The healthcare revenue cycle starts with front-end processes. Simply put, all those tasks that are performed before the patient arrives at a hospital, clinic, or private practice: appointment scheduling, authorizations, pre-registration in the database, financial advice, advance billing, medical need, notification of admissions, etc.

These front-end processes are fundamental to effective billing and revenue cycle management. But they are often overlooked or understated in importance during regular healthcare operations.

And the problems start to come later: poor quality data, such as duplicate records or typos, jeopardize the billing. Even a simple detail – such as forgetting to collect a signature on a patient’s chart – can result in a claim being denied.

If you face these problems or believe you can improve some tasks, take a look at the best ways to implement front-end processes.

The Importance of RCM

Revenue cycle management (RCM) is the set of processes from the moment the patient makes a medical appointment until the healthcare facility issues the bill and is reimbursed for its services.

The traditional healthcare revenue cycle can be divided into front-end and back-end. The first concerns everything that involves the patient; the second involves the financial part of the process and deals with claims management and reimbursement.

Therefore, a successful RCM is imperative to smooth operations for healthcare facilities and organizations, even to ensure their financial survival. At this point, you might ask yourself: what is successful revenue cycle management?

The short answer is to make the front-end and back-end processes work properly and complement each other.

To make this happen, you should watch out for the following things:

• Ensuring that patients are properly scheduled and that providers have their schedules filled to establish a consistent flow of income to the healthcare facility.
• Verifying a patient’s insurance coverage status and recording that data for future visits.
• If necessary, collect upfront payments from patients and reduce the risk of defaulted dues.
• Collecting and verifying patient data will help a healthcare facility or organization determine the costs of certain treatments, trends related to patient diagnosis and treatment, and associated costs over time.

Doing It Right From the Start

Popular wisdom says that what starts wrong ends up wrong. Therefore, healthcare teams should adopt some simple yet efficient practices to make front-end processes more efficient and avoid unexpected back-end complications and medical billing errors.

It all starts with proper patient registration. Keep in mind that a detailed record can help the doctor identify some problems and symptoms even before seeing the patient face to face. Overworked teams often skip these important steps.

Smaller clinics can add extra data at the registration stage, such as measuring the patient’s height and weight, or even their blood pressure, while still in the waiting room. Larger hospitals are adopting digital processes for this data collection.

Whatever your case, it is necessary to check all patient data as soon as they enter the hospital or clinic; to ensure you have all the information necessary your reception staff should be able to answer the following questions:

• Does the patient have insurance coverage?
• Is their registration information correct and up to date?
• How much of the final cost is covered, and how much will the patient pay out-of-pocket?
• Is the patient aware of this information, and do they agree with it?

From this initial collection, your front-end processes should run faster.

Still, pay attention to the following details so that everything goes smoothly:

• Measure KPIs and the impact of the front-end to the back-end of the office.
• Book patient visits smartly to try to minimize the waiting times and avoid long lines in your waiting room.
• Adopt alternative communication methods to avoid patients’ no-shows. You can remind them of their appointments by phone calls, SMS, or emails, maybe even the sum of these processes.
• Verify any data collected in the front-end to ensure it’s correct, which reduces time and effort by the back office later on to the bill and collect payment.
• Collect as much of the balance due from a patient at the front-end and start of services to make it less likely for them to carry a balance later on.

If you can organize all of this, the back-end processes will run more smoothly and with less chance of errors or confusion. As a result, you will significantly improve your revenue cycle management.

Don’t Neglect Your RCM’s Health

The healthcare revenue cycle is a complex process with many small details that can go wrong and cause big problems in the end. Front-end and back-end tasks also involve different departments and workers, so the chance of errors occurring is more common than it seems.

The best way to ensure adequate communication between the different links in the chain is to implement a more organized policy of front-end processes. When you ensure that all the patient’s personal data is correctly and properly collected, you help the whole process flow better and see a considerable increase in your RCM in just a few months.

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