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.
pete@medicalhealthcaremanagement.co.uk
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It is dangerous for an insured patient to assume his insurance covers everything.
Often it does not. This will impact on how much you get paid.
Private medical insurance is designed for short-term issues. For example, an injury that suddenly happens and treated/cured relatively quickly.
A broken hand can be treated quickly. A diabetic problem may not.
Consider it this way.
Private medical insurance is in place to cover elective non-urgent issues.
If the condition was known before the policy was taken out, it may not, however, be covered.
But it does NOT follow that if the injury is short-term and treatable under private medical insurance cover, all parts will be covered.
It will depend on the type of policy held.
Basically, the higher the costs of the cover, the more covered. The lower cover may set a financial limit on how much can be paid out.
They may, for example, exclude consultations.
Whilst it may impact on the consultant surgeon it will be a sad day if a consultant even stops to consider if he/ she will treat a patient based on an insurance policy. They would not remain an MHM client if they did.
But what is the impact on the consultant?
For one thing, a budget type policy could easily lead to shortfalls. It may also lead to excess. It may result in the refusal of consultation fees.
This will lead to a requirement for the consultant to have such amounts collected from the patient.
Therefore what is covered is indeed relevant to the private consultant.
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In the world of medical billing, the most efficient way of doing something is to do it right the first time.
You don’t get paid.
My late Father drilled into me from a very early age:
Measure twice; Cut Once
and
Do it once and do it right
What has that got to do with medical invoicing? Everything.
MHM recently completed a project for a private hospital. The project was to investigate why invoices were not being paid.
One insurance company was proving particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company required invoices to be submitted electronically.
Except for the data on which the invoice was raised was incomplete. So the invoice could not be submitted.
For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. This caused the invoice to fail at the point of logging electronically with the insurance company. Thus the invoice was not passed to the insurance company for payment. Instead, it was put in a “holding” pile.
In other words, the invoices were not being done right the first time.
To resolve the problem, it was imperative to make sure ALL the details were correct. That way invoices could be correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the root cause of the issue. But why was this proving so troublesome?
It transpired medical secretaries thought the hospital receptionist was responsible for getting it right.
The hospital receptionist said the medical secretaries were responsible.
Then they both claimed the person who actually raised the invoice was responsible.
The reality was that nobody was making sure the data was right.
The spat had caused, over the previous six months, the hospital to be short of tens of thousands of pounds. Indeed the holding pile was greater than the value of average daily outpatient appointments. And it was STILL growing.
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded in patient records and checks them again. The person responsible for medical invoicing highlights on a daily basis ANY invoices which can’t be processed. The holding pile is now less than 0.5% of a MONTH’S worth of invoices.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%. It’s not overkill at all.
pete@medicalhealthcaremanagement.co.uk
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That’s an interesting question. Many don’t appreciate that a private medical practice can fail.
And some do.
A private medical practice can fail for the same reason that ultimately any business fails.
It runs out of cash.
Whilst obviously there may be a lack of patient numbers or lack of customers in a “normal” business, it is the financial contribution patients make that matters.
Without a paying private patient the consultant will not generate any money.
If no money is generated into a private practice it will require more money putting into it than being taken out.
And that defeats the object of opening and running a private medical practice.
It is that simple.
Which is why it is even more concerning for a consultant to see patients and NOT invoice them.
The first rule of medical billing should be to guarantee that you actually raise an invoice and that invoice is complete in all parts.
Without doing so, your practice WILL fail.
pete@medicalhealthcaremanagement.co.uk
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I’m a really, really impatient person. I like everything done yesterday.
Which is why I go incredibly slowly to start with.
When I begin to raise invoices for a consultant surgeon, for example, I’ll check I have the right provider number. I’ll check all the online systems and EDI protocol are 100% accurate. Is the consultant’s address correct?. I’ll check the insurance company has the right BACS payment details.
What I’m actually doing is reducing down to absolute zero as many reasons as I can possibly think of that will prevent the invoice being raised correctly.
