Front-loading revenue cycle can improve patient service, save money, expert says

SAN FRANCISCO -- "Whether you believe it or not, the front desk is the face of your organization."

That's the bottom line for medical practices, said William Augustine, director of revenue cycle for Asante Physician Partners in Medford, Oregon.

Making that bottom line work for your practice may require a reorganization of resources that may not feel natural to your practice, he said, but it is essential to improving up-front patient interactions and revenue cycle function.

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Augustine painted an all-too-familiar picture for his audience at the 2017 Medical Group Management Association Annual Conference in San Francisco Monday to make that point: the bustling front desk in your doctors' office where staffers collect copays, check in patients, verify insurance, collect mail, handlie phone calls, schedule appointments and scan, all while multiple patients wait to be seen.

As a patient, he said, you walk up to the desk and often the person doesn't look up, so you end up looking at the top of their head because they are too busy doing any number of other things to really give you their attention.

With the front desk buried, staff can get frustrated because they are trying to help patients, and Augustine said in his previous roles he almost always heard people in the billing office complain about the front desk.

"If the front desk could just get it right I would be able to get so much more done."

[Also: Mid-cycle losses have healthcare focusing on coding, predictive analytics to improve revenue cycle]

Meanwhile, the practice's executives wanted to know what the billing office was doing to reduce the number of days claims spent in accounts receivable, but declined to hire more people.

If you want to make sure the right people are manning the front desk, and clean claims are the norm not the exception, the answer is to front-load the revenue cycle process, Augustine said, starting with your perception of what exactly that cycle includes.

"Revenue cycle is all the way from beginning to end. From the minute of the first patient contact, the account is zero over done, you've reported on it and everybody is satisfied. That's revenue cycle."

It is not limited to the commonly perceived duties of sending claims, posting payments and following up. In fact, it includes check-in, verification, up front collections, benefits and so on.

Augustine said he even agrees with the notion floated by some that it starts with recruiting the right physicians, and making sure they're contract eligible.

[Also: Cerner names RCM expert Jeff Hurst to lead revenue cycle business]

Front-loading that revenue cycle means moving the process of making sure claims are correct to before you send them out, something that may seem obvious, but as far as he has seen, is not common practice.

It means a shift in timing of the billing steps, in personnel and in tools that makes these changes easier, he said.

The most crucial key is to make sure that verifying the patient's information is a priority before they walk in the door -- that includes all insurance verification -- and knowing exactly how you're going to get paid before the patient even gets there.

That means reviewing demographic information, insurance and benefits, and having a conversation about what they will owe and how they are going to pay before the patient arrives, Augustine said.

To make this possible, practices must reorganize some of their billing personnel and put more people on these front-end duties.

Here's where the front desk and the billing office strike their balance. Augustine strongly cautioned against reassigning employees from the billing office to the front office. Inevitably, he said, they will become the front desk person who is too busy doing other things to stop and speak to patients who are trying to get their questions, concerns and needs met.

"You want nice cheery people who like working with patients up front. These are not your denial people. You want denial people who are bulldogs, that are going to fight with the insurers. So leave them in the billing office, but just give them a new role," Augustine said.

He highlighted a few simple tools that will help facilitate this transition: At a bare minimum there should a report or work list of appointments three to seven days out that employees can work from to start doing insurance verifications.

Also, a patient demographic sign-off sheet should have basic demographic information waiting for the patient when they come in. It should be clear and concise and generated from the billing system, then given to the patient to acknowledge and sign.

If their patient information has changed, it is important to reach out to your verification team to do an on-the spot insurance verification.

Also, if the opportunity for automation exists, do it, he said.

"It's the front-loading concept that you want to take away. So maybe you've got something that does this automatically, make sure it's doing it before they come in so you can interact with the patient," Augustine said.

And remember, this is about your bottom line too. Augustine pointed out data that show it costs roughly three times as much to fix a denial after the fact then to get the claim right the first time. If you get it right on the front end more often, you'll see significant cost savings.

The same concept applies to days in AR. It takes three times as long there if a denial has to be fixed then if you get it right the first time, Augustine said.

Keep in mind, change is not easy so be prepared. When you shift people from denials to the front end of revenue cycle, there will be a three- to six-month period where you either hire additional staff to cover for that period so that you have front end verifiers and same number of people on back end, or know that you're going to take a little hit on denial recoveries.

"In 3 to 6 months you will see reduced denials, and as you see reduced denials you won't have the need for those people you moved to the front end," Augustine said.

Twitter: @BethJSanborn