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!
The “when” may be defined as asking for an increase to be considered before an invoice is submitted.
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.
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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.
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.
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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.
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Medical Healthcare Management Ltd will be closed from 12pm Thursday, December 24th to Tuesday, December 29th, 2020.
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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!
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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.
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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.
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.
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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.
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.
That is why it’s important to invoice quickly. If you are not, what can you do about it?
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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.
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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.
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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!
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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.
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.
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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.
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Recently a family member decided an appointment with a private consultant was necessary.
As the family member had private medical insurance, a phone call was made to the consultant suggested by the GP. It turned out although not an MHM client, the consultant practice manager and I are old friends. So I made the call myself and booked the appointment.
Came as a surprise the next day, for my family member to announce the insurance company had called. They wanted her to see a different consultant. My family members quizzed them why. Eventually, she was told the second consultant didn’t charge as much as the one she wanted to see. Not a good thing to say. My family member insisted on seeing the consultation of her choice. I quickly found out how much the second consultant charged. It was indeed less.
Nonetheless, the appointment with the first choice consultant happened.
Two weeks later a letter arrived from my family member’s insurance company stating the consultant had been paid. However, there was a shortfall as the 1st consultant’s fee was higher than that of the second consultant. My family member was required to pay the difference.
The fact that my practice manager friend is pulling her hair out with the increases in shortfalls she’s seen this year whilst relevant, is not the point.
The stark reality is that the insurance company was using finance as criteria upon which to base the decision which consultant one of their policyholders went to see.
And that, I’m sorry, is NOT right.
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I had a Zoom meeting last week with a consultant who was keen to grow his practice.
We’d known each other for a while. Indeed we had begun speaking when he had not achieved his goals. Because they were actually wishes. More money. Increased number of patients. Sadly even if they had been specific goals, the chances are he wouldn’t have achieved them anyway. Why?
In any business, 20% of what you do, results in 80 % of your profits. It does not have to be 80/20. It can be 60/40 or 70/30. But the overriding rule is that some things contribute more to a business than others. Flipping that on its head means 80% of what you are doing could only be resulting in 20% of your profits.
That is precisely what the private consultant surgeon was facing.
This consultant had private practicing rights in three different hospitals. On the two days a week he opened his clinics or attended theatre, he drove to hospital A. After this clinic, he got in his car and drove for an hour to Hospital B. Once his clinic at Hospital B was over, he got back in his car and drove for another hour to Hospital C. After that clinic he went home.
He also had a 6-week waiting time to see him at Hospital A.
At the very least, he was driving two hours each day. Once on a Tuesday and once on a Friday.
Which in my view, at his normal hourly rate of £250 per hour, equaled £500 worth of lost revenue. Twice a week equates to £1,000. Looked at another way, 20% of his day was generating him precisely ZERO.
His answer to the question of WHY? was met with the standard – “that’s where the patients want to see me”
When the issue was looked at from another angle, however, it transpired the waiting list was highest at the hospital nearest to him. Hospital A. Indeed he saw the fewest patients at hospital C i.e. the one furthest away. He saw a few more patients at Hospital B than at Hospital C but nowhere near as many as at Hospital A. Hospital A incidentally, accounted for 70% of his referrals anyway.
In January 2019, he gave up his practicing rights in hospital C. Fearful of too much change – sensible man – he maintained his rights in Hospital C. The hour he’d saved by not driving to C was used to see more patients at Hospital A. The number of consultations increased. The additional revenue generated was very welcome.
Curiously such was his reputation that patients who would have seen him in Hospital C drove to see him in Hospital A.
In May of 2019, he gave up practicing at Hospital B. As before he used his “driving time” to see more patients at Hospital A. 70% of his referrals still came from hospital A. But patients could be seen much quicker. That in itself was attracting more patients. No more 6-week waiting list because he had an additional four hours a week to see them.
By the end of last month, he was seeing more patients than he had seen during the whole of 2019. He was also making more money.
He had stripped out anything that didn’t contribute to revenue
His targets were more specific. He had achieved his goals. Sort of.
