Scheduling Appointments

Scheduling Appointments

Methods of Scheduling  
1. Describe how scheduling appointments efficiently meets the needs of both physicians and patients.  
2. Describe the correct use of appointment books and computer scheduling to make appointments.  
3. Explain why the medical office must retain an updated copy of the daily appointment schedule.  
Types of Scheduling  
4. Describe several types of scheduling, including stream scheduling, wave scheduling, modified wave scheduling, double booking, open booking, and patient self-scheduling.  
5. Identify types of patient appointments that may be clustered in the appointment schedule.  
Setting up the Appointment Schedule  
6. Identify factors to be considered when setting up the appointment schedule. Set up the appointment schedule.
7. Explain how to set up the appointment schedule.  
Making an Appointment  
8. Differentiate between the information needed to make an appointment for a new patient and an established patient. Make an appointment.
9. Differentiate among medical conditions that require emergency care, urgent care, and routine care.  
10. Describe how to schedule appointments for individuals who are not patients.  
Managing the Appointment Schedule  
11. Describe the method for changing or canceling appointments. Manage the appointment schedule.
12. Describe how to update the schedule on the day of the appointment and document changes.  
13. Identify three methods to remind patients to make or keep appointments.  
14. Describe how to store appointment books and daily schedules.  
Scheduling Diagnostic Tests, Procedures, and Admissions  
15. Identify how to schedule inpatient and outpatient diagnostic tests and procedures. Schedule inpatient and outpatient diagnostic tests or procedures.
16. Identify how to schedule hospital admissions and surgery. Schedule inpatient or outpatient surgery.

Introduction to Appointment Scheduling

Scheduling appointments is one of the most important administrative responsibilities performed in the medical office. Until the 1970s, people went to a medical office expecting to wait as long as an hour or more. Most physicians liked to see a full waiting room; it reassured them that their practice was healthy.

In the twenty-first century, people have little tolerance for waiting in a medical office. Lifestyles have changed and people have busy lives. Many have to take personal time away from work to go to the medical office, and they feel that their time is as valuable as the physician’s time.

Scheduling appointments correctly and efficiently is crucial to the smooth operation of the medical office. Many factors must be taken into consideration when scheduling appointments. The patient who has made an appointment weeks or even months in advance wants to be seen within 15 to 20 minutes after arriving at the medical office. The physician wants a smooth flow of patients during the time scheduled for seeing patients. Patients who are ill or have accidents want to be able to see their physician on the day of the illness or injury. They prefer to be given a specific time, even if it is later in the day, rather than come into the office and wait for an open moment.

Guidelines for Appointment Scheduling

The most important criteria the medical assistant must take into consideration when scheduling appointments are exhibiting good interpersonal skills and reducing the amount of time a patient has to wait to see the physician. To meet these criteria, the medical assistant should follow seven guidelines:

1. Maintain the confidentiality of the patient. For example, do not discuss protected health information within hearing distance of other patients.

2. Speak clearly and do not appear rushed. Make sure the tone of your voice is friendly and courteous.

3. Concentrate only on the person to whom you are speaking.

4. Obtain all of the necessary information from the patient. Make sure the information is both correct and complete.

5. Repeat the information relayed to you by the patient. This avoids errors.

6. Schedule the proper amount of time for the type of appointment you are scheduling. For example, a new patient requires more time than an established patient.

7. Document all of the necessary information correctly in the appointment book or in the computer appointment scheduling system.

Methods of Scheduling

Two methods are used to schedule appointments. Appointments can be scheduled manually, using an appointment book. They can also be scheduled electronically using a computer. These methods are described in more detail next.

Appointment Book Scheduling

Appointment books are usually spiral-bound, so they will lie flat when opened (Figure 40-1). Each physician in the practice may have a separate book, or one book may serve the needs of two or more physicians. Appointment books are available in the following formats: pages for a single day, pages that display a week when open (over two pages), or pages with two or three physicians’ schedules for a single day. The pages are further divided into time intervals. The pages are typically divided into 10- or 15-minute intervals. The medical assistant should choose the appointment book format that meets the needs of the practice.

The appointment book is usually maintained in pencil so that information can be changed if needed (e.g., when rescheduling a patient’s appointment). In preparing for a day’s visits, a typed or hand-printed list of patients, known as a daily appointment schedule, must be created. This list or the appointment book itself (if kept in ink) must be retained as a permanent record. The daily appointment schedule is discussed in more detail later in the chapter.

Computer Scheduling

Using a computer to schedule appointments offers advantages. The computer allows the medical assistant to designate appointment intervals. The appointment interval can be adjusted to 10, 15, or 20 minutes depending on the needs of the practice. The computer makes it easy to add, delete, or change appointments; set up repeating appointments; and set up a recall system. A recall system identifies patients that need to be contacted when it is time for them to schedule another appointment.

The medical assistant enters the patient’s appointment into a data entry screen. This screen requires the entry of the same information as an appointment book. The computer also allows the medical assistant to print out a daily appointment schedule of patients to be seen that day (Figure 40-2).