What happens if I don’t take this approach?
Invoices come flying back. They don’t come back straight away of course.
It may take weeks before I’m notified there is a problem. Then I have to work out why it went wrong, get all the details to put the error right, actually put it right and then resubmit the invoice.
Then I have to wait again for the invoice to be reprocessed. Eventually, the invoice gets paid.
One absolutely true example. Recently MHM project managed a group of three surgeons in the Midlands. All three were seriously considering closing the practice as they were not making any money. They were not getting paid as they should.
The senior of the three was responsible for invoicing for all three each week.
Just under 50% of the invoices he produced came back unpaid. The insurance companies concerned requested more details or raised query against them.
The senior consultant complained he hadn’t got enough time to keep sorting these things out. He had to raise invoices as quickly as possible. He tended to view any medical invoicing problem from the “quickest fix” point of view. To use his words “I only want to be a surgeon and not a whatever-you-call-it”
My kind of guy. Don’t talk about it. Get on with it. Play to your strengths. Save that is precisely what he was not doing.
He jokingly told me his blood pressure was sky high due to the constant stream of invoice problems.
Yet it was this “quickest fix” approach that was the cause of his blood pressure. Many times his quick fix in one area (get them on the phone or treat the patient as a self-funder for example) caused a problem in another area. Then he had to fix that.
This was leading to a six /seven-week delay before invoices were accepted by insurance companies on top of the agreed payment terms.
It took me two months to re-map the process, test, amend it and bed it in. In month three we started to see the results. Invoice failure rate had dropped from roughly half to below 6%. Cash flow had doubled. The time with which the three consultants got paid decreased from around every 75 days to about 50.
All three consultants were happy. Imagine the surprise though when I told them that wasn’t good enough?
I thought we should see at least a 98% acceptance rate and to be paid every 30 days. And I wanted to achieve that as of yesterday starting with raising the invoices every single day rather than weekly. The invoice process was robust. There were very few errors. There were few reasons why we shouldn’t be paid.
Told you I was impatient.
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A group of surgeons I know is having problems getting paid by insurance companies.
Not just an individual insurance company but all insurance companies.
More specifically or so the surgeon’s practice manager claimed, there were many invoices unpaid by insurance companies 3 months after the consultation or episode date.
This was all the fault of the insurance companies who simply do not want to pay.
To be clear this was not the surgeons complaining the fee had been reduced or was incorrect.
This was a case of the surgeons not being paid at all.
I found this odd as in my experience ALL the insurance companies I deal with pay well before 3 months have elapsed.
The practice manager therefore altered the patients’ terms and conditions to read “patients will be asked to pay anything not settled after three months from the date of consultation”. This is, in his words “a long stop” and would prevent the issue arising.
I’m not convinced however putting such a plaster over the wound is the correct action to take.
I’m definitely not convinced a “long stop” will prevent the problem because it will allow the invoices to become three months old and then do something about them. More importantly, it is based ON AN ASSUMPTION
It assumes the invoices are being delivered to the insurance company within three months of the consultation (or for that matter surgical episode date) anyway.
I raised the following two points with the consultants and their Practice Manager:
The patient is ultimately liable for payment anyway.
The contract is between the consultant and the patient. Not the consultant and the patient’s insurance company.
Whilst it is useful to insert the “three months” clause it would have been better to add it was ultimately the patient’s liability anyway as well.
Is the “three month’s clause” not missing the point entirely?
WHY aren’t the invoices being paid within three months?
It’s this second point that is the more relevant of the two.
Insurance companies are NOT the enemy.
Of course, I disagree with many of their fee reductions.
I also disagree when they decree certain multi procedures are now deemed to be part and parcel of each other.
They also make mistakes sometimes. The reason for my disagreement is obvious.
I’m here to get the maximum amount of revenue for my clients.
Anything that reduces such revenue is not good.
Nonetheless, insurance companies should not be treated as if they are the enemy.
