Taking ONE real-life client as an example.
Week ending Friday, July 24th: out of 15 consultations, 4 (four) came back with excess deductions £575.
So for a total of £2,500 worth of revenue from outpatient consultations £575 or 23% came back short.
Looking back to the same week in 2019, the number of excess was roughly half this.
The question as to why this is happening is not the concern.
The concern is what are you going to do about it.
If 23% continues the downside and potential loss to the consultant is significant.
There is only one real way to resolve this issue. Phone them!
Sure you can write letters and even email but nothing gets a response like a ringing telephone.
Most patients claim to be unaware of the issue but some think this is an issue between them and their insurance company.
In other words, the patient thinks they need to pay the insurance company.
They think the consultant gets paid in full by the insurance company.
There are variations on this but the crucial point for the consultant is not to establish why; its to ensure he recovers the excess efficiently.
But if telephoning the patient is the most efficient way to tackle the issue, it does not automatically follow its the easiest.
It has to be done professionally and with due diligence.
The long-suffering med-sec really won’t have the time to do this as professional and caring as she undoubtedly is.
I promise you faithfully, she won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
There is an alternative though: do nothing.
Some patients actually will pay but this assumes they a) are aware of the excess and b) make it good straight away.
What if they don’t?
Assume it’s not £575 or 23% a week or £27.6k a year (£575 multiplied by 48 – not 52 weeks as you will have 4 weeks off a year).
Assume instead its 10% for 24 weeks (i.e. roughly half of the current numbers) and allows for some patients paying without being contacted.
The potential losses for the consultant, in this case, reduce to £13,800 per annum.
That’s a chunk of change in anybody’s book.
What’s significant is that at a number of client meetings recently I’ve asked what the client considered the biggest threat to the practice during 2020.
Most popular was a further reduction in private insurance fees.
That may indeed turn out to be a big problem.
But at this point, empirical evidence suggests its potentially leaving the back door wide open so to speak and enduring £13,800 worth of potential losses right off the bottom line.
I’d be really interested to hear from anyone who is seeing an increase in excess and their views on remedies.
pete@medicalhealthcaremanagement.co.uk
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In terms of medical billing, this perhaps is one of the statements I say to private consultant surgeons more frequently than others.
The following example illustrates that despite the rejection of the fee how the fee was established confirms there is little the consultant can do about it.
The consultant surgeon concerned had applied to be recognised by a private medical insurance.
MHM had spoken to the consultant and pointed out fees should be confirmed when recognition was being arranged.
The consultant was well qualified, had held a substantial NHS post for a number of years and his/her specialism was in high demand.
The private medical insurance company was keen to offer recognition.
Thus recognition was granted.
Yet despite the warning by MHM fees had not been checked.
MHM was subsequently asked to handle the medical billing side.
In order to do so, we need to know how much consultation fees were.
The medical professional, however, did not know what the consultation fees were.
Thus alarm bells immediately started ringing.
Consultation fees would have agreed to and would have been detailed in the pack supplied to them by the insurance company concerned as we had advised. So we called the insurance company and quoted the newly acquired provider number.
As usual, the insurance company was keen to point put the consultant had agreed to adhere to the published fees.
It is always amusing when “fair and reasonable” is quoted to me because it depends on what the consultant thinks is “fair and reasonable”.
More specifically what happens if the thinking differs between the two parties concerned. And that is precisely what happened in this example.
The insurance company deemed that £175 was a fair and reasonable fee for a consultation.
The medical professional deemed that £250 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge consultation at £250.
MHM pointed out that it would indeed charge £250 as instructed.
All that would happen, however, is the insurance company would reduce the value of the invoice down to the £175 originally agreed.
And that is precisely what did happen.
Despite the medical professional objecting strongly to a consultation fee of £175 and insisting a “fair and reasonable” fee was £250, the invoices were reduced in value.
It mattered little to the insurance company that the MHM client had colleagues who were both charging and getting paid £250.
