I’m a contractor.
I provide an outsourced service for my clients.
I run my business to generate an income for me.
Notice all three of those sentences started with the word “I”?
But when I (sic) go and see a potential new client or even an existing one, I always remember it’s not what I want that is important. The word ‘I” e.g. generating an income for me, is the last thing of interest to the potential client.
What is important is to never forget the potential or existing client is much more interested in what I can do for THEM.
It is truly surprising the number of businesses and indeed individuals who forget the person to whom they are speaking is interested primarily in one thing THEMSELVES.
Whilst this does not mean the entire world is full of totally selfish people, it does mean that people are much more interested in what I can do for them than what having them as a client can do for me.
All of my clients are medical professionals.
Without stating the obvious, they all have their patient’s well-being at heart.
But that does not mean they have my wellbeing at heart because (a) I’m not a patient (b) I need to produce results for them.
If I were a patient it’s pretty much guaranteed they would have my interests at heart.
But I’m not.
I need to produce results for my clients otherwise I’m history.
Recently I blogged about a potential supplier who didn’t return phone calls to me. During the final conversation and in a desperate attempt to secure my business he came out with the classic:
“But Pete your order really IS important to me!”
That had the opposite impact than he desired for I’m not in the slightest bit interested if it’s important to him.
I’m only interested in what giving my business to him can do for ME.
Think about it. You don’t walk into Starbucks for coffee because you are interested in them.
You walk in because you want a coffee.
By all means, Starbucks will satisfy your thirst in pleasant surroundings too but never will they think you’ve gone in just to help them sell coffee.
It is just the same as my clients are only interested in what I can do for them.
And I never forget it.
Having said all that, I recently had a bad chest infection. Being self-employed you can’t call in sick so I duly attended a meeting with one of my clients.
He is very interested in the results I produce for him. That is why he uses me.
He was pleased to see HIS business was in good hands. A good result for both of us!
Afterward, though he started asking questions about my cough, cold, how long I’d had it, etc.
He then went on to give me some antibiotics.
I did think it was funny that I’d gone to see a client and ended up having a medical appointment with him.
Especially as he’s a gynaecologist.
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A Consultant Surgeon performs an AB1234 worth £525.
At the same time, he performs a DC2468 worth £576.
The patient is insured so an invoice has to be submitted for payment.
Therefore you have to calculate the fee payable by the insurance company.
Total is £1,101.
You can’t charge a total of £1,101 i.e. both.
You can only charge 100% of the first code’s fee (£525) and 50% of second code’s fee (£576) i.e. £525 plus £288.
Total is £813.00
The problem though is that fee calculation is also wrong.
You should charge as follows – 100% of the higher fee and 50% of the lower fee. In the above example, it’s been calculated the wrong way round.
The correct calculation is:
£576.00 for the DC2468
£262.50 or 50% of the AB1234 fee
£576 plus £262.50 =
The potential gain for the consultant is therefore £25.50.
Or look at it another way, if you charge it the wrong way round, the consultant will undercharge and loose £25.50
It becomes a bigger issue as most surgeons perform the same procedures many times a month.
The same error repeated 10 times costs £255 each month.
How easy is it to make such an error?
Very, very easy.
If the consultant surgeon supplies a theatre list most likely he’ll have the codes written down.
But it’s a danger to assume they are written down in the order they should be invoiced.
You must check them and make sure you are billing codes in the right order if you are to ensure the consultant gets paid the right fee for his work.
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In one single sentence the cornerstones of how a private consultant surgeon can achieve the financial reward for all his efforts.
Every single time you perform an outpatient clinic the details are passed on.
Invoices can then be raised and sent to either an insurance company or self-funding patient for payment.
Every single time.
Do NOT make the mistake of collecting them ready for “later in the month” because “later” never comes. Or at the very least you are risking an issue coming up which will either delay or cause invoices not to be raised at all.
Instead after every outpatient clinic the details are passed over for invoicing. I’ve got some clients who actually take a photograph of their clinic list on their smartphones and send it to me securely. It’s a ritual with them.
