Ever wondered why MHM clients get very regular payments both from Insurance Companies, Private Hospitals and self-funding patients too?
It is down to the above discipline – the ritual – both on the part of MHM and on the part of its clients.
Specifically, every single time an MHM client completes an outpatient clinic or is in theatre the detail is sent to MHM.
Some clients send them daily, others send them weekly. But send them they do.
Then it’s a question of ritual.
Every single morning at 8 am, I have the ritual of picking up the clinic or theatre lists from the previous day.
And then they are invoiced to the insurance company concerned or direct to the patient.
Monday to Friday this is the first job every single morning.
It is a RITUAL.
So how does this ritual help MHM clients?
It means payment has been requested on behalf of MHM clients. This in turns means insurance companies are able to process the invoice for payment.
Does this sound far too simple?
Well, in reality, it is very simple.
It is literally a question of RITUAL LEADING TO VERY REGULAR PAYMENTS TO MHM CLIENTS.
Paradoxically, I know many medical secretaries who instead raise invoices “on a Friday afternoon” or “after I’ve typed my consultant’s letters”.
The inevitable happens.
On a Friday afternoon, the telephone goes berserk or something comes up that prevents the invoicing from being completed.
Because there is no ritual, the consultant does not get paid as quickly as they think they should.
Indeed I was talking to a med-sec last week who was telling me she has a three-month backlog in uninvoiced outpatient clinics.
She wasn’t happy that at 10.20 am on Thursday, November 14th, I had a backlog of ONE clinic dated from the previous day.
I wonder how many times I’ve said “invoice right = get paid right” over the years?
I dread to think.
But invoice right = get paid right does not just mean having the patient’s details, coding, and fee right.
It means making sure an invoice is generated as soon as MHM is asked to do so and it means making sure it is delivered to the body responsible for paying it.
It is a ritual.
And it is a ritual that generates good results.
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Many times I’m asked how and why MHM clients achieve their practice aims with apparently so little effort. How do they take the island?
MHM does not allow its clients to define their private work as a practice: it is a BUSINESS.
Private consultants refer to it as a practice; I call it a business.
What seems like a mere play on words, is anything but. The whole of the business is geared towards making a sufficient financial return for the effort that is required.
Whilst this is absolutely NOT at the expense of providing 1st class 100% professional medical care for the patients, it does mean that patients aside, everything else is geared towards obtaining a financial return.
If the business does not generate a financial return, what is the point?
That’s why MHM negotiated a fee increase for two separate clients in respect of surgical episodes (both were increased by 40%) last week.
The consultants concerned did extra work and were therefore entitled to charge more. It is, after all, a business.
The question then arises of how they achieve their business aims with “so little effort”.
This may be summed up very simply: it’s NOT true.
But let’s be clear. I’m not talking about the consultant’s professional skills and abilities. I’m talking about the divorce between their professional skills and the amount of effort put in to run the business as a business.
All MHM clients are smart enough to outsource the management of their business; they themselves rarely get involved for they realise they are in a different world than they are used to.
Let me illustrate this by comparison with an NHS patient and a private patient.
All MHM clients have NHS commitments.
They see numerous patients all the time. But these patients are delivered without much effort on the part of the consultant. That is absolutely not the case with a private patient.
The consultant must go out and advertise himself by whatsoever means to attract patients to him.
Then he must make sure, unlike his NHS patient in respect of which he’ll be paid his NHS salary regardless, that the private patient or insurance company pay for the consultation, etc.
So what does “burn the boats” mean?
Burn the boats means that everything the private consultant does to support his business MUST be 100% organised and efficient.
A private medical practice – a BUSINESS – cannot be run in a half-hearted manner.
It takes – like any other business – considerable time and effort to get it right. Burn the boats means there is no way off the island.
Of course, a private consultant can choose to close his private practice/business and leave the island but the mindset when you start private work is that it has got to succeed for the boats have been burned.
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This is a topic that comes up frequently when I meet Private Consultant Surgeons.
Indeed, the point was touched upon earlier this year regarding asking self-funding patients to pay in advance.
Self-funding patients represent the major risk of non-payment for the private consultant.
That said MHM does not advocate requesting payment before a consultation.
One group of Private Consultant Surgeons made it mandatory that ALL self-funding patients paid in advance.
