I’m used to insurance companies declining to pay a consultation charge for an Orthopaedic Surgeon within 10 days of surgery.
The reality is that this does not impact only on Orthopods.
I’ve seen it happen with GI Surgeons. And I’ve seen it with ENT clients.
It’s the very reason before I invoice consultations within 10 days of treatment, I ask if the consultation was “routine”. Or if there were additional medical reasons.
But it is only the consultant surgeon who knows why the consultation took place.
If routine, a post-surgical follow-up within 10 days of the surgery, might not get paid.
If on the other hand there were medical reasons, then it is possible.
It is best to call the insurance company and advise you will be submitting the invoice.
Then provide evidence WHY the consultation was necessary.
Nine out of ten times the consultant will then get paid.
After all the insurance company is NOT the enemy.
But what does throw me completely is when it is an initial consultation that has been declined because:
“Under the patient’s policy benefit is only payable when treatment is related to an eligible in-patient or day-patient stay within six months. Outstanding treatment costs are, therefore, due from your patient.”
How can an initial consultation be refused under such conditions?
What I’m actually being told is that the consultation is not covered under the terms of the policy.
That is different.
I did suggest to the insurance company concerned it amended the wording. It should read: “initial consultations are not covered under your patient’s scheme”
It’s annoying when this happens. You have to speak to the insurance company concerned. The question becomes: why the consultation was declined?
Where I have the problem is asking an unnecessary question. If the insurance company had made it clear WHY the consultation was declined there is no reason to call.
In the time I’ve taken to resolve the query I could have called the patient and obtained payment for the declined consultation for one thing.
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An email arrived last week asking me to call a prospective new client.
He’d been reading my blogs and wanted help to grow his practice.
In particular, he wanted a review of the performance of his practice and asked if I would call and arrange to go see him.
In his email, he said he thought he should be seeing more patients and his current patients should be paying quicker too.
I don’t even charge for this as occasionally there are only minor items that require attention.
So I called the telephone number provided and was promptly put on hold.
Nobody expects to have a phone answered immediately every single time. It’s not normally a problem.
Or is it?
Where I did have a problem with this particular call was being told “your call is important to us” every 15 seconds whilst listening to Bach, and I like Bach.
Whilst listening I looked at the consultant’s website.
It was very good and promoted the consultant really well. Details of his practice were impressive. The photograph of him on his website was very professional. The contact page was really good.
A “Frequently Asked Questions” page was very comprehensive. A “contact us” page contained phone number, email address, and location. They were all available for the patient to see.
Meanwhile, I was still being told “your call is important to us” and was listening to Bach.
Then I started to think about it from that point of view.
If I’d have been a patient wishing to make an appointment I might well have hung up by now and called another consultant.
The patient may have been referred to that particular consultant by his/her GP or even by an insurance company so from that point of view the patient remains on hold and waits.
But what would happen if the patient had not been referred to the consultant by a GP or an insurance company?
In other words, he had a choice.
All patients have a choice.
A private consultant surgeon is in the service industry. It may be medical but it is still a service. And that means the service must be first class. Not just first-class medical treatment.
The level of customer or patient service is a big factor in the patient’s choice.
Every single part of the patient’s journey, therefore, MUST be 1st class.
That most definitely includes having the phone answered promptly.
It’s the little steps that matter when you are running a business and a private medical practice is a business.
Charge the right fee.
Make sure you invoice quickly.
Take steps to collect all outstanding shortfalls and excess amounts.
If the practice is difficult to contact the number of patients will drop.
When I finally got through and spoke with the consultant we agreed to meet next Wednesday.
One of the items for discussion will be his patients struggling to actually speak to his practice in the first place.
If you want a quick review of your practice send me an email!
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It was the classic environment where chaos reigned supreme.
There was a serious amount of money outstanding.
Didn’t take long to work out why.
The problem was the practice principal. He insisted everything had to be done immediately. His view was that the practice was a business. It must solve all problems immediately.
