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, January 7th 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, January 20th, – 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 – GET ON WITH IT!!
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Two different MHM clients – both consultant surgeons – have been advised by a specific insurance company that the fees for their initial and follow up consultations are being reduced.
They are not amused, to say the least.
But what can they do about it? Nothing.
Actually, that’s not strictly true. In a perfect world, there is much they can do. But we don’t live in a perfect world. We live in this one.
In a perfect world they can, for example, pass any reduction in fees on to their patients.
Save of course their recognition agreement with the insurance company forbids them to do so. If they do they are at risk of de-recognition. Ah came the reply, the insurance company won’t find out. Yes, they will.
Or they can stop seeing patients referred to them by that specific insurance company.
In both cases during the last half of 2019 that is over £10,000 worth of referrals.
Both would suffer double percentage digit drops in private practice turnover. That is not good.
Both of these consultants, however, are by no means stupid.
Neither of them just reacts.
An immediate reaction is potentially the worst thing to do. Indeed many years ago MHM worked with one consultant who did just that when denied a fee by an insurance company. He even went so far as to tell the insurance company concerned unless they immediately put his consultation fees back up he would forgo his recognition with them and refuse to see their insured patients.
They didn’t so he did.
And immediately saw a 23% drop in the private practice turnover. Do NOT react.
What is required is a considered response to all the options.
In the case of the MHM clients, I calculated what the drop-in consultation fees would mean over a six month period against an assumption that the lack of referrals would lead to 25%, 50% or a 100% drop in patients from that specific insurance company.
In all cases, for obvious reasons, there was a loss. But at least that loss was now quantified.
It is worth noting that the drop in consultation fees would not impact in a drop of surgical fees because surgical fees were excluded from the reduction.
That said a refusal to see patients from the specific insurance company concerned due to consultation fee reduction would automatically lead to a 100% drop in surgical fees as clearly if a consultant does not see a patient, it is extremely unlikely he’ll take that patient into theatre.
Sadly there are only two options in reality: accept the reduction or don’t accept the reduction.
I’m afraid the insurance company really is in the driving seat when it comes to setting their fees and there is little a private consultant surgeon can do about it.
Many years ago a private consultant surgeon could charge what they liked and to a certain extent with a self-funding patient, they still can. However, with insured patients, those days are long gone.
Rightly or wrongly, those days are over.
So what should the private consultant surgeon do?
MHM suggests an analysis of how the reduction will impact on the private practice should be undertaken.
That will at least quantify how the reduction will impact on the private consultant surgeon in actual financial terms. All the data will be contained on a sales ledger and with the aid of an excel spreadsheet, it’s relatively easy to perform the analysis.
Such an analysis also confirms how the reduction will impact on MHM for MHM charges a percentage of what is actually paid to the consultant. If that figure is lower then the MHM fee will also be lower. In other words, the pain is shared.
Thus I don’t like it any more than the private consultant surgeon but I can’t do a lot about it either.
The bottom line remains to accept the fee reduction or reject the fee reduction.
That I’m afraid is the reality.
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Every single consultant I’ve ever met is dedicated to patient care and the best possible outcome for his or her patient.
But sadly that has little to do with the outcome of the practice as a business.
They may think it does.
But it doesn’t.
Patients reviews are ALWAYS good and they reflect clinical outcome.
Potential patients do actually read them and take the decision to see a consultant based, in some part, on good patient reviews.
But other than that, there are numerous other items impacting the business outcome.
Planning has a HUGE impact on the outcome.
Specifically, if you don’t have a plan you won’t be able to know if you have achieved the desired outcome anyway.
But what needs to go into the plan?
Sounds crazy but the aim of the plan should be to achieve the outcome, yet you can’t reach the outcome until:
a) you define what the outcome should be
b) you define the plan to achieve the outcome.
Just talking about it won’t be enough. It never is.
Unfortunately, far too many consultants start a private practice without deciding what their desired outcome is. Instead, they make reference to “making more money” or “seeing more patients”
But the smarter ones start by saying I want to make, for example, £5,000 a month (outcome) so I need to see at least 20 patients during that month.
It matters little if it’s £5,000 or £25,000.
What matters is they have a defined outcome with a plan to get there.
Then they start giving immediate thought and planning on how to see 20 patients a month.
None of which has anything to with clinical outcome!
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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 with him about starting a private practice.
So I did my homework.
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.
He was in no doubt my homework confirmed he would be able to start a successful private practice.
He looked at me quizzically when I expressed my doubts
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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Recently, I was talking to one of my clients.
She was unhappy with the fees she was getting from insurance companies.
Sadly she was also unhappy about how often she got paid too.
Therefore she wanted me to contact all insurance companies and do something about it.
Unfortunately, not only had she agreed on her fees, she had agreed on the payment terms too.
When she applied for recognition with the various insurance companies towards the end of 2018, she thought to give it a year and she would be able to increase her fees.
Sadly, this was never going to happen.
Certainly, she could ask the question but it was doubtful she would get an increase.
And that’s precisely what happened.
There is not a lot she can do about it.
Nor can I.
So instead she wanted the payment terms amended.
Two of the insurance companies paid her within a few days.
Others paid her once a week.
The remaining insurance companies paid her monthly.
She wanted ALL insurance companies to pay her within a few days.
This is never going to happen either.
The reality is, just as it is with fees, the insurance companies are in the driving seat.
They are not going to amend their payment terms.
Even more so when the consultant agreed to the terms originally.
I’m all for arguing with insurance companies.
But I won’t pick an argument that I know every well I won’t win. There is no point.
If you agree to your fees and your payment terms, you pretty much are stuck with them.
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The other day I wrote of the importance of setting targets and then measuring performance.
Several consultants emailed asking what is, in my opinion, the most useful and important measure.
In all cases, the answer was the same.
THE most important measure is???
It doesn’t matter what specialism you are in, without new patients your practice will fail.
Therefore, you need to know:
2. Where are these patients being referred from?
It isn’t sufficient to know the total number of new patients last month.
You also need to know WHERE these patients came from.
But knowing, for example, 70% or 80% or whatsoever percent of new patients are referred from insurance companies.
You also need to understand which insurance companies are making referrals to you.
More importantly which are NOT.
If for argument’s sake, you are seeing 20 new patients a month via insurance companies, it is crucial to know which insurance companies?
More importantly, which insurance companies are not referring ANY new patients?
Then you can ask the question why not?
The self-funding market may well be the one which grew the most in 2019 and is forecast to be the highest grower in 2020 but that does not mean the insurance market should be ignored.
In fact, a second important measure is how many new self-funding patients and how many new insured patients.
Without both, the practice will struggle.
So the first most important measure in any practice is:
The second most important measure is:
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A couple of examples recently where consultants who have tried to base their fees on the best rate available.
Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400.
He decrees he will charge PMI Company 1 the PMI Company 2 rate.
Right up to the point PMI company 1 receives the invoice for the higher amount.
They will decline to pay that fee.
Most likely they will shortfall it.
But, replies the Consultant, no problem.
The patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t.
Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable.
Carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling.
Continue doing it over a number of months and for sure eyebrows will be raised.
Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain the same by “inappropriate billing” is not the smartest way to go about it.
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So we are almost 3 weeks into 2020 and hopefully, this year will be an improvement on last.
Which brings me neatly to the idea of goal setting for 2020.
Some private consultants did not reach the goals they intended to last year.
Why is that?
There are numerous reasons. The main one, however, lies in the definition of the target itself.
For example, I want to see more patients.
Alternatively, I want to make a lot more money.
The problem with such targets is they are not really targeted at all.
They are nothing but wishes.
Much better goals would be: I want to see 25% more patients.
Or I want to make 50% more in 2020 than I did in 2019.
It matters little what the target is.
What is important is that it’s a clear and precise target.
This is much better for a number of reasons.
The first reason is that they are measurable.
This means it is possible to compare the 2020 performance against that of the previous year.
Is it better or worse?
In either case, the answer alone will enable the private consultant to take action.
If it is better, ask yourself why?
If worse, also ask yourself why?
The very fact you have the data available means you are in a better position to move the business forward.
Further, you will be making decisions on how to progress based on information rather than “feeling”
The reality is, is that it is extremely dangerous to run a business based on guesswork.
Any consultant needs data upon which to base his/her business decisions.
It is alarming, however, how many do NOT have the basic information.
In the majority of cases, the data is actually right under your nose.
It should be anyway.
All MHM clients have a weekly report available to them.
It details how many patients the consultant saw that week, that month and even that year.
How many patients attended a new consultation?
