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.
Read more →
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.
Read more →
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.
Read more →
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.
Read more →
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!
Read more →
I was literally 70% through billing for a client’s clinic lists from last Friday. Eight separate patients and a mixture of initial and follow up consultations.
All was going well until I noticed the details of one of the patients on the clinic list were incomplete. The only solution was to speak to the patient’s insurance company. I need accurate data to bill effectively and efficiently. So I called the insurance company but like many when you call them you join a queue and have to wait.
So far I’ve been on hold for 16 mins.
Yet this problem could have been so easily avoided if the correct details had been taken down and checked. The problem was the policy number had not been recorded, as it should be.
Just got through and it transpires the date of birth is also wrong. The patient was born a year earlier than stated on the clinic list.
Three observations really:
The insurance company may well clear and pay the invoice even if the details are incomplete and/or incorrect, there again they may not.
If the details had been checked originally before the clinic list had been produced, none of this would have been necessary and the invoice would have been processed for payment much quicker.
Finally, if your med-sec is handling your billing, whilst he/she is on the phone for 20 mins to an insurance company she’s not actually talking to patients and booking them in or typing your letters. Indeed patients can’t call her because she’s on the phone sorting out issues such as the above.
So it’s taken around 20 mins to sort this one single issue and that is what can take up so much time!
How many times have I said most clearly: INVOICE RIGHT = GET PAID RIGHT??
Read more →
There are only 24 hours in a day.
All of my guys are incredibly busy. I’m amazed at the volume of work they get through in a single day.
They are either on-call, doing a ward round or in theatre. Then they have to see their private patients. That explains why most of them call me either very early in the morning or in the evening.
It doesn’t bother me.
It’s my job to fit in around them and make their life easier.
Recently however I was asked to review the private practice of a consultant who was having serious difficulties generating any cash into his practice.
And following my question to his long-suffering medical secretary, it didn’t take long to establish why. The question was: what is the biggest problem you have this week. The reply said it all:
“I never get a response to the queries or receive the information I need after I’ve asked Mr. Surgeon. He always seems too busy to deal with the things I need”
Yet most of the information the med-secretary needed was fundamental to generating cash into the practice.
For example: two clinic lists from last week were still unprocessed (result: no invoices sent out) or remittances from an insurance company (no idea who had or hadn’t paid) or the post Mr. Surgeon picked up and put in his bag one day last week (it had cheques from patients in it)
So I sat down with Mr. Surgeon and asked him what he thought about it. His response was a classic: “I just don’t have time to deal with all that. My private patients are paying to see me so they must come first”
The stark reality is he is right enough to be dangerously wrong.
He is right as regards putting the patients first but he needs to ensure his administrative support is first rate too.
The reason Mr Surgeon is having difficulty generating the cash due is in him not dealing with such issues as the missing clinic lists or not passing over remittance advices.
Mr Surgeon needed to make very sure, the support facilities of the practice were dealt with.
The word “support” suggests these things can be demoted to a “Too busy to deal with that and they are not that important so I’ll deal with it later” category.
Eventually, they catch up with you.
In the case of Mr. Surgeon, they were the reason he was struggling to generate cash into his practice.
Compare and contrast that with another real-life MHM client: Mr. B Surgeon. He is very different from Mr. A Surgeon save curiously they see a similar number of patients each week and are in theatre on the same day too.
Mr. B Surgeon will send his clinic list the day he sees his patients.
His theatre lists arrive the same day too.
All of which means his invoices are out the proverbially electronic door within 24 / 36 hours.
In the unlikely event, there are queries, a response comes back to me either that same day or at the latest the next.
His cash flow is many, many times greater than Mr. A Surgeon.
In case you are wondering why I don’t have such issues with MHM clients its because every single week my clients take their post or clinic lists etc scan them to me and promptly proceed to forget about them thereafter.
Read more →
Taking ONE real-life client as an example.
Week ending Friday, July 24th: out of 15 consultations, 4 (four) came back with excess deductions £575.