Within 3 months they had lost over 90% of their self-funding patients.
This represented a value several times LARGER than the balance due to unpaid self-funding consultations.
Cancellations, however, are completely different from “Did Not Attend”.
Frankly, none of my clients suffer from a significant number of cancellations.
Yes, there is a small number but in no way is it a problem.
It is more an inconvenience.
But there is another aspect to the debate.
That aspect is those patients who ‘Do Not Attend”.
Patients who do not attend for their consultation represent a 100% loss just the same as cancellations.
It matters little if the consultation is 20, 30 or 45 minutes.
If the patient does not attend the consultation then that time is lost. No revenue may be charged for it.
Certainly, this is true if the patient is insured for it is extremely unlikely any insurance company will allow a fee to be charged if the patient did not attend.
The issue, however, is different if the patient is self-funding.
Of course, it is possible for the consultant to send an invoice to the patient who did not attend.
That does not mean, however, the invoice will be paid.
The conclusions are therefore as follows:
if the patient is insured there is very little the consultant can do about DNA patients
if the patient is self-funding however taking a deposit (which can be deducted from the final charge) has the effect of REDUCING the number of “Did Not Attend” patients.
Would such an approach have a negative impact on the reputation of the consultant?
I suspect it would.
It would be interesting to hear from anyone who has a different approach and the results they have obtained. Feel free to email me at:
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One of the most fatal ways to restrict the growth and profitability of a private medical practice or indeed any business is a failure to communicate.
Over the years I’ve enjoyed excellent relationships with clients – my original client, for example, is STILL a client. His practice has grown and it is still growing.
Another client saw around 6 patients a month when we started working together in 2012; now he sees around 100.
In both cases, MHM is used as the mailing address for correspondence from insurance companies and from patients.
Most of the time a client doesn’t need to see them anyway.
They just need to know any issues – shortfalls or excess for example – have been sorted and they either have been or are being paid.
Other clients though have not shown such growth.
Indeed I have struggled to get their invoices paid quickly, shortfalls and excess under control and self-funders are problematic also.
This is down to one reason and one reason alone.
Clearly, in the first example, the benefits of a clean and robust working process are beneficial.
Included in such a process is the weekly client’s report I send out.
For example, I have one client who is always complaining his cash flow comes in peaks and troughs.
It will do if I only get the clinic lists intermittently and I only receive notifications of payments from him intermittently also.
Other important pieces of correspondence are also only sent to me on an ad-hoc basis.
The reason cited for this is that the client simply does not have the time to communicate.
I have to say 99% of the time I agree. He should be busy seeing patients or in theatre rather than talking to me.
In the nicest possible way, I’m actually not bothered if a client talks to me or not.
In other words, this is not a personal gripe from me regarding a failure to communicate; far from it. I’ll react to the information supplied to me usually the same day it arrives.
But if the information doesn’t arrive, I have nothing to react to.
It is more important the information is received by the client and failure to communicate by passing it on to me that which is the real issue.
Reverting to the first client, he uses the MHM address for all accounts and billing correspondence.
He also uses the MHM email address for his electronic remittances.
All the information comes straight to me. Taking one month this year, his total billing for that particular month was £18,500. At this precise point – April 26th – he is still owed £150 (1%)
99% of his invoices have been paid or if subject to excess/shortfalls, they have been collected.
Turning to the second client, his total billing for the month was just over £4,250.
All the information from insurance companies etc goes to him. At this precise point, he is still owed £822 (22%). Only 78% of his invoices have been paid.
And that is why communication is everything in business and the domino effect should and can be avoided.
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A little over a year ago, a group of surgeons based in the southwest of England contacted MHM.
In an effort to reduce a large number of issues with outstanding self-funding debtors, they had decided to ask new self-funding patients to pay for their initial consultation in advance.
I have to say my initials thoughts were this would absolutely stop any issues with self-funders.
It would do so for one very unfortunate reason.
There would be no self-funders at all because they had refused to pay in advance anyway.
The patients went to see other consultants instead.
And that is exactly what happened.
Hence the phone call to MHM with an instruction to establish a process whereby issues with self-funders were substantially reduced but not at the expense of turning patients away.
If you’ve read previous blogs you’ll already know how to process self-funders and the major reasons behind outstanding self-funder debts.
