Have you ever consider where your practice really is in terms of medical billing?
This is the routine I follow:
What do I look for? Precisely where the Practice is now.
When? The very first day
It seems the most obvious place to start.
But numerous times a practice doesn’t really know what is happening in terms of invoicing and billing. That, if you think about it, is crazy.
It may well be the practice principals think they are owed too much money but seldom do they consider the three most fundamental questions of all before they may reach their conclusion.
In any event “think” is not good enough. You need to know. You MUST answer three fundamental and parallel questions FIRST.
How much are you owed?
Do you know how much? How can you be so sure it is the total amount you are owed? Does it include every single piece of work undertaken in the practice?
In other words, is there a sales ledger (sometimes known as a debtors ledger)?
You would be surprised how many times I’m told the figure is £X based on a sales ledger the practice accountant produced four or even five months ago for the last financial year-end of the practice.
All that does is confirm the position a number of months ago.
That is not good. The data should be no more than 30 days old i.e. if it’s November 20th, 2019 today then that data should be no older than August 20th.
Therefore you need to ensure the information really does confirm how much you are owed. Does it?
If the data is “out of date” then that may indicate it too is inaccurate.
For example: if the sales ledger indicates most of the money is overdue then the supplementary question of “who says?” springs to mind.
Taking the above example of a report being between four or five months old, some of the amounts WILL have been paid either in full or partially.
How many have been paid?
Have such amounts been allocated to the sales ledger?
Was such an allocation accurate?
Therefore you must make sure the information you are looking at is the most recent that is available. Is it?
For example, I recently reviewed the sale ledger of a private practice covering three surgeons who were firm of the opinion they were owed “a fortune” by the various private medical insurance companies.
Yet when the analysis was completed between 20-30% of the overdue balances were actually down to shortfall and excess payments.
They aren’t due from any insurance company; they are due from patients.
Therefore you must make sure you really do know who owes you the money. Are you sure?
Look at it this way: you may have the greatest sat nav on the planet in your car but if it cannot confirm precisely where you are, don’t bother telling it to route to Glasgow. Or to London. Or to Birmingham. It won’t get you there!
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An email arrived last week asking me to call a prospective new client.
He’d been reading my blogs and wanted help to grow his practice.
In particular, he wanted a review of the performance of his practice and asked if I would call and arrange to go see him.
In his email, he said he thought he should be seeing more patients and his current patients should be paying quicker too.
I don’t even charge for this as occasionally there are only minor items that require attention.
So I called the telephone number provided and was promptly put on hold.
Nobody expects to have a phone answered immediately every single time. It’s not normally a problem.
Or is it?
Where I did have a problem with this particular call was being told “your call is important to us” every 15 seconds whilst listening to awful music.
Whilst listening I looked at the consultant’s website.
It was very good and promoted the consultant really well. Details of his practice were impressive. The photograph of him on his website was very professional. The contact page was really good.
A “Frequently Asked Questions” page was very comprehensive. A “contact us” page contained phone number, email address, and location. They were all available for the patient to see.
Meanwhile, I was still being told: “your call is important to us”.
Then I started to think about it from that point of view.
If I’d have been a patient wishing to make an appointment I might well have hung up by now and called another consultant.
The patient may have been referred to that particular consultant by his/her GP or even by an insurance company so from that point of view the patient remains on hold and waits.
But what would happen if the patient had not been referred to the consultant by a GP or an insurance company?
In other words, he had a choice.
All patients have a choice.
A private consultant surgeon is in the service industry. It may be medical but it is still a service. And that means the service must be first class. Not just first-class medical treatment.
The level of customer or patient service is a big factor in the patient’s choice.
Every single part of the patient’s journey, therefore, MUST be 1st class.
That most definitely includes having the phone answered promptly.
It’s the little steps that matter when you are running a business and a private medical practice is a business.
Charge the right fee.
Make sure you invoice quickly.
Take steps to collect all outstanding shortfalls and excess amounts.
If the practice is difficult to contact the number of patients will drop.
When I finally got through and spoke with the consultant we agreed to meet next Wednesday.
One of the items for discussion will be his patients struggling to actually speak to his practice in the first place.
If you want a quick review of your practice send me an email!
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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!
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It was the classic environment where chaos reigned supreme.
There was a serious amount of money outstanding.
It didn’t take long to work out why.
The problem was the practice principal.
He insisted everything had to be done immediately.
And therein lay the problem.
Resolving every problem immediately didn’t allow sufficient thought as to what the problem really was. Nor did it consider the cause nor allow time to consider the options.
Instead, the problem was receiving less than a minutes attention.
The cause of the problem was ignored.
Any and all businesses require a plan.
Without one it is difficult to track where the business is going. Simple said the practice principal. The plan is to see as more patients.
It never occurred to him that practice management is important.
It should not be subject to a stream of quick-fix solutions and absolutely not when the cause of the problem hasn’t been established either.
Once the plan and goals were actually defined, the functions of the practice need to be split in two.
Primary and secondary.
The identification of primary productive areas and secondary non-productive areas is done by using a value chain. Devised in the mid-’80s by Prof Michael Porter it is one of the simplest management tools. So, what is primary? What is secondary?
Primary: anything directly focused on your patients.
Secondary: anything not patient-focused.
Anything secondary should be outsourced.
Thus practice staff will be free to concentrate on their primary area: patients.
The extra time generated will allow the practice to speak to MORE patients.
It’s a case of concentrating on what the practice is there for. If you measure your practice against a value chain, you’ll discover the primary values are supported by secondary values.
Outsource secondary values and the practice will become more profitable.
Yet numerous private practices make the mistake of not distinguishing between primary and secondary functions.
With the result, chaos reigns supreme.
The practice doesn’t work as well as it should. For example, numerous patients were complaining the practice telephone wasn’t getting answered. And they didn’t care.
They telephoned another consultant instead.
The practice principal totally disagreed. Secondary “non-productive” areas should be ignored. Concentration on “primary productive” areas would take precedence. More patients. Always more patients.
He still insisted on solving problems immediately.
Sadly his only answer was to blame everyone else.
His 150 miles an hour approach might explain why the practice had gone through 4 practice managers in just over 32 months.
The above happened just over 2 years ago. The practice principal called me last week. Sadly it appears I was right all along.
He hadn’t avoided the CHAOS FIELD.
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I left school more years ago than I care to remember.
Then as now I make sure I do my homework though.
The only difference is now I do it for private medical consultants some of whom are thinking about starting a private practice.
All of you have done your fair share of homework in the past.
The journey to becoming a surgeon is not exactly an easy one.
Lots and lots of work, study and long, arduous hours. There is lots of homework on the way too. Followed by even more work, study and long arduous hours. There is even more homework thrown in after that.
Then you are qualified.
But to start a private practice add on about five years of post-qualification experience and hey presto you decide to open a private practice!
That is more or less the path a surgeon (friend of a current MHM client) took.
I was asked to go chat with him about starting a private practice.
As the geographic area concerned contained a major urban conurbation, the population numbers were high. So that ticked the first box!.
There were three private hospitals within a 25-mile hospital too. The second box ticked.
When I checked the number of consultants at each hospital (Google is a mine of information) there were 22 at the first, 15 at the second and 15 at the third. The third box ticked.
I’d done my homework and established there was a demand for my surgeon’s specialism within the area.
The surgeon, when we spoke, was really pleased to hear the results and was in no doubt my homework confirmed he would be able to start a successful private practice.
It was that last item – the number of consultants already in place – that concerned me.
Could it be that the demand for his specialism was already being satisfied by the 52 consultants already providing his specialism?
My surgeon friend would have to compete with those consultants.
He would have to market himself to potential patients and see enough patients to make his private practice pay.
His fees from private insurance companies would have to be sufficient to cover his costs AND make a profit.
He would have to provide all the support facilities to run his private practice which would cost money.
Then he would, of course, have to pay tax on whatever was left.
Let me be clear I was NOT saying don’t start a private practice.
I was suggesting that the demand for his specialism might already be satisfied by his competitors.
He should, therefore, be fully aware of the difficulties he would face BEFORE he started his private practice.
All because I had done my homework.
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Not getting paid doesn’t happen by accident.
Something causes it to happen. There is ALWAYS A CAUSE.
