by Katie Nunn, MBA, CMPE
Medical Billing Process 101: Step #1 – The Patient Comes to the Doctor
What is the “revenue cycle”? In the simplest of terms, it is these steps:
- The patients come to the doctor
- The doctor treats the patient
- The office bills the insurance company
- The insurance company sends the EOB and payment to the doctor
- The cycle starts over
We all know that there is more to it than that, but that is the essence of what people are talking about when they say Revenue Cycle or Revenue Cycle Management. 
The First Step of Revenue Cycle Management
Where this occurs can be many different settings. Hospital, office, home of the patient, telemedicine, or even interpreting a test or study all classify as places of service. These are all places that a physician or provider may provide billable services. However, the first step to getting paid can often happen before the patient ever arrives at any of these locations. The appointment scheduling process is often the first step. I’m going to call this the Pre-Visit time. The important information that must be obtained at pre-visit:
- Patient demographics
- Insurance information
- Eligibility verification
- Referrals and Authorizations
Not only is the telephone often the first impression the patient has of a practice, it is the start of how a practice gets paid. Making sure that patient demographic and insurance information are obtained and are correct ensures that the claims and bills will be processed efficiently. If a patient’s insurance is put in incorrectly, the claim will get kicked out and slow down the process of getting reimbursed for services.
If a patient’s address is incorrect, when it comes to sending the patient a bill, it could be returned in the mail. Furthermore, if the patients phone numbers are not correct, if you need to move their appointment time you won’t be able to get a hold of them.
Other important aspects of the Pre-Visit phase include, customer service and appointment reminders. Having employees on the phone that are trained to provide excellent customer service can make a huge difference for a practice and growing revenue.
However, simply telling your team to be nice is not enough. Setting customer service expectations and giving employees examples of good customer service goes a long way to generate better customer service and improving revenue. If a practice has the ability to record calls and play them back for staff to hear how they sound, this can be a great training method.
Appointment reminders are a great way to help reduce your no-show rates. Today, people have come to expect their doctor’s office to be able to text message them reminders. It is ideal to be able to send reminders via multiple methods like email and text. Some practices also have an automated call go out as well. Even with multiple reminder methods, you may still have a no-show rate around 6-7%.
It is also important to verify demographic information with patients each-time they call. Many offices develop a bad habit of not verifying patient demographics for return patients. This can lead to not having the patients current address and phone number. Then the office may need to get ahold of the patient and can’t. Verifying address and phone numbers should be part of every office’s procedures when they speak to their patients over the phone.
It is easy to undervalue the importance of the people answering the phone at an office. They not only set the tone for the patient’s experience but they also start the process for revenue coming in. A practice should give these employees training and coaching to provide the best service possible.
It is also important to understand that this can be a demanding position. Staff that answer the phone are often under fire from patients, coworkers, and providers. They get it from all angles. They are also often responsible for other tasks like checking patients in and out. It is vital to provide them with support and appreciation. They are as important to a practice as any other member of the team.