Pre-Appointment Activities

Pre-appointment activities during scheduling and check-in ensure that the patient and practice are well prepared for the appointment and that the appointment is as efficient and successful as possible. These activities are pivotal to a practice’s patient experience and revenue performance.

While the scheduling process is the core pre-appointment activity, schedulers must perform several other important activities before and after scheduling, including

• ensuring the patient has an account
• confirming whether the patient is covered by an insurance carrier/product contracted with the MGH/MGPO
• connecting patients with no insurance or non-contracted insurance to resources to help them before arrival, thus avoiding surprises and unnecessary bills for the patient and ensuring that the MGH/MGPO receives payment for all services rendered
• helping the patient gain access to Patient Gateway
• providing the patient with all necessary information before check-in (e.g., co-pay required, appointment reminders, questionnaires).

Required Training

• Ensure that administrative staff, schedulers, and front desk staff attend required training upon hire and adhere to ongoing training requirements.
  • Administrative staff, schedulers, and front desk staff must attend Epic Cadence training.
  • Administrative staff must also attend co-payment training and Ambulatory Administrator Onboarding training to learn front desk workflows, best practices, and Insurance 101.

Appointment Scheduling Process

It is important that practice leaders communicate the importance and value of each of these items and help staff who may be challenged to cover all these activities in a single interaction, while balancing other responsibilities in a busy, high-volume practice.

• Verify:
  • Name, date of birth, address, email, phone numbers (cell, home, work), PCP, and primary language
  • Whether an interpreter is needed
  • Insurance coverage:
    • Refer to specific Mass General Brigham and departmental policies for handling patients with non-contracted insurance.
    • Avoid bypassing non-contracted payer warnings.
  • Whether the patient has special needs
  • Special billing (e.g., research, motor vehicle accident, workers’ comp, third-party liability, Do Not Bill, grants, cosmetic flag)
  • That appropriate visit resources are linked in Epic (e.g., interpreters, chairs, rooms, medical assistance visits, referrals, and authorizations)
  • Other patient needs and preferences (e.g., stretchers, family members, Epic preferences)

• Offer to enroll the patient in Patient Gateway unless they are already enrolled or have declined enrollment.

• Complete or review:
  • Epic Cadence scheduling requirements in the Hospital Account Record (HAR)
  • Medicare Secondary Payer Questionnaire (MSPQ) for Medicare patients
  • Infection Control Precautions in Epic
  • Appointment notes (e.g., reason for appointment)
  • A follow-up appointment, if indicated, in Epic using Cadence functionality (e.g., visit types, auto search)
  • Demographics, if necessary
  • The Patient Estimates Process, if a patient requests an estimate for their visit
  • Referral or authorization, if required for the upcoming visit

• Provide:
  • Appointment time, suggested arrival time, and length of appointment
  • A reminder that the patient should bring a photo ID
  • Anticipated co-payment amount and a reminder that co-payment is expected at the time services are rendered
    • The following script is recommended: “As a reminder, the system shows that you will have a $XX co-payment due at the time of your visit. We accept all major credit cards and checks for your convenience.”
  • Pre-visit questionnaires via Patient Gateway
  • Practice information and expectations
  • Parking, accommodations, and general hospital information (e.g., maps, transportation options, traffic/public transportation alerts) via email or hard copy
  • Questionnaires and other forms for patients to complete on day of appointment
  • The testing, blood work, and lab work that needs to be completed before or at the appointment

• “Warm transfer” a patient to the PSC, with patient approval, if:
  • The patient is new and does not have an MRN
    • Explain the reason for the transfer, what to expect when they connect with a PSC representative, and the process for contacting the practice to schedule an appointment.
    • Note: While registration by the PSC is generally required before scheduling, for practices under the Center for Ambulatory Services access model, patient registration is handled at the time of scheduling with no need for a transfer to the PSC.
  • The patient, member, or guarantor is not verified (indicated by “elapsed” in the Reg Status field in Patient Summary of the Appointment Desk in Epic)
  • The patient has self-reported changes in fields that cannot be updated (e.g., name, insurance coverage)
  • Note: If a patient does not wish to be transferred to the PSC, give them the PSC phone number (1-866-211-6588) and instruct them to call the PSC before the appointment date.

Appointment Reminders

• Remind patients of upcoming appointments at least 3 days in advance – via phone call, TeleVox automated reminders/updates, or Patient Gateway – to minimize no-shows and late arrivals.