Same-day scheduling is a priority at Maury Regional Medical Center in Columbia, TN, but there are two big obstacles:

Incorrect orders. Physician offices must place an order (either by phone or fax) to schedule a procedure. Surprisingly often, a key piece of information is missing, according to Preservice Manager Jennifer Smith.

Orders need to include basic demographics: a diagnosis supporting the ordered test; evidence showing the test is medically necessary; the proper order of procedure per the radiologist protocol; and the physician’s name, signature, and date of the order. If any of that is missing, the patient is put on the schedule regardless. “We work on the back end to get a correct order prior to the patient arriving,” Smith says. Usually, staff are stuck leaving repeated voicemails to try to correct the problematic order. Even after multiple calls, it does not always work. “This results in a delay in the patient proceeding with their scheduled appointment,” Smith notes.

Patient access has made some changes to avoid this situation. First, the radiology department created a booklet to educate providers and prevent some common errors that hold up everything. “This helps providers order the appropriate test for the patient and the correct studies for with, or without, contrast,” Smith says.

Someone might order a screening mammogram, but the patient really needs a diagnostic mammogram. It also is common for physicians to order a CT of the head with contrast, but the radiologist strongly suggests ordering it without contrast. “Nurses have confessed to being confused on what is IV contrast and what is oral contrast,” Smith notes.

Patient access also met with physicians’ office staff to review recurring mistakes that interfered with scheduling. “We also help the physicians’ office navigate insurance websites to determine medical necessity,” Smith says.

This was causing problems with health plans denying the ordered test, such as an MRI of the left lower extremity for a diagnosis of headache. “We do a lot of education on medical necessity,” Smith shares. “The providers’ offices do not find the payor sites user-friendly.”

Missing authorizations. “Every authorization request requires supporting clinicals to get the request approved,” Smith says.

Usually, staff make multiple calls to the nursing staff to secure it, not always successfully. Many times, inability to make contact results in the need to reschedule the patient days later, pleasing no one. “Getting an approved precertification for the radiology test is dependent on if the prerequisites for the study were met and who the payor is,” Smith adds.

Recently, some payors denied authorization for MRI of the spine unless patients already had undergone an X-ray or several weeks of physical therapy. “This makes it difficult to get patients added on the same day for certain radiology studies,” Smith laments.

If patients cannot schedule the appointment at the hospital, most end up going to a freestanding radiology center instead. “We do everything within our power to get the patient scheduled same day,” Smith reports.

The scheduling team also reminds the ordering provider’s office to include the clinical notes with the order. It is important this happens at the time of scheduling to avoid hassles and hold-ups. “We promptly notify the physician office of any missing clinical notes that are needed to complete the request,” Smith says.

If a patient really wants a same-day appointment, the scheduling and precertification teams work to make it happen. Schedulers contact the precertification team member who handles “stat” requests to find out if an authorization is required for that specific study. If not, the patient is put on the schedule immediately. If it does, the patient usually is scheduled anyway. “Simultaneously, the pre-cert rep will work on obtaining the authorization,” Smith says.