With the beginning of the year and ever increasing high deductible plans, a clear strategy on clinic front desk processes for patient collections is on the minds of every practice administrator. Allocation of staffing resources, process review, and training is key to maintaining your patient collections revenue stream. At the same time, making sure that you are not overstaffed at your front desk and your processes are excessively complicated will maintain strong customer service while supporting the collections and information gathering required for reimbursement.
A whopping 12% of physician revenue goes to pay for administrative overhead according to According to a recent Health Affairs study – with inefficiencies in medical billing making up 74% of the costs. Administrative tasks that surround the ever increasing patient responsibility is a key area to focus. These can be broken into two main areas; front end and back end.
Clinic front desk processes are centered around patient demographics, eligibility, payment portals and copay/deductible collections. Each of these areas is technology and training driven. Staff that know how to collect and enter patient demographics can reduce back end errors significantly. Likewise, proper eligibility review has a huge impact on reducing claim rejections, denials and the possibility of timely filing issues. High performance practice management systems allow automated eligibility checking which displays the results right on the schedule for each front desk access, as well as on-demand eligibility while entering demographics. Having a secure and effective payment portal allows staff to gather front desk payments in any form, quickly search for past payments and establish payment plans for large balances. Perhaps most importantly, the front end creates the culture of expectation. If your staff infuse an expectation of payment into their language and actions, your patients will respond accordingly.
Managing your front end processes:
High performance practices have 1.29-1.38 FTEs per physician at the front-desk according to the Medical Group Management Association or MGMA. However, having adequate staff without supporting processes and tools will not solve the problem.
First, make sure that you have a documented patient scheduling and check-in process. This begins with demographics and insurance information collection prior to the appointment. Demographics must be checked and verified again at the time of the appointment. A bad address or phone number can mean months of delay in receiving patient payments and must be avoided. ORI utilizes an advanced skip tracing tool to track down valid demographics for mail returns and invalid phone numbers. Having an appointment reminder process in place allows a second demographic and insurance check prior to the appointment. A combination of text, e-mail and phone calling strategies can be efficiently automated with current technology for minimal cost.
Secondly, gather insurance prior to the appointment and verify one week prior to the scheduled date. This will allow an opportunity to stage a follow-up call with the patient if insurance is returning as ineligible. For government payers, such as pre-paid medical assistance plans, it is common for insurance to change at the beginning of the month. Verifying all appointments with medical assistance payers on the first day of the new month ensures these changes can be found and implemented. Outsource Receivables utilizes practice management and clearinghouse systems that provide automated eligibility requests and returns to provide efficient and thorough eligibility checks.
Clinics that provide services requiring authorizations must have a regular authorization review to request new auths prior to initial services or get additional authorization units to prevent expiration. ORI supports clinics with advanced authorization management through practice management tools. When PM systems do not provide these tools, an authorization inventory database is maintained that tracks new authorization requests, current authorization status, and authorization problem solving for denied claims. If not properly managed, authorization issues can introduce thousands in delays and lost revenue for the practice.
Each of these preparations lead up to the actual appointment. If the preparation is done properly, staff can focus on patient collections and service rather than rushing to just get the demographics entered. Many patients are experiencing high deductible plans and copays at the time of service which can be a stressful experience. Institute a clinic culture that let’s patient’s know that payment on the date of service and payment plans for large balances is part of their overall service. Patients must be reminded of their copays and deductible prior to their appointment. Also, let patients know what forms of payment you expect and the terms of your payment plans during these interactions. When patients arrive they should be asked to review their demographic file and have any existing balances as well as copays and deductible amounts calculated and ready for payment.
An important part of clinic front desk processes is training staff on how to ask for payment. The process can be difficult when dealing with a full waiting room and sick people or upset children. Providing your staff with a clear process for requesting payment with supporting signage and a handout on clinic policy helps them navigate patients who may otherwise try to avoid payment. For those patients that require more attention that can be reasonably offered at the front desk, provide a private call booth, business office contact card or other easy means to connect patients via phone with the billing office to setup a payment plan.
Lastly, hand written receipts, delayed payment deposits and a multiple transaction logs are a recipe for disaster. Disorganized front desk receipts are enough to make your accountant wish they had a different job. Having an effective credit card, cash and ACH check portal allows a single form of accepting payments and generating receipts in a quick and consistent manner.
On the back-end, the area of patient statements, phone calls and collections processes demand focus and timing. These tasks depend on accurate demographics, eligibility and patient payment posting and only re-emphasize the importance. If your clinic needs an assessment of patient collections processes fill out our contact form.