Recently my stepdaughter received confirmation from her GP additional tests were required for an issue that had arisen.
Both she and her Mum were somewhat disturbed that the waiting time for the test would be over 2 months. As my stepdaughter had private medical cover through her employer, she duly contacted her insurance company and was authorised to see a private consultant. Off she went. No issues and a precautionary follow up arranged for a couple of months later. The benefits of having private medical cover were apparent – much shorter waiting time.
Mindful of the world I’m in, I asked if she was sure she was covered for everything. Yes, she replied; she hadn’t checked because her employer provided the policy, therefore, she was fully covered. So I waited for the “oops – no I’m not” moment.
Sure enough, shortly after, a letter arrived stating that whilst the test was covered by her insurance the consultation(s) themselves were not. How could this be? She had contacted her insurance company and been authorised. Her insurance company made the classic reference to the small print when the point was pursued further. By no means am I suggesting all PMI companies fail to point such things out but empirical evidence indicates sometimes they don’t?
So why had the fact consultations were NOT covered been left unexplained to her?
The other classic reference of it being her responsibility to check the exact offering of the policy was made. That just doesn’t cut it for me. The PMI should have been completely transparent and explained what was or was not covered. This is something my guys (more specifically their med-secs) are asked to bring to the patient’s attention when the initial consultation is arranged. Again and again I both see and hear patients stating they were unaware that certain items are not covered by insurance.
They have private medical insurance and that’s the end of it as far as they are concerned.
It’s why MHM clients are advised to enquire if their patient has confirmed precisely what is or is not covered by their private medical insurance.
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Just taking ONE client as an example.
Out of 15 consultations, 4 (four) came back with excess/shortfall deductions totaling £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 2017, the number of shortfalls/excess were 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 are 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 shortfall/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 shortfall/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 still.
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 2014. 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 shortfalls etc and their views on remedies.
pete@medicalhealthcaremanagement.co.uk
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Just taking ONE client as an example.
Week ending Friday, February 14th: out of 15 consultations, 4 (four) came back with excess/shortfall deductions totaling £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 2013, the number of shortfalls/excess were 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 are 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 shortfall/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 shortfall/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 still.
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 2014. 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 shortfalls etc and their views on remedies.
pete@medicalhealthcaremanagement.co.uk
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I’m often asked who is actually responsible for paying an excess or a shortfall.
Interestingly the question was asked recently 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. They would be collecting excess or shortfall amounts from the patient on his behalf.
The responsibility for 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.
So, when the patient claims the cost of your services from their insurance company there could well be excess for which the patient is liable. You, however, are responsible for collection.
The patient’s insurance company is not responsible.
The consultant who asked the question called a few days later.
To his horror, he had over £5,000 worth of uncollected excess in the previous two years unpaid which nobody was collecting.
The real question however is:
pete@medicalhealthcaremanagement.co.uk
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It is not a “nice to have” anymore. It is a necessity.
A Private Consultant Surgeon must have the facility to take payments by card and/or over the telephone.
Consider the following real MHM clients. Surgeon A is a very forward thinking. Surgeon B can’t even update his iPhone [keeps forgetting his password]. Both performed a similar number of surgical episodes and outpatient consultations in November 2017. Every single one was invoiced.
Today is December 11th.
Client A – shortfalls/excess against his November work totaled about £1,600. Today he has £42 worth of excess and shortfalls still outstanding.
Client B – shortfalls/excess against his November work totaled about £1, 510. Today he has £967 worth of excess and shortfalls outstanding.
Both had their shortfalls/excess invoiced to their respective patients in precisely the same way. Client A saw a 98% success rate in the collection of shortfalls/excess. Client B only saw a 35% success rate.
WHY?
Surgeon A – I take online payments.
Surgeon B – I do NOT take online payments.
You should see his website! You can see his availability by clicking on his online diary. You can’t book a consultation but you can see where and when his clinics are for the next two months.
He has a website too (took me 8 months to convince him to get one). He does NOT like online payments. He doesn’t trust them. I’m not allowed to use the MHM on-line payment facility.
For Surgeon B I’m going have to chase down his patients more than Surgeon A. Doesn’t bother me. I’ll collect Surgeon B’s excess and shortfalls eventually. I get paid the same amount for both clients. It costs both of them the same. I just have to put more effort in for Surgeon B to get my fee – big deal (not). So I’ll have to make numerous reminder phone calls for Surgeon B. For client A I’ll have to make a phone call or two.
But if I were Surgeon B I’d be irritated if I were still owed £967 for my March work.
I spoke with him yesterday and came out with my “dinosaur thinking” comment (again). I described what was happening with Surgeon A. Per normal he laughed. He pointed out that whilst he was not planning on becoming extinct just yet, he still didn’t like the idea of online payments.
If you want to use MHM to reduce the number of excess and shortfalls you have outstanding, email me at the address below:
pete@medicalhealthcaremanagement.co.uk
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They are not just for tax reasons. They are not just to keep the accountant happy. There is time critical reason too.
A remittance advice confirms the values that have been paid in respect of invoices submitted by the medical practitioner. It is a mistake to assume that the invoice will always be paid completely. It may not be.
For example and taking one remittance received by an MHM client.
Of the ten invoices paid on the remittance, four of them detailed deductions made. Deductions were made against the value of the invoice originally submitted. 40% in other words.
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 the appropriate entry on the consultant surgeons debtors ledger. Only then was the payment made recorded appropriately. It was then the number of deductions was immediately 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 and had not been renewed. 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 precise date of the surgery, the policy as “live” and 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 were in error and the invoice immediately cleared for payment. Insurance companies do make mistakes. Not many thankfully but they do happen.
If the deduction is correct, however, then immediate action should be taken to contact the patient and a request made for payment – by the patient – be 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.
pete@medicalhealthcaremanagement.co.uk
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They are not just for tax reasons. They are not just to keep the accountant happy. There is a time critical reason too.
A remittance advice confirms the values that have been paid in respect of invoices submitted. It is a mistake to assume that the invoice will always 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 detailed deductions. Deductions were made against the value of the invoice originally submitted.
This is why remittances should be checked.
In the above example, each invoice detailed on the remittance was reconciled against the appropriate entry on the consultant surgeons debtors ledger. Only then was the payment made recorded appropriately. It was then the number of deductions were immediately 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 and had not been renewed.
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 precise date of the surgery, the policy was “live” and consequently the insurance company were wrong to decline the invoice for payment.
A call to the insurance company concerned quickly identified and confirmed the insurance company were wrong and the invoice 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 – be made.
So the number and reasons why deductions have been made can easily be identified and subsequently actioned on behalf of the consultant surgeon.
pete@medicalhealthcaremanagement.co.uk
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Take, for example, a patient who requires an injection which may be performed at a consultation.
Thus you raise an invoice for, as an example, £185 [£90 for the consultation and £95 for the injection]
Upon receipt of the invoice by the patient’s insurance company, the value is rejected. You CAN’T charge both for a consultation and an injection on the same invoice on the same day.
You can charge for one or the other but not both.
So you are paid £90 for the injection only.
What is interesting is that the immediate reaction from some consultants could well be to charge just for the injection.
That said, its already been suggested that the alternative and better way would be to have the patient attend an outpatient consultation on, for example, March 10th and then attend for the injection on March 25th.
See the patient twice in other words.
In such case the consultant CAN charge for both.
Not sure that’s in the patient’s best interests though but if the aim is to max revenue it is certainly in the best interests of the consultant.
Right up to the point the insurance company finds out.
Where it gets really tricky, is that some insurance companies WILL let you charge for a consultation and an injection at the same time.
Others will let you charge for some injections at consultation but not all injections.
Some, as mentioned, will not allow a charge for consultation and injection regardless if they happen at the same event.
And don’t forget not only do different insurance providers pay different rates for consultations.
They also pay different rates for the injection too.
Unless you check each consultation and injection episode with the insurance company concerned, you will be!
More likely you will actually undercharge at some point in time.
For example: if the insurance company DOES allow a fee for consultation and injection if you charge only for one sooner or later?
You’ll be out of pocket.
pete@medicalhealthcaremanagement.co.uk
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A question, which was asked recently at a private practice seminar MHM were presenting at.
The patient is responsible.
