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Reimbursement and Practice Management

Lean: Up Front

Steps to assess and improve your medical practice front office efficiency.

After reading this article you will know how to:

  • Assess workstation efficiency
  • Identify ways to improve workflow in the front office
  • Evaluate the use of paper processes used to obtain patient information
  • Identify ways to shift information gathering and data entry

View related pearls

Your front office is much more than an administrative work area; it is the hub of your practice — a place where patient flow begins and where each worker's efforts make a lasting mark on your patients' perceptions of service quality. This area is key to starting the revenue cycle off on the right foot, yet it's not uncommon for practice leaders to all but ignore the front office when searching for ways to enhance operations.

The employees in your front office are critical to your bottom line. Think of them as your "directors of first impressions," as well as your "chief officers" of time-of-service collections, denial prevention and patient arrival. Because the front office performs such a wide variety of functions, it is an apt choice for improvements. Here are a few opportunities to consider:

Workstation. In many practices, front office employees seem to be constantly on the move, which is to be expected when you've stationed the photocopier on a table near the back wall, the scanner on a shelf adjacent to a doorway, the credit card machine in the business office and the fax machine at the nurses' station deep inside the clinical area. Those may not be the exact placements in your practice but you get the idea. Everyone may get good exercise doing their jobs but forcing these employees to constantly leave their desks drains productivity, which costs you money.

Recapture that lost productivity by developing a workstation that envelops the front office – one that puts the employee close to the tools and resources he or she needs to get the job done quickly and correctly. Use this as your mantra: the employee should never have to get up to perform his or her job. Depending on your current space, you may need to rethink the placement of machines, purchase additional cabinetry and, perhaps, consult with a professional, such as an architect or designer.

Creating efficient and effective workstations is a great place to start your improvement initiative because employees can see the results quickly and appreciate your efforts, which, in turn, facilitates their embracing other changes you have in store.

Paperwork. Gather all the forms and other paperwork you use in the front office. This may include forms for registration, waivers, medical histories, referrals and other information you routinely collect from patients. Assess each piece of paper for the following characteristics:

  • Professionalism – Does it reflect the practice in a positive manner, or has it been repeatedly photocopied into a blurry mess?
  • Formatting – Are forms and other paperwork, structured for the most efficient use? Does your medical history form give patients enough space to enter their information, or must they write into the margins in micro-script?
  • Redundancy – Are you requesting the same information over and over again?
  • Necessity – Do you really need all these forms (and if the answer is 'yes,' are there other opportunities to gather some of that information elsewhere, such as during the scheduling call)?

Information Input. Look for different ways to gather information from patients. Do you have the capacity to automate the process? What patient data does your current process require your employees to re-key into a computer? Could you automate the collection and entry of that information? Or, could you shift some of the effort to the patient by turning them into focused, temporary, unpaid employees?
Many businesses are familiar with this concept. Restaurants that offer salad bars are, in essence, asking the customer who wants salad to serve as unpaid wait staff. Banks provide ATMs so that the customer can do the teller's job. In the same way, engaging patient to help you will add value to you - and to the patient. The scope of duties for these "free" employees can range from minor (using an electronic signature pad) to fundamentally transformative (implementing a "boarding pass" system that allows patients to check in at home, and eliminating the front office altogether).
Implementing the self-service approach has its downsides (accuracy concerns, for example) and costs (you may have to invest in computer kiosks or tablets for patients to use), but the goal should remain the same: create more value and convenience for patients — and you.

Administrative Tasks. Collection of patient information — demographic and insurance information, for example — is often performed at the front office. Although we tend to focus on the consequences of errors, don't forget that mistakes made at the front office negatively impact the patient, too. One incorrect digit recorded for a cell phone number means that the patient won't receive notification of a test result in a timely manner. One mistaken keystroke in the patient's insurance policy number may equate to the loss of a thousand-dollar bill if it causes a denial.

Every transaction is critical to ensuring the patient's experience with your practice is a positive one — one that allows both parties to focus on the patient's care and treatment plan. Take some time to assess the workflow related to the important administrative tasks taking place in the front office, recognizing that your efforts benefit your patients, too. If you have automation tools in place to verify insurance eligibility and collect time-of-service payments, look to see if your employees are using them.

All too often, we assume that the introduction of a new resource erases a deficiency, yet the tool is only as good as the employee who uses it. If, after implementing a new resource or tool, a gap remains between expected outcomes and actual results, perhaps that resource isn't being used as you intended. When patient eligibility determination and other business-critical administrative tasks are not performed as needed, it's an opportunity to invest time and effort into re-training employees, documenting the workflow, establishing expectations and monitoring performance.

Arrival. The front office is the front door of the practice, and the role of communicating the patient's arrival is a vital one. Completing the arrival step successfully results in a notification to the clinical team that the patient is ready to be seen. A properly executed arrival sequence also records the patient's arrival into the practice management system, which can later serve as an invaluable cross-reference for billing purposes. "Arriving" the patient is a step that must be performed in a timely manner with utmost attention to accuracy; anything less introduces delays into the daily patient flow and, ultimately, dissatisfaction for patients. 

By prioritizing the role of the front office, you are putting the spotlight on all of the processes that emanate from this vital sector of your practice. By focusing on the need to provide value to the patient, your efforts can pay off in the form of more consistency in customer service, recording of information, and, ultimately, patient flow.

Pearl: Outfitted for Success

Provide the training, tools, equipment and resources your employees need to get the job done. If you want your staff to process patients through the front office quickly, then strategize what needs to be done to make that happen. Automate insurance eligibility, make practice forms available on your website for patients to download (so they can bring completed forms to their visits), and buy a high-speed scanner for each staff member to use, with the placement of the equipment at his or her workstation.

Pearl: The Buck Stops…

Stop setting your front office up for failure by assigning too many tasks to one individual. Do you ask one person to answer telephones, greet and register patients, schedule visits, and so on? This may be fine if you only see a handful of patients a day, but in busy practices with multiple physicians you can't assume that one individual can handle all of the work.

Think about the position and find ways to streamline its task. For instance, designate one individual to answer telephones and another to schedule follow-up visits – they can cover for each other, or even rotate positions, to better facilitate accountability and training. It will give the employees a sense of pride in their jobs (vs. simply "holding down the fort"), and create a win-win situation for your practice.

Pearl: Back Up Power

Integrate a back-up plan into your operations. Each afternoon, take a few minutes to review the next day's schedule so changes can be shared with the front office by 4 p.m. When a provider schedule change occurs, immediately contact the patient(s) to reschedule. Schedule changes should be exceptions – not routine. Ideally, it would be "one and done" scheduling – yet "life happens". Back-up plans are valuable because they allow you to comb through schedules to spot mistakes

Pearl: Delayed Awareness

Communicate delays to all stakeholders. Make sure that physicians know to notify the office immediately when they are delayed — especially if it is a tie-up offsite. Make it a standard protocol that this news is passed along to the front office immediately, too.

Occasionally, clinical staff or nurses take calls from physicians about a delay, get busy and inadvertently forget to inform the front office. When a physician is delayed 20 minutes or more, it is a good idea to offer patients who are waiting for their delayed appointment the choice of rescheduling or continuing to wait. Simply having a choice will make patients feel less put-upon when a delay occurs. If necessary, bring added support staff to the front office to help with rescheduling appointments.

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