If you leave invoicing until later (Friday for instance) it is very easy not to invoice at all. It can happen also if, for whatsoever reason, you leave invoicing until “tomorrow”.
Tomorrow turns into never.
Many times, I’ve been called in to examine and review the billing process of private medical practice and discovered an issue with invoicing frequency. So why is “tomorrow” “Friday” or “when I get the chance” the worst possible words for me to hear?
Nine out of ten times such an approach is a big clue as to the reason why the practice is not enjoying the level and frequency of cash it should be.
If you want to ensure your practice is paid promptly, the very first place to start is raising an invoice. It is crucial. And invoices should be raised DAILY!
Once a week is not helpful.
The danger in invoicing on a Friday or a Monday or only on any set day a week is if something happens that day – for example, the consultant needs a clinic booking urgently or a patient needs a letter immediately, then the invoicing gets left behind.
And that is normally the cause of the problems.
If invoices are raised daily should something happen to delay that ONE day’s invoicing, it is corrected the very next. There is no backlog.
Let me give you a real-life example.
Tuesday, November 5th a consultant ran an outpatient clinic and saw five patients. Three follow-ups and two initial consultations. £850 worth of consultations.
Yet invoices were not produced for this work until Monday, November 18th, – one day short of two weeks later!
Is it any wonder the consultant was extremely dissatisfied with the practice cash flow?
It didn’t take long for me to identify that on twice previous occasions over the previous few months one entire clinic list had NOT been invoiced (worth £725) and three initial consultations (worth £600) had also not been invoiced.
In the case of the initial consultations, insufficient insurance details had been obtained at the point of registration and remedy had been left until “later”!
In all £1,325 worth of invoicing had been missed.
No wonder cash flow was poor.
But before we go any further do NOT blame the medical secretary. She has enough to do. The phone rings or she has to meet and greet the patients. She has numerous letters to type.
That is precisely what she should be doing for she is there to ensure the “front of house” runs smoothly.
The error, if you will, is then expecting her to fit invoicing in around all that or, as was suggested to me, in her “spare time” WHAT SPARE TIME?
She hasn’t got any and nor should she.
In the above example, the solution was obvious. Either get someone in to process all the invoices and the cash receipts or outsource it.
Private medical practice is a business. It must be managed as a business; end of.
Without putting too fine a point on it, failure to ensure the invoicing and accounts process is not 100% efficient is pretty much guaranteed to lead to the business having cash flow issues.
DON’T LEAVE IT UNTIL FRIDAY – DO IT NOW!!
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I was chatting to a surgeon recently about surgical fees.
His view was they were too low and a certain insurance company was, in his view, trying to reduce the number of consultants they recognised by keeping fees low.
He went on to explain that since he had been recognised, his fees had always been decreased and never increased.
Curiously he was the second person to make this point in the same week although the second person had heard a rumor surgical fees had gone up.
So when I got back to the office I picked the telephone up and called the insurance company concerned.
The insurance company knows me well.
They should do.
As they are one of the major players in the industry and as all my clients are consultant surgeons for whom I raise electronic invoices and send to numerous insurance companies it’s almost certain I’m going to speak with them every single week.
I asked them to confirm the fees for both consultants.
In the case of the first surgeon, he was factually incorrect.
His fees had increased earlier this year and he was charging the correct fee.
The argument that the new higher fee was still not enough is different from the fact his fees had in fact INCREASED as he and I discussed after I called him back.
But I did urge him to check his surgical fees were correct as of November 2019.
The situation with the second surgeon, however, was more disturbing. Not only had his fees increased, but he was also blissfully unaware they had been increased.
Instead, he had carried on charging a lower amount both for initial and follow up consultations.
He was most unamused to realise he had – between July 1st and November 1st, undercharged by just over £1,000.
I wasn’t being cruel therefore in suggesting both consultants went out and checked if their surgical fees had altered too.
Funnily enough, both having gone on to read my recent blogs on this issue, they emailed me this week asking if I would be good enough to check their fees every single month.
Check your fees or get somebody to check them every single month!
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Earlier this year, MHM was engaged to review the billing process of a private hospital.
The project was to investigate why private medical insurance companies were not paying.
One insurance company was proving to be troublesome. An analysis of a month’s invoices soon identified why. This particular company required invoices to be submitted electronically.
Except the invoices were inaccurate. For example, the patient’s policy number was wrong. This caused the invoice to fail.
Instead, it was put in a “holding” pile.
To resolve the problem, it was imperative to make sure the details were correct. Invoices could then be processed and not placed on hold.
It is vital all the details are 100% correct.
That was, or so it appeared to be, the cause of the issue.
But was it?
It transpired medical secretaries thought the receptionist was responsible. Conversely, the receptionist thought the medical secretary was responsible.
Then they both claimed the person who raised the invoice was responsible. The reality was, nobody was doing the job.
The spat had caused the hospital to be short thousands of pounds. Indeed the holding pile was greater than the value of daily outpatient appointments. And it was STILL growing.
The receptionist obtains the details. Then she checks them. The medical secretary ensures all the details are recorded accurately. She checks them again. The person responsible for medical invoicing highlights ANY which can’t be processed.
The holding pile is now less than 0.5%.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%.
It’s not overkilling at all.
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Ever wondered why MHM clients get very regular payments both from Insurance Companies, Private Hospitals and self-funding patients too?
It is down to the above discipline – the ritual – both on the part of MHM and on the part of its clients.
Specifically, every single time an MHM client completes an outpatient clinic or is in theatre the detail is sent to MHM.
Some clients send them daily, others send them weekly. But send them they do.
Then it’s a question of ritual.
Every single morning at 8 am, I have the ritual of picking up the clinic or theatre lists from the previous day.
And then they are invoiced to the insurance company concerned or direct to the patient.
Monday to Friday this is the first job every single morning.
It is a RITUAL.
So how does this ritual help MHM clients?
It means payment has been requested on behalf of MHM clients. This in turns means insurance companies are able to process the invoice for payment.
Does this sound far too simple?
Well, in reality, it is very simple.
It is literally a question of RITUAL LEADING TO VERY REGULAR PAYMENTS TO MHM CLIENTS.
Paradoxically, I know many medical secretaries who instead raise invoices “on a Friday afternoon” or “after I’ve typed my consultant’s letters”.
The inevitable happens.
On a Friday afternoon, the telephone goes berserk or something comes up that prevents the invoicing from being completed.
Because there is no ritual, the consultant does not get paid as quickly as they think they should.
Indeed I was talking to a med-sec last week who was telling me she has a three-month backlog in uninvoiced outpatient clinics.
She wasn’t happy that at 10.20 am on Thursday, November 14th, I had a backlog of ONE clinic dated from the previous day.
I wonder how many times I’ve said “invoice right = get paid right” over the years?
I dread to think.
But invoice right = get paid right does not just mean having the patient’s details, coding, and fee right.
It means making sure an invoice is generated as soon as MHM is asked to do so and it means making sure it is delivered to the body responsible for paying it.
It is a ritual.
And it is a ritual that generates good results.
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Many times I’m asked how and why MHM clients achieve their practice aims with apparently so little effort. How do they take the island?
MHM does not allow its clients to define their private work as a practice: it is a BUSINESS.
Private consultants refer to it as a practice; I call it a business.
What seems like a mere play on words, is anything but. The whole of the business is geared towards making a sufficient financial return for the effort that is required.
Whilst this is absolutely NOT at the expense of providing 1st class 100% professional medical care for the patients, it does mean that patients aside, everything else is geared towards obtaining a financial return.
If the business does not generate a financial return, what is the point?
That’s why MHM negotiated a fee increase for two separate clients in respect of surgical episodes (both were increased by 40%) last week.
The consultants concerned did extra work and were therefore entitled to charge more. It is, after all, a business.
The question then arises of how they achieve their business aims with “so little effort”.
This may be summed up very simply: it’s NOT true.
But let’s be clear. I’m not talking about the consultant’s professional skills and abilities. I’m talking about the divorce between their professional skills and the amount of effort put in to run the business as a business.
All MHM clients are smart enough to outsource the management of their business; they themselves rarely get involved for they realise they are in a different world than they are used to.
Let me illustrate this by comparison with an NHS patient and a private patient.
All MHM clients have NHS commitments.