Interestingly the question was asked by a consultant surgeon who had started his/her private practice two years earlier and who was of the opinion that such excess were 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 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 but for which you are responsible for collection. Not the patient’s insurance company.
The consultant who asked the question called a few days later because to this horror, he had over £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?
pete@medicalhealthcaremanagement.co.uk
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I always check what is happening with shortfalls and excess for they are a major area of risk to a private medical consultant. Using a single private consultant surgeon as an example:
Taking a single consultant and looking at her work for a single week – out of 15 consultations 4 came back with excess / shortfall deductions totalling £575. So for a total of £2,500 worth of outpatient consultations £575 or 23% came back short. Looking back to the same week in 2016, the number of shortfalls / excess were considerably less.
The question as to why this is happening is not the immediate concern although I will blog about that next week if anyone wants me to?
The concern is what you should do about it.
If 23% of submitted invoice values continue to come back as shortfall or excess, the downside and potential loss to a consultant surgeon is significant.
What to do about it?
The very first thing to do is to make sure the patient has been invoiced for the amount due immediately. If payment is not received within a week then there is only one subsequent single course of action.
Phone the patient.
I do. Once I have the patient on the phone I take payment via a debit or credit card.
Sure you can write letters and even email but nothing gets a response like a ringing telephone. Most patients are unaware of the issue (yes I know when they open their policy they are made aware of excess values) 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 because 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. The point is to ensure he recovers the shortfall / excess efficiently.
That means speaking to the patient.
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 care. This is not a debtor I’m talking to on the telephone. It is a PATIENT!
The long suffering med-sec really won’t have the time to do this as professional and caring as she undoubtedly is. The majority of medical secretaries won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
What if the consultant doesn’t employ someone to tackle this? What if they don’t do anything?
Assume it’s not £575 or 23% a week or £27,600 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) and allows for some patients paying without being contacted.
Thats still £13,800 per annum.
What’s significant is that when speaking to a group of private consultant surgeons I asked what they considered the biggest threat to their practice(s). Most popular is the anticipated further reduction in fees paid by private medical insurance companies. There is little if anything that can be done about that.
The second concern, however, is the number of shortfalls and excess.
It’s becoming a big challenge. A challenge that will get bigger in my view.
At this point, empirical evidence suggests its potentially leaving the back door wide open 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 shortfalls etc.
pete@medicalhealthcaremanagement.co.uk
by Read more →
A few weeks ago, I was checking what was happening with shortfalls and excess since the start of the year. Using a single private consultant surgeon as an example:
Week ending Friday January 22nd: out of 15 consultations 4 came back with excess / shortfall deductions. The total £575.
So for a total of £2,500 worth of outpatient consultations £575 or 23% came back short.
Looking back to the same week in 2015, the number of shortfalls/excess was considerably less.
The question as to why this is happening is not the immediate concern although I will blog about that next week if anyone wants me to?
The concern is what you should do about it.
If 23% of submitted invoice values continue to come back as shortfall or excess, the downside and potential loss to a consultant surgeon is significant.
What to do about it?
The very first thing to do is to make sure the patient has been invoiced for the amount due immediately. If payment is not received within a week then there is only one subsequent single course of action.
Phone the patient.
Once I have the patient on the phone I take payment via a debit or credit card.
Sure you can write letters and even email but nothing gets a response like a ringing telephone.
Most patients are unaware of the issue (yes I know when they open their policy they are made aware of excess values) 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 because 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. The point is to ensure he recovers the shortfall/excess efficiently.
That means speaking to the patient.
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 care.
This is not a debtor I’m talking to on the telephone.
It is a PATIENT!
The long-suffering med-sec really won’t have the time to do this as professional and caring as she undoubtedly is.
The majority of medical secretaries won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
What if the consultant doesn’t employ someone to tackle this? What if they don’t do anything?
Assume it’s not £575 or 23% a week or £27,600 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) and allows for some patients paying without being contacted.
That’s still £13,800 per annum.
What’s significant is that when speaking to a group of private consultant surgeons I asked what they considered the biggest threat to their practice(s). Most popular is the anticipated further reduction in fees paid by private medical insurance companies. There is little if anything that can be done about that.
The second concern, however, is the number of shortfalls and excess. It’s becoming a big challenge. A challenge that will get bigger in my view.
