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. 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: Front Office Staff.

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Front Office Staff You are the KEY to it All

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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


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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

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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 patient’s insurance information

  • Determine when referrals are required for services provided by the practice

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Front Office Staff

  • Reduce expenses by collecting copayments at the time of service

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The Customer

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

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The Customer

  • Patients

  • Patient Family

  • Referring Physicians

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The Customer

  • First contact is extremely important as it generally defines the customer’s perceptions about not only the practice but the physician(s) as well.

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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

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The Customer

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

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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

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The Customer

A satisfied customer tells just 5 people

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Customer Service Phrases

  • Perception is reality!

  • The customer is always right, even when they are wrong

  • Time is a commodity, just like money

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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.

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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 patient’s complaint. It may be necessary to adjust the scheduling for specific services, certain physicians, brief and extended visits, etc.

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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.

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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.

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Word of mouth is powerful publicity.

It can work for you or against you!

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Three types of publicity

  • Good publicity

  • Bad publicity

  • No publicity

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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

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Different Personalities

  • Listen with empathy

  • Listen with neutrality

  • Ask questions if necessary

  • Convey that you are interested in the person’s ideas even if you do not agree with them

  • State your own views, using an “I” message instead of a “you” message.

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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.

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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 can’t help you, but I will get someone who can.”

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  • 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

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  • 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”

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Telephone Etiquette

  • Greeting

    • Tone

    • Quality

    • Smile

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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

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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

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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

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  • The reception area should not be:

    • Empty

    • Chaotic

    • Cluttered

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  • Is the waiting room clean and friendly?

  • If your office offers reading material, they should be kept current and relatively benign.

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Do not eat where patients

can see you!

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  • Patient presents - Receptionist on phone

    • Acknowledge the patient’s presence

    • Make eye contact with the patient and assess the situation

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  • 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.

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Any conversations regarding other

patients should be done quietly

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Keep personal conversations to a

minimum and discussed quietly

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  • If the office opens at 8:00 a.m., this means that all staff should be ready to work at 8:00 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

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  • 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.

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  • What impression does your appearance give to your customer?

  • Does your appearance convey a sense of trust, competence, and professionalism?

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

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  • 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

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  • 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

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  • 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.

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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.

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Appointment Scheduling Insurance

  • Keep a log of all the insurance plans the physicians participate in

  • Appointment schedulers must know the practice’s process for scheduling patients when some physicians are and others are not credentialed with a particular insurer.

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Appointment SchedulingInsurance

  • Verify:

    • Does your physician participate with the patient’s insurance plan?

    • Is there a copayment?

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Appointment SchedulingInsurance

  • If you determine that your physician does not participative in the patient’s 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.

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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.

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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

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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

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Appointment SchedulingInsurance


  • 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.

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Appointment Arrival

  • Greet the patient

  • Complete your registration process for all new patients

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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.

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Appointment Arrival

Review the patient’s insurance

card(s) at each encounter

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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.

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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

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Appointment Arrival Insurance

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

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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.

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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.

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MedicareFee for Service (Original)


Jane Doe







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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 doesn’t cover.

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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 can’t pay any deductibles, co-payments, or other cost-sharing under their Medicare Advantage Plan or other Medicare Health Plan.

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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.

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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.

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Medicare Advantage Plans

  • Medicare Advantage Plans are part of Medicare

    • Patients generally get all of their Medicare-covered health care through that plan.

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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 plan’s doctors and hospitals to receive covered services

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Medicare Advantage Plans Cont' d

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

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Medicare PPOs Cont' d

  • If the patient go to doctors, hospitals, or other providers who aren’t part of the plan (“out-of-network” or “non-preferred”), the patient usually incurs more out-of-pocket expense.

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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.

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Anthem Medicare Advantage HMO

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Anthem Medicare Advantage HMO

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Anthem Medicare Advantage PPO

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Anthem Medicare Advantage PPO

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Medicare Private Fee-for-Service Plans

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Medicare Private Fee-for-Service Plans

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Medicare Private Fee-for-Service Plans

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Insurance Cards Cont'd

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Insurance Cards Cont'd

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Insurance Cards Cont'd

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CIGNA Cont' d

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CIGNA Cont' d

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CIGNA Cont' d

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CIGNA Cont' d

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CIGNA – Additional Information

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United Healthcare

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Repricing – Cont' d

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Check - Out

Collect the copayment

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