Pediatric Coding Alert

Presented by Victoria Jackson

The following supplement to Pediatric Coding Alert is the transcript of a teleconference presented by The Coding Institute. To obtain the slides for the conference, please log on to our Online Subscription System at http://codinginstitute.com/login and download the current issue, and the slides will be contained therein. If you're not sure how to use the Online Subscription System or need help downloading the issue, please contact our customer service department at 1-800-508-2582 or service@medville.com, and one of our representatives will be able to assist you.

The speaker for the teleconference, Victoria Jackson has 25 years of experience in medical administration and is currently the administrator/CEO of Southern Orange County Pediatric Assoc. She is also owner and executive director of OMNI Management Inc., a medical practice management and billing company, and a board member of the Primary Care Assembly of the Medical Group Management Association. Ms. Jackson also serves on The Coding Institute's Editorial Advisory Board and is a nationally respected coding and billing consultant.

Good Morning, Mandy and good morning to all of you.  I hope all of you are bright eyed and bushy-tailed, it is 8 o'clock here in sunny California, except this morning, it is raining.  We have had our share of rain this year and quite honestly, I am tired of it and am ready for the sunshine. I would like to give you just a bit about my background.  I am a Pediatric Administrator and CEO of a five-site general pediatric practice. I also own and am an Executive Director of a practice management company.  We do management and billing for other types of specialties and other practices and I have been working with The Coding Institute for a number of years and find these conferences invaluable for our staff.

So, let us begin today with telephone management, telephone etiquette and telephone contact is the common form of the first time communication between you and your office patients and it is invaluable for not only making that first impression, but retaining patients.  The importance of good telephone manners cannot ever be overemphasized.  It is something that we all have to remember.  Most customers are turned away because of bothersome telephone habits that can be easily corrected.  Are you or your company guilty of some of these annoyances?  I did some research and found some statistics on the internet that show that the following are things that bother people the most, when dealing with people on the phone:  Long automated phone menus, which we will talk about a little bit.  If you have an automated attendant, I think it is wonderful.  Personally, we do and especially in the mornings I want to make sure that the phones are answered, but if you have an automated attendant on your phones in a doctor's office, make sure that you do not have too many menus.  More than four especially in a medical practice is too many.  42% of the people said that if they get to fourth one, most of this time they just press 0.  Do not have too many layers.  So if you have, as I have, you have called a company and you press 1 to press another number to press another number and ultimately end up with somebody's voicemail, which is extremely frustrating.  So make sure that if you are going to have an automated attendant that you do not have many choices. 

The next thing that 25% people did not like was not having an answer on the second or the third ring.  Most telephone companies in The United States have ringers that ring every six seconds and we are going to do a little bit of a study here for just a second.  I am going to have silence for 12 seconds beginning right now.  That is the end of 12 seconds, which would have been two rings.  It is a long time for somebody on the other end of the phone, and they cannot see obviously what is happening in your office. They do not know if you are sitting or talking with an employee, if someone is there, if you are out to coffee. If they have been in your office and they know that the office is busy, and they can expect that, but if they have been in your office and the phones have not been too busy and the staff has been talking or there is no one present to answer the phone, that makes it even more difficult. 

The last thing that annoys people are toll free numbers that are constantly busy.  You may have a billing company or you may yourself have a toll free number that people can dial into.  If you are going to have that toll free number and you are going to go to that expense for that toll free number, make sure that it is not constantly busy.  You may want to have two or three lines coming in and you can do that with one toll free number.  In the medical field, unlike any other, it is so important that we retain our patients to provide an ongoing source of revenue for the practice.  For without the patients, the practice would not survive and we would all be out looking for another type of work.  The medical field is unique, I think we all do it because we love it.  But if we do not have patients, we do not have a practice and we do not have a job.

Enjoying my work, and certainly wanting to provide excellent patient service, therefore prompts me to make sure that the office staff understand how important not only the face-to-face contact, the first impression that they have when they see somebody in the office and service is, but also that the telephone service that we provide on a constant and consistent basis each and every day is just as positive.  Meeting and greeting patients face-to-face in the offices allows the staff members to interact with the patients with smiles, body language - that can be positive.  But on the telephone, it is just as important that these same smiles and positive body language be communicated to the patient that is on the phone.  Why this is important and how it can be accomplished, we will be covering this morning.  You should all have the presentation hopefully, the handouts, and we are going to follow them and go through the pages.  Feel free to jot down any questions as we go through them and we will handle any and all questions at the end of the conference.  So, again thank you for joining us and let us get started.