This number of new patients is crucial.
If a practice is not attracting new patients, eventually it will lose money. Sounds obvious?
But do you know how many new patients you saw in December 2019?
How many new patients did you see in December 2018?
Did you see more patients in December 2019 than you did in December 2018?
In the answer is yes, then that’s positive.
But if the answer is no, then that could indicate a problem.
Either way, the supplementary question, in either case, is: WHY??
Once you have the data and once you have decided if you are moving towards your target or away from your target, then the next step is easy.
Take an action that you think will move you toward your goal.
Or take an action that will replicate any improvement you have made.
Of equal use is realising what you are doing is not working.
If by the end of March 2020 you are, despite your best efforts, seeing fewer patients than targeted, you have identified that fact very early.
Early enough to think about an alternative strategy.
Set specific goals to be achieved by specific points in the year.
Monitor your actual performance against such targets those pre-defined points (s) in time.
Make sure you are either exceeding or meeting your goal.
Now you have a better perspective on what is really happening in your practice and also what it should be accomplishing for you.
And all because you have set goals and not just made wishes.
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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them.
Before asking the question of why and how does a patient choose you as a consultant an earlier question is necessary.
Why have the patients taken out private medical insurance?
There are three major reasons.
Empirical research for MHM clients indicates whilst most private healthcare originates via a patient’s employer, the number one reason for holding private healthcare cover is to avoid and cut short NHS waiting lists.
This is the main reason patients have private medical insurance cover.
But whilst private health cover gives prompt access to treatment, the second reason for having private healthcare insurance is that it offers the additional benefit of when and where the patient may be treated. Aligned to this is the ability to recover, if surgery is necessary, in a private suite, which is more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you as a consultant, it is equally useful to consider why the patient has private medical insurance in the first place.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
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It is truly depressing when I hear “my to-do list” is two pages long.
That is normally followed by the statement “I haven’t stopped all day but haven’t achieved anything”
A couple of observations.
There are approximately 8 working hours in the day. In my case, there are not 8 hours; there eight 45-minute time slots.
The first port of call is to ask how many of those hours were you ACTUALLY working?
Actually working does not include chatting to a colleague or speaking on the telephone to a friend about a movie.
The reason I mention this is I took a call last Thursday from the manager of a private practice. She was complaining bitterly about there not being enough hours in the day.
In reality of course, unless she wants to work over every single evening, she can’t increase the actual number of hours available to much more than eight.
In my humble opinion, she doesn’t need to anyway.
She called because she wanted to know, how I could manage to blog twice a day? She wanted to do the same. Where did I find the time to write two blogs each day.
Well, firstly I don’t “find” the time. I allocate one hour each morning – between 8 am and 9 am- to write two blogs.
This has ZERO to do with each blog taking 30 minutes. Some actually take less. Others more.
It has everything to do with working when I should be working.
What is important is my insistence on doing NOTHING during that hour other than to write blogs ie working.
I don’t check emails. Nor do I stand around chatting to others about their weekend, the new TV series on last evening or today’s weather forecast.
Which brings us neatly to the all-powerful “to-do” list.
Mine (actually an ICAL calendar) is compiled the night before.
It lists all the items I want to complete the next day starting with 7 am – make coffee (important!!) check bank, clear overnight emails. The to-do list continues until 7.45 am with a 15-minute slot for yet more coffee.
8 am – 60-minute writing blogs.
During those 60 minutes, I will literally do NOTHING other than write blogs.
No distractions. No chatting with colleagues. No doing something other than writing.
In other words, I work when I should be working.
Now compare that with my practice manager friend who freely admits she is “weeks” behind on completing her medical billing.
My immediate reaction was to ask why are you considering writing blogs when you are so far behind on such an important task as raising invoices for the practice.
Secondly, why are you weeks behind?
The cause of her dilemma is not her ability. Nor is it her reluctance to work.
The true reason is she doesn’t quite appreciate, whilst she is working she should be working and only working.
More specifically, she should focus solely and absolutely on the task in hand.
Instead, she allows herself to be distracted by whatever comes across her desk or whoever walks into her office.
When she told me it took her roughly 3 hours to process a clinic list with 15 consultations on it, I nearly fell off my chair!
That should take no more than ONE hour.
But there again, I’m not letting anything distract me or anybody discuss the new “1917” movie with me (excellent by the way), I’m working on that clinic list.
