In the last newsletter, we discussed finding the right front desk staff, training, customer service and other important issues.  This issue will focus on how the front desk fits into your billing team.  Your front desk staff is your first line defense in making sure that your practice’s billing process runs smoothly.  Believe it or not, today’s front desk staff have to be “Billers”.  They need to understand the process and they need to understand how their jobs affect the final outcome of getting patient bills paid.

Appointment Scheduling/ Phone Calls

It is important that the front desk staff know how to handle patient phone calls.  They should have a script that they can follow to make sure they are getting all of the billing information needed and that they are imparting all of the information necessary to the patient for their carrier’s requirements.

On the initial phone call they should be:

• Getting patient information – Name, address, phone numbers, insurance company name and type of coverage they have – HMO, PPO, etc.

• If a patient needs a referral form for their visit the front desk must be able to quickly determine this and instruct the patient how to obtain one and inform the patient how important it is that they come in with the appropriate forms to ensure their visit will be covered.

• If the patient will owe a co-pay, the front desk person must quickly figure this out and inform the patient that payment will be expected at the time of service.

• If the office has a policy of not seeing patients without their forms or payment, the patient should be told this during the initial call.

• If the patient is expected to register in advance,  they should be told that they will receive a packet in the mail or that they should come early to complete their paperwork.

• All of this should be done in 2-3 minutes per call.  Training and a script are essential for this function to be efficient and effective.

At each visit, the front desk staff should:

• Review the demographic forms as they are turned in to ensure that all information is completed properly and review quickly that the information looks correct.  For instance, check date of birth to make sure they didn’t put the current year instead of their actual birth year, that their SSN has 9 digits, that their insurance ID number looks correct based on your knowledge of the employer type, etc.

• Collect the co-pay and any past due balances  (It is helpful to review all patients a day or two before their visit to look     for past due balances, referral form requirements and pre-authorizations).

• Verify with the patient that their information has not changed – addresses, phone numbers, and insurance information.

• Review referral forms to make sure they are completed properly, have a date prior to the date of service and that what is being authorized for the visit is marked.

• Have them sign annual or one-time paperwork if not done previously – HIPAA,  waivers, insurance authorizations, etc.

The front desk staff should be trained how to handle situations where any of these requirements are not met by the patient and who they can call for assistance.

Collecting Co-Pays, Past Due Balances, Deductibles and Co-insurance

Today’s front desk person is an insurance clerk as well as a cashier.  They need to be able to:

• Read an insurance card to discern what the appropriate co-pay is

• Understand the importance of collecting past due balances at the time of service to avoid future collection problems. Collect money from patients with a kind, but firm manner

• Post and reconcile over the counter collections; keep a spotless cash receipts log and cash out at the end of the day, accounting for all monies received

• Once reconciled, make up deposit slip from their log each day

• Understand the importance of their role in the collections process and their accountability to safeguard the cash until it is turned over to the appropriate supervisor.

Good over the counter collections can increase a practice’s cash flow by many thousands of dollars each week.  Today’s front desk person is the most important part of this function so they must be trained, diligent and detail-oriented.

Sign-in sheets, Fee Slips and Charge Capture

Today’s front desk person acts as the watchdog of the upfront billing function to ensure that the practice has a chance of getting paid for all of the services they render.  It is essential that the practice have a sign-in sheet or a schedule that is updated constantly throughout the day to ensure that there is a master list of patients seen each day.

From this list, the front desk should:

• Reconcile that a charge slip is received back from the providers for each patient seen

• Quickly review the fee slips to see that the doctor has completed the form, checking and completing all boxes appropriate, including making sure they have checked off all CPT codes and entered a diagnosis code

• Once the front desk has a completed fee slip for each patient on the schedule or sign-in sheet, they should batch them together with the schedule and turn in to billing for posting and submission for the day (p.s. batches should not be held for missing fee slips for too long so a process for filling in batches after they are turned in should be part of the front desk training)

Demographic Entry/Error Correction/Education

In many cases, the front desk is responsible for entering the demographic information as well as setting up the new files.  It is essential that the front desk staff understand the importance of entering the data correctly in all areas.  If demographic information is entered incorrectly it can cause a claim to be denied, a patient statement to not be delivered or a patient to not receive any mailings from the office. 

The billing department should always quickly review the demographic entry before entering the charges for accuracy.  When errors are found it is important that they bring these to the attention of the inputter.  The billing supervisor/office manager should stress to the staff how important it is to have accurate data the first time a bill goes out.  Staff should be shown their errors, or better, should be asked to go in and fix the errors.  If errors are a consistent problem, a log should be kept to track the most frequent errors so a solution can be found.

If the front desk is also doing charge entry, it is important to give them some quiet time at the end or beginning of the day or after lunch to do their posting.  It is a good idea once or twice a year to have your staff switch roles and have the front desk rotate through the billing department and have your billers sit up front for a few days.  This will help them to be more compassionate and helpful to one another. 

In summary, the new age front desk must know as much about billing as they do about scheduling and patient customer service.  It is essential that the front desk staff be treated as part of the billing department so they can hear firsthand what the problems are since they are in many cases the first line of defense in getting information.  Front desk staff should occasionally be asked to attend billing department meetings and in some cases should attend some billing and coding classes.  The more educated your front desk staff is in billing the more successful your practice will be in collecting for services due.

Lawrence S. Simon, CPA is Co-Chair of our Healthcare Services Group and has over twenty-five years of experience serving the healthcare industry. Larry can be reached at lsimon@marg.com.