardiograms, radiology reports, spirometry reports) - Continuity of care (consultation reports, home health reports, hospital documents) The patient medical record is a legal document, and corrections to a paper record are made by adding a correcting entry or addendum, or by drawing a line through data and inserting new data; it should never be permanently deleted. Include the date and name of the person who created the addendum. All information in the medical record should be kept confidential and private, with access limited to those authorized. Compliance should always be maintained. #### Monitor Patient Flow Sheets, Superbill, or Encounter Forms - Patient flow sheet - Records and tracks patient health data, such as vitals or lab results - Encounter form/Superbill - Records the diagnosis and procedures covered during the current visit - Encounter notes - Clinical notes that include history of present illness and current medications list - Laboratory report - Includes results from lab tests that were performed - Radiology reports - Includes results and interpretation from radiology services provided The diagnosis and procedure codes must be linked in order to substantiate the medical necessity, for example, demonstrating how a sore throat would justify the need for a strep test. The encounter form, also known as the superbill, contains a compilation of the frequently utilized diagnosis and procedure codes by the medical practice. These codes are chosen to generate a claim for billing medical services. The encounter form is commonly generated electronically, although it can also exist as a physical paper document in certain instances. The encounter form can be customized and adjusted to cater to the specific requirements of the healthcare organization or specialized practice. ### Storage of Medical Records Electronic health records are typically stored in the cloud; most are backed up in real time and easy to access and retrieve. Electronic records and backup data must be stored off-site in case the original data source is lost or damaged. Current paper medical records are kept on-site, while archived records are kept in a convenient off-site location for easy retrieval when needed. Archived records may need to be retrieved for medical history, general patient care, or legal reasons, such as a subpoena. Medical record retention times vary by state. However, they must be stored appropriately and for the minimum amount of time specified by each state. Records must be maintained and well organized, regardless of whether they are stored electronically or on paper, in order to provide effective healthcare. Ensure that all federal and state privacy and confidentiality regulations pertaining to medical records are followed, regardless of the methods used. ### Review of a chart Charting refers to the systematic recording of patient observations and information in their medical records. This encompasses assessments, decisions, therapies, and any necessary subsequent actions. It facilitates the seamless provision of healthcare and integrates all interactions with other healthcare providers and the patient. Electronic health records automatically record the individual\'s information, as well as the date and time, whenever there are any additions, modifications, or corrections made. Paper records necessitate the presence of the individual\'s handwritten text, including their name, date, and time. Electronic health records incorporate interactive flow sheets that optimize the seamless coordination of care and aid in the management of the patient\'s medical conditions. Electronic Health Records (EHRs) facilitate efficient communication within the medical institution and between other institutions that have incorporated EHR systems to assist in patient care. Medical records of patients are utilized to aid in delivering efficient medical treatment and invoicing a third-party payer. Furthermore, they can also be employed to bolster research endeavors aimed at enhancing overall well-being. Prioritize the thorough and precise review of the documentation process before finalizing the record. A chart review is conducted to ensure that the encounter, prescriptions, follow-up, and communications are thoroughly and precisely documented. The ICD-10-CM diagnosis code(s) indicate the purpose of the visit, such as tonsillitis or an annual exam. The CPT® procedure code(s) indicate the specific medical services rendered, such as an examination or laboratory tests. ### Review Patient Records Prior To The Visit In team-based care settings, the MA frequently assumes additional responsibilities, including previsit planning. Previsit planning can begin several days before the appointment and include reviewing the patient\'s medical record to determine the following. - Important dates for preventive testing (Pap smears, colonoscopies, mammograms) and immunizations (refer to the CDC website for schedules). - Ensure timely completion of patient care management tasks (e.g., HgbA1c, diabetic foot check, cholesterol testing). - Prescriptions that have expired or will expire soon. Examine the preventive care section of the patient\'s medical record to see if any preventive and diagnostic testing, immunizations, or exams are due, such as diabetic foot checks. Also, look through the medication section of the chart to see if the patient requires prescription refills. Electronic orders for diagnostic testing or prescriptions can be generated in the order section of the patient\'s EHR. The provider will review the orders and either sign off on them or make changes and discuss them with the patient. ### Clinical Quality Measures and Responsibilities During the visit Part of the MA\'s routine includes gathering specific information from the patient. This will allow for a more efficient patient visit and eliminate any additional work that could cause the patient or the medical provider to be delayed. Clinical quality measures help identify treatments, processes, experiences, and outcomes. These may include patient engagement and safety, care coordination, utilization of health-care resources, and preventive patient screening. When conducting the patient interview, include the following: - Discuss any changes in your health status. - Reconcile medications and request refills as needed. - Confirm allergies. - Screen for health conditions as per facility protocols. - Fall risks - Screening for mental health and developmental issues. - Update medical history. - Educate patients on recommended preventive services and timelines. - Discuss any necessary or recommended immunizations. Many electronic clinical quality measures exist to help measure and track the quality of health care services. Many health care providers are required to report clinical quality measures to assess the quality of care provided to their patients. Clinical quality measures can help identify areas for quality improvement, disparities in care and outcomes, and improve care coordination among providers. While medical assistants are not permitted to make recommendations, they are frequently the liaison between the provider and the patient, helping to reinforce instructions and ensure comprehension. They are patient educators, and patient education leads to better adherence to treatment. ### Document Preventive Maintenance and Screenings An MA is responsible for recording patient education and communications about preventive maintenance and screenings in the patient\'s medical record. The MA should include the topic requested by the provider for coaching, the materials used, and general discussion points covered, as well as questions and responses from the patient. Document all patient education in the patient record to demonstrate that the patient has received and understands the educational material required to successfully adhere to treatment plans.