Resolving every single problem immediately didn’t allow sufficient thought as to what the problem really was and thus it did not allow consideration of the cause and time to consider the options.
Instead, identification of the problem was receiving less than a minutes attention. The cause of the problem was ignored because the solution to any problem was a “knee jerk reaction”
Any and all business require a plan. Without one it is difficult to track where the business is going. Simple said the practice principal. The plan is to see as more patients.
Anything that prevents that is removed.
It never occurred to him that the administration must be complete.
It should not be subject to a stream of quick-fix solutions and absolutely not when the cause of the problem hasn’t been established either.
Once the plan and goals were actually defined, the functions of the practice needed to be split in two.
Primary and secondary.
The identification of primary productive areas and secondary non-productive areas is done by using a value chain. Devised in the mid-’80s by Prof Michael Porter it is one of the simplest management tools ever.
So, what is primary? What is secondary?
Primary: anything directly focused on your patients.
Secondary: time spent undertaking tasks that are not patient-focused.
Anything and everything that is secondary should be outsourced. Thus practice staff will be free to concentrate on their primary area: patients.
The time generated by adequate examination will allow the practice to speak to MORE patients. Increased consultations will follow.
It’s a case of concentrating on what the practice is there for. If you measure your practice against a value chain, you’ll discover the primary values are supported by secondary values.
Outsource secondary values and the practice will become more profitable.
Yet numerous private practices make the mistake of not distinguishing between primary and secondary functions.
With the result, chaos reigns supreme. The practice doesn’t work as well as it should. For example, numerous patients were complaining the practice telephone wasn’t getting answered. They didn’t realise the staff was implementing yet another quick fix solution.
And they didn’t care.
They telephoned another consultant instead.
The practice principal totally disagreed. Secondary “non-productive” areas should be ignored. Concentration on “primary productive” areas would take precedence. More patients. Always more patients.
He still insisted on solving problems immediately.
Sadly his only answer was to blame everyone else. His 150 miles an hour approach might explain why the practice had gone through 4 practice managers in just over 32 months.
The above happened just over 2 years ago. The practice principal called me last week. Sadly it appears I was right all along.
He hasn’t avoided the CHAOS FIELD.
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I left school more years ago than I care to remember. Then as now I make sure I do my homework though. The only difference is now I do it for private medical consultants some of whom are thinking about starting a private practice.
All of you have done your fair share of homework in the past.
The journey to becoming a surgeon is not exactly an easy one. Lots and lots of work, study and long, arduous hours. There is lots of homework on the way too. Followed by even more work, study and long arduous hours. There is even more homework thrown in after that. Then you are qualified.
But to start a private practice add on about five years of post qualification experience and hey presto you decide to open a private practice! That is more or less the path a surgeon (friend of a current MHM client) took.
I was asked to go chat to him about starting a private practice.
As the geographic area concerned contained a major urban conurbation, the population numbers were high. So that ticked the first box!.
There were three private hospitals within a 25-mile hospital too. The second box ticked.
When I checked the number of consultants at each hospital (Google is a mine of information) there were 22 at the first, 15 at the second and 15 at the third. The third box ticked.
I’d done my homework and established there was a demand for my surgeon’s specialism within the area.
The surgeon, when we spoke, was really pleased to hear the results and was in no doubt my homework confirmed he would be able to start a successful private practice.
It was that last item – the number of consultants already in place – that concerned me.
Could it be that the demand for his specialism was already being satisfied by the 52 consultants already providing his specialism?
My surgeon friend would have to compete with those consultants.
He would have to market himself to potential patients and see enough patients to make his private practice pay. His fees from private insurance companies would have to be sufficient to cover his costs AND make a profit.
He would have to provide all the support facilities to run his private practice which would cost money.
Then he would, of course, have to pay tax on whatever was left.
