Title: Front Office Staff You are the KEY to it All
1Front Office StaffYou are the KEY to it All
- Presented by
- Joy Newby, LPN, CPC
- Newby Consulting, Inc.
- 5725 Park Plaza Court
- Indianapolis, IN 46220
- Voice 317.573.3960
- Fax 317.705.0131
- E-mail help_at_joynewby.net
2Front Office Staff
- Set the tone for the entire practice every time
the telephone is answered - Confirm the practice operates in a professional
manner and is respectful of patients - Assist referring physicians by scheduling patient
appointments quickly and efficiently
3Front Office Staff
- Start the billing process by collecting (and,
when performed, entering) patient demographics - Start the insurance filing process by collecting
(and, when performed, entering) the patients
insurance information - Determine when referrals are required for
services provided by the practice
4Front Office Staff
- Reduce expenses by collecting copayments at the
time of service
5The Customer
- The need for quality customer service and
satisfaction is at an all time high.
6The Customer
- Patients
- Patient Family
- Referring Physicians
7The Customer
- First contact is extremely important as it
generally defines the customers perceptions
about not only the practice but the physician(s)
as well.
8The Customer
- Attracting new patients costs three times as much
as it does to retain current patients. - In many practices, 75 of new patients are
referred from current, satisfied patients
9The Customer
- Research indicates that as much as 65 of
patient satisfaction is based on non-clinical
issues (like atmosphere, communications, and
customer service).
10The Customer
- 98 Dissatisfied customers never complain -
they just leave - 85 Dissatisfied customers tell 9 people about
their poor experience, and 13 tell 20 people
11The Customer
- A satisfied customer tells just 5 people
12Customer Service Phrases
- Perception is reality!
- The customer is always right, even when they are
wrong - Time is a commodity, just like money
13Customer Patience
- Patients expect prompt service!
- Most studies have shown that patients perceive a
reasonable wait time to be 15 minutes. - Frustration begins to set in at about 30 minutes
and goes down hill from there.
14Customer Patience
- If a patient is in the waiting room for longer
than 20 minutes past their scheduled appointment
time, proactively investigate the reason and take
action. Report these observations to your
supervisor. - Take notes on all patient complaints, describe
the situation as well as the patients complaint.
It may be necessary to adjust the scheduling for
specific services, certain physicians, brief and
extended visits, etc.
15Customer Patience
- If the physician is dealing with an emergency or
running behind, tell the patient when they
present for the appointment. - If patients are presenting early (more than 15
minutes) for their appointment without making
prior arrangement, be nice but remind them of
their scheduled appointment time.
16Customer Patience
- Waiting is not just an issue when your patients
present at the office. This is also an issue when
your physician sees patients in the hospital or
provides services at other locations such as a
nursing home.
17Publicity
- Word of mouth is powerful publicity.
- It can work for you or against you!
18Publicity
- Three types of publicity
- Good publicity
- Bad publicity
- No publicity
19Different Personalities
- Communicate in private
- Treat the other person with respect
- Preserve their dignity and your own
- Keep your focus on issues not personalities
- Assume the other person is expressing a
legitimate concern
20Different Personalities
- Listen with empathy
- Listen with neutrality
- Ask questions if necessary
- Convey that you are interested in the persons
ideas even if you do not agree with them - State your own views, using an I message
instead of a you message.
21Different Personalities
- Try to reach a compromise if possible
- Reinforce positive behavior by saying thank you
- Remember you do not ever want to get angry and
lose control or say things that you do not mean - When the confrontation is resolved, note that
laughter is said to be internal jogging.
22Different Personalities
- When encountering difficult patients, pause and
think before acting. - Do not forget that sometimes without realizing it
you can just get off on the wrong foot - It may be best to simply say, I cant help you,
but I will get someone who can.
23Manners
- Always mind the manners your parents taught you!
- Remember to say please and thank you
- Patients should not be called by their first name
without permission
24Manners
- Never refer to a patient by their condition such
as the sore throat in room one. - When interacting with referring physicians always
refer any physician as Doctor
25Telephone Etiquette
- Greeting
- Tone
- Quality
- Smile
26Telephone Etiquette
- Listening Skills
- Effectively handling telephone calls requires
excellent listening skills - It may be necessary to elicit additional
information needed for proper scheduling or when
taking a message
27Telephone Etiquette
- Holding
- Ask the patient if they can hold
- Wait for a response and acknowledge before
putting them on hold - Be cognizant of the length of time a customer is
on hold - Never place a caller on hold to finish a
personal, non-business related conversation
28Telephone Etiquette
- Messages
- If the person requested is not available, always
offer to take a message - All messages should be dated and timed
- Make sure you obtain all relevant information
29Atmosphere
- The reception area should not be
- Empty
- Chaotic
- Cluttered
30Atmosphere
- Is the waiting room clean and friendly?