Is it any surprise such private consultant surgeons get paid quickly? Other MHM clients have the clinic list (s) sent over every Friday afternoon without fail. They get paid quickly too.
It’s a ritual for them.
Contrast that with another MHM client who sends all the data over infrequently. Sometimes at the end of each month or more often than not every couple of months or so.
This client does not get paid as frequently as the others. The reasons are somewhat obvious.
Ritual is also applicable when dealing with excess or shortfall payments. The moment you are notified, you MUST action them for the longer they are left unattended the danger of non-payment increases.
I check every single remittance advise a private medical insurance company sends in. Any and all shortfalls/excess deductions are actioned the very same day.
It is a ritual.
Religiously – MHM check every single piece of data BEFORE an invoice is submitted for payment.
The policy number is checked to see if it has changed.
The patient’s date of birth and postcode is checked to see if that has altered.
The CCSD code is checked and the fee also checked against the appropriate insurance company’s fee schedule.
If there is a discrepancy, it is corrected.
Then – and only then – is the invoice submitted for payment. Religiously.
So how does just doing these two things contribute so much to a private consultant surgeon achieving his rewards?
Both cut down the opportunities for payment to be delayed, queried or not made substantially.
The crazy thing is the one piece of “equipment” used more often than any other at MHM to ensure both are achieved with the minimum amount of distress both to MHM and its clients?
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What follows is absolutely real and why medical invoicing can be more troublesome than it need be.
One of my guys ran an outpatient clinic last Thursday
The clinic list arrived with me on the following Monday. There were 8 patients: 3 initials and 5 follow-ups.
Within 30 minutes 7 invoices had been produced and delivered to the various insurance companies. But that final EIGHTH invoice caused significant issues. Why?
The patient’s insurance details had not been recorded correctly.
So I rang my client’s medical secretary and ask if she knew what they were. The FIRST phone call – I’m told the patient is with insurance company A but did not know his policy number. Length of the phone call: 5 mins
A SECOND phone call was necessary. This time to the insurance company. I was on hold for 11 minutes to this particular insurance company which is about normal for an insurance company. Some are 4 – 5 minutes. With some, you are on hold for considerably longer. Once I got through however despite having the correct name, date of birth and postcode I was informed the patient’s policy had lapsed.
Length of the phone call: 11 minutes plus 5 minutes = 16 minutes.
A THIRD phone call was made. This time to the patient. Answer machine so I left a message to call me back. He did. The patient confirmed it was totally the wrong insurance company. He told me the correct insurance company but did not know his policy number!
Length of phone call(s) 5 minutes
A FOURTH phone call to the other insurance company. Placed on hold for TWENTY-THREE minutes! Finally, get through and I’m advised the correct policy number, etc. Invoice raised.
The total length of phone calls: 49 – FORTY-NINE MINUTES!!
There is no problem with spending 49 minutes on the phone; none whatsoever.
But just consider the problem if the medical secretary at the same time as that had patients trying to speak to her? Or she had correspondence to get out? Or she had clinics to book? She would have struggled for sure.
Finally, consider how much easier it would have been if the patient had been asked to bring a copy of their insurance details with them when they registered.
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Don’t say – “all the details should be obtained”.
Say “all the details MUST be obtained”.
In other words, turn “should” into a must. But why is this so important? And why must you do it every day?
Many clients have asked why mhm obtains payment so quickly from insurance companies or from a self-funding patient.
The number one reason is that I don’t use the word “should”.
I use the word must.
And that is why it is so important – the consultant surgeon gets paid quicker. When I work alongside a medical secretary – the most underappreciated person in any medical practice normally – I emphasise the absolute need to get all the patient’s details.
For example: make sure the details are correct, make sure the patient’s policy number is correct, make sure the patient’s date of birth and postcode are correct.
When should this be done? NOW. It should be done every single time you have a patient in front of you or are reviewing a patients details.
Once all the details are correct – as they must be – the chances of getting paid increase dramatically.
