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The front desk team is a critical component of the revenue cycle management process. While the Physician Xpress Account Managers and revenue cycle management team are committed to optimizing the revenue cycle, we have learned over the years that the total collection rate is highly dependent on the consistency of the Pediatric Practice Front Desk Team members.
This article provides some background on the importance of the Pediatric Practice front desk team members and some specific standards/processes for the front desk team to adhere to for optimal claims process that results in optimal collection rates for a Pediatric Practice.
Front Desk Accuracy and Its Downstream Impact on Revenue
In a pediatric practice, the front desk team plays a critical role not only in creating a welcoming environment but also in safeguarding the financial health of the practice. When patient check-in is incomplete or inaccurate—such as failing to verify insurance eligibility, overlooking plan terminations, or entering outdated policy information—the consequences often fall heavily on the Physician Xpress back-end billing team. The result? Claims submitted with invalid or out-of-network insurance details are denied, delayed, or written off, directly impacting the Pediatric practice’s revenue.
For example, if a front desk team member checks in a child without confirming whether the parent has updated their insurance after a new job, the claim may be sent to the previous carrier, resulting in a denial. Or if a Medicaid patient has switched plans and this change is not caught at check-in, the billing team may unknowingly submit to the wrong managed care organization (MCO), leading to unnecessary rework and delays.
While the Physician Xpress revenue cycle team invests time and effort to correct and appeal these claims, the primary responsibility for verifying insurance, entering accurate data and scanning the insurance card is the responsibility of the pediatric practice, specifically the Pediatric Practice front office team. Eligibility verification is a point-of-service task, and the Physician Xpress account management team relies on the data entered by the practice. For optimal results, pediatric practices should implement and monitor front desk training, use real-time eligibility tools and payer portals, and establish front desk checking in processes. The Physician Xpress team assists by flagging recurring front-end errors and flagging accounts, but it is ultimately the practice’s responsibility to ensure clean and accurate patient registration upfront. The success of the revenue cycle starts at the front desk. Without accurate insurance verification and documentation, even the best billing team cannot prevent denials.
Routinely Review/Update Front Desk Check-in Processes
Consider creating a new front desk process or updating the existing process to increase the impact of the front desk team. Providing clear guidelines on the expectations at checking and monitoring/managing the consistency of the front desk team is an important role of the practice owner or their practice manager. Consider incorporating the following into the Front Desk
Team checking in process:
New Born Babies:
Front Desk team members should notify the parent that as soon as possible, the parent should add the new born baby to their policy but no later than 30 days after the birth. The front desk team members should also state that the baby is NOT automatically added to a parent policy, the parent needs to call and add the baby to their family plan or obtain individual insurance for the baby. Usually, a Pediatric Practice can use the parent’s valid insurance card for the appointments within the first 30 days of birth. When the child is added to an existing or new insurance policy, the parent needs to request that the insurance is eligible as of the date of birth. If the newborn will be on a managed medicaid plan, inform parents that the Managed Medicaid plans the practice accepts.
Consider adding a process to the practice that if there is no insurance verified via one of the insurance sites as the 2 month well visit, the front desk should change the status to “Self Pay” including make eligible for VFC Vaccines. For these patients, the Front Desk should collect the Self Pay visit cost up front.
Insurance Eligibility Process:
Each morning the front desk team members need to verify the insurance for all patients listed on the schedule. In the PediatricXpress system this means that all eligibility checkmarks are confirmed as eligible insurance as shown on the appointment book (“Grey” checkbox on schedule). For insurances that do not show as eligible or ‘unknown’ eligibility, the front desk team needs to access the appropriate payer provider portal for the insurance site to verify the insurance. If Front Desk team members cannot verify the insurance, they need to call the insurance company. If they still can not verify the insurance, the front desk team members should identify the patient as “self-pay” including making them “VFC Eligible” and collect self pay amount due prior to the visit.
For HMO Plans – access the payer portal site and verify that the practice or the Providers in the practice are listed as the PCP. The Front Desk team members should inform parents that only patients that have the practice as PCP will have their insurance accepted at the practice. If the insurance is not showing the practice as PCP, consider changing to “Self Pay” until the family makes the update.
If the insurance card is not scanned into the EHR system, obtain a copy and scan the insurance card. Note that if the parent does not have a copy of the insurance card, go to the payer portal and copy the insurance card (usually can download as an image and upload into the insurance card scan section).
The front desk team should only enter insurances that are accepted and eligible for the patient at the date of service.
Create a Chart of Payer Portals for Front Desk Team Members:
Create a chart that displays the most common payers/insurances the practice accepts and list the payer site to login as well notes and specific instructions related to the payer for verification of insurance. After creating this chart, print the chart and consider making a laminated copy to post at the front desk. This chart should be updating at least 1x per year.
Monitor and Manage the Front Desk Team Check in Process:
The practice leader and/or owner should be providing routing feedback to the front desk team members on the consistency of their checking in of patients.
