klieg er chap 26

P474

26Medical Office Communication

LEARNING OBJECTIVES

You will be able to do the following after completing this chapter:

Key Terms1. Define, appropriately use, and spell all the Key Terms for this

chapter.

Greeting Patients2. Describe how a warm, professional greeting affects

patients.

3. Demonstrate the correct procedure for giving patients verbal instructions on how to locate the medical office.

4. Explain the purpose of the medical practice information booklet.

5. Demonstrate the correct procedure for constructing a patient information brochure.

Managing the Telephone6. Describe how a medical assistants tone of voice affects

telephone conversations.

7. List 12 guidelines for telephone etiquette and explain the importance of each.

8. Demonstrate the correct procedure for answering a multiline telephone system.

9. Explain the considerations for screening incoming calls.

10. Explain the importance of a triage (protocol guidelines) manual.

11. Describe the process of placing a caller on hold when needed.

12. List the seven types of information documented when taking a phone message.

13. List three types of outgoing calls that administrative medical assistants may make.

Scheduling Appointments14. Explain the importance for patients, medical assistants, and

physicians of managing office appointments efficiently and consistently.

15. Demonstrate the correct procedure for preparing and main-taining the office appointment book.

16. List one method of blocking off, or reserving, time not to be used for patient scheduling.

17. Explain the considerations for canceling a patient appointment.

18. List 10 abbreviations commonly used in scheduling appointments.

19. Demonstrate the correct procedure for scheduling a new patient for an office visit.

20. List six appointment-scheduling techniques and explain the advantages and disadvantages of each.

21. List two special problems that can occur in scheduling appointments and explain what can be done to prevent each.

22. Explain the purpose of an appointment reminder.

http://evolve.elsevier.com/klieger/medicalassisting

The daily functioning of a medical practice relies on good communication skills. As you have learned in previous chapters, effective communication involves excellent skills not only in speaking and listening but also in conveying nonverbal and written messages. Medical assistants and other health professionals must use effective communication skills in such daily activities as: Greeting patients Speaking with patients and other professionals on the telephone Scheduling appointments Corresponding with patients and other health professionals in writingWhen applying effective communication skills in these areas, health professionals must meet patient expectations for professionalism, as well as HIPAA regulations on how patient information can be communicated or disclosed (Box 26-1).

Klieger_Ch026_main.indd 474 3/2/2009 6:51:30 PM

P MedicalOfficeCommunication chapter 26 475

23. Demonstrate the correct procedure for scheduling a patient for outpatient diagnostic testing.

Handling Mail24. Explain why it is important to sort incoming mail.

25. List four classifications of U.S. mail.

26. List eight special services offered by the post office that can help medical offices track, insure, and receive delivery con-firmation for the mail they send.

27. Demonstrate the correct preparation of an envelope.

Managing Written Correspondence28. Explain the proper use of a letter and a memo in medical

office communication.

29. List nine guidelines for preparing effective written communi-cation in the medical office.

30. Identify proofreaders marks used to edit written correspondence.

31. Demonstrate the correct procedure for composing, keying, and proofreading a business letter and preparing the envelope.

32. Demonstrate the correct procedure for composing a memo.

33. Describe the format used to prepare a manuscript based on clinical research performed in the office.

34. List seven types of medical office reports and describe the purpose of each.

Patient-Centered Professionalism35. Analyze a realistic medical office situation and apply your

understanding of medical office communication to determine the best course of action.

36. Describe the impact on patient care when medical assistants have a solid understanding of communication in the medical office.

KEY TERMS

abstractautopsy reportcertified mailcluster schedulingconsultation reportsdischarge summarydouble bookingemergencyestablished patientsfull-block formathistory and physical (H&P)

reportmanuscriptmatrixmedical practice information

booklet

memomodified-block formatmodified-wave schedulingnecropsynew patientsopen-hour schedulingoperative reportpatient information brochureprogress notesproofreadingradiology reportregistered mailstreaming schedulingtime-specified schedulingtranscriptionistwave scheduling

Read the following scenario and keep it in mind as you learn about the importance of communicating effectively in the medical office in this chapter.

Tara is a new medical assistant at a physicians office. Dr. Vickers has hired her to answer the phone and to greet patients as they arrive, as well as to assist with making appointments as needed. On a particularly busy day, the phone is ringing with two lines already on hold and a new patient arrives at the reception desk. Steve, the physicians assistant, asks Tara to make an appointment for another patient to see Dr. Vickers as soon as possible. Since the office makes appointments in a modified wave, Steve tells the patient to wait to be seen because Tara has found an opening in about a half hour. In all the confusion, Tara does not return to the patients who are on hold for several minutes, and one of the calls is an emergency. Furthermore, Tara is short-tempered with the new patient who has arrived at the office. Taras frustration about the busy schedule she is expected to keep shows, and the new patient states that she is not sure that she has chosen the best physicians office for her medical care.

What effect will Taras frustration have on this medical office? How would you have handled this situation differently?

GREETING PATIENTSAsamedical assistant, youmay serveas a receptionist.Thereceptionist is the first person a patient sees in themedicaloffice.Makesurethepatientsfirstimpressionofyouandthemedicalpracticeispositive.Ifapatientiscallingforthefirsttime to schedule an appointment, make sure the patientknowshowtofindtheoffice.Procedure26-1showshowtouseverbalinstructionstogivepatientsdirectionsforlocatingthemedicaloffice.

AsyourecallfromChapter24,thereceptiondeskshouldbeaccessibletopatientswhentheyentertheoffice.Inaddi-tion,thecounterheightneedstobehighenoughtomaintainthe confidentiality of patient information. You must keepseveral considerations inmindwhen greetingnew patientsand established patients, as well as other visitors to themedicaloffice.

New PatientsPatientsnew to themedicaloffice (first visitorfirst visit totheofficein3years)needtofeelwelcome.Somepracticeswillmail a new patient packet before the patients first officevisit. If forms have not been sent previously, give the newpatient a pen and the forms thatmust be completed; theseformsarediscussedinChapter34.Explainthepoliciesofthemedicaloffice,orgivethepatientamedical practice informa-tion booklet,orpatient information brochure,thatprovides


P476 Section iV AdministrativeMedicalAssisting

BOX 26-1

HIPAA: the Privacy Rule and Security Rule

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandates that the privacy and security of patient informa-tion be maintained in a confidential manner. This process begins when the individual arrives for their first appointment. Patients must be given detailed written information concerning their privacy rights. This includes the steps the practice will take to protect their privacy and how the medical practice will use patients protected health information (PHI).

To document that the medical practice made an effort to comply with this regulation, the practice must obtain a written acknowl-edgment from the patient that he or she has reviewed these rights. Acknowledgment may be in the form of a signature or the patients initials on the notice signifying that he or she has received the required information. If the patient declines to acknowledge receiving a Notice of Privacy Practices, this must be documented in the patients chart. This documentation shows a good faith effort was made by the practice to inform the patient and details the reason for failure to accomplish this act and comply with the regulation.

Medical practices must also post a Notice of Privacy Practices in the office, usually in the reception area. Additional copies of the notice should be made available if a patient requests a copy. The regulation also requires medical practices to have a written policy and procedure in place for determining who has access to patient medical information. For example, the policy may state that the receptionist may view the names of the patients coming into the office but may not view patients records.

To accommodate computerized information, two types of access codes (passwords) should be used. The first set would allow the receptionist to view the physicians schedule but would not allow the receptionist to view patient records. The second set would allow the physician, nurse, and medical assistant to view the patient records for the purpose of patient care. A tracking system that keeps detailed information of all staff members viewing a patients medical record should be in place.

The HIPAA regulation also addresses the issues of sign-in sheets and calling the names of patients who are sitting in the waiting area.

Can a medical practice use patient sign-in sheets and call out the names of patients in the waiting room?Yes; the practice can do both, as long as the information disclosed is appropriately limited. The Privacy Rule allows for incidental

disclosure as long as appropriate safeguards are in place. For example, the sign-in sheet cannot contain confidential patient infor-mation (e.g., reason for the visit, medical problem). It is best to change used sheets with clean ones periodically during the day. Calling patients by name is still the most acceptable, courteous, and respectful way to invite patients into the examination area.

thisinformation(Box26-2).Aninformationbookletorbro-chureshouldprovideanswerstononmedicalquestions.Pro-cedure 26-2 explains information necessary to construct abrochure. Figure 26-1 provides samples of various types ofbrochuresused toprovide information toapatient about amedicalpractice.

Letpatientsknowthatwhentheyfinishreviewingthebro-chure, you will be glad to answer any questions about themedical practice. In addition, inform patients that you areavailabletohelpthemcompletetheforms,ifnecessary.Some-timespatientshavetroublereadingorseeing,andjusthandingthemaformtobecompletedmaybeseenasuncaring.Peopleunabletoreadareembarrassedtosayso,andthereforetheymaynotfillouttheformscorrectly.Somemaynotunderstandthe questions being asked because of medical terminologyusedintheforms.Patientsmaynotwanttoadmittheyneedhelpormaybeconfused.

Helpingpatientswithformsalsosavestime.Someofficeshaveaprivateareasetasidetoanswerquestionsandtofilloutforms. This allows for minimal distractions and patientprivacy.

Established PatientsPersonalize the greetingwhen returning patients come intothe office (e.g., The doctor will be with you shortly, Ms.Jones; please make yourself comfortable in the reception

BOX 26-2

Patient Information Booklet

The patient information booklet (or brochure) communicates policies of the practice, (e.g., payment must be made at the time of service). It clarifies appointment policies, office hours, prescription refill policies, and so on. It should avoid technical terminology and should be written as if the staff is speaking to the patient (e.g., We want to make your medical care our number-one priority).

A patient brochure, or medical practice information booklet, should answer frequently asked questions, thus saving staff time by limiting the need to repeat information. This reduces telephone calls about office policies (e.g., office hours). The booklet invites the patient to be an active partici-pant in his or her care.

area).Remember,donotaddressapatientbytheirfirstnameunlessthepatienthasgivenyoupermissiontodoso.Ifotherpatients approach the desk while you are speaking with apatient,stoplongenoughtoacknowledgetheirpresenceandtell themyouwill be available shortly.This lets themknowthattheyareimportantaswellandwillreceiveyourfullatten-tion.Everypatientshouldbemadetofeelthatheorshehasthefullattentionoftheofficestaffandthathisorherneedshavepriority,nomatterhowbusytheofficeisthatday.



