This is a comprehensive guide on how to schedule surgeries with hospitals or ambulatory surgical centers. This guide can be followed by the surgical coordinator or the front desk staff if you do not have surgery coordinators on staff.
Alternatively you can also use our surgery scheduling software.
Downloads on this web page
Surgery scheduling checklist
Before sending a surgery packet to your surgery partner (ambulatory surgery center or hospital), you need to ensure that your surgery packet contains most of the following:
- Surgery information sheet of the surgical center / hospital including patient’s Insurance Prior Authorization. Make sure the prior authorization number is included as well as proof of prior authorization.
- Surgery consent form signed by the patient and the surgeon
- Signed informed consent forms for any special procedures. Ensure that the patient and surgeon signatures are included.
- Pre-operative instructions signed by the patient.
- Patient Record Release. Make sure this is signed by the patient before they leave your clinic else you will not be able to receive patient records from the primary care office.
- History and physical (medical clearance) signed and dated by the primary care physician. This should include the Preoperative Medical Consultation, Lab and EKG
- Specialty History form. This will depend a lot on your specialty, Ensure that this is signed by the admitting physician / surgeon.
- Materials Request Form. This will also depend on your specialty. However, the ASC/Hospital has to be given ample notice to ensure that the surgeon’s desired equipment/lenses etc are available during the time of surgery.
- Operative Report Request Form. While this is not a must have, it is a good idea to send it along with the surgery packet itself. This helps your billing department.
If you use our surgery scheduling software (included in our healthcare CRM), the surgery checklist looks like this (you can create your own as well).
Surgery related papers to print and give to the patient
Make sure that your patient gets these papers printed and handed over to them before they leave your office.
- History and physical request (requirements) handed over to the patient. It is preferred that you personally fax this over to the primary care physician office as well.
- Anesthesia Fact Sheet printed and handed over to the patient.
- Medication Reconciliation List printed and handed over to the patient. This has to be filled out before they go in for the surgery.
- Patient bill of rights. This might also contain the advanced directive of the patient. Make sure that your patient is handed this before they leave the office.
- Preoperative and postoperative appointments with the surgeon / your office.
How to do a surgery booking successfully
If you follow these steps, most of your surgery scheduling workflow should go smoothly
- The patient arrives at your desk with a surgery note from the surgeon. Before anything, you need to make sure that the surgeon has provided all the details of the surgery. At a minimum, you should have CPT(s), ICD(s), surgery location (ASC or hospital), surgeon name (themselves or someone else), any special procedures, anesthesia recommendations (MAC/General etc), urgency of the surgery. If any of these are missing, then ask the surgeon or the scribe for these details right then. You cannot process the surgery booking without these details.
- Fill out the surgery center’s pre admission surgery form. This will contain the surgery details and the patient’s insurance information. If the patient does not have insurance coverage, this will contain the financial responsibility details in it. Keep in mind that at this point, you do not have the prior authorization number yet. You will have to update this document with the PA number once you receive the prior authorization from the patient’s payer.
- Pick a surgery date based on what the surgeon recommended. Keep in mind that without prior authorization or medical clearance, your surgery will not happen (in most non-urgent cases). These two take time to get done. Pick a date (for non urgent cases) that’s around 30 days out. This gives you enough time to book everything and have a small room for delays/rescheduled appointments.
- Look up the patient in your EMR and print the specific ASC / hospital’s required surgery booking forms.
- This would be a good time to set the preoperative and postoperative appointment dates for the patient as well. These should be set according to the surgery date you picked.
- Transfer the patient demographics, the surgeon name, the surgery CPT and ICD onto the surgery consent form. Make sure the patient signs it right then. You will get the surgeon’s signature later that day (on this form).
- Next, if you have any special procedures in the surgery booking form, transfer the patient’s demographics, the surgeon name, the special procedure details onto the informed consent form. Make sure the patient signs it right then. You will get the surgeon’s signature later that day (on this form).
- Your surgery center partner may or may not have a requirement to get pre-operative instructions signed by the patient. If this is a requirement for your ASC, get these signed from the patient.
