Efficient Front-End Processes Critical for Revenue Cycle Management Success

The current revenue management cycle that is used by most healthcare organizations consists of two parts: front-end and back-end. Mostly the front-end deals with the patients and back-end resources deal with billing and claims management. Each component of the revenue management cycle has its own procedures and consists of separate departments and staff. Increases revenue and reduces cost with immaculate patient intake with Sybrid MD front office management.

The front end is responsible for patient interactions and is a crucial part of revenue generation for healthcare. The front-end processes are important for healthcare providers as they represent the face of the medical organization. The staff responsible for the front-end operations is the first people a patient interacts with when they decide to choose the service of particular healthcare. The key front-end processes are:

Scheduling an appointment

Scheduling appointments is the first and the most important part of front-end operation. It is the patient’s first impression of healthcare and its services. Healthcare should ensure a properly planned schedule in order to decrease the patients waiting time and increase the overall productivity of healthcare and physicians. Mistakes during scheduling can lead to waits and patients getting the same appointment time. This is not good for healthcare and its reputation as it can also jeopardize the revenue and growth of providers.

Healthcare with a customer-centric approach will perform well in this situation. The patient should feel that their time is being valued and in case of delays in appointment timings that mindset of the patient might change which can adversely affect the healthcare business.

On-time scheduling is beneficial for both the physician and patients. Since in healthcare, it is important to give each patient proper time this can be assured through on-time schedules with no delays. Hence, it is important to use various communication mediums like phone calls, text messages, emails. Text reminders can help can minimize wait time and ensure the on-time arrival of the patients. Most healthcare providers have shifted towards automated scheduling to improve efficiency and are using technologies such as patient portals. It helps the patient to book an appointment from the comfort of their homes.

Eligibility verification and registration 

After the successful scheduling of an appointment, the front-end moves towards the eligibility verification step. Here the front-end staff record patients’ demographics using either the practice management system or the Electronic Health Record (EHR) application. Patient data include their insurance information, social security number, income, demographics, background, and medical history.

To ensure the smooth running of the front-end operations, it is important to train the staff to gather complete and accurate information of the patient. This is crucial for a seamless revenue generation. Accurate verification of the patient’s data provides the basis for efficient collection of bills and claims.

Eligibility issues can include recording incomplete or incorrect information that can make it hard to make an accurate claim or even lead to claim denials. A claim that is sloppy and not very specific has a higher chance of being rejected. Hence, it is essential to make sure that the eligibility of each patient is properly checked. Some important questions related to the eligibility verification include,

  • Is the patient already covered?
  • Is the patient currently availing of any benefits program or additional insurance?
  • Is the information related to eligibility and insurance is accurate and complete?
  • How much of the cost can the patient pay if there is co-pay?

So in order to avoid claim denials, the front-end staff needs to make sure the patient’s information is complete and accurate. 

Collecting upfront 

With the increase in the popularity of high-deductible medical plans, more and more patients are paying out of their own pockets. It has also reduced the number of patient accounts that might end up in bad debt. This is why the upfront collection is getting more and more important for healthcare revenue-boosting.

Healthcare can come up with payment plans that help the patient to pay their medical fee in installments, allowing patients to pay off their medical bills over time. Another option is to allow multiple payment options easing up the payment process for the patients (credit or debit card payment, payment through cash, etc.). 

The modern healthcare industry is moving toward a customer-centric value-based system. As more and more healthcare companies are adopting this approach it is important to establish a front-end revenue management cycle that is efficient to provide a seamless running of operations and providing a highly satisfied patient experience. All the components of the front-end operations including the scheduling, eligibility verifying and upfront collection need to be in perfect alignment with each other as well as with the back-end operations. The healthcare provider can also partner with various billing service providers, billing experts, and medical coders to ensure the smooth running of the RCM for effective revenue generation.