- If your office offers reading material, they
should be kept current and relatively benign.
31Atmosphere
- Do not eat where patients
- can see you!
32Atmosphere
- Patient presents - Receptionist on phone
- Acknowledge the patients presence
- Make eye contact with the patient and assess the
situation
33Atmosphere
- Assisting a patient in reception area and the
phone rings - Be courteous to both parties
- If you are almost finished with the customer ask
the caller to hold one moment - If you will be a little longer with the patient
at the desk, consider having another staff member
handle the caller.
34Atmosphere
- Any conversations regarding other
- patients should be done quietly
35Atmosphere
- Keep personal conversations to a
- minimum and discussed quietly
36Atmosphere
- If the office opens at 800 a.m., this means that
all staff should be ready to work at 800 a.m. - This means you have
- already had your breakfast
- taken your coat off
- the lights and computers are turned on
- the patient entrance is promptly unlocked
- telephones are on, and most importantly
- a smile is on your face
37Atmosphere
- If your office offers refreshments in the waiting
room - Be sure the refreshments are ready when you open
- Someone is responsible for checking the supply
throughout the day.
38Atmosphere
- What impression does your appearance give to your
customer? - Does your appearance convey a sense of trust,
competence, and professionalism?
39Atmosphere
- Remember, perception is reality. Your attire
should be professional and reflective of the
practice.
40Atmosphere
- The following items should be avoided in the work
place. - Unique piercing such as tongue, eyebrow, or nose
- Garish nail polish such as black, blue, or green
- Garish hair colors such as blue, green, or pink
- Face glitter, stickers, jewels, etc.
- Exposed tattoos
41Atmosphere
- Strong scented candles or perfumes many make
patients physically uncomfortable or even ill. - If you smoke, be courteous
- Bring in a jacket or some type to wear outside
when you smoke. - Wash your hands immediately when returning from
your break - Freshen your breath
42Atmosphere
-
- When you leave at night, make sure there are no
patients left in the waiting area or exam rooms - If at all possible, at least one staff person
should remain in the office until the last
patient has left.
43Appointment Scheduling
- Patients Calling for Appointments
- When scheduling new patients, it is imperative to
obtain insurance information at the time the
appointment is scheduled. - Ask them to read their insurance card starting
with the front of the card, but make sure they
also read the back of the card.
44Appointment Scheduling Insurance
- Keep a log of all the insurance plans the
physicians participate in - Appointment schedulers must know the practices
process for scheduling patients when some
physicians are and others are not credentialed
with a particular insurer.
45Appointment SchedulingInsurance
- Verify
- Does your physician participate with the
patients insurance plan? - Is there a copayment?
46Appointment SchedulingInsurance
- If you determine that your physician does not
participative in the patients insurance plan,
inform the patient during the call - Explain that a lesser benefit may be payable if
they seek care from an out of network provider - If the patient choses to proceed scheduling the
appointment, explain your policy for claim
filing, payment, etc.
47Appointment SchedulingInsurance
- As the new patient reads the information from the
card, listen for key words such as HMO, PPO,
primary physician name, network physicians,
patient responsible for obtaining referrals,
prior authorization, etc. These are red flags
that the patient may be assigned to a specific
physician or network.
48Appointment Scheduling
- Remind all new patients/referring physicians that
they should bring the following items for their
appointment - Driver's License or picture ID
- Social Security Card (some patients may refuse)
- All insurance cards
- Employer information
- Name, address, and phone number of nearest
relative - Name, address, and phone number of emergency
contact
49Appointment Scheduling
- When time allows, consider sending an information
packet to the patient prior to the first
appointment. - Regardless of whether you send registration forms
or ask patients to present 15 minutes early for
the appointment to fill out forms
50Appointment SchedulingInsurance
- Copayments
- Listen for copayment information.
- Generally, copayment information is printed on
the front of the card. Inform patients having
copayment responsibilities that - Payment is expected at the time of service
- Whether you accept cash, credit card, checks,
debit cards, etc.
51Appointment Arrival
- Greet the patient
- Complete your registration process for all new
patients
52Appointment Arrival
- Confirm existing information for established
patients - Consider handing each arriving patient a printout
of his/her information along with a red pen and
ask the patient to review and correct the
information. - Updates should be made in the patient account.
