From scheduling a patient’s appointment at the front desk, through insurance verification, charge capture, billing and finally to the A/R and collections departments, each of your hard-working staffers perform critical roles in your practice’s revenue cycle. Understanding what these roles and tasks entail, how they sometimes overlap and what happens when one component is missing or falls short in performance are essential to controlling your revenue cycle.
Essential Tasks Performed By Front Desk
Major tasks of the front desk include patient scheduling, insurance eligibility and authorization, as well as collecting payments, such as co-pays, deductibles and other balances due, up front.
Patients should be scheduled in a manner that promotes sufficient provider time for each visit, with short waiting times. Long waits as well as limited access to care can put a practice in jeopardy as patients seek care elsewhere. This can also cause problems with patients seeking care from out-of-network providers by reducing care coordination between the primary physician and other providers.
Insurance verification and pre-authorization
As the ‘face’ of the practice, front desk greets patients and verifies insurance information with each visit. Having some “face time” with patients allows them to express concerns and received explanations and recommendations from the doctor.
A recent survey found that while 79 percent of practices verified insurance information at an initial visit, only 25 percent of those verified coverage on subsequent visits. Front-end verification can therefore make the back-end’s job easier by reducing the chance of denials up front.
Staff should be asking patients the following:
- Is insurance registration information accurate and up to date?
- Is this patient covered on the plan?
- Are there other insurance plans covering the patient?
- Are there a maximum number of allowable visits?
- What is the patient’s liability of the total costs?
In addition, according to the Medical Group Management Association (MGMA), missing or incorrect insurance information were among the top five reasons for denied claims.
Payers are also increasingly asking providers to submit prior authorization forms up front prior to providing services or treatment. Doing so beforehand can reduce denied claims and headaches for your back-end staff.
Upfront collections from patients
Spending more “face time” with patients by the front desk or reception also gives them a better chance to collect monies owed up front, also known as “point of service” collections.” The front desk shouldn’t limit collecting to just co-pays for that particular visit but any other amounts already owed. Higher-deductible plans mean more money due form patients, so collecting balances due or other costs at the time of service can mean an easier time collecting payments due by your back office’s A/R department.
Back end staff often deal with many different payers, making upfront verification more critical, as incorrectly-identified claims will result in denials, making their job more difficult. One of the primary tasks of back office personnel is properly managing payer contracts, as well as payer accuracy and performance.
A/R and collections
Once all payers and payments have been received and posted, any remaining balances are sent to collections where staff prepare and send out bills as well as work counseling patients on financial responsibility and if necessary, work out a payment plan to pay off the balance.
With higher deductibles and co-pays increasingly the rule, more patients and their families are feeling pressured and may be experiencing difficulty in paying off balances that are competing with household expenses, mortgages, rent food and other essentials. Staffers that show a willingness up front to work with rather than against patients can work wonders toward maintaining goodwill.
Follow-up on denials
90 percent of denials are preventable and can be resubmitted with corrected claims; however only about half are ever resubmitted for payment. Follow-up is therefore critical to capture what is a significant amount of potential revenue. Unfortunately, many offices are so focused on new claims that they allow older denied claims to get lost in the shuffle.
How can each component’s performance of be measured and improved?
Get feedback from patients and other employees
For front desk personnel, successfully balancing clinical and clerical demands, engaging with patients while providing good customer satisfaction is challenging. While measuring front desk performance may be hard to pin down, getting feedback from patients or the back office about inaccurate insurance data or a wrong address or phone for the patient can be a tip-off that problems exist. One good way to improve performance is to assign designated tasks to specific employees, even if it means having to hire someone, rather than have one or two receptionists attempting to “do it all.”
Communication is key to success
At the back office, staff must make sure that all eligible payers have reimbursed fully according to the terms of their contracts. If denials have spiked, they should find out by which payer and whether due to contractual changes or other reasons. Good communication between payers as well as the front office is critical for the back office
How can partnering with a medical billing service help your revenue cycle?
Turning to a professional, experienced practice management and billing service such as M-Scribe can offer the following benefits:
- Turning your billing tasks over to the professionals can help free up medical office staff for more patient-centered tasks.
- We can work with all practice management software.
- Improved documentation accuracy prior to claim submission with the process being handled by certified experienced coders and billers. Accurate, timely submissions mean fewer denials caused by staff often distracted by other office and patient-related duties.
- Faster follow-up within resubmission deadlines on any claims that may be denied mean a better chance of still capturing reimbursement.
- Fewer denied claims will result in higher reimbursement rates, which improves the bottom line of your revenue cycle.
Contact M-Scribe at 770-666-0470 or by email for a free analysis of your practice’s financial goals to learn how to boost your office team’s efforts at maintaining the revenue cycle.