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Patient Flow Key to Cash Flow

Designing Effective Patient Flow to Enhance Cash, Cost & Customer Service

Tom Hajny


Patient Flow & the Revenue Cycle


Patient flow is as critical to the revenue cycle as it is to the efficient delivery of clinical care. In fact, it is part and parcel of the entire package of effective and efficient clinical care, customer service, staff and physician productivity, practice cost, and cash flow. The purpose of patient flow and the revenue cycle is to collect or have a payment arrangement in place for all patients lowering bad debt, accelerating billing, and enhancing customer service while supporting patient care.


In too many practices, communication of the financial expectations and the asking for payment at the time-of-service is seen as injurious to customer service and an impediment to the patient receiving quick access to clinical staff. A well thought out patient flow overcomes these objections. The process identifies and resolves patient payment problems prior to and at the time-of-service allowing patients to focus solely on their healthcare needs.


Prior to Service. Patient flow begins prior to service with chart preparation and the review of the patients past payment history. If there are outstanding patient balances or a bad debt history, this needs to be discussed with the patient before they are standing before the receptionist in a crowded waiting room. Make the phone call to explain to the patient the need to clear those balances prior to service. Will you lose some patients who have no interest in making payment? Yes. Is it unfair to ask patients, who can pay, to pay? No. Also, in the pre-visit preparation stage: review insurance and benefit levels for co-pays, deductibles, and co-insurance. Include your findings with (or on) the encounter form.


The Patient Presents. Hopefully, during the scheduling process the new patient has been apprised of your practices financial expectations. If the patient has a co-pay, collect it without fail. Chasing around after $10 or $15 dollars after service is expensive. If the patient has no insurance, discuss with the patient that full payment will be expected after service and collected at the exit desk. With that the patient is ready for their service.


At Service, the Physician. Here's the tricky part. For the Patient Flow to realize its full potential, the clinicians must do their part. The breakdown usually comes because the encounter form, complete with diagnosis codes and itemized charges, is not completed. There may be many reasons for physicians to hold the encounter form usually under the headline of  Coding but none sufficient. By not completing the coding and charges during the patients visit, insurance billing, full capture of charges, and the ability of staff to work with non-insured patients in collection of dollars owed for services will be destroyed. When service is complete, the encounter form and the patient should be delivered to the exit desk.


At the Exit Desk. With the encounter form, the exit desk is able to work with the non-insured patient (or patients with high deductibles or prior balances) in the collection of payments. The charges will be calculated and payment requested. If necessary, the financial expectations of the clinic will be reiterated and payment arrangements negotiated. Also, at this stage, any follow-up services would be scheduled. When the patient has departed the charges and codes can be entered into the practice management system. For insured patients, the service given that day will be billed to insurance that night (i.e. cash acceleration).


It is a fairly simple process but the critical control points must be managed.  A breakdown in any one will doom the overall outcome. Review your current system:



  • What percent of co-pays are collected at reception?

  • What is the wait time from entering to service?

  • Do you prepare the charts with financial histories?

  • Do the physicians code and document charges concurrently?

  • Is there an exit process?

  • Are non-insured patients paying in full before leaving the clinic?

  • Are you entering charges and codes into the system at the time of discharge and billing that day?

Patient flow is many times assumed as an organic entity which has arisen naturally due to other factors and is not subject to change. However, it is a system which is alterable and needs to be subject to the logic which drives clinical care and the revenue cycle.



Greenbranch Publishing