Founder Letter: Is Your Front Office Falling Short of the Mark?

The front office team is the heartbeat of every rehab therapy practice. They play a crucial role in managing administrative work, enabling your clinical staff to focus on providing exceptional patient care, while billers ensure timely payments.  Unfortunately, front desk staff aren’t immune to rehab therapy’s burnout problem, and frequent turnover opens the door for mistakes and errors to creep into your workflows. Without well-laid-out expectations and processes, this can hinder their ability to perform at their best, leading to errors that affect both the patient experience and clinic operations. This is where technology tools can be utilized to help streamline the patient journey. 

As clinic owners and directors, it's understandable that much of your attention may lean toward the clinical side, as patient care is the core of your practice. Yet I will argue that the front desk is equally, if not more, vital in shaping the patient experience. It’s often the first point of contact for patients, setting the tone for their treatment journey. Mistakes made in the front office can have cascading effects, negatively impacting not only patient satisfaction but also the efficiency of your clinicians and billing processes.

Let’s walk through some common front desk errors and how to avoid them:

Missing information for patient registration.     

First visit procedures are critical to minimizing downstream errors, including billing and collections. Unfortunately, if your staff isn’t thorough in collecting every bit of essential information, it creates bottlenecks and unnecessary rework to get paid for clinical services. As Shannon Carillo, a senior solutions architect at WebPT with over 35 years of experience in clinical and billing operations, highlights in this blog on front office mistakes 67% of claim denials we see in WebPT’s revenue cycle management services start with data collection errors at the front desk.  

One of the biggest drivers of claim denials is an incomplete registration process. Failing to have all the correct patient information a payer requires to approve a claim completed during that first patient encounter. What makes it worse is that something so simple can go unnoticed until a claim has already been submitted—and subsequently denied. 

Luckily, there’s a pretty straightforward way to solve for incomplete information. Using digital patient intake (DPI) streamlines the registration process. DPI can be sent to patients ahead of their first appointment so they can fill it out completely at their leisure, allowing them to look up key details and provide accurate information. With the DPI  information flowing directly into your EMR, not only are there efficiency gains, but you also sidestep the possibility of manual entry mistakes by the front office. That said, diligence in ensuring patients complete their digital intake forms on time and accurately is critical. Designing the digital form to be intuitive and easy to use helps ensure patient compliance.

Not verifying benefits or getting prior authorizations. 

Patient registration information accuracy isn’t the only administrative hurdle for claims. Claims can also get caught up in denial hell due to insurance verification mistakes or oversights—lapsed coverage, incorrect policy numbers, missing referrals, and worst of all, lack of pre-authorization for treatment. That all points back to not having the right processes in place for benefits verification and to handle the dreaded prior authorizations that payers are increasingly requiring.   

This is exactly the type of administrative burden that makes sense to automate where you can.  As billing expert Colleen Bailey,  points out in Accounts Receivable for Rehab Therapy Practices: Signs You're Being Too Reactive, clinics that use automation for proactive benefits verification and and gaining knoweldge of the need for authorizations prior to a patient’s initial visit are not only avoiding more claims denials, but are also saving significant rework that delays payment compared to those who are waiting to fix problems after a claim is rejected.  

In addition to DPI, electronic benefits verification (eBV) allows front office staff to check a patient’s eligibility with just a few clicks, allowing for multiple patients to be handled in a short period, rather than dealing with the phone tree and wait times with payers. It’s yet another way to leverage technology to reduce front office staff’s workload and reduce the chance for human error. 

Unfortunately, there’s not much that can be done with understanding which payers require authorizations at the moment (although there was some momentum last year from the legislature to curtail the need for prior authorizations). However, those payers requiring pre-authorization remain a small percentage of the overall payer mix for most clinics, so with the reduction of workload with the aforementioned tools, obtaining prior authorization for treatment can be accelerated, decreasing patients’ scheduling delays. 

Schedules aren’t full every day.  

Time is money for modern rehab therapy practices. With payments from Medicare and many commercial payers declining in recent years, clinics that rely on insurance-based patient payments must work hard to fill every slot on their schedules daily in order to maximize revenue and margin. 

Understanding the metrics of your practice allows you to calculate how many patients your providers need to see per day,  and the time intervals you need to schedule your therapists in order to meet that goal, and the larger goal of getting to the margin you’re looking for in your business.  

Being aware of your clinic's average arrival rate will also allow for healthy ‘overbooking’ to ensure therapists maintain a full schedule. The entire team, both front and back office, must work together to optimize arrival rates with patients respecting the importance of arriving on time and as expected. This is no easy task for the front office, as patients are often looking to reschedule or cancel appointments, and each provider may be working different schedules. This is another often chaotic manual process where—you guessed it—technology can improve efficiency. 

As we lay out in this blog on managing your clinic’s schedule, offering real-time online self-scheduling through a link on your website is not only what patients want and expect, but it also saves many office phone calls to manage therapists’ schedules over the phone. An added bonus is that most online scheduling tools have waitlist functionality, allowing for early opening detection and auto-calls or texts to patients requesting that time slot or opening with that therapist. These tools help to minimize cancellations and no-shows, keeping therapists’ schedules as full as possible. 

Of course, the goal is to avoid those no-shows or cancellations entirely. Automatic text appointment alerts and emails sent to remind patients about upcoming appointments have been shown to help with arrival rates. At the very least, patients who can’t make their scheduled appointment will have the chance to reschedule so that continuity of care is maintained. 