The objectives for the conference, basically I have a couple, make the first impression of the office a good one, how to develop effective telephone skills, understanding verbal body language, sharpening listening skills, dealing with difficult callers and how to end calls.  Okay, so we are going to talk about that, and finally, that ending call seems like that you could or should be just able to hang up the phone, but listen to what I say as we talk and we will cover that. So how many times have you yourself called an office or a business to have the phone ring several times before it is picked up?  A telephone rings as I said once every 6 seconds; it does not sound like a lot but when you are on the other end of that ring, it seems forever.  So, remember the extra size of that 12 seconds if it is 30 seconds or 5 rings or 6 rings.  So we have the rule here in the office that we try to pick up our phone calls by our second or the third ring, that is really important.  You also want to have enough staff, so that the person picking up the phone does not seem frazzled.  How many times that have you called the physician's office to say or hear, 'Doctor's office, would you hold?' without ever even giving you an opportunity to say yes or no.  Obviously for calling the physician's office, we should not be calling a physician's office with dire emergencies, we should be calling 911.  But a lot of people have what they consider an emergency call that it is not an emergency enough for them to call the paramedics or the fire department, but certainly an emergency in their mind that they want to speak with someone, and they want the call answered.  So you have to listen. How many times when you call or the telephone is picked up and they do not even say hello, because as they have picked up the telephone, someone has walked-in and they are talking to them without saying, hello to you, and then they say hello on the telephone. So that first impression both in the office and on the telephone is important. 

In the office, they are going to make eye contact hopefully with them, but on the telephone they cannot make that eye contact and they do not know what is going on.  I have often said to my staff, as telephone calls get answered, you can look up and make contact the person, you can even put up a finger as in, just a second I will be with you. You can make that face-to-face contact - they know that you are on the telephone. They can see that you are busy. The person on the telephone cannot see this. They do not know what you are doing.  So if you want those people to come back, just as important with the first contact, the smile, the first impression, the greeting, remembering the contact, calling them by name -  it is just as important that that first phone call be answered. Because the first impression that we create with our patients and their families is the most lasting and can be the most difficult one to change, it is critical that this first impression on the telephone is a very positive one. So to make this possible, you need to make sure that your environment is organized.  If you have organization within your desk, you will find that it is easier for you to work, and if you are organized, then you are going to have good body skills. So work environment, your own workspace, your station, your cubicle, your desk wherever you want to be, this is where it all happens. So you should have it set up so that it is both functional and comfortable. Look around and see that you have also tools that you will be using close at hand.  You may need files for resources if you are going to be answering questions, they should be organized and certainly up-to-date.  It will allow you to respond quicker to the questions that you may be asked. Make sure that your chair, your computer screen, your keyboard are placed so that you are able to sit comfortably and with good posture. Sitting with correct ergonomics that we all hear about, will give you greater comfort and help you avoid the various aches and pains that can result from poor body positioning.  If you think about it, when you are slumped down in the chair and you are relaxed, you might be a little complacent on the telephone; if you are sitting up straight and you feel good about yourself and you have a smile on your face, it comes across on the phone.  So the work environment is extremely important.  You physically, be physically ready to properly handle a call. You should always finish your conversations with coworkers before placing or answering a call.  Remove or finish work that you have in progress from your fields of vision, so it does not distract you. Make sure when answering that you are not chewing gum, eating or drinking.  If your attention is drawn to something else on your desk or around you, you will listen less effectively and the patient or the family member will sense that you are not giving them your full attention.  It is very important that that happen.  We have covered your workstation and physical - now you mentally.  Successful analysts develop a ritual to put them in the right mindset: they sit up straight and they take a deep breath.  Think about a yoga instructor who takes a deep cleansing breath before she starts, just to relax herself.  This deep breath clears your mind of the previous call, and other external distractions. And you, like me, are like yeah right, I have time to take a deep breath to relax - I am in a pediatric office, or a high stress office and I am going to stop and take a deep breath before I answer the telephone.  But you have to do it.  It allows you to focus then on that task, that phone call.  The deep breath is also calming, when we relax physically we relax mentally as well.  Before the call, remember to smile, because the caller on the other end can actually here that smile, it sounds funny, but if you are frowning or you are distracted or you are thinking about something else, you are not again giving the impression to the person on the other end that you are really listening to them.  If it is necessary, put a mirror in front of you, a little mirror just to look at, see that smile.  Again, that smile comes through, it is very important.

Information.  It is important to have any information that you may need to facilitate a call at your fingertips and to fully understand all of the scripts, scenarios, information that you may have to give out to the patients and families.  Also know your limits as a receptionist or a phone nurse or a back office assistant.  Know your limit as to the information that you can give to the patient or the families, especially with HIPAA.  If necessary, rehearse some of the scenarios with other employees to make sure you feel comfortable with things that happen in the normal day.  Often we will go over scenarios and how they sound, just to us, and rehearse them.  These four things will help you prepare to start your day, so that you will be able to do those telephone calls with ease.

Effective telephone skills, answering calls, how to put a patient on hold, when to screen the call, when to transfer the call and ending calls and again ending calls is hanging up, but really is not.

