Self Pay Collections and Insurance A/R Needs THIS From Your Offices

Nearly every healthcare organization is challenged by the tension between their patient access (front office) processes and their business office (or back office) processes. Even though both areas handle the same patients, missed opportunities for self pay collections, errors or omissions in data capture, and miscommunication can all result in a halt or slowdown of the overall process that ensures proper payment is received for the care provided. 

With few exceptions, healthcare organizations are structured to manage the front office and the business office separately, but in order for self pay collections and insurance reimbursement to succeed, there must be collaboration. While their responsibilities differ, the front office and back office both share the same goal: to extend the excellence in care to a positive patient financial experience without leaving money on the table.

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When the front and back offices work together

We often say “patient care doesn’t end at the exit door,” implying that the patient financial experience is part of the continuum of care. But honestly, patient care could end at the exit door if the front office and back office are successful in their roles the first time, and every time. Here is a window into what that might look like.

Front office:

  • Captures complete and accurate patient and insurance data
  • Clarifies for the patient his or her insurance details, including deductible, co-pay and coverage
  • Confirms eligibility for services and, if necessary, discusses this with the patient in advance
  • Determines any previous balance (either a self pay balance or an estimation of monies owed based on the patient’s insurance)
  • Explains and/or educates the patient about his or her financial responsibility
  • Asks for and receives co-pay and/or any previous balance

Back office:

  • Submits a clean claim to the payer(s) via automation of patient management system (PMS)
  • Focuses on edit design and management to increase clean claim rates and reduce payer denials
  • Receives proper reimbursement
  • Handles appeals from the payer based on what the patient’s insurance does or does not cover

Note what the back office doesn’t have to do when the front end gets it right:

  • No calls or research to correct errors in patient data or insurance information.
  • No claims submitted with errors made by the front end and/or missed by the back end
  • No denials due to errors made at the front end
  • No need to send patient statements
  • No outbound or inbound calls with the patient to resolve patient balances

Ultimately, the front office and back office working harmoniously means cost to collect will decrease.


A smooth workflow between the front office and back office creates other desirable outcomes:

  • Costs to collect are mitigated
  • First time claim payment rate climbs
  • Denials rate drops

Indeed, the patient in this model will remember his or her care as the “whole” experience (because the financial experience would be less of a factor in overall patient satisfaction), and the healthcare organization would benefit from maximum reimbursement.

Of course, this is a utopian scenario. In practice, it doesn’t always happen this way, and in some cases it doesn’t often happen this way. Yet thinking of the “ideal” process helps identify areas for improvement as well as ways to eliminate that wedge that sometimes creeps in between the front end and back office when collaboration isn’t at its pinnacle.

Success is in your staffing model

Why are so few organizations getting the front office/back office workflow and relationship right? Often, it’s because they haven’t hired or trained the right skills for front office, patient-facing positions. Like putting your best foot forward, provider organizations require highly skilled staff who qualify as detectives, educators and empathizers, not to mention detail hounds.

Front office staff—both those interacting by phone and in person—must demonstrate compassion toward patients while being able to articulate benefits accurately and answer questions thoroughly, keeping in mind that the patient may be very ill, may have many bills from multiple organizations and may need assistance in putting all the pieces together.

Thinking even more broadly, front office staff must be trained to see the importance of their roles to the entire A/R process, to overall patient satisfaction. When they realize they are integral to the entire revenue cycle, and when they are properly trained to use the right words, timing, and tone, they will take care to capture data accurately and will also be more at ease in asking for patient balances to be paid prior to or at the point of care.

Further, in the back office, hiring highly skilled staff and training them thoroughly on your patient management system to automate the claims filing process and create edits to kick back claims with errors will improve productivity and will keep office metrics in check. For some organizations, cross-training between front end and back end often improves employee morale and workplace satisfaction, increasing understanding and communication between the two.

The Bottom Line

Your self pay collections rely heavily on your front office and back office working seamlessly together, or else you’re depriving your organization of considerable of revenue and/or margin. If you’re looking for more ways to increase your self pay payments, you might be interested in our eBook, A Winning Self Pay Strategy. Click below!

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About Holly Krueger, Vice President, Strategic Partnerships

Holly Krueger, Vice President, Strategic Partnerships

Holly’s many years of healthcare revenue cycle expertise, both operationally and as a vendor provider of services and software, prepared her perfectly for her current role. She brings a fresh perspective to MediRevv's executive team and is responsible for leading strategic account initiatives and enhancing overall client engagement.

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