Scheduling & Receiving Flashcards by Samantha Lee

What can schedules be useful for besides the obvious?

accounting & legal proceedings

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What does matrix refers to?

blocking off time slots

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t/f: appointment schedules are legal documents

true

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how long should appointment records be kept for?

vary by state law, but generally 3 years

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What should be included when documenting appointments?

name of pt
parent’s name when appropriate
reason for visit
provider
date and time
pt’s current phone number

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What info should be included in new pt registration packet?

insurance, demographic, employer

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who is considered a new pt?

pt who hasn’t received services from provider within past 3 years

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who is considered an established pt?

pt who received services from provider of same specialty/subspecialty belonging to same practice within 3 years

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what are some aspects of the patient care partnership

high quality hospital care
clean & safe environment
involvement of own care
protection of privacy
help leaving hospital
help w/billing claims

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what is not covered by general release of info form and requires it’s own special consent form?

genetic testing
mental health & therapy records
substance abuse records

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t/f: pt should be notified when their PHI was given w/o consent bc of emergent situations/public health risk

true

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benefits of using EHR w/billing and collections features

streamline workflow for submitting insurance claims & receiving payment for services

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what can possibly happen to cost of emergency/urgent procedures w/o preauthorization bc of lack of time?

decreased/partial payment from insurance

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what responsibility do patients have?

be honest & report all symptoms, injuries, any medications
treat staff w/courtesy & respect

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what does the provider have the right to expect

pt to keep account in good standing to maintain businesses & pay expenses

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descirbe the Federal Truth in Lending Act (TILA)

provider myst provide detailed description of finance charges when pt pay in more than 4 installments
prevent abuses in consumer credit cost disclosures
requires uniformity in disclosures throughout credit industry

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define clustering scheduling

based on specific visits/procedures at specific time

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give the pros of clustering scheduling

streamlines evaluations of pts w/similar complaints
paperwork can be done in batches in advance
unnecessary personnel can do other tasks

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give the cons of the clustering schedules

off track/running late can throw flow offtrack
may not leave opportunities to individualize exams

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define CLUSTERING SCHEDULING

schedule pts based on specific visit/procedure @ specific times

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what are the pros of cluster scheduling

streamlines evaluations of pts w/similar complaints
visit paperwork can be done in batched in advance
unnecessary personnel can focus on other tasks

what are the cons of cluster scheduling

off track/running late visit can throw appt off track
may not leave opportunities to individualize evaluations

define DOUBLE BOOKING SCHEDULING

same appt time for at least 2 pts

what are the pros of double booking

efficiency

what are the cons of double booking

if problem w/one pt, can delay other causing rest of schedule to be behind

define WALK-IN/OPEN HOURS SCHEDULING

no scheduled time and seen in order of arrival

what are the pros of walk-in/open scheduling

good for complaints of unexpected onset

what are the cons of walk-in/open scheduling

complex complaint/multiple ppl with same problem overwhelms staff & resources

define SINGLE BOOKING

1 pt booked for specific amnt of time and done when appt will take longer

what are the pros of single booking

- focus on pt & thoroughly assess complaints - better for appts that take longer

what are the cons of single booking

can leave gaps in schedule if problems easily addressed & straightforward

define STREAMING SCHEDULING

appts scheduled for specific amnt of time based on need to keep continuous flow of pts

what are the pros of streaming scheduling

most effective use of timeslots

what are the cons of streaming scheduling

if insufficient time/unexpected problem it can cause other visits to be delayed

define WAVE SCHEDULING

pts scheduled during first 30 min of each hour leaving last 30 min for same day appts

what are pros of wave scheduling

- give ample time for unexpected visits & staff to do tasks - effective in seasonal events

what are the cons of wave scheduling

- cause lag in schedule/workflow - excessive downtime when last half hour not needed

define MODIFIED WAVE SCHEDULING

wave but schedules pts in last 30 min at 10-20 min intervals

what are the pros of modified wave scheduling

- same as wave (time for unexpected visits & tasks/good seasonally) - sees more pts in allotted time period

what are the cons of modified wave scheduling

- same as wave (lag in workflow & excessive downtime) - back up when pts late/providers delayed/unexpected events

what should be documented when pts are making appts

- pt name - parent of pt if appropriate - reason for visit - provider to be seen - date & time - pt current phone number

for CPT purposes, what is considered a new pt?

person who has not received services within 3 years

for CPT purposes, what is considered an established pt?

pt received services from provider of same specialty and subspecialty belonging to same practice within 3 years

describe HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

insurance plan requiring subscribers to use network providers

describe EXCLUSIVE PROVIDER ORGANIZATION (EPO)

insurance plan similar to HMO but with exceptions; subscribers must use network providers

describe PREFERRED PROVIDER ORGANIZATION (PPO)

insurance plan receiving more comprehensive benefits w/network providers & does not require PCP

describe INDEMNITY PLANS

insurance plan where access is offered to any licensed physician/hospital but generally more expensive

define TICKLER FILE

long-time standby filing system to augment regular calendar & scheduling system

what info is required to schedule inpatient procedures?

- full/birth name - DOB & age - gender and marital status - social security - address - phone number - designated/emergency contact - employer & work phone number of guarantor - hospital insurance coverage w/verification of preauthorization - name, address, phone number of referring provider - provider's diagnosis & plan of care for committee review - expected date of surgery, name of surgery, length of procedure, type of planned anesthesia, estimated blood units (if applies) - time, date, name of lab/scans/type of pt prep (if applies)

what info should be obtained when receiving a pt

- full name of pt - DOB - SS # - marital status - current address & length of time at address - phone number & email - name & relationship of person responsible for charges - pt occupation - health insurance info - photo ID