Answering calls: again always pick up the phone in no more than three rings.  Remember the 60 seconds, 30 seconds is 6 rings, a long time.  Always identify your company office and give your name.  Some of us have very long names, Southern Orange County Pediatrics Associates sounds like a lot. We do not say that most of the time, pediatrics and your name.  'Pediatrics, this is Vicky, may I help you?  What can I do to assist you?'  So you have to be comfortable with what you are saying.  And the most important thing is to decide how and what you are going to say and make it short enough so that you are not slurring and they are hearing the adequate information.  Always be polite without going overboard.  I do not want to get somebody on the telephone who is going to be sugary sweet.  I want to have things handled, I want to go to the task at hand.  Always be polite, speak clearly and never mumble - that is so important. My husband talks sometimes as he is facing the wall and he is talking to me, and I will go, 'what did you say?' and he will say it again and I think men purposely mumble.  But I know that you have had that person on the other end of the phone say something that you cannot hear them, so make sure that you speak slow enough and clear enough especially in a family practice office or in an internist's office where you may have senior citizens, that is ever important.  Ask how you may help or what you can do for the caller.  If you have to put them on hold, never put a person on hold without their permission.  They have to give you that permission or acknowledgment.  If they do not wish to be placed on hold, offer to take a number and call them or have someone else call them back. 

Now that sounds great, does not it.  It is not always realistic at 8:30 in the morning especially in a pediatrics office, but it is very important that you do that, and it is very important that you do this as quick as possible.  If you have to put a person on hold, give them a realistic time when you put them on hold.  As in, 'Pediatrics, this is Vicky, good morning may I help you? or 'Pediatrics, this is Vicky, I am going to put you on hold for just a moment, I have two calls ahead of you.'  Let them know realistically, 'I will be with you in about 30 seconds.'  If it is going to be a longer time than 1-3 minutes, you may want again to call them and take a number.  If possible, tell the person why you are placing them on hold, do not give excuses, be realistic and be professional.  If the call is on hold for a long time, try to go back and acknowledge to the caller that you are aware that they are still there and that you know that they are there.  You may have to put someone else on hold to do that but if you find that it is going to be a really long time, pick up, excuse yourself from the person that you are speaking with, go back and say something like, 'Mrs. Smith I remember you are there, thank you so much for your understanding and I will be right back with you.'  So if that call is on hold for a long time, try to go back. Ideally again, a call back would be good.  Thank them for being on hold once you take the call.  So, when you pick up that call, 'thank you so much for holding, I really appreciate it or I understand that you are on hold,' however you want to do it, but thanking them is important.  If you are answering calls with another staff room member, there are two of you or three of you in the front, know what calls you have placed on hold and why.  Nothing is more frustrating than calling an office, being put on hold, having that call picked up and say 'have you been helped yet?'  'Well I think so but I am not sure.'  'Okay, well I will put you back on hold.'  So you have to communicate with your fellow employees, if you want to assign specific lines that you are going to take care of, especially at the high peak times. Telephone companies can do studies for you, they can give you an idea of what your high peak times are, and you may want to allocate more staff at that time.  Sometimes my doctors answer the phones, when we are busy, first thing in the morning if they are in the office.  So work together with your fellow staff members, utilize specific lines and try not to pick up a call and not know who the caller is.

When to screen calls.  Screening calls is not really good for public relations.  PR does not say that we want to screen calls because they kind of give the impression to the patient that we really do not want to talk to them or maybe the doctor does not want to talk to them, but if you have to screen calls for your providers, then the following guidelines may help:  As above, in answering always identify yourself, because this will encourage the callers to try to identify themselves and eliminate some of the screening process.  If it is necessary to find out the name of the caller, avoid 'who is calling?' and replace it with 'May I tell the doctor who it is?' or 'may I tell Dr. Smith who called?'  If possible, give a report before asking for the identity of the person, so it does not seem that the doctor or the person that they are calling does not want to talk to that person, that particular individual.  So something like, 'Dr. Smith is in a room of the patient.  This is John, I will be happy to take a message and have him call you as soon as he is free.'

Again, try to give a time period, 'free' could mean 12 o'clock and it is only 9 o'clock in the morning.  You may have a callback time that your physicians or your nurses or your back office people or your lab people have, be sure to communicate that.  When is it necessary to transfer?  Sometimes it is necessary to transfer a caller and you can do that right away.  Always explain why you need to transfer the person, do not just transfer them, do not just listen and go hold a second and transfer.  Tell the person that you are going to transfer them.  The same with putting them on hold, get the caller's permission to do it.  If you know that the person that you are transferring them to is not necessarily going to be there and they might be going to voicemail, make sure it is okay to do that.  Nothing is more frustrating than to transfer a person to another person only to get a voicemail, have that person come back to you and say, 'I did not get a live person.'  So a scenario might be, 'our phone nurse is taking calls right now, I am going to transfer you.  She may not be able to pick up the call, would it be okay to go into the voicemail?' or 'may I take a message for her and have her call you back?'  Again get the person's permission. If possible, make sure that somebody can accept that call, if you are going to transfer it.  If you have that kind of a phone system where you can stay on the line until that person has actually picked up, and if possible if you do not have that, if you are going to transfer them, maybe you have the kind of phone system that you can transfer them, get the person that you are transferring them to, tell them why you are transferring them and then go ahead and put the call through.  It gives the information to the person so that they may not have to go through the whole process again.  That redundancy in a medical office is very frustrating.  It is the same thing as handling a patient, giving that information to the medical assistant, having the physician walk in and go over the whole thing again.  It is nice to be able to have the person that is ultimately going to handle the call not have to repeat themselves 3 or 4 times, so that is very important. 

