Practice Management Alert

Question: Our multispecialty practice recently enabled online scheduling through the patient portal. A patient selected a 15-minute “follow-up” slot for new breathing discomfort because that was the earliest option. The appointment was routed directly to the pulmonologist’s schedule without staff review. At check-in, the medical assistant determined that the patient needed a longer urgent evaluation, but the physician was already fully booked. What should we do to prevent this from happening again?

Georgia Subscriber

Answer: It sounds like you need to establish a “pause” between the appointment scheduling and the appointment confirmation. Consider configuring the system to distinguish routine, self-schedulable services from requests that require staff review. Reserve direct booking for clearly defined visit types, such as established patient preventive visits or routine follow-ups; and route symptom-based requests, new patient visits, procedures, and other higher-risk services to a scheduling work queue.

You can make these changes by making sure the scheduling interface in the portal uses short, plain-language screening questions that support scheduling instead of diagnosis. For example, the questions can ask whether the patient is new or established, the main reason for the visit, whether symptoms are new or worsening, and whether the patient has been directed to schedule by a clinician.

Assign staff (and train, if necessary) to monitor the scheduling queue at specific intervals during business hours. Establish a procedure for escalation criteria, and have staff contact the patient when the selected visit type or duration does not match the stated concern. When making assignments for monitors, know what situations can override template rules (as well as when staff can do so), where monitors will place urgent requests, how monitors will document unsuccessful outreach, and what instructions appear in the scheduling queue when the practice is closed.

Limit the information displayed or transmitted to what is needed for scheduling. Review portal vendors, interfaces, analytics tools, and tracking technologies for compliance with applicable privacy and security requirements. The practice should use appropriate access controls and audit controls, confirm that required business associate agreements are in place, and avoid exposing sensitive appointment details in unsecured email or text notifications.

Finally, monitor the process to see how it’s going. Track inappropriately scheduled appointments, urgent requests, abandoned bookings, conversion to completed visits, no-shows, patient complaints, and staff corrections. Review the data by visit type and location, then adjust appointment labels, screening questions, template permissions, and staffing as needed.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC