Overview

To provide new front desk team members with the essential knowledge, skills, and tools needed to perform their roles effectively while upholding the high standards of patient care and professionalism at OSSWF.

Understanding Your Role

Front Desk Responsibilities

• Greeting and assisting patients with check-in and check-out.

• Verifying patient information and insurance details.

• Scheduling, rescheduling, and canceling appointments.

• Managing phone calls, emails, and patient inquiries.

• Processing copayments and handling financial transactions.

• Ensuring HIPAA compliance and patient confidentiality.

• Coordinating with medical staff to maintain patient flow.

• Maintaining a clean and organized front desk area.

• Handling patient concerns and escalating issues as needed.

• Following office policies and emergency procedures.

Systems & Software Training

Using Appointment Flow

Customer Service

The front desk is the first point of contact for patients at OSSWF. Providing exceptional customer service is essential to ensuring a positive patient experience. This section will outline key principles and best practices for delivering excellent service.

Greeting Patients

• Use a friendly, professional tone when welcoming patients:
  “Good morning/afternoon, welcome to Orthopedic Specialists. How can I assist you today?”

• Address patients by name whenever possible to personalize their experience.

• Be aware of body language—stand or sit upright and avoid crossing arms.

Handling Difficult Situations

• Dealing with Frustrated Patients:

  • Listen actively and acknowledge their concern.

  • Stay calm and professional, even if the patient is upset.

  • Apologize for any inconvenience and offer a solution or escalate to the appropriate person if needed.

  • Example: “I understand this is frustrating. Let me see how I can assist you.”

• Managing Long Wait Times:

  • Keep patients informed about delays and provide updates when possible.

  • Offer water or reading materials to enhance their comfort.

  • Show appreciation for their patience: “Thank you for your patience today. We’ll be with you as soon as possible.”

Test Your Knowledge

Insurance & Billing Basics

Glossary of Health Coverage & Medical Terms

• Allowed Amount: Maximum amount on which payment is based for covered health care services. This may be called "eligible expense," "payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference.

• Appeal: A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part).

• Balance Billing: When a provider bills you for the difference between the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

• Claim: A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered.

• Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of your allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance of plan's allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount).

• Copayment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

• Deductible: The amount you could owe during a coverage period (usually one year) for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

• Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include: walking boots, knee braces, splints, etc.

• Excluded Services/Non-Covered: Health care services that your health insurance or plan doesn't pay for or cover. Examples include: 

• Health Insurance: A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium, A health insurance contract may also be referred to as a "policy."

• Marketplace: A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket costs of coverage available through the Marketplace, and information about other programs, including Medicaid and the Children's Health Insurance Program (CHIP).

• Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

  • In-network: Health care providers, facilities, and suppliers that have a contract with your health insurance plan to provide services at negotiated (typically lower) rates. Using in-network providers usually results in lower out-of-pocket costs for the patient. 

  • Out-of-network: Health care providers, facilities, and suppliers that do not have a contract with your health insurance plan. This often means higher costs for the patient, as the insurance may cover a smaller portion of the bill or not cover it at all. 

• Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or DME is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn't a promise your health insurance or plan will cover the cost.

• Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

• Primary Care Provider: A physician, including an M.D. or D.O., nurse practitioners, clinical nurse specialist or physician assistant, as allowed under state law and the terms of the plan, who provides, coordinates or helps you access a range of health care services.

• Referral: A written order from your primary care provider for you to see a specialist or get certain health care services. In many health maintenance organizations (HMOs), you need to get a referral before you can get health care services from anyone except your primary health care provider. If you don't get a referral first, the plan or health insurance may not pay for the services.

• Specialist: A physican specialist focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has special training in a specific area of health care.

Fracture Care

Understanding Fracture Care Billing at OSSWF

Thank you for representing Orthopedic Specialists of SW Florida (OSSWF) at the front desk. One of the most common billing topics patients have questions about is fracture care. This guide will help you understand how fracture care is billed and how to effectively communicate with patients about their financial responsibility.

What is Fracture Care Billing?

Fracture care is billed as a global service package, which means it is charged at the beginning of treatment rather than per visit. This differs from standard office visits and can sometimes cause confusion for patients.

What Does the Global Package Include?

The global package for fracture care covers:

• All normal/uncomplicated office visits related to the fracture for 90 days.

• Follow-up evaluations to monitor healing.

However, some services are not included in the global package and may incur additional charges. These include:

• X-rays

• Casts and braces

• Physical and/or occupational therapy

• Injections

• Treatment of complications

Why is Fracture Care Billed Like Surgery?

Many insurance companies classify fracture care as a surgical procedure, even if no surgery is performed. This is based on national coding standards set by the American Medical Association (AMA).

As a result, the charge may appear as a surgical procedure on the patient’s Explanation of Benefits (EOB). Depending on their insurance plan, the cost can range from $300 - $1,200 and may be applied toward their deductible.

Setting Patient Expectations

Patients may be surprised by the way fracture care is billed. As front desk staff, you play a key role in helping them understand their financial responsibility. Encourage patients to:

• Review their insurance benefits to understand deductible and out-of-pocket costs.

• Ask questions if they are unsure about their coverage or charges.

• Contact our billing department at (239) 461-3652 for further clarification.

Frequently Asked Questions (FAQs)

Q: "I was diagnosed with a fracture before my appointment at OSSWF. Why are you still billing for fracture care?"

A: The fracture care global fee is not for the initial diagnosis, but for the continued management and follow-up care over the next 90 days.

Q: "I was diagnosed with a fracture, but no treatment was required. Why am I still being billed for fracture care?"

A: Even fractures that do not require immediate intervention still require monitoring and follow-up. Treatment may include rest, bracing, physical therapy, or medications. Your physician will continue to assess the healing process and address any concerns.

Key Takeaways for Front Desk Staff

• 1. Fracture care is billed as a package, covering 90 days of follow-up care.

  2. It is classified as a surgical procedure by insurance, which may impact how it appears on a patient’s bill.

  3. Additional services like X-rays, casts, and therapy are billed separately.

  4. Encourage patients to review their insurance benefits and contact our billing team with questions.

Global Period

Test Your Knowledge

Compliance & Office Policies

Miscellaneous

Patient Portal

You can activate, reset the password, view the username, and see when the patient last logged into their patient portal. Go into the patient account and where the brief information about the patient is, there will be a Portal section.

Non-Covered Charges

Front desk collects and posts the charges for the following:

• FMLA Paperwork 

• Disability Parking Permit

• X-Ray/MRI Disks

• Non-Covered DMEs

Service Animals

Hands-On Practice & Role Playing

Scenario 1: New Patient Appointment

A new patient arrives for their first appointment at OSSWF. They have never been seen before and are unsure what paperwork they need to complete.

What do you collect?
A) Insurance card, photo ID, completed new patient forms, and referral (if required by their insurance)
B) Only their photo ID
C) Just their insurance card

Scenario 2: Returning Patient with New Insurance

A returning patient arrives for their appointment and casually mentions that they have a new insurance plan but did not bring their new card.

What do you do?
A) Proceed with check-in and ask them to bring the new card next time
B) Ask for a copy of their new insurance card and verify coverage before check-in
C) Tell them they cannot be seen without their card

Scenario 3: Patient with Balance Billing Concerns

A patient receives a bill for a recent visit and says, “I thought my insurance covered everything. Why am I getting charged?”

What do you do?
A) Review their explanation of benefits (EOB) with them and check if they owe a copayment, coinsurance, or deductible.  
B) Tell them to call their insurance company
C) Tell them they must pay the full amount immediately

Scenario 4: Patient Requesting Durable Medical Equipment (DME)

A patient comes saying they have an appointment to pick up their knee brace.

What do you do?
A) Use MotionMD and have patient sign delivery ticket/ABN if needed. 

B)

C)

Scenario 5: Patient Without a Referral

A patient with an HMO plan arrives but does not have a referral from their primary care provider.

What do you do?
A) Allow them to be seen without a referral
B) Inform them that their insurance requires a referral and offer to reschedule or assist in obtaining one
C) Bill the insurance anyway and see what happens

Scenario 6: Patient Arriving Late and Out of Network

A patient arrives late to their appointment and you notice their insurance is out of network.

What do you do?
A) Check if the provider is willing to see out-of-network patients and inform the patient of any balance billing concerns
B) Proceed without discussing costs
C) Turn them away immediately