Insurance companies WILL settle a claim within 3 months. I can honestly say I don’t have a single invoice for one of my clients sent to an insurance company still unpaid after three months by the insurance company.
So why are the group of surgeons referred to earlier having problems and introducing the “three-month” rule?
Without even drilling too far down into how and when the surgeons were invoicing, I can tell you the probable cause and why they subsequently feel the rule is necessary.
That is why the invoices are not being paid earlier than the consultants are currently experiencing.
It is all about getting it right the first time.
First time means having a clinic list or a theatre list invoiced promptly with all the details required by the insurance company appearing correctly on the invoice.
Putting the effort in upfront always generates the best results.
It may be tiresome and it may be an inconvenience to have to stop, make a phone call so you DO have the correct details but it pays in the long run.
Its also all about 30 days after the invoice has been transmitted to an insurance company if it is still unpaid, getting them on the phone and asking if there is a problem.
If there is, it gets sorted immediately.
An invoice should not be allowed to be dated more than three months from the episode or consultation date.
Consider it this way.
If you invoice quickly and invoice correctly, the number of potential issues which may delay payment reduces considerably.
You simply must make it easy for a private medical insurance company to deal with your invoices.
I actually said that to a consultant surgeon recently who wasn’t sure he agreed until I asked him if he liked money or not?
I rest my case.
As regards the consultants who have now introduced the “three-month rule” the rule itself should be entirely unnecessary.
The cause of the problem should be examined and steps are taken to prevent the invoices from becoming more than three months old.
pete@medicalhealthcaremanagement.co.uk
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I’ve been asked to re-publish the following.
The first thing to realise about increasing a fee is that you CANNOT increase a fee for all your surgical episodes.
Having said that it is possible on occasion to request an uplift in fee.
The question of time taken, however, to perform the actual episode is not in itself the first reason to request an increase in fee.
All insurance companies WILL consider a request to increase fee but the time duration of the episode is not the place to start.
It is the “what, when & how to ask” that is the most important item to consider.
What, for example, may be, for example, a 50% increase in the stated fee.
Do NOT merely ask for a 100% increase in fee because the probability is that you will not get it!
When?
The “when” may be defined as asking for an increase to be considered before an invoice is submitted.
How?
This may be defined as having the correct information in order for the increase to be considered.
When MHM is asked to request a 50% increase in fee, it asks its client to supply the following information:
a. The precise details of why medically the consultant feels his fee should be increased. In other words, a written explanation from the consultant as to why the episode was more complicated than anticipated. The consultant is also asked to provide a copy of his/her theatre notes.
b. Details from the anesthetist who provided his/her services during the episode
c. Copies of correspondence from the Hospital detailing the original schedule i.e. time allocated etc.
MHM will then call the insurance company concerned and advise them a fee increase is being requested.
It will tell the insurance company a fee increase from say £500 to £750 is being requested. It will advise the insurance company all the information is available and ask to where the supporting documentation is to be supplied.
Only then will an invoice be raised and submitted.
It is then a question of checking the invoice every single week to ascertain the status of the invoice.
By following the above process MHM has on numerous occasions obtained an increase in the fee for its clients.
Without following the process, you probably won’t get an increase in your fee.
pete@medicalhealthcaremanagement.co.uk
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With Covid-19 being around the world, all the major insurance companies continue to allow a charge to be raised in respect of remote consultations.
That hasn’t always been the case.
In the pre-Covid days, some insurance companies would not allow you to charge for them.
Vitality is the company that immediately springs to mind. This is not a criticism of Vitality for it is up to them what they allow a charge for or not.
But it is worth just stepping back and thinking about the demand for remote consultations.
Many consultants were previously not in favour of them anyway.
When the lockdown was introduced early in 2020, remote consultations were seen as the way to continue with a patient’s care. Very much a case of needs must!
What becoming disconcerting however were the number of people who claimed they were the future.
However…
It’s not the consultant who ultimately has the say on whether remote consultants are the future or not.