Ending calls, always repeat anything you agreed upon step by step to the caller, example, name and number, problem, ask if there is anything else that you might do for the caller, thank the caller, be good natured. Sometimes that is hard to do.  Let the caller hang up first, and the reason that I say that is because, this is what I am talking about ending calls.  If you have gone over everything, and you have listened very carefully and you have asked them that if there is anything else that they need and they hang up first, that is wonderful.  You may have, without thinking, slammed the phone down in the patient's ear before they hang it up, and it could be loud because you are in a hurry.  So if you let that person hang up first, they are not going to hear that phone slammed down.  And as soon as you have completed the call, if you cannot do it while on the call, record any information that you might need regarding that call immediately.  Have a log sitting by you, so that you can take the information.  Verify the information with the caller when they are on the phone;  'So, Ms. Jones, I understand the problem (whatever the problem might be), and I am going to leave a call for the phone nurse, she can reach you at this number, you are going to be home between 10 and 12, I will try to have her call you back.  Is there anything else I can do for you?  Thank you so much and I will make sure that that happens.'  So you have acted immediately.  Now when you hang up the telephone, make sure that you do it, make sure that you have that adequate information. 

Okay, moving onto verbal body language: communication challenges, voice tone, pleasant attitude, emotional reflection, and verbal body language.  There are challenges to communicating by phone that do not exist within the forms of other communication.  Body language is conveyed through the tone of voice and nonverbal actions. On the phone it is all verbal.  I am sitting here at my desk this morning, having my coffee and my hands are moving because I am Italian and that is how I talk, you cannot see that.  You also cannot see that I have a smile or a frown on my face.  I am not happy because it is raining outside and I am trying not to let that reflect.  I know that I have a busy day ahead of me, but I am trying to concentrate on the task that is at hand, which is conveying to you the message that I want to get across.  The importance of conveying a pleasant person by developing a telephone voice is difficult, but you need to accomplish it with each and every call that you do.  As a person answering the call, you need to check any emotional baggage at the door of the office when you enter each day.  I often tell my staff when you lock the door, you leave the office here, and when you lock the door at home, you leave home there so that you do not bring those nuisances or those distractions with you to work, and I do not want my staff to take the distractions from work home. They need to be separated. So, again you need to let the caller hear your smile.  If I am talking like this and I am thinking about something else and you do not know that I am looking across the room, let me think, I am think about - 'Oh! I am sorry Mrs. Smith.'  There is a distraction there that they can hear you there.  So this is very true an attitude can be felt or heard in your voice, and for any calls to be handled properly, it is important that as you answer the phone during the day, you remember to have an attitude that is pleasant, not one that is an 'attitude.'  That is, one that you would want to hear yourself if you were the caller.  I know we have all had calls where there is a person on the other end of the phone who is having a really bad day.  'Hi! Can I help you?'  And you know that it is going to go downhill from there.  So smile, avoid using slangs such as 'uh-uh' or 'nope' or 'yeah'; no eating no gum chewing, no slamming of the phone, that is very important.  Emotional reflection, try to put yourself in the caller's position.  They are calling because there is a problem and they expect understanding from us, and you have to acknowledge the understanding with empathy.  I understand that you are having a problem.  I can hear that you are frustrated and I am really sorry.  Agree as often as you can and do not interrupt the patient.  I know it is busy, we are in hurry, but try to let them finish their statements, so that you understand completely what it is.
 
Sharpening listening skills, and this is a tough one, what to listen, how to listen, why to listen and how you provide customer service.  'What to listen' sort of follows the emotional reflection and explains listening.  It is easy to assume that you know what a patient or a caller will say because you probably have 4 or 5 types of phone calls that you are going to get all day.  In your mind, you want to jump ahead of them.  However, the person making the phone call, that is the first time that they have done it, and their phone call is the most important need that they feel right there, and they may need to feel that they are being listened to.  Good service starts with listening quietly and carefully until the patient is finished.  Sometimes, it is really difficult to do that, because the office is busy or you may have other calls to attend to, but you have to listen and say something like, 'Mrs. Smith I can hear that you have something very important, and I want to give you my undivided attention.  However, I have another line on hold so can I call you back?  Do you mind if I put you on hold?  Can I have someone else help you?'  Especially, if you feel there is a frustration, we all get calls, the patients are frustrated, they do not understand, they do not understand because they have insurance, why are they even getting the bill.  Insurance companies are not likely to be very friendly with them.  That is a really stressful time in most offices and that is the time that you have especially need to listen.  In the pediatrics' office you have six children and you have anxious parents and you have had parents that have been up all night, and the last thing that they want to hear is no understanding.  So learn to listen.  Listen carefully and completely, so that you get the correct information.  If you cut them off in the middle, they are going to get very frustrated.  They are going to have to start again and it is going to be very difficult for you to handle that caller, that problem. 