PROCEDURE

26-1 GiveVerbalInstructionsonHowtoLocatetheMedicalOffice

TASK: Provideverbalinstructionstoacalleronhowtolocatethemedicaloffice.

EQUIPMENT AND SUPPLIES Telephone Citymap Penorpencil

SKILLS/RATIONALE

b. Askthepersontorepeatthedirectionsbacktoyouifthelocationissomewhatdifficulttofind.Rationale. Thisprovidesexcellentcustomerserviceandafavor-ableimpressionofthemedicaloffice.

5. Procedural Step. Provide the caller with the offices phone number in case the person needs to call for further clarification of directions en route. If time permits, the medical assistant may mail written directions and a map to the patient before the appointment.Rationale. Again, this provides excellent customer service and afavorableimpressionofthemedicaloffice.Writtendirectionsandamapmaybeincludedintheoffices informationalbrochure,which isoftenmailedtonewpatients.

6. Procedural Step. Ask the caller if they have any questions.Rationale. Clarifies information provided and helps avoid anymisunderstanding.

7. Procedural Step. Politely end the call after answering any questions.Rationale. This action displays a professional approach and pro-videsafavorableimpressionoftheoffice.

1. Procedural Step. Address the patient or caller in a polite and professional manner.Rationale. Thetoneandpitchofyourvoicecanpromoteapositivefirstimpressionoftheoffice.

2. Procedural Step. Ask the person, Where will you be coming from?Rationale. This provides themedical assistantwith a location onwhichtobasedirections.Findthelocationonacitymapifneeded.AnInternetmappingservice(e.g.,MapQuest)mayalsobehelpfulinprovid-ingdoor-to-doordirections.

3. Procedural Step. Determine the most direct route to the medical office, with alternate routes if possible. Provide the person with major cross streets and landmarks.Rationale. Providing themostdirect routewillsave thepatientorcallertimeandwilllessenthelikelihoodofnotfindingtheoffice.Havingalternateroutes,crossstreets,andlandmarksavailablewillbehelpfulforpeopleunfamiliarwiththearea.Forexample,turnleftonMcCleary,takethenextrightontoDearborne.Ourparkinglotisacrossthestreetfromthebank.Keepinmindthatthepersonmaybedriving,walking,ortakingpublictransportation.

4. Procedural Step. Allow the patient or caller sufficient time to write down the directions.a. Repeat thedirectionsbackto theperson,asneeded,

withacheerfulandpleasanttone.

FiGUre 26-1 Brochures provide information to the patient about the various services that the medical practice offers and often answers frequently asked questions that the patient needs to understand.



PROCEDURE

26-2 CreateaMedicalPracticeInformationBrochure

TASK: Createamockpatientinformationbrochureforamedicalpractice.

EQUIPMENT AND SUPPLIES Computer Softwareprogramthatallowsforbrochurelayouts Examplesoflocalmedicalpracticebrochuresandlocalmedicalofficepolicies Penorpencil

SKILLS/RATIONALE

2. Procedural Step. Write and key a short paragraph describing each of the topics to be included in the bro-chure. Proofread the keyed information.Rationale. Themedical assistant can read the content andmakecorrectionsasneeded.Abrochureshouldneverbesentoutwithincor-rectinformationortypos.Remember,thismaybethefirstinteractionapatienthaswithyourofficeandanimpressionwillbeformed.

3. Procedural Step. Determine the layout of the brochure.a. Thelayoutshouldbevisuallypleasing.b. Considertheplacementoftheofficelogo.c. Ensure that the name of the practice, address, and

phonenumberareprominent.d. Some software programs have a brochure template

thatmayworkforcreatingthisbooklet.Ifaseparateprogramisnotavailable,anywordprocessingprogramcanbeused.

4. Procedural Step. Have the office manager or physician approve the final draft.a. Makecorrectionsasrequested.b. Thephysicianhasfinalapproval.

5. Procedural Step. Print the brochure.Thismaybedoneattheofficeiftheofficephotocopiercanprovide quality copies.Otherwise, submit the bro-chure electronically to a printing company for profes-sional-lookingbrochures.

1. Procedural Step. Determine the content information to include in the informational brochure to be provided to patients.Rationale. Provides an effective means to communicate withpatientsaboutofficepolicies.Itemsforconsiderationmayinclude:

Practicesphilosophystatement Goalsofthepractice Descriptionofthepractice Physical location of the office (address), including amap

Telephonenumbers,e-mailaddress,webpage Officehours,day,andtime Namesandcredentialsofstaffmembers* Typesofservices Policy regarding appointment scheduling, no-shows,andcancellations

Paymentoptions Prescriptionrefillpolicy Typesofinsuranceaccepted Referralpolicy Releaseofrecordspolicy Emergencyprotocols Whotocontactifthephysicianisunavailable Frequentlyaskedquestions Anyspecialneedsconsiderations Personal information about the physician (e.g., arearoots,specialinterests,andincludespecialtrainingandboardcertification)

*Some offices choose not to include this information.



Other VisitorsOccasionally, people other than patients, such as familymembers, sales representatives, and other physicians, mayrequest to see the physician. If possible, answer questionsconcerningwhenthephysiciancanseethem,orassist themwithmakinganappointment.Theofficeshouldhaveapro-ceduretoletthereceptionistknowwhichvisitorsthephysi-cianwill seewithoutanappointment.Allvisitors shouldbetreatedcourteously.

PATIENT-CENTERED PROFESSIONALISM

Why must the medical assistant greet patients and all visitors to the medical office in a professional manner?

Why is it important that the medical practice information brochure be structured to anticipate patients most common nonmedical questions?

MANAGING THE TELEPHONEEverycallerwhophonesthemedicalofficeformsanimpres-sionofthephysicianandallhealthcareworkersintheoffice.Infact,peopleoftenformamentalpictureofthepersontheyarespeakingwithaccordingtothewayhisorhervoicesoundsonthetelephone.Whenpeopletalkfacetoface,animpressionis formedbasedonmanyfactors.Whentalkingonthetele-phone,aspeakerspersonalityisprojectedbythevoicealone.The receptionists voice should be businesslike, courteous,pleasant,andfriendly.

Telephone VoiceThequalityofyourvoice is importantbecause it isamajorwaytoexpressyourideastoothers.Apersonsvoicetendstoproject that persons personality to listeners. The voice is avaluabletooltopromoteaprofessionalimage.Youhaveprob-ablyheardthisbefore,butitistrue:ifyousmilewhiletalkingonthephone,callerscantell.

ToneYour tone,or the soundofyourvoice, shouldbeexpressiveandpleasantnotmonotone.Thepitch(highsandlows)shouldbelowbecausethisprojectsandcarriesthevoicebetterandtendstobecalming.Whenemphasizingawordorimportantpoint,thepitchshouldberaised.Raisingtheinflectionofthevoiceattheendofasentenceisusefulbecausepeopletendtorememberwhattheyheardlast.

VolumeThevolumeusedwhendeliveringamessagemustbeappro-priateforwhatisbeingsaidandforthephysicalconditionofthepatient.Speakingloudlyisirritatingtomostpatients.Theymayfeeltheyarebeingspokentorudely(e.g.,yelledat)ordisrespectfully.

ClarityYouneedtospeakdistinctlysothatitwillbeeasyforpatientstounderstandyourmessage.Patientsalsoneedtounderstandthetermsused.Speakinlayterms(nontechnicalterms);themessageislostifthepatientdoesnotunderstandthetermi-nology.Pronouncewordscorrectly,andaskpatientstopro-nounceorspelltheirlastnameifyouareunsurehowtosayitcorrectly.

Rate of SpeedIf you speak too rapidly, you will not be well understoodand waste time repeating yourself. Speaking too slowlycauses your words to sound disconnected, which canalso irritate the listener. Speaking too quickly or too slowlycanmakeitdifficultforthelistenertofollowtheconversation,and the personmay lose interest. Speaking clearly requiresthatyouadjustyourrateofspeedaccordingtothelistenersneeds.

Telephone EtiquetteThewordetiquetteessentiallymeansmanners.Usinggoodetiquetteonthemedicalofficetelephonehelpsmakeagoodimpressiononthosewhocall.Goodtelephonemannersreflectthe qualities of pleasantness, promptness, politeness, andhelpfulness.Guidelinesforpropertelephoneetiquettefollow.Whenmakingphonecalls,alwaysknowthepurposeofwhythecallisbeingmade.Youwanttopresentafavorableimpres-sion on the patient that you are organized and capable ofhandling their needs. If you have told a patient youwouldreturntheircallatacertaintime,doit.

Before the Call1. Prepareyourselfbycheckingyourbodyposture.2. Make sureyouhave the supplies to takemessages (pens,

paper, message pad, appointment book, and watch torecordtime).

When Speaking with the Caller1. Always identify yourself and the office so that callers

knowtheyhavereachedthecorrectnumber(e.g.,Goodmorning,WestsideMedicalOffice,thisisLisa.HowcanI help you?). Use a greeting that is going to give thecaller the impression that the medical office staff isprofessional.

2. Beascourteousoverthetelephoneasyouwouldbewithsomeonefacetoface.

3. Avoidslangtermsandtechnicalterms.4. Listen attentively. Do not interrupt callers until they

finishsayingeverythingtheywanttosay.Ifyouspeaktooquickly, an important fact may bemissed. Do providefeedbacktoletpeopleknowyouarelistening.Soundalertandhelpful.

5. Thinkabouthowthecallerfeels.Beempatheticandshowconcernforwhatapatientissaying.Thepatientsneedsarecriticaltothemedicalpractice.Concentrateonwhat



protocolsestablishedbythephysician.Whenthisinformationisfirmlyandcompetentlyrelayed,callersgainconfidenceintheofficesabilitytoassistthem.Oftenanewpatientwillcallandrequestdirectionstothefacility;itisimportantthatthisinformationbeprovidedaccuratelyandwithclarity(seePro-cedure26-1).

Placing the Caller on HoldThetelephoneinamedicalpracticeisinconstantuse.Mostofficeshavemorethanonetelephoneline,andmorethanonecallcancomeintotheofficeatthesametime.SeeProcedure26-3foramoredetailedexplanationoftheprocessforputtingacalleronhold.

