While reviewing a new process for pre-authorizations, a colleague recently made the statement, “If billing isn’t happy, no one is happy!” Despite the comment being made tongue-in-cheek, the underlying message bears remembering. The best chiropractor can provide the most transformative care in the most efficient manner but will not be able to treat any patients if the business side of the practice is not carefully managed. It all starts at the front desk.
The face of the practice really isn’t the carefully crafted website. The decor of the practice may make an impression on patients. However, nothing influences a patient’s experience like the interaction with the person behind the front desk. They define the first experience with the patient who calls to schedule an appointment; set the tone for the appointment by calming the patient in chronic pain who is frustrated with traffic, and establish the relationship that brings the patient back. It is a hard reality, but many practice management surveys confirm patients will find another provider before dealing with an unfriendly or unresponsive front desk.
For many practices, the highest place for staff turnover is the front desk. A new face every time the patient checks in does not communicate the stability patients need when they anticipate reoccurring appointments over an extended period. Finding the perfect fit for this critical position is necessary, but there are also common checkpoints to improve the odds of making sure your front desk staff members are the start of a carefully managed practice and a great patient experience.
...many practice management surveys confirm patients will find another provider before dealing with an unfriendly or unresponsive front desk
Before the Visit
The front desk “owns” the accuracy of the data within the patient’s demographic screen, including but not limited to the insurance plan. If the plan is loaded as a Medicare, Medicare Advantage, gap coverage, or even a workers’ compensation case, it clearly has an impact on the rate the practice is reimbursed for services rendered and when the practice will receive payment. Contrary to traditional training procedures, the front desk is not the spot to train someone about the nuances of insurance plans. That skill set is brought to the role, or it risks being a skill that quickly becomes secondary to the chaos of phone calls and patients’ needs. Picking “something close” from the list of plans on the insurance tab may complete the check-in process, but the error becomes a denial multiplied by the number of visits provided.
A savvy front desk staff member will utilize the insurance plan alerts within the electronic health record (EHR) and avoid making an appointment with a noncredentialed provider and manage other payer limitations before services are scheduled or provided. Informing the patient at the time an appointment is scheduled of known limitations or out-of-pocket expenses reduces confusion and frustration, and increases the probability of prompt payment.
Day of Appointment
On the day of the appointment, a skilled team member will use patient photos captured by the EHR for security purposes to greet each patient by name as they approach the desk. A personal welcome starts every visit on a positive note. Patients grow weary of responding to the same questions when their visits are in short sequence. If a patient’s insurance eligibility has been checked against the scheduled appointment, there should be even less reason to ask, “Is your insurance still [insurance carrier]?” Instead, the messaging can be more direct, “The insurance eligibility was checked for today’s visit, and your copayment is $35. Would you like us to use the card on file?”
The front desk staff should work closely with the billing team to ensure that changes to payer policies are understood and shared with the providers. Each team member has the opportunity to review the payer Listserv and email notifications routinely without waiting for denials to indicate change.
The number of rescheduled no-show appointments can even be attributed to the efforts of the front desk.
General Housekeeping
Before considering any candidates for the job, take the time to define the scope of the position. It sounds oversimplified, but this exercise will draw attention to the priority of specific functions and the importance of this role for the practice. It is not uncommon within a chiropractic office for the staff to function as a team—everyone covers for everyone. However, this approach can lead to staff members being the Jack-of-all-tasks and expert of none unless it is carefully navigated. Think about the body of knowledge and level of detail really needed to successfully manage the front desk.
The ability to multitask is an essential skill, and the ability to respond to multiple tasks without losing the personal touch is a skill that should always be rewarded. Track the task to have tangible evidence of the positive impact front desk staff members have on the practice. Consider monitoring the decrease in rejections because of eligibility or insurance identification issues. Utilize daily scheduling reports to confirm the number of anticipated copayments against those collected. The number of rescheduled no-show appointments can even be attributed to the efforts of the front desk.
Performance indicators may vary by practice, but the need for vital staff members to feel valued and understand their key role in the overall success of the practice is universal.
It is important to have qualified chiropractic staff in addition to the most current equipment and resources to care for the patient. No one would argue that point. Running a successful practice requires constant attention to the entire workflow and being open to opportunities for improvement. And it does all start with the front desk.
Kama Morrow, CPC, RCC, CCS-P, is the client services manager for Practice EHR. She has spent nearly three decades in the industry leading electronic health record (EHR) implementations and providing consulting and training for a variety of healthcare organizations. Morrow is a frequent contributor to highly regarded industry publications and national conferences, providing insights on practice management, coding, billing, and other industry-related topics. For more information about Practice EHR, email info@practiceehr. com or call 469-305-7171.