It is the patient’s appetite for them which dictates their future.
For the same reason as the consultant ie lockdown, patients were happy to have a remote consultation.
But what will happen when Covid-19 is finally defeated?
In my view some patients WILL be happy to continue with remote consultations. But many won’t.
There is, however, an additional factor.
As at today, most insurance companies pay the same for a remote consultation as a face-to-face consultation. That has not always been the case.
For example: BUPA paid significantly less for a remote consultation pre-Covid.
That insurance companies allow the same fee to be charged is purely a PR exercise in my view.
It would have looked terrible to reduce fees in respect of remote consultations during a pandemic.
But consider what will happen AFTER Covid-19.
I will not be at all surprised to see the fees for remote consultations reduced significantly post Covid.
Coupled with a falling demand from patients too, then remote consultations may not be so attractive to a private consultant as they are now.
pete@medicalhalthcaremanagement.co.uk
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I’m a really, really impatient person.
I like everything done yesterday.
Which is why I go incredibly slowly to start with.
When I begin to raise invoices for a consultant surgeon, for example, I’ll check I have the right provider number.
I’ll check all the online systems and EDI protocol are 100% accurate and I’ll check that the insurance company has the right BACS payment details.
I’ll check the remittance advices are going to the right place.
What I’m actually doing is reducing down to absolute zero as many reasons as I can possibly think of that will prevent the invoice being raised correctly.
Of crucial importance is making sure there are no reasons for payment to be declined.
What happens if I don’t take this approach?
Invoices come flying back. They don’t come back straight away of course.
It takes time before I’m notified there is a problem.
Then I have to work out why it went wrong, get all the details to put the error right, actually put it right and then resubmit the invoice.
Then I have to wait again for the invoice to be reprocessed.
Eventually, the invoice gets paid.
One absolutely true example. Recently MHM project managed a group of three surgeons in the Midlands.
All three were seriously considering closing the practice as they were not making any money.
They were not getting paid as they should.
The senior of the three was responsible for invoicing for all three each week.
Just under 50% of the invoices he produced came back unpaid.
The insurance companies concerned requested more details or raised query against them.
The senior consultant complained he hadn’t got enough time to keep sorting these things out.
He had to raise invoices as quickly as possible.
He tended to view any medical invoicing problem from the “quickest fix” point of view. To use his words “I only want to be a surgeon and not a whatever-you-call-it”
My kind of guy. Don’t talk about it. Get on with it. Play to your strengths.
Save that is precisely what he was not doing.
He jokingly told me his blood pressure was sky high due to the constant stream of invoice problems.
Yet it was this “quickest fix” approach that was the cause of his blood pressure.
Many times his quick fix in one area (get them on the phone or treat the patient as a self-funder for example) caused a problem in another area.
Then he had to fix that.
This was leading to a six /seven-week delay before invoices were accepted by insurance companies on top of the agreed payment terms.
It took me two months to re-map the process, test, amend it and bed it in.
In month three we started to see the results.
Invoice failure rate had dropped from roughly half to below 6%.
Cash flow had doubled.
The time with which the three consultants got paid decreased from around every 75 days to about 50.
All three consultants were happy. Imagine the surprise though when I told them that wasn’t good enough?
I thought we should see at least a 98% acceptance rate and to be paid every 30 days.
And I wanted to achieve that as of yesterday starting with raising the invoices every single day rather than weekly.
The invoice process was robust. There were very few errors. There were few reasons why we shouldn’t be paid.
All because we followed the “do it once and do it right” approach.
pete@medicalhealthcaremanagement.co.uk
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Medical Healthcare Management Ltd will be closed from 12pm Thursday, December 24th to Tuesday, December 29th, 2020.
08
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A pre-authorisation can be backdated.
The patient will obtain authorisation for a consultation in advance of the actual date normally. But sometimes, the patient arrives for the consultation without it. First question: should you see the patient?
Yes. Patient care comes first.
