Deductibles go uncollected when your front desk can't explain them
One front desk person didn't ask patients to pay because she couldn't calculate a deductible. Find out what yours knows before you replace anyone.
Co-founder, JotPsych
You told your front desk to collect at the visit, and patients with deductibles still leave without paying. Replacing your front desk person looks like the fix. Find out first what that person knows about deductibles.
"It's important that you try to collect at the point of service."
"Amy, I didn't realize this person doesn't know how to calculate deductibles."
Words from clinic leaders in Amy Lafko's training. An instruction to collect says nothing about how to work out what a patient owes.
- Ask your front desk person to teach you what a patient owes. Pick a patient on this week's schedule whose deductible isn't met. Amy Lafko, a consultant who trains clinic leaders, gives this test to any leader who thinks, "I've been clear." "Go ask someone to teach you as if you're the new team member," Lafko said.
- Write down the first term your front desk person can't explain. Listen for terms like "deductible," "coinsurance," and "out-of-pocket maximum."
- Teach that term first. For a deductible, start with the HealthCare.gov definition: "the amount you pay for covered health care services before your insurance plan starts to pay." In 2025, 88 percent of workers with single coverage in job-based plans had a general annual deductible, the health policy group KFF found.
From KFF's 2025 Employer Health Benefits Survey, published October 22, 2025. A patient pays toward the deductible for most covered care before the plan pays, so a front desk person has to be able to explain one.
- Check the process side too. Find out how your system shows your front desk what a patient owes at check-in, and what your front desk can't find or trust there. The easy answer is a new front desk person, Lafko said. "Leaders get curious."
Was the collection expectation explicit, with its exceptions and consequences?
Can the front desk person explain the balance and answer a patient who objects?
Has the front desk person raised concerns about collecting at the visit?
How does the system report the copay or amount due to the front desk at the visit?
How does the front desk record the collection in the system?
What can the front desk person not find, or not trust, in the system?
Questions for the front desk person and for the system behind a missed collection. A gap on the person side calls for clearer expectations, teaching, or coaching; a gap on the process side calls for a changed step, rule, tool, or handoff.
Then fix what you find. Teach your front desk person when the gap is knowledge, and change the step when the gap is the process. Run Lafko's test again to check the fix. "A people problem does not mean that you have problem people," Lafko said.
Run JotPsych's eligibility check before the visit to see the patient's remaining deductible, as the payer reports it.
Book 15 minutes- Amy Lafko, chief executive of Cairn Consulting Solutions, and Taya Gordon, chief executive of Atlas & Perpetua Healthcare Consulting, “Two Sides of the Same Coin: Why You Need Both People and Process to Succeed with Revenue Management,” session D7, Medical Group Management Association (MGMA) 2026 Annual Conference, San Antonio, September 28, 2026. The person and process questions are paraphrased from the session slides.
- HealthCare.gov, glossary entry “Deductible”, read September 30, 2026.
- KFF, 2025 Employer Health Benefits Survey, October 22, 2025, read September 30, 2026.