Recently, I was talking to one of my clients.
She was unhappy with the fees she was getting from insurance companies.
Sadly she was also unhappy about how often she got paid too.
Therefore she wanted me to contact all insurance companies and do something about it.
Unfortunately, not only had she agreed on her fees, she had agreed on the payment terms too.
When she applied for recognition with the various insurance companies towards the end of 2018, she thought to give it a year and she would be able to increase her fees.
Sadly, this was never going to happen.
Certainly, she could ask the question but it was doubtful she would get an increase.
And that’s precisely what happened.
There is not a lot she can do about it.
Nor can I.
So instead she wanted the payment terms amended.
Two of the insurance companies paid her within a few days.
Others paid her once a week.
The remaining insurance companies paid her monthly.
She wanted ALL insurance companies to pay her within a few days.
This is never going to happen either.
The reality is, just as it is with fees, the insurance companies are in the driving seat.
They are not going to amend their payment terms.
Even more so when the consultant agreed to the terms originally.
I’m all for arguing with insurance companies.
But I won’t pick an argument that I know every well I won’t win. There is no point.
If you agree to your fees and your payment terms, you pretty much are stuck with them.
Sorry!
pete@medicalhealthcaremanagement.co.uk
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The other day I wrote of the importance of setting targets and then measuring performance.
Several consultants emailed asking what is, in my opinion, the most useful and important measure.
In all cases, the answer was the same.
THE most important measure is???
It doesn’t matter what specialism you are in, without new patients your practice will fail.
Therefore, you need to know:
2. Where are these patients being referred from?
It isn’t sufficient to know the total number of new patients last month.
You also need to know WHERE these patients came from.
But knowing, for example, 70% or 80% or whatsoever percent of new patients are referred from insurance companies.
You also need to understand which insurance companies are making referrals to you.
More importantly which are NOT.
If for argument’s sake, you are seeing 20 new patients a month via insurance companies, it is crucial to know which insurance companies?
More importantly, which insurance companies are not referring ANY new patients?
Then you can ask the question why not?
The self-funding market may well be the one which grew the most in 2019 and is forecast to be the highest grower in 2020 but that does not mean the insurance market should be ignored.
In fact, a second important measure is how many new self-funding patients and how many new insured patients.
Without both, the practice will struggle.
So the first most important measure in any practice is:
The second most important measure is:
pete@medicalhealthcaremanagement.co.uk
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A couple of examples recently where consultants who have tried to base their fees on the best rate available.
Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400.
He decrees he will charge PMI Company 1 the PMI Company 2 rate.
Great idea.
Right up to the point PMI company 1 receives the invoice for the higher amount.
They will decline to pay that fee.
Most likely they will shortfall it.
But, replies the Consultant, no problem.
The patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t.
Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable.
Carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling.
Continue doing it over a number of months and for sure eyebrows will be raised.
Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain the same by “inappropriate billing” is not the smartest way to go about it.
pete@medicalhealthcaremanagement.co.uk
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So we are almost 3 weeks into 2020 and hopefully, this year will be an improvement on last.
Which brings me neatly to the idea of goal setting for 2020.
Some private consultants did not reach the goals they intended to last year.
Why is that?
There are numerous reasons. The main one, however, lies in the definition of the target itself.
For example, I want to see more patients.
Alternatively, I want to make a lot more money.
The problem with such targets is they are not really targeted at all.
They are nothing but wishes.
Much better goals would be: I want to see 25% more patients.
Or I want to make 50% more in 2020 than I did in 2019.
It matters little what the target is.
What is important is that it’s a clear and precise target.
This is much better for a number of reasons.
The first reason is that they are measurable.
This means it is possible to compare the 2020 performance against that of the previous year.
Is it better or worse?
In either case, the answer alone will enable the private consultant to take action.
If it is better, ask yourself why?
If worse, also ask yourself why?
The very fact you have the data available means you are in a better position to move the business forward.
Further, you will be making decisions on how to progress based on information rather than “feeling”
The reality is, is that it is extremely dangerous to run a business based on guesswork.
Any consultant needs data upon which to base his/her business decisions.
It is alarming, however, how many do NOT have the basic information.
In the majority of cases, the data is actually right under your nose.
It should be anyway.
All MHM clients have a weekly report available to them.
It details how many patients the consultant saw that week, that month and even that year.
How many patients attended a new consultation?
This number of new patients is crucial.