The MHM process does not, and absolutely should NOT, suggest asking the self-funder to pay everything in advance!
It is not the way to solve the problem.
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Most MHM clients have reported issues with self-funders when we get involved. It is also the source of many calls made to MHM.
With the self-funding market increasing, it is important to understand the reasons self-funders can be a problem.
But what, based on empirical evidence, are the three most common reasons a self-funder hasn’t paid:
The first issue is always the same. When the patient is contacted as a self-funder, he/she claims never to have received an invoice.
Whilst this is obviously easy to rectify, how many medical professionals are 100% certain the invoice was sent in the first place?
Obviously some self-funders will be naughty so to speak but generally, they will pay if sent an invoice.
So the first common reason – the self-funder hasn’t been invoiced.
The second issue concerns the use of debit or credit cards. In 99.9% of cases when a patient arrives at a private hospital he/she will be asked to provide a swipe of their card.
Sadly on numerous occasions, the patient is unaware the card only covers the hospital fees. It does NOT cover the consultant’s fee.
The MHM solution is when the patient first makes contact with the consultant, he/she is advised the card swipe will NOT cover the consultant’s fee.
This should be followed up by a note on the consultant’s invoice stating: This invoice is NOT covered by any debit/credit card details you may have provided to the hospital.
The second common reason – the patient thinks they have already paid
The third issue is the easiest of all to resolve. Frequently, a self-funding patient has called upon receipt of the consultant’s invoice to say they are insured.
This must be addressed immediately. Invoicing the wrong person is absolute insanity.
The cause is a failure at the patient’s initial point of registration to ensure the correct details are taken.
The third common reason – there is a major failure in the consultant’s registration process.
If the above three items are correctly managed and a firm process put into place to manage the minority of self-funders who don’t pay, the number of outstanding self-funding invoices drops in most cases by over 80%
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Anybody ever watched the movie “Jerry Maguire” and the immortal quote – show me the money!
Clearly a guy I recently bumped into at a medical conference hadn’t. He was the Practice Manager for a large hospital group.
His complaint was the lack of cash from insurance companies coming into the business.
His solution had been to analysis the internal administrative process of the hospital; make sure everybody knew their role and when to do it.
He ended up with a very comprehensive PowerPoint presentation.
Indeed he had spent four months doing just that.
After four months nothing had changed really.
I couldn’t help but think about his thought process.
He had gone around writing reports and compiling analysis rather than actually speaking to the insurance companies and finding out what the problem was from THEIR end?
In other words WHY they were not paying him?
If he had done so he would have immediately realised his practice was not invoicing correctly.
If he had asked the insurance companies they would have told him just that.
Only then could the practice start to review and possibly change the process to make sure they did get paid.
Start with the basics. Or as Jerry Maguire would say:
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This blog could easily have been called ‘YOU WON’T UPLIFT A FEE BY DOING THAT”
Recently a private consultant – the colleague of a current client in fact – called me with a problem.
Sadly it was a problem very much of their own making!
In an effort to increase fees, the consultant had decided that a surgical episode should be billed as follows: AB1234 £640 and CD2468 £75. So the total fee = £715.00 and on March 1st, 2019 the insurance company was sent an invoice for £715.0.
And promptly proceeded to reject it.
The fee for the AB1234 was and still is correct.
But with this particular insurance company offering 50% of a second code, the CD2468 fee was wrong to start with. It should not have been £75. It should have been £37.50. Great. Save the invoice would still have been rejected.
Why this time?
If the private consultant had checked they would have discovered that this second CD2468 code was deemed by the insurance company to be part and parcel of the AB1234 procedure.
Thus it was never going to get paid anyway and it was deemed unbundling to submit an invoice and charge for both items.
Skip forward to September 2015. The consultant – or more accurately his long-suffering secretary – has called, emailed and written to the insurance company because the consultant is still unpaid the £640 for the AB1234.
Hence the phone call to MHM.
For once even I couldn’t do anything about the multi-code element.
It very clearly states on the insurance company website that a consultant cannot invoice a CD2468 alongside an AB1234.
In fact, it also says so on the CCSD website.
It is deemed unbundling to do so. The bottom line is that from June 2019 to September 2019 the consultant has been £640 out of pocket.
MHM called the insurance company and has confirmed the original invoice has now been canceled and re-submitted an invoice for an AB1234 £640.00. It is being paid too.