Telephone MessagesWhen you take a message, certain information should beobtained(seeProcedure26-3fordetails).Remember,alwaysrecord what the patient tells you. Write the message in aduplicatetelephonelogbook.Givetheoriginaltotheappro-priatepersonforfollow-up.Utilizecopymessagesthatleaveacopywithinthemessagebook,butalwaysremembertotearouttheoriginal.

Outgoing CallsYoumustalsobeprepared toplaceoutgoingcalls.Haveallneeded informationavailablebeforemaking thecall.Beforedialingthenumber,alwayslistenforadialtone.Manytimesacallmaybecomingintotheofficeatthesametimeyouaretryingtodialout.Inthiscase,aloudnoiseonthephonelinewillbeheard.Outgoingcallsthatmedicalassistantsmayneedtomakeincludethefollowing:

Changingorconfirmingapatientsappointment. Makingoutpatientappointmentsorpatientreferrals. Orderingsuppliesorlaboratoryforms. Callinginprescriptionsand/orrefills.

Long-Distance CallsWhen you need to call a person or company in a differentstate, it is importanttoknowinwhichtime zone thepersonorcompany is located.Figure26-2shows the timezonesoftheUnitedStatesandCanada.Forexample,ifyouwereinanofficeinMassachusettsandneededtomakeacalltoNevada,youwouldneedtorememberthatNevadais3hoursbehindMassachusetts in time. Therefore 9 am inMassachusetts is6am inNevada.Somemedicaloffices require thatall long-distancephonecallsberecordedinalong-distancetelephonelog (caller, time, and reason for calling). Check your officepolicymanualforanyspecialconsiderationsforlong-distancecalling.

Telephone DirectoryAttimesyoumayneedto lookupa telephonenumberanduse a telephone directory. The telephone directorys whitepageslistresidentialphonenumbersandaddressesinalpha-beticalorderbyresidentslastnames.Theyellowpageslistareabusinessescontactinformationinalphabeticalorderby

BOX 26-3

Handling Rude or Impatient Callers

Stay calm and speak slowly. Getting angry will only make matters worse.

Be diplomatic and polite. Show willingness to resolve the problem. Think like the caller. Remember their problems or concerns

are important. Offer to have the office manager talk to the caller.

is being said, keeping inmind thepatientneeds to feelimportant.

6. Askquestionsifyoudonotunderstandsomething.7. Listenforovertones;muchcanbelearnedfromapersons

toneofvoiceandrateofspeech(Box26-3).8. Takenotes tohelpyouremember the importantpoints

andtogainclarification,especiallydateandtime.9. Giveclearexplanations.

10. Trytoavoidplacingcallersonhold.Whenitisnecessary,askthecallerfirst,andthankthecallerforholdingwhenreturning to the line. Be sure their time on hold isminimal.

When the Call Is OverLeavethecallerwithapleasantfeelingwhentheconversationisfinished(e.g.,Thankyouforcalling,Ms.Jones).Remem-berthatthefirstimpressionofthemedicalofficestaffwillstaywiththecallerlongafterthecallisover.

Incoming CallsWhenthemedicalassistantusespropertelephonetechniques,screening incoming calls becomes easier. Before picking upthe receiver,discontinueanyother conversationsoractivity(e.g., eating, chewinggum) that canbeheardby thecallingparty. Procedure 26-3 explains the proper techniques foransweringamultilinetelephoneinamedicaloffice.Whenacallerrequeststospeaktothedoctor,themedicalassistantcanusethesetechniquestoprocesstherequestsinaprofes-sional manner. Calls from other physicians should be putthroughtothephysicianpromptly,ifheorsheisavailable.

Tactmustbeusedwhenacaller requests to speak to thephysician. The callers must never feel that the physician istryingtoavoidthem.Itisbesttoacknowledgethatthephysi-cianisnotavailableoriswithapatientbeforeaskingforthecallersidentity.Ifthecallerwantstoholdforthephysician,keepthecallerinformedaboutwhatishappening(e.g.,Thedoctor is still unavailable. Would you like to continue tohold?).AlwaysoffertotakeamessageoraskwouldyoulikemetotransferyoutoMs.Johnsvoicemail?

Officepolicy should list the typesof situations forwhichthemedicalassistantcaninterruptthephysician.Table26-1providestheprotocoltobeusedasaguidewhencertainsitu-ationsarise.Medicalassistantsarenotpermitted toexerciseindependentdecisionsandmustlimittheiractionstopreset



PROCEDURE

26-3 AnsweraMultilineTelephoneSystem

TASK: Answer amultiline telephone system in a physicians office or clinic in a professionalmanner.Respondtoarequestforaction,placeacallonhold,transferacalltoanotherparty,andaccuratelyrecordamessage.

EQUIPMENT AND SUPPLIES Telephone Appointmentbook Messagepad Telephoneemergencytriagereferenceguide Physicianreferralsheet Penorpencil Headset(optional)

SKILLS/RATIONALE

(1) Appointments. Because these are typically themostcommonphonecallsmade to themedicaloffice, it is important to have the appointmentbook or electronic scheduling program easilyaccessibleandnearthetelephone.

(2) Payment or account balance information.Ifthemedicalfacilitydoesnothaveaseparatedepart-ment that handles these calls, it is best to havepatient records close to the phone so that themedicalassistantansweringthephonehasaccess.

(3) Physician referrals.Mostmedicalfacilitieshaveaphysicianreferrallisttypedandlocatednearthephone.Thelistshouldcontainphysicians,labora-tories, hospitals, andothermedical services fre-quentlyusedbythephysicianinpatientreferrals.

(4) Emergencies.Emergencycallsmayormaynotbemadetothemedicalfacility.Ifthisisacommonoccurrenceforthepractice,anemergencyscreen-ing reference guide should be located near thephone. Along with the triage reference guide,emergencyphonenumbersforfire,police,poisoncontrol,andambulanceservicesshouldbereadilyaccessibleif911doesnotconnectwiththeseser-vicesinyourarea.

Rationale. The medical assistant can handle many calls andconserve the time and energy of the physician or other staffmembers.

f. Ifyouareunabletoassistthecaller,transferthecallertothepersonwhocanassist.First,askifyoumayputthecalleronhold.Waitforaresponse,andplacethecallonhold.Thentransferthecalltotheappropriatestaffmember. (note:Sometelephonesystemsallowyoutoimmediatelytransferthecallerwithoutplacinghimorheronhold.)

1. Procedural Step. Answer the phone.a. Smilebeforeansweringthephone.

Rationale. Thecallermaynotbeabletoseethesmilebutwillhearitinyourvoice.Often,atelephonecalltomakeanappointmentisthefirstinteractionthepatienthaswiththeofficeorclinic.Makethefirstimpressionapleasantone.

b. Answerthetelephonebythethirdring;speakdirectlyintothetransmitter,withthemouthpiecepositioned1inchfromthemouth.Rationale. Answering promptly conveys interest in the caller.The voice carries better when the mouthpiece is properlypositioned.

c. Speakingdistinctlywithapleasant toneandexpres-sion,atamoderaterate,andwithsufficientvolume,identify theofficeandyourself.Thegreeting shouldstartwiththetimeofday(suchasGoodmorningorGoodafternoon),anda request tohelp shouldbeincluded.Rationale. By speaking distinctly with a pleasant tone, at amoderaterate,andwithsufficientvolume,thecallerwillbeabletounderstandwhatisbeingsaid.Byidentifyingthefacilityandyour-self,thecallerwillknowthatthecorrectnumberhasbeenreachedandtowhomtheyarespeaking.Example: Good morning, Dr. Smiths office, this is Staceyspeaking.HowmayIhelpyou?

d. Verifytheidentityofthecallerandrequestthecallersphonenumber.Rationale. This confirms the origin of the call and provides aphonenumbertoreturnthecallshoulditbedisconnectedoriftheintendedreceiverofthecallisunavailable.

e. Providethecallerwiththerequestedinformationorservice,wheneverpossible.Medical assistants handle four types of calls on a routine

basis:

Continued



PROCEDURE

26-3 AnsweraMultilineTelephoneSystemcontd

(2) Nameofthecaller.Ifyouareunsureofthespell-ingof the callersnameordidnotunderstandthecaller,askthecallertospellitforyou.Rationale. When taking a telephone message, it isimportant todetermine the relationshipof thecaller to thepatient if the caller is someone other than the patient, toensure that thecallerhasa legal right toaskquestionsorbegiveninformationaboutthepatient.

(3) Dateandtimethemessageistaken.(4) Urgencyofthemessage.

Rationale. Itisimportantforthephysicianorotherhealthprofessionaltoknowifthissituationmustbehandledimme-diately,asinanemergency.

(5) Allergies.Ifnoallergiesexist,writenoneor0inthebox.Allergyinformationisavailableinthepatientsmedicalrecordbutanychangesneedtobenoted.(Thisinformationmaybeunnecessaryifnodrugtherapyisneededforthepatient.)Rationale. The condition reported may require aprescription.

(6) Messagecontent.Recordexactlywhatthepatienttellsyou.Rationale. The heart of the message includes thereasonwhythecallwasmadeandthecallersquestionforthephysicianorotheralliedhealthprofessional(oractionthecallerwantsthephysiciantotake).

(7) Returnphonenumber.Rationale. Thepersonforwhomthecallwasplacedmusthavethephonenumberofthecallertoreturnthecall.

(8) Pharmacynameandphonenumber.Thisinfor-mationmay be found in the patientsmedicalrecord.Rationale. Including the name and number of thepatients pharmacy in themessage provides the physician

MESSAGE FROMFor Dr. Name of Caller Ref. to pt. Patient Pt. Age Pt. Temp. Message Date Message Time

Allergies

UrgentAMPM

AMPM

AMPM

Yes

DOCTOR - STAFF RESPONSEYes No

Yes No

No

Message:

Respond to Phone # Pharmacy Name / # Patient's ChartAttached

Patient's chart # InitialsBest Time to Call

Product # 78-9156-Pkg, #78-9157-Pads, Bibbero Systems, Inc., Petaluma, CA.