So for a total of £2,500 worth of revenue from outpatient consultations £575 or 23% came back short.
Looking back to the same week in 2019, the number of excess was roughly half this.
The question as to why this is happening is not the concern.
The concern is what are you going to do about it.
If 23% continues the downside and potential loss to the consultant is significant.
There is only one real way to resolve this issue. Phone them!
Sure you can write letters and even email but nothing gets a response like a ringing telephone.
Most patients claim to be unaware of the issue but some think this is an issue between them and their insurance company.
In other words, the patient thinks they need to pay the insurance company.
They think the consultant gets paid in full by the insurance company.
There are variations on this but the crucial point for the consultant is not to establish why; its to ensure he recovers the excess efficiently.
But if telephoning the patient is the most efficient way to tackle the issue, it does not automatically follow its the easiest.
It has to be done professionally and with due diligence.
The long-suffering med-sec really won’t have the time to do this as professional and caring as she undoubtedly is.
I promise you faithfully, she won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
There is an alternative though: do nothing.
Some patients actually will pay but this assumes they a) are aware of the excess and b) make it good straight away.
What if they don’t?
Assume it’s not £575 or 23% a week or £27.6k a year (£575 multiplied by 48 – not 52 weeks as you will have 4 weeks off a year).
Assume instead its 10% for 24 weeks (i.e. roughly half of the current numbers) and allows for some patients paying without being contacted.
The potential losses for the consultant, in this case, reduce to £13,800 per annum.
That’s a chunk of change in anybody’s book.
What’s significant is that at a number of client meetings recently I’ve asked what the client considered the biggest threat to the practice during 2020.
Most popular was a further reduction in private insurance fees.
That may indeed turn out to be a big problem.
But at this point, empirical evidence suggests its potentially leaving the back door wide open so to speak and enduring £13,800 worth of potential losses right off the bottom line.
I’d be really interested to hear from anyone who is seeing an increase in excess and their views on remedies.
Read more →
In terms of medical billing, this perhaps is one of the statements I say to private consultant surgeons more frequently than others.
The following example illustrates that despite the rejection of the fee how the fee was established confirms there is little the consultant can do about it.
The consultant surgeon concerned had applied to be recognised by a private medical insurance.
MHM had spoken to the consultant and pointed out fees should be confirmed when recognition was being arranged.
The consultant was well qualified, had held a substantial NHS post for a number of years and his/her specialism was in high demand.
The private medical insurance company was keen to offer recognition.
Thus recognition was granted.
Yet despite the warning by MHM fees had not been checked.
MHM was subsequently asked to handle the medical billing side.
In order to do so, we need to know how much consultation fees were.
The medical professional, however, did not know what the consultation fees were.
Thus alarm bells immediately started ringing.
Consultation fees would have agreed to and would have been detailed in the pack supplied to them by the insurance company concerned as we had advised. So we called the insurance company and quoted the newly acquired provider number.
As usual, the insurance company was keen to point put the consultant had agreed to adhere to the published fees.
It is always amusing when “fair and reasonable” is quoted to me because it depends on what the consultant thinks is “fair and reasonable”.
More specifically what happens if the thinking differs between the two parties concerned. And that is precisely what happened in this example.
The insurance company deemed that £175 was a fair and reasonable fee for a consultation.
The medical professional deemed that £250 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge consultation at £250.
MHM pointed out that it would indeed charge £250 as instructed.
All that would happen, however, is the insurance company would reduce the value of the invoice down to the £175 originally agreed.
And that is precisely what did happen.
Despite the medical professional objecting strongly to a consultation fee of £175 and insisting a “fair and reasonable” fee was £250, the invoices were reduced in value.
It mattered little to the insurance company that the MHM client had colleagues who were both charging and getting paid £250.
Even before I asked the question I knew this was to be true. It mattered even less to the insurance company that a second colleague was paid even more than £250.
This was so because the second colleague was in a completely different specialism!
