Front Office Staff You are the KEY to it All - PowerPoint PPT Presentation

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Front Office Staff You are the KEY to it All

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Front Office Staff You 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 – PowerPoint PPT presentation

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Title: Front Office Staff You are the KEY to it All


1
Front 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

2
Front 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

3
Front 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

4
Front Office Staff
  • Reduce expenses by collecting copayments at the
    time of service

5
The Customer
  • The need for quality customer service and
    satisfaction is at an all time high.

6
The Customer
  • Patients
  • Patient Family
  • Referring Physicians

7
The Customer
  • First contact is extremely important as it
    generally defines the customers perceptions
    about not only the practice but the physician(s)
    as well.

8
The 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

9
The Customer
  • Research indicates that as much as 65 of
    patient satisfaction is based on non-clinical
    issues (like atmosphere, communications, and
    customer service).

10
The Customer
  • 98 Dissatisfied customers never complain -
    they just leave
  • 85 Dissatisfied customers tell 9 people about
    their poor experience, and 13 tell 20 people

11
The Customer
  • A satisfied customer tells just 5 people

12
Customer Service Phrases
  • Perception is reality!
  • The customer is always right, even when they are
    wrong
  • Time is a commodity, just like money

13
Customer 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.

14
Customer 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.

15
Customer 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.

16
Customer 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.

17
Publicity
  • Word of mouth is powerful publicity.
  • It can work for you or against you!

18
Publicity
  • Three types of publicity
  • Good publicity
  • Bad publicity
  • No publicity

19
Different 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

20
Different 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.

21
Different 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.

22
Different 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.

23
Manners
  • 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

24
Manners
  • 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

25
Telephone Etiquette
  • Greeting
  • Tone
  • Quality
  • Smile

26
Telephone 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

27
Telephone 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

28
Telephone 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

29
Atmosphere
  • The reception area should not be
  • Empty
  • Chaotic
  • Cluttered

30
Atmosphere
  • Is the waiting room clean and friendly?
  • If your office offers reading material, they
    should be kept current and relatively benign.

31
Atmosphere
  • Do not eat where patients
  • can see you!

32
Atmosphere
  • Patient presents - Receptionist on phone
  • Acknowledge the patients presence
  • Make eye contact with the patient and assess the
    situation

33
Atmosphere
  • 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.

34
Atmosphere
  • Any conversations regarding other
  • patients should be done quietly

35
Atmosphere
  • Keep personal conversations to a
  • minimum and discussed quietly

36
Atmosphere
  • 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

37
Atmosphere
  • 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.

38
Atmosphere
  • What impression does your appearance give to your
    customer?
  • Does your appearance convey a sense of trust,
    competence, and professionalism?

39
Atmosphere
  • Remember, perception is reality. Your attire
    should be professional and reflective of the
    practice.

40
Atmosphere
  • 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

41
Atmosphere
  • 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

42
Atmosphere
  • 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.

43
Appointment 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.

44
Appointment 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.

45
Appointment SchedulingInsurance
  • Verify
  • Does your physician participate with the
    patients insurance plan?
  • Is there a copayment?

46
Appointment 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.

47
Appointment 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.

48
Appointment 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

49
Appointment 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

50
Appointment 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.

51
Appointment Arrival
  • Greet the patient
  • Complete your registration process for all new
    patients

52
Appointment 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.

53
Appointment Arrival
  • Review the patients insurance
  • card(s) at each encounter

54
Appointment 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.

55
Appointment 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

56
Appointment Arrival Insurance
  • Check-in staff determine which insurance is
    primary when the patient has coverage under two
    or more insurance plans.

57
Appointment 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.

58
Appointment 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.

59
MedicareFee for Service (Original)
  • Card

Jane Doe
14
08
-
10
-
06
60
What 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.

61
Medigap 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.

62
Medicare 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.

63
Medicare 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.

64
Medicare Advantage Plans
  • Medicare Advantage Plans are part of Medicare
  • Patients generally get all of their
    Medicare-covered health care through that plan.

65
Medicare 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

66
Medicare Advantage Plans Cont' d
  • Includes Managed Care Plans (Medicare HMOs),
    Medicare PPOs, Medicare Special Needs Plans, and
    Medicare Private Fee-for-Service Plans.

67
Medicare 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.

68
Medicare 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.

69
Anthem Medicare Advantage HMO
70
Anthem Medicare Advantage HMO
71
Anthem Medicare Advantage PPO
72
Anthem Medicare Advantage PPO
73
Medicare Private Fee-for-Service Plans
74
Medicare Private Fee-for-Service Plans
75
Medicare Private Fee-for-Service Plans
76
Insurance Cards Cont'd
77
Insurance Cards Cont'd
78
Insurance Cards Cont'd
79
CIGNA
80
CIGNA Cont' d
81
CIGNA Cont' d
82
CIGNA Cont' d
83
CIGNA Cont' d
84
CIGNA HMO OPEN ACCESS
85
CIGNA Additional Information
86
United Healthcare
87
Repricing
88
Repricing Cont' d
89
TRICARE
90
TRICARE Cont' d
91
TRICARE Cont' d
92
TRICARE Cont' d
93
TRICARE Cont' d
94
TRICARE Cont' d
95
TRICARE Cont' d
  • t

96
TRICARE Cont' d
97
Check - Out
  • Collect the copayment

98
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