Learning Objectives

Learning Objectives • Define, spell & pronounce the terms listed in vocabulary. • Identify & explain the features of a multiple-line telephone system, & also explain how each can be used effectively in a healthcare facility • Do the following related to effective use of the telephone: • Discuss the telephone equipment needed by a healthcare facility. • Summarize active listening skills • Demonstrate effective & professional telephone techniques • Consider the importance of tone of voice & enunciation • Explain the importance of thinking ahead when managing telephone calls; also, describe the correct way to answer the telephone in the office. • Discuss the screening of incoming calls, & list several questions to ask when handling an emergency call • Do the following related to taking a message: • Document telephone messages accurately • List the seven elements of a correctly handled telephone message • Report relevant information concisely & accurately • Discuss various types of common incoming calls & how to deal with each. • Discuss how the medical assistant should handle various types of difficult calls • Discuss typical outgoing calls, including why knowledge of time zones & long distance calling is necessary • Discuss the use of a telephone directory, & describe how answering services & automatic call routing systems are used in a healthcare facility. • Discuss the legal & ethical issues related to telephone techniques.

Telephone Techniques Page 113 - 130

Page 114 Telephone Equipment Multiple-Line Telephone • Familiarity with multiple-line telephone systems is a must. • These telephones have a button for each line, & the buttons flash when a call comes in on the line. The button will also flash, in a different rhythm, when a caller is on hold on the line; this can serve as a reminder for you to check back with the caller to see whether they would like to remain on hold or leave a message.

Page 114 Telephone Equipment: Cont. Headset • Most business telephones have a handset that can be used to answer the telephone. However, since you are most frequently responsible for answering the phone & may want to consider using a headset. • Use of a headset can improve your ergonomics & help prevent neck strain. Also, having a headset frees you hands to use the computer or take a message.

Pages 114 – 115 Telephone Equipment: Cont. Features • Most multiple-line business telephones have many features that allow you to perform a number of different tasks in the healthcare facility. Speakerphone • This function allows you to hear & speak to the caller without using the handset or a headset. • Always inform the caller that you will be putting them on speakerphone, & let the person know who else will be listening in. • Be careful when using a speakerphone because the sound can travel farther than you might think

Page 115 Telephone Equipment: Cont. Conference Calls • Many multiple-line telephones allow you to set up a conference call, in which you can have multiple people on the call from different locations. • The person initiating the call calls one person, puts them on hold, & continues the sequence until all parties are on the call. • Conference calls can be used when the healthcare facility has more than one location & people from all locations must be involved in a conversation.

Page 115 Telephone Equipment: Cont. Caller ID • Caller ID allows the user to see who is calling before they pick up the handset to answer the telephone. The caller’s telephone number & name appear on a screen, & the user can decide whether to take the call. • If the user subscribes to call-waiting services, another benefit, called call-waiting caller ID, is often available. This function allows the user to see who is calling even when the user is already on the telephone.

Page 115 Telephone Equipment: Cont. Voice Mail • Voice mail is widely used in business offices because it affords an around-the-clock method for receiving messages. It allows the caller to hear a recorded message that may also provide information about what to do in case of an emergency. • It allows special temporary greetings when the user is away from the office. You can keep patients happy answering voice mail messages promptly. • It can be frustrating to those who find themselves speaking to an electronic device more often than a human being.

Page 115 Telephone Equipment: Cont. Call Forwarding • Call forwarding allows the user to forward calls to another designated number, such as an answering service. Usually a code is entered, then the telephone number to which the call should be forwarded. • If you are going to be busy with a patient, the calls can be forwarded to another employee until the task is completed. This prevents the user from missing important calls when away from the main telephone.

Page 116 Telephone Equipment: Cont. Intercom • This feature allows two-way communication, but it does not require you to pick up the handset or use a headset. • This type of communication is not confidential, but it can be used to notify staff members of an emergency or to ask the provider to come out of an exam room.

Page 116 Telephone Equipment: Cont. Call Hold • This is often used when you have answered an incoming call & then another line rings. • Interrupt the call you on by asking if you can place the person on hold for a moment; wait for an answer before pushing the hold button • Never answer with “Please hold.” • Always find out the nature of the call before placing the person on hold. If it is an emergency, handled the second call before you return to the first call.

Page 116 Telephone Equipment: Cont. • If it is not an emergency, ask if you can place the person on hold & wait for an answer before pushing the hold button. If the person refuses to be placed on hold, determine the reason why & assure them that you will return to their call quickly. • Use this function if you need to retrieve information or speak to someone else.