This isn’t done in an aggressive manner at all. Far from it. In fact, 99.9% of all med-secs understand the reasons why and are only too glad to help. Most likely because most med-secs do not like “accounts” or “having to chase for money”
In other words, it is a state of mind. It is a state of mind supported by the very strict adherence to a number of routines. Actually the word routine itself is not a strong enough, It’s a discipline. It is the discipline to make sure all the details are obtained when the patient registers. It’s the discipline to make sure the clinic list is sent down to me every single week. And finally, it’s a discipline to make sure all the invoices are raised, checked and delivered either to an insurance company or direct to a self-funding patient.
And that’s why mhm clients get paid so quickly.
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All MHM clients are very dedicated individuals. Having spent approximately 15 years of training and to become a consultant surgeon, they then go on to work incredibly long hours.
They do so because they actually love what they do.
All at some point, however, have taken the decision to start a private practice.
It’s unlikely they would be my clients otherwise if you think about it. They start a private practice because they wish to make more money doing what they love. To have any other objective is either (a) silly or (b) engaging in self delusion.
There is no shame in admitting you start a private practice to make more money.
At that point however your private practice becomes a business.
As I’ve blogged many times, it must, therefore, be run as a business. A business with more than a little social conscience but nonetheless still a business.
Yet, sadly, many consultant surgeons make the mistake of believing their practice/business will grow and make them rich if they continue doing what they love to do. Sadly that is not true for doing what you love seldom leads to long-term financial success.
And that means, as much as you love being a Private Consultant Surgeon, you must measure the performance of your practice/ business.
This is the point the private consultant surgeon realises he/she must learn to understand financial analysis i.e. the numbers. It’s not all that complicated actually.
Supplying data to your accountant every year isn’t the same as understanding the numbers behind your practice though.
Let me give you a real example.
I was contacted recently by an established private surgeon who, he claimed, appeared to be working all the hours God sends but said he was always broke.
It didn’t take long to work out why.
The first good indicator was a complete lack of financial analysis other than a tax report a little over one-year-old. No debtors ledger was available so the surgeon didn’t have any real idea how much he was owed.
It transpired both patients and insurance companies were only invoiced monthly.
So I took the last six months worth of clinic lists and checked how many had or had not been invoiced. Quite a lot had not.
I did the same with surgical episodes with the same result. This was followed by an investigation into how much had not been paid even if invoiced.
But it was also a simple case of adding up the total revenue generated for each month, calculating the total costs (room rental, monthly indemnity insurance premiums, secretarial costs etc) and subtracting one from the other.
Even if any type of provision was made for tax liability was ignored (bad move!) the results were not encouraging.
The really bad news is that the consultant looked very blank when I asked which percentage of patients were referred to him from which source i.e. how many GP referrals, private referrals, recommendations from previous patients, insurance company referrals etc.
It was clear this particular consultant had no real idea of how his practice or business was performing.
And that was and still is a very dangerous place for any business to be.
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An interesting question asked by a consultant in the process of starting her own private practice.
And a question I couldn’t really answer.
What I could do was interrogate, based on a month’s worth of outpatient clinic lists for existing MHM clients, how long established private consultant surgeons took for initial and follow-ups.
A number of different specialisms were covered. They included: three orthopedic surgeons (one foot, one knee, one hand). An ENT surgeon. A gynecologist. A dermatologist A GI surgeon, and an ophthalmologist.
The average time for an initial consultation was 30 mins.
Some were under 20 mins. Some much longer. But the average time spent was 30 mins. To further investigate why that amount of time was allocated, I asked each consultant why it took as long as it did?
And got precisely the answer I expected. Some patients required more time to examine, explain and discuss their condition than others. Not one consultant allowed a “maximum” amount of time.
When asked why, for example, they had allocated the length of time they actually had, most made the same comment. It was based on their experience together with the recommendations from colleagues whom they had asked.
To get an understanding from a private insurance perspective, I asked the same question of various insurance companies.
They too shared the view that 30 minutes was about right. All had no fixed time “allowance” for an initial consultation. Two, however, were concerned that one consultant only allowed 20 minutes for an initial consultation.
The same process was followed when the question of follow up consultation was examined.
Unsurprisingly, the time taken for a follow-up consultation was shorter.
