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Maximize Revenue With Front-Desk Protocols

The Doctor's Office, March 12, 2008
Too often, providers overlook front-desk procedures as a tool for protecting their money. Having fundamental frontdesk procedures in place is a vital component to having a claim paid the first time it is submitted to the insurance carrier. Some areas to watch include:

1. Checking insurance eligibility. The eligibility of the patients may be checked by staff members at the time of the patient's arrival, before the patient arrives, or the day before the patient's appointment. However, an exception to this policy may be when checking the eligibility of Medicaid patients. In some states, the status of a patient's Medicaid eligibility could be changed at any time up to midnight. In this case, the best way to verify the Medicaid patient's eligibility is to check the eligibility on the day of the appointment.

2. Verifying demographic information. Medicare has issued a directive stating that the Medicare patient's name, birth date, the spelling of the patient's name, and the ID number should be verified against the patient's Medicare card to ensure that this information matches the information in your computer system. If any of the information is incorrect, Medicare will deny the claim. These protocols should be in place when validating the demographic and insurance information for all of your patients, regardless of the type of insurance.

3. Collecting copays and outstanding self-pay balances. It is usually best to collect the copay before the provider sees the patient. Also, it is important to check the amount of the patient's copay each time the patient comes into the office. Besides collecting copays, the front desk may also collect outstanding balances.

4. Completing registration forms. Having the patient complete and sign a registration form is essential for the front desk to oversee so that all of the pertinent information is available to be put on the claim.

5. Putting the charges into the computer. Following are some of the questions that should be addressed before the charges are entered:

  • Is the patient new or established?
  • If there is more than one diagnosis, are the diagnoses being put into the system in order of importance?
  • If there is more than one procedure code, does each procedure code have its own diagnosis?
  • Are the correct age-specific annual codes billed?
  • Is the claim being submitted to the current insurance carrier?
  • Are the ID numbers on the claim correct?
6. Answering the telephone. Telephone etiquette is another aspect of protecting practice revenue. Strong telephone skills will create a positive impression. It is important that when front-desk personnel answer the phone, they identify the practice and give their own name.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor's Office, a monthly newsletter by HealthLeaders Media.