He did not know if he had seen as many patients as he wanted to because he hadn’t set a specific number
He also didn’t know if he was making as much as he should have been because he hadn’t set a specific target.
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One of the most common remarks I hear from my guys is the number of patients they see in the NHS.
They literally have patients queuing up to see them.
Such a comment is normally followed by the opposite when discussing a private practice.
This, for me, confirms the absolute difference between the public and private sectors.
In the NHS, a consultant surgeon does not have to do much in order for patients to be delivered to them.
In the private sector, the opposite applies.
In the private sector a consultant surgeon, because fundamentally a private practice is a business, MUST attract a patient.
He must engage in pro-active marketing.
He must ensure it is known his practice is there.
First of all, however, he must comprehensively understand WHY a patient is choosing to go private.
It is not merely the case of a patient wanting to be seen private because he or she has private medical insurance.
It is understanding WHY the patient has private medical insurance. I, for one, dispute it is because private care is better than NHS care.
More likely it is because the private patient wishes to be seen quicker.
Even so, a consultant surgeon MUST engage in marketing.
If the patient can be seen at the private practice quicker than at an NHS location but the patient is unaware the private practice exists then all bets are off.
Therefore a marketing plan of some description is an integral part of a private consultant surgeon’s business plan.
And therein lies the reference to the first and absolute cultural difference between an NHS practice and a private practice.
In an NHS practice, patients will be delivered to the consultant surgeon without him even asking.
In private practice, patients will not just be delivered. They have to be attracted to the practice or more accurately to the business.
Note the use of the word BUSINESS for a private practice is a business.
This is not the time to discuss which marketing strategies will and do work best for a private consultant surgeon.
This blog is more concerned with highlighting that due to the differences between the NHS and the private sector, a private consultant surgeon has no choice but to have a marketing strategy.
Just as a consultant must have a robust infrastructure to support the business (secretarial support, invoicing, banking, etc), it is equally as important to have a marketing strategy.
Look at it this way, if any business does not have a regular number of customers or clients (in the case of a medical practice PATIENTS) then inevitably the business will not succeed.
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It is truly depressing when I hear “my to-do list” is two pages long.
That is normally followed by the statement “I haven’t stopped all day but haven’t achieved anything”
A couple of observations.
There are approximately 8 working hours in the day. In my case, there are not 8 hours; there eight 45-minute time slots.
The first port of call is to ask how many of those hours were you ACTUALLY working?
Actually working does not include chatting to a colleague or speaking on the telephone to a friend about a movie.
The reason I mention this is I took a call last Thursday from the manager of a private practice. She was complaining bitterly about there not being enough hours in the day.
In reality of course, unless she wants to work over every single evening, she can’t increase the actual number of hours available to much more than eight.
In my humble opinion, she doesn’t need to anyway.
She called because she wanted to know, how I could manage to blog twice a day? She wanted to do the same. Where did I find the time to write two blogs each day.
Well, firstly I don’t “find” the time. I allocate one hour each morning – between 8 am and 9 am- to write two blogs.
This has ZERO to do with each blog taking 30 minutes. Some actually take less. Others more.
It has everything to do with working when I should be working.
What is important is my insistence on doing NOTHING during that hour other than to write blogs ie working.
I don’t check emails. Nor do I stand around chatting to others about their weekend, the new TV series on last evening or today’s weather forecast.
Which brings us neatly to the all-powerful “to-do” list.
Mine (actually an ICAL calendar) is compiled the night before.
It lists all the items I want to complete the next day starting with 7 am – make coffee (important!!) check bank, clear overnight emails. The to-do list continues until 7.45 am with a 15-minute slot for yet more coffee.
8 am – 60-minute writing blogs.
During those 60 minutes, I will literally do NOTHING other than write blogs.
No distractions. No chatting with colleagues. No doing something other than writing.
In other words, I work when I should be working.
Now compare that with my practice manager friend who freely admits she is “weeks” behind on completing her medical billing.
My immediate reaction was to ask why are you considering writing blogs when you are so far behind on such an important task as raising invoices for the practice.
Secondly, why are you weeks behind?