Moral of the story?
You will NOT make more money by unbundling.
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At a recent presentation, I was asked about the costs and use of accounting software.
Bearing in mind the presentation was to consultants who had not yet established a private practice, numerous eyebrows were raised when I answered…
This does not mean accounting software is unnecessary, expensive or unsuitable for an established practice.
Some private practices do need a software package and there are some fine software packages out there.
They are cost-efficient too. MHM works, very successfully, with many of them.
But for those seeing say 10 or 12 patients a week use MS Excel or Apple Numbers and an online diary.
MHM has more than a few clients and uses Excel to run a sales/debtors ledger.
The invoice can be sent as a PDF attachment to an insurance company. The sales ledger – once password protected – can be sent either to the client and/or the client’s accountant.
If a private practice is a business – and it is – then you MUST keep an eye on all costs. If you do not, profit will reduce.
It’s always useful to ask yourself the question.
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Two codes AB1234 £619.00 and XX2468. £124.50. Total £743.50.
It came, as somewhat of a shock to be told therefore the amount being paid to the MHM client was only £24. How can this be???
Basically, because someone at the insurance company deducted a £100 excess but by mistake recorded the AB1234 as excess also.
So instead of being paid £743.50 less £100 excess i.e. £643.50 the MHM client was out of pocket by another £619.50.
As a result, a phone call to the insurance company followed and the insurance company accepted they made a mistake. In the real world, insurance companies do make mistakes.
Took 30 minutes to sort it all out but think about it. That 30 minutes mean you are getting paid what you are entitled to.
Are you confident your fees are being paid correctly and mistakes aren’t being made?
How do you know? Have you checked?
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Working for consultant surgeons is fun.
However, since one particular private medical insurance company decided to outsource their help desk or their “advisors” late last year, there has been a marked reduction in their level of customer service from it.
Considering the people calling them are either consultant surgeons or calling on behalf of a consultant surgeon, that is pretty bad.
Indeed the average time on hold for this particular insurance company, for example, is now well over 10 minutes.
That’s pretty awful considering it used to be less than a minute.
What is ironic however is that now I have a choice of music to listen to.
For example: would I like to listen to classical music, pop music, jazz or rock music? I decided on classical as it happens and am currently listening to Bach. I like Bach.
But it has got me thinking…
Isn’t being given the option of what to listen to missing the point entirely?
This is an even worse option than being told my “call is important to us” and then the call is unanswered.
Shouldn’t the aim be to answer the phone call rather than offering a choice of music to listen to?
All private consultant surgeons sooner or later will need to speak to an insurance company.
Whether this is at the point they are attempting to gain recognition or to check a fee is correct is not relevant.
Sooner or later – particularly if you are billing an insurance company – you have no choice but to speak to them.
But is it absolutely necessary to call?
That is my favourite question to ask.
The first port of call so to speak is always to consider if an action is necessary. In other words, what is causing that action to be necessary and can anything be done to prevent the necessity of the action?
In the case of speaking to a medical insurance company, in theory, many of the calls should not be necessary.
If an invoice is raised and submitted correctly for example then payment should – again in theory – just flow through. Reducing the necessity of speaking to an insurance company is always a good aim.
It is the very reason I check remittance advice sent by an insurance company most carefully.
They record many of the details as to why an invoice, for example, hasn’t been paid either in full or partially.
For example: if a partial payment has been made the reason why will be detailed on the remittance advice.
Thus the number of calls required to a private medical insurance company will be reduced.
Nonetheless, the fact remains there will ALWAYS be an occasion to call an insurance company. It may be, for example, that the fee has been reduced and you don’t know why.
The point is there may be genuine reasons why it IS necessary to speak to an insurance company.
Contrast this however with another insurance company I’ve spoken to this morning. I called them and was told I was on hold, was caller number 3 and the estimated hold time was 4 minutes.
Fine; I can live with that.
It is up to me whether I’m prepared to wait in line or call back.
Having formally complained to the medical insurance company in the first example that their customer service is not good four times so far, I did consider WHY they had outsourced?
It would appear the reason is financial. It’s cheaper.
It was once said by an extremely wealthy man that price is what you pay and value is what you get. I agree wholeheartedly.
Cheaper isn’t always the best.