Even before I asked the question I knew this was to be true. It mattered even less to the insurance company that a second colleague was paid even more than £250.
This was so because the second colleague was in a completely different specialism!
Sadly the MHM client had based their practice business plan on a consultation fee of £250. They had done so because they had asked colleagues how much they were paid.
Then they had assumed such fees would equally apply to them.
MHM, per normal, had no issue calling the insurance company concerned and arguing the case on behalf of the medical professional.
That said it was an argument that it was never going to be won. The simple reason remained that at the point of recognition the MHM client had accepted the fees.
Sure enough, the insurance company stood firmly behind its agreement with the consultant.
ASSUMPTION LEADS TO PROBLEMS.
The moral of this sorry tale is best summed up by the above heading.
I’m not suggesting you shouldn’t challenge fees for consultations or indeed a surgical episode but don’t put yourself on the back foot by accepting fees and then challenging them afterward.
As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!
pete@medicalhealthcaremanagement.co.uk
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In the world of medical billing, the most efficient way of doing something is to do it right the first time.
You don’t get paid.
My late Father drilled into me from a very early age:
Measure twice; Cut Once
and
Do it once and do it right
What has that got to do with medical invoicing? Everything.
MHM recently completed a project for a private hospital. The project was to investigate why invoices were not being paid.
One insurance company was proving particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company required invoices to be submitted electronically.
Except for the data on which the invoice was raised was incomplete. So the invoice could not be submitted.
For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. This caused the invoice to fail at the point of logging electronically with the insurance company. Thus the invoice was not passed to the insurance company for payment. Instead, it was put in a “holding” pile.
In other words, the invoices were not being done right the first time.
To resolve the problem, it was imperative to make sure ALL the details were correct. That way invoices could be correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the root cause of the issue. But why was this proving so troublesome?
It transpired medical secretaries thought the hospital receptionist was responsible for getting it right.
The hospital receptionist said the medical secretaries were responsible.
Then they both claimed the person who actually raised the invoice was responsible.
The reality was that nobody was making sure the data was right.
The spat had caused, over the previous six months, the hospital to be short of tens of thousands of pounds. Indeed the holding pile was greater than the value of average daily outpatient appointments. And it was STILL growing.
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded in patient records and checks them again. The person responsible for medical invoicing highlights on a daily basis ANY invoices which can’t be processed. The holding pile is now less than 0.5% of a MONTH’S worth of invoices.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%. It’s not overkill at all.
pete@medicalhealthcaremanagement.co.uk
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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 with half an hour or so per normal. He called me this morning instead. He explained why.
Every Wednesday, he and his wife have a “date night”
They switch both of their respective phones off.
No emails, text or ring tone interrupting them. They spend time talking to each other.
And that got me thinking.
A couple of years ago I started doing something similar.
At the end of each day, I’d put my phone on silent and switched my emails off too. Why?
Because each day I need time to review any opportunities/problems I’ve got to deal with the next day.
It also means I can think about an issue at length, leave it overnight ready to be re-thought about on the next day. That stops me making knee jerk reactions and allows time to have a fully considered opinion ready.
Rarely will you get an immediate reaction from me.
My response to an issue has, therefore, been thought through.
Yet many medical practice managers or indeed consultant surgeons running a practice, don’t stop and think through an issue.
They are too busy.
But alternatively, they are too busy because they don’t stop and think through the issue.
Sadly I see this all too often when I go meet a potential new client.
Many of the issues they are facing have their source in a previous decision. The previous decision itself could well be based on a decision before that one even.
One of those decisions in the chain was almost certainly not thought through.
For example: recently I blogged about a group of gynecologists in the West Midlands who, in an effort to stop issues with self-funding patients decided ALL self-funding patients must pay in advance.
Immediately the problem with self-funding patients stopped. Because there weren’t any self-funding patients anymore.
This was a solution to the problem. It worked. Sadly, however, it had some unpleasant side effects i.e. no patients.
Clearly, they hadn’t thought through the consequences of their decision.
They had reacted.