Sadly the MHM client had based their practice business plan on a consultation fee of £250. They had done so because they had asked colleagues how much they were paid.
Then they had assumed such fees would equally apply to them.
MHM, per normal, had no issue calling the insurance company concerned and arguing the case on behalf of the medical professional.
That said it was an argument that it was never going to be won. The simple reason remained that at the point of recognition the MHM client had accepted the fees.
Sure enough, the insurance company stood firmly behind its agreement with the consultant.
ASSUMPTION LEADS TO PROBLEMS.
The moral of this sorry tale is best summed up by the above heading.
I’m not suggesting you shouldn’t challenge fees for consultations or indeed a surgical episode but don’t put yourself on the back foot by accepting fees and then challenging them afterward.
As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!
Read more →
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
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.
Read more →
I called one of my friends early one evening last week. His phone went straight to voice mail. Curiously he didn’t call me back with half an hour or so per normal. He called me this morning instead. He explained why.
Every Wednesday, he and his wife have a “date night”
They switch both of their respective phones off.
No emails, text or ring tone interrupting them. They spend time talking to each other.
And that got me thinking.
A couple of years ago I started doing something similar.
At the end of each day, I’d put my phone on silent and switched my emails off too. Why?
Because each day I need time to review any opportunities/problems I’ve got to deal with the next day.
It also means I can think about an issue at length, leave it overnight ready to be re-thought about on the next day. That stops me making knee jerk reactions and allows time to have a fully considered opinion ready.
Rarely will you get an immediate reaction from me.
My response to an issue has, therefore, been thought through.
Yet many medical practice managers or indeed consultant surgeons running a practice, don’t stop and think through an issue.
They are too busy.
But alternatively, they are too busy because they don’t stop and think through the issue.
Sadly I see this all too often when I go meet a potential new client.
Many of the issues they are facing have their source in a previous decision. The previous decision itself could well be based on a decision before that one even.
One of those decisions in the chain was almost certainly not thought through.
For example: recently I blogged about a group of gynecologists in the West Midlands who, in an effort to stop issues with self-funding patients decided ALL self-funding patients must pay in advance.
Immediately the problem with self-funding patients stopped. Because there weren’t any self-funding patients anymore.
This was a solution to the problem. It worked. Sadly, however, it had some unpleasant side effects i.e. no patients.
Clearly, they hadn’t thought through the consequences of their decision.
They had reacted.
Yet the reaction caused another problem i.e. no more self-funding patients. That was unfortunate as 23% of their practice was derived from self-funding patients.
The above example is indicative of the cause of many of the issues within that particular practice.
It was relatively easy to put the self-funding issue right because I’ve faced that specific challenge a few hundred times previously (email me for how).
Getting the practice manager and the three consultants to change their mindset though was much more difficult.
They did change though because they had seen a 100% reduction in self-funder outstanding invoices.
Sadly this was at the expense of a 100% reduction in self-funder patients.
They changed not just because I knew the answer. They changed because they realised when I faced that issue previously, I’d allowed myself sufficient time to give it serious thought and consideration before reaching a decision.
I implemented a course of action that didn’t put patients off by asking payment in advance but did reduce the number of outstanding self-funder invoices.
As a bonus, it stopped the problem with self-funding patients who were DNA too!
And that is why it is important to put the time aside and think through an issue before deciding on a specific course of action.
Read more →
Recently a friend of mine called asking for a favour.
I’ve known this guy years. We started our respective businesses around the same time.
He has now reached the point where he needs to relocate his staff to a new building. As his business continues to expand, he has simply run out of room.
As he wanted to move from where he is now to Wolverhampton and as I obviously know the area better than he, would I have a look at offices that are available and get back to him?
Sure, no problem.
You are paying next time we go for a curry.
So that afternoon I looked on Google to see what was available.
Having identified possibilities it was time to get the details. So I called the first four agents. I explained the premises were not for MHM but for a client who’s identity at this stage was confidential.