Daily Appointment Schedule

Each day the list of the patients to be seen that day, called a daily appointment schedule, serves several functions. It is used as a guide for pulling the patients’ medical records for that day. It also is used as an office reference sheet of patients with appointments on that day. Usually the daily appointment schedule contains the patients’ names and telephone numbers and the reasons for their visits (e.g., new patient, physical examination, recheck).

If the medical office uses an appointment book, the daily appointment schedule must be typed or hand-printed by the medical assistant. More commonly, a computer is used to schedule appointments, and the list is printed out in hardcopy form or viewed by staff directly on the computer. According to Health Insurance Portability and Accountability Act (HIPAA) requirements, the daily appointment schedule should never be posted in an office area accessible to patients. This list may be updated and reprinted if there are changes or additions, or changes can be made in dark-blue or black ink. The office must keep an updated record either on paper or electronically to verify tax returns and insurance claims.

Types of Scheduling

Several methods are available to schedule appointments in the medical office. They include time-specified scheduling, wave scheduling, modified wave scheduling, double booking, and open booking. Many offices allow established patients to request appointments or schedule appointments using the Internet. In addition, appointments may be clustered or categorized depending on the type of patient or type of examination or treatment. The method an office uses to schedule appointments is based on the needs of the practice and physician preference.

Time-Specified (Stream) Scheduling

Time-specified scheduling, also known as stream scheduling, involves scheduling appointments at a specific time. Most offices use this method for scheduling appointments. The goal of time-specified appointments is to minimize the waiting time for the patient and at the same time to keep a steady flow of patients moving through the office (like a stream of water). The amount of time allotted for a time-specified appointment depends on the reason for the visit. In general, the following times are allotted:

When using the time-specified method, the medical assistant needs to make sure to allow time in the schedule to accommodate urgent visits, such as ill or injured patients. There are two other terms that may be used for this type of scheduling: fixed appointment scheduling and single booking.

Wave Scheduling

With wave scheduling, three or four patients are scheduled every half-hour and are seen in the order in which they arrive at the office. The goal is for patients to arrive in “waves” so that there is always a patient waiting to be seen. Sometimes, ill patients are seen before those with routine appointments.

This scheduling system assumes that some patients will need to be worked into the schedule. Sometimes patients become uncomfortable when they realize that another patient was given the same appointment time, but a simple explanation can usually reassure the patient. The medical assistant might say, “We schedule all our patients on the hour, and then they are seen in the order they arrive. There is always a patient to be seen, and we find that waiting time is often shorter.”

Setting Up the Appointment Schedule

Appointments are usually scheduled up to 6 months in advance. Before scheduling can begin, the appointment book or computer software must be set up to indicate the times when the physician will see patients. Times when the physician is not available to see patients must be blocked out. The appointment schedule showing only available times for appointments is sometimes called the appointment matrix (Procedure 40-1).

 Procedure 40-1   Setting up the Appointment Schedule


Set up an appointment schedule.


1. Procedural Step. Block times when the office is not open to see patients. This includes times before office hours begin, lunch and/or breaks, afternoons or days when the office is closed, and holidays when the office will be closed. Some offices set up the appointment schedule 6 months in advance, whereas others do it for a year in advance. In an appointment book, draw an X through times when the office is closed. If the office uses a computer program, set up times when the office is open and set the appointment interval (10, 15, or 20 minutes).

    Principle. In an effective appointment schedule, only available appointment times are blank.

2. Procedural Step. Block times when each individual physician is not available to see patients, including lunch and hospital rounds. In addition, block days when each physician will be away from the office for vacations, conferences, or other anticipated absences. If the physician has regular meetings or other regular commitments (such as nursing home visits), mark these also. In an appointment book, draw an X through the times when the physician is not available. If the office uses a computer program, schedule the meeting, vacation, or other anticipated absence like an appointment, using color-coding to show that the times are unavailable.

3. Procedural Step. For each physician, mark times when the physician does certain types of examinations, procedures (e.g., physical examinations, obstetric visits), or surgery. In an appointment book these are often highlighted with a marker or given a written title at the beginning of the time block. In a computer program these times may be set up as if for a separate physician (e.g., Dr. Gomez and Dr. Gomez—OB visits), or a color-coding system can be used.

4. Procedural Step. Depending on office policy, block out as much time as is anticipated for same-day appointments, catch-up time, and unexpected needs. Depending on the practice, catch-up time may be 15 minutes in the morning and afternoon for each doctor, and time for same-day appointments may be an hour or longer for all physicians or one particular physician on a rotating basis. These times can be marked in various ways as long as office staff understand that they must be saved until the scheduled day.

    Example: On this day, the office will be open from 9 to 5, but Dr. Warner will be available to see patients only from 9 to 1 because he plans to attend a conference in the afternoon. The appointment interval is 15 minutes. Dr. Warner likes to have 15 minutes set aside for catch-up time at 10:30 in the morning.