Call BackYes No

Chart. Mes. Follow-up Date Follow-up Completed-Date/Time Response By:

Doctor's / Staff Orders / Follow-up Action

3

Example:Iwouldliketotransferyoutotheaccountingdepartment.MayIputyouonhold?Thankyou.Pleasehold.note: Never leave a caller on hold for more than 90seconds. If the line is not answered within this time,returntothecallerandasktotakeamessage.Ifthecallerdoesnotwanttobeputbackonhold,askthecallerforaphonenumberatwhichthecallcanbereturned.

2. Procedural Step. If more than one line is ringing at once, put a caller on hold:a. Answerthefirstline,andaskifyoucanputthecaller

onhold(remembertowaitforaresponse).b. Answer the second line, and ask the caller toplease

hold(again,waitingforaresponsefirst).c. Return to thefirst call, and eitherhelp the calleror

directthecalltothecorrectperson,usingtheappro-priate hold request, or ask for a phone number atwhichthecallcanbereturnedassoonaspossible.

d. Returntothesecondcall,andrepeattheprocessforsubsequentincomingcalls.Rationale. Thisensuresthatallcallersaretreatedwithcourtesyandrespect.

3. Procedural Step. Take a message.a. Collect complete andaccurate information that you

canpassontothepartywithwhomthecallerwishestospeak.Rationale. Complete, accurate information helps the personquicklyandefficiently return thecallandaddresses theneedsorconcernsofthecaller.

b. Recordthefollowinginformation:(1) Recipientofthemessage.

Rationale. When taking a telephone message, it isimportant to know to whom the message needs to bedirectedsothatthemessageisreceivedpromptly.

Continued



PROCEDURE

26-3 AnsweraMultilineTelephoneSystemcontd

tive. Sometimes both the provider and themedical assistant place their initials in theresponsebox.Rationale. Completing this portion of the form andplacingitinthemedicalrecordisnecessaryaftersuchcalls,asthisactionmustbedocumentedinthemedicalrecordaspartofthecontinuousrecordofcaregiven.

4. Procedural Step. Terminate the call in a pleasant manner, and replace the receiver gently.a. Besuretothankthecallerandaskifthereisanything

furtheryoucandotoassistthecallerbeforehangingup.

b. It is best if the caller ends the call first. The properlanguagetoendacallistosay,Good-bye,Ms.Jones,andthankyouforcalling.Itisneverappropriatetosaybye-byeortouseanyotherformoffamiliariza-tionwhenendingacall.Rationale. Propertelephonetechniqueisoftenthefirstimpres-sionanewpatienthasofthemedicalpractice.

withareadymeansofcontactingthepharmacyshouldtheneedariseandensuresthecorrectpharmacyiscalled.

(9) Initialsofmessagetaker.Rationale. Forpurposesofaccountabilityandincaseaquestion arises, the identification of the person taking themessage needs to be indicated and should be recordedduringthecourseofthephonecall.

(10) Physicianandstaffresponse.Thissectionoftheform is completed by the individual to whomthemessagewasdirected.Itisusedwheneveratelephoneencounterwithapatientresultsin,forexample,thereportingofsymptomsorachangeintreatment.Theproviderwrites intheactiontakenortobetaken(e.g.,physicianwritespre-scription that medical assistant will call in topharmacy),callback(yesorno),chartmessage(yesorno),andfollow-update.note:Ifthemedicalassistantisassignedtomakethefollow-upcall,theproviderusuallywriteshisorherinitialsimmediatelyfollowingthenarra-

FiGUre 26-2 Time zones in the United States and Canada. (From Hunt SA: Fundamentals of medical assisting-revised reprint, St Louis, 2007, Saunders.)

WashingtonAlaska

Mexico

Hawaii

British Columbia

PACIFIC

Alberta

SaskatchewanManitoba

Ontario

QuebecOregon

Idaho

Montana

Wyoming

Nevada

California

Utah

Arizona

Colorado

New Mexico

Kansas

Oklahoma

Missouri

Arkansas

Texas

Louisiana

Mississippi

Illinois

North Dakota

South Dakota

Minnesota Wisconsin

IowaNebraska

Michigan

IndianaOhio

West

Virgin

ia

Pennsylvania

New York

VirginiaKentucky

Maine

NewBrunswick

MassachusettsNew HampshireVermont

ConnecticutRhode Island

New Jersey

DelawareMaryland

North CarolinaTennessee

AlabamaGeorgia

South Carolina

Florida

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MOUNTAIN

2

CENTRAL

3

EASTERN

4

ATLANTIC5

NovaScotia

Bermuda, Puerto Rico,Virgin Islands, andThe Bahamas



TABLE 26-1

Protocol for Screening Telephone Calls

Type of Call Action Taken by Medical Administrative Assistant Call Handled by Whom

Patientrequestsappointment If not a potential emergency, schedule appointment. Medical administrative assistantPatientrequestsprescription

refillTake a message with medication name and patients pharmacy

name and number. Send message with patients medical record to physician.

Physician will call pharmacy if approved; clinical medical professional will phone patient to inform patient as to action taken by the physician (refilled or not refilled).

Patientaskstotalkwithphysicianorclinicalmedicalprofessionalbecausepatientisillorneedssomemedicalinformation

Take a message, send message with patients medical record to physician or clinical medical professional. (Depending on the severity of the patients illness, the call may need to be transferred immediately to the physician or clinical medical professional.)

Physician or clinical medical professional

Patientisreturningacalltothephysicianorclinicalmedicalprofessional

Transfer call directly to physician or clinical medical professional as requested.


Anotherphysiciancallsforthephysician

Transfer call directly to physician as requested; no need to ask the reason for the call.

Physician

Outsidelaboratorycallswithtestresults

Transfer call directly to individual requested by the laboratory. Identified staff member

Patientisuncomfortableidentifyingthereasonforcalling

Ask the patient if the call is an emergency. If not, ask the patient if you can have the clinical medical professional return a call to the patient.

Clinical medical professional

Patientcallsfortestresults Take a message; send message with patients medical record to physician or clinical medical professional.


Patientcallswithinsuranceorbillingquestion

After confirming the identity of the patient and if the patient is entitled to the information, answer the patients question. Some information may not be able to be released over the phone and may need to be mailed directly to the patients home.

Medical administrative assistant

Insurancecompanycallsrequestinginformationonapatient

Identify requested information and identity of caller. Usually, only limited information may be given over the phone, and the caller should send a written request for information that has been authorized by the patient.

Medical administrative assistant

Personalcallsforamemberoftheofficestaff

Transfer directly to the staff member. If the call is for the physician and the physician is with a patient, notify the caller of that fact and ask if you should interrupt (i.e., The doctor is with a patient right now; would you like me to interrupt?). note: Follow office protocol regarding physician interruptions.

Identified staff member

Administrationcallsforamemberoftheofficestaff

Transfer directly to the staff member. If the call is for the physician and the physician is with a patient, notify the caller of that fact and ask if you should interrupt (i.e., The doctor is with a patient right now; would you like me to interrupt?). note: Follow office protocol regarding physician interruptions.


Patienthasacomplaint Attempt to handle the situation if at all possible; otherwise, take a message or transfer the call to the appropriate individual. If necessary, notify physician of complaint.

Medical administrative assistant or identified staff member

Patienthasbeenpoisoned Immediately give caller telephone number of poison control center and obtain identification of patient. Poison control centers are properly equipped to handle poisonings in a rapid manner; assist with emergency help as appropriate.

Notify physician, and document call in patients medical chart

Pharmaceuticalsalesrepresentativewantsappointmenttogivesalestalktophysicianandclinicalmedicalprofessional

Make appointment under the guidelines established for the office. Medical administrative assistant

Officesupplysalesrepresentative

Take message and give to staff member chiefly responsible for buying office supplies.


Modified from Potter BA: Medical office administration; a worktext, Philadelphia, 2003, Saunders.



thebusiness(orbusinessowners)nameandtypeofbusiness.Yellowpages can alsobe foundon the Internet. Some tele-phonedirectoriescontainaspecialsectionthatlistslocalgov-ernmentormunicipalcontact information(cityhall,publicworks, governmental offices, and schools). Many medicaloffices keep a list of frequently called telephone numbers(laboratories, local hospitals and pharmacies, and supplycompanies).Thismaybeaprintedlistorafilestoredontheofficecomputersystem.


What telephone techniques would you use if you were responsible for answering the telephone at the medical office? What impact will this have on patients who call?

Why must the medical assistant be aware of telephone etiquette? What are some general guidelines to follow?

SCHEDULING APPOINTMENTSAnadministrativemedicalassistant isoften thepersonwhoschedulesappointmentsinthemedicaloffice.Forconsistency,itisbestifonlyonepersonschedulestheappointments,butthis is not always possible, especially in a large practice.Although offices should have their own set of policies andprocedures (which is important since these documents areused to trainnewpersonnel), somegeneralprinciplesapplywhenschedulingappointmentseffectively.Medicalassistantsneed to understand the importance of effective scheduling,howtousetheofficeappointmentbook,orthecomputerizedscheduling feature of their practice management softwareand the techniques available for scheduling appointments.Remember, appointment scheduling needs to focus on theneedsofthephysician(e.g.,timeneedstobeallottedforthephysician to return phone calls, review patient laboratory

FiGUre 26-3 The appointment book allows appointments of differing lengths of time to be recorded (e.g., 15 minutes to 60 minutes), and time can be blocked off when a physician is not available to see patients. (Courtesy Bibbero Systems, Inc., Petaluma, CA; 800-242-2376; fax 800-242-9330; www.bibbero.com.)

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results,meetwithdrugrepresentatives,andtocompletedicta-tionsofchartnotes,letters,etc.).Also,theabilitytoscheduleefficientlywillrequireattentiontothedynamicsofthefacility(e.g., number of examination rooms, availability of equip-ment,andtimeneededforproceduresscheduled),andavail-ableresources(e.g.,staff).

Effective SchedulingGoodschedulingmanagementallowsforefficientofficefunc-tioning.Theschedulingsystemchosenmustbeflexibleenoughto handle emergency situations, aswell as the routine dailyschedule.Patientsdonotfind it acceptable towait for longperiods.Fewpatientsarewillingtowaitlongerthan20minutes.Havinganappointmentschedulethataccommodatesthephy-sicianspreferencesandcommitmentsallowsforasmoothlyoperatingpractice.Eachofficeshouldhaveastandardforthetimeneeded for each typeofprocedure so that themedicalassistantcangaugethetimeneededfortheappointmentandassign appointments accordingly. Always advise patients ofdelayssincethisallowsthepatienttheoptionofreschedulingtheirappointment,wait,orreturnlater.Itisnotalwaysneces-sarytoprovidethereasonwhytheproviderwillbelate.