We were looking for premises that could seat 15 people plus two offices (one for MD and one for the General Manager).
We also needed on-site car parking. I also explained this was very much an initial inquiry and I was merely establishing what, where, how much, etc.
After giving it some thought, I’d call them back in one week’s time. Nothing would happen before that.
Why then have I taken three phone calls this morning asking me to update them and enquiring how we move forward?
Again I repeated this was an initial inquiry and pointed out nothing would happen until my friend and I have looked at the details. But still, I was asked the same questions I’d already answered.
The decision would not be taken for the next seven days
I don’t want to arrange a viewing of a specific property yet
I’m not able to state who my client is
I’m not interested in them coming to see me and discuss requirements
Premises for 40 people are NOT suitable – I said up to 15!
Offices for 6 people with no car parking is a stupid suggestion.
If I hadn’t got to find the best possible premises the three who hassled me this morning would drop straight off the list and I’d only deal with the remaining agent. And for one reason alone.
She has accepted and understood the brief and instructions and therefore she goes to the top of the list.
Two of those who hassled me have the same property available as the one who has NOT hassled me. And the premises look very suitable too.
Now let me think whom I’m going to call back?
My point is I gave a very specific brief to all four.
It does not instill me with much confidence regarding the three who don’t appear to be willing to follow even that.
I know all four have a job to do but wasting my time by calling is unacceptable.
Final thought, the one agent who called my mobile this morning because my direct line was engaged should maybe have considered my direct line was engaged because I was USING IT!!!
Read more →
One of the most often asked questions is “how as a private consultant surgeon can I increase my payments from insurance companies?”.
The answer, as regards medical invoicing, is very simple to answer:
But what does that mean in reality?
It means taking all the items that should be done and turning them into a MUST be done.
For example, I took a phone call from a consultant’s secretary this morning who wanted a favour.
She was struggling to get an invoice posted electronically. She was trying to invoice BUPA. Simple enough you may think but despite having a policy number, she could not process the invoice.
So how did it take me approximately 3 seconds to work out precisely WHY she couldn’t process the invoice?
She told me the policy number began BI-6000 etc.
That told me the policy number was not a BUPA policy number; it was a BUPA INTERNATIONAL policy number.
She was trying to invoice the wrong insurance company.
A quick fix to process the invoice, again online, to BUPA International and it sailed through.
If standards had been raised to ensure that every single patient registration form had been completed correctly, this problem would not have occurred.
The invoice would have been processed the same day. Instead, a shortcut had been attempted and the patient’s insurance company detailed incorrectly.
If standards had been raised to ensure this was checked and spotted the invoice would have been immediately processed.
There are no shortcuts if you want to get paid.
Thus an increase in cash flow – the outcome desired by the private consultant – was not being reached.
However, if you stop to think there are two questions:
When the patient was registered, why wasn’t a check performed to ensure the right insurance company was recorded? It should have been.
Why had the standards been set too low?
If it becomes a case of the patient MUST be asked i.e standards are raised then this specific problem is never allowed to arise.
And that’s what I mean by raising your standards.
So why is this crucial?
Because more and more private medical insurance companies are insisting invoices be submitted electronically.
The issue is not one of is that the right thing for them to do or not.
The real issue is that it is happening and standards must be raised to ensure you CAN invoice electronically.
In other words, if you don’t have all the right details it is much, much harder to invoice.
You will instead have to re-contact the patient and get the right details.
Therefore it makes more sense to say you MUST get the details upfront and you must RAISE YOUR STANDARDS to the point of saying – the correct details MUST be obtained and checked.
I’ve even witnessed where an invoice can’t be processed because the postcode has been recorded as W01 (numeric) when it should say W01 (alpha) Incidentally.
Many times I’ve said insurance companies are not the enemy.
Even if I frequently disagree – I do on a daily basis sometimes – insurance companies will pay a private consultant IF (and only if) ALL the details are correct. In other words, invoices must be raised to the correct standard.