And time is money too.
I’ve actually written this blog whilst being on hold and listening to Bach. So I’ve used the time to do other things too. What would happen, however, if I was a private consultant surgeon with an already overworked medical secretary who had letters to type or worse still was on hold so patients couldn’t ring her?
That would reflect badly on my practice.
I’m all in favour of outsourcing.
I would say that though because my business is intrinsically the provider of an outsourced facility to private consultant surgeons.
Even so, I get seriously frustrated at being told either my call is important – well answer it then – or I’m offered a choice of music to listen to.
I don’t actually want either to hear either.
I want my issue resolved quickly and efficiently.
Cheaper and slower shouldn’t be an option.
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If you get the basics right many problems with getting paid aren’t allowed to happen.
As a result, accidents aren’t allowed to happen.
The basics are as follows:
Patient’s full name
Their full address including their postcode
The Patient’s date of birth
Policy number of insurance company.
A pre-authorisation number issued by the insurance company
Correct CCSD code
But it doesn’t stop there.
Your name and address
Your provider number
A unique invoice number
Date of the treatment/consultation
But if you don’t get all 14 on your invoices you make it harder for the insurance company to pay you.
Where do you get the above data from?
If you are practicing from a private hospital almost certainly the above will be recorded on the hospital’s registration form.
If you are invoicing electronically, its pretty much standard that you MUST have the above data immediately to hand anyway.
The same is also true if you are dealing with a self-funding patient or you endure having to collect a shortfall/excess amount from a patient.
In other words, the chances are you are going to need all 14 pieces of data. Therefore it makes more sense to get them right the first time.
But the proof of the pudding is very much in the eating. Have a guess at what are the TWO major reasons an insurance company does NOT pay your invoice?
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An MHM client held one of his twice-weekly outpatient clinics recently. Nine patients; so there should be NINE invoices.
Except there are only EIGHT?
A quick look at the list indicates one of the patients is designated as inclusive care; no invoice required.
But hang on a second, an invoice was raised for a surgical episode recently for this very patient and sent to an insurance company for payment.
Indeed it’s been passed for the payment already.
How can the follow up be deemed inclusive care if the surgical episode was chargeable to an insurance company?
Generally speaking, it can’t.
The patient had been incorrectly designated as inclusive care for this clinic.
Once the error is corrected, there are NINE invoices. Happy days. After all its only one episode
Make that mistake only once a week for a single month and you potentially lose over £500.
And that is why MHM checks the clinic list is right each time and every time.
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A shortened version of a recent conversation with a well established private consultant surgeon.
Very recently one of the major PMI players announced a further reduction in payable fees.
The immediate retort from another very well established MHM client was to pass any reduction on to the patient.
That’s all well and good but not if she is fee assured with the insurance company concerned.
If a fee reduction is passed on to a patient by a fee assured consultant, the consultants’ recognition may be put at risk.
None of the above means MHM agrees with insurance companies reducing fees – even though market forces may on occasion be the root cause of such reduction.
By all means, argue with the insurance company.
And I already am.
But don’t assume the argument fees should not be reduced will be successful.
There again it might not.
Instead, make sure you are charging the very maximum you can.
Make sure you are charging for everything you do.
If the surgery takes twice as long as expected, request an uplift fee. If a double consultation is required, charge for a double consultation.
It’s not as difficult as you may think it is.
And don’t forget to do a sanity check each month.
If you think a 20% reduction in fees is bad, consider the 100% reduction if you fail to charge an entire consultation.
Whilst the question of where fees will go will be considered in future blogs, its important before even thinking about your fees to make absolutely sure you are charging the right fee already.
You’d be surprised how many aren’t!!!!
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How can I charge more for my work?
This always spins off into a debate concerning how private medical insurance companies are the enemy.
Fees are always being reduced with the private surgeon being paid less and less it is claimed.
That may be true sometimes but is not the right place to start.
The right place to start is to make sure the private consultant surgeon is charging the correct fee.
Such fee may be less than the surgeon wants of course but, many times, be more than he thought he was entitled to.
Take the example of an orthopaedic surgeon who contacted MHM to process her medical invoices recently.
She was of the opinion her consultation fees were too low. That also may be correct. But that was the consultation fee the insurance company was prepared to pay.
