The front desk: Where the revenue cycle begins

Episode 17: The Front Desk: Where the Revenue Cycle Begins

As we learned in our last episode, in thinking about our Revenue Cycle as a whole, it truly begins at the front desk.

When your new patient calls for the first time, and the new patient registration process begins, you are setting yourself up for success or failure, depending on how you’ve set up your front desk.

How well have you trained your front office on proper data collection? Do they understand how crucial their work is, and do they feel appreciated for doing a good job?

Your front desk is the face of the clinic, they are your ambassadors, if you will. They are in charge of first impressions, in many cases, both on the phone and when the patient arrives at the clinic in person. And it’s a tough job; Many times they’re expected to answer the phones as well, which can easily put a person into overload. And then we depend on them to do a great deal of data entry with hyper accuracy for that clean claim. On top of all of this, they get to deal with unappreciative or rude patients, and we have a tendency to make this an entry level job with very little training.

No wonder our clean claims rates aren’t a lot higher. This is not a recipe for success.

If you’re now finding yourself feeling a little sheepish about the fact that your front desk matches that description, don’t despair. Most clinics do.

So, what are the best ways to break out of this pattern, and level up your front desk?

We highly recommend specified front office training for all of your staff. Training materials can be found on our Medical Money Matters Toolkit and at a minimum, it should include training and written workflows on all of the following:

• Basic knowledge of the insurance companies in your area,
• Detailed instruction as to how to enter them into your PM system,
• Registration workflows, including all data fields that need to be captured,
• Appointment scheduling rules and parameters for new and existing patients, including the appointment types we mentioned in our previous episode about balancing payer mix, and
• Detailed instruction on how to utilize your PM system for insurance eligibility verification, and what to do with any patient who fails an eligibility check.

We should stress with our front office folks that delays in revenue cycle create wasted time and potential loss of revenue for the clinic.

Sometimes when we say things like “loss of revenue” we don’t connect the dots the way we should and members of our front office can shrug that off. So it’s good to be clear about what regular losses of revenue mean. We joke that it is death by a thousand papercuts,” but it can have serious consequences for the staff person, such as:

• Loss of bonus​
• Wage freeze​
• Job Cuts​ and most definitely
• Stressful environments if the clinic is under financial strain.

It’s critical that the front office team confirms that the right patient is being reviewed – many names sound or are spelled similarly. Staff should always review coinsurance, copays, and deductibles​ upon check in, and at least have a rudimentary understanding of what those mean.

It’s also critical that they confirm that you have the correct patient address on file, along with their insurance plan name and the benefit level​. More on powerful check in questions in a moment. They also need to document who is the subscriber for the patient’s insurance coverage and whether or not the patient is a dependent.

Once those data points have been collected or verified, it is also important to verify insurance plan effective dates for each date-of-service, as coverage can change month to month due to:​

• Medicaid MCO changes​
• Becoming Medicare eligible​
• A change in employer ​
• Non-payment of premiums​
• Renewal cycles other than January 1 ​
• Changes to coordination of benefits (if a patient no longer has dual coverage, the secondary may now be primary or vice versa)​, or
• Aging out of a parent’s plan​

Phew! There’s a lot to remember. And, we’ve given this important task to entry level staff. I encourage you to think about that, and about how you can support them to be better at their jobs – what they do for you is mission critical!

If you are a subspecialty clinic, or if you’re sending patients out for specialty care, it’s also important to understand your patient’s health plan policies with regard to referrals and authorizations. Most patients don’t understand their benefits at this level, but they expect that you do. As you might imagine, this part of the work is also very significant to the outcome in the revenue cycle – if you don’t have a referral or prior auth on file prior to seeing the patient, the insurance company can refuse to pay you. Sometimes your staff can get a retroactive referral or auth, but it’s not good business practice to bet on that, and it’s also a waste of time to be doing rework because it didn’t get done correctly the first time. We strongly recommend that our clients have a list of common payers in your area who require referrals or authorizations for specialists.

Now that the patient has made his or her appointment, and the day is drawing near, there are several workflows that are used by highly performing practices:

First is, appointment confirmations. These can be automated by text (my favorite type, as they are quick and easy and relatively inexpensive), although this is effective if done manually by phone as well. This helps reduce no-show rates, making your schedule much higher octane. It also allows your team to capture last minute information prior to the face-to-face encounter, and it gives your team a chance to confirm that the necessary referral or authorization is in place. They can use this time to remind the patient to bring insurance card(s), copay / outstanding balance payment, medication lists, etc. and they can even capture demographic changes. If you don’t have a system for confirming appointments in place, I highly recommend adding one. There are a lot of great products out there if your practice management system doesn’t have this built in.

The next workflow is check-in prep, which we recommend that your team does by reviewing the schedule 48 hours in advance. They can huddle with Billing Department to address patients with new outstanding balances, coverage issues, eligibility failures, any return mail, or payment plans. Charts can and should be flagged for any special information or payment needs upon check in, so they capture it while they have the patient in front of them.

We’ll conclude our episode on the importance of the Front Desk with the three most powerful questions they can ask patients upon check-in.

I wish I had a nickel for every time I checked into a clinic and was asked, “Is your insurance still the same?” Best practice is to ask to see their insurance card. Patients should be expecting this by now, and since you’re billing their insurance as a courtesy to them, they should be happy to share it with you! Your team should verify it by comparing to what is on file now, and scan the card (both front and back) when any changes are identified.

And instead of asking “Are you still at the same address?” the second powerful question to ask is, “Are you still on First Street?” and third, you might imagine that instead of asking if their phone number is still the same, a highly performing front office person will ask, “Is the number ending in 5309 still a good number for you?”

If you do nothing more from listening to this episode, please make certain that your front office staff don’t ever ask patients, “Is your information still the same?” Everyone will say “yes,” even if it’s not! This just creates unnecessary rework, and it slows your cash flow.

Join me for our next episode, where we’ll get to hear some surprising things about the No Surprises Act, and how some planning at your front desk will allow you to follow those rules, and positively impact your cash flow. I’ll be interviewing Grant Engrav, healthcare attorney, and one of the nation’s experts on The No Surprises Act.