At this point, empirical evidence suggests its potentially leaving the back door wide open 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 shortfalls etc.
pete@medicalhealthcaremanagement.co.uk
by Read more →
It is not a “nice to have” anymore. It is a necessity.
Consider the following real MHM clients. Client A is a very forward thinking. Client B can’t even update his Iphone [keeps forgetting his password]. Both performed a similar number of surgical episodes and outpatient consultations in January 2016. Every single one was invoiced.
Today is February 17 th.
Client A – shortfalls / excess against his January work totalled about £1,600. Today he has £42 worth of excess and shortfalls still outstanding.
Client B – shortfalls / excess against his January work totalled about £1, 510. Today he has £967 worth of excess and shortfalls outstanding.
Both had their shortfalls / excess invoiced to their respective patients in precisely the same way. Client A saw a 98% success rate in collection of shortfalls / excess. Client B only saw a 35% success rate.
WHY?
Client A – I take on-line payments.
Client B – I do NOT take on-line payments.
You should see his website! You can see his availability by clicking on his on-line diary. You can’t book a consultation but you can see where and when his clinics are for the next two months.
He has a website too (took me 8 months to convince him to get one). He does NOT like on-line payments. He doesn’t trust them. I’m not allowed to use the MHM on-line payment facility.
With Client B I’m going have to chase down his patients more than Client A. Doesn’t bother me. I’ll collect Client B’s excess and shortfalls eventually. I get paid the same amount for both clients. It costs both of them the same percentage fee. I just have to put more effort in for Client B to get my fee – big deal (not). So I’ll have to make numerous reminder phone calls for client B. For client A I’ll have to make a phone call (maybe two – who knows?)
But if I were Client B I’d be irritated beyond belief that I was still owed £967 for my January work.
I spoke with Client B yesterday and came out with my “dinosaur thinking” comment (again). I described what was happening with Client A. Per normal he laughed. He pointed out that whilst he was not planning on becoming extinct just yet, he still didn’t like the idea of on-line payments.
I give up.
If you want to use MHM to reduce the number of excess and shortfalls you have outstanding, email me at the address below:
pete@medicalhealthcaremanagement.co.uk
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Ever thought what is the most often quoted reason for non-payment by a patient of their excess?
The same reason is quoted over and over again. It’s not “I haven’t got the money” nor is it “I didn’t realise it was so much, Not even “The invoice must have got lost in the post”.
“I’ve paid it because when I registered at the Private Hospital, they took a swipe of my debit (or credit] card and the fees are taken from that”
That is often quoted to me. Twice last evening in fact.
Why is it always being quoted and should you be suspicious when it’s said to you?
In answer to the first question, it’s because the patient assumes the bill for your professional services will be “sorted” by the hospital.
They genuinely don’t realise that the transaction is between them and you as the Consultant.
Clearly, the above statement may not be applicable if the patient has purchased a “package” with the Private Hospital.
In answer to the second part, you should not be suspicious.
This is not to suggest the fault lies with the reception staff at the private hospital in any way.
Recently I went with my own partner to a private hospital. As she registered, it was very clearly explained that her debit card covered only the hospital fees if there were any.
There was even a sign up to that effect on the wall in front of us.
So my partner, as with all private patients, should realise what is covered by the swipe of their debit or credit card.
Yet a few weeks’ later when the invoice arrived from the consultant, my partner said to me something was wrong, as the Hospital had taken a swipe of her card when she attended the consultation.
I explained most likely WHY she had received an invoice from the consultant.
She, nonetheless, insisted that was wrong because her debit card had been swiped by the hospital.
This despite it being explained when she registered what her debit card would and would not cover.
Quite rightly, she called the consultant’s secretary (not an MHM client by the way!) who explained the situation and payment was made by debit card immediately.
It does demonstrate, however, the most often quoted reason why payment for an excess invoice has not been made.
“Can’t be right – the hospital took a swipe of my debit card when I registered”
pete@medicalhealthcaremanagement.co.uk
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Per normal I was checking what was happening with shortfalls and excess over the weekend. Using a single private consultant surgeon as an example:
Week ending Friday January 22nd: out of 15 consultations 4 came back with excess / shortfall deductions totalling £575. So for a total of £2,500 worth of outpatient consultations £575 or 23% came back short. Looking back to the same week last year, the number of shortfalls / excess were considerably less.