Yet the reaction caused another problem i.e. no more self-funding patients. That was unfortunate as 23% of their practice was derived from self-funding patients.
The above example is indicative of the cause of many of the issues within that particular practice.
It was relatively easy to put the self-funding issue right because I’ve faced that specific challenge a few hundred times previously (email me for how).
Getting the practice manager and the three consultants to change their mindset though was much more difficult.
They did change though because they had seen a 100% reduction in self-funder outstanding invoices.
Sadly this was at the expense of a 100% reduction in self-funder patients.
They changed not just because I knew the answer. They changed because they realised when I faced that issue previously, I’d allowed myself sufficient time to give it serious thought and consideration before reaching a decision.
I implemented a course of action that didn’t put patients off by asking payment in advance but did reduce the number of outstanding self-funder invoices.
As a bonus, it stopped the problem with self-funding patients who were DNA too!
And that is why it is important to put the time aside and think through an issue before deciding on a specific course of action.
pete@medicalhealthcaremanagement.co.uk
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Recently a friend of mine called asking for a favour.
I’ve known this guy years. We started our respective businesses around the same time.
He has now reached the point where he needs to relocate his staff to a new building. As his business continues to expand, he has simply run out of room.
As he wanted to move from where he is now to Wolverhampton and as I obviously know the area better than he, would I have a look at offices that are available and get back to him?
Sure, no problem.
You are paying next time we go for a curry.
So that afternoon I looked on Google to see what was available.
Having identified possibilities it was time to get the details. So I called the first four agents. I explained the premises were not for MHM but for a client who’s identity at this stage was confidential.
We were looking for premises that could seat 15 people plus two offices (one for MD and one for the General Manager).
We also needed on-site car parking. I also explained this was very much an initial inquiry and I was merely establishing what, where, how much, etc.
After giving it some thought, I’d call them back in one week’s time. Nothing would happen before that.
Why then have I taken three phone calls this morning asking me to update them and enquiring how we move forward?
Again I repeated this was an initial inquiry and pointed out nothing would happen until my friend and I have looked at the details. But still, I was asked the same questions I’d already answered.
The decision would not be taken for the next seven days
I don’t want to arrange a viewing of a specific property yet
I’m not able to state who my client is
I’m not interested in them coming to see me and discuss requirements
Premises for 40 people are NOT suitable – I said up to 15!
Offices for 6 people with no car parking is a stupid suggestion.
If I hadn’t got to find the best possible premises the three who hassled me this morning would drop straight off the list and I’d only deal with the remaining agent. And for one reason alone.
She has accepted and understood the brief and instructions and therefore she goes to the top of the list.
Two of those who hassled me have the same property available as the one who has NOT hassled me. And the premises look very suitable too.
Now let me think whom I’m going to call back?
My point is I gave a very specific brief to all four.
It does not instill me with much confidence regarding the three who don’t appear to be willing to follow even that.
I know all four have a job to do but wasting my time by calling is unacceptable.
Final thought, the one agent who called my mobile this morning because my direct line was engaged should maybe have considered my direct line was engaged because I was USING IT!!!
pete@medicalhealthcaremanagement.co.uk
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One of the most often asked questions is “how as a private consultant surgeon can I increase my payments from insurance companies?”.
The answer, as regards medical invoicing, is very simple to answer:
But what does that mean in reality?
It means taking all the items that should be done and turning them into a MUST be done.
For example, I took a phone call from a consultant’s secretary this morning who wanted a favour.
She was struggling to get an invoice posted electronically. She was trying to invoice BUPA. Simple enough you may think but despite having a policy number, she could not process the invoice.
So how did it take me approximately 3 seconds to work out precisely WHY she couldn’t process the invoice?
She told me the policy number began BI-6000 etc.
That told me the policy number was not a BUPA policy number; it was a BUPA INTERNATIONAL policy number.
She was trying to invoice the wrong insurance company.
A quick fix to process the invoice, again online, to BUPA International and it sailed through.
Sorted.
