We worked with two people at the same practice who had never compared notes. One ran the front desk. The other ran collections. They were working opposite ends of the same dollar, and the practice was paying both of them for it.
Her end of the dollar
The front desk lead checked people in, verified coverage when time allowed, and collected copays when the amount was obvious. Nobody had ever measured her on that last part. There was no target, no report, no screen telling her what each patient owed before they sat down. So on busy days, and most days were busy, the copay was the step that slid. When we finally measured it, roughly half the patient dollars owed at the visit were walking out the door uncollected.
That’s a system result, worth saying plainly. She was doing her job as it had been defined. Collecting wasn’t in the definition.
The other end
The collections lead was good at her job, and her job had a bonus attached: recovering old patient balances. Last year her team chased down and recovered about $71,000 of them. Statements, second statements, phone calls, payment plans. Real work, done well.
Then we traced where those old balances came from. Most of them started life as a copay or patient share that didn’t get collected at a visit, months earlier, one busy morning at a time.
The pipe between them
Follow one dollar through. A patient owes $40 at the visit. It doesn’t get collected, because nothing said it should. The insurer’s payment notice later confirms the patient owed it, assuming the notice gets recorded on time. A statement goes out. Then another. Then a call. Somewhere around month six, the collections team recovers it, and the recovery counts toward a bonus.
The dollar arrived eventually. It just cost a statement run, a second statement, staff time, some patient goodwill, and a slice of itself in bonus on the way in. A dollar collected at the door costs almost nothing. The same dollar collected in month six has been paid for twice.
Why nobody saw it
Two ends, two reports, two managers. The front desk was measured on wait times and schedules. Collections was celebrated for recoveries. Both looked good in their own report, and the pipe between them didn’t have a report at all. Nobody in that building did anything wrong. The design paid a bonus for cleaning up a miss it had never measured, and it would have kept doing that forever.
How do you improve point of service collections?
Give the desk the number: check coverage the day before, estimate the patient’s share, and show it at check-in. The ask becomes a statement instead of a negotiation, and the rate becomes a metric someone owns.
What turned up, what we built, what stays
Turned up: about half of patient-owed dollars uncollected at the visit, and $71,000 chased months later that mostly began as those same misses.
Built: an upfront collection rate, the share of patient dollars owed at the visit that actually gets collected there, tracked by location and by desk. And the missing tool underneath it: each patient’s owed amount known before they sit down, so collecting stops requiring guesswork.
The tool is less exotic than it sounds. Coverage gets checked the day before the visit, the patient’s share gets estimated from their plan, and the number shows up on the check-in screen next to their name. That one change rewrites the conversation at the desk. The ask stops being a negotiation, do you want to pay something today, and becomes a statement, your share today is forty dollars. Same person asking. Different job, because now she has the number.
Stays: the rate trends weekly like any other vital sign. The front desk finally has a number that belongs to them, with the tool to move it. And collections gets to work true old debt instead of last spring’s copays.
The bonus design got repointed rather than removed. Collections kept its incentive, aimed at true old debt instead of last spring’s copays, and the front desk picked up a small recognition of its own, tied to the upfront rate. Incentives follow measurement. Once the rate existed, paying people against it was the easy part.
The patient side improves too, which nobody expected to care about and everybody did. A $40 ask at checkout is a normal moment. The same $40 arriving as a statement, then a second statement, then a call six months later is a small ongoing insult, and it lands on people the practice wants to keep. Collecting at the door isn’t just cheaper. It’s kinder.
Your version
Pull one month. Add up the patient responsibility your insurers’ payment notices confirmed for those visits. Then add up what was collected at the time of service. Divide. That’s your upfront rate, and most practices guess high by a lot. Whatever the gap is, you’re currently paying to collect it the expensive way.
We’ll measure your upfront collection rate from your own data and show you the pipe between your front desk and your collections team. Grab 30 minutes with us. Prep nothing.