They see numerous patients all the time. But these patients are delivered without much effort on the part of the consultant. That is absolutely not the case with a private patient.
The consultant must go out and advertise himself by whatsoever means to attract patients to him.
Then he must make sure, unlike his NHS patient in respect of which he’ll be paid his NHS salary regardless, that the private patient or insurance company pay for the consultation, etc.
So what does “burn the boats” mean?
Burn the boats means that everything the private consultant does to support his business MUST be 100% organised and efficient.
A private medical practice – a BUSINESS – cannot be run in a half-hearted manner.
It takes – like any other business – considerable time and effort to get it right. Burn the boats means there is no way off the island.
Of course, a private consultant can choose to close his private practice/business and leave the island but the mindset when you start private work is that it has got to succeed for the boats have been burned.
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This is a topic that comes up frequently when I meet Private Consultant Surgeons.
Indeed, the point was touched upon earlier this year regarding asking self-funding patients to pay in advance.
Self-funding patients represent the major risk of non-payment for the private consultant.
That said MHM does not advocate requesting payment before a consultation.
One group of Private Consultant Surgeons made it mandatory that ALL self-funding patients paid in advance.
Within 3 months they had lost over 90% of their self-funding patients.
This represented a value several times LARGER than the balance due to unpaid self-funding consultations.
Cancellations, however, are completely different from “Did Not Attend”.
Frankly, none of my clients suffer from a significant number of cancellations.
Yes, there is a small number but in no way is it a problem.
It is more an inconvenience.
But there is another aspect to the debate.
That aspect is those patients who ‘Do Not Attend”.
Patients who do not attend for their consultation represent a 100% loss just the same as cancellations.
It matters little if the consultation is 20, 30 or 45 minutes.
If the patient does not attend the consultation then that time is lost. No revenue may be charged for it.
Certainly, this is true if the patient is insured for it is extremely unlikely any insurance company will allow a fee to be charged if the patient did not attend.
The issue, however, is different if the patient is self-funding.
Of course, it is possible for the consultant to send an invoice to the patient who did not attend.
That does not mean, however, the invoice will be paid.
The conclusions are therefore as follows:
if the patient is insured there is very little the consultant can do about DNA patients
if the patient is self-funding however taking a deposit (which can be deducted from the final charge) has the effect of REDUCING the number of “Did Not Attend” patients.
Would such an approach have a negative impact on the reputation of the consultant?
I suspect it would.
It would be interesting to hear from anyone who has a different approach and the results they have obtained. Feel free to email me at:
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One of the most fatal ways to restrict the growth and profitability of a private medical practice or indeed any business is a failure to communicate.
Over the years I’ve enjoyed excellent relationships with clients – my original client, for example, is STILL a client. His practice has grown and it is still growing.
Another client saw around 6 patients a month when we started working together in 2012; now he sees around 100.
In both cases, MHM is used as the mailing address for correspondence from insurance companies and from patients.
Most of the time a client doesn’t need to see them anyway.
They just need to know any issues – shortfalls or excess for example – have been sorted and they either have been or are being paid.
Other clients though have not shown such growth.
Indeed I have struggled to get their invoices paid quickly, shortfalls and excess under control and self-funders are problematic also.
This is down to one reason and one reason alone.
Clearly, in the first example, the benefits of a clean and robust working process are beneficial.
Included in such a process is the weekly client’s report I send out.
For example, I have one client who is always complaining his cash flow comes in peaks and troughs.
It will do if I only get the clinic lists intermittently and I only receive notifications of payments from him intermittently also.
Other important pieces of correspondence are also only sent to me on an ad-hoc basis.
The reason cited for this is that the client simply does not have the time to communicate.
I have to say 99% of the time I agree. He should be busy seeing patients or in theatre rather than talking to me.
In the nicest possible way, I’m actually not bothered if a client talks to me or not.
In other words, this is not a personal gripe from me regarding a failure to communicate; far from it. I’ll react to the information supplied to me usually the same day it arrives.
But if the information doesn’t arrive, I have nothing to react to.
It is more important the information is received by the client and failure to communicate by passing it on to me that which is the real issue.
Reverting to the first client, he uses the MHM address for all accounts and billing correspondence.
