Practice, like B.J. said, is a slip and check process. Invariably problems occur at the front desk since CAs are human.

Here are some of the common problems that arise in everyone's practice and some solutions for preventing and handling them.

Solutions: All patients should be on multiple appointment schedule (MAS).

-- confirm all appointments before patient leaves the office. Physically check to make sure appointment is in the book.

-- Maintenance patients need to schedule next appointment. If patients are unsure of their own schedule that far ahead, make a tentative appointment and send a maintenance postcard as a reminder with appointment noted on the back. Tell patients to call if they cannot keep appointment. This will immediately increase patient control because you are giving the patient the responsibility which increases commitment as well.

-- Missed appointments. Calls must be made and updated daily.

-- Make up appointments must be scheduled by the following day.

-- Increase patient control by reminding them of importance of consistency every time they re-schedule an appointment. If they change day, try to reschedule for same time and tell them why. If they need to change time, try to keep it as close to regular time as possible and tell them why. You don't want to sound pushy or not understanding, you simply want to educate while still being helpful and caring.

-- Doctor must be notified of any un-handled problems with patients as they arise. As soon as a patient misses two or more adjustments in a row, doctor must be notified immediately. After notifying the doctor, CA should continue to take action until the doctor decides if this is something he or she needs to handle personally.

Solutions: All new patients must be confirmed for their appointments 24 hours in advance.

-- Make sure patients are being scheduled properly when at a health fair. Patients should understand they should only make an appointment if they are going to keep it.

Solutions: Take action to make sure you help patients with whatever blocks they are having and, in turn, focus them on their subluxations. Remember, in focusing, you should ask questions as opposed to giving a sermon.

-- Avoid leaving messages whenever possible. If a patient doesn't respond to your message, send a personal note on the back of the re-call card.

Solution: Make sure maintenance patients fill out a postcard at every adjustment. These postcards are placed in the tickler file and mailed out on Mondays the week prior to their appointment as a reminder.

Solution: Whenever a patient changes their MAS or payment plan, the T-Card and ledger/billing card or computer must be updated with the appropriate changes immediately.

6. PROBLEM: Patients missing their workshop appointment.

Solutions: The workshop is part of the patient's program and is as important as an adjustment. The workshops are a requirement and patients are notified of this before they start care. Make sure patients are being scheduled for their workshops at the post consultation. The CA must also explain the importance of the workshop just as the doctor does during the consultation.

-- If patients say they can't make it because of this or that, simply ask the patient if they can change their plans in order to be there. This will reinforce the value of being at the workshop as opposed to just saying, "OK, can you make it next week?"

Solution: If you are unable to get something done, you need to let the doctor or office manager know immediately. They will help you organize, so you can get it done or delegate it to someone else. Do not allow yourself to get behind. Let them know ahead of time in order to prevent a problem from happening and then having to spend extra time in clearing it up.

Solution: No patient is to be without a payment plan at any time. If patient is having hard time or needs to change payment plan, they will need to PAG until they see BM and a new plan is established.

Solutions: At the end of each shift, write any patient NP referral on the appropriate T-Card. Existing patients are your main source for referrals. You must keep this up to date.

-- New patient referrals are also supposed to be written in the NP book. This is what the BM will use in order to sent "Thank You" notes and "Welcome" letters to the appropriate people.

Solutions: Any patient who changes an appointment or their MAS must have their original schedule erased from the book prior to the new MAS being entered.

-- If a patient goes on vacation and is scheduled for their next appointment, be sure to cancel the appointments they are going to miss.

-- Never leave these changes pending. It's easy to forget to do it if you don't do it right at the time the patient tells you.

Solutions: Whenever a patient walks in late, remind them of time you had them scheduled and ask if it would be easier for them to be on time if we scheduled them later.

-- Whenever a patient misses an appointment without calling, let them know that a call is much more appreciated than just not showing up. If they ever need to change an appointment before or after business hours, they can call the 24 hour answering service. They just need to leave their name, time they are scheduled and most importantly what time they will be coming in instead. We don't call back to confirm. We will just expect the patient at the time they left with the answering service. Otherwise, we have found we end up playing phone tag all day.

-- When calling the patient after they missed without calling, don't just say "Oh, that's OK," or "You missed you appointment, so I was calling to re-schedule." This will cause you to lose patient control. Patients will feel like they don't need to call because they know you will call and take care of it.

Solutions: This must first be addressed in the consultation. Patients need to understand the importance of consistency and intensity from the beginning.

-- If patient needs to intensify, the doctor must be the one to tell them in the adjustment room what they need to do and why. The CA then simply follows through on the doctor's recommendation.

-- Both the doctor and CA must be aware of patients who need to intensify by checking the MA sheet and looking at the back of the patient's T-Card for their last week's adjustment schedule.