How the times are blocked out depends on the scheduling method used by the office. If the office uses an appointment book, the times are blocked out by drawing lines through the blocked times. If a computer is used to schedule appointments, the times are blocked out by setting aside blocks of time. Various types of color-coding are used in a computer scheduling program, but blocked times are different colors than open appointment times (Figure 40-4).

The appointment schedule must take three variables into consideration: the scheduling system, the physician’s preferences and needs, and the facilities and equipment requirements. Each of these is discussed later.

Appointment Intervals

Appointments are usually scheduled at intervals of 10 minutes, 15 minutes, or 20 minutes in either a manual or a computer system. An appointment may be scheduled for more than one block, depending on the type of appointment. For example, if a 10-minute interval is used, an established patient coming to have his blood pressure checked might be scheduled for one 10-minute interval and a new patient might be scheduled for three 10-minute intervals. In this case, a 10-minute interval uses one line and a new patient uses three lines in the appointment book or on the computer schedule. If a 15-minute interval is used, all appointments are scheduled in multiples of 15 minutes. In general, more time must be allotted for new patients, physical examinations, and special procedures than for routine follow-up visits.

Physician’s Preferences and Needs

The second variable influencing the appointment schedule is the physician’s preferences and needs. Physicians may prefer to do physical examinations and/or procedures at specific times as well as a certain number of either during a day. The appointment slots for those times would need to indicate the type of visit (such as a physical). If there are multiple physicians, their preferences may vary and certain rooms may need to be shared.

At times during the day the physician is not able to see patients, and therefore these times must be blocked out on the schedule. Time must be blocked out when the physician has another obligation, such as hospital rounds and nursing-home visits. Time may also need to be blocked out for lunch, pharmaceutical representatives, and catch-up. Days are also blocked out of the schedule for vacation, days off, attendance at conferences, giving lectures, and other professional activities. Protocols for each physician should be kept available for those setting up the appointment schedule.

Guidelines for Scheduling

When scheduling an appointment, the medical assistant needs to obtain the proper information from the patient, document it accurately, and confirm it with the patient. The procedure for scheduling appointments varies depending on whether the patient is an established patient or a new patient.

Established Patients

For insurance billing, an established patient is defined as a patient who has received services from the physician or another physician of the same specialty in the same group practice within the past 3 years. If the patient is seen by another physician in the group who has a different specialty, this does not make the patient an established patient for that physician. For example, a patient has been treated for several years by a family practice physician who refers the patient to an orthopedic surgeon within the group. The patient is a new patient for the orthopedic surgeon. If the patient is seen by a different family practice physician for an urgent care appointment, the patient is an established patient for that physician. Patients who have not been seen within the past 3 years are typically treated as new patients, although their old medical records will be found if possible.

If an established patient is scheduling a return appointment, the physician usually specifies a time period on the patient’s charge slip for the return visit (e.g., 1 week, 2 weeks, 1 month, 6 months). The appointment should be scheduled as close as possible to the date specified by the physician. The appointment must also be scheduled for the length of time preferred by the physician, which is usually 10 to 15 minutes. Before locating available appointment times to offer the patient, the medical assistant should ask what day of the week and what time of day are convenient for the patient. For an established patient, it is necessary to obtain the patient’s name, date of birth, and physician. If an appointment book is being used, it may be easier to ask the patient for a home and work telephone number than to look up this information. When a computer system is used, telephone numbers appear in the appointment window when the correct patient is selected.

If the patient is at the office, the medical assistant should complete an appointment reminder card and give it to the patient. The medical assistant enters the patient’s name, the name of the physician, and the date and time of the new appointment on the card.

If the patient has submitted an appointment request electronically, the medical assistant should attempt to accommodate the patient’s wishes when scheduling the appointment or make the appointment as close to the time requested as possible. The patient should receive an e-mail or letter verifying the date and time of the appointment.

Special Situations

Some situations require special attention when scheduling an appointment for an established patient. The most common situation is when a patient visits the medical office and the physician orders laboratory tests to be performed at a medical laboratory. The physician will want to review the results of these tests before the patient comes in for a return visit. When scheduling the patient’s return visit, the medical assistant must be sure to allow enough time for the patient to have these tests performed and the results to be returned to the office.

Patients who must undergo a laboratory test at the medical office that requires fasting (e.g., fasting blood sugar) should be scheduled early in the morning and provided with written instructions. This provides the least amount of inconvenience for the patient who must abstain from food and fluids until the specimen has been collected.

Sometimes the patient needs to be scheduled for an appointment for a date later than can be accommodated by the appointment schedule. In this situation, the medical assistant can either tell the patient the date when he or she can request the appointment, or the patient’s name can be put on a recall list. When the patient’s name comes up, the medical assistant either schedules the appointment and notifies the patient or sends a letter reminding the patient to schedule the appointment.

Apr 16, 2017 | Posted by in NURSING | Comments Off on Scheduling Appointments
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