If you want to increase or improve your cash flow, the very first thing to do is to raise your standards in the area of invoicing.
Read more →
Never, ever base your practice business plan on there being 12 months in a year.
The question should be how many WORKING months there are in the year.
It is extremely rare for any private consultant to find he or she is inundated with patients during December. There will be some. Nonetheless, there won’t be many.
Many patients have got other things on their mind during that particular time of the year.
That doesn’t mean the whole of December will be lost but around half of it will.
The same came be said of August. Patients prefer to go on holiday.
Come to think of it, many consultants like to go on holiday in August too. Just as they like to have Christmas off as well as the patients.
So if your business plan is to make say £120,000 a year (or any other target for that matter), don’t assume your monthly target should be £10,000 each month.
Instead, you should set a monthly target of £10,909 a month ie £120,000 divided by 11.
The issue gets even more complicated though for many MHM clients when study leave, NHS commitments or whatever else they get up to.
Factoring in an additional allowance for commitments unconnected to the practice or an allowance for patient preference is important.
Read more →
It is depressing the number of times I hear clients criticising insurance companies.
In my experience the reasons normally cited are incorrect. Far from it.
I’ve lost track how often I’ve been told an insurance company won’t pay for something.
Yet when I ask if the insurance company have actually been asked IF they will accept a charge, the answer comes back that they have not.
I have all the private medical insurance companies on speed dial.
They need to be as I speak to most of them every single day of the week.
There are many, many things I’m already aware of.
There are also some things that I don’t know or more importantly that may have CHANGED.
I ask them all sorts.
For example – I ask them to confirm a patient’s policy number. I ask them to confirm why an invoice has only been partially paid.
Sometimes I ask them if I can or cannot charge for a certain medical episode.
Which brings me neatly to the W9040 code.
I was invoicing for an orthopaedic consultant surgeon recently. His specialism was knees and during a follow-up consultation he administered a W9040.
This particular CCSD code represents an injection into a joint or soft tissue.
The question arose if I could charge a particular insurance company for a follow-up consultation fee AND a fee for the injection.
So I called them. The answer came back yes I could.
I could charge £120 for the consultation and £50 for the injection i.e. £170.
The insurance company would happily pay such an invoice.
Compare and contrast that with work I was performing for a dermatologist recently.
This time the question arose of a S5210 (an Injection into subcutaneous tissue). I’ve only recently started invoicing for this client and thus it was important to establish what could and could not be charged for.
More specifically, would the insurance company accept an invoice for the follow-up consultation AND the injection?
Yes, they would.
£125 for the consultation and £108 for the injection i.e. £233.
Remember however that I had asked ONE specific insurance company.
When I asked others the same question, some would NOT allow the separate charge.
What was concerning was previously the dermatologist had not been charging for the S5210 at all.
I actually asked his practise manager why this was so.
The answer came back that the question had been asked of an insurance company before and the answer was no.
The problem was that whilst the insurance company concerned did not (and still don’t) allow a charge, other insurance companies DID allow a separate charge.
But nobody had asked the other companies.
Instead it was assumed the decision covered ALL insurance companies.
Thus on numerous occasions insurance companies are wrongly blamed for their actions.
It was only by speaking with the individual insurance companies that I identified which ones would accept the charge and which ones would NOT accept the charge.
Insurance companies are NOT the enemy.
If you call them, you may be surprised at what you are told.
That is not to say you will always obtain a positive response but you may be pleasantly surprised.
Read more →
For the simple reason, cash does not flow.
Cash has to be managed.
Around this time of year, I take calls from consultant surgeons who in view of their impending tax payments require an increase in cash collections.
It’s happened every year since MHM was formed. The normal instruction is to increase the cash flow. Immediately. Simple enough. I can do that.
Existing clients don’t call because invoices have already been generated for them and they’ve already been paid for their work.
Their cash has already been maximized.
The real problem faced by potential clients though was highlighted this morning when a consultant surgeon referred to needing an outstanding cash flow “purge” within his practice.
