Front Desk Collections

By Chandresh Shah

As you know, I have been focusing on a high-level financial analysis of your practice.

Part of this analysis involves looking into your collections and related gross collection percentages. However, collections do not always meet expectations and there are a few possible reasons you should look for:

1. Shift in your payer mix (click here for last week’s article)

2. Decline in reimbursement rates

3. Poor follow-up on unpaid insurance receivables (Insurance A/R)

4. Poor front desk collections

5. Poor claim filings

6. Not sending out patient statements

7. Poor patient receivables management (Patient A/R)

8. Possible embezzlement

This week I will be focusing on the fourth reason: Poor front desk collections.

For certain medical practices, a payment at-the-time-of-service policy should be in place. If patients do not make payments at the time of their office visit, insurance has to be filed for these services and consequently, the office must wait for its payment.

As a result, collections will fluctuate and the related gross collection percentages will not be as good as they could have been if these payments were secured at the time of the visit.

An explanation of benefits (EOB) review is very important. Staff members must be educated on this as local collection percentages can be a direct result of not filing clean claims.

Patient-Centered Front Desk Collections

Customer service, or Patient service in Medical Practices is gathering more prominence however this focus can create a sense of confusion among practice owners and providers.

Consider this all too common scenario:

You fail to collect copay and/or outstanding balances at the front desk.

Patient receives a bill which is generally delayed because you wait for the insurance to pay their part first. By this time, the patient had forgotten about the visit.

When they get the bill after a month or two, they are surprised for two reasons. One, they did not think they owed anything, and second, the staff did not mention that they would get a bill after some time – or better, provide some kind of estimate.

This means the patient did not ‘budget’ for this and spent money elsewhere.

This leads to frustration – they may call their health plan which generally does not help. This leads to frustration. They take it out on – you guessed it, your practice – the front desk person, the biller, and sometimes, even the provider.

This scenario is a result of what I believe is a wrong idea of Patient Centered Service. This confusion can arise if the following questions are not addressed within the practice:

  • Does Patient-Centered service mean not focusing on patient collections?
  • Will patients be unhappy with you?
  • Will you lose patients if you ask for an outstanding balance?

As a response to that, data gathered has shown the exact opposite – Engaging patients in meaningful financial conversation actually creates a positive image of your practice and its patient service.

I know you work very hard to take care of your patients and in fact, coach your staff to do the same. Somehow, conversation related to money is left out and avoided at all costs. Everyone feels it inappropriate to talk about money when a patient is in pain. Ironically, if you don’t engage in a comprehensive conversation with a patient that includes financial terms, this can portray the wrong image of your practice. Practices that engage in a holistic approach of 360 degrees conversation including money show that you actually care about the overall well-being of a patient.

We all hate dealing with uncertainty. Spending a little time talking to patients about money goes a long way in patient satisfaction and in the process, keeping your patient aging or patient account receivables low.


In summary, you should train and make sure the front desk is proactive in engaging and alerting patients about statements, and their financial responsibility and even educate them a bit about how their insurance plan works if possible. This is one of the best services you can do for them to maintain a healthy relationship.

Author: Chandresh Shah

Chandresh Shah specializes in Healthcare IT and Medical Billing. He knows the market inside out; what works, what doesn’t. He advises and works with small business owners.