- Print out the HIPAA / Patient Record Release form. Make sure this is signed by the patient before they leave your clinic else you will not be able to receive patient records from the primary care office.
- You need to get the patient to visit their primary care for their medical clearance. Typically, your ASC / hospital would have their own H&P form. If not, you should have one from your practice. First, find out if your surgeon has written down any pre admission tests ordered or not. If there are, then you have to enter these pre admission tests on to the medical clearance request form. Print out the History and physical (medical clearance) form and transfer the patient information, surgery information (ICD, CPT), surgery center details on to the H&P form. Tell the patient to get this form signed and dated by the primary care physician. This should include the Preoperative Medical Consultation, Lab and EKG if your surgeon has ordered them. We prefer to fax this form and the patient record release form over to the primary care office ourselves.
- If there are any further instruction forms that are specific to your ASC or your own practice print those out, explain to the patient.
- After this, the patient’s part is done.
- Next, you would have to handle the specialty history form. This will depend a lot on your specialty. Pull up the patient’s EMR record detail. There, you will find the specific answers to your specialty history form. Ensure that this is signed by the admitting physician / surgeon.
- At this point, you should scan all the signed documents and upload them to the patient record in the EMR.
- As soon as possible, start the prior authorization process. Each payer has their own set processes. Some payers have their prior authorization requests done online. Some payers have a standard form that you have to fill out and fax to them. Fill out the patient, surgery details and send the prior authorization request to the payer. Of course, with some payers, you will not need prior authorizations and their response will advise you the same.
- It’s best to have a separate fax number for your surgery coordinator. As soon as you get a fax response for the prior authorization, make sure you note the start and expiration date of the prior authorization. You cannot have the surgery before the PA start date nor can you have the surgery after the PA expiration date. Upload the prior authorization request to the patient record in the EMR.
- Next, you will have to update the pre admission patient information and insurance sheet with this prior authorization number.
- The next step would be to wait for the medical clearance form from the patient’s primary care physician office. Our advice is to reach out to the PCP office a day after the patient’s medical clearance appointment and ask for the fax to be sent. The PCP office might ask you to send over the patient record release (as they should). Once you get the medical clearance form along with the pre admission test results from the primary care physician office, print them out and attach them to the patient record in the EMR.
- Your next step would be to fill out the Materials Request Form. This will also depend on your specialty. Collaborate with your surgeon to find the answers for this form. Once you get the responses, fill out the materials request form (one form) for ALL the surgeries that you are sending across to the ASC or hospital partner.
- This would be a good time to attach the Operative Report Request Form for each patient and surgeon as well.
- Once you have all these papers signed, packaged together, you can send the entire patient packet to your surgical partners.
Typical surgery booking form(s)
If you are using our surgery scheduling software, you would do this on the following screen.
Getting appropriate signatures from the patient
If you are using our surgery scheduling software, you would do this on the following screen.
Getting history and physical from the patient’s provider, pre-admission testing (PAT)
If you are using our surgery scheduling software, you would do this on the following screen.
Setting up pre-op, surgery and post op dates – notes
- Based on the surgical clearance date/time obtained, the coordinator can then pick a date for the surgery. To be on the safe side, you should pick a surgery date at least 7 days away from the surgical clearance date.
- Having a pre-op appointment with the patient without the clearance forms being obtained usually does not make any sense. It is advisable to set up a pre-op appointment after the clearance appt date. There are also specific cases that one needs to take care of (e.g certain pre-op procedures/injections need to be administered and the surgery needs to be done within X days of the pre-op appt. Typically a 5 day period is a good target to set between the pre-op and the surgery date. For post op appointments, you should target the next day, next week, next month.
- The surgery scheduler then schedules the pre and post operative surgery dates. They explain to the patient that these are tentative dates and that these might change based on the actual surgery date.
- The surgery scheduler then also hands patients informational leaflets about the surgery, what to expect etc (i.e patient education handouts)
- This is also the right time to communicate a tentative surgery date to the hospital or the surgery center – by this time you are somewhat sure about the PAT date.