Why do we listen?  We listen to get complete facts, so that you can best handle the call.  If you do not get all the facts, you do not know who it is going to.  You do not know whether you can handle it, whether you have to take a message, whether you need to transfer it, who you need to transfer it to?  So again listening completely and letting the patient finish, and sometimes you may have to interrupt this, try to do it carefully and with understanding. 

Calls to a medical office often or business for the providers, if not handled properly will make the patient go elsewhere.  They will go some place else where someone is going to listen to them.  Retention of patients is vital to our practices and providing good costumer service is the first step in reassuring the patient that each and every member of the office team has the best interest about the patient in their mind, it is very important for that to happen.  If we have a receptionist who is new or a phone nurse who is new, and they do not give that impression, they do not make that patient feel as special as they possibly could, that they are the only thing that they are thinking about at that moment, then that patient is going to go some place else.  Not only they are going to do that, they are probably going to complain to their friends, to their family and to other people.  And again that unsatisfied patient tells 10 people, and 10 people tell 10 more people, and pretty soon it hurts the practice.  On the other hand if you have a receptionist who always listens, she is always very friendly on the phone, and that first impression, that first phone call is the most important, then they are going to be comfortable making the phone call, they know that they are going to be listened to, and they know that they are going to be made to feel important, even if what they are calling about is not as important to you as it is to them.  They are going to feel that importance.

The next thing is dealing with difficult callers.  This is a tough one.  We have all had experience handling complaints, defusing difficult situations and trying to keep the customers happy.  You are all trying to do it in the time constraints that you are given.  You are probably sitting in the front office or your receptionists are sitting in the front office.  The patients are coming and going.  They are checking in patients, they are pulling charts, if you have a chart system.  They are looking on the computer, they are asking for co-pays.  We expect a lot of the people that answer a phone, and in my office, it is the second most important job.  The first one is medical records - seems somewhat of a contradiction that the medical record person would be the most important person in your office, but they are if you have paper charts, because if you do not have the charts, you cannot see patients.  You can see them but you do not have good history.  We are lucky enough in our office having an electronic medical record system.  So things are handled a little bit differently.  All of our phone messages are put on the computer.  We do not do it by hand.  We do not have to pull a chart.  We do not have to give a written note to the phone nurse.  We do not have to give a written note to the doctor.  We simply put it in the computer and it is transferred along with the patient's chart directly to the person if we have a call back, which makes it a little bit easier for us.  But how do you handle those complaints?  This is a tough one because you have to listen very carefully to what it is that they are saying.  You have to show sincere interest and you have to be empathetic again.  I understand, I sense your frustration, I will really try to help you, let me see what I can do to assist you.  The main thing is never ever argue with the patients, at our office we would never do that.  You have to be wrong.  So you have to remain calm but never argue and never blame co-workers. Susie should not have done that I am really sorry, never say something like that, because it is very divisive for the office.  Explain clearly what it is you are going to do and give the sense that you are anxious to help them solve the problem or correct any mistake that might have happened.  However in doing that, never make unrealistic promises.  Apologize if you cannot and say I am sorry to a customer. ' I am sorry, I am sorry, I am sorry' is better than 'we are sorry,' because it could sound more personal.  Might not have been your problem, might have been another person, might be somebody that is having a bad day.  But you are not going to apologize for someone else.  I am sorry that that happened.  Act fast, acting quickly shows that you are sorry and that you are going to handle the issue. 

Now, that being said how you are going to do that?  It is okay to say, 'Mrs. Smith, I do not know exactly what happened, but I am going to follow up on this, and I am going to get back to you.  I am going to try to do it very quickly, it might take me a few minutes but I will call you back. '  And again, reiterate the number, make sure that they are going to be there, and if you find that you cannot solve the problem, then you are the one that needs to call Mrs. Smith back, you call her back and say, I am really sorry, I have to pass this call onto Samantha.  She is in a different department, I have explained to her the whole situation, and she will be calling you back within an hour.  Now if something happens and Samantha does not call you back, please feel free to call me back and I will check and see what is going on.  You handled the problem, you seemed interested.  It is okay to say, 'I cannot handle it, I do not know,' but you have done that.  Difficult situations result if that does not happen, and how do you defuse those difficult situations?  That is a tough one and again you have to know what is a difficult situation.  So it could be just a patient is difficult or a family member, it can be stress in the office, it can be stress with that person, maybe there is someone in the family that is really ill.  Again, listening to that is really important, because you are not going to know what is going to happen, if that does not, so the difficult situations are the ones that you may have the most difficult time with.  You may have to pass that call onto somebody else.  If you have a parent or a patient on the other end of the line who said that you do not understand and you are not listening to me, they are raising their voice, it is okay to say, 'you know I can feel that I am not helping you.  I am going to pass the call onto my supervisor or to the manager or to someone else in the office.'  Tell them who it is, make sure that before you pass that call on, you have talked with the other person.  If there is a difficult situation that you cannot handle and there are a lot of things that contribute to that: time, maybe they did not get a call back the last time, maybe there is a misconception about what it is that they expected, unrealistic expectations from them, you did not communicate as the person that answered the phone, what you were going to do, you did not follow up, and so they are having to call back in a second or a third time.  You did not include the patients in what it is that you told them. 