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To successfully perform medical invoicing or medical billing there has to be a degree of focus on the task itself.
In fact, there has to be a total concentration on the expected outcome. But what is the outcome
The outcome is always the same. Getting an invoice paid. The total focus must be applied to this outcome. Making sure the private consultant surgeon is paid is the task. The total focus must be on that. The problem arises when the total focus is not possible.
For example: in the middle of invoicing for 12 consultations and 4 medical episodes the telephone rings. Worse than that the person responsible for medical billing decides, as they don’t really enjoy doing that specific task, to do something else instead.
A major distraction from focus is other people’s demands.
MHM once had a client who called 8 times within 35 minutes. He afterward complained his billing wasn’t being done quick enough. It didn’t take a genius to work out that the 8 phone calls were actually the total distraction themselves.
It doesn’t really matter what the distraction is even though with modern technology advancing so much over the years, the likelihood of distractions has increased ten-fold. For example, I may be in the middle of a task and my mobile pings to say an email has arrived. A phone may also ping because a text has arrived. The opportunity for distraction(s) is enormous.
Yet these distractions can remove focus from the planned outcome.
They can stop processing an invoice correctly, resolving an issue that is preventing an invoice from getting paid or they can even stop an invoice being raised in the first place.
Modern technology is great. It enables MHM to communicate with its clients speedily and efficiently. Clients can provide data to MHM equally efficiently. It also enables MHM to raise invoices electronically and deliver them at the push of a button. But it can also be a blessing in disguise if MHM were to let it distract from the job in hand.
Thus it is worth repeating that the planned out is for the private medical professional to get paid.
That is what MHM is there for; nothing else.
If the technology on occasion stops that, then remove the technology for a while.
This may sound revolutionary but in the real world, ignoring technology when the technology actually prevents achieving the planned outcome is not as silly as it sounds.
For example: when I’m raising medical invoices for a client – every single morning invoices are processed at MHM – I switch my email off. Thus there are no distractions caused by emails arriving. Before anyone raises the question of an email being important, may I suggest that in reality whilst emails may be important seldom are they time critical?
They are normally requests for data or asking a question.
All three examples are important but they are not, despite what people may claim, time-critical.
My favourite example of this is the person who was tasked with locating new premises for MHM. She emailed me one-morning last year but when I didn’t immediately respond, telephoned to confirm if I had received her email. This despite the instruction to email details to me and being advised I would respond later that week.
As she couldn’t even follow that instruction, she immediately lost the opportunity of finding new offices!
The world will not end and a private medical practice won’t immediately collapse if an email, a phone call or even a text are not immediately responded to.
That is not to say a patient inquiry should not be immediately answered. In the case of a patient calling then absolutely they should. Have someone designated to answer the phone. It looks awful if a patient calls and the phone isn’t answered.
But don’t have the same person responsible for medical billing AT THE SAME TIME for if you do the phone calls and/emails will provide the distraction to caused the planned outcome to be missed.
Medical billing is not the easiest thing to do in the world. It requires concentration and attention to detail. If the outcome is expected to be prompt payment of an invoice for medical services, the focus should be directed to just that. You know what happens if I switch my email off during the morning or I have the text alert set to silent?
Except I raise numerous invoices for clients, resolve issues with insurance companies and make sure MHM clients are paid.
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I was at a medical conference recently and one of the speakers – a well-established consultant surgeon and an incredibly safe pair of hands – stated during his presentation that a private surgeon could not charge for inpatient care.
He may well be a safe pair of hands but on that point he was wrong.
After the conference, I had a word and said he was incorrect. It IS possible to charge for inpatient care.
I couldn’t help but suggest to him that the mere fact there was a separate code for inpatient care indicated it could be charged.
Obviously, it may well depend on the insurance company concerned. In principle, however, it is possible to charge. I knew I was right because I’d actually charged for inpatient care for an MHM client a few weeks earlier. And the invoice had been paid.
But he wouldn’t budge.
He was right.
I was wrong.
Skip forward a few weeks and I received an email from my consultant surgeon friend confirming that I had been right all along and he had been wrong.
Why is it sad that I had been right?
Because my consultant surgeon friend has been in private practice for well over a decade and he’d NEVER charged for inpatient care.
More significantly though, my friend had not checked each month what could and could not be charged for.
