Receptionists wear many hats. They are the face of your practice, act as a detective, and are your gateway to financial success. As such, they play a large role in growing your practice.

So how can you be sure your receptionist is effectively answering the call? We’re going to go over two key components of your receptionist’s role in the success and growth of your practice: their roles in wound care and insurance verification and payments.

Part 1: The Face of the Practice

The Face of the Practice

Receptionists are the first and the last contact of your patients. They must always answer the phone with a smile and show concern and empathy for all the patients they encounter. Receptionists must also stress the importance of coming in for wound care appointments. If a patient does not feel welcome, they will not schedule an appointment or visit your practice.

Detective

A receptionist must decipher who needs to be seen quickly and who does not. Many receptionists have no medical background and are not able to make this decision.

As a physician, you should sit down with your receptionist and list out keywords or symptoms that help your receptionist know how to triage and schedule patients accordingly. When your practice performs wound care, it is vital that you see your wound care patients within 24-48 hours. You want to make sure that you are seeing actual wounds and not scrapes or “sores” that are really calluses.

Train your receptionist on how to ask clarifying questions. If you have access to HIPAA-secure messaging, asking a patient to send a photo is a great way to assess the situation.

Part 2: Your Receptionist’s Role in Insurance Verification and Payments

Create a Script

Your receptionist holds one of the many keys to your financial success.  Two of the biggest sources of lost revenue for a practice comes from:

1. Not collecting from patients at the time of service, and
2. Not knowing if patients are eligible for certain procedures or supplies.

Many physicians fail to recognize that a receptionist can make or break the financial success of the practice. If a receptionist fails to gather insurance information, authorize visits, or collect against deductibles, the practice can quickly lose revenue. Wound care is procedural in nature and goes against the patient’s deductible. It is not enough to just collect co-pays.

Create a script for your receptionist that allows them to show empathy, schedule correctly, and collect important information.

Example Phone Script

“Thank you for calling __________.”

“How can we help you today?” (I would like to schedule an appointment)

“What can Dr.________________ help you with?”

“Can I get your name?”

“Which foot?”

“Where does it hurt?”

“How long has it been bothering you?”

“What have you done to help it?”

“Are there signs of infection; is it red, hot, or swollen?”

“I am so glad that you called our office, Mr./Mrs. _________________.”

“Dr. __________________ specializes in ____________________ , and we can get you in on ____/____/____ and get that____________________ resolved quickly.”

“Do you have insurance that you would like us to process on your behalf?”

“Can I get your policy number, so we can check the benefits for you?”

“Great! We are in-network with that insurance plan.”

“Mr./Mrs. _________________ , you will still be responsible for your in-network co-insurance, co-payments, and deductibles at the time of service.”

“We look forward to seeing you Mr./Mrs. _________________ at (time and date of their next appointment).

Welcome to (name of your clinic)! I know you will get the help you will need here.”

Insurance Verification

It is essential that you know the patient’s insurance deductible obligations, insurance copay/coinsurance due, and whether they have coverage for orthotics, surgery, and wound care supplies.  While it is usually easy to find co-pay and deductible information through your EMR or Availity portal, a phone call is usually required to find out if your patient has benefits for DME, surgery, and/or wound care supplies. Most practices use a standard form, like the one that is pictured.

Thorough insurance verifications are the key to reducing confusion for you and your patients. Your receptionist should perform these for every new patient and on a yearly basis for returning patients. Your receptionist should check, not only for copays and deductibles, but also coverage for common CPT codes for which your office bills.

Collecting Deductibles & Co-Insurance

If someone comes in for wound debridement, a biopsy, and wound care supplies and has only met $3,000 of a $4,000 deductible; the cost of debridement, biopsy, and wound care supplies—up to the remaining deductible ($1,000 in this example)—needs to be collected at the time of service from your patient.

If a patient’s deductible has been met, you must collect the co-insurance at the time of the visit.

In order to collect the approximate amount of money due, you need to have a reimbursement schedule at your front desk from the insurance companies.  If you do not know what your insurance companies reimburse, use the Medicare fee schedule for a good estimate.

If payments are not collected at the time of service, you will be billing the patient and hoping that you will get paid.

Conclusion

It is essential that you train your staff to get accurate insurance information, check the insurance benefits, and collect the correct payment from the patient at time of service.

Taking these steps will help you achieve financial success in your practice. If you have further questions about Amerx wound care dressings, insurance forms or would like to speak with an Account Manager about our doctor and patient direct programs, please call (800) 448-9599 or email .