The question as to why this is happening is not the concern. The concern is what are we going to do about it for if 23% continues the downside and potential loss to the consultant is significant. What to do about it? The very first thing to do is to make sure the patient has been invoiced for the amount due immediately. If payment is not received within a week then there is only one subsequent single course of action.
Phone the patient. I do. Once I have the patient on the phone I take payment via a debit or credit card.
Sure you can write letters and even email but nothing gets a response like a ringing telephone. Most patients are unaware of the issue (yes I know when they open their policy they are made aware of excess values) 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 because 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 shortfall / excess efficiently.That means speaking to the patient.
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. The majority of medical secretaries won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
What if the consultant doesn’t employ someone to tackle this? What if they don’t do anything?
Assume it’s not £575 or 23% a week or £27,600 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) and allows for some patients paying without being contacted.
Thats still £13,800 per annum.
What’s significant is that when speaking to a group of private consultant surgeons I asked what they considered the biggest threat to their practice(s). Most popular is the anticipated further reduction in fees paid by private medical insurance companies. There is little if anything that can be done about that.
The second concern, however, is the number of shortfalls and excess. It’s becoming a big challenge and so it should be.
At this point, empirical evidence suggests its potentially leaving the back door wide open 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 shortfalls etc and their views on remedies.
pete@medicalhealthcaremanagement.co.uk
by Read more →
If you get the basics right many problems with getting paid aren’t allowed to happen. The basics mean the absolute minimum and mandatory requirements in order to present an account for your services. The basics are as follows:
Patient’s full name
Patient’s full address
Patient’s post code
Patient’s date of birth
Policy number of the insurance company concerned
Pre-authorisation number issued by the insurance company
Correct CCSD code
But it doesn’t stop there.
Your invoice should always have on it:
Your name and address
Your provider number
A unique invoice number
The date of the invoice
The date of the treatment / consultation
The right CCSD code
A value!
14 points. But if you don’t get all 14 on your invoices you make it harder for the insurance company to pay you!
If anybody wants a blank invoice that does satisfy ALL the above, go to the freebies tab on this website! If you are billing electronically – and you should be – you’ll still need the vast majority of the 14 points.
But the proof of the pudding is very much in the eating. Have a guess at what are the TWO major reasons an insurnace company does NOT pay your invoice?
1. you haven’t sent one (crazy but true)
2. you haven’t included the right information.
pete@medicalhealthcaremanagement.co.uk
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One of the major areas MHM is approached about is excess and shortfalls.
As at May 2015, 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 only 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 made.
So what can the private consultant surgeon do about it?
The number one rule in tacking the thorny issue of excess deductions is to identify when they happen. This is actually very easy. The remittance from the insurance company WILL confirm when an excess or shortfall deduction 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:
pete@medicalhealthcaremanagement.co.uk
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A well established ENT surgeon called MHM recently most upset her fees had not been paid in full and an excess deduction made even though pre-authorisation had been obtained.
The patient had contacted their insurance provider, cited the correct treatment codes and having confirmed everything is in order they were given a pre-authorisation number to cover costs of the treatment. This code was passed on to the consultant’s secretary prior to treatment. Not a problem.
Except the pre-authorisation number did NOT confirm all costs will be covered.
Pre-authorisation only confirms there is a policy in place and the consultant may submit her charges to the insurance company concerned. The consultant may even have an agreed fee structure with the insurance company or may be charging precisely in line with the fees set out by the insurance company. That has nothing to do with the excess on the policy.
This is not to say the patient is unaware. For sure when they contact their health insurance provider they hear clearly what is or is not covered. And further still if YOU call an insurance company are on hold to an insurance company some even play the message when on hold “pre-authorisation does not guarantee payment; it only confirms there is a policy in place subject to the terms and conditions of that policy” In other words, subject to the excess level you have agreed to.
Come excess time (see previous MHM article) the patient more often than not tries to fall back on “pre-authorisation” as a reason why they should not have to pay the consultant. It gets even more complicated when the policy is held by the patient’s employer and not by the patient themselves. Although in fairness in such cases most employer’s do reimburse the employee.