If standards had been raised to ensure that every single patient registration form had been completed correctly, this problem would not have occurred.
The invoice would have been processed the same day. Instead, a shortcut had been attempted and the patient’s insurance company detailed incorrectly.
If standards had been raised to ensure this was checked and spotted the invoice would have been immediately processed.
There are no shortcuts if you want to get paid.
Thus an increase in cash flow – the outcome desired by the private consultant – was not being reached.
However, if you stop to think there are two questions:
When the patient was registered, why wasn’t a check performed to ensure the right insurance company was recorded? It should have been.
Why had the standards been set too low?
If it becomes a case of the patient MUST be asked i.e standards are raised then this specific problem is never allowed to arise.
And that’s what I mean by raising your standards.
So why is this crucial?
Because more and more private medical insurance companies are insisting invoices be submitted electronically.
The issue is not one of is that the right thing for them to do or not.
The real issue is that it is happening and standards must be raised to ensure you CAN invoice electronically.
In other words, if you don’t have all the right details it is much, much harder to invoice.
You will instead have to re-contact the patient and get the right details.
Therefore it makes more sense to say you MUST get the details upfront and you must RAISE YOUR STANDARDS to the point of saying – the correct details MUST be obtained and checked.
I’ve even witnessed where an invoice can’t be processed because the postcode has been recorded as W01 (numeric) when it should say W01 (alpha) Incidentally.
Many times I’ve said insurance companies are not the enemy.
Even if I frequently disagree – I do on a daily basis sometimes – insurance companies will pay a private consultant IF (and only if) ALL the details are correct. In other words, invoices must be raised to the correct standard.
If you want to increase or improve your cash flow, the very first thing to do is to raise your standards in the area of invoicing.
pete@medicalhealthcaremanagement.co.uk
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Never, ever base your practice business plan on there being 12 months in a year.
There aren’t!
The question should be how many WORKING months there are in the year.
It is extremely rare for any private consultant to find he or she is inundated with patients during December. There will be some. Nonetheless, there won’t be many.
Many patients have got other things on their mind during that particular time of the year.
That doesn’t mean the whole of December will be lost but around half of it will.
The same came be said of August. Patients prefer to go on holiday.
Come to think of it, many consultants like to go on holiday in August too. Just as they like to have Christmas off as well as the patients.
So if your business plan is to make say £120,000 a year (or any other target for that matter), don’t assume your monthly target should be £10,000 each month.
Instead, you should set a monthly target of £10,909 a month ie £120,000 divided by 11.
The issue gets even more complicated though for many MHM clients when study leave, NHS commitments or whatever else they get up to.
Factoring in an additional allowance for commitments unconnected to the practice or an allowance for patient preference is important.
pete@medicalhealthcaremanagement.co.uk
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It is depressing the number of times I hear clients criticising insurance companies.
In my experience the reasons normally cited are incorrect. Far from it.
I’ve lost track how often I’ve been told an insurance company won’t pay for something.
Yet when I ask if the insurance company have actually been asked IF they will accept a charge, the answer comes back that they have not.
I have all the private medical insurance companies on speed dial.
They need to be as I speak to most of them every single day of the week.
There are many, many things I’m already aware of.
There are also some things that I don’t know or more importantly that may have CHANGED.
I ask them all sorts.
For example – I ask them to confirm a patient’s policy number. I ask them to confirm why an invoice has only been partially paid.
Sometimes I ask them if I can or cannot charge for a certain medical episode.
Which brings me neatly to the W9040 code.
I was invoicing for an orthopaedic consultant surgeon recently. His specialism was knees and during a follow-up consultation he administered a W9040.
This particular CCSD code represents an injection into a joint or soft tissue.
The question arose if I could charge a particular insurance company for a follow-up consultation fee AND a fee for the injection.
So I called them. The answer came back yes I could.
I could charge £120 for the consultation and £50 for the injection i.e. £170.
The insurance company would happily pay such an invoice.
Compare and contrast that with work I was performing for a dermatologist recently.