The average time taken was 20 minutes. One consultant allocated just 10 mins; another 30 mins.
Yet across the various specialisms, the average was around the 20-minute mark consistently.
Again, insurance companies were asked the same question regarding follow-up consultations. Again there was no fixed time “allowance” for a follow-up consultation.
But the question remains for the consultant setting up her own private practice relevant. Why?
If she had allowed 60 minutes for a consultation, she would see only two patients per hour.
At say £125 per consultation, she would charge £250 per hour.
But if she allowed 20 minutes per consultation, she could see three patients each hour. She would be able to charge £375 per hour i.e. 50% more (£125/£250)
Whilst 60 minutes for a single initial consultation is most likely not required, it is the principle being looked at. The same would prove true of follow-up consultations if the fee were £95 per consultation. Two per hour = £190 whereas three per hour = £285.
Paradoxically, I have a somewhat pragmatic view as I suggested to the consultant just starting her practice. It is highly unlikely she would have so many patients as to require the question to be investigated as we have done here.
No MHM client, I’m very pleased to say, actually cared how long the consultation took. And that is how it should be. They were only concerned with providing the best medical care and attention they can.
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I’ve been asked to revisit why coding is such a big part of medical invoicing.
It is integral because without the correct code the chances of getting paid decrease dramatically. It is extremely unlikely if you wish to invoice electronically you will be able to invoice without a code anyway.
Insurance companies use medical coding to identify and detail a medical procedure. For example: if you are an Orthopaedic surgeon you will understand precisely what a Multiple arthroscopic operation on the knee is.
But that is a lot to put on an invoice. Plus there may be variations on such an episode.
Instead, put the code W8500 on the invoice. That will specifically identify the surgery you have undertaken.
As mentioned earlier if you are planning to invoice electronically you won’t be able to input the whole description anyway.
So where do you find the code?
Most codes can be located on the CCSD website: www.ccsd.org.uk
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the five major healthcare insurers – Aviva, AXA-PPP, BUPA, Simply Health and Vitality Health.
Its main purpose is to maintain a common standard of procedure codes. Such codes reflect current medical practice within the private healthcare sector. They are published as the CCSD Schedule of codes.
The various insurance companies will, therefore, recognise the majority of codes.
However, a word of caution.
Whilst the example above of W8500 will be recognised, a CCSD code does not come with a suggested fee rate.
The fee rate for each code is up to the individual insurance company concerned. To find the correct fee for the code, you will need to check with that insurance company.
For example, the W8500 mentioned earlier carries a fee of £615 for one insurance company. For a different insurance company, the fee may be £550. If you charge £550 instead of £615 by mistake, you will NOT have your fee increased.
If however, you charge £615 when it should be £550, your fee will be reduced.
Whilst not so important for consultations, a CCSD code is imperative IF a surgical episode is required. The patient must quote the code to his or her insurance company when pre-authorisation is being requested.
When an invoice is sent to the insurance company, the code should appear on the invoice, This will reconcile to that expected by the insurance company.
If alternatively, you do NOT use CCSD codes payment will be substantially delayed if made at all!
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Having analyzed where the private practice is both in terms of outstanding accounts, it is important to have a structured and rational action plan.
Why do it this way though?
On numerous occasions, MHM has been called in when previous attempts to resolve an accounts issue have failed. The number one cause of this failure is the tendency to mistake movement for action.
For example, one group of surgeons had previously ordered all outstanding invoices be resent to insurance companies and self-funders. This was always doomed to fail.
It didn’t take much to work out that if invoices hadn’t been paid in the first place as they were wrong, sending them out again wouldn’t achieve anything. It didn’t.
If you wish to reduce the amount of money you are owed, the first thing you should do is to ensure the amount does not get higher!
It was no mistake that the four blogs published this week appeared in a specific order. This was no accident. They appeared that way by design.
If you do not know precisely where you are now, you will NEVER reach your destination. Do not think you know where you are. Make sure your core data is robust, up to date and accurate. Then keep it that way! Otherwise, over time you will go backward.