In reality, the orthopaedic surgeon was unaware some of the insurance companies were prepared to pay a fee for minor procedures carried out at a consultation.
They would pay a procedure fee together with a fee for the consultation.
Whilst some insurance companies weren’t prepared to pay both fees, some were. Instead, the consultant had been charging ONLY for the minor procedure.
She had not been charging for a consultation as well.
The same situation was equally applicable to a private dermatologist just as it was applicable to a GI surgeon.
It is not therefore applicable solely to orthopaedic surgeons.
It is applicable to many specialisms.
The issue therefore becomes one of: am I charging the right fee?
To confirm the fee is correct a review of procedure codes and the fee for the procedure code should be undertaken.
Both may then be compared against the fee structure of the private medical insurance company concerned.
Each code and combination of codes must be checked against the fee schedule of the private medical insurance company.
The often stated assumption that all insurance companies pay the same fee for the same procedure code should be rejected.
Take the example of a repair of the primary repair of Achilles tendon. Insurance company A pays a fee of £336 whereas insurance company B pays £405 – £69 more!
The orthopaedic surgeon concerned was of the belief insurance companies paid out the same fee.
She had UNDERCHARGED by £69 as a result.
To return to the original issue of charging a consultation fee alongside a fee for a minor procedure, take a look at injection into soft tissue.
The same insurance company paid a fee of £108.
The orthopaedic surgeon in question was unaware that a follow-up consultation could be charged in ADDITION to the fee for the injection.
Another £150 on top of £108!
Thus the correct charge was not £108. It was, in fact, £258
To further illustrate the point a dermatologist may charge the very same insurance company, £91 for curettage of skin or lesion.
He or she may ALSO charge a follow-up consultation fee in addition.
If the follow-up consultation fee is £100 (and it is for the MHM client concerned) the fee for the WHOLE event has doubled!
Thus the most common mistake in medical invoicing is not realising that fees can and do differ between insurance companies and will quite happily pay MORE for your work.
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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 protocols are 100% accurate. Is the consultant’s address correct?. I’ll check the insurance company has the right BACS payment details.
What I’m actually doing is reducing down to absolute zero as many reasons as I can possibly think of that will prevent the invoice being raised correctly.
What happens if I don’t take this approach?
Invoices come flying back. They don’t come back straight away of course.
It may take weeks before I’m notified there is a problem. Then I have to work out why it went wrong, get all the details to put the error right, actually put it right and then resubmit the invoice.
Then I have to wait again for the invoice to be reprocessed. Eventually, the invoice gets paid.
One absolutely true example. Recently MHM project managed a group of three surgeons in the Midlands. All three were seriously considering closing the practice as they were not making any money. They were not getting paid as they should.
The senior of the three was responsible for invoicing for all three each week.
Just under 50% of the invoices he produced came back unpaid. The insurance companies concerned requested more details or raised queries 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. The 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 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 no reasons why we shouldn’t be paid.
Told you I was impatient.
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A Scottish colleague called me last week. A case of “can I pick your brains for two minutes?”
I’m always happy to take such calls for many times I have called others with precisely the same request. My colleague was confused as to what could or could not be charged alongside a consultation fee. Specifically, the consultant surgeon she worked for was administering injections at a consultation and she thought she could not charge a consultation fee AND a fee for the injection. She thought this would be a clear case of unbundling.
Except she was wrong.
Her consultant was perfectly entitled to charge a separate fee for the injection.
A quick analysis of the outpatient consultations where my colleague had NOT charged since January 2015 revealed she had UNDERCHARGED by a total of £837 so far this year. She had however and quite rightly charged for every single consultation – failure to do otherwise is the fastest way to lose the private consultant’s money – but had shown on her invoice the fee for the appointment alongside a ZERO fee for the injection. In the case of one single insurance company she had failed to charge in respect of 9 separate patients £450 worth of injections (9 @ £50 each)
The bottom line is that if she undercharged injections by £837 in the first 6 months of 2015, should she continue throughout 2015 she would lose her consultant £1,674 for the entire year.
How did I know the answer to this one? MHM has clients in the same specialism as my colleague’s consultant. Also, MHM checks fees every 90 days with all insurance companies for the rules of what can and cannot be charged, what is bundled and what is deemed unbundled change. Plus, most importantly, applicable fees alter!