So exclusion versus inclusion is very, very important in defusing those difficult situations, again expectations, flexibility is another thing that helps to defuse a difficult situation.  You cannot be so narrow-minded as to not be flexible and try to look outside the box as to how to handle the call.  Try to be creative with what it is that you are going to do, again, role playing sometimes in offices will help to do that, because people handle calls very differently, but most important is keeping the patient aware of what is happening, keeping them up-to-date with what is happening and making sure that you are going to be the one who follows up to make sure that everything was handled appropriately.  Do not turn it over to somebody else and assume that it is handled.  Check on it because that is important.

Above all, we want to keep our costumers happy and that is really important.  The last thing that we are going to talk about and we have about seven or eight minutes, is ending calls.  I said that ending calls were something that we do not think about, you just handled the call, you have talked with them. You have done everything that he needed to do, but it is really important that you spend as much time and effort in ending the call as you do in answering the call.  So, you have to have some type of a script for yourself in your mind with each and every call that you take, making sure that you have covered everything, there is nothing left unattended, is there anything else that you want to say, saying good bye to them, giving them an opportunity to express anything that they have to say.  You may even have something that you can offer to them: 'The next time that you call with this problem, you may find it helpful to know that Susie handles these calls and her extension is xyz.'  Or 'you know Mrs. Smith this is a call that really could have waited until our phones weren't quite busy.  Our phones are really busy from 8:30 to 9:00 every morning and you may find it helpful to know that non-emergent calls could be handled better after 11:00 with a concern like this. Our phone nurses answer calls and will get back to you.'  Give them some information about the office if you have the time to do it, so that the next time that they have a call, that is a non-emergent caller and not an appointment call, they will not call right at 8:30.  They will not get frustrated with you.  Late in the afternoon, after the kids come home from school, if you are in a pediatric office or a family practice office, 4 o'clock tends to start another busy time, why, because everybody wants their children and themselves to feel better before the day ends. Fridays typically, Thursdays before a holiday weekend.  So, anything else that you can help them with along the way will give them information for that next call that they make.  So they are going to have a very favorable impression of the office. They know that the call was handled.  They know that they can expect that same type of behavior the next time.  You have kept your promise to them.  Remember those promises are very important.  If you say that you are going to do something, make sure that you do it.  If you do not follow-up or you do not call the patient to make sure that everything was adequately handled, then the promise was not kept and they are going to remember that the next time they call. Hanging up, try to let them hang up first again, because you may inadvertently slam the phone down on their ear and they hear that.

So, success is something on the telephone that is really hard to know whether or not you have had it. You can hear the inflection in their voice on the person on the other end of the line just as they can hear yours, and if you sense that there is a question in their mind and or maybe an apprehension or they say 'I guess that solves it.' Do not let that caller hang up at that point.  See if you can better satisfy what it is that they have to say.  You may have to ask a couple more questions and then they take a little bit more time.  But just as if they were having a bad day, you should be able to sense if that caller felt satisfied, did they get their questions answered, was everything handled properly? 

Again we go back to the things that I said at the very beginning of the conference.  Statistics show that the three top things that the people don't like are no answer by the second or the third ring, so it is important again to make sure, that you know when your peak times are and that those calls are answered.  The patients do not like being put on hold.  The patients do not like long automated attendants and it is not necessarily the automated attendants that they do not like, it is the long cumbersome menus that they may have to go through to get to that point.  You should always have an option within the first four menus to press zero and get to a live person.  If it is your medical office and it is a physician calling from an outside office or another office calling, you should have an opportunity for them to get through first, and you should have an emergency line, if you have an automated attendant, so that it rings differently.  Now do people take advantage of that? Certainly.  Patients know sometimes that if they press 5 on the automatic attendant, because they have been in the office and they hear that ring, and that call is handled differently.  Take the call the first time it happens if it is not a true emergency, handle the call, but let them know that they came in on an emergency line and next time they might find it helpful too, give them some indication that what it is that they need to do.  You are not being impolite certainly by telling them that:  'We try to keep that line open for true emergencies.'  So, that is okay.

So, success is a lot of things.  Success is answering the calls on the first, second or third ring, no longer than the third ring. The third ring is 18 seconds, that is a long time.

Success is communication, listening.  Success is verbal body language that is positive.  Again if you hear that tone in the voice of that person who is really having a bad day or they sigh when they answer the phone, 'hi this is the doctor's office, what can I do to help you?'  That is not going to be what you want to hear.  If you hear the person on the other end of the phone and they are sighing, it is okay to acknowledge it.  'I can really hear that you are having a bad day, what can I do to help you?'  Keeping promises.  Transferring calls and putting patients on hold, get their permission.  It almost sounds like a stupid thing to say, but you have to do that.  You want their permission to put them on hold. You want their permission to transfer them, because you are asking to put them some place else. You are not going to handle it, so you want their permission.

