The front desk plays a big role in any practice. It can be either a bottleneck or an open water dam as far as patient flow. Likewise, the front desk can be the cause of a hemorrhage of money or work like a skilled plumber that makes sure no leaks (ie money, patient info, eligibility checks) are falling thru the cracks.
A few years back, I realized that if we were to survive as a practice, we would have to make some changes to how the front desk functioned.
Adapting to changes
So I sat with the front desk and explained that from now on, they had a few more responsibilities they had to master. Simply handing people forms and checking people in is only the tip of the iceberg. The front-desk in essence would be the command center of operations for our practice. Kind of like a control tower at the airport.
Below are the four areas that we would begin to implement and work on in order to meet the challenges the business of healthcare was throwing at us.
Handle billing issues
Many billing questions are discussed when patients check in. Parents want to know why they are getting a bill, why insurance didn’t pay, how much do services cost and so forth. It seemed to me that being able to handle basic questions right then would help resolve issues sooner rather than later. Not to mention when parents understand their medical bill, they tend to pay.
Consequently, one of the first changes we made was for the front desk to handle basic billing inquiries from patients. No longer could they refer billing issues to the biller. As a result, they had to learn how to read ledgers, summarize charges, explain what the CPT codes meant and why we were billing a 99051, for example.
Show me the money
Higher copayments, higher-deductibles, HSA’s and other “fabulous” insurance initiatives meant that parents/patients would eventually have higher patient responsibility amounts. Therefore, front desk personnel had to be comfortable with asking people for money.
Asking people for money, although a seemingly simple task, is very uncomfortable for many. However, it is a non-negotiable requirement for the front desk staff member. If they don’t feel comfortable with this task, they couldn’t work in the front desk. Here is why…
Our small 2-doc office collects upwards of $9000 a month in front desk collections alone between copayments, on-account balances and self-paid. Without a firm (and comfortable) front desk protocol that requires the staff to ask for patient balances, we’d add an additional $108,000 to our accounts receivables a year.
How many times have you heard from parents, “I didn’t know I had to do that.” “Why didn’t anybody tell me?” “Nobody called me to let me know.” “How was I supposed to know?” “Mary told me I could come in today… now your telling me there aren’t any appointments?”
One of the biggest time/money wasters is poor communication. Thus, we understood that in order to reduce cost we would have to ensure that the front desk was communicating properly with parents. Not just with billing issues, but with virtually every aspect of a medical practice. From making sure the patient knows what time to show up to what forms to bring after they’ve been discharged from the hospital to what hospital they went to get their labs done so the nurse knows where to call to get results.
Private practices are increasingly more complex in terms of insurance companies’ rules, office policies, financial protocols, office procedures, patient demands, and types of insurance just to name a few. Without a front desk that is able to clearly communicate to parents all of the different complexities we have in our systems, our office would be even more thwarted in attaining our goals. Communication matters more than ever.
To be an effective ops command center, the front desk staff has to be empowered. They need to know they have the power to make relevant choices depending on the situation. And this empowerment extends beyond administrative duties.
The truth is that despite having practice policies and rules to help staff follow guidelines, many situations do not fall under a clear right or wrong way. In other words, they fall under the proverbial “grey” area. And when you have “grey” areas, you need to have staff that: 1) are critical thinkers and 2) are empowered.
Enhanced patient experience
Having the front desk staff be well versed in these four areas has many advantages. For example, billing issues like balances, insurance verification, explanations of benefits etc. can all be handled immediately with parents because the staff has the tools and the knowledge to answer most questions. As a result, billing issues get resolved sooner.
Moreover, a well trained empowered front desk staff should be able to take charge to alert the appropriate clinical staff, manage the schedule to accommodate scheduling need while communicating with other patients of certain situation.
Involving the staff to resolve billing issues as well as perform front desk collecting responsibilities helps them to be mindful of obtaining patient demographic and insurance information. The result? Clean claims!
They now see for themselves that the more work they perform up-front, the less patient follow up and delinquent letters we have to send out later.
Better rapport = better results = less A/R
When a parent has a question about billing and we say, you have to speak to the billing department to resolve that issue, the conversation has been disrupted. Eight out of 10 times the person in the billing department doesn’t have rapport with the parent, so billing related conversation have a different dynamic.
On the other hand, when any of our front desk staff says, I’ll be happy to help you with the billing questions, the conversation isn’t interrupted. But more important, our front desk staff has a better rapport built with the parent because they have had multiple positive exchanges in the past with the parent. Thus, the conversation turns more towards educating and informing rather than, “this is your bill and you have to pay for it because that is what the EOB says.”
Fundamentally the more conversations about billing we have with parents the more success we will have in collecting. The upside? Resolved billing issues equals less A/R. And the best place we can have those conversations is when the patient is in the office; not two days later when the biller has time to give the parent a call back.
Nothing is perfect
Giving the front desk all these responsibilities does create other problems. For example, sometimes billing related tasks pulls them away from some of their other front desk responsibilities. So the staff has to to learn how to prioritize and manager all their task; which is an acquired skills set that takes time to master.
Experts may not agree
I understand many experts suggest that the more task the front desk is given, the less effective they are in doing them. But let’s be realistic. We are a small office as it is. I can’t have staff that only answers telephone calls, another that only handles billing inquires and another that only checks people out while another just focuses on making appointments.
In a small medical office, everybody wears more than one hat. The challenge is, which hats should staff wear. And in order to meet the demands of this high patient responsibility climate we have been dealt, the front desk has to assume the responsibility of a command center.
What do you think?