Page 116 Telephone Equipment: Cont. Speed Dialing • Speed dialing allows you to program keys on the telephone keypad to automatically call a stored telephone number by just pressing one key. • It can be a time-saver; however, all staff members must know which telephone numbers have been programed into particular keypad numbers.

Page 116 Telephone Equipment: Cont. Cell Phones • Personal cell phones can present issues particularly in regard to patient confidentially. • Pictures can be taken of confidential information, & that information can be transmitted quickly to someone else or put on the Internet. • Calls can be made or taken at inopportune times & may affect the care of patients. • Most healthcare facilities have a policy that prohibits employees from having their personal cell phones with them during working hours.

Page 116 Telephone Equipment Needs of a Healthcare Facility Number & Placement of Telephones • Telephones should be placed where they are accessible but private. Each provider, in addition to the office manager, requires a telephone at their desk. A telephone should be available in the laboratory area & the clinical area, & multiple phones should be present in reception & business office areas. Many healthcare facilities also have a telephone available for patients to use. This telephone often has a separate line so that patients use does not interfere with the staff members’ work.

Pages 116 – 117 Effective Use of the Telephone Active Listening • When you are on the telephone, you have fewer nonverbal cues to help you determine the message; therefore, it is very important that you use good listening skills. • When you use active listening skills, your patients realize that you think they are important & that you respect the message they are communicating to you, whether you are on the telephone or face-to-face.

Page 116 Active Listening • Be present in the moment • Focus solely on the conversation • Don’t interrupt • Don’t start forming your response before the person has finished speaking • Confirm what the speaker has said, & ask if your interpretation is correct. • Always be respectful & professional.

Page 117 Effective Use of the Telephone: Cont. Developing a Pleasing Telephone Personality • Each time you answers the telephone, you are representing the healthcare practice. • The manner in which the telephone is answered can influence the caller’s impression of the whole office & whether the person wants to be seen there. • When patients call the healthcare facility, they should hear a friendly yet professional voice. • A pleasing telephone personality facilitates the sending of the message.

Page 117 Effective Use of the Telephone: Cont. • Nonverbal communication occurs during a telephone conversation • Tone of voice – Be aware of your tone of voice. • smile when you answer the phone • Speed of Speech –speak at a moderate rate of speed • Pitch – vary the pitch of your voice & avoid speaking in a monotone. • Volume – Use a normal volume & tone of voice, & speak directly into the mouthpiece • Enunciation – speak very clearly & distinctly • Pausing or hesitation – give the caller your full attention

Page 117 Effective Use of the Telephone: Cont. • It is important to always be courteous & tactful. Think about the words you will be using before actually speaking them. For those of us working in a healthcare facility, it is easy to integrate medical terminology into our conversation. However, we must be careful not to use medical jargon when speaking with patients because this makes the message more difficult for them to understand.

Page 118 Managing Telephone Calls Thinking Ahead • Be prepared before you start: • Answering calls – have supplies for taking messages • a computer or a paper message form • working pens • a watch or clock to record the time • a list of commonly used telephone numbers. • For outgoing calls – have the information you need • patient’s health record • telephone number of the person you will be calling • a list of questions • a pad & a pen to make notes during the conversation

Page 118 Managing Telephone Calls: Cont. Confidentiality • All communication in a healthcare facility must maintain patient confidentiality. • When using the telephone, you must be aware of what is going on around you & who may be able to overhear your conversation.

Page 118 Managing Telephone Calls: Cont. Answering Promptly • Telephone contact is often the first interaction with a patient. If the person's call is not answered promptly, this creates a negative impression before they even talk to someone. It is important that a call be answer within three rings.

Page 119 Managing Telephone Calls: Cont. • If you routinely answer the telephone know how to activate emergency medical services (EMS). • You may need to make this call for a patient who has called the healthcare facility & is now unable to contact EMS on their own. • If your phone system allows it, you can set up a conference call that includes the patient, EMS, & yourself. • Get a telephone number where the caller can be reached if you get disconnected. • Keep the patient &/or caregivers on the line while contacting EMS.

Page 119 Managing Telephone Calls: Cont. Identifying the Facility • When answering incoming telephone calls, you should identify the facility first, state your name, & then follow with an offer of help. • “Good morning, Walden-Martin Family Medical Clinic. This is Ana. How may I help you?” • Always follow the policy of the healthcare facility when answering calls. Speaking slowly & smoothly, with good enunciation, ensures that your callers understand whom they have reached.