This time the question arose of a S5210 (an Injection into subcutaneous tissue). I’ve only recently started invoicing for this client and thus it was important to establish what could and could not be charged for.
More specifically, would the insurance company accept an invoice for the follow-up consultation AND the injection?
Yes, they would.
£125 for the consultation and £108 for the injection i.e. £233.
Remember however that I had asked ONE specific insurance company.
When I asked others the same question, some would NOT allow the separate charge.
What was concerning was previously the dermatologist had not been charging for the S5210 at all.
I actually asked his practise manager why this was so.
The answer came back that the question had been asked of an insurance company before and the answer was no.
The problem was that whilst the insurance company concerned did not (and still don’t) allow a charge, other insurance companies DID allow a separate charge.
But nobody had asked the other companies.
Instead it was assumed the decision covered ALL insurance companies.
Thus on numerous occasions insurance companies are wrongly blamed for their actions.
It was only by speaking with the individual insurance companies that I identified which ones would accept the charge and which ones would NOT accept the charge.
Insurance companies are NOT the enemy.
If you call them, you may be surprised at what you are told.
That is not to say you will always obtain a positive response but you may be pleasantly surprised.
pete@medicalhealthcaremanagement.co.uk
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That’s an interesting question. Many don’t appreciate that a private medical practice can fail.
And some do.
A private medical practice can fail for the same reason that ultimately any business fails.
It runs out of cash.
Whilst obviously there may be a lack of patient numbers or lack of customers in a “normal” business, it is the financial contribution patients make that matters.
Without a paying private patient the consultant will not generate any money.
If no money is generated into a private practice it will require more money putting into it than being taken out.
And that defeats the object of opening and running a private medical practice.
It is that simple.
Which is why it is even more concerning for a consultant to see patients and NOT invoice them.
The first rule of medical billing should be to guarantee that you actually raise an invoice and that invoice is complete in all parts.
Without doing so, your practice WILL fail.
pete@medicalhealthcaremanagement.co.uk
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Monday, August 10 – an MHM client emailed me advising patient invoices were missing.
Go back to Saturday, August 1 when the client held his normal Saturday clinic.
Immediately he completed the clinic, he scanned his two page clinic list and sent it securely to MHM.
Therefore on Monday, August 3, MHM issued 8 invoices for both self-funding patients and also to insurance companies.
MHM sent the client his weekly report. This document confirms how many invoices have been raised. It confirms how many previously raised have been paid and which invoices are still outstanding.
But it also enables the MHM client to check the correct number of invoices were raised that week. Ten in total.
And they hadn’t been which is why the client emailed MHM.
Consequently, it transpired the client’s two page clinic list contained four patients per page for the final page with the additional two patients had not been scanned.
Both patients were in respect of consultations and had a combined value of £525
It is of little interest both to the MHM client or MHM itself WHO made the error.
Of much more relevance is that the error was immediately identified.
And then corrected.
Otherwise that particular MHM client could have found himself £525 out of pocket.
Which is why it is crucial that you receive a weekly report confirming what is happening with YOUR money.
pete@medicalhealthcaremanagement.co.uk
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It is dangerous for an insured patient to assume his insurance covers everything.
Often it does not. This will impact on how much you get paid.
Private medical insurance is designed for short-term issues. For example, an injury that suddenly happens and treated/cured relatively quickly.
A broken hand can be treated quickly. A diabetic problem may not.
Consider it this way.
Private medical insurance is in place to cover elective non-urgent issues.
If the condition was known before the policy was taken out, it may not, however, be covered.
But it does NOT follow that if the injury is short-term and treatable under private medical insurance cover, all parts will be covered.
It will depend on the type of policy held.
Basically, the higher the costs of the cover, the more covered. The lower cover may set a financial limit on how much can be paid out.
They may, for example, exclude consultations.
Whilst it may impact on the consultant surgeon it will be a sad day if a consultant even stops to consider if he/ she will treat a patient based on an insurance policy. They would not remain an MHM client if they did.
But what is the impact on the consultant?