Makingthescheduleflowsmoothlycanbeachallengeforthemedicaloffice.Ittakesthecooperationofallstaffmemberstomake ithappen.Buteffective scheduling is thebackboneofanefficientmedicalpractice.

Appointment BookManytypesofappointmentbooksareusedinmedicalofficestoday.Often,appointmentbooksarespiral-bound,andeachpageisdatedandcontainsadayoftheweek.Thetimeallottedfor appointments varies from every 10minutes to every 60minutes(Figure26-3).Theappointmentbookmustbeaccu-ratebecausethedailyworkflowdependsonitscontents.



Beforeappointmentscanbemade,itmustbedeterminedwhenthephysicianisavailable.Mostofficesestablishamatrix(reserved time) or develop some other format to block offtime that is not to be used in patient scheduling. Using aslantedlineoranXtomarkoffthenonpatientappointmentperiodsinformsstaffaboutwhenthephysicianisnotabletoseepatients.Abriefstatementexplainingthisnotationisused(e.g.,hospitalrounds;seeFigure26-3).Openappointmenttimesareindicatedbytheblankboxesinthegrid.Inanofficeof several providers, eachmayhave their ownappointmentbook.Ifprovidersaresharingexaminationrooms,thesched-ulingiscritical.

Procedure 26-4 explains the process of establishing thematrixofanappointmentbookpageandschedulingapatientappointment indetail.Whenappointmentsareentered, thepatientsnameandphonenumberareentered.Ifapatientisano-showorcancelsthedayoftheappointment,anotationnexttothepatientsnamemustbeplacedinink.Thisdocu-mentationprotectsthemedicalpractice incaseofa lawsuit.Theappointmentbookisalegaldocument;thisiswhymostofficesrequirethatonlyblackinkbeusedtowriteinit.Otherimportantaspectsofschedulingappointmentsincludetheuseof computerized appointment systems and abbreviations inscheduling.Everyoneintheofficemustbeapprisedofabbre-viations made in the appointment books, so they may beawareofallnotationsinthebook.Itisimportanttoremem-berthatwhenapatientfailstoappearfortheirappointment

(noshow,orN/S),theincidentmustappearinthepatientschart.

Computerized AppointmentsComputerized systems for appointment scheduling offermedical assistants great flexibility. The systemwill search aparticular physicians schedule and can also search otherhealthprovidersinthemedicalpracticetolocateanavailableappointmenttime.Theschedulecanbeprinteddaily(Figure26-4).Aswithanycomputerizeddata,abackupsystemshouldbeinplaceifthesystemfails.Electronicappointmentbooksare very efficient in that they canmark all electronichealthrecords (EHRs) for thatday,or if thepracticedoesnotuseEHRs,thecomputercanpullupallpatientsnamesinalpha-beticalorderforpullingthechartsefficiently.Theelectronicappointmentbookprintsoutagridthatidentifiestheappoint-menttimesforeachhealthcareproviderallowingthesched-uletobereviewedfortheday.

AbbreviationsWhenanappointmentismade,areasonshouldberecorded.Usinganabbreviationallowsthemedicalassistanttoindicatethereasonfortheappointmentwithoutwritingoutthereasonusingcompletewordsandsentences(e.g.,completephysicalexamisCPE).Thisismuchquickerandalsohelpspreventspelling errors and hard-to-read explanations. Box 26-4 showscommonabbreviationsused forappointmentsetting.

PROCEDURE

26-4 PrepareandMaintainanAppointmentBook

TASK: Establish thematrixofanappointmentbookpageandscheduleanewandestablishedpatientappointment.

EQUIPMENT AND SUPPLIES Appointmentbook Officepolicyforofficehoursandlistofphysiciansavailability Pencil Calendar

SKILLS/RATIONALE

note: This can be accomplished manually in anappointment book or electronically in a computersoftware program. (For the purposes of this proce-dure,thistaskisperformedmanuallyinanappoint-mentbook.)Rationale. Predetermined time(s)must beblockedout on theappointmentbooksothatpatientsarenotinadvertentlyscheduledtobeseenduring these times. Matrixing theappointmentbook

Continued

1. Procedural Step. Matrix the appointment book.a. Identify and mark with an X in an appointment

book those times when the office is not open forpatientcare.

b. Determinethehours thateachphysicianwillnotbeavailableforappointments.

c. Blockouttimeforemergencyvisits,andreservetimeforunexpectedneeds.



PROCEDURE

26-4 PrepareandMaintainanAppointmentBookcontd

8

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DATE

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APPOINTMENT SCHEDULE

Mon. Tue. Wed. Thu. Fri. Sat.

9

10

11

12

1

2

3

5

4

1-c

Continued



PROCEDURE

26-4 PrepareandMaintainanAppointmentBookcontd

patientmustberescheduledforanyreason.Ifthepatientisnewtothefacility,writeNP(newpatient)afterhisorhername.Accom-modatingthepatientsneedsmakes itmore likely thepatientwillkeeptheappointment.note:Anappointmentbookisalegaldocumentandcanbe subpoenaed as evidence in court.Becauseofthis,appointmentsshouldbeenteredinink.However,ifamanualappointmentbookiskept,standardprac-ticeistoentertheappointmentsinpenciltoallowforchanges such as rescheduling. A record of no-showappointments should be kept and documented inpatient records. A photocopy of the appointmentpageisacceptedasapermanentrecord.

3. Procedural Step. Complete an appointment card.Whenthepatientisrequiredtocomebackforafollow-upappointment,makethepatientanappointmentcardtoincludethedateandtime.Ifmakinganappointmentbyphone,repeatthedateandtimetothepatient.Rationale. Appointmentcardsandrepeatingappointmentinforma-tionhelpthepatientremembertheappointment.

shows the available time slots that can be used for patientappointments.

2. Procedural Step. Schedule an appointment.a. Whenapatientrequestsanappointmenttime,iden-

tify the patients chief complaint to determine theamountoftimeneededfortheappointment.Rationale. Thepatientschiefcomplaintdeterminestheamountoftimerequiredforthevisit.Officepoliciesshouldbeestablishedtoprovidestandardproceduretimesforpatientscheduling.

b. Identifywhetherthepatientisaneworanestablishedpatient and determine the patients preference fordateandtime.Rationale. Newpatientsoftenrequirealongerofficevisitthanestablishedpatients.

c. Oncethepatientagreestothedateandtime,enterthepatientsfullname,reasonforthevisit,andpatientsdayphonenumber(home,work,orcellnumber)intheappointmentbook.Rationale. Writing in a reason for the visit allows the clinicalassistant toprepareequipmentandsuppliesneeded for thevisit.Writing in a telephone number allows for quick reference if the

BOX 26-4

Common Abbreviations Used in Appointment Setting

BCP Birth control pillBP Blood pressure checkBx BiopsyCan CancelledCons ConsultationCPE, CPX Complete physical examinationECG, EKG ElectrocardiographyFB Foreign bodyFU Follow up (follow-up)HTN HypertensionI&D Incision and drainageLab LaboratoryN&V Nausea and vomitingNP New patientNS No-showOV Office visitPAP Pap (Papanicolaou) smear (test)Pgt Pregnancy testPX PhysicalReC, RECK RecheckRef ReferralRS RescheduleSOB Shortness of breathSurg SurgeryS/R Suture removalURI Upper respiratory infectionUTI Urinary tract infection

Becarefulwhenusingabbreviations;allstaffmembersmustbeknowledgeableabouttheabbreviationsusedandinagree-mentabouttheirmeaningandonlyusethosethathavebeenapprovedbythemedicaloffice.

New Patient AppointmentsWhenanewpatientcalls themedicaloffice foranappoint-ment,youshouldobtainthefollowinginformation:

1. Name.Obtain thepatients lastname,firstname,andmiddleinitial.Askthepatienttospellthelastnametoavoidanerror.

2. Address. Obtain the home address and the billingaddress,ifdifferentfromthehomeaddress.

3. Telephone number.Obtain the telephonenumbers forhome,cellularphone,andworksothatanappointmenttimecanbeconfirmed,canceled,orchanged.

4. Purpose of the visit. This information is necessary toschedule the correct length of time for theappointment.

5. Referral.Ifanotherphysicianisreferringthepatient,trytoschedulethepatientassoonaspossible.Thepatientneeds to bring any applicable documents to theappointment.

6. Insurance coverage. Insurance information can beverified to save timewhen thepatient comes into theoffice.

Procedure 26-5 explains the process of scheduling newpatients in detail, both manually and using the computer.Chapter25providesmoreinformationonusingthemedicalofficecomputertoperformschedulingandothertasks.



FiGUre 26-4 Computer-generated appointment schedule. (From Hunt SA: Fundamentals of medical assisting-revised reprint, St Louis, 2007, Saunders.)

Schedule for 10/13/XX for Dr. Howard Lawler

-

-

Established-Patient AppointmentsAnestablishedpatientisanypatientwhohasbeenseeninthepast3yearsbythephysicianoranotherphysicianintheprac-tice,nomatterwhatthelocale(patientswhohavenotbeentotheofficein3yearsshouldbeconsiderednewpatients).Thefollowing information is needed when established patientscall:

1. Telephone. Obtain the telephone numbers for bothhomeandworkforthesamereasonasanewpatient.

2. Purpose of the visit. This is obtained, aswith the newpatient,forschedulingpurposes.

3. Insurance information. Ask if the patients insuranceinformationhaschanged.

4. Demographic information. Ask established patients iftherehasbeenanychangeintheirhomeaddress.

Appointment TechniquesMedical assistants are often responsible for schedulingappointments. An office policy listing time periods for the

varioustypesofmedicalservicesallowsthemedicalassistanttoassignappointmenttimesaccordingly.Routineofficevisitsrequireanaverageof15to20minuteswhenonlybasicequip-mentandstaffareneeded(Figure26-5).

Eachofficemustchooseamethodofschedulingappoint-mentsthatfitstheactivitiesofthephysicianandneedsoftheoffice.Varioustechniquesareusedforschedulingpatients.