Above all, with the new HIPAA regulations, make sure that when you are talking with somebody on the telephone, if it is not the patient or if it is a patient or a parent, that you have some means with which to identify them so that you can give medical information if you are able to do that.  Know your boundaries, that is very important as I said in the beginning.  Keep your work environment, your workstation, note the boundaries that are in limits that you can handle calls with, because those things are important.

I think Mandy we are a little past 45 minutes, we can go ahead and open that for questions.

Thank you, Ms. Jackson.

Q & A Session:

Question:  I have some questions that were send in by attendees.  The first one asks, which do you think is more important, a live operator or the phone being answered quickly?

Answer:  If I had to rank it in order of importance, I probably would say a live person.  Realistically, not many of us can do that.  Smaller offices, surgical offices and dermatology offices, those offices that have fewer patients during an hour, they have maybe four patients in an hour, three patients in an hour, obviously are not as busy.  So if I had my preference, I would always have a live person, but again realistically we cannot do that in our office, because it is too busy.  And 'too busy' is a term that I also do not like, but we have automated attendant system.  Some of the times on some of our sites it is on, some of the times it is not, depending on the day and the office.  Again, with an automated attendant system, you do not want to go too many layers deep.  If you can utilize different telephone lines for different types of things in the office, you can also utilize different people.  I will give you an example of that.  We have centralized future scheduling, so that those calls do not come through our regular telephone lines in our office.   We have centralized phone nursing, and we have centralized billing so that alleviates those phone calls going through the medical offices and that helps, that gets the caller answered quicker.  If I had to rank it, a live person first, this probably is not as realistic across the country.  But if you are going to use an automated system of some kind, no more than four menus and that is it and being able to get to a live person if they want to choose that.

Question:  Okay, another question I have asks, we have a large number of elderly patients that really want to tell you all of their symptoms and hold up the line and no matter how graciously or tactfully you try to be, they are not deterred from doing it their way?

Answer):  What are you going to do with those people?  Those people are calling because they want to talk with somebody.  I compare senior citizens to new moms in both practices and we do family practice management.  It is tough, it is really tough with the new mom who has questions and nobody is home, and it is equally is tough with those senior citizens who think whatever symptoms they have at that time is going to cause them to either be in the hospital or die.  And that is hard, and that is a really hard situation.  If you can in your office have somebody allocated during the day - we are lucky enough to have phone nurses in your offices, if you can have somebody allocated to take those calls and to really try and talk with them.  The caveat to that is providing educational information for them.  The senior citizens are not as familiar with the Internet, but the young moms are, but you can have printed information for the senior citizens that you give out when they come in.  A lot of times, they just want companionship, they want to talk with someone.  They may be away from their families or they may not understand, understanding with senior citizens is very difficult.  It is very difficult for them to understand their condition and understand what it is that is going on, but ultimately you cannot spend all day on the phone with them either.  So graciously say, 'I understand that you have some concerns, I am going to have somebody call you back within the next 30 minutes that can really spend some time going over these things with you, so that you will have a clear understanding.'  Additionally, you may have to schedule an appointment for them.  'I understand that you really have concerns and I do not think we can address them on the phone, so I am going to schedule an appointment for you to come in and see the doctor.  What time would be convenient for you to do that?'  Or even have them come in and talk with one of the nurses, if you are lucky enough to have a nurse in the office that could spend some time with them.  A patient advocate is somebody that would really listen to them, most of the time that is all they want, it is just that they want to be listened to, they want somebody else to talk with them.  They want reassurance that everything is going to be okay, especially if they have just gone through with some type of an illness or an injury or whatever the case may be, so they want understanding.  Again, there are a couple of ways to handle it.

Question: How do you suggest to get a patient to get to the point quickly?

Answer:  Senior citizens, it is tough.  Again, I think that you have to listen to what it is that they are saying and I find that most people will probably tell you what they really want in the first couple of sentences, they want to continue to reiterate what it is they want, so you do not want to interrupt them and just say, 'stop, wait, do not talk anymore.'  But when you can and you can get a word in, you can say something like, 'okay Mrs. Smith I understand the concerns that you have today are (and maybe say them out), now is there anything else that is bothering you, and listen for a second and then say something like, 'I think this call is going to be best handled by my phone nurse, my doctor, whoever it is that you want to handle and I am going to have them call you because they are not available right now or I am going to transfer you to them, but I am going to put you on hold just a second, so that I can inform them why I am transferring you, so that you do not have to repeat all of the things we have just talked about.'  Again, you have to listen for that break, when they take a breath, and it is hard to do sometimes with seniors, it is really hard to do with the moms, because the moms are so anxious, especially those that do not have extended families around.  If you are on the phone enough, you kind of get a sense of when that break may come, but never assume what the patient is thinking.  I think that is the most important thing. We all handle the same kinds of calls all day, but you just cannot assume that this is going be what you think it is without listening, because they are going to go, 'no that is not what I meant,' so you have to be real careful with that

Question:  The final question I have here is what do you consider a reasonable amount of time to return a message?