How many of you check what the correct fee is? Not just when you set the practice up but on a regular basis?
But I can’t help but wonder how many consultants undercharge – are you one of them but don’t realise it?
For more details email: firstname.lastname@example.org
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At a conference recently a friend of mine was discussing the future of the private practice industry and what lay ahead.
My colleague shared the view that the “younger” newly appointed consultant is more adaptable to the direction of change in the private practice.
Thus they were a major driver in how the industry moves forward.
I say they are entrepreneurs.
Let me explain why.
Certainly newly appointed consultants cannot look forward to a hefty NHS pension at the end of their career.
The younger consultants are also facing a squeeze in fees from private medical insurance companies. Not to mention they journeyed through a number of years to reach the position they are in now.
Yet they find themselves in an increasingly competitive market.
The market is more competitive than those who came before them. The younger consultants are, so the evidence suggests, much more open to a business orientated approach than before. They have to.
In other words, the newly qualified consultant still has a mortgage to pay, mouths to feed, etc so is much more receptive to being an entrepreneur.
Say what you may but the fact remains the private medical healthcare environment is changing. Just as the NHS healthcare environment is changing.
At the forefront of such changes will be the newly qualified consultant surgeon. To adapt or take advantage of such opportunities as may arise, the new qualified are using technology as never before. For example, they are much more amenable to the use of internet-based technology for marketing and PR. They have to be entrepreneurial.
To prosper, let alone survive, they must invest in technology. What is interesting is that they are more willing to do so than ever before.
To succeed with a private practice requires a significant amount of seriously hard work. This is not to suggest the application of medical skills is not important. It is.
But what is equally important are entrepreneurial skills. Marketing, financial expertise, and business managerial skills for example. These should not be assumed to be easy. They now have to be acquired.
Consider that a consultant – newly qualified or otherwise – works within the NHS.
The NHS provides a support infrastructure including premises, secretarial support and, crucially, a constant supply of new patients.
In the private sector, none of these items will be supplied. The consultant has to go out and actively find them for himself.
And that is why the consultant surgeon should be viewed as an entrepreneur.
Does anyone have a different view? I’d be delighted to hear from you.
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Following a recent blog regarding websites, I was asked my view of social media eg Twitter or Facebook. Whilst in my view a private surgeon should have a website, social media may not be the right place to be unless EXTREME care is exercised.
Any social media utilised by a private surgeon which also allows a patient to post comments thereon might well be a recipe for disaster.
Consider the untold damage if the patient posted on-line the care by the Surgeon was first class but the standard in the hospital was awful.
Guilt by association. Even worse if the patient posts online that the care administered by the surgeon was poor!
One consultant recently expressed the view that the only difference in 2019 to when he started many, many years ago is that now patients no longer merely gripe to friends and family. They can also go online.
An excellent point indeed.
His view is to always perform the best job he can. Just as he should do. That will stop patient complaints. But sooner or later somebody will complain.
MHM is often asked the question which clients have the healthiest private practice. For sure, those that have a website tend to fall into this category. Interestingly though, not one of those clients engages in social media.
So the conclusion may well be not only could social media be a dangerous place to be but, thus far, it has not proved to generate additional patients either.
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One of the major areas MHM is approached about is excess and shortfalls.
In October 2019, empirical evidence indicated 26% of all claims to private medical insurance companies are subject to an excess/shortfall. This is not to imply the insurance companies are to blame.
The reality is that patients have reduced the costs of their premiums over the last few years by agreeing to a higher excess.
But the knock-on effect of this has been an increase in excess deductions.
So what can the private consultant surgeon do about it?
The number one rule in tacking the issue of excess deductions is to identify when they happen. This is actually easy. The remittance from the insurance company WILL confirm when an excess has been made. It most likely will also state their insured (the patient) has been notified.
But under no circumstances should the problem be left at that.
The practice must, at the very least, action all shortfalls straightaway. Under no circumstances should this be allowed to exceed 7 days. Excess or shortfall deductions made again MHM clients are actioned within 48 hours. Such action may be an invoice for the amount of the excess/shortfall immediately sent to the patient. The invoice must state how much is due, why and how it should be paid.
This must be followed by a very robust process that makes sure such invoices are followed up.
If you want a complimentary PFD of the invoice MHM uses for excess or shortfalls, email me at the address below:
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