This highlights to me a more fundamental underlying issue. Let me explain.
A consultant surgeon – just the same as any business – should know how much he is invoicing both in terms of patient numbers and the value of those patients.
If he is invoicing correctly and ensuring he gets paid he can also, therefore, calculate his revenue receipts.
he wasn’t a consultant surgeon but sold another service or product, he should be able to perform the same calculation.
So he knows how much he is or should be invoicing. Providing he proactively manages his practice.
If you think about it, most consultant surgeons already know their overheads too. They know how much their room rental is. They know how much the staff cost.
And they know how much their professional indemnity costs (too much before you ask).
Of course, there are other expenses but fundamentally they already know their expenditure.
They know their total costs.
Therefore they know or should know how much they are spending too.
Enter stage left Mr. Micawber:
He knew a thing or two about how to run a private medical practice did Charles Dickens.
For one thing, he knew cash doesn’t just flow into it.
It has to be managed.
Read more →
Monday, August 10 – an MHM client emailed me advising patient invoices were missing.
Go back to Saturday, August 1 when the client held his normal Saturday clinic.
Immediately he completed the clinic, he scanned his two page clinic list and sent it securely to MHM.
Therefore on Monday, August 3, MHM issued 8 invoices for both self-funding patients and also to insurance companies.
MHM sent the client his weekly report. This document confirms how many invoices have been raised. It confirms how many previously raised have been paid and which invoices are still outstanding.
But it also enables the MHM client to check the correct number of invoices were raised that week. Ten in total.
And they hadn’t been which is why the client emailed MHM.
Consequently, it transpired the client’s two page clinic list contained four patients per page for the final page with the additional two patients had not been scanned.
Both patients were in respect of consultations and had a combined value of £525
It is of little interest both to the MHM client or MHM itself WHO made the error.
Of much more relevance is that the error was immediately identified.
And then corrected.
Otherwise that particular MHM client could have found himself £525 out of pocket.
Which is why it is crucial that you receive a weekly report confirming what is happening with YOUR money.
Read more →
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.
Read more →
Occasionally I get asked this question and a very important question it is too.
The normal answer is to open a practice at the nearest hospital to home. After all, nobody wants to commute more than they need to.
Bu there is another critical factor in the final decision.
Three years ago, I was contacted by an orthopaedic surgeon who was seriously struggling to grow his practice. His practice had been open for just over a year.
But he was struggling to get new patients either a self funders or via an insurance company.
It didn’t take more than an hour of desk research to work out what the critical factor was.
A search of Google indicated that there were eight orthopaedic surgeons practicing at his hospital. All of them were recognised by the major insurance companies. All but one were fee assured. With the exception of three, they all offered consultations twice a week. He offered one.
In other words, patient requirements were already well covered.
It was, and still is, difficult to compete for a finite number of patients against either well established consultants.
Nonetheless, never quit or give up.
There are many different steps to take. A well drafted marketing plan supported by a formal strategic objective would be the first item on my list.
But included in that would be a reality check.
His practice is not going to grow and grow and grow.
Expectations need to be managed accordingly.
There is, however, a lesson to be learnt.
Before you decide precisely where you are going to open your practice, make sure you check how many consultants are already there.
Read more →
A patient who needed a receipt called me yesterday. She needed one so she could claim the money from her health cash plan.
The patient had seen physiotherapist and paid for her treatment. With a receipt, she can claim the fee back from the Health Cash plan provider. Alternatively, the patient could have been insured but outpatient appointments not covered under her policy.
A Health Cash Plan is designed to ease the financial burden of having such regular health checks.
They are NOT the same as a private medical insurance policy.
So why are they relevant to the consultant surgeon?
Well, sometimes the patient’s insurance cover does NOT include outpatient appointments. The patient has paid for them but requires a receipt so they may claim the cost from the Health Cash Plan provider,
Thus it is important to understand what a Health Cash Plan is and how it may complement a private medical insurance policy.
Read more →