If a practice is not attracting new patients, eventually it will lose money. Sounds obvious?
But do you know how many new patients you saw in December 2019?
How many new patients did you see in December 2018?
Did you see more patients in December 2019 than you did in December 2018?
In the answer is yes, then that’s positive.
But if the answer is no, then that could indicate a problem.
Either way, the supplementary question, in either case, is: WHY??
Once you have the data and once you have decided if you are moving towards your target or away from your target, then the next step is easy.
Take an action that you think will move you toward your goal.
Or take an action that will replicate any improvement you have made.
Of equal use is realising what you are doing is not working.
If by the end of March 2020 you are, despite your best efforts, seeing fewer patients than targeted, you have identified that fact very early.
Early enough to think about an alternative strategy.
Set specific goals to be achieved by specific points in the year.
Monitor your actual performance against such targets those pre-defined points (s) in time.
Make sure you are either exceeding or meeting your goal.
Now you have a better perspective on what is really happening in your practice and also what it should be accomplishing for you.
And all because you have set goals and not just made wishes.
pete@medicalhealthcaremanagement.co.uk
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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them.
Before asking the question of why and how does a patient choose you as a consultant an earlier question is necessary.
Why have the patients taken out private medical insurance?
There are three major reasons.
Empirical research for MHM clients indicates whilst most private healthcare originates via a patient’s employer, the number one reason for holding private healthcare cover is to avoid and cut short NHS waiting lists.
This is the main reason patients have private medical insurance cover.
But whilst private health cover gives prompt access to treatment, the second reason for having private healthcare insurance is that it offers the additional benefit of when and where the patient may be treated. Aligned to this is the ability to recover, if surgery is necessary, in a private suite, which is more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you as a consultant, it is equally useful to consider why the patient has private medical insurance in the first place.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
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It is truly depressing when I hear “my to-do list” is two pages long.
That is normally followed by the statement “I haven’t stopped all day but haven’t achieved anything”
A couple of observations.
There are approximately 8 working hours in the day. In my case, there are not 8 hours; there eight 45-minute time slots.
The first port of call is to ask how many of those hours were you ACTUALLY working?
Actually working does not include chatting to a colleague or speaking on the telephone to a friend about a movie.
The reason I mention this is I took a call last Thursday from the manager of a private practice. She was complaining bitterly about there not being enough hours in the day.
In reality of course, unless she wants to work over every single evening, she can’t increase the actual number of hours available to much more than eight.
In my humble opinion, she doesn’t need to anyway.
She called because she wanted to know, how I could manage to blog twice a day? She wanted to do the same. Where did I find the time to write two blogs each day.
Well, firstly I don’t “find” the time. I allocate one hour each morning – between 8 am and 9 am- to write two blogs.
This has ZERO to do with each blog taking 30 minutes. Some actually take less. Others more.
It has everything to do with working when I should be working.
What is important is my insistence on doing NOTHING during that hour other than to write blogs ie working.
I don’t check emails. Nor do I stand around chatting to others about their weekend, the new TV series on last evening or today’s weather forecast.
Which brings us neatly to the all-powerful “to-do” list.
Mine (actually an ICAL calendar) is compiled the night before.
It lists all the items I want to complete the next day starting with 7 am – make coffee (important!!) check bank, clear overnight emails. The to-do list continues until 7.45 am with a 15-minute slot for yet more coffee.
8 am – 60-minute writing blogs.
During those 60 minutes, I will literally do NOTHING other than write blogs.
No distractions. No chatting with colleagues. No doing something other than writing.
In other words, I work when I should be working.
Now compare that with my practice manager friend who freely admits she is “weeks” behind on completing her medical billing.
My immediate reaction was to ask why are you considering writing blogs when you are so far behind on such an important task as raising invoices for the practice.
Secondly, why are you weeks behind?
The cause of her dilemma is not her ability. Nor is it her reluctance to work.
The true reason is she doesn’t quite appreciate, whilst she is working she should be working and only working.
More specifically, she should focus solely and absolutely on the task in hand.
Instead, she allows herself to be distracted by whatever comes across her desk or whoever walks into her office.
When she told me it took her roughly 3 hours to process a clinic list with 15 consultations on it, I nearly fell off my chair!
That should take no more than ONE hour.
But there again, I’m not letting anything distract me or anybody discuss the new “1917” movie with me (excellent by the way), I’m working on that clinic list.
pete@medicalhealthcaremanagement.co.uk
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To successfully perform medical invoicing or medical billing there has to be a degree of focus on the task itself.
In fact, there has to be a total concentration on the expected outcome. But what is the outcome
The outcome is always the same. Getting an invoice paid. The total focus must be applied to this outcome. Making sure the private consultant surgeon is paid is the task. The total focus must be on that. The problem arises when the total focus is not possible.
For example: in the middle of invoicing for 12 consultations and 4 medical episodes the telephone rings. Worse than that the person responsible for medical billing decides, as they don’t really enjoy doing that specific task, to do something else instead.
A major distraction from focus is other people’s demands.
MHM once had a client who called 8 times within 35 minutes. He afterward complained his billing wasn’t being done quick enough. It didn’t take a genius to work out that the 8 phone calls were actually the total distraction themselves.
It doesn’t really matter what the distraction is even though with modern technology advancing so much over the years, the likelihood of distractions has increased ten-fold. For example, I may be in the middle of a task and my mobile pings to say an email has arrived. A phone may also ping because a text has arrived. The opportunity for distraction(s) is enormous.
Yet these distractions can remove focus from the planned outcome.
They can stop processing an invoice correctly, resolving an issue that is preventing an invoice from getting paid or they can even stop an invoice being raised in the first place.
Modern technology is great. It enables MHM to communicate with its clients speedily and efficiently. Clients can provide data to MHM equally efficiently. It also enables MHM to raise invoices electronically and deliver them at the push of a button. But it can also be a blessing in disguise if MHM were to let it distract from the job in hand.
Thus it is worth repeating that the planned out is for the private medical professional to get paid.
That is what MHM is there for; nothing else.
If the technology on occasion stops that, then remove the technology for a while.
This may sound revolutionary but in the real world, ignoring technology when the technology actually prevents achieving the planned outcome is not as silly as it sounds.
For example: when I’m raising medical invoices for a client – every single morning invoices are processed at MHM – I switch my email off. Thus there are no distractions caused by emails arriving. Before anyone raises the question of an email being important, may I suggest that in reality whilst emails may be important seldom are they time critical?
They are normally requests for data or asking a question.
All three examples are important but they are not, despite what people may claim, time-critical.
My favourite example of this is the person who was tasked with locating new premises for MHM. She emailed me one-morning last year but when I didn’t immediately respond, telephoned to confirm if I had received her email. This despite the instruction to email details to me and being advised I would respond later that week.
As she couldn’t even follow that instruction, she immediately lost the opportunity of finding new offices!
The world will not end and a private medical practice won’t immediately collapse if an email, a phone call or even a text are not immediately responded to.
That is not to say a patient inquiry should not be immediately answered. In the case of a patient calling then absolutely they should. Have someone designated to answer the phone. It looks awful if a patient calls and the phone isn’t answered.
But don’t have the same person responsible for medical billing AT THE SAME TIME for if you do the phone calls and/emails will provide the distraction to caused the planned outcome to be missed.
Medical billing is not the easiest thing to do in the world. It requires concentration and attention to detail. If the outcome is expected to be prompt payment of an invoice for medical services, the focus should be directed to just that. You know what happens if I switch my email off during the morning or I have the text alert set to silent?
Nothing.
Except I raise numerous invoices for clients, resolve issues with insurance companies and make sure MHM clients are paid.
pete@medicalhealthcaremanagement.co.uk
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I was at a medical conference recently and one of the speakers – a well-established consultant surgeon and an incredibly safe pair of hands – stated during his presentation that a private surgeon could not charge for inpatient care.
He may well be a safe pair of hands but on that point he was wrong.
After the conference, I had a word and said he was incorrect. It IS possible to charge for inpatient care.
I couldn’t help but suggest to him that the mere fact there was a separate code for inpatient care indicated it could be charged.
Obviously, it may well depend on the insurance company concerned. In principle, however, it is possible to charge. I knew I was right because I’d actually charged for inpatient care for an MHM client a few weeks earlier. And the invoice had been paid.
But he wouldn’t budge.
He was right.
I was wrong.
Skip forward a few weeks and I received an email from my consultant surgeon friend confirming that I had been right all along and he had been wrong.
Why is it sad that I had been right?
Because my consultant surgeon friend has been in private practice for well over a decade and he’d NEVER charged for inpatient care.
More significantly though, my friend had not checked each month what could and could not be charged for.
That also begged the question if the fees he was charging had been checked with the same frequency too. He hadn’t so as a favour I checked for him.
The good news is that only 3 of his fees had altered.
The bad news is that one of them had gone up £107 five months earlier yet he was charging the old and lower fee.
Thus it is important not only does a Private Consultant Surgeon need to establish what he can or can’t charge for, it is just as important to check HOW MUCH you can charge for!
pete@medicalhalthcaremanagement.co.uk
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Another familiar issue that came again last week.
Consider if, during the initial consultation, you advise your patient surgery is required.
The patient is therefore given a CCSD code equating to the surgical episode to quote to his or her insurance company. He goes away, quotes the CCSD code to his insurance company and is given a pre-authorisation code for, as an example, AB1234 by his insurance company.
The patient then contacts your secretary and passes over the pre-auth number.
Everybody is happy.
But what happens if, during surgery, you realize a change of surgical procedure is necessary?
Does it make a difference?
Not to the patient.
It also doesn’t make a difference to you either for you have performed the surgical procedure you deemed to be the absolutely correct procedure at the time.
The point at which it does make a difference, however, is the fee the amended surgical procedure attracts. For example:
The original code of AB1234 may, for example, generate a fee of £452.
But if during surgery, a different procedure was necessary a different code will be applicable.
For example XX4268 instead of the original procedure code of AB1234. XX4268 generates a fee of £619.00 whereas AB1234 generates £452.
So the question: which code do you charge for?
The XX2468 obviously.
There is a step to be taken before the invoice is raised.
The best practice is to call the insurance company and explain the situation.
All insurance companies are very used to such calls from MHM. Some request a letter from the consultant surgeon explaining why the change was necessary.
Some do not.
And thus MHM invoices the correct fee and you get paid the right fee.
What happens if you do NOT make the call to the insurance company and just invoice for a different CCSD code to that authorized?
Having never ever done that I wasn’t sure. So I called two of the major private medical insurance companies.
Both said the same.
At best the invoice will be seriously delayed pending their request for an explanation. In the worse case, the invoice will be declined.
pete@medicalhealthcaremanagement.co.uk
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I was asked my view of social media eg Twitter or Facebook. Whilst in my view a private surgeon should have a website, social media may not be the right place to be unless EXTREME care is exercised.
Any social media utilised by a private surgeon which also allows a patient to post comments thereon might well be a recipe for disaster.
Consider the untold damage if the patient posted on-line the care by the Surgeon was first class but the standard in the hospital was awful.
Guilt by association. Even worse if the patient posts online that the care administered by the surgeon was poor!
One consultant recently expressed the view that the only difference in 2019 to when he started many, many years ago is that now patients no longer merely gripe to friends and family. They can also go online.
An excellent point indeed.
His view is to always perform the best job he can. Just as he should do. That will stop patient complaints. But sooner or later somebody will complain.
MHM is often asked the question of which clients have the healthiest private practice. For sure, those that have a website tend to fall into this category. Interestingly though, not one of those clients engages in social media.
So the conclusion may well be not only could social media be a dangerous place to be but, thus far, it has not proved to generate additional patients either.
pete@medicalhealthcaremanagement.co.uk
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I was watching an excellent piece of video yesterday by my friend Dev Lall.
Dev was explaining how most consultants do not appreciate they have to work on marketing their practice.
And he is right!
However, it got me thinking about my own work and how certain consultants do not seem to understand seeing patients isn’t enough to ensure good cash flow.
To increase your cash flow you need to get paid. Obvious.
Except, far too many consultants do not understand how and why private insurance companies pay them.
For example: to get paid by ANY insurance company you need the right patient details.
Because without them, you can’t invoice.
And if you can’t invoice you won’t get paid.
It is as simple as that.
This is illustrated over and over to new MHM consultants when I take over their invoicing.
However, it’s not the consultant who actually gets the details.
It is the consultant’s secretary or the hospital.
The switched-on consultants who may be defined as making more money because they see more patients AND get paid are well aware of this.
Moreover, they take the time to ensure their medical secretary or hospital, fully understand the need to make sure details are correctly obtained.
Effectively, by making sure all the support functions are in place (getting the patient details right), he/she has worked ON their practice. They have put the time and effort in.
Working ON a private practice does not mean the consultant has to do everything himself. In fact, that is the very worse thing you can do.