Time-SpecifiedTime-specified schedulinggiveseachpatientanappointmentforadefiniteperiod(e.g.,10-10:15am).Themedicalassistantscheduling the appointmentneeds toknowexactlywhy thepatientisbeingscheduled.A15-minuteappointmentisade-quate for a follow-up visit, inmost cases, butmore time isneededforawell-patientvisit.

WaveWave scheduling is not as structured as the time-specifiedsystem and allows for more flexibility. Wave schedulingis designed to self-adjust and avoid backups. This type of



PROCEDURE

26-5 ScheduleaNewPatient

TASK: Scheduleanewpatientforanofficevisit.

EQUIPMENT AND SUPPLIES Appointmentbook Telephone Pencilandpaper

SKILLS/RATIONALE

Rationale. It is important to have this information so you canthen locateandscheduleanappropriateappointment timeslot intheappointmentbook.

2. Procedural Step. Obtain the patients demographic information and chief complaint.

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APPOINTMENT SCHEDULE

1-a

Continued

1. Procedural Step. Obtain preliminary information.

a. Name of the physician for whom to book theappointment.

b. Purposeoftheappointment.c. Schedulingpreferencesofthepatient.



PROCEDURE

26-5 ScheduleaNewPatientcontd

Rationale. Patients are better satisfied if they are given achoice.

b. Enter the time agreedon in the appointment book,followedbythepatientsdaytimetelephonenumber,reasonforvisit,andtheabbreviationNP.Rationale. Writing in a reason for the visit allows the clinicalassistant toprepareequipmentandsuppliesneeded for thevisit.Writing in a telephone number allows for quick reference if thepatientmustberescheduledforanyreason.NPestablishesthenewpatientstatus.

5. Procedural Step. Obtain additional information at the time the appointment is made.a. Requestinsuranceinformationandexplainanyfinan-

cialpoliciesatthetimetheappointmentismade.Rationale. This ensures that the patient will be aware of thepayment policy and that the office can verify insurance benefitsbeforetheappointment.

b. Providedirectionstotheoffice,aswellasanyspecialparkinginstructions.Rationale. This provides for excellent customer service andrelieves any patient anxiety about being able to find themedicalfacility(seeProcedure26-1).

c. Repeat the day, date, and time of the appointment,andaskifthepatienthasanyquestionsbeforeendingtheconversation.Rationale. Thishelpsverifythatthepatientunderstandswhenthe appointment is scheduled and allows the patient one moreopportunitytoaskquestionsorclarifytheofficepaymentpolicy.

a. Patientsname(verifythespellingofthename).b. Patientsaddress.c. Patients daytime phone number, including cell or

worknumber.d. Patientsdateofbirth.

Rationale. Notalltheinformation,suchastheaddressanddateofbirth,willberecordedintheappointmentbook.Thisinformationwill be used to start the patientsmedical record. However, it isimportant that this information is gathered at the time the firstappointmentisscheduled.

e. Determinethenewpatientschiefcomplaint,andaskwhenthefirstsymptomsoccurred.Rationale. This information is needed to help determine thelength of time needed for the appointment and the degree ofurgency.

3. Procedural Step. Determine whether the patient was referred by another physician.Reference thepatienthistory formfor this informationoraskthepatientdirectly.Youmayneedtorequestaddi-tional information from the referring physician, andyour physicianwillwant to send a consultation reportandathank-youletter.

4. Procedural Step. Enter the appointment in the appointment book.a. Search the appointment book for the first available

appointment time and an alternate time. Offer thepatientachoiceofthesedatesandtimes.Itisbesttogivethepatienttwoappointmentoptions:amorningappointmentononedateandanafternoonappoint-mentonanotherdate.

FiGUre 26-5 Medical assistant scheduling an appoint-ment in an appointment book.



nutritionist)mustseethesepatientsandthetimetheycanbescheduledislimited.

Open HourOpen-hour scheduling allows patients to be seen any timewithin a specified time frame on a first-come, first-servedbasis. This type of scheduling is typically used in walk-inclinicsbecauseofthesteadyflowofpatients.Anappointmentbookisoftenneededtoestablishamatrixandtomarkwhichpatient has arrived first. A disadvantage of this schedulingmethod is thatpatientsmayhave towait foraconsiderablylongtime,dependingonthenumberofpatientsalreadytherewhentheyarrive.

Acute NeedsFromtimetotime,patientscallandrequesttoseethephysi-cianthesameday.Themedicalassistantwillhave toscreenthepatienttodeterminetheurgencyofthecallandtheneedfor an immediate office appointment.Office criteria shouldbe developed to determinewhat constitutes an emergency.The physician or other supervisory medical staff must beavailabletohelpwiththedecisionprocess.Somepatientswillbeadvised togodirectly to theemergencyroombecauseoftheir condition. If a patient is scheduled to come in on anemergencybasis,itusuallymeansthepatientistoldtoarriveattheendoftheday,ortocomeinrightaway,butthepatientmayhavetowait.

Someofficesbuildabufferperiodintotheirscheduletoaccommodate emergencies or walk-in patients. This bufferperiodisadesignatedflexiblehourintheschedulethatisusedtomeettheneedsofpatientswhilenotdisruptingtherestoftheschedule.Afterall,patientscannotpredictwhentheywillbecomesickorinjured.Youwill learnmoreabouthandlingofficeemergenciesinChapter46.

Special CircumstancesProblems that disrupt the scheduling process include no-shows,cancellations,latearrivalofpatients,latearrivalofthephysician,andunexpectedtimeswhenthephysicianiscalledaway from the office. Inclement weather can make traveldangerous,resultingincancelledappointments.Anelectricalpowerlosscancauseamedicalpracticetoclose,resultinginthecancellingorreschedulingofappointments.No-Shows and Cancellations. Patientssometimesfailtokeepanappointment,ortheycancelanappointmentwithoutresched-uling. No-show information needs to be noted in theappointment book and on the patientsmedical record forlegalpurposes.Patientswhodothischronicallyarenoncom-pliantwithtreatment.Late Arrival of Patients. If a patient is repeatedly late for ascheduledappointment,schedulingthepersonattheendofthedayhelpsalleviatetheresultingdelay.Late Arrival or Unexpected Absence of Physician. Patientsunder-stand occasionally waiting for the physician, usually 20minutes, but repeated lengthy waits result in agitation andstress.Patients shouldbenotified if theywillberequired towaitmorethan20minutes.Thisshowsrespectfortheirtime

schedulingtakesintoaccountno-showsandlatearrivals.Eachhourblockisdividedintotheaverageappointmenttime.Forexample,iftheaverageamountoftimeusedforeachappoint-mentis15minutes,fourpatientscouldbescheduledbetween9and10am.Inthiscasethefourpatientswouldbegivenanappointmenttimeatthebeginningofthehour(9am).Patientsareseenintheorderoftheirarrival.Theideabehindtheflex-ibleappointmentsystemisthateachpatientwillnotarriveatexactly thesametimeorrequire theentire time,andbytheendofthehour,allpatientswillbeseenandtheschedulewillbeontrack.

Modified WaveAswiththewavemethod,modified-wave schedulingisalsobased on the idea that each visit will not take the requiredtime. However, instead of scheduling the entire group ofpatientsatthebeginningofthehour,thegroupissplitinhalf.Onehalfof thegroup is scheduled for thebeginningof thehour and the remaining on the half hour. Thus, using theexample given in the wavemethod, two patients would begivena9amappointmentandtheothertwowouldbegivena9:30amappointment.Thisallowstimetocatchupbeforethenexthourbegins.

StreamingStreaming scheduling uses the concept of meeting theneeds of the patient. Appointments are set according towhythepatientiscomingintotheoffice,thereforeallowingenoughtimefortheprocedure.Inmostcases,eachtimeslotis broken into 15-minute intervals. A procedure needinganhourwouldusefourtimeslots,butaprocedureneedingonly 5 minutes (e.g., blood pressure check) would get one15-minute slot and anotherpatientneedingonly 5minutesmaybebookedinthesameslot.Thistypeofbookingaccountsforthein-and-outpatientandleavesenoughslotsopenforemergencies.

Double BookingDouble bookingissimilartowavescheduling,butinsteadofmorethanonepatientscheduledatthebeginningofthehour,twopatients are scheduled to see the physician at the sametime.Thisissimilartoanairlinesellingmoreseatsthanavail-able. The assumption is therewill be cancellations and no-shows.Thisformofschedulingishelpfulifapatientneedstobeseenthatdayandhasnoappointment,butitoftencausesthe office schedule to fall behind. This type of schedulingshouldnotbedoneonaregularbasis,andpatientsshouldbeinformedthattheyarebeingdouble-bookedandthattheywillprobablyhavetowaitafterarrival.

Cluster (Group) or CategorizationIncluster scheduling,severalappointmentsforsimilartypesof examinations are grouped. For instance, some medicalofficeswill only do complete physical examinations the lastFridayof themonthoronlyonFridays.Grouping specialtyexaminationsallowsthepracticetomeetpatientdemandsandisabetteruseofresources.Often,specialtypersonnel(e.g.,a



andallowsthemanopportunitytoreschedule.Alwaysnotifypatientsifthephysicianwillbedelayed,andgiveanapproxi-mate time of the physicians arrival. Patientsmay take thisopportunitytorunanerrandormakesomephonecalls.Thisreducestheirstressandtheresultingstressplacedontheofficestaff.

Appointment ReminderAnappointmentremindercardhelpspatientsremembertheirnextappointment.Manypatientswillcarrythecardintheirwalletorpurseforeasyreference.Itshouldbegiventopatientsbefore they leave the office. If a new patient schedules anappointment, an appointment card can be sent with thepatientinformationpacket.

Theappointmentcardtakesmanyforms,buttheinforma-tion it contains is standard. The following information isimprintedonthecard(Figure26-6):

Linetorecordpatientsname Line(s)torecorddateandtimeofappointment Physiciansname,address,andtelephonenumber Sometimes,officepolicyconcerningcancellations

Anotherwaytoremindpatientsaboutupcomingappoint-mentsiswithaphonecall.Themedicalassistantmaycalleachpatient scheduled for an appointment the day before as areminder.Becertainyouhavethepermissionof thepatientto leave information such as appointment times on theiranswer machine. This could be a HIPAA violation if donewithoutpermission.