For one thing, a budget type policy could easily lead to shortfalls. It may also lead to excess. It may result in the refusal of consultation fees.
This will lead to a requirement for the consultant to have such amounts collected from the patient.
Therefore what is covered is indeed relevant to the private consultant.
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Occasionally I get asked this question and a very important question it is too.
The normal answer is to open a practice at the nearest hospital to home. After all, nobody wants to commute more than they need to.
Bu there is another critical factor in the final decision.
Three years ago, I was contacted by an orthopaedic surgeon who was seriously struggling to grow his practice. His practice had been open for just over a year.
But he was struggling to get new patients either a self funders or via an insurance company.
It didn’t take more than an hour of desk research to work out what the critical factor was.
A search of Google indicated that there were eight orthopaedic surgeons practicing at his hospital. All of them were recognised by the major insurance companies. All but one were fee assured. With the exception of three, they all offered consultations twice a week. He offered one.
In other words, patient requirements were already well covered.
It was, and still is, difficult to compete for a finite number of patients against either well established consultants.
Nonetheless, never quit or give up.
There are many different steps to take. A well drafted marketing plan supported by a formal strategic objective would be the first item on my list.
But included in that would be a reality check.
His practice is not going to grow and grow and grow.
Expectations need to be managed accordingly.
There is, however, a lesson to be learnt.
Before you decide precisely where you are going to open your practice, make sure you check how many consultants are already there.
pete@medicalhealthcaremanagement.co.uk
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A patient who needed a receipt called me yesterday. She needed one so she could claim the money from her health cash plan.
The patient had seen physiotherapist and paid for her treatment. With a receipt, she can claim the fee back from the Health Cash plan provider. Alternatively, the patient could have been insured but outpatient appointments not covered under her policy.
A Health Cash Plan is designed to ease the financial burden of having such regular health checks.
They are NOT the same as a private medical insurance policy.
So why are they relevant to the consultant surgeon?
Well, sometimes the patient’s insurance cover does NOT include outpatient appointments. The patient has paid for them but requires a receipt so they may claim the cost from the Health Cash Plan provider,
Thus it is important to understand what a Health Cash Plan is and how it may complement a private medical insurance policy.
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Following on from this mornings post, one of my guys called me.
He was curious as to whether his targets were sufficient or not.
Yet that is not a question I can or even should be able to answer.
It is totally a matter for him to decide if the money he makes each year from his practice is enough to compensate him for the hassle and stress of running a private practice.
That is not me ducking the question. I’m not in a position to say the between £100,000 and £200,000 he makes each year is enough.
It would be for me. But I’m not him.
Conversely however, I hear statements said to some of my clients as:
“I know a consultant who only works three days a week and makes £500,000 a year”
That could well be true.
But not if you are just starting out it isn’t. And some of mine are only a year into private medicine
Think about the economics of it for a second.
Firstly, it won’t be over a year ie 12 months or £41,666 a month (£500,000 / 12 months) Unless the consultant never wants a holiday or to have Christmas off more likely it will be over 11 months.
And that makes the maths even worse.
Over 11 months the monthly billing would need to equate to: £45,400 a month.
But with the average private medical insurance company paying around £225 for an initial consultation and £175 for a follow up ie £200 per consultation, that means the consultant would have to see circa 225 patients a month. Each and every month.
However, before anybody emails me saying I’m ignoring surgery and the self funding market, may I point out even with those included the maths still don’t add up.
I’m not saying it isn’t possible to make £500,000 per year out of private medicine for it is. I have clients who ARE making those sort of amounts. But they work a darn more than 3 days a week.
The point I’m making is whilst I will ALWAYS say having a target is crucial so a practice performance can be measured, having an unrealistic target is plain silly.
You are NEVER going to reach it. Certainly not in the early years.
All you’ll end up doing is seeing how far away from it you are.
Its much better to have £100,00, reach that and they aim for £150,000. Then once you hit £150,000 aim for £200,000.
pete@medicalhealthcaremanagement.co.uk
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I find it really interesting when I ask that question of consultants considering starting a private practice.