Let me be clear I was NOT saying don’t start a private practice. I was suggesting that the demand for his specialism might already be satisfied by his competitors.
He should, therefore, be fully aware of the difficulties he would face BEFORE he started his private practice.
All because I had done my homework.
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Not getting paid doesn’t happen by accident.
Something causes it to happen. There is ALWAYS A CAUSE.
If you leave invoicing until later (Friday for instance) it is very easy not to invoice at all. It can happen also if, for whatsoever reason, you leave invoicing until “tomorrow”.
Tomorrow turns into never.
Many times, I’ve been called in to examine and review the billing process of private medical practice and discovered an issue with invoicing frequency. So why is “tomorrow” “Friday” or “when I get the chance” the worst possible words for me to hear?
Nine out of ten times such an approach is a big clue as to the reason why the practice is not enjoying the level and frequency of cash it should be.
If you want to ensure your practice is paid promptly, the very first place to start is raising an invoice. It is crucial. And invoices should be raised DAILY!
Once a week is not helpful.
The danger in invoicing on a Friday or a Monday or only on any set day a week is if something happens that day – for example, the consultant needs a clinic booking urgently or a patient needs a letter immediately, then the invoicing gets left behind.
And that is normally the cause of the problems.
If invoices are raised daily should something happen to delay that ONE day’s invoicing, it is corrected the very next. There is no backlog.
Let me give you a real-life example.
Tuesday, March 5th a consultant ran an outpatient clinic and saw five patients. Three follow-ups and two initial consultations. £850 worth of consultations.
Yet invoices were not produced for this work until Monday, March 18th, – one day short of two weeks later!
Is it any wonder the consultant was extremely dissatisfied with the practice cash flow?
It didn’t take long for me to identify that on twice previous occasions over the previous few months one entire clinic list had NOT been invoiced (worth £725) and three initial consultations (worth £600) had also not been invoiced.
In the case of the initial consultations, insufficient insurance details had been obtained at the point of registration and remedy had been left until “later”!
In all £1,325 worth of invoicing had been missed.
No wonder cash flow was poor.
But before we go any further do NOT blame the medical secretary. She has enough to do. The phone rings or she has to meet and greet the patients. She has numerous letters to type.
That is precisely what she should be doing for she is there to ensure the “front of house” runs smoothly.
The error, if you will, is then expecting her to fit invoicing in around all that or, as was suggested to me, in her “spare time” WHAT SPARE TIME?
She hasn’t got any and nor should she.
In the above example, the solution was obvious. Either get someone in to process all the invoices and the cash receipts or outsource it.
Private medical practice is a business. It must be managed as a business; end of.
Without putting too fine a point on it, failure to ensure the invoicing and accounts process is not 100% efficient is pretty much guaranteed to lead to the business having cash flow issues.
DON’T LEAVE IT UNTIL FRIDAY – DO IT NOW!!
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I called one of my friends early one evening last week. His phone went straight to voice mail. Curiously he didn’t call me back within 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 leave their respective phones at home and go out to eat. Or eat then go to the cinema.
No emails, text or phones 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.
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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…
You may not need it yet.
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 too.
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 for whom it raises invoices on Excel and uses the same 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: am I paying for something I don’t actually need?
For a copy of an MHM Excel based sales/debtors ledger go to the Freebies section on this website. The invoice is there too.
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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.
Simple explanation. 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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I spent some time yesterday looking at the invoicing of a consultant surgeon.
I noticed that the invoices for initial consultations going out to one particular insurance company were being charged at exactly the same fee as for follow-up consultations i.e. £125 each.
Instead, they should be £175 for initial and £125 for a follow-up.
So… £50 multiplied by the number of errors spotted so far over the first month I’ve checked (9) = £450!
The bad news is that this has been happening for, so far as I can tell at the moment, for at least the last four months.
Potentially, £1,800 worth!
It is easy to lose money
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Most consultants when they first start a private practice, consider how best they can set their fees. In reality, it is not the consultant who sets his or her own fees. It is the patient’s insurance company.
