Key Takeaways
  • Excellence in front office operations translates into excellence in revenue cycle operations
  • Focus on excelling in these areas: scheduling, pre-registration, insurance verification, authorization, patient check-in and consent to treat
  • Primary benefits include reducing no-shows, expediting patient flow and room turn-over, increasing provider productivity, preparing patients for out-of-pocket responsibilities, clarifying whether the service is reimbursable by the patient’s insurance
  • How you ask for patient payments is important to your success

Let’s start with a simple “imagine” exercise.  Imagine you walk into a medical practice.  It’s standing room only. There’s a steady stream of people wandering back and forth to the front desk and several unhappy people engaged in too-loud conversations with the staff.  Now, imagine you walk into a second practice. Patients are seated calmly. There’s small trickle of people coolly walking to the front desk, having a brief, quiet exchange and returning to their seats.

Which practice do you think is doing better at revenue cycle?

Front office drives everything in revenue cycle.  It’s the key that starts the engine.  If you want to maximize your collections, you’ll want to start by maximizing your front office operations. Everything that happens here matters – from how quickly you answer phones to whether people remember to say, “please and thank you.”  There are no silver bullets.  But there are a lot of things you can do that add up to making a big difference to your bottom line.  And to making your practice look and feel like the second one above.

The 6 Main Components of Front Office Operations

To optimize revenue cycle, I tell my clients to pay careful attention to these six areas of front office operations:

  1. Scheduling
  2. Pre-registration
  3. Insurance verification
  4. Authorization
  5. Patient check -in
  6. Consent to treat

While it’s true that everything matters, you’ll get the most leverage by making sure your practice is excelling in these areas.  And based on my experience, practices that are doing things well in these areas tend to be doing well everywhere else.  Let’s briefly explore each one.

Scheduling

Get yourself in the cadence of working one week ahead to confirm appointments. I know a lot of practices confirm appointments 24 – 48 hours in advance, and that’s fine to do, too.  But by calling a week ahead, you give yourself time – time to fill a cancellation, time to gather and collect up-to-date information, time to contact payers if you need to. When you are working next week’s schedule, you’re setting yourself up for success.

Pre-registration

Gathering the information you need prior to a patient’s arrival is the gold standard for efficiency. Some patients feel comfortable using online portals, some prefer to do it over the phone. It’s important to meet the patient where they want to be met, but wherever and however you do this, you want to do it before the patient shows up at your front desk during your busiest times.

Insurance Verification

Is the information you have up to date? Does the patient have a co-pay?  Have they met their deductible? The ideal time to verify this information is before the patient shows up, and while you have plenty of time to correct old and fill in missing information and discuss it with the patient.

Authorization

Plans change, policies change, coverages change. If you’re working your schedule a week in advance, you’ll have time to identify any missing insurance authorizations. Giving yourself time to obtain required authorization translates to smoother front office workflow and better revenue collection.

Patient Check-in

If you’ve done a good job with the above, the patient check in process will be quick and efficient.  That maximizes efficiency and minimizes stress for staff and patients. Use this quick exchange to get copies of insurance cards, have patients complete HIPPA forms, collect patient co-payments (more on this later) and make sure you get that last important item…

Consent to Treat

We all know how critical this document is.  But when front office operations are chaotic practices can lose track of who has completed what.  This form really is the cornerstone of revenue cycle, so make sure you have it on file. It may sound crazy, but missing this form is more common than you’d imagine. Make sure it doesn’t happen at your front office.

I know these six components sound basic, and they are.  But there’s a difference between doing them and doing them well.  When I walk into a practice, I can tell in 15 seconds how well they do at revenue cycle.  That’s where that opening exercise comes from. If the front office is a calm, smooth-running area, I know they are doing well at revenue cycle. If it’s a frenzied, chaotic scene, I know they are leaving money on the table.  Take a moment to look at your front office. How does it stack up?

The Direct Benefits of Optimizing the Front Office

What happens when your front office is a well-oiled machine?  Here’s how optimizing the above turns into tangible operational and financial benefits.

  • Reduces No Shows – Empty slots on the schedule are lost revenue that can never be recaptured. A smooth-running front office, working the schedule a week in advance minimizes lost revenue from no shows and empty slots on the schedule.
  • Expedites patient flow and room turn-over – Optimizing front office operations reduces wait times and keeps patients and physicians happy.
  • Increases provider productivity – When front office operations are optimized, you’re maximizing billable time over idle time. That’s a big win!
  • Prepares patients for out-of-pocket expenses – Informing patients of their financial obligations is good medicine and good business. Your front desk is the wrong place for a surprise.  Having those discussions on the phone, before the patient shows up, will help keep your front office calm and efficient.
  • Clarifies whether the service is reimbursable by the patient’s insurance – It’s not uncommon for a patient to cancel an appointment when they learn a service will not be reimbursed by their insurance. Having this discussion in advance allows patients to make unrushed, rational decisions and gives you time to fill the slot if they choose not to keep the appointment.

You may have noticed a theme emerging: you want to minimize lengthy or awkward conversations at your front desk.  By working your schedule a week in advance, and engaging patients on the phone to address potential issues, you keep your front office moving smoothly and enhance revenue cycle operations. But there is one front office conversation that cannot be avoided – and it’s the most important conversation of all… the one where you ask the patient for payment.

The Best Way to Ask for Payment: “How will you pay?” vs. “Can you pay?”

If you don’t collect patient out-of-pocket expenses upfront, there’s a 90% likelihood you won’t collect them at all. Yes, you read that correctly! That means you can reduce bad debt with good point-of-service collection practices. And with ever increasing out-of-pocket patient responsibilities, being proficient in this area is growing more and more important to your revenue cycle activities – a trend that isn’t likely to reverse any time soon.

There’s only one place you can have this conversation – it’s your front desk.  And there’s only one time to have it – before services are rendered.  Please don’t wait until after the patient has seen the physician to ask for payment. The time for that conversation is during the patient check in process.  And how you ask is just as important as where and when.  So here are a few tips to improve your outcomes:

Ask the right question – The correct way to ask for patient co-pays is, “How will you be paying today?”  That’s much different than, “Can you pay for that now?”  A lot of practices with high patient AR simply don’t know how to ask for their money.  A simple change in how you phrase the question can improve collections.

Scripting and practicing help – Provide your staff with a script or bullet points and take time to practice asking the question.  There’s no reason or logic to leaving this important conversation to chance.  Practice and repetition will make everyone better.

Recognize that not everyone will be good at this – Even with scripts and training, not everyone is going to be good at asking for payments. Capitalizing on the strengths of those who are comfortable in this role, and avoiding setting up others to fail, gives everyone the opportunity to excel while improving your front office performance and revenue capture.

Have your “A-Team” ready for peak times – You won’t always have the luxury of putting your best, most confident people at the front desk to ask for payment.  Consider the advantages of making sure you have them there during your busiest times.

Conclusion: Revenue Cycle Starts with Front Office Operations

As I stated in the beginning, front office drives everything in revenue cycle.  It’s the key that starts the engine.  Focus on excelling at these front office areas, scheduling, pre-registration, insurance verification, authorization, patient check-in and consent to treat and you will be on your way to excelling in revenue cycle.  In my next post, I’ll focus on middle office operations and how to optimize your processes in this area to improve your revenue cycle activities.

About the author:
Jacqueline Todd-Washington, VP of Revenue Cycle Management, Alta Medical Management

Jacqueline has over 35 years of experience in Revenue Cycle Management, helping practices of all sizes and across multiple specialty areas capture the revenue they deserve. Her motto is, “It’s your money!” and she loves to share her knowledge with anyone who asks.

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