That also begged the question if the fees he was charging had been checked with the same frequency too. He hadn’t so as a favour I checked for him.
The good news is that only 3 of his fees had altered.
The bad news is that one of them had gone up £107 five months earlier yet he was charging the old and lower fee.
Thus it is important not only does a Private Consultant Surgeon need to establish what he can or can’t charge for, it is just as important to check HOW MUCH you can charge for!
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Another familiar issue that came again last week.
Consider if, during the initial consultation, you advise your patient surgery is required.
The patient is therefore given a CCSD code equating to the surgical episode to quote to his or her insurance company. He goes away, quotes the CCSD code to his insurance company and is given a pre-authorisation code for, as an example, AB1234 by his insurance company.
The patient then contacts your secretary and passes over the pre-auth number.
Everybody is happy.
But what happens if, during surgery, you realize a change of surgical procedure is necessary?
Does it make a difference?
Not to the patient.
It also doesn’t make a difference to you either for you have performed the surgical procedure you deemed to be the absolutely correct procedure at the time.
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.
There is a step to be taken before the invoice is raised.
The best practice is to call the insurance company and explain the situation.
All insurance companies are very used to such calls from MHM. Some request a letter from the consultant surgeon explaining why the change was necessary.
Some do not.
And thus MHM invoices the correct fee and you get paid the right fee.
What happens if you do NOT make the call to the insurance company and just invoice for a different CCSD code to that authorized?
Having never ever done that I wasn’t sure. So I called two of the major private medical insurance companies.
Both said the same.
At best the invoice will be seriously delayed pending their request for an explanation. In the worse case, the invoice will be declined.
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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 of 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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I was watching an excellent piece of video yesterday by my friend Dev Lall.
Dev was explaining how most consultants do not appreciate they have to work on marketing their practice.
And he is right!
However, it got me thinking about my own work and how certain consultants do not seem to understand seeing patients isn’t enough to ensure good cash flow.
To increase your cash flow you need to get paid. Obvious.
Except, far too many consultants do not understand how and why private insurance companies pay them.
For example: to get paid by ANY insurance company you need the right patient details.
Because without them, you can’t invoice.
And if you can’t invoice you won’t get paid.
It is as simple as that.
This is illustrated over and over to new MHM consultants when I take over their invoicing.
However, it’s not the consultant who actually gets the details.
It is the consultant’s secretary or the hospital.
The switched-on consultants who may be defined as making more money because they see more patients AND get paid are well aware of this.
Moreover, they take the time to ensure their medical secretary or hospital, fully understand the need to make sure details are correctly obtained.
Effectively, by making sure all the support functions are in place (getting the patient details right), he/she has worked ON their practice. They have put the time and effort in.
Working ON a private practice does not mean the consultant has to do everything himself. In fact, that is the very worse thing you can do.
The switched-on consultants buy somebody else’s expertise to work ON their practice with the result the consultant has time to see MORE patients because the expert has attracted more patients to the practice in the first place.
Once the invoicing and billing are also placed in the hands of an expert, cash flow improves too.
Everybody is happy!
Time and effort in private practice are not just about seeing more and more patients.
It involves working ON your practice and not just in it.
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This issue came up recently with a consultant surgeon.
How are benefits and fees accounted for against a patient’s package?
Consider the total benefits payable under a patient’s policy. For example, the benefits payable is £100.
It could be more. The fees mentioned below could be higher too.
Against such a benefits package, fees are deducted thus:
£20 is paid out. The total benefits figure reduces to £80.
Subsequently, the patient requires surgery. £50.
This is also paid.
The accumulator reduces to £30.
Finally the hospital tenders their account: £20. The gasman submits his: £10. The benefits accumulator, therefore, reduces to ZERO.
The benefits package is equal to the fees.
If the initial is £21, the surgery £51, the hospital £21, and the gasman £16 then the total fees = £109. Against a total benefits package of £100.
Thus, if fees exceed the total benefits a shortfall will be created.
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I work in set 45-minute time slots.
That does not mean everything has to be completed in 45 minutes or less. It means that I work solidly for 45 minutes.
Each and every time.
Personally I can’t fully concentrate for more than that amount of time.
But the real question is not what do I put into those 45 minutes? The real question is how much EFFORT do I put into the 45 minutes?
For example, a clinic list arrived yesterday evening. I knew it was arriving because that particular client has a clinic on a Monday evening. It needs checking, invoicing and recording the next day.
