By Angela Hunsberger, Hayes Management Consulting
Twitter: @HayesManagement
Early in my career, I worked for two providers in a small privately-owned practice in the Midwest. For seven years I sat behind the front desk scheduling patients, checking them in, updating demographics, and filing insurance claims. My manager trained me to be thorough and accurate but yet I had no clue how truly significant my actions impacted our bottom line. Back then, the most important thing to remember was to obtain a good address so we could send a bill if needed. Boy, was I short-sighted.
Ten years of implementing and training practice management systems along with clinical optimization projects have taught me just how crucial the front desk staff are to an organization’s success. From a financial perspective, there are four areas that must be included when training front desk staff because they play a vital role as the patient’s visit completes the revenue lifecycle.
#1. Demographics
Billers get all the glory when it comes to insurance claim processing. However, in my training programs everyone receives a handout as a visual aid that highlights the top half of a claim form. I explain that almost 50% of the claim is completed by the front desk when they collect demographics. And while a good phone number and address are highly important, accurate guarantor and insured party demographics are equally critical for insurance claim processing. Now that most claims are sent electronically, take a moment to explain to your staff why punctuation is not acceptable. Another commonly overlooked area is the required demographics for Meaningful Use. Race, ethnicity, and language (among other measures) are necessary to qualify for incentive payments. It’s worth emphasizing to your staff that collecting accurate and complete demographics should not be rushed and that accuracy is more important than speed.
#2. Eligibility Verification
Like most offices, front desk staff are asked to process patient insurance eligibility. Some systems offer integrated eligibility verification with a click of a button that sends an electronic ANSI X12 270 eligibility transaction request through the clearinghouse to the payor. The information in the 271 response returned by the payor is often hard to read and does not always include enough detail to determine eligibility. This forces a workflow variation where staff must verify eligibility through individual payor websites or by calling and facing long wait times on hold. In some cases, even specific policies have intricacies that require patient follow-up before patients can receive care from your providers. Another challenge to eligibility verification is that some patient policies change daily. How often should front desk need to verify a patient’s plan? Moreover, how much responsibility do you place on your front desk staff to understand and explain to patients coinsurance or deductible collection processes?
Does your workflow include a strategic action plan when patients do not meet eligibility requirements? What if the patient is already in your office ready to receive services? This is a huge front-end responsibility and the front desk staff need proper training on how to read eligibility responses and should work with billing staff on tips and tricks to better understand processes, policies, and procedures. Simply verifying that a plan is “active” is not all there is to eligibility verification.
#3. Patient Face-Time
Christa Horne and Nicki Morgan, from the front desk administrative team at Affinity Health Group, explain “It begins with the receptionists. We are the first face the patients see. That one-on-one face time motivates and shows the patients you care. Longer face time gives the patient time to express all their concerns and receive full detailed explanations, or recommendations from the doctor.” Extended face time also broadens the opportunity to collect money owed to your practice. More than taking a copay at patient appointments, staff should be trained on collecting ANY past due balances or even pre-payment of non-covered services. Another common scenario is when patients are seen for preventative visits that are typically covered by their insurance plans but then the visit turns into something more and now requires a copay at check out. My experience has revealed front desk staff are not always comfortable answering questions about account balances and patients are frequently instructed to call a billing line. Having the patient right in front of you is one of the optimal moments to collect. Ensure your front desk staff have the proper training to answer accounts receivable questions and are confident in navigating the computer system to find balances due. Prep each appointment before the patient arrives to find past due balances to collect at check in.
#4. Juggling Tasks
Working at the front desk was one of the more difficult roles that I’ve filled in healthcare. I can empathize how it feels while the patient waits (sometimes impatiently) as you update the computer. I can still feel the provider lurking over my shoulder to take the patient back when I have yet to get everything ready before the clinical handoff. The phones are ringing off the hook and the line of patients waiting to check in is growing. As I hurry to answer questions, scan copies of insurance cards, get signatures, and enter everything in the computer, I take a deep breath and concentrate because I’m doing more than collecting an address to send a patient statement. The phone number I’m entering will be used by our clinical staff as well to communicate lab results. The insurance eligibility came back as inactive and now I also have to tell my patient their credit card declined. Oh, the computer froze up so it will be just another few minutes.
While recently writing an operations workflow manual with a client, I was reminded of my time spent behind the front desk. Balancing patient satisfaction, customer service, and the demands between billing and clinical staff was challenging. As a consultant, I can now understand the billing perspective and how frustrating it must be it is when front desk staff accidentally enters punctuation, forgets to make a copy of the insurance card, and how the same eligibility mistakes continue to be repeated. Front desk staff have a demanding and fast-paced, multi-tasking role within your organization. Provide learning opportunities and work as a team to leverage these four ways your front desk staff can directly impact the revenue cycle.
This article was originally published on Hayes Management Consulting and is republished here with permission.