The Revenue Cycle Does Not Start with a Bill—It Starts with Hello
If you have ever received a bill in the mail for any kind of medical reason, it might appear that this occurrence marks the beginning of the revenue cycle. However, the real genesis of the revenue cycle is at the front desk. Scheduling, eligibility verification and registration processes—all of the things that happen before you even see a provider—are the foundation that the revenue cycle is built on.
These tasks may not be revenue-generating in theory; however, one misstep in any of them can lead to major financial implications down the road. Errors may not show up immediately; sometimes it takes days, weeks, or even months to surface. In time, the cracks in the foundation become apparent and make a lot of work for representatives on the back end.
If you have wondered why your organization’s road to revenue is bumpy rather than smooth, might we suggest you take a second look at patient access? Read on to learn why.
What is Patient Access Anyways?
Patient access is the collection of administrative and financial processes that connect patients with healthcare services, including scheduling, pre-registration, insurance eligibility verification, authorization coordination, and registration. These front-end activities establish the accuracy of patient information and help prevent billing errors and claim denials later in the revenue cycle.
Much like dining at a nice restaurant and being greeted by the maître d’, the patient access team at a provider’s office marks the first human interaction that a patient has. If this greeting is upbeat and compassionate while establishing clarity around what is expected up front, it is safe to say that the rest of the experience will be a positive one. If the greeting lacks enthusiasm and empathy toward the patient, leaving more questions than answers, it should come as no surprise that the rest of the experience will trend that way.
In fact, industry research tells us that nearly one in five patients switched providers in the past year, and almost 90% of them said it was because the organization was hard to do business with — bad experiences with front desk or administrative staff among the top reasons cited.
Moral of the story? Your patient access team needs to be educated and prepared to make patients feel comfortable and confident from the moment they walk through the door.
The Iceberg Problem
How do patient access errors impact the revenue cycle?
Patient access errors can trigger claim denials, delayed reimbursement, administrative rework, and additional collection costs. Inaccurate insurance information, incomplete registration, and missed eligibility checks create problems that may not surface until a claim reaches the payer. Addressing these errors before care is delivered can reduce downstream financial disruption.
Patient access teams are often guilty of making mistakes when it comes to insurance eligibility. It’s reported that 12% of claims are denied nationally, and registration and eligibility issues are the single largest driver, accounting for 24% of those denials. Within that category, the top causes include:
- coordination of benefits (50%)
- benefit maximum issues (27%)
- plan coverage mismatches (17%)
- patient eligibility errors (6%)
Take for instance a routine office visit. The claim might reimburse $60-90. Say it gets denied due to a transposed digit in the insurance ID at check-in. At the practice level, MGMA estimates simple rework — correcting and resubmitting — costs around $25 per claim, already a quarter to nearly half of what the visit was worth. At the hospital system level, where a denial like this often requires fuller documentation and payer coordination to resolve, Premier’s research puts the cost closer to $57 per claim — in some cases nearly the entire value of the claim itself. Multiply either scenario across hundreds of low-dollar claims in a single facility, and “one little misstep” at the front desk adds up to real money walking out the door.
Why the Role is Undervalued
From an org chart perspective, it can be easy to overlook patient access teams as less valuable than front-line workers and c-suite executives. As such, training and resources allotted to these teams become limited. To avoid financial pitfalls, you have to start with giving patient access team members a seat at the table.
Include them in organization-wide meetings with fellow executives and department heads. Don’t just assume they know how important their role is—show them, through personalized outreach where you are asking them how they’re doing and what they need. Sometimes it’s another set of hands or language around a difficult situation they need help addressing. Other times it’s just the simple acknowledgement that their job matters and they’re not in it alone.
Culture Eats Strategy for Breakfast
You can have all of the processes, workflows, technology frameworks and money in the world—but if your culture is suffering, it doesn’t matter. Investing in the heart of your organization starts with patient access. Training, tools, staffing and recognition can have major downstream implications.
If you want cleaner claims, fewer denials, less bad debt and better patient trust from the first interaction, it’s closer than you think. The revenue cycle does not start with a bill; it starts with hello.