Page 119 Managing Telephone Calls: Cont. Identifying the Caller • If the caller does not offer a name, you should ask, “May I ask who is calling?” • It can be helpful to write down the caller’s name & try to use it at least three times during the conversation, if it does not compromise patient confidentiality. • This helps make a strong connection with the patient & assures the person that they have been identified correctly.

Page 119 Managing Telephone Calls: Cont. • Occasionally callers refuse to identify themselves to you & insist that they speak with the provider. • You must be clear, in a professional manner, that you can not connect the caller to the provider without knowing who the caller is. • The caller may be a sales representative who knows that if they identify themselves, they will not get the opportunity to talk with the provider.

Page 119 Managing Telephone Calls: Cont. • When it becomes clear that the caller will not give a name but still insists on speaking with the provider, you can tell the person that the provider is busy with patients & has asked that messages be taken; if the caller cannot leave a name for the message, then they may want to write a letter & mark it Personal. • Most people do not want to wait for the response to a letter & will then give you their names so that a message can be taken.

Pages 119 – 220 Managing Telephone Calls: Cont. Screening Incoming Calls • You will be expected to screen calls. To do this you must determine who the caller is & the nature of the call. This makes it so you can routed the calls correctly. Either: • to the billing office • to the triage area • directly to the provider

Page 220 Managing Telephone Calls: Cont. Screening Guidelines • In a facility with multiple employees, the provider may designate one individual, such as a nurse or an experienced & trained MA, as the telephone screener. • A special sheet of instructions listing specific medical emergencies (e.g., chest pain, heavy bleeding, fainting, seizure, & poisoning) should be posted by each telephone. The telephone numbers for the nearest poison control center, hospital, & ambulance should be listed.

Page 220 Managing Telephone Calls: Cont. • Emergency calls should be routed to a provider immediately. • Additional instructions should include what action to take if no provider is available (e.g., sending the patient to an emergency department or calling for an ambulance). • Most offices have some means of constant contact with the provider, whether by pager, cell phone, or another method.

Page 220 Managing Telephone Calls: Cont. Getting the Information the Provider Needs • As you gain experience you will begin to have a sense of the questions the provider will have for patients who call the facility. • One way to learn about questions to ask is to listen to the provider carefully as they question patients about their symptoms. • This can help you learn more about signs & symptoms & enables you to be a better assistant to the provider.

Page 220 Managing Telephone Calls: Cont. • If the provider is unavailable for part of the day, take a messages & inform callers that the provider currently is out of the office but will return calls when they return. It is important to give callers the time frame in which the provider will be returning calls so that patients’ time is not wasted waiting for a call. • If the caller is unavailable when the provider usually returns calls, ask what would be a convenient time & let the caller know you will try to work with that time frame.

Page 220 Managing Telephone Calls: Cont. Placing Callers on Hold • If the call needs to be transferred to someone else in the healthcare facility & that person is not immediately available you should ask if the caller would like to be put on hold, or if he or she would prefer to be called back. • If you know that the person with whom the caller needs to speak may be busy for quite a while, inform the caller of that. The caller may still want to wait.

Page 220 Managing Telephone Calls: Cont. • You should check back with callers on hold periodically to make sure they still want to remain on hold. No longer than 1 minute should pass before you check back. When you return to the call, you can use a statement such as, “Thank you for waiting. Would you like to continue to hold or should I take a message?” • Minimizing the wait for the caller shows concern, & freeing up the telephone lines is important for other people trying to contact the healthcare facility.

Page 220 Managing Telephone Calls: Cont. Transferring a Call • You may determine that a call should be transferred to the provider or to another person in the facility. • If you answer telephone calls you have to know who does what in the healthcare facility. An organization chart with telephone extensions can be helpful, but it must be kept up to date so that calls can be transferred successfully.

Pages 220 – 121 Managing Telephone Calls: Cont. Taking a Message • Telephone messages, whether handwritten or in electronic format, are important to patient care. • Information needed for a complete message: • name of the person calling • name of the person to whom the call is directed • caller’s daytime, evening, &/or cell number • reason for the call (phone number of the caller’s pharmacy if a medication is requested) • action to be taken • date & time of call & your initials

Page 122 Managing Telephone Calls: Cont. Messages Taken on Paper • Many types of message pads or books are available. • Many are pressure-sensitive, making a copy of the message & serving as a telephone call log. • The original is given to the person the message is for & you will have a copy to use for follow-up. • Having legible handwriting is a must when taking handwritten messages.

