Like a football team, every medical office has an offensive line.  The offensive line is responsible for protecting the quarterback and ensuring that the ball crosses the goal line before they run out of plays or time on the clock expires. Get into the mindset that your front-end staff is your offensive line and scoring touchdowns is your balance resolution. The more effective your front-end team is in preventing denials, the faster and more efficiently you can score a touchdown.  

A few simple adjustments to your playbook will have your offensive line in shape and ready for game time. Check out these 5 training tips and put them into action for your organization:  

Training Tip #1: Implement a Checklist - It is Simple, Effective and Maintainable

Develop a comprehensive checklist of all information that needs to be obtained or verification steps that need to be completed by your front end staff during or prior to a patient’s visit.  Divide this list across the various front-end teams (scheduling,  pre-access, etc.) to ensure each team is responsible for functions appropriate to their roles. Perform routine quality reviews to confirm that your list remains comprehensive in an ever-changing revenue cycle world and that each team member is upholding their obligations.

Training Tip #2: Listen to Your Denials and Create Feedback Loops

Analyze your denials—were they preventable? If so, during which step did the checklist break down? Can you identify an individual or group of individuals who are contributing to the denial pool?  Dig deeper to truly understand the root of the problem.  Perhaps authorization was obtained, but not recorded in the billing system. An insurance card may have been captured at the time of service, but coverage was not verified with the payer.  An ABN may have been presented to the patient, but not completed accurately. Each of these scenarios is preventable and easily correctable when you listen to what the denials are saying.

Training Tip #3: Assign Subject Matter Experts and Share the Knowledge

There is a time of panic for every clinic or office when the subject matter expert leaves the organization. Say MVP employee, Cam, knew everything, and now he is gone! Cam has been managing procedure authorizations single-handedly for the past 10 years. No one knows more than Cam, in fact, no one knows anything about authorizations but Cam. But this scenario, too, is preventable.

It may not make sense to have every individual in the office be an expert on every facet of the pre-bill procedures, but all procedures should be well documented, easily obtainable and shared in a basic capacity with all team members on a routine basis.  This ensures that when Cam is out of the office on an extended leave or retires after years of service, the office won’t be at a stand-still while his replacement starts from scratch.

Training Tip #4: Improve Patient Communication- and set financial expectations upfront

While conversations with patients about their coverage can be uncomfortable, it is important to have them proactively.  When a patient better understands their coverage, out-of-pocket expenses and liability for any non-covered services before their visit, they are prepared for any related bills they may receive after services are performed.  All too often, this lack of proactive communication leaves the patient feeling frustrated and deceived. They may even have agreed to services that are beyond their financial means due to unclear expectations at the time of service. Additionally, setting expectations that copayments and past due balances will be collected at time of service increases collections.  When patients are well informed, they can anticipate their balance due and budget for related expenses.  This will decrease the effort required for collecting patient balances after payer processing and also decrease the receivables adjusted due to bad debt.

Training Tip #5: Document, document, document- to reduce confusion and save time

Train your team to document everything.  When Cam speaks to the payer to obtain service authorization, he should not only be recording the authorization number but the name of the representative at the payer to whom he spoke, the date and time of the call, a reference number for the call and he should scan any approval documents to the EMR.  If a new address is provided for the patient, document who provided the information and confirm that it is updated across all ancillary systems.  As discussions regarding service coverage are had with a patient, the conversation should be summarized and logged.  Should there be later disputes regarding any of these items, they will be well documented and accessible by any team for follow-up work as needed.

The Bottom Line

While as a coach you cannot plan for every game time situation your team will encounter, developing a solid training plan will help defend your team against preventable denials, patient complaints and miscommunication among teammates and help your team get to that goal line faster. Follow the above tips to ensure a well-trained and competitive front line offense in your healthcare organization.