He also uses the MHM email address for his electronic remittances.
All the information comes straight to me. Taking one month this year, his total billing for that particular month was £18,500. At this precise point – April 26th – he is still owed £150 (1%)
99% of his invoices have been paid or if subject to excess/shortfalls, they have been collected.
Turning to the second client, his total billing for the month was just over £4,250.
All the information from insurance companies etc goes to him. At this precise point, he is still owed £822 (22%). Only 78% of his invoices have been paid.
And that is why communication is everything in business and the domino effect should and can be avoided.
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A little over a year ago, a group of surgeons based in the southwest of England contacted MHM.
In an effort to reduce a large number of issues with outstanding self-funding debtors, they had decided to ask new self-funding patients to pay for their initial consultation in advance.
I have to say my initials thoughts were this would absolutely stop any issues with self-funders.
It would do so for one very unfortunate reason.
There would be no self-funders at all because they had refused to pay in advance anyway.
The patients went to see other consultants instead.
And that is exactly what happened.
Hence the phone call to MHM with an instruction to establish a process whereby issues with self-funders were substantially reduced but not at the expense of turning patients away.
If you’ve read previous blogs you’ll already know how to process self-funders and the major reasons behind outstanding self-funder debts.
The MHM process does not, and absolutely should NOT, suggest asking the self-funder to pay everything in advance!
It is not the way to solve the problem.
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Most MHM clients have reported issues with self-funders when we get involved. It is also the source of many calls made to MHM.
With the self-funding market increasing, it is important to understand the reasons self-funders can be a problem.
But what, based on empirical evidence, are the three most common reasons a self-funder hasn’t paid:
The first issue is always the same. When the patient is contacted as a self-funder, he/she claims never to have received an invoice.
Whilst this is obviously easy to rectify, how many medical professionals are 100% certain the invoice was sent in the first place?
Obviously some self-funders will be naughty so to speak but generally, they will pay if sent an invoice.
So the first common reason – the self-funder hasn’t been invoiced.
The second issue concerns the use of debit or credit cards. In 99.9% of cases when a patient arrives at a private hospital he/she will be asked to provide a swipe of their card.
Sadly on numerous occasions, the patient is unaware the card only covers the hospital fees. It does NOT cover the consultant’s fee.
The MHM solution is when the patient first makes contact with the consultant, he/she is advised the card swipe will NOT cover the consultant’s fee.
This should be followed up by a note on the consultant’s invoice stating: This invoice is NOT covered by any debit/credit card details you may have provided to the hospital.
The second common reason – the patient thinks they have already paid
The third issue is the easiest of all to resolve. Frequently, a self-funding patient has called upon receipt of the consultant’s invoice to say they are insured.
This must be addressed immediately. Invoicing the wrong person is absolute insanity.
The cause is a failure at the patient’s initial point of registration to ensure the correct details are taken.
The third common reason – there is a major failure in the consultant’s registration process.
If the above three items are correctly managed and a firm process put into place to manage the minority of self-funders who don’t pay, the number of outstanding self-funding invoices drops in most cases by over 80%
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Anybody ever watched the movie “Jerry Maguire” and the immortal quote – show me the money!
Clearly a guy I recently bumped into at a medical conference hadn’t. He was the Practice Manager for a large hospital group.
His complaint was the lack of cash from insurance companies coming into the business.
His solution had been to analysis the internal administrative process of the hospital; make sure everybody knew their role and when to do it.
He ended up with a very comprehensive PowerPoint presentation.
Indeed he had spent four months doing just that.
After four months nothing had changed really.
I couldn’t help but think about his thought process.
He had gone around writing reports and compiling analysis rather than actually speaking to the insurance companies and finding out what the problem was from THEIR end?
In other words WHY they were not paying him?
If he had done so he would have immediately realised his practice was not invoicing correctly.
If he had asked the insurance companies they would have told him just that.
Only then could the practice start to review and possibly change the process to make sure they did get paid.
Start with the basics. Or as Jerry Maguire would say:
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This blog could easily have been called ‘YOU WON’T UPLIFT A FEE BY DOING THAT”
Recently a private consultant – the colleague of a current client in fact – called me with a problem.