But what do you do if the patient does not have a pre-authorisation? How should the private surgeon handle it? Ask the patient to ring their insurance company and obtain the pre-authorisation as soon as they can. But….
If the consultation was on November 8th and the patient does not call the insurance company until November 15th, the patient should make sure the insurance company knows. In this example, the patient did not tell the insurance company it was a week earlier. When MHM tried to invoice, it was declined. The consultation was before the date the pre-authorisation was issued.
If the patient holds an insurance policy, which will not allow the backdating of a pre-authorisation you’ll have more difficulties. In which case an invoice should be sent to your patient.
The insurance companies are not being unreasonable.
The patient has incurred a potential liability on behalf of an insurance company. The insurance company knows nothing about it though. But ultimately the patient is liable for the consultation. Thus the invoice is sent to the patient. The patient rings up (normally quite upset) and points out they are insured and are covered.
Numerous phone calls between the patient and the insurance company follow. The invoice is re-submitted to the insurance company and its paid in full.
It would have been paid a lot quicker IF the patient had been asked to advise their insurance company the consultation was for a specific date. When the patient arrives for the consultation it is then simply a matter of confirming the correct authorisation numbers have been obtained.
If this is happening to you, it’s an issue that should be addressed.
Otherwise you may spend 15 – 30 mins just sorting this one problem out!
pete@medicalhealthcaremanagement.co.uk
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All MHM clients are very dedicated individuals.
Having spent approximately 15 years of training and finally becoming medical professionals, they go on to work incredibly long hours.
They do so because they actually love what they do.
All at some point all have taken the decision to start a private practice.
It’s unlikely they would be my clients otherwise if you think about it.
They start a private practice because they wish to make more money doing what they love anyway.
To have any other objective is either (a) silly or (b) engaging in self-delusion.
There is no shame in admitting you start a private practice to make money.
As I’ve blogged many times previously a private practice must be run as a business – a business with more than a social conscience but nonetheless still a business.
Yet, sadly, many consultant surgeons make the mistake of believing their practice will grow and make them rich if they continue doing what they love to do.
Sadly that is not true for doing what you love seldom leads to long-term financial success.
And that means you must measure the performance of your practice.
This is the point at which the private consultant surgeon realizes he/she must understand financial analysis i.e. the numbers.
It’s not all that complicated. Supplying data to your accountant every year isn’t the same as understanding the numbers behind your practice though.
Let me give you a real example.
I was contacted recently by an established medical professional. He claimed to be working all the hours God sends but said he was always broke.
It didn’t take long to work out why.
The first good indicator was a complete lack of financial analysis other than a tax report a little over one-year-old. No debtors ledger was available.
He didn’t have any real idea how much he was owed.
Indeed it transpired both patients and insurance companies were only invoiced monthly.
So I took the last six months’ worth of clinic lists and checked how many had or had not been invoiced.
Quite a lot had not.
I did the same with surgical episodes with the same result. This was followed by an investigation into how much had not been paid even if invoiced.
But it was also a case of adding up the total revenue generated for each month, calculating the total costs (room rental, monthly indemnity insurance premiums, secretarial costs, etc). Then one was subtracted from the other.
Even if any type of provision was made for tax liability was ignored the results were not encouraging.
The really bad news is that the consultant looked very blank when I asked which percentage of patients were referred to him from which source.
It was clear this particular consultant had no real idea of how his practice or business was performing.
And that was and still is a very dangerous place for any business to be.
pete@medicalhealthcaremanagement.co.uk
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It actually happened too.
Consider a CCSD code for a follow up consultation = 20310. Now consider the CCSD code for a ECG = 20110.
A consultant surgeon couldn’t understand why he was not getting paid the right values for his follow up consultations i.e. £150. Instead, he was getting either £72 from one insurance company, £96 from a second or zero a third. The reason was clear when MHM investigated.
It was because some of the invoices for his follow-ups consultations had been coded as 20110 [ECG reporting] and not 20310 [follow up consultation]
That one digit incorrectly quoted was making all the difference.