Not scheduling a patient’s follow-up appointments.

Dropouts are the bane of any practice’s existence, both in terms of lost revenue and in the lost opportunity to help patients reach their goals. Reviewing the average number of visits a patient is seen for and the percentage of patients who are only seen for one visit are two critical metrics to monitor if this is a problem for your practice. 

Having therapists walk patients to the front desk to schedule their future appointments after their initial evaluation and having patients stop by the front desk after every visit are key parts of the clinic process that must be part of employee training. Once the patient is at the front desk, scheduling and copay collection become part of the patient's routine each time they come in for an appointment, which can mitigate patient dropout. 

I always found it helpful to tell patients that my schedule could get booked up and that they should schedule out for at least the next two weeks to ensure they got the times that worked best for them. I would also share with the patients that the physician had ordered two visits a week for four weeks, or whatever was on the script, assuming I agreed with that assessment; that way, the patient knew that we were on the same page and that they would be “following doctor’s orders.”

There are some reasons for patients dropping out that are outside of a practice’s control, like illness, transportation, or relocation. Others, like financial concerns, scheduling conflicts with work/life responsibilities, or the simple fact that they found PT to be too difficult, are things that can be worked out with the patient. Payment plans can help alleviate financial concerns, scheduling accommodations can help avoid conflicting priorities, and a discussion with the therapist about the plan of care can find treatment options that work for both parties.  

Take the scenario I described above with the patient coming in twice a week for four weeks. If the patient confided that they had a high copay and they would only be able to come in once a week for four weeks, I would relay that information to the front desk for scheduling and also make sure to include that in my initial evaluation and plan of care to alert the physician. 

Another important front office policy is to never allow a patient to cancel without attempting to reschedule that appointment. If the patient states they don’t want to reschedule, it opens the door for the front office to have a conversation with a patient about why they’re not coming back. 

Not regularly collecting co-pays and deductibles.

The front office is also your first line of defense (or offense) when it comes to attacking your A/R. Part of the check-in process should be to collect any copays or deductibles that are due at the time of service. With deductible and co-pay amounts rising, you can’t afford to miss out on collecting while the patient is in your clinic. 

Claims may make up the bulk of the payment per visit in some cases, but during the first few months of the year or if the patient is generally young and healthy and has not used their healthcare benefits much, the insurance deductible amount has probably not been met. At that point, the patient should be treated like a cash-pay patient, with payment collected upfront at the time of service. 

In my clinic, we always tried to collect the copay or coinsurance before the patient received treatment. For insurances that charged a percentage of billed charges,  we had a cheat sheet at the front desk for each of our major insurances to know what the average payment per visit was, and we would take the benefit percentage based on that amount.  For example, if the deductible was 20% and the insurance paid on average $75, we would charge the patient $15 and inform them that this was an estimated charge. Most importantly, patients must be made aware of their financial responsibility at the first visit and told that the front office will be collecting at each visit upon arrival.

Providing the patients access to an electronic payment portal via your website or that’s visible on the patient statements via QR code or URL makes it convenient for people to pay on their own time, but there’s no time like the present when you have the patients are right in front of you and you are able to answer any questions they may have.

No conversion of calls, emails, and messages into booked appointments 

Having calls to action on your website and in your social media posts is a fantastic way to engage potential patients, but also requires time and attention to any inquiries that may come your clinic’s way.  The front office is a crucial part of your marketing and “sales” team, and these potential patients should be considered “sales leads.” 

With that in mind, setting up front desk SLAs or Service Level Agreements for response times and conversions is critical to making sure patients come away with the best first impression possible, whether that’s in person, via phone call, or email.  Consumers have choices, and in the age of instant gratification, every minute counts. Following submission of an online appointment request or inquiry, the average conversion time of engaging that potential patient into scheduling is significantly reduced after 5 minutes. An email response is expected within 1 hour by 88% of people. With phone calls, 2 minutes is about the limit that people are willing to wait.

It takes coaching from clinic leadership to implement these SLAs and on how to guide conversations into scheduling an appointment efficiently, even if that’s not the initial ask. Having consistent training and specific talking points regarding why patients should choose your practice—or choose to start PT to begin with—can pay dividends in more appointments on the books.  With the current shortage of PTs across the country, managing wait lists for appointments is also a critical skill that can minimize patients moving on to another practice.

You’re not creating a welcoming environment.

As important as every administrative responsibility is for your front desk, first impressions matter and you can’t shortchange the patient experience. Patients coming to rehab therapy for the first time are most likely nervous, maybe even scared, and almost certainly in pain. If the clinic reception area feels sterile and your staff can’t manage much more than a terse “Hello,” before thrusting a clipboard in their hands, that patient won’t feel at ease and start off on the wrong foot.

As soon as the patient enters your office, the ambiance should reflect your practice’s ethos, exuding helpful, welcoming, and healing vibes. That ethos should also be backed up by the staff in creating an environment where patients feel at home: comfortable, friendly, and safe. Adopting digital tools like DPI, eBV, and online scheduling can help to streamline the mundane, often redundant administrative part of the visit, while allowing your staff to focus on the human connection element.  Self-scheduling appointments and automatic appointment reminder texts can help in bringing patients back, but the driving force is going to be the relationship and the trust that they build with the people who make up your practice. 

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The front office in any PT practice carries some of the most important parts of the business.  From the first impression and capturing all of the accurate, pertinent patient information to patient scheduling and co-pay collection, the patient experience can be made or broken if focus is not paid to process, training, technology tools, and the right staff.