The switched-on consultants buy somebody else’s expertise to work ON their practice with the result the consultant has time to see MORE patients because the expert has attracted more patients to the practice in the first place.
Once the invoicing and billing are also placed in the hands of an expert, cash flow improves too.
Everybody is happy!
Time and effort in private practice are not just about seeing more and more patients.
It involves working ON your practice and not just in it.
pete@medicalhealthcaremanagement.co.uk
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This issue came up recently with a consultant surgeon.
How are benefits and fees accounted for against a patient’s package?
Consider the total benefits payable under a patient’s policy. For example, the benefits payable is £100.
It could be more. The fees mentioned below could be higher too.
Against such a benefits package, fees are deducted thus:
Initial: £20.
£20 is paid out. The total benefits figure reduces to £80.
Subsequently, the patient requires surgery. £50.
This is also paid.
The accumulator reduces to £30.
Finally the hospital tenders their account: £20. The gasman submits his: £10. The benefits accumulator, therefore, reduces to ZERO.
The benefits package is equal to the fees.
However….
If the initial is £21, the surgery £51, the hospital £21, and the gasman £16 then the total fees = £109. Against a total benefits package of £100.
Thus, if fees exceed the total benefits a shortfall will be created.
pete@medicalhealthcaremanagement.co.uk
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Working for a consultant surgeon is fun.
However, since one particular private medical insurance company decided to outsource their help desk or their “advisors” late last year, there has been a marked reduction in their level of customer service from it.
Considering the people calling them are either consultant surgeons or calling on behalf of a consultant surgeon, that is pretty bad.
Indeed the average time on hold for this particular insurance company, for example, is now well over 30 minutes. That’s pretty awful considering it used to be less than a minute.
What is ironic however is that now I have a choice of music to listen to. For example: would I like to listen to classical music, pop music, jazz or rock music? I decided on classical as it happens and am currently listening to Bach. I like Bach.
But it has got me thinking…
Isn’t being given the option of what to listen to missing the point entirely? This is an even worse option than being told my “call is important to us” and then the call is unanswered. Shouldn’t the aim be to answer the phone call rather than offering a choice of music to listen to?
All private consultant surgeons sooner or later will need to speak to an insurance company.
Whether this is at the point they are attempting to gain recognition or to check a fee is correct is not relevant.
Sooner or later – particularly if you are billing an insurance company – you have no choice but to speak to them. But is it absolutely necessary to call?
That is my favourite question to ask.
The first port of call so to speak is always to consider if an action is necessary.
In other words, what is causing that action to be necessary and can anything be done to prevent the necessity of the action? In the case of speaking to a medical insurance company, in theory, many of the calls should not be necessary.
If an invoice is raised and submitted correctly for example then payment should – again in theory – just flow through.
Reducing the necessity of speaking to an insurance company is always a good aim. It is the very reason I check remittance advice sent by an insurance company most carefully.
They record many of the details as to why an invoice, for example, hasn’t been paid either in full or partially. For example: if a partial payment has been made the reason why will be detailed on the remittance advice.
Thus the number of calls required to a private medical insurance company will be reduced.
Nonetheless, the fact remains there will ALWAYS be an occasion to call an insurance company. It may be, for example, that the fee has been reduced and you don’t know why. The point is there may be genuine reasons why it IS necessary to speak to an insurance company.
Contrast this however with another insurance company I’ve spoken to this morning. I called them and was told I was on hold, was caller number 3 and the estimated hold time was 4 minutes. Fine; I can live with that. It is up to me whether I’m prepared to wait in line or call back.
Having formally complained to the medical insurance company in the first example that their customer service is not good four times so far in 2019, I did consider WHY they had outsourced? It would appear the reason is financial.
It’s cheaper.
It was once said by an extremely wealthy man that price is what you pay and value is what you get.
I agree wholeheartedly.
Cheaper isn’t always the best.
And time is money too. I’ve actually written this blog whilst being on hold and listening to Bach. So I’ve used the time to do other things too.
What would happen, however, if I was a private consultant surgeon with an already overworked medical secretary who had letters to type or worse still was on hold so patients couldn’t ring her?
That would reflect badly on my practice.
I’m all in favour of outsourcing. I would say that though because my business is intrinsically the provider of an outsourced facility to private consultant surgeons.
Even so, I get seriously frustrated at being told either my call is important – well answer it then – or I’m offered a choice of music to listen to. I don’t actually want either to hear either.