Answer:  Reasonable by whose terms?  We deal with a lot of insurance companies and a lot of businesses where you have to call and ask questions whether it would be for credentialing or for insurance company information and eligibility, and nothing makes me more angry than to hear on the other end of the phone a voicemail that says we will call you back within 24 hours.  I do not want to be called back within 24 hours.  I want an answer today, and if I am calling at 4:00 o'clock in the afternoon I have actually called insurance companies at maybe 10 minutes to 4, they close at 4, they put you on hold and then the phones get cut off and they say that the company is now closed, please call back and that is a real bad one.  I think two hours is very reasonable.  Busier times of the year, it might be a little bit longer, but again realistic time, and we strive for two hours with all of our calls, even the doctors that have to return messages.  I have phone nurses, again as I said, so it is kind of easier for me to do that.  But because I have phone nurses that handle a good majority of the messages that come in for medical issues, that means that the doctors have less phone calls to do and they try to do them between patients if they can.  At the very most, the doctors call back at the end of the morning and at the end of the evening, so your receptionist or your phone person that is taking the messages has to have a good sense of what is going on in the office.  They have to know how busy it is and they have to be realistic when they tell the people when they are going to be called back.  We have centralized scheduling as I mentioned and people can leave voice mail.  We are just going to Internet scheduling, not necessarily where the patient can schedule an appointment, but they can put down a range of times or dates and we are going to be able to e-mail them back with an appointment time.  But I think two hours is enough.  In any other industry, it can be longer, in the medical industry, the people want the problem solved, especially if it is a medical issues and not a business one.  If they are calling about their statements, we try to get the calls back in the same day again.  I do not like the term 24 hours.  It just seems like it sounds so long.  So two hours in the medical part of the practice and maybe 4-6 hours in the business part of the practice, if you have to call back, but I think that is reasonable.

At this time, we have no further questions.  I would like to turn the program back to Ms. Jackson for any closing comments she may have.

Okay, thank you very much Mandy.  Again, if you have questions that you think about, you can fax them to Nicole or to the Coding Institute and I will be happy to answer questions.  In doing research for the presentation, I found a lot of good resources on the Internet, which I used a lot.  One of the things that I realized while doing this is that it is important to communicate with your staff what you expect from them.  Telephone answering sounds like a very simple thing and it can be a very simple thing, but you have to communicate what your expectation to your staff is.  Role-playing during office meetings is a really good way to show them how they sound.  As a manager, if you are a manager listening on the other end, picking up the phone and calling your office on the front line, not the back line to see how they answer, to see what type of tone they are setting.  Going to the office, if you have multiple sites and standing and listening to how the calls are handled.  Talking with patients yourself.  I have been known to go down and sit down at the phone at a receptionist's office and I have been with this practice for 26 years and so most of my front office staff has changed over the period of 26 years a number of times in some cases and it surprises me when I go down and say to one of my front office girls to take a break, I am going to answer the phone, and they kind of look at me like, my God, does she know how to answer the telephone?  I think it is ever so important that as a manager, that you involve yourself with the practice and the things that happen every day.  Not only the phone calls, but listening to how doctors sound.  It just is important for them to sound not hurried, so role-playing is a really good way to communicate effective skills, not only with telephones, but with how patients are greeted and what is said, but you cannot just stay in your office and listen.  You get the calls from the patient when they are unhappy and it is very frustrating for me to hear sometimes what the patient's interpretation of what was said is when I know that it may not have really been that, but you have to apologize for the behavior.  Never blaming a person, saying, I am sorry if that happened, not we are sorry that that happened.  You never say, she should not have done that or they should not have done that.  Just, I am sorry that that happened and I will look into it, but involving yourself in the practice I think is very important.  If you are in a small office, it is easy to do.  If you are in a larger practice of multiple sites it is more difficult to do, but you have to remember just as the receptionist you are going to get calls from people outside the practice and you have to put that big smile on your face.  You can be distracted and Lord knows that we are all just distracted.  It is more difficult in today's environment to run a medical practice and maintain any kind of profit and to retain patients, because there is competition all over.  So, as important as it is to smile when the patient walks through that door and acknowledging them, good telephone management skills are equally important.  Putting a smile on the face, put a mirror at your receptionist's desk, but double check, don't hover over them.  I am not a micro-manager, I do not mean to sound that way but you have to listen as well and being able to have stand-up meetings with your staff once a day, go over the schedule, see who it is who is coming in, see what problems that might have arisen from the day before, talk about the telephone calls that are a burden or bothersome and find creative ways to solve them because that is ever so important also.  If you have one type of phone call that bothers everybody, then see if you can come up with a solution to fix it. 
Again those peak times 8:30, 9:00 o'clock when you first go to service, make sure that you have enough staff up front to handle the calls and if you are going to put a call on hold, you be the one to pick it up or be sure that the person who is picking that up knows who it is.  Personalization and a smile on your face is probably the most important think for success with telephone management.  So, that being said, thank you all very much for attending today, and if there are no other questions, I guess we are finished.

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