Explain it to the patients this way. If you take out car insurance whether you are fully comp or third party the chances are you will agree an excess of £100, £200 etc In other words, you are liable for the first £100 or £200 of the repair costs.
Its precisely the same with private medical insurance.
The bottom line though is whether your patient has pre-authorisation or not you may, as exampled by this particular ENT surgeon, still find yourself out of pocket IF there is an excess. Pre-authorisation will NOT stop such incidents.
It’s not designed to for pre-authorisation does not authorise anything; it only confirms there is a policy in place.
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Consider when the patient has contacted his/her insurance company and been issued with a pre-authorisation number.
This does not mean, the insurance company will accept your charge.
This happened to an MHM client – a gynaecologist – a few days ago. We spoke to the insurance company concerned who advised whilst they did indeed issue a pre-auth, this did not mean they would accept the charge. In this example, pre-authorisation had been refused. Yet again the message came through loud and clear:
Pre-authorisation is not a guarantee of payment.
No argument from me on that one. It has always been so. My issue though is why did the insurance company issue a “DECLINED” pre-authorisation? If they were not prepared to issue a pre-authorisation then they should not have issued one at all. There is NO WAY I’d be able to tell if the pre-authorisation was acceptable or not.
This point was duly made to the insurance company who were not able to consider the comment. They had always done it that way. I have the utmost respect for private medical insurance companies most of whom are extremely efficient and willing to help. Whilst I’ve had numerous disagreements with all of them regarding fees or associated issues, never have they implied or stood behind the “we’ve always done it that way” position.
But on this occasion, it feels very much like a case of stop wasting your breath!
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Recently my stepdaughter received confirmation from her GP additional tests were required for an issue that had arisen.
Both she and her Mum were somewhat disturbed that the waiting time for the test would be over 2 months. As my stepdaughter had private medical cover through her employer, she duly contacted her insurance company and was authorised to see a private consultant. Off she went. No issues and a precautionary follow up arranged for a couple of months later. The benefits of having private medical cover were apparent – much shorter waiting time.
Mindful of the world I’m in, I asked if she was sure she was covered for everything. Yes, she replied; she hadn’t checked because her employer provided the policy, therefore, she was fully covered. So I waited for the “oops – no I’m not” moment.
Sure enough, shortly after, a letter arrived stating that whilst the test was covered by her insurance the consultation(s) themselves were not. How could this be? She had contacted her insurance company and been authorised. Her insurance company made the classic reference to the small print when the point was pursued further. By no means am I suggesting all PMI companies fail to point such things out but empirical evidence indicates sometimes they don’t?
So why had the fact consultations were NOT covered been left unexplained to her?
The other classic reference of it being her responsibility to check the exact offering of the policy was made. That just doesn’t cut it for me. The PMI should have been completely transparent and explained what was or was not covered. This is something my guys (more specifically their med-secs) are asked to bring to the patient’s attention when the initial consultation is arranged. Again and again I both see and hear patients stating they were unaware that certain items are not covered by insurance.
They have private medical insurance and that’s the end of it as far as they are concerned.
It’s why MHM clients are advised to enquire if their patient has confirmed precisely what is or is not covered by their private medical insurance.
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I took a phone call from a friend recently who works for one of the major insurance providers. He asked why I was still against the principal of open referral. The benefits for both patients and consultants were obvious in his view.
Without being obtuse, I disagree. Firstly because the question of benefits is being looked at from the wrong angle. Secondly, because it depends on who is “selling” such benefits?
His reply was the standard – the benefits are applicable to patients and are twofold. Firstly, he /she has a choice of private consultant. Secondly, it’s cheaper and this is reflected in the policy premium.
Maybe. But in my experience, I’ve seen and heard slightly different. I’ve spoken to patients who made an appointment with THEIR consultant of choice only to be told by the insurance company they should see another consultant instead i.e. one NOT of their choice. And I’ve not heard of anyone having his or her policy premium reduced because they saw a different consultant.
I’m uncomfortable with a patient calling an insurance company and being recommended to change consultant based on the insurance company’s experience. I’m even more uncomfortable if cost enters into the equation.
E-mail me if you have a different view.
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