Practice Management Basics: A Healthy Revenue Cycle Begins Up Front

The revenue cycle is a fundamental yet complex process that requires collaboration across multiple areas of a practice and organization. Consistently efficient processes are vital for a practice to achieve ongoing fiscal stability. Revenue cycle management is often focused on the central billing office, coding, or finance teams, all of which are essential. Today, however, we will concentrate on the front lines of clinic practices that play a crucial role in revenue cycle success.

Patient Experience and Communication

A patient encounter begins with the prospective patient’s first call to your practice, which is usually handled by the receptionist at the front desk or central call center personnel. Practices of all sizes rely on the contribution of many staff members to provide the necessary coverage during times when the volume is high. Cross-training and knowledge-sharing are paramount to ensuring that all responsibilities are handled deftly. Though the use of technology is expanding with online appointment scheduling/registration and automated phone queues, many patients and practices still rely on and prefer personal contact. It is critical to provide consistent training to ensure that those staff members who answer telephones and receive patients have excellent communication and listening skills. Coach them on how to ask the right questions and how to be sensitive to patient requests, even when they may disagree with the urgency or “needs” a patient expresses. Ask your employees to view their jobs as problem solvers and information gatherers—not appointment bookers or gatekeepers. Practices are most successful when employees have pride and ownership in the processes and patient experience. Align employee incentives with objective metrics and accountability wherever possible.


A healthy revenue cycle relies on proficient appointment scheduling as the first step in generating a patient encounter. The primary objective of appointment scheduling is to fill provider schedules within a given workday or workweek to maximize practice revenue and provider utilization. Not every practice is incentivized on volume alone; some reimbursement models are based on quality or cost outcomes associated with value-based contracts. It is important to establish a scheduling policy that reflects the business model of your practice, specialty, and preferences as a provider.In addition to patient, provider, and staff satisfaction, revenue suffers when scheduling breakdowns occur. Staff members must understand the financial implications of filling a provider schedule and work to avoid gaps or vacant appointment slots. There are many techniques for maximizing schedule utilization, depending on the focus of your practice and specialty. Generally, group practices will benefit from utilizing consistent visit definitions, scheduling templates, and scheduling algorithms. Although giving up schedule control scares many providers, we recommend empowering a well-trained team to maximize every clinic session. Incentivize performance by incorporating objective metrics into job competencies and performance reviews, reinforcing specific tactics with training and accountability.


Pre-registration efforts speed up the registration process by reducing the time needed to fill out or update demographic information or medical history at the time of visit. This time invested will also help providers stay on time throughout the day by reducing check-in processing time. When a new or established patient calls to schedule an appointment and the date and time are set, the dialogue between the caller and telephone receptionist must include capturing complete and accurate demographic data (name, address, telephone numbers, workplace, and insurance coverage), reviewing the billing policies and collection procedures, and giving directions to the office or facility if necessary. Be sure to document the patient’s email address and preferred method of contact by the practice. Pre-registration efforts are often a lower priority for overwhelmed staff, but the compounding effects of omitting this process impact multiple areas including revenue integrity and patient throughput/satisfaction. Inaccurate demographic information can also lead to delays in billing and collections that could be avoided with disciplined preregistration processes.

Appointment Reminders

When a patient misses an appointment, the practice loses revenue and incurs additional costs. Appointment reminders help you increase revenue by reducing the number of patients that do not show up for their scheduled appointments. Reminders can also identify patients who are unlikely to show or those who fail to confirm with enough time to backfill or double book a visit. Automated email, text, or telephone appointment reminders can save valuable staff time and help maximize provider productivity. Many practices continue to make personal reminder calls, which is resource intensive but yields more accurate indicators of patient intention.No-show, cancellation, and reschedule rates can represent more than 50% of total completed visits. Data is often inaccurate due to lack of clarity around inbound vs. outbound cancellations as well as manual entry by front office staff who may apply different definitions for a no-show or last-minute cancellations. Establish consistent definitions and protocols for entering visit data, and empower staff with ownership of these metrics to drive improvement. Develop criteria for practice staff to double-book or manage appointments based on feedback from reminder efforts, and avoid requiring provider approval for scheduling changes.

Check-in, Registration, and Eligibility

Establishing a registration procedure to obtain accurate patient information is an essential function of the revenue cycle, especially in the case of payments by third-party payers where accurate information is a prerequisite for reimbursement. After scheduling the appointment and collecting the information, the next step is to verify insurance coverage details with the plan provider(s) by phone or by internet before the patient arrives for the appointment. Upon the patient’s arrival, front office staff should present or request all relevant paperwork, including updates to the patient’s demographic and insurance information as well as any new medical practice information. The patient’s demographic data must be updated every time the patient presents for an appointment to ensure its accuracy. The practice’s financial policy and the HIPAA Privacy Policy are a part of the information package. Front office staff should obtain the necessary signatures in writing and copy the insurance and identification card, as well as request the patient’s co-payment, deductible, or any open balance payments. You can mail or email new patients a copy of the practice registration forms and payment policy with a confirmation of the appointment time. Some practices post patient registration forms on their website or patient portal for those who prefer to provide information online before arriving for their appointment.


A practice’s front office employees are the gateway to financial health for the medical practice. Their knowledge of billing and their ability to educate patients on the practice’s financial policies, establish patient expectations, and collect payments at the point of care are critical to a well-run billing and collection process. The ability of the front office employees to obtain and transcribe/input patient information accurately and efficiently is vital to ensuring that the billing is accurate the first time. Invest the time and energy in these employees and processes to maximize revenue and increase patient, provider, and employee satisfaction.

Let us know what is working for your practice to manage the revenue cycle. Also, if you would like to learn more about how Coker Group can help support your organization, please contact us.

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