The cause of her dilemma is not her ability. Nor is it her reluctance to work.
The true reason is she doesn’t quite appreciate, whilst she is working she should be working and only working.
More specifically, she should focus solely and absolutely on the task in hand.
Instead, she allows herself to be distracted by whatever comes across her desk or whoever walks into her office.
When she told me it took her roughly 3 hours to process a clinic list with 15 consultations on it, I nearly fell off my chair!
That should take no more than ONE hour.
But there again, I’m not letting anything distract me.
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They are not just for tax reasons. They are not just to keep the accountant happy. There is a time-critical reason too.
Remittance advice will confirm the values that have been paid. It is a mistake to assume that the invoice will be paid completely. It may not be.
For example and taking one remittance received by an MHM client.
Of the ten invoices paid, four of them were subject to excess deductions.
This is why remittances should be checked. And before they are stored for tax reasons or to keep your accountant happy.
In the above example, each invoice detailed on the remittance was reconciled against a debtors ledger. Only then was the payment recorded. It was then the number of deductions was identified. In this example, the total came to some £350.
The next step is to identify why the deductions have been made.
Whilst all four deductions were correct and were in respect of excess amounts it is surprisingly common for a deduction to have been made in error.
In the recent past, one MHM client had an invoice for surgery deducted in full because the patient’s policy had expired. At least according to the patient’s insurance company it had expired. It had done so after the date of the surgery. In this case, at the date of the surgery, the policy was “live”
Consequently, the insurance company was wrong to decline the invoice for payment.
A call to the insurance company concerned quickly identified and confirmed the insurance company was in error. The invoice was immediately cleared for payment. Insurance companies do make mistakes. Not many thankfully but they do happen.
If the deduction is correct then immediate action should be taken to contact the patient and a request made for payment – by the patient – made.
So the number and reasons why deductions have been made by a private medical insurance company can easily be identified and subsequently actioned on behalf of the consultant surgeon.
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There a few things I hear that automatically set alarm bells ringing when I look at the invoicing and billing process of a business.
“I’ll take a look at it next week”
“I’ll get round to it in a bit”
“I’ve been meaning to look at that”
The final of those items was said to me recently at a virtual medical conference recently.
I was sitting on a panel facing an audience of medical professionals who wanted to ask what made a medical practice successful.
In amongst the various questions was one relating to how to monitor the medical billing of a medical practice.
To me the answer is simple. Before you can measure any part of a business, you must establish a standard to measure against. Which is what I said to the questioner. I asked if he knew how many invoices he had raised last month and the total value he had invoiced. Sadly he didn’t know either.
But, I continued, to improve the performance of your practice you must make sure you know how you are performing against whatever standard you decide is the most appropriate.
Now consider the issue of invoicing with a real MHM example. One of my guys – a private consultant surgeon – saw 25 patients between Monday, November 9th, and Friday, November 13th. Therefore I should be able to see 25 invoices.
That is a simple but effective control which makes sure everything is invoiced. The standard has been set because one invoice is required for each patient.
If I only have 23 invoices I have a problem!
But it also means at the end of November I can add up the number of invoices and also tell the client how many patients he has seen during November. Then we can compare that number with the number the previous year and see if it is higher or lower.
The introduction of such a basic management control isn’t a nicety. It is an absolute necessity if you are going to manage the invoicing process or indeed the whole business effectively.
The audience member agreed fully but then the alarm bells went off when he said “I’ve been meaning to look at that for a while now” He hadn’t because there always seemed to be some other problem to deal with.
That tells me his management controls aren’t as robust as they should be. It also tells me he is suffering from one of the worst and easily avoidable causes of business failures out there:
Leads to a backlog of invoices because it diverts you from identifying a backlog is building up.
Is even worse than having no cash because it distracts you from raising the invoices and thereby getting paid.
Procrastination is the cause of the problem he has because various insurance companies have declined his invoices for treatment as the consultation was more than 6 months ago.
Set time aside every single week to make sure, you perform a sanity check. Make sure you DO invoice. Make sure you review what is happening with YOUR money!
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