Cashing in At the Front Desk
By Cynthia A. Ethier
Engagement Manager
Beacon Partners, Inc.

As the world continues into the new millennium, health care organizations are looking for more ways to operate with greater efficiency and effectiveness. A primary component of this effort is a competent Front Desk, which:

• presents the opportunity to verify and update demographic data
• enables staff to view/photocopy the patient’s insurance card
• provides face-to-face verification of co-payments/payments on accounts/deductibles, thereby reducing lag days for cash collection and decreasing the need to mail patient statements
  

The Front Desk establishes the primary contact with the patient and serves as the billing communication link to the patient. Thus it is key to capturing the correct billing and insurance information. Ownership and accountability goals must be defined.

Current accounts receivable systems enable Front Desk staff to post charges and payments at the time of service. This allows the billing cycle to begin immediately rather than with the delay of sending the charges elsewhere to be entered. The earlier the billing cycle begins, the earlier payment is received. Collecting payments up front increases cash flow and decreases the business expense of sending billing statements.

When the Front Desk staff is held accountable for accurate collection of demographic and insurance data, bills are sent to the correct third party payers or guarantors the first time around. This is an asset in decreasing an organization’s accounts receivable denials. Also, with the defined responsibility for payment collection, the Front Desk has a vested interest in the practice’s accounts receivable.

Historically it has been the Front Desk’s responsibility to schedule appointments. In order to promote customer service and patient satisfaction, outside calls should be made a back office function to ensure that the Front Desk is available to assist all patients when they present, instead of having them queue up while the staff is on the phone. A centralized call area can efficiently handle all incoming calls, book appointments, take messages and issue prescription refills. This will ensure that the Front Desk can focus on the patient without being interrupted by an onslaught of phone calls. Thus, patients feel that they have received the staff’s quality attention, reaffirming their respect from and importance to the health care organization.

Several mechanisms must be in place at the Front Desk to assist with accountability: specific job descriptions, performance appraisals, policies and procedures, training and support (system and procedural).

Job Descriptions and Performance Appraisals
Frequently job descriptions for Front Desk staff are generic and lack precise accountability. Explicit job descriptions assist employees in understanding their responsibilities. When employees are given ownership of specific functions, they are generally less stressed. Instead of feeling responsible for everything, they have specific tasks for which they are held accountable. Additionally, management is more efficient, knowing whom to hold accountable for the completion of specific functions affecting the revenue cycle. Performance appraisals must be developed to include objective standards related to the defined responsibilities, providing an effective vehicle for management to identify breakdowns in the billing process as well as areas needing improvement. Communication of each employee’s roles and responsibilities is necessary to ensure that the employees fully understand management’s expectations.

Policies and Procedures
Critical steps to ensuring that the Front Desk staff is following standard operating procedures consistently are the development of and adhere to standard policy and procedures. Operational policies and procedures should be put in place and reviewed regularly by staff and management to ensure realism in their support of the mission of the organization. These policies and procedures should include customer service, verification of demographic and insurance data, collection of payments at time of service, and daily reconciliation and deposit procedures. Tools should be developed to ensure Quality Assurance and monitor and measure general as well as HIPAA compliance.

Training and Support
The success of the Front Desk is directly dependent on the training and support given its staff. A mandatory training program should focus on system education, i.e., entering demographic and insurance data accurately and entering and posting time of service charges and payments, requesting payments from patients, insurance plans (reading the insurance cards) and referrals, all with a strong emphasis on customer service. A support line should be set up to assist the Front Desk with questions that arise during patient hours. At regular intervals Front Desk staff should be monitored and measured to assess needs for additional training.

By utilizing your health care organization’s major asset, your Front Desk personnel, and empowering them with job descriptions, policies and procedures, training and support, you will decrease your accounts receivable and cash in at the Front Desk.

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About the Author
Cynthia Ethier has more than 22 years of business experience in the health care industry. Ms. Ethier’s experience includes physician system implementations, re-engineering of practice operations, and the management of Information Services resources. She is well versed in the management, implementation, and training of front-desk applications. In a recent consulting engagement, Ms. Ethier provided interim management and analytical analyses of the Registration, Charge Entry and Payment Posting applications for an academic multi-specialty physician group practice. She successfully decreased staff overtime by 100% while increasing productivity by 50%. Ms. Ethier can be reached at 781-982-8400 ext. 417 or cethier@beaconpartners.com

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