Page 122 Managing Telephone Calls: Cont. Messages Recorded Electronically • Most electronic health record (EHR) systems can record telephone messages. The EHR automatically saves a copy of the message to the patient’s health record, sends the message to the provider, who can either call the patient directly or give you directions to respond to the the patient. The electronic system may be able to flag a message, to indicate its urgency, that it requires a call back, or that a prescription refill is requested.

Page 122 Managing Telephone Calls: Cont. Taking Action on Telephone Messages • The message process is not complete until the necessary action has been taken. • If a handwritten system is used, use an identifying mark to indicate a message that requires action. • If an electronic system is used, check periodically during the day to be sure you do not have to complete the response to the message, such as calling the patient back or contacting the pharmacy.

Pages 122 – 123 Managing Telephone Calls: Cont. Retaining Records of Telephone Messages • If a handwritten system: • Message relates to patient care? A copy of the message should be added to the patient’s health record. If the health record is electronic, this may mean scanning in a copy of the paper message & attaching it to the EHR. • The copy in the message book usually is retained for the same period that the statute of limitations runs for medical professional liability cases.

Pages 122 – 123 Managing Telephone Calls: Cont. • Electronic system is used? • The message is automatically saved to the patient’s record, along with the response to the message. • These are key points if a medical professional liability case is brought against the provider. • Accurate telephone records can ensure quality patient care & customer service.

Page 123 Typical Incoming Calls • Handling incoming calls is often your responsibility as a medical assistant. • You can handle many calls directly, but some will require the assistance of others. • Knowing how to respond to the different types of calls will make you a valuable asset to the healthcare facility.

Page 123 Typical Incoming Calls: Cont. Requests for Directions • Each office should have a clear set of written directions that can be read to a caller who wants to know how to get to the office. • Prepare the directions from various points in the area. Place these directions close to the telephone so that all employees can find them. • Put a map on the office website & direct patients there for printable directions. • Never simply suggest that callers refer to an Internet map when they ask for directions.

Page 123 Typical Incoming Calls: Cont. Inquires About Bills • A patient may have questions about a statement that came in the mail. If you are responsible for billing, politely ask the patient to hold the line while you obtain the patient ledger. On returning to the line, thank the patient for waiting & explain the charges carefully. If an error has occurred, apologize & say that a corrected statement will be sent out at once. Always remember to thank the patient for calling. • If billing matters are handled by another employee, tell the patient that the call will be transferred to the billing office. • If the healthcare facility uses an external billing service, you may need to provide the caller with that agency’s telephone number.

Page 123 Typical Incoming Calls: Cont. Inquiries About Fees • A good estimate should be given to patients as to what they can expect to pay, especially on the first visit. Asking a patient to just appear at the office without having any idea of the cost is unreasonable. • Discuss with the provider or office manager what range should be quoted to the patient, & then follow your quote with the statement that the fees vary, depending on the patient’s condition & tests the provider orders.

Page 123 Typical Incoming Calls: Cont. • Most healthcare facilities require patients to pay the health insurance co-payment (or co-pay) on the day service is provided, & the caller should be informed of this. • If fees are regularly discussed on the telephone, a suggested script should be included in the polices & procedures manual. • Do not be evasive; have a list of fees available you can discuss with patients.

Page 123 Typical Incoming Calls: Cont. Questions About Participating Providers • Patients call the office to inquire whether the provider is a participating provider with their particular insurance plan. • A list of the insurance plans with which the provider has a contract should be readily available to you. • This is important because insurance benefits vary widely for patients based on whether they see a participating provider or a nonparticipating provider.

Page 123 Typical Incoming Calls: Cont. Requests for Assistance with Insurance • In the ever-changing world of health insurance, patients often are confused about their coverage, how payment is determined, & what they are actually financially responsible for when it comes to their bill from the healthcare facility. • A solid understanding of the basics of health insurance, including managed care, allows you to answer patient questions about insurance.

Pages 123 Typical Incoming Calls: Cont. Radiology & LaboratoryReports • Because of the increased use of EHRs, radiology & laboratory results often are available to providers as soon as the technician has completed the test. • When the patient calls for those results, a message is taken, & the provider decides whether the MA can relay the results or the provider needs to speak to the patient directly.

Learning Objectives