Consideration of fee setting should be viewed from two distinct areas:
1: Consultation fees 2: Surgical Fees
Consultation fees first.
Consultation fees (for both initial and follow up) will be agreed at the point of recognition by the respective insurance companies of the medical professional e.g. consultant surgeon, anesthetist, etc.
Clearly, if you have 20 years experience and are one of the few consultants within your geographic area, then you may be able to command a higher fee.
In reality, most likely you not be in such a position. You will be offered consultation fees at a level set by the insurance company you are dealing with. In return, the insurance company will refer patients to you.
In the case of self-funders, however, there is nothing to stop you charging any consultation fee you like. Save of course if there are other consultants in your area then their fees will influence that which you charge.
Surgical fees, if anything, are the easier one to deal with.
The insurance company with whom your patient is insured will always set surgical fees. You may feel the fee is too low and therefore charge more. Almost certainly your invoice WILL be rejected. Keep sending invoices in for fees greater than that allowed by a particular insurance company and you run the risk of being de-recognised.
Whether it is right or wrong for insurance companies to hold such power over the setting of surgical fees is for another article. I have very firm views on it but at this point, the stark reality is that the insurance companies do hold such power.
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Monday morning comes round all too quickly and its time to invoice last week’s clinics.
This is a good example of not paying sufficient attention to the clinic list. It almost cost the consultant £50. The patient was marked down as a follow-up. An invoice for £100 was required for the patient’s insurance company.
According to MHM, the consultant had never seen this particular patient before. A quick phone call established that this was actually a new patient so a £150 invoice was required for an initial consultation and not for a £100 follow up.
Who was responsible for making the mistake isn’t really the driver. It is important of course but mistakes happen. Of more importance is having a process to identify and correct the error. before it costs you £50.
All you have to do is outsource the invoicing to someone who checks absolutely everything.
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Every time I give a presentation to consultants wishing to start a private practice it’s pretty much guaranteed, I’ll get asked about having a website. In particular, I’ll be asked – do I need one?
Short answer: YES!!
Ah! – Comes the response from a fellow presenter with a very well established practice – I don’t have one. I don’t need one. That may be so because he is well established. But for someone just starting out being on the private hospital’s website, just being on the PMI website or on a directory of consultants is not enough. Neither is, although still a big source of referrals, having patients referred only by a GP.
Patients are much, much more switched on these days. They will trawl the Internet looking for whom they consider being a suitable surgeon with whom to book a consultation. They may still ask their GP for an opinion. And then be concerned if the GP recommends another surgeon because the surgeon is a friend of the GP. What does the GP do if he doesn’t know a suitable surgeon? Yep – he goes to the Internet too.
The bad news is that it is not just a case of building a website. I call it the “build it and they will come” principle. Websites need to be maintained and refreshed – at least every six months. Then there is the question of social media.
MHM don’t build websites nor do we manage social media for its clients. It’s far too complicated. We just pass on the requirement to one of our partner organisations. Based on the analysis of MHM clients with a website and those without, it is pretty clear those with a website see more patients.
You sure you can’t be bothered with all this Internet stuff?? How many of you still rely on GP referrals only?
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A consultant surgeon came up to me after a recent presentation asking for my opinion on a situation he’d found himself in.
Having successfully operated within the NHS for some time he decided to open a private practice. Before he jumped in the water, he never considered such questions as “how deep the water was?”! Therefore he’d contracted to pay room rental. He had employed a medical secretary. His website was built. He may well need all of these at some point.
He had not, however, stepped back and researched, for example, how many colleagues already had a private practice in the same specialism as he did. If he had, he would have discovered there were 8 of them. Great. There is obviously a demand for that specialism BUT the flip side is that the demand is already being satisfied.