53Appointment Arrival
- Review the patients insurance
- card(s) at each encounter
54Appointment ArrivalInsurance
- For new patients and established patients with
new insurance information, simply taking the
card(s) and copying them is ineffective. - You MUST read the card carefully to determine the
type of coverage and if any special requirements
apply, e.g. referrals, prior authorization,
copayments, etc. - Be sure to date and initial the copy to indicate
when the information was received and who was
responsible for entering the information.
55Appointment Arrival Insurance
- For established patients, compare the insurance
card(s) with the chart copy - Date and initial the copy when the information is
the same - Verify if the patient needs a referral
56Appointment Arrival Insurance
- Check-in staff determine which insurance is
primary when the patient has coverage under two
or more insurance plans.
57Appointment ArrivalInsurance
- Patient services involving accidents, e.g.,
workers compensation, automobile or liability
coverage, should be interviewed in private to
determine who is responsible for payment.
58Appointment Arrival
- Copayments
- You may collect copayments when the patient
arrives and checks in at the front desk - Alert the checkout staff if the patient states
they are not prepared to pay their copayment at
the time of service.
59MedicareFee for Service (Original)
Jane Doe
14
08
-
10
-
06
60What is a Medigap policy?
- A Medigap policy is health insurance sold by
private insurance companies to fill the gaps in
Original Medicare Plan coverage. - Medigap policies help pay some of the health care
costs that the Original Medicare Plan doesnt
cover.
61Medigap Cont' d
- A Medigap policy only works with the Original
Medicare Plan. If the patient joins a Medicare
Advantage Plan or other Medicare Health Plan,
their Medigap policy cant pay any deductibles,
co-payments, or other cost-sharing under their
Medicare Advantage Plan or other Medicare Health
Plan.
62Medicare Prescription Drug Coverage
- As of January 1, 2006, Medicare offers
prescription drug coverage for all people with
Medicare. Insurance companies and other private
companies are working with Medicare to offer
Medicare drug plans.
63Medicare Prescription Drug Coverage Cont' d
- There are two types of plans that provide
insurance coverage for prescription drugs. - Medicare prescription drug coverage that adds
coverage to the Original Medicare Plan, some
Medicare Cost Plans, and Medicare Private
Fee-for-Service Plans. - Prescription drug coverage that is part of
Medicare Advantage Plans and other Medicare
Health Plans.
64Medicare Advantage Plans
- Medicare Advantage Plans are part of Medicare
- Patients generally get all of their
Medicare-covered health care through that plan.
65Medicare Advantage Plans Cont' d
- Plans can include prescription drug coverage
- Most plans have extra benefits and lower
co-insurance than Original Medicare - Patients may have to use the plans doctors and
hospitals to receive covered services
66Medicare Advantage Plans Cont' d
- Includes Managed Care Plans (Medicare HMOs),
Medicare PPOs, Medicare Special Needs Plans, and
Medicare Private Fee-for-Service Plans.
67Medicare PPOs Cont' d
- If the patient go to doctors, hospitals, or other
providers who arent part of the plan
(out-of-network or non-preferred), the
patient usually incurs more out-of-pocket
expense.
68Medicare PPOs Cont' d
- Fees for non-preferred (out-of-network) providers
are subject to Medicare Limiting Charge rules. - Every PPO plan must pay for all covered services
the patient receives out-of-network, but every
plan is different in what the patient must pay
out-of-pocket.
69Anthem Medicare Advantage HMO
70Anthem Medicare Advantage HMO
71Anthem Medicare Advantage PPO
72Anthem Medicare Advantage PPO
73Medicare Private Fee-for-Service Plans
74Medicare Private Fee-for-Service Plans
75Medicare Private Fee-for-Service Plans
76Insurance Cards Cont'd
77Insurance Cards Cont'd
78Insurance Cards Cont'd
79CIGNA
80CIGNA Cont' d
81CIGNA Cont' d
82CIGNA Cont' d
83CIGNA Cont' d
84CIGNA HMO OPEN ACCESS
85CIGNA Additional Information
86United Healthcare
87Repricing
88Repricing Cont' d
89TRICARE
90TRICARE Cont' d
91TRICARE Cont' d
92TRICARE Cont' d
93TRICARE Cont' d
94TRICARE Cont' d
95TRICARE Cont' d
96TRICARE Cont' d
97Check - Out
98Questions????