Exploring the Importance of Accurate Frontend Data Capture

(or Avoiding the Early Train Wreck of Missing & Inaccurate Information)

There is a common adage that circulates through the proverbial cubicles at Full Circle Business Solutions: “Garbage in, garbage out.” Pretty glamorous catchphrase, eh? We remind ourselves and each other of this little truism on a regular basis because, in our world of revenue cycle management (RCM), quality business outcomes demand quality data input. What we capture and enter on the frontend quite literally determines what we will receive on the backend—will it be a quick claim with timely payment or will we be met with a denial? 

So, let’s talk about it. What are we capturing on the frontend, who’s capturing and verifying the data, where (and why?!) are things likely to go sideways, and how do we better set ourselves up for success?

Here are my thoughts.

Take it from the top—our first chance to get things right.

In the RCM process, step one is wrapped up in scheduling and registration, and this is where we set ourselves up for success throughout the life of the cycle. If we cross all the t’s and dot all the i’s here, we are more likely to see timely and successful billing outcomes. Here’s what we should be capturing and verifying from the patient at this point in the process:

• Contact information
• Mailing address
• Date of birth
• Social security number
• Proof of insurance (primary, secondary, tertiary) and policy numbers
• Legal name (no, really—middle initial and all, get it right!)

On the insurance side of things, scheduling and registration is also where we need to determine things like:

• Is our facility in network?
• Is pre-authorization required for the procedure?
• Are tests required before scheduling the procedure?
• What is the patient deductible and outstanding financial responsibility?

The consequences of failing to capture and verify the above information can be immediate, and it is always frustrating. For example, if we transpose numbers in a patient’s date of birth, we’re looking at an automatic payer denial because the policy can’t be tied to the patient; now imagine that we also got the wrong contact information for that patient! That means we can’t even contact them to confirm the correct date of birth. Then what?! In situations like this, business office staff end up fishing for details in hopes of resubmitting a claim and securing a payment; it costs precious time and may ultimately result in a write-off.

In my experience, the best way to avoid these scenarios is to recognize when and where mistakes are most likely to occur, and that’s what we’ll explore from here.

Where the dominoes fall—recognizing when we get things wrong.

Everything in RCM is part of a domino effect, and if we get our wires crossed in the beginning, we can expect a train wreck further down the line. To keep ourselves on track, we have to examine the “how” and “why” behind our most common mistakes and understand their consequences.

First and foremost, on our “how and why” list? Human error. It’s never personal, this is just the downside to not being a machine driven by artificial intelligence and automation—we make mistakes. We’re sleep deprived, distracted, stressed, rushed and probably hangry, and sometimes that means we miss a detail (this is why we talk about checks and balances later on…stick around!). But beyond human error, I find that mistakes can also often be tied to a lack of consistent operations processes or even a lack of familiarity with facility billing software.

Billing software is most likely to be an issue in a new facility or a facility that’s implementing new software. When you’re working in an already fast-paced environment and trying to navigate new tech, retention can be a challenge. So, if your facility is working with new software (or staff who are new to said software), it’s ideal to employ an extra verification step (we’re doubling down on checks and balances!). Invest the time upfront to have an extra pair of eyes verify what’s going into the system; it’s a lot more efficient than having to appeal a denial, resubmit a claim, and rebill a patient.

Speaking of retention, consistent processes and forms can also contribute greatly to accurate data input. If everyone follows the same steps in the same order for every patient and procedure, we automatically reduce the likelihood of mistakes. Few things aid information retention like repetition. It sounds simple—and it is, really—but that also means it’s easy to overlook. So, don’t sleep on operating procedures or paperwork; keep them consistent and make them a mandatory follow.

As for what to expect when we jump the tracks at any point? Consider this: If a new employee who doesn’t quite understand our billing software inputs the wrong pay source and a claim is tied to the wrong contract, the result is a denial. Now we have to reverse the entire process, correct and resubmit the claim, and then rebill for the patient payment. What could have been a quick three-week turnaround time for payment is now likely to take three months or more.

Makes the verification “redundancy” upfront sound like less of a pain, doesn’t it?

Stay ahead by staying on track. Here’s how. 

Okay, this is the part you’ve been waiting for: How to avoid the mistakes and train-wreck outcomes. The reality is that mistakes are inevitable, but we can have a plan to minimize their likelihood and manage the response when they happen. That said, here are some key considerations for getting things right at scheduling and registration.

• Educate yourself and your staff. We should be in learning mode every day, largely because there are opportunities to course correct and improve almost every day that we’re at work. This means it’s ideal to offer real-time feedback, when doing so is an option; if we can address missteps along the way, we can better mitigate poor habits and misunderstandings. 
• In addition to offering on-the-spot education and insight, regularly scheduled training is a great idea, too. Whether it’s monthly, quarterly or biannually, create built-in opportunities to refresh your staff on operating procedures, software navigation, utilizing verification resources, and what should be collected during scheduling and registration. In a world like RCM where the goal posts are always moving, it’s best to overeducate. Lean into checks and balances. Believe it or not, effective RCM takes a village. Physician schedulers, anesthetist offices, surgery centers, testing sites—everyone should be sharing the same verified information, and each area has a responsibility to get things right. This also means that every office should have someone on staff to verify registration information, specifically where insurance is concerned. So often, we don’t know what we don’t know, and that’s when it’s critical to have someone who can verify. No one who manages scheduling or registration should be singularly responsible for gathering, entering and verifying data.
• Take ownership and improve. Because RCM is a process that requires village cooperation, all we can ever really do is take ownership of our part. Seek out, facilitate and capitalize on educational opportunities; lean into the experience and insight of those whose job it is to verify information; and commit to always following the proper procedures and protocols. That may seem cliché, but complacency is all too often the catalyst for human error. Take ownership of your job, the present situation and the associated processes, and you will pave the way for great results and quality outcomes.