After all, that is what I get paid to do.
It’s also the action that will generate the most revenue for me
So, the previous evening I’d entered into my ICAL a 45-minute time slot for today.
Once you start a task, do NOT stop.
Don’t stop until you have completed the task. All of it. Personally, I won’t even talk to anybody. My email is set so I don’t get an alert every time an email arrives.
All distractions are removed.
It’s the proverbial do not disturb sign not just in my office but also in my head.
45 minutes later or sometimes even less, I’ve finished the task completely. All of it.
So I reward my self with a coffee or I check the BBC news for 15 minutes. Or I’ll book some cinema tickets. Whatever.
15 minutes later, I’ll start again.
And won’t stop until that task is 100% completed.
This second task could be ringing patients. It could be checking my emails. Might even be logging onto the bank. It matters what the task or tasks are.
What matters is within those 45 minutes, I’m working as efficiently as I can.
For maximum financial reward.
It always makes me smile when I hear that.
Normally its followed by the statement “I’ve worked flat out today but got nothing done”
The most likely cause is that distractions have been allowed.
Don’t let them.
In terms of medical billing, that specific task is ALWAYS first.
Because the outcome of this specific task generates the most revenue for me.
So, in terms of outcome what are you doing today and does it lead to the maximum benefit for you?
If it does, start it and don’t stop.
If it does NOT, what are you doing it for?
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Sometimes, getting more patients isn’t always the right answer.
The right answer is to get paid for the ones you have already seen.
Over the last three months MHM has been working very closely with an ENT consultant. His sole aim is to see more and more patients.
That way, he will make more money and retrieve the dire financial situation he has found himself in.
Thus he has reduced his consultation time down from 30 to 20 minutes. Therefore he’ll see one more patient each hour.
But the cause of his financial problem is not he doesn’t have enough patients.
He is owed a considerable amount of money. He is not getting paid.
Seeing more patients and not getting paid for them, will not help!
He needs to get paid for the ones he has seen as well as the new patients.
A simple cause.
Invoices aren’t being raised after each clinic. Instead, they are being raised every Saturday morning when “it’s quiet”.
But the problem with that is not all invoices are being raised.
Many of the patient details are incorrect. But his secretary can’t correct the details because many of the insurance companies she needs to speak to to get the right aren’t open on a Saturday.
Or if she needs to speak to a patient, she may or may not be able to reach them by telephone.
The very first thing to do is to make sure the details ARE correct. That is much easier than it sounds.
Then, she needs to invoice every single day.
In doing so she will identify issues quickly. Then she must resolve those issues the very same day.
It’s only by doing so will the dire financial situation the ENT has found himself in will get resolved.
Seeing more patients but not being able to charge for them, won’t resolve his problem.
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One of my major bugbears with medical practice is the ability to answer the phone.
Sounds simple. It is!
Yet many practices do not answer the phone. Instead, the call goes to an answering machine and then one of two things happen.
The call is never returned.
The caller rings another consultant.
The new patient wishes to see a consultant. Most likely he or she will have a choice of whom they see. It could be you or it could be a competitor. It is not a given they will choose you.
So what will be their reaction if they can’t make an appointment because no one answers the phone or can be bothered to go elsewhere?
They will call another consultant.
By all means have the option available for the patient to book online. I’m all for it. But don’t just rely on that.
We are in the people business.
And people like dealing with people. More accurately, they like to talk with people.
So answer the phone and talk to them.
It is inevitable that your phone will be engaged at some point or your practice will be closed for the weekend. Hopefully, the patient will leave a message.
But make VERY sure that call is returned.
If you don’t, potentially you will lose a new patient.
And if you don’t attract and keep new patients, frankly your practice is dead.
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Consider when the patient has contacted his/her insurance company and been issued with a pre-authorization 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.
They confirmed whilst they did indeed issue a pre-auth, this did not mean they would accept the charge.
In fact, pre-authorization had been refused.
Yet again the message came through loud and clear:
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-authorization?
If they were not prepared to issue a pre-authorization then they should not have issued one at all.
This point was duly made to the insurance company. Their reply was poetic.
They had always done it that way.
I have the utmost respect for private medical insurance companies.
Most are extremely efficient and willing to help.
Whilst I’ve had numerous disagreements with all of them regarding fees etc, 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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