Pre-cert and prior authorizations – notes
- After the patient leaves, the surgery scheduler starts getting the needed pre-certification from the payer. Note the differences between a pre-cert and a prior auth.
- If it is a non urgent or elective surgery, then you need to send a precertification request to the payer first. The payer will let you know whether the requested procedure is covered or not. This is similar to an eligibility request in that you do not need to submit any medical documentation.
- If and when the payer responds to the pre-certification request with a denial (i.e. surgery is not covered by the patient’s plan), then the surgery coordinator needs to discuss with the patient and the surgeon about next steps.
- If the payer responds with an approval, the next step is to submit the patient’s medical records and the surgeon’s documentation to prove why a particular procedure was chosen. Only after you get a prior authorization, are you truly ready for the surgery.
- Meanwhile, if it is an emergency procedure, the surgical coordinator can skip the pre-certification process and try to get the prior authorization retroactively after the surgery. Various payers stipulate that such prior authorizations should be obtained between 24 and 72 hours after admission.
Using NisosHealthCRM, you would do it like this:
Staying in contact with the patient
- Our recommendation is for the surgeon’s office to stay in close contact with the patient to remind them of the clearance appointment they have with their PCP. This ensures that the clearance / PAT happens on time.
- On the date of clearance appointment, the surgery coordinator should call the PCP office to obtain the clearance and the patient history / continuity of care document. This should include the entire medication list as well. Here’s a sample medication list form that you can ask your patients to carry with them to their PAT.
- Keep in mind that the clearances for history and physical should be received at least a week before the surgery depending on the patient’s health conditions.
- Once you receive the surgical clearance form from the PCP office, the surgeon’s office (your office) needs to go over the history with the patient as a checklist. Often patients do not understand what is a surgery and what is not (a classic example is a C section). Here’s a checklist sample.
- The surgery scheduler also needs to dig deeper into patients’ medications and specifically ask for any over the counter “herbal medication” they might be taking. Most patients do not think that herbal medication can interfere with anything related to their surgeries – but they might interfere with anesthesia.
- Based on the age, medical history of the patient, sometimes, diagnostic testing might be required. This is almost never a standard list, but these are prerequisites of that particular surgery – and these need to be done, results obtained at least a week before the surgery. There’s a lot more information available here on Medscape.
- Patients are, understandably, anxious and might delay their care / surgery. You should try to educate your patient multiple times (in our experience).
- The surgery scheduler should be advising the patient on preoperative fasting, medications, anesthesia, and postoperative care that the patient should expect. The reasons for fasting should be explained to the patient repeatedly – this is where most of our surgery cancellations occur. Patients simply do not understand that not fasting opens them up to chances of vomiting, nausea post operatively.
You don’t necessarily need a pre-op in your surgery scheduling process/workflow. We recommend that you almost always should have a pre-op and a post-op date set up. This will ensure that you get another chance to counsel the patient, prepare them for the surgery, get all loose ends tied up.
Surgery Planning – NisosHealthCRM
Being true partners to your surgery center/hospital
- Your surgery center partners have significant investments in equipment and need your help in achieving their targets as well. Understand that clearly. You cannot promise 30 patients, get a block time for your surgeon and show up with 10 patients.
- Throughout this time, the surgery scheduler is / should be coordinating with the surgery center or hospital about the block of time and number of patients that they should be expecting.
- Until all the prerequisite steps have been met, the surgery cannot be confirmed from your practice’s side. As you know, unless you confirm the surgeries from your side, the surgical center runs the risk of losing revenues (their investments are significantly higher than yours).
- Make sure that you do not submit one piece of information at a time. Your surgery partner will expect an entire surgery packet from you – send the entire packet together, in one shot and always keep your surgery partner up to date on the latest status of the patient.
- Any laboratory/diagnostic test results and all medical clearance documentation should be submitted to the surgery department beforehand. This helps to avoid repeating procedures and therefore saving time + money.