Scheduling Ancillary Appointments for PatientsSometimesmedical assistants schedule patients for surgery,consultations, referrals,physical therapy, x-rays, andoutpa-tient diagnostic testing (Procedure 26-6). To make certainthesethingsaredoneinatimelymanner,themedicalassistantwilloftencallandscheduletheappointmentasaconvenienceforthepatient.Themedicalassistantmustbeawarethateachhealthcareplanhas itsownrequirements thatmustbemetbeforeprovidinganauthorizationnumber.Schedulingguide-linesforancillaryappointmentsrequirethatthemedicalassis-tanthave all information readily availablebefore calling foranappointment.Forexample,thepatientshouldbeconsultedastopreferencefordayandtime(e.g.,Fridaymorningsworkbest for me). The patients health record must be readilyavailable before calling since pertinent information will befoundwithinthechart(e.g.,diagnosis,healthinsuranceinfor-mation).Afterschedulingtheappointmentthepatientshouldbecalledtoinformhimorherofthedayandtime,aswellasof anypreparationneedbefore the test (e.g.,nothing toeatpastmidnight).All informationabout theappointmentandthepatientsnotificationmustbedocumentedinthepatientshealth record.Table 26-2provides information themedicalassistantmusthaveavailablewhenmakingancillaryappoint-mentsorschedulingsurgeryforthepatient.

FiGUre 26-6 Appointment reminder card.

Mary Jones Mon. June 110:00

Mary Jones

10:006/1


Why is it important to follow established guidelines when scheduling patients? What are the established guidelines?

How would you handle the situation of a physician being delayed for his afternoon appointments? How are patients affected by this situation?

Why is it important to inform waiting patients of a provid-ers delay?

HANDLING MAILHandling correspondence is an important administrativemedical office duty. Incoming and outgoingmedical officemailneedstobehandledproperlytomakesurepatientsandofficestaffalikereceivetheircorrespondence.Settingprotocolfor the efficient handlingof incoming andoutgoingmail iskey to an organized daily routine,whichwill include other



PROCEDURE

26-6 ScheduleOutpatientandInpatientAppointments

TASK: Scheduleapatientforaphysician-ordereddiagnostictestorprocedure,eitherinanoutpatientorinpatientsetting,orinpatientadmissionwithinthetimeframerequestedbythephysician,confirmtheappointmentwiththepatient,andissueallrequiredinstructions.

EQUIPMENT AND SUPPLIES Physiciansorderforeitheranoutpatientorinpatientdiagnostictest,procedure,orinpatientadmission Name,address,andtelephonenumberofdiagnosticfacilityperformingthetestortheadmittingfacility Patientmedicalrecord Testpreparationorpreadmissioninstructions Telephone Pencil

SKILLS/RATIONALE

Establish the date and time of the procedure or time of admission.

Determine any special instructions or requirements for the patient.

Notify the facility of any urgency for test or procedure results.

5. Procedural Step. Notify the patient of arrangements, including the following:a. Name, address, and telephone number of the

facility.b. Date and time to report for the test, procedure, or

admission.c. Instructions concerning preparation for the test or

procedure(suchaseatingrestrictions,fluids,medica-tions,etc.).

d. Tellwhat,ifany,preparationisnecessary.e. Directionstothefacilityandparkinginstructions.f. Askthepatienttorepeattheinstructions.g. Send written instructions to the patient, if

applicable.Rationale. Thesedetailsareprovidedtoensurethatthepatientunderstandsthepreparationnecessaryforthetestandtheimpor-tanceofkeepingtheappointment.

6. Procedural Step. Document in the patients chart all information provided.

7. Procedural Step. Conduct follow-up.a. Placeareminderofthetest,procedure,oradmission

onthephysiciansdeskcalendarorappropriateticklerfile.

b. Record the scheduled test, procedure, or admissiononanofficetrackinglogforfollow-upwiththefacilityiftheresultsarenotreceivedinatimelymanner.

c. Placethenotificationforthetestorprocedureinthepatients record and make it available to thephysician.Rationale. Thisallowsfortimelyfollow-upoftheresults,whichwillimpactpatientcare.

1. Procedural Step. Schedule appointment using an order for an outpatient or inpatient diagnostic test, procedure, or admission and the expected time frame for results.

Rationale. A physicians order is required prior to schedulingdiagnostictests,procedures,orinpatientadmissions.Theurgencyofreceivingthetestresults,havingproceduresdone,orpatientcareaffectsthetimingoftheappointment.

2. Procedural Step. Secure approval for the procedure from the patients insurance company.

Rationale. In some cases it is important to confirm that apatientsinsurancebenefitsarevalidandtheneededprocedurewillbecoveredbythepatientsinsurancepolicy.Thisisaccomplishedbycontactingtheinsurancecompanydirectly.

3. Procedural Step. Determine patient availability.a. Callthepatienttodeterminetheavailabilityofdates

andtimesbeforeschedulingtheappointment.Rationale. Thisensuresthatthepatientwillbeabletocomplywithallarrangements.Thebestpractice is toobtainanalternatedateandtimeaswell.

b. Pullthepatientsrecordbeforecallingtoschedulethetestoradmission.Rationale. All of the patients information, such as address,phonenumber,andinsuranceinformation,willberequestedbythefacility.Havingthepatientsrecordaccessiblebeforecallingensurestheinformationisreadilyavailable.

4. Procedural Step. Contact the facility and schedule the procedure, test, or admission.a. Provide the facilitywith the informationneeded for

arrangements. Order the specific test or procedure needed, or inform

the facility of the admitting order. Provide the patients diagnosis. Give the patients name, address, daytime telephone

number, and date of birth. Provide the patients insurance information, including

policy numbers and addresses.



Table 26-2

Information Needed to Schedule Patients for Ancillary Services

Inpatient Elective Admission

Inpatient Direct Admission (Emergency from medical office) Inpatient Procedure Outpatient Admission Outpatient Procedure

Patient demographics Patient demographics Patient demographics Patient demographics Patient demographicsPatient diagnosis Patient diagnosis Patient diagnosis Patient diagnosis Patient diagnosisPhysician admitting Physician admitting Physician admitting Physician admitting Physician admittingType of bed or floor Type of bed or floor Procedure room schedule Type of bed or floor Procedure room scheduleInsurance authorization Insurance authorization Insurance authorization Insurance authorization Insurance authorizationPatient preparation (fax

admit orders to hospital on admission date)

Patient preparation (fax admit orders directly to designated floor)

Patient preparation (provide patient with instructions)

Patient preparation (fax admit orders to hospital on admission date)

Patient preparation (provide patient with instructions)

Preadmission testing Preadmission testingLength of procedureAnesthesia required

Preadmission testing Preadmission testingLength of procedureAnesthesia required

Notify patient of dates and other information

Notify physician Notify patient of dates and other information



dutiesforthemedicalassistant.Medicalassistantsresponsiblefor handling the mail should familiarize themselves withpostal laws, regulations, and procedures. TheUnited StatesPostal Service (USPS) website, www.usps.com, is a greatresourceforthisinformation.

Interoffice mail,themailcomingfromwithintheofficeorfromotherofficesof thesamepractice,canbehandled inavarietyofways,accordingtoofficeprotocol.Thistypeofcor-respondencedoesnotgothroughtheUSPS.

Incoming MailWhenmailarrives,itneedstobesortedintocategoriesbeforebeingopened.Manydifferenttypesofmailwillbesenttothemedical office: payments, insurance correspondence, jour-nals, personal mail, magazines, brochures, and advertise-ments.Thesortingofmailsavesvaluabletimeforthephysicianandofficestaff.LettersmarkedPersonalareseparatedfromothermail anddeliveredunopened to the person towhomtheyareaddressed.IfaPersonalletterisaccidentallyopened,Openedinerrorshouldbenotedontheenvelopewiththeopenersinitials.

TheUSPSclassifiesU.S.mailintoseveraltypes,orclasses(Box 26-5). Considerations for handling incoming mailincludethefollowing:

First-classmailshouldbeopenedwithaletteropener(toavoid damaging the contents), date-stamped, andinspected for signatures, enclosures, and completeaddresses.

Envelopesshouldbeattachedtothecorrespondencetowhichtheybelong,ifthedateofmailingmightbecomeanissue(e.g.,legalnotices,delinquentbillpayments).

Correspondencereceivedfrompatientsorotherphysi-cians regarding a patients illness, laboratory reports,pathology reports, and operative reports should beattached to thepatientsmedical recordandplacedonthephysiciansdesk.

BOX 26-5

U.S. Postal Service (USPS) Mail Classifications

First-class mail includes all sealed or unsealed letters up to and including 13 oz (e.g., correspondence, statements).The maximum weight is 70 lbs, and the maximum size is 108 inches in length and girth combined. If the envelope is not standard size than all four sides of the envelope should be marked First Class.

Bound and printed mail or standard mail includes circulars and advertising materials that weigh less than 16 oz.

Media mail includes library material, packages, and manu-scripts weighing 1 to 70 lbs with a combined girth of 108 inches.

Whenpaymentsarereceived,thepaymentisenteredinthedailyjournalandpostedonthepatientsledgercardoraccountbytheappropriateperson.

Mail should be arranged according to importance andplacedon thephysiciansdesk (i.e., expressmail,first-classmailontop).

Thephysicianwillneedtoinitialallpapersthatrequireproof that he or she has read them (e.g., laboratoryreports,pathologyreports).Initialssignifythatthephy-sicianhasreviewedthematerialpersonally.