He had however asked a well-established colleague how many patients the colleague saw and how much he charged. About 12 a week with a £200 initial consultation fee and a £150 follow up fee i.e. average of £175 per patient, came the response. Circa £2,000 a week worth.
So the consultant surgeon was concerned as to why he was only seeing 2 or 3 patients a week and his consultation fees had been set at £125 initial and £100 follow up – an average of £112.50 per consultation. How come? Well, his colleague had been recognised by the private insurance companies as far back as 2012 and his private practice had built up over the years.
So there are various points he failed to consider before opening his private practice. None of which absolutely mean don’t open the practice but they do mean seriously think about issues before deciding to open such a private practice.
Or in other words, make sure you know how deep the water is before you jump in.
How many of you have found yourself in a similar situation?
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It’s great when a patient pays cash – on the way out he or she produces a roll of £10 notes and pays in full. It happened just before Christmas to an MHM client.
Couple of items to remember, however.
1. The consultation still needs to be invoiced – unless of course, you want HMRC to raise serious eyebrows (and you DON’T!!)
2. The cash has to be accounted for
It was this second point that caused a wry smile.
A sanity check picked up the consultation and an invoice to the self-funding patient was sent. With the result a most irate patient phoned MHM. So where was the cash?
Being just before Christmas, the MHM client had gone out and bought some ad-hoc Christmas presents with it. He’d clean forgotten the extra £150 in his wallet was actually practice money. It should always be treated as completely separate from his own personal money and banked into the separate practice account he has as you should have too! But he’d forgotten.
Thus the MHM client today had to take out of his own bank account and pay into the practice account £150 prior to MHM emailing a receipted invoice to the patient.
It was a very nice bottle of Merlot though – I really enjoyed it.
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The response to a recent question.
Consider if, during the initial consultation, a patient is advised surgery is required. The patient is therefore given a CCSD code equating to the surgical episode to quote to his or her insurance company. Following a conversation between the patient and their insurance company a pre-authorisation code for, as an example, AB1234 is issued to the patient and passed on to the consultant surgeon.
What happens if, during surgery, a change of surgical procedure is deemed necessary? Does it make a difference? Certainly not to the patient and not to the consultant surgeon who has performed what he or she deemed to be the absolutely correct procedure.
The point at which it does make a difference, however, is the fee the amended surgical procedure attracts. For example:
The original code of AB1234 may, for example, generate a fee of £452. But if during surgery, a different procedure was necessary a different code will be applicable. For example XX4268 instead of the original procedure code of AB1234. XX4268 generates a fee of £619.00 whereas AB1234 generates £452.
So the question: which code do you charge for? The XX2468 obviously. But…
There is a step to be taken before the invoice is raised. Best practice is to call the insurance company and explain the situation. All insurance companies are very used to such calls from MHM.
And thus MHM invoices the correct fee and you get paid the right fee.
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Lovely lady. She sounded if she was aged between 30 – 40.
Called her to clarify one small point on her registration form and pretty much knew what the discrepancy was. I was right. She was born in 1957 and not in 1857. I’m confident my client is an absolute expert in his field but even he isn’t that good!
The serious point.
What would have happened if I had tried to process an online invoice when the date of birth was wrong?
It wouldn’t have gone through that’s what.
And I can give you 158 reasons why not.
But you only need 1.
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Take these examples:
Surgeon A is an ENT consultant surgeon.
He performs an E1910 on two different patients. He bills both patient’s insurance company £1,600 each. No problem except Patient ONE’s insurance company fee structure is £1,600 for an E1910 but Patient TWO’s insurance company fee structure is £1,945 for the same E1910 episode.
Surgeon A has therefore by invoicing Patient TWO’s insurance company £1,600 i.e. the fee he gets from Patient ONE’s insurance company undercharged by £345 or 20%
Surgeon B is a gynaecologist and has the same issue.