- The better your surgery no-show rates are, the more advantageous block times your surgeons get. Over time, we have noticed that some ASCs end up dropping some associated surgical partners because of the no show and cancellation rates.
- The surgery scheduler should be following up with and remaining in touch constantly with patients so they don’t cancel or back out. Bake this into your surgery scheduling process as an integral step.
You can keep track of all pre-requisites using our surgery scheduling software like this:
No shows and cancellations – part of the surgery scheduling process
Despite how good your surgery scheduling process is, you are going to have noshows and cancellations. While this is bad for your practice’s financial health, it is even worse for the patients that actually do need surgery based on their diagnoses. If not for your own practice, ensuring noshows and cancelled surgeries are re-booked, helps your patients as well.
- No shows and cancellations happen – it’s part of the process. Most surgery coordinators forget to follow up with these patients and bring them back to the table. You should treat such candidates as any other no-show / cancelled patient appointments. A gentle nudge / reminder usually gets the job done.
- Patients that do not show up for the pre-operative appointments will most likely not show up for their surgeries either – following up with patients to ensure that they do show up for their pre-operative appointment is very important.
- Following up with a patient after the day of surgery to ensure no complications occurred is CRUCIAL. The surgery scheduler needs to make that part of their workflow for the patient as well.
- Usually, the surgery center does provide all post operative care instructions, however, care instructions specific to your speciality should be followed through by your team. This could include the medications the patient can and cannot take, the correct way to take eye medications, eye and wound care, the appropriate emergency contact information that the patient needs.
- The surgery scheduler should also ensure that the patient does show up for their post-operative appointment the next day after the surgery.
- When the patient shows up for their post-op appointment, the coordinator should also ensure that the patient has follow up appointments (recommended) one week after surgery, one month after surgery, and three months after the patient’s surgery.
- The day after the surgery is typically the best time for the surgery scheduler or the front desk staff to follow up with a patient satisfaction survey.
- Following up and following through this entire process with clear indicators of dependencies helps you do more surgeries. If you provide full transparency between the patient, surgery scheduler on both your practice’s side and the hospital/ASC’s side, you will certainly close more surgeries. You would also need your surgeon to ensure closing the loop on surgery scheduling and successful surgeries.
COVID – special considerations for your surgery scheduling process
These days, in addition to the regular steps in your workflow, you also have to manage COVID related tests. Keep in mind that most surgical centers will ask for both a surgeon and patient COVID test results.
As a general practice, you should have a list of COVID testing centers that each one of your surgical partners approve of. A COVID test result will be valid for 72 hours, so you should plan on having your patient take the test 3 days (max) before the surgery date.
We have noticed that surgeons are fast tracked at most of these COVID testing centers. You should advise your surgeon accordingly (even if they are aware of the same).
Most COVID testing centers fax the results back to the surgical centers. However, considering how things are working these days, it is in your best interest to ensure that the results are faxed to you as well. Follow up with the center to obtain the fax – mostly because this puts you more in control of the surgery appointment.
You need to ensure that you have all the necessary paperwork so your surgeon can perform the surgery during the block time they are allocated. Do everything you can, to ensure that.
Post surgery workflow
On the day of the surgery, ensure that you also deliver a surgery package to your surgeon (just in case the surgery center / hospital is missing any paperwork – we have seen that happen a few times). After the surgery, ensure that your surgeon hands you the operating note.
The op note is what you are going to need for billing. Ensure that it has enough information and highest levels of specificity for you to be reimbursed in full without any denials. Make sure that
- The note contains both the pre-op and post-op diagnoses (just in case it has changed).
- Operative note contains CPT terminology as much as possible but not the CPT code itself (sometimes, this clashes with billing codes)
- The note has at least a few sentences about “Indications for Surgery” that your coders can use
- Surgeon’s operative note has “Complexity” section that buttresses your claim for payment
- Finally, the note, of course, has to have the description of the surgery
Post Surgery WorkFlow
It’s a lot easier to manage all these steps with a surgery scheduling software. Learn more about our free surgery scheduling software here.