I want my issue resolved quickly and efficiently.
Cheaper and slower shouldn’t be an option.
pete@medicalhealthcaremanagement.co.uk
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I work in set 45-minute time slots.
That does not mean everything has to be completed in 45 minutes or less. It means that I work solidly for 45 minutes.
Each and every time.
Personally I can’t fully concentrate for more than that amount of time.
But the real question is not what do I put into those 45 minutes? The real question is how much EFFORT do I put into the 45 minutes?
For example, a clinic list arrived yesterday evening. I knew it was arriving because that particular client has a clinic on a Monday evening. It needs checking, invoicing and recording the next day.
After all, that is what I get paid to do.
It’s also the action that will generate the most revenue for me
So, the previous evening I’d entered into my ICAL a 45-minute time slot for today.
Once you start a task, do NOT stop.
Don’t stop until you have completed the task. All of it. Personally, I won’t even talk to anybody. My email is set so I don’t get an alert every time an email arrives.
All distractions are removed.
It’s the proverbial do not disturb sign not just in my office but also in my head.
45 minutes later or sometimes even less, I’ve finished the task completely. All of it.
So I reward my self with a coffee or I check the BBC news for 15 minutes. Or I’ll book some cinema tickets. Whatever.
15 minutes later, I’ll start again.
And won’t stop until that task is 100% completed.
This second task could be ringing patients. It could be checking my emails. Might even be logging onto the bank. It matters what the task or tasks are.
What matters is within those 45 minutes, I’m working as efficiently as I can.
For maximum financial reward.
It always makes me smile when I hear that.
Normally its followed by the statement “I’ve worked flat out today but got nothing done”
The most likely cause is that distractions have been allowed.
Don’t let them.
In terms of medical billing, that specific task is ALWAYS first.
Because the outcome of this specific task generates the most revenue for me.
So, in terms of outcome what are you doing today and does it lead to the maximum benefit for you?
If it does, start it and don’t stop.
If it does NOT, what are you doing it for?
pete@medicalhealthcaremanagement.co.uk
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Sometimes, getting more patients isn’t always the right answer.
The right answer is to get paid for the ones you have already seen.
Over the last three months MHM has been working very closely with an ENT consultant. His sole aim is to see more and more patients.
That way, he will make more money and retrieve the dire financial situation he has found himself in.
Thus he has reduced his consultation time down from 30 to 20 minutes. Therefore he’ll see one more patient each hour.
But the cause of his financial problem is not he doesn’t have enough patients.
He is owed a considerable amount of money. He is not getting paid.
Seeing more patients and not getting paid for them, will not help!
He needs to get paid for the ones he has seen as well as the new patients.
A simple cause.
Invoices aren’t being raised after each clinic. Instead, they are being raised every Saturday morning when “it’s quiet”.
But the problem with that is not all invoices are being raised.
Many of the patient details are incorrect. But his secretary can’t correct the details because many of the insurance companies she needs to speak to to get the right aren’t open on a Saturday.
Or if she needs to speak to a patient, she may or may not be able to reach them by telephone.
The very first thing to do is to make sure the details ARE correct. That is much easier than it sounds.
Then, she needs to invoice every single day.
In doing so she will identify issues quickly. Then she must resolve those issues the very same day.
It’s only by doing so will the dire financial situation the ENT has found himself in will get resolved.
Seeing more patients but not being able to charge for them, won’t resolve his problem.
pete@medicalhalthcaremanagement.co.uk
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One of my major bugbears with medical practice is the ability to answer the phone.
Sounds simple. It is!
Yet many practices do not answer the phone. Instead, the call goes to an answering machine and then one of two things happen.
The call is never returned.
The caller rings another consultant.
The new patient wishes to see a consultant. Most likely he or she will have a choice of whom they see. It could be you or it could be a competitor. It is not a given they will choose you.
So what will be their reaction if they can’t make an appointment because no one answers the phone or can be bothered to go elsewhere?
They will call another consultant.
By all means have the option available for the patient to book online. I’m all for it. But don’t just rely on that.
We are in the people business.
And people like dealing with people. More accurately, they like to talk with people.
So answer the phone and talk to them.
It is inevitable that your phone will be engaged at some point or your practice will be closed for the weekend. Hopefully, the patient will leave a message.
But make VERY sure that call is returned.
If you don’t, potentially you will lose a new patient.
