First Spin in the Revenue Cycle: Good Front End Practices Make the Difference
By Michael J. Landers
Senior Consultant
Beacon Partners, Inc.

Like other industries, health care today tries to do more with less. Physician practices – like hospitals and other medical organizations - operate “lean,” using a minimum of people to get the work done. This approach is boosted by a newfound focus on “best practices”: heightening efficiency to maximize time and effort.

However, sometimes the front end of physician offices operates so lean that it compromises the quality of information captured. Office staff cannot commit the time to ensure thorough patient registration, referral management and health coverage verification. As a result, the revenue cycle suffers. Payers reject billed claims that lack accurate demographic and insurance information. Poor front-end practices produce poor billing statements that can drastically decrease the incoming flow of cash.

Problems with registration
Patient registration performed in a practice’s front office is often inadequate to meet the needs of back-office billing staff. In this “do more with less” world, too few front-desk employees must often strive to perform too many tasks, such as:

• Greeting patients;
• Collecting demographic insurance information;
• Booking appointments;
• Coordinating the referral process;
• Answering phones; and
• Managing the office’s patient flow.

Practices often add the registration process to an already full plate. Such a burden may result in less attention to the registration process and its quality. As a result, back office staff faces claims clean-up to rectify missing data required by third-party payers.

Create a central registration unit
Registration generates an organization’s bread and butter with respect to timely reimbursement. Administrators should consider it a priority to streamline the process and keep it cost effective. A central registration unit is one solution to streamline the registration process. By designating key staff members as registration experts, a practice can shift the process from the front desk to employees who have dedicated responsibility for it. This frees front-desk staff to manage patient flow and appointments.

Although a group may need to invest time and training for a central registration unit, the return from increased cash flow should offset upfront expenditures. Where operational design permits, a practice might reorganize existing staff into the registration unit rather than hire additional employees.

Separate registration from the front desk
Another option is to separate the registration process from the front-desk setting. A full-time registration clerk in the back office can work away from hectic front-desk activities, achieving cleaner, more thorough patient registration.

Consider preregistering patients by contacting them prior to scheduled appointments to ensure that you have all required demographic and insurance information. This works well in high-volume offices where it’s difficult to complete full registration at the time of visit. Patients then only have to verify their information when they arrive, expediting the registration process. Specialist settings, which often have lower patient volume, may accomplish preregistration at the time of appointment scheduling.

When registration occurs before a visit, the practice has more time to verify insurance coverage and ensure that information provided by the patient is still in effect and entered accurately. If coverage issues arise, the patient can resolve the problem with the insurance company.

Maintain training
Don’t overlook ongoing training. Too often, front desk employees tackle job responsibilities without adequate training. Bad habits may develop from the first day on the job; rectifying them may require considerable time and effort. Good internal training programs that incorporate daily processes with existing policies and procedures may prevent small errors from snowballing. Furthermore, employees can ingest the information in a controlled setting free from the hectic pace of the front desk.

Regardless of the option employed, the quality of registration information captured by staff trained to focus on that task is a great improvement over that of employees who must also handle extensive front-desk tasks. Your organization will more readily attain the goal of getting it right the first time. Although you may spend some money upfront to implement a central registration unit or separate registration responsibilities from the front desk, you should save money as a result of fewer denials and less follow-up.

Reprinted with permission from the Medical Group Management Association, 104 Inverness Terrace East, Englewood, Colorado 80112-5306; 303.799.1111. www.mgma.com. Copyright 2005.