Insurance companies were seeing 20110; some were querying the code when the patient hadn’t had an ECG but others were happily paying the fee for the 20110. The third insurance company did not cover 20110 ECG as part of their patient offering and thus declined to pay anything.
When numbers were audited the average discrepancy was £65. When all numbers were in, the number of errors equaled 11. And thus the client was out of pocket by approximately £725.
The consultant concerned was not happy, especially when his work did not require an ECG anyway. Thus one day’s analysis and the consultant now receives the right fee – because the right code and fee are being used.
Even getting ONE digit wrong can cost £725.
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Take, for example, a patient who requires an injection which may be performed by a private orthopaedic surgeon at an outpatient consultation.
Thus you raise an invoice for, as an example, £195 [£100 for the consultation and £95 for the injection]. Please be aware for the purposes of this article the values are fictitious!
Upon receipt of the invoice by the patient’s insurance company, the value is rejected; as you CAN’T charge both for a consultation and an injection on the same invoice on the same day.
You can charge for one or the other but not both.
So you are paid £95 for the injection only.
What is interesting is that the immediate reaction from some consultants could well be to charge just for the injection and argue that is the right thing to do.
That said, it has already been suggested that the alternative would be to have the patient attend an outpatient consultation on, for example, December 18th and then attend for the injection on December 21st. See the patient twice in other words.
In such a case, the consultant CAN charge for both.
Not sure that’s in the patient’s best interests though but if the aim is to max revenue it is certainly in the best interests of the consultant.
I’m certainly not saying its right or wrong.
I am saying it’s an option.
Where it gets really tricky, is that some insurance companies WILL let you charge for a consultation and an injection at the same time.
Others will let you charge for some injections at a consultation but not all injections. Some, as mentioned, will not allow a charge for consultation and injection regardless if they happen at the same event.
And don’t forget not only do different insurance providers pay different rates for consultations; they also pay different rates for the injection too.
Gets a whole lot worse when the injection is pre-authorised as the fee for a consultation is higher than that for the injection, the orthopaedic surgeon charges for the consultation only yet the insurance company is expecting an invoice for the injection.
Confused yet?
Unless you check each consultation and injection episode with the insurance company concerned, you will be!
More likely you will actually undercharge at some point in time. For example: if the insurance company DOES allow a fee for consultation and injection if you charge only for one sooner or later?
You’ll be out of pocket.
pete@medicalhealthcaremanagement.co.uk
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Following on from a recent blog and questions raised at a presentation to consultant surgeons, I was asked to further explain why you must invoice quickly.
The obvious one is that the sooner you invoice, the sooner you get paid. Fairly straight forward you may think. Yet many consultants in my view take far, far too long to invoice – delays of up to 2 weeks are not unusual.
However, have you ever considered what might happen if there is benefits limit on a patient’s policy?
You won’t even know if there is or not and certainly you don’t know what the limit is.
But if the limit is reached either partially or in full before you’ve submitted your invoice you are pretty certain to be shortfalled.
It is almost like whoever asks first gets paid first and whoever asks last gets paid IF there is enough money left.
So if you invoice for your work a few weeks after the event and more importantly after everyone else, you run the risk of increasing the number and value of the shortfalls you are subject to.
For example, MHM was recently asked to review the invoice process of a consultant surgeon.
In doing so, the cash flow of the consultant was compared to that of an existing MHM client. The consultant had many, many shortfalls and excess amounts on his accounts.
The MHM client had less than 12.
Why?
Same specialism, similar volumes of work.
However, MHM invoiced for the original client within 48 hours of receiving his clinic/theatre list. The consultant was raising invoices at the end of each month.
Coincidence.
No.
That is why it’s important to invoice quickly. If you are not, what can you do about it?
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 and therefore 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. More often than that, however, is an email alert pinging up! 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, of course, other people’s demands.