And if you don’t attract and keep new patients, frankly your practice is dead.
pete@medicalhealthcaremanagement.co.uk
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Consider when the patient has contacted his/her insurance company and been issued with a pre-authorization number.
This does not mean, the insurance company will accept your charge.
This happened to an MHM client – a gynaecologist – a few days ago.
We spoke to the insurance company concerned.
They confirmed whilst they did indeed issue a pre-auth, this did not mean they would accept the charge.
In fact, pre-authorization had been refused.
Yet again the message came through loud and clear:
No argument from me on that one. It has always been so.
My issue though is why did the insurance company issue a “DECLINED” pre-authorization?
If they were not prepared to issue a pre-authorization then they should not have issued one at all.
This point was duly made to the insurance company. Their reply was poetic.
They had always done it that way.
I have the utmost respect for private medical insurance companies.
Most are extremely efficient and willing to help.
Whilst I’ve had numerous disagreements with all of them regarding fees etc, never have they implied or stood behind the “we’ve always done it that way” position.
But on this occasion, it feels very much like a case of stop wasting your breath!
pete@medicalhealthcaremanagment.co.uk
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A common mistake made by a private consultant surgeon is undercharging for their work.
This is alarming when most consultant surgeons wish to increase their fees.
This always spins off into a debate regarding private medical insurance companies being the enemy.
Fees are always being reduced with the private surgeon being paid less and less.
That may be true sometimes.
It is not the right place to start, however.
The right place to start is to make sure you are charging the correct fee.
Such fee may be less than you want of course but, many times, be more than he thought you were entitled to.
Take the example of an orthopedic surgeon who contacted MHM to process her medical invoices recently.
She thought her consultation fees were too low.
That also may be correct.
But that was the consultation fee the insurance company was prepared to pay.
The orthopedic surgeon was unaware some of the insurance companies were prepared to pay a fee for minor procedures carried out at a consultation.
They would pay a procedure fee together with a fee for the consultation.
Whilst some insurance companies weren’t prepared to pay both fees, some were. Instead, the consultant had been charging ONLY for the minor procedure.
She had not been charging for a consultation as well.
The same situation was equally applicable to a private dermatologist just as it was applicable to a GI surgeon.
It is not therefore applicable solely to orthopedic surgeons.
It is applicable to many specialisms.
The issue, therefore, becomes one of: am I charging the right fee?
To confirm the fee is correct a review of procedure codes and the fee for the procedure code should be undertaken.
Both may then be compared against the fee structure of the private medical insurance company concerned.
Each code and combination of codes must be checked against the fee schedule of the private medical insurance company.
The often stated assumption that all insurance companies pay the same fee for the same procedure code should be rejected.
Take the example of a repair of the primary repair of Achilles tendon. Insurance company A pays a fee of £336 whereas insurance company B pays £405 – £69 more!
The orthopedic surgeon concerned was of the belief insurance companies paid out the same fee.
She had UNDERCHARGED by £69 as a result.
To return to the original issue of charging a consultation fee alongside a fee for a minor procedure, take a look at injection into soft tissue.
The same insurance company paid a fee of £108.
The orthopedic surgeon in question was unaware that a follow-up consultation could be charged in addition to the fee for the injection. Another £150 on top of £108!
Thus the correct charge was not £108.
It was, in fact, £258
To further illustrate the point a dermatologist may charge the very same insurance company, £91 for curettage of skin or lesion.
He or she may also charge a follow-up consultation fee in addition.
If the follow-up consultation fee is £100 (and it is for the MHM client concerned) the fee for the WHOLE event has doubled!
Thus the most common mistake in medical invoicing is not realising that fees can and do differ between insurance companies and also that some, not all but some, private medical insurance companies will actually and quite happily pay MORE for your work than you may be aware of.
pete@medicalhealthcaremanagement.co.uk
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Two consultant surgeons apply for recognition by insurance companies.
They have been told by various insurance companies that the fees for their initial and follow up consultations are lower than they anticipated.
They are not amused to say the least.
But what can they do about it?
Nothing.
Actually, that’s not strictly true. In a perfect world there is much they can do. But we don’t live in a perfect world. We live in this one.
In a perfect world they can, for example, pass any reduction in fees on to their patients.
Save of course their recognition agreement with the insurance company forbids them to do so.
If they do they are at risk of de-recognition. Ah came the reply, the insurance company won’t find out.
Yes, they will.
