Front Desk and Patient Responsibility April 24/25

2015 User Conference
Front Desk and Patient Responsibility
April 24/25, 2015
Presented by:
Christopher Becker
PM Session
Front Desk Responsibility
Main Areas of Responsibilities Involving
Practice Collections
1. Registering the Patient.
2. Collecting Insurance information.
3. Checking Eligibility (validating Insurance).
4. Collect Patient Copay/Payments.
In addition to:
Checking in Patients.
Forms handling, signature and/or scanning information.
Answering phones.
Making Appointments.
Changing Appointments.
.....and being nice and pleasant to your patient’s parents.
2015 Office Practicum User Conference
Front Desk Responsibility
Patient Registration/Updating Registration
1. Filling in as much information as possible into OP.
a. A new patient form that has information ordered the way it is input
into OP saves time and decreases errors.
b. In OP14 new “families” designations when properly filled in can
reduce billing and statement issues.
c. If the practice is participating in MU or PCMH or other incentive, it
is essential to fill in information with a “red mu” designation.
d. Confirm the address of new patients with a drivers license or some
other identification.
e. If the patient is not new, on every visit ask the following questions:
i. Do you still live at?
ii. Is your phone # still?
iii. What is the best number to reach you?
iv. Has your Insurance changed?
f. Ask the above at every visit...even if the patient or family was seen
the day before.
2015 Office Practicum User Conference
Front Desk Responsibility
Collecting Insurance Information
1. New Patients
a. require a copy of the patient’s insurance card. If one is not
available assume nothing.
i. Recommendations are that the practice establish guidelines on
entering unconfirmed insurance.
b. If a card is available either scan it in before entry or photocopy for
later scanning.
c. If the patient’s plan does not exist in OP, check with your office
biller to confirm the addition.
d. Most insurance plans show the parent as the policy owner,
however most medicaid plans require the patient as the policy
owner. It is important to make sure the front desk personnel know
which is which.
e. Once the patient’s insurance plan is entered into OP and properly
linked to the plan, remember to set as primary (or secondary).
2015 Office Practicum User Conference
Front Desk Responsibility
Checking Patient Insurance Eligibility
New or existing patients should have eligibility checked prior to or at the time
of the visit every time the patient is seen...even if it was yesterday.
1. OP supports individual and batch insurance eligibility checking.
2. Eligibility requests are sent through your clearinghouse to the patient’s
insurance plan. The plan responds to the request send patient eligibility.
NOTE: the clearinghouse does not change or alter the information from
the plan. Not all insurances send the information you need.
3. When the patient is checked in, real time eligibility should be run while
the parent is standing there. This provides an opportunity if the eligibility
is returned as inactive or canceled.
4. In addition, eligibility can be checked one to several days in advance
using batch eligibility from the schedule tracking screen.
5. There is an “art” to getting the most meaningful eligibility into OP.
2015 Office Practicum User Conference
Front Desk Responsibility
Collecting Patient Copays/Payments (cont)
1. Make use of “@@” in order for the front to be aware of past balances,
updating insurance or other information.
2. The parent should be told the copay/past balance amount and asked
what method they would like to use.
3. SAY NOTHING AFTER THIS...because...the next person who talks
loses. This can lead to an uncomfortable silence, but eventually the
parent will respond.
4. Most likely they will present an accepted method of payment. If they
cannot pay, the front desk should follow the internal payment policy the
practice has established.
5. Any payment should have a receipt given to the parent.
6. If accepting a card for payment, best practices dictate the card is never
out of sight of the parent. DO NOT ENTER the card number, with the
exception of the last 4 digits.
7. If possible, have a private place the parent can discuss payment issues
so that it is not done at the front window.
2015 Office Practicum User Conference
Front Desk Responsibility
Collecting Patient AR
Be aware of your patient A/ is the most difficult to collect.
OP14 comes with excellent reports to manage Patient A/R.
Understand the three “legs” of patient collection (in order of success):
▪ Time of service.
▪ Phone call for unpaid balance balance.
▪ Patient statements.
▪ Consider additional patient options:
▪ Card on file.
▪ Payment plans (through automatic card payments).
▪ Statement payment through your patient portal.
▪ Member directed payment from the insurance plans.
▪ Things to avoid:
▪ Post-dated checks.
▪ Discounts (with some exceptions).
▪ Inconsistency in handling patient collections.
2015 Office Practicum User Conference
Front Desk Responsibility
Receiving the Best Eligibility Possible
1.Make absolutely certain the correct Real-time
ID is used. Never assume it was the same as
the previous clearinghouse or your old system.
2.5010 rules require the use of either the group
NPI or provider NPI...however they do not
specify a preference, that is at the payer's
3.Service Type codes often determine correct
copay fields:
a. 30: Health Benefit Plan Coverage,
returns the most insurance info, but
often gives incorrect co-pay.
b. 98: Professional Physician Visit Office, insurance info specific to
physician office, often delivers the
best co-pay info.
c. 96: Professional (Physician), similar
to 98, but required as the only code
for many BC/BS plans.
2015 Office Practicum User Conference
Front Desk Responsibility
Receiving the Best Eligibility Possible
4.Patient-Guarantor issues
a. Some payers require that the
guarantor information be sent, in that
case, check the box at the bottom of
the tab. This will avoid any potential
changes to the patient record.
5.Primary ID for eligibility:
a. Although 5010 mandates use of NPI,
there are many plan exemptions.
Nearly all Medicaid plans are
exempt, some BC/BS plans are as
well as municipalities. You may need
to check with a specific plan to see
what they require.
6.Medicaid/Commercial HMO's:
a. Most Medicaid plans do not return
PCP assignment. This is not an OP
or Clearinghouse issue, it is a plan
decision. The good news is that we
have recently been seeing them, and
our hope is that it will continue.
2015 Office Practicum User Conference
Front Desk Responsibility
Receiving the Best Eligibility Possible
Getting the right eligibility approaches
an art form. Why? Because the
standards are open to interpretation
by the plans.
Consequently, don't be afraid to be
creative, you may have to try multiple
combinations of codes to achieve the
correct eligibility. Never assume the
real-time eligibility is correct, if it does
work, contact your Clearinghouse to
see if there has been a change or
2015 Office Practicum User Conference
2015 Office Practicum User Conference
We want your feedback!
2015 Office Practicum User Conference