Outgoing MailCorrespondencethatleavesthemedicalofficeshouldbepre-paredproperly.Thishelpsensureitwillarriveatitsdestina-tionquicklyandwillcreateaprofessionalimpression.Generalguidelines for properly preparing outgoing mail are asfollows:

Copiesshouldbemadeofallcorrespondence,providinga record of what was sent, and filed in the patients



BOX 26-6

Special Handling Methods for Mail

Most medical office mail is sent first class, but certain items require special handling. Registered mail is used when items have a declared monetary value and are being sent via first-class mail. Registered mail

can be insured for a maximum amount of $25,000. This option is available for First Class and Priority Mail. Insured mail is also used when items have a monetary value, but it is used for items valued at $400 or less and being mailed

via First Class or Priority Mail. Return receipt is used when the medical office needs proof that an item mailed was received by the intended person. The recipi-

ent must sign the return receipt, which is returned to the sender, and this provides proof that the senders mail was received. Restricted delivery is used when the item needs to be delivered only to a specific recipient. It can be used to help maintain

patient privacy (e.g., delivery is restricted to only the patient, and no one else is authorized to receive the mail). Certified mail is used when it is necessary to prove that a letter was delivered and is available for Priority Mail. The recipient

signs a return receipt to verify that the delivery was made. Certified mail is used for items that are considered urgent. It also provides proof that that an item was mailed. A letter sent to discharge a patient from the practice must be sent by certified mail. The receipt is kept with the patients record.

Express mail guarantees overnight delivery or second-day service within the United States. It is available 7 days a week for items up to 70 lbs and measuring 108 inches in combined length and girth.

Priority mail is first-class mail weighing more than 13 oz and up to 70 lbs. It is the fastest method to have heavier mail delivered within 2 or 3 days. Priority mail rate over 13 oz is determined by zone and weight.

Mailgrams are special services offered by both the U.S. Postal Service (USPS) and Western Union.

FiGUre 26-7 Method of folding a letter to place inside a #10 envelope. (From Young AP, Kennedy DB: Kinns the medical assis-tant, ed 10, St Louis, 2007, Saunders.)

record.Theoriginalletterandatypedenvelopeshouldbeclipped togetherandplacedon thephysiciansdeskforsignature.

Use theappropriatehandlingmethodtosendthemail(Box26-6).

Foldtheletterorcorrespondencecorrectlybeforeplacinginsidetheenvelope.

Preparetheenvelopeproperly.These guidelines are discussed in detail in the following

sections.Thevolumeofmail leaving theofficewill increasewhenpatientstatementsaresentout.AsmentionedinChapter

24, apostagemeter reduces the time spent in stamping theenvelopesandsaves frequent trips to thepostoffice topur-chasestamps.Thepostagemetercanbesetfortheproperclassofmailandthecorrectamountanddate.

Folding LettersThe foldingand insertingofa letterwilldependon the let-terheadusedandtheenvelopesprovided.Thelettershouldbefaceupandfoldedintothirdstofitintoa#10envelope(Figure26-7).Ifa #6 34 envelopeisused,thelettershouldbefoldedinhalfandthenintothirds(Figure26-8).

FiGUre 26-8 Method of folding a letter to place inside a #6 3 4 enve-lope. (From Young AP, Kennedy DB: Kinns the medical assistant, ed 10, St Louis, 2007, Saunders.)



BOX 26-7

State Abbreviations for Mailing Addresses

AK AlaskaAL AlabamaAR ArkansasAZ ArizonaCA CaliforniaCO ColoradoCT ConnecticutDC District of Columbia*DE DelawareFL FloridaGA GeorgiaGU Guam*HI HawaiiIA IowaID IdahoIL IllinoisIN IndianaKS KansasKY KentuckyLA LouisianaMA MassachusettsMD MarylandME MaineMI MichiganMN MinnesotaMO MissouriMS Mississippi

MT MontanaNC North CarolinaND North DakotaNE NebraskaNH New HampshireNJ New JerseyNM New MexicoNV NevadaNY New YorkOH OhioOK OklahomaOR OregonPA PennsylvaniaPR Puerto Rico*RI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVA VirginiaVI Virgin Islands*VT VermontWA WashingtonWI WisconsinWV West VirginiaWY Wyoming

*Not a state, but this abbreviation is used.

Envelope PreparationWhen addressing an envelope, following simple guidelineshelpsthepostofficespeedthemailtoitsdestination.1. A business letter envelope is 4 918 12 inches (#10). The

address shouldbegin 14 lines from the top and4 inchesfromtheleftedgeoftheenvelope.Thisisthemostcommonenvelopeusedforcorrespondence.

2. A standard size envelope is 3 658 12 inches (#6 34 ). Theaddress should begin 12 lines down from the top and 2inchesfromtheleftedge.

3. Only use capital letters to start words throughout theaddress.

4. Donotusepunctuation.5. Usesinglespacingandblockformat.6. Usetwo-letterabbreviationforstate,district,orterritory.

Stateabbreviationsoftwoletterswithoutperiodsorspaceswere developed to use with the optical character reader(OCR), which reads numbers, capitals, and small letterstyped by machine or word processor. OCR has all postoffice locationsandzipcodenumbersandcanrecognizethestateabbreviationfasterthanthewholeword.Box26-7providesalistofacceptablestateabbreviations.

7. The last line intheaddressmusthavethecity,state,andzipcode.Usingzipcodesspeedsmailtoitsdestination.Azip codedirectory canbepurchasedat thepostofficeorcanbefoundon-line.Itisimportanttorecognizethatonly27 characters are to be used in the last line, includingspaces.

8. Ifmail is to be sent via special handling (e.g., registeredmail), thisneeds tobe identified inall-capital lettersandplacedbelowthestamp.Figure26-9showsproperlyaddressedenvelopes.note: Envelopes can be processed by using the envelope

andorlabelfunctioninawordprocessingprogram.


Why is it important to sort the mail in a planned sequence?

How important is it to follow USPS guidelines when addressing an envelope?

How might patients be affected if mail is not handled efficiently?



FiGUre 26-9 Correct format for addressing A, #6 3 4 envelope and B, #10 envelope.

Woodrow Medical Associates, PC

5114 Granite DriveParis, KS 00003

12 lines

2 inches MR ROLAND PARKS76 MEADOWLARK LANEROME MO 00002

9 lines

SPECIAL DELIVERY

Woodrow Medical Associates, PC

5114 Granite DriveParis, KS 00003

3 lines

4 inches

PERSONAL

ELLEN BORENZTWIN LAKES1418 TARYTON STREETROME MO 00002

14 lines

At least1 inch

At least 5/8 inch

A

B

MANAGING WRITTEN CORRESPONDENCE

All written correspondence from the medical office mustcreate a good impression. It should be neat, in the correctformat, professional and courteous in tone, and error-free.You need to understand the basic guidelines for effectivewrittencorrespondenceaswellasthewritingformatsusedforbusinessletters,memos,andmanuscripts.

Guidelines for Effective Written CorrespondenceAll written correspondence, whether sent within the office,outtopatients,orotherorganizations,needstobewritteninaclear,concise,professionalway.Basicguidelinesforeffectivewrittencorrespondenceareasfollows:

1. Before writing, plan themessage so that itmeets theneedsofthereader.Themessageshouldcontainalltheinformationthereceiverneedstohave,writteningoodgrammaticalstyle.

2. Presentideaspositively(e.g.,PleasefeelfreetocallifIcanbeofassistance insteadofIf Icanbeof furtherhelp,pleasedonothesitatetoletmeknow).

3. Include all essential information.Confusionor errorscan resultwhen a letter does not include all essentialinformation. Often, time is wasted because a secondletterneeds tobewritten to add toor clarify thefirstcommunication.

4. Ensure clarity. Written communications need to bewrittenclearlysothattheycannotbemisunderstood.

5. Writeinanaction-orientedstyle(e.g.,WewillmailyouthelabreportinsteadofThelabreportwillbemailedtoyou).Clear,directwritingiseffectiveandefficient.

6. Use concrete or specific language (e.g., a fever of106.4 F instead of a high fever).Confusion existswhen general statements are used because the readermayhavedifficultyunderstandingthemeaning.

7. Usepropersentencestructure.8. Useproperparagraphstructure.9. Editandproofreadmessagescarefully.Reviewingbasic

grammar,punctuation,capitalization,andwordusageruleswillassistintheeditingprocess.

ProofreadingAsyouknow,anycommunicationapatientreceivesfromthemedical office creates an impression. Clear, well-organized,



andaccuratecommunicationcreatesagoodimpression;com-municationthatisnotclear,organized,oraccuratecreatesanegative impression. Before sending anything you write ortype,youneedtoproofreadittobecertainthedocumentisfreeoferrors.Somemedicalassistantsproofreaddirectlyfromthe computer screen, scrolling lineby line.Othersprefer toprint out the document and proofread the hard copy. Keypointstorememberwhenproofreadingareasfollows:

1. Whenreviewingaletter,paycloseattentiontothedate,enclosurenotation,andrecipientsname.

2. Concentrateasyouread,andcheck forkeyingerrors.Even though most word processors have a spellingchecker,itwillnotdetectamiskeyedwordifitisanotherword spelled correctly (e.g., mistakenly keying spatinsteadofstat,ortwoinsteadoftoo).

3. Usethecorrectword(e.g.,affect/effect,advice/advise).4. Checkpunctuationafterproofreadingforspellingand

wordusage.5. Donot rely solelyonspell checkalwayshaveadic-

tionaryandThesaurushandy.Remember if youhavemisspelledwords in yourwritten

communications, patients may also mistrust the quality ofyourskills.

Table26-3listsfrequentlyusedproofreadingsymbolsandproofreadersmarks.Alwaysbesuretoreadovertheprintedcopyofadocumentbeforesendingit.

Letter and Memo PreparationMedicalofficecorrespondenceisoftenintheformofletters,memos,andelectronicmail(e-mail,discussedinChapter7).Medical assistantsneed touse the correct formwhenusingthesetypesofcorrespondence.

Business LettersAbusinessletterincludesthefollowingelements:1. Date line.Thepositionofthedatelineonthepagedepends

onthestyleoftheletterused. Typedthreelinesbelowtheletterhead. Writtenasmonth,day,andyear(e.g.,October1,2009,not10/1/09).

Datetheletterusingthedayitwasdictatedorwritten,notthedaytyped.

2. Inside address.Whenusingletterhead,theinsideaddresscontains the name and address (with zip code and anysuitenumbers)towhomtheletteriswritten.Ifnotusingletterhead, the name and address of the physician andmedicalofficearealsoincludedandappearflushwiththemarginbeforetheinsideaddress. Typedthreetoeightlinesbelowthedateline. Placethepersonsnameonthefirstlineandthecom-panysnameonthesecondline.

Containsnomorethanfivelines. Single-spacetheaddress.

3. Attention line. May be used if a persons name is notknown or is not stated on the first line of the insideaddress.Theattentionl

klieg er chap 26

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