Or they can stop seeing patients referred to them by that specific insurance company.
Both of these consultants, however, are by no means stupid.
Neither of them just reacts.
An immediate reaction is potentially the worst thing to do.
Many years ago MHM worked with one consultant who did just that when denied a fee by an insurance company.
He even went so far as to tell the insurance company concerned unless they immediately put his consultation fees back up he would forgo his recognition with them and refuse to see their insured patients.
They didn’t so he did.
And immediately saw a 23% drop in the private practice turnover.
Do NOT react.
What is required is a considered response to all the options.
In the case of the MHM clients, I calculated what the drop-in consultation fees would mean over a six month period against an assumption that the lack of referrals would lead to 25%, 50% or a 100% drop in patients from that specific insurance company.
In all cases, for obvious reasons, there was a loss.
But at least that loss was now quantified.
It is worth noting that the drop in consultation fees would not equal a drop in surgical fees because surgical fees were excluded from the reduction.
That said a refusal to see patients from the specific insurance company concerned due to consultation fee reduction would automatically lead to a 100% drop in surgical fees as clearly if a consultant does not see a patient.
Sadly there are only two options in reality: accept the reduction or don’t accept the reduction.
I’m afraid the insurance company really is in the driving seat when it comes to setting their fees and there is little a private consultant surgeon can do about it.
Many years ago a private consultant surgeon could charge what they liked and to a certain extent with a self-funding patient, they still can.
However, with insured patients, those days are long gone.
So what should the private consultant surgeon do?
MHM suggests an analysis of how the reduction will impact on the private practice should be undertaken.
That will at least quantify how the reduction will impact the private consultant surgeon in actual financial terms.
All the data will be contained on a sales ledger and with the aid of an excel spreadsheet it’s relatively easy to perform the analysis.
The bottom line remains to accept the fee reduction or reject the fee reduction.
pete@medicalhealthcaremanagement.co.uk
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It is depressing the number of times I hear potential clients criticizing insurance companies.
In my experience the reasons normally cited are incorrect. Far from it.
I’ve lost track how often I’ve been told an insurance company won’t pay for something.
Yet when I ask if the insurance company has actually been asked IF they will accept a charge, the answer comes back that they have not.
I have all the private medical insurance companies on speed dial.
They need to be as I speak to most of them every single day of the week.
There are many, many things I’m already aware of.
There are also some things that I don’t know or more importantly, that may have CHANGED.
I ask them all sorts. For example – I ask them to confirm a patient’s policy number. I ask them to confirm why an invoice has only been partially paid.
Sometimes I ask them if I can or cannot charge for a certain medical episode.
Which brings me neatly to the W9040 code.
I was invoicing for an orthopedic consultant surgeon recently. His specialism was knees and during a follow-up consultation, he administered a W9040.
This particular CCSD code represents an injection into a joint or soft tissue.
The question arose if I could charge a particular insurance company for a follow-up consultation fee AND a fee for the injection.
So I called them.
The answer came back yes I could. I could charge £120 for the consultation and £50 for the injection i.e. £170.
The insurance company would happily pay such an invoice.
Compare and contrast that with work I was performing for a dermatologist recently.
This time the question arose of an S5210 (an Injection into subcutaneous tissue).
I’ve only recently started invoicing for this client and thus it was important to establish what could and could not be charged for.
More specifically, would the insurance company accept an invoice for the follow-up consultation AND the injection?
Yes, they would.
£125 for the consultation and £108 for the injection i.e. £233.
Remember however that I had asked ONE specific insurance company.
When I asked others the same question, some would NOT allow the separate charge.
What was concerning was previously the dermatologist had not been charging for the S5210 at all.
I actually asked his practice manager why this was so.
The answer came back that the question had been asked of an insurance company before and the answer was no.
The problem was that whilst the insurance company concerned did not (and still don’t) allow a charge, other insurance companies DID allow a separate charge.
But nobody had asked the other companies.
Instead, it was assumed the decision covered ALL insurance companies.
Thus on numerous occasions, insurance companies are wrongly blamed for their actions.
It was only by speaking with the individual insurance companies that I identified which ones would accept the charge and which ones would NOT accept the charge.
Insurance companies are NOT the enemy.
If you call them, you may be surprised at what you are told.
That is not to say you will always obtain a positive response but you may be pleasantly surprised.
pete@medicalhealthcaremanagement.co.uk
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