MHM once had a client who called 8 times within 35 minutes. He afterward complained his medical billing wasn’t being done speedily enough. It didn’t take a genius to work out that the 8 phone calls were actually a total distraction from raising the very invoices he expected to be raised during the morning.
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 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 look’s 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 an 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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Ever thought what is the most often quoted reason for non-payment by a patient of the excess?
The same reason is quoted over and over again.
It is not ‘I haven’t got the money” nor is it “I didn’t realise it was so much”, not even “The invoice must have got lost in the post”.
Actually, it is…
“But when I registered at the Private Hospital, they took a swipe of my debit (or credit] card and the fees should have been taken from that”
Why is this always being quoted?
Why should you be suspicious?
In answer to the first question, it’s because the patient assumes the bill will be “sorted” by the hospital.
They don’t realise that the transaction is between them and you.
In answer to the second part, you should not be suspicious.
This is not to suggest the fault lies with the reception staff at the private hospital.
Recently I went with my own partner to a private hospital and as she checked in, it was very clearly explained that her debit card swipe covered only the hospital fees.
There was even a sign up to that effect on the wall in front of us. So my partner, as all private patients, should realise what is covered by the swipe of their debit card.
Yet a few weeks’ later when the invoice arrived from the consultant, she said something was wrong The Hospital had taken a swipe of her card when she attended the consultation.
Quite rightly, she called the consultant’s secretary who explained the situation and payment was made the same day.
It does demonstrate, however, the most often quoted reason why payment for an excess invoice has not been made.
pete@medicalhealthcaremanagement.co.uk
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Every single consultant I’ve ever met is dedicated to patient care and the best possible outcome for his or her patient.
But sadly that has little to do with the outcome of the practice as a business.
They may think it does.
But it doesn’t.
Patients reviews are ALWAYS good and they reflect the clinical outcome.
Potential patients do actually read them and take the decision to see a consultant based, in some part, on good patient reviews.
But other than that, there are numerous other items impacting the business outcome.
Planning has a HUGE impact on the outcome.
Specifically, if you don’t have a plan you won’t be able to know if you have achieved the desired outcome anyway.
But what needs to go into the plan?
Sounds crazy but the aim of the plan should be to achieve the outcome, yet you can’t reach the outcome until:
a) you define what the outcome should be
b) you define the plan to achieve the outcome.
Just talking about it won’t be enough. It never is.
Unfortunately, far too many consultants start a private practice without deciding what their desired outcome is. Instead, they make reference to “making more money” or “seeing more patients”
But the smarter ones start by saying I want to make, for example, £5,000 a month (outcome) so I need to see at least 20 patients during that month.
It matters little if it’s £5,000 or £25,000.
What matters is they have a defined outcome with a plan to get there.
Then they start giving immediate thought and planning on how to see 20 patients a month.
None of which has anything to with clinical outcome!
pete@medicalhealthcaremanagement.co.uk
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Excess and shortfalls are the biggest headaches any private medical practice will face. You will not stop them despite what you may think so you MUST have a process in place to identify them and action them.
What are excess and shortfalls?
Just like your own car insurance when a patient takes out medical cover, the policy will have an excess. For example, the patient is liable for the first £100 or £250. The value of the excess will be dependant on the precise details of the policy.
Normally, lower insurance premiums are accompanied by higher excess amounts and vice versa. You may, of course, ask the patient what excess his/her policy has and that will help. But that will NOT stop you from having excess deductions made against any payment for your services made to you.
Each private medical policy will have its own maximum entitlement figure. This is known as the benefit payable.
For example, the total benefit that may be paid out under a policy says £12,000 in any one year (just an example to illustrate the point).
That seems fine until you realise the average cost of a hip replacement in the UK is currently around £11,500. If the patient requires additional consultations (say £500 worth) and additional costs appear (another £350 for example) then the total cost will soon exceed the total benefit of £12,000 i.e. the total medical fees of £12,350 is greater than the benefit payable.
Thus the shortfall (the patient’s liability) in this example is £350.