The answer should be: make money!
Nonetheless on many occasions I hear:
the practice should be seeing 20 patients a week
or
I want to grow a successful private practice.
Both of these are fine ambitions when starting out in private practice.
Yet neither actually puts into perspective why a consultant wants to start a private practice. Considering the enormous effort required to start up, grow a private practice and keep growing it, they are dangerously insufficient.
The real aim of any consultant wishing to enter the word of private medicine should be to make money.
Otherwise why bother?
That does not imply for a split second, making money is more important than a patient’s health. I’m pleased to say I do not have one single consultant who puts money before a patients health.
But I do have a considerable number of clients who put making money very high of the list of practice aims.
And that’s how it should be.
However:
In addition, there is a better answer to the question of why start.
That answer is to make a specified amount of money. For arguments sake, lets say £100,000 in the first year.
It doesn’t really matter what the actual number is. It could be £100,000 or £200,000 or £1,000,000 for all I care.
What the number will do is allow the new consultant to establish a target to aim at. More importantly still, it will enable him or her to measure against the target.
And that is absolutely vital if you are going to run a private practice.
After all, if you’ve got nothing to aim at, how will you know if and when you’ve hit the target?
pete@medicalhealthcaremangement.co.uk
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The silly seasonJuly and August represent the silly season for me with people on holiday.
Consider, the practice secretary on leave for the last two weeks of July. Consequently, when she is back, I will invoice for the last two weeks of that month.
In other words, one clinic each week.
Yet she only sent me one clinic list for the last week in July.
In the second clinic a particular patient’s follow up appointment needs an invoice.
Standard practice in such a case is to look back at the initial consultation.
However…
The initial consultation was not invoiced for the clinic list for that day hadn’t been supplied.
And the total clinic was worth £3,450.
And this is why, not raising an invoice is 100% guaranteed to lead to non-payment.
pete@medicalhealthcaremanagement.co.uk
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Yesterday I spoke about the clarity of data. You need to be able to read it.
Consequently, I took a phone call last afternoon from an MHM client. He reminded me how I once gently pointed out texting me was not a good idea.
We laugh about it now but back in 2018 when we started working together it was painful.
For example: if there was a problem with the clinic list I’d phone him and leave a message for him to call back.
Generally speaking this lead to a text message asking what the problem was.
So I’d text back.
This lead on to a mammoth text change that could easily take an hour. An hour of interruptions and an inability to sort a single problem out because it wasn’t clear what the issue was.
Nor was it clear what the suggested solution was.
This would happen most days to our mutual annoyance.
To be honest, I could not afford to spend so much wasted time that way. And neither could the client.
So we stopped.
Now if there is a problem, I text and ask him to call. He texts back giving me a time and I call him at that time.
Consequently on a bad week we speak once. On a terrible week, we speak twice. But we seldom have those sorts of weeks anymore.
Indeed today was the first time I’ve spoken to him since early July.
And that is why it is vital to get the right data, in the right format and prevent the very opportunity for issues to arise.
pete@medicalhealthcaremanagement.co.uk
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It’s really strange how, in the search of efficiency, the exact opposite happens.
Take a relatively new MHM client.
He is very good at finishing a clinic and immediately sending a scan of his clinic list to MHM. He does so every time.
The problem is he takes a photograph of his clinic list, attaches it to a secure email and sends it.
Perfect.
Except I can’t read it. That’s because the quality of the picture is poor.
In days gone by, the standard joke was you couldn’t read a medical professionals handwriting. Actually this isn’t true. For instance, all MHM clients have excellent handwriting.
It’s when technology is used incorrectly in search of efficiency that the problems arise.
Consequently, I normally have to phone the client. And that equals a delay!
More importantly this leads to an unnecessary delay in payment.
There is little point in raising an invoice without all the correct data. The chances are you can’t anyway.
Above all, the data should be in a format easily read and understood.
Look at it another way:
Invoice right = get paid right.