He performs a Q0800 on two different patients who are insured by separate insurance companies. He invoices both insurance companies at £636 each. Save Patient ONE’s insurance company’s fee structure is £636 whereas Patient TWO’s insurance company’s fee structure is £800. Surgeon B, by using the fee structure for Patient ONE only, has undercharged by £164
Both carry on billing not realising that the fee depends on whom the patient is insured.
Different private medical insurance companies publish different fees for the same surgical procedure.
To illustrate we checked four different medical insurance companies this afternoon in order to confirm the fees for an E1910.
The fee was £636, £676, £775 and £800.
We then turned to Surgeon B and the medical code of Q0800 and found the fees were, dependant on which of the four medical insurance companies we checked, £636, £676, £775 and £800 respectively.
Is there a lesson in all this?
There certainly is. Don’t set fees at the level published by a single insurance company.
Check which fee is paid by which insurance company for the same procedure i.e. don’t assume they are the same. They may not be.
A published medical fee for the consultant surgeon can and does alter not only between private medical insurance companies but can also alter over time.
In every single case, it’s always worth checking the fee structure paid by the patient’s insurance company and not assuming it is the same across all private medical insurance companies.
Invoice for two different codes in the same surgical episode incorrectly and it is easy to get into even more trouble. For example Insurance Company X may allow 100% of the higher value code and 50% of the second but Insurance company Y may allow 100% of the first but only 33% of the second. Imagine what happens if all episodes are billed at 100% and 33%. Immediately you’ve lost 17% of your second fee!
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A question, which was asked recently at a private practice seminar MHM were presenting at.
Interestingly the question was asked by a consultant surgeon who had started his/her private practice two years earlier. He was of the opinion that such excess was the responsibility of the patient’s insurance company who would collect excess or shortfall amounts from the patient on his behalf.
Sadly this is absolutely NOT the case at all.
The responsibility for the collection of such items rests very squarely on the consultant himself.
Consider excess and the cause of excess?
When the patient obtains private medical insurance there will be an amount – or excess – agreed on the policy.
The exact amount of the excess will depend on how much the patient pays for his/her policy. Generally speaking the higher the premium, the lower the excess.
It’s just like car insurance, if you agree a £500 excess, the premium will be lower than if you only agree £100. That’s fine – until you come to make a claim on your insurance. Private medical insurance carries the same principles.
So, when the patient comes to see you and you claim the cost of your services off their insurance company there could well be excess for which the patient is liable. The consultant is responsible for the collection. Not the patient’s insurance company.
The consultant who asked the question called a few days later because to this horror, he had in excess of £5,000 worth of uncollected excess in the previous two years unpaid and due to him which nobody was collecting.
The supplementary issue, however, is why were the excess amounts allowed to build up over two years without anybody noticing?
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The patient arrives for the consultation but hasn’t obtained a pre-authorisation from his/her insurance company.
Yes, of course, you should; patient care must come first.
But the patient does not have a pre-authorisation! It does happen, it shouldn’t but in the real world, it does.
How should this be handled then? Ask patient to ring his/her insurance company and obtain the pre-authorisation a soon as they possibly can.
If say the consultation was on October 28th and the patient calls the insurance company on October 30th, the patient should make sure the insurance company know when the consultation took place.
In this example, the patient did not tell the insurance company it was two days earlier. When MHM tried to invoice, it was declined as the consultation was before the date upon which 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 even more difficulties.
This is not the insurance companies being unreasonable.
The patient has incurred a liability on behalf of the insurance company, which the insurance company knows nothing about.
Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient.
The patient rings up (normally quite upset) and points out they are insured and are covered for consultations in their view.
Numerous phone calls between the patient, the insurance company later, the issue is finally resolved.
The invoice is submitted to the insurance company and its paid in full.
It would have been paid a lot quicker and without the hassle IF the patient had been asked by the consultant to advise their insurance company the consultation was for a specific date.
If this is happening to you, it’s an issue you can address and prevent otherwise you may spend 15 – 30 mins just sorting this out!!
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