But wait……
If there is already a £100 excess on the policy and a £350 shortfall, the patient’s personal liability to you will be £450.
This may be an extreme example but it is the principle that is important to understand.
In reality shortfalls and excess payments are normally around the £75 to £100 mark respectively. That doesn’t seem a lot but have 10 shortfalls/excess a month and over that one month, you will be owed £750 by your patients personally.
Over a year you will be owed £9,000.
That is why excess/shortfalls are one of the biggest problems faced by a private consultant surgeon.
Once shortfalls/excess have been identified (preferably as they are actually deducted from payments made to you), you must have a robust process in place to manage them. That can only be done one way.
You MUST CONTACT THE PATIENT, there is simply no alternative.
The first thing to do is to send your patient an invoice for the excess or shortfall.
This should include how much to pay and how to pay it. If this invoice is ignored by your patient then the best solution is to telephone the patient and ask for payment. The longer an invoice for excess or shortfall remains outstanding, the likelihood of it being paid reduces.
You must act quickly: preferably every single week.
Whatever you do, therefore, do NOT under any and all circumstances leave excess and shortfall amounts unattended.
Excess and shortfalls can simply build up and up to the point where you realise you are owed thousands and thousands of pounds with little chance of getting paid.
Consider it this way.
You cannot prevent excess and shortfalls from happening.
pete@medicalhealthcaremanagement.co.uk
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Recently I was reading an article in a business management magazine.
The article highlighted some of the challenges faced by small business owners when they start.
But it could also have been written about a consultant surgeon starting a medical practice.
The article illustrated how many small business owners attempted to start their business without assistance.
It is therefore common subsequently for the business to struggle with, for example, a lack of customers or a lack of cash.
This is normal for a consultant surgeon starting a private practice too.
It is not easy to start a private practice. There is a huge amount to be considered.
The basic rule is that if it can go wrong it will go wrong.
It happened when I formed MHM too.
Despite 35 years worth of managerial experience in running a business for various employers, I was used to ringing IT and having them install a new computer.
As a small business, ALL of that had to be done by myself. I soon realised, even though it cost, it was much better to go out and find someone who DID know what to do.
The first item in the article stated the first challenge facing a new small business is a lack of clients.
The same situation a newly established private medical practice faces too.
The second item was the lack of cash.
When I go meet a prospective client both are mentioned. Regarding the second point, the amount of cash generated by the small number of patients is nowhere near what was expected.
Yet I recollect when speaking to a colleague who specialised in marketing for consultant surgeons, most practices do not have a process in place to utilise the positive experience enjoyed by existing patients.
Their lack of new patients could be helped by using testimonials from current patients. The new practice does not have the right marketing strategies (both online and offline) to attract patients consistently.
Instead, marketing is left to drift.
My colleague is an expert at medical marketing yet she suffers from consultants believing she is too expensive to engage.
Alternatively, the new private consultant surgeon has a conversation with a colleague who has an established practice.
Hopefully, this pays dividends but it does suppose the established surgeon is maximizing his own marketing efforts.
Precisely the same happens when the subject turns to medical invoicing.
Many newly established private medical practices assume the invoicing – the “accounts bit” – is just as easy as marketing.
It will sort itself out in the end. If it doesn’t they ask a colleague how they do it.
Once again it assumes the colleague is managing his billing correctly.
Sadly he may not be.
The paradox, therefore, is that many consultant surgeons when they start out, make the same mistake as I did with my IT requirements when I started.
Two weeks and a few hundred YouTube videos later, I bit the bullet and called someone who DID know.
It cost me £150 but within ONE day I had all the systems up, running and working very efficiently.
The old adage of “if you think hiring a professional is expensive, try hiring an amateur” springs to mind.
Yet many private surgeons, by attempting to manage their own medical invoicing or asking their medical secretary to do the billing to an expert standard, make precisely the same mistake.
pete@medicalhealthcaremanagement.co.uk
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