It is better to check the quality of the format used to send your data as well as the data itself.
pete@medicalhealthcaremanagement.co.uk
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One of the most often asked questions is “how can I improve or increase my cash flow”.
The answer, as regards medical invoicing, is very simple to answer:
But what does that mean in reality?
It means aiming to be a winner
It means taking all the items that should be done and turning them into a MUST be done.
For example, I took a phone call from a consultant’s secretary this morning who wanted a favour.
She was struggling to get an invoice posted electronically.
She was trying to invoice BUPA.
Simple enough you may think but despite having a policy number, she could not process the invoice.
So how did it take me approximately 3 seconds to work out precisely WHY she couldn’t process the invoice?
She told me the policy number began BI-6000 etc.
That told me the policy number was not a BUPA policy number; it was a BUPA INTERNATIONAL policy number.
She was trying to invoice the wrong insurance company.
A quick fix to process the invoice, again online, to BUPA International and it sailed through. Sorted.
If standards had been raised to ensure that every single patient registration form had been completed correctly, this problem would not have occurred.
The invoice would have been processed the same day and payment made when required.
Instead, a shortcut had been attempted and the patient’s insurance company detailed incorrectly.
If standards had been raised to ensure this was checked and spotted the invoice would have been immediately processed.
There are no shortcuts if you want to get paid.
As it happens in this case the issue was already a week old before I took the phone call.
Thus an increase in cash flow – the outcome desired by the private consultant – was not being reached.
However, if you stop to think there are two questions:
When the patient was registered, why wasn’t the check performed to ensure the right insurance company was recorded because it should have.
What should have happened was the standards had been set too low.
If it becomes a case of the patient MUST be asked i.e standards are raised then this specific problem is never allowed to arise.
And that’s what I mean by raising your standards.
So why is this even more crucial as we work our way through 2020?
Because more and more private medical insurance companies are insisting invoices be submitted electronically.
The issue is not one of is that the right thing for them to do or not.
The real issue is that it is happening and standards must be raised to ensure you CAN invoice electronically.
In other words, if you don’t have all the right details it is much, much harder to process an invoice electronically.
You will instead have to re-contact the patient and get the right details.
Therefore it makes more sense to say you MUST get the details upfront and you must RAISE YOUR STANDARDS to the point of saying – the correct details MUST be obtained and checked.
I’ve even witnessed where an invoice can’t be processed because the postcode has been recorded as W01 (numeric) when it should say W01 (alpha) Incidentally.
Many times I’ve said insurance companies are not the enemy.
Even if I frequently disagree – I do on a daily basis sometimes – with some of their fees plus other items they do which are seriously irritating, all insurance companies will pay a private consultant IF (and only if) ALL the details are correct.
In other words, invoices must be raised to the correct standard.
Never quit. Aim to be a winner instead.
If you want to increase or improve your cash flow, the very first thing to do is to raise your standards in the area of invoicing.
pete@medicalhealthcaremanagement.co.uk
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Insurance companies use medical coding to detail a medical procedure.
For example: an Orthopaedic surgeon will understand what a Multiple arthroscopic operation on the knee (including meniscectomy, chondroplasty, drilling or microfracture) is.
That is a lot to put on an invoice!
The CCSD code W8500 will identify the procedure.
Put this code on the invoice instead.
Codes can be found on the CCSD website:
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the major healthcare insurers.
The Group’s purpose is to maintain a common standard of procedure codes.
A CCSD code is imperative IF a surgical episode is required.
The patient should quote the code to his or her insurance company when pre-authorisation is being requested.
However, be warned.
The example above of W8500 does not come with a suggested fee.
The rate for each code is up to the individual insurance company. You need to contact them to discover what fee they will pay for each.
When an invoice is sent to the insurance company, the code should appear on the invoice. It will reconcile to that expected.
If you do NOT use CCSD codes payment will be delayed if made at all!
Without a CCSD code, you will not be able to invoice electronically anyway!
pete@medicalhealthcaremanagement.co.uk
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