Sadly it was a problem very much of their own making!
In an effort to increase fees, the consultant had decided that a surgical episode should be billed as follows: AB1234 £640 and CD2468 £75. So the total fee = £715.00 and on March 1st, 2019 the insurance company was sent an invoice for £715.0.
And promptly proceeded to reject it.
The fee for the AB1234 was and still is correct.
But with this particular insurance company offering 50% of a second code, the CD2468 fee was wrong to start with. It should not have been £75. It should have been £37.50. Great. Save the invoice would still have been rejected.
Why this time?
If the private consultant had checked they would have discovered that this second CD2468 code was deemed by the insurance company to be part and parcel of the AB1234 procedure.
Thus it was never going to get paid anyway and it was deemed unbundling to submit an invoice and charge for both items.
Skip forward to September 2015. The consultant – or more accurately his long-suffering secretary – has called, emailed and written to the insurance company because the consultant is still unpaid the £640 for the AB1234.
Hence the phone call to MHM.
For once even I couldn’t do anything about the multi-code element.
It very clearly states on the insurance company website that a consultant cannot invoice a CD2468 alongside an AB1234.
In fact, it also says so on the CCSD website.
It is deemed unbundling to do so. The bottom line is that from June 2019 to September 2019 the consultant has been £640 out of pocket.
MHM called the insurance company and has confirmed the original invoice has now been canceled and re-submitted an invoice for an AB1234 £640.00. It is being paid too.
Moral of the story?
You will NOT make more money by unbundling.
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At a recent presentation, I was asked about the costs and use of accounting software.
Bearing in mind the presentation was to consultants who had not yet established a private practice, numerous eyebrows were raised when I answered…
This does not mean accounting software is unnecessary, expensive or unsuitable for an established practice.
Some private practices do need a software package and there are some fine software packages out there.
They are cost-efficient too. MHM works, very successfully, with many of them.
But for those seeing say 10 or 12 patients a week use MS Excel or Apple Numbers and an online diary.
MHM has more than a few clients and uses Excel to run a sales/debtors ledger.
The invoice can be sent as a PDF attachment to an insurance company. The sales ledger – once password protected – can be sent either to the client and/or the client’s accountant.
If a private practice is a business – and it is – then you MUST keep an eye on all costs. If you do not, profit will reduce.
It’s always useful to ask yourself the question.
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Two codes AB1234 £619.00 and XX2468. £124.50. Total £743.50.
It came, as somewhat of a shock to be told therefore the amount being paid to the MHM client was only £24. How can this be???
Basically, because someone at the insurance company deducted a £100 excess but by mistake recorded the AB1234 as excess also.
So instead of being paid £743.50 less £100 excess i.e. £643.50 the MHM client was out of pocket by another £619.50.
As a result, a phone call to the insurance company followed and the insurance company accepted they made a mistake. In the real world, insurance companies do make mistakes.
Took 30 minutes to sort it all out but think about it. That 30 minutes mean you are getting paid what you are entitled to.
Are you confident your fees are being paid correctly and mistakes aren’t being made?
How do you know? Have you checked?
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Working for consultant surgeons 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 10 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, 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.
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If you get the basics right many problems with getting paid aren’t allowed to happen.
As a result, accidents aren’t allowed to happen.
The basics are as follows:
Patient’s full name
Their full address including their postcode
The Patient’s date of birth
Policy number of insurance company.
A pre-authorisation number issued by the insurance company
Correct CCSD code
But it doesn’t stop there.
Your name and address
Your provider number
A unique invoice number
Date of the treatment/consultation
But if you don’t get all 14 on your invoices you make it harder for the insurance company to pay you.
Where do you get the above data from?
If you are practicing from a private hospital almost certainly the above will be recorded on the hospital’s registration form.
If you are invoicing electronically, its pretty much standard that you MUST have the above data immediately to hand anyway.
The same is also true if you are dealing with a self-funding patient or you endure having to collect a shortfall/excess amount from a patient.
In other words, the chances are you are going to need all 14 pieces of data. Therefore it makes more sense to get them right the first time.
But the proof of the pudding is very much in the eating. Have a guess at what are the TWO major reasons an insurance company does NOT pay your invoice?
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