You MUST ensure your invoices are completely accurate. INVOICE RIGHT = GET PAID RIGHT! This means checking your CCSD codes, checking the fee for each code across all insurance companies, checking you’ve got all the right patient details, etc. INVOICE RIGHT = GET PAID RIGHT!
There is simply no excuse for not posting payments to your debtor’s ledger.
If you do not, then very rapidly your data will become useless. Recently, a consultant surgeon claimed to me posting payments to a sales ledger was not as important as chasing invoices for he was in his words “more interested in what hadn’t been paid than what had”.
This almost certainly was the origin of £’000 worth of unpaid excess and shortfalls which he was horrified to discover existed but that he was completely unaware of.
If payments are monitored then identification of excess/shortfalls is quicker. It was also put your practice in the position of being able to do something about them. That must mean contacting the patient and having a robust process to ensure excess and shortfalls are collected. Failure to do so WILL cause all sorts of problems for you.
Do not mistake movement for action.
It literally is similar to building a house. If the foundations are not solid, the chances are the house will collapse. Yet some consultants make the mistake of “actioning” an accounts issue without establishing what really is the cause. Do not become one of them!
The bad news is whilst the original identification and investigation of each step should be allowed sufficient time to be completed correctly, as they impact on each other so much, implementation of an action plan, should be done all at the same time.
The ultimate management challenge – how to change but stand still all at the same time!
If you know what to look for and have devised action plans before, this whole process can take around two weeks. If you do NOT know what to look for and devote enough dedicated resources (and there are many, many more points than have been covered in four blog posts) allow for about 3 months worth of trial and error.
Most likely if you are experiencing issues with getting paid, not devoting enough dedicated resources caused the issue in the first place.
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Excess and shortfalls are the biggest headaches any private medical practice will face. You will not stop them despite what you may think so you MUST have a process in place to identify them and action them.
What are excess and shortfalls?
Just like your own car insurance when a patient takes out medical cover, the policy will have an excess. For example, the patient is liable for the first £100 or £250. The value of the excess will be dependant on the precise details of the policy.
Normally, lower insurance premiums are accompanied by higher excess amounts and vice versa. You may, of course, ask the patient what excess his/her policy has and that will help. But that will NOT stop you from having excess deductions made against any payment for your services made to you.
Each private medical policy will have its own maximum entitlement figure. This is known as the benefit payable.
For example, the total benefit that may be paid out under a policy says £12,000 in any one year (just an example to illustrate the point).
That seems fine until you realise the average cost of a hip replacement in the UK is currently around the £11,500. If the patient requires additional consultations (say £500 worth) and additional costs appear (another £350 for example) then the total cost will soon exceed the total benefit of £12,000 i.e. the total medical fees of £12,350 is greater than the benefit payable.
Thus the shortfall (the patient’s liability) in this example is £350.
If there is already a £100 excess on the policy and a £350 shortfall, the patient’s personal liability to you will be £450.
This may be an extreme example but it is the principle that is important to understand.
In reality shortfalls and excess payments are normally around the £75 to £100 mark respectively. That doesn’t seem a lot but have 10 shortfalls/excess a month and over that one month, you will be owed £750 by your patients personally.
Over a year you will be owed £9,000.
That is why excess/shortfalls are one of the biggest problems faced by a private consultant surgeon.
Once shortfalls/excess have been identified (preferably as they are actually deducted from payments made to you), you must have a robust process in place to manage them. That can only be done one way.
You MUST CONTACT THE PATIENT, there is simply no alternative.
The first thing to do is to send your patient an invoice for the excess or shortfall.
This should include how much to pay and how to pay it. If this invoice is ignored by your patient then the best solution is to telephone the patient and ask for payment. The longer an invoice for excess or shortfall remains outstanding, the likelihood of it being paid reduces.
You must act quickly: preferably every single week.
Whatever you do, therefore, do NOT under any and all circumstances leave excess and shortfall amounts unattended.
Excess and shortfalls can simply build up and up to the point where you realise you are owed thousands and thousands of pounds with little chance of getting paid.
Consider it this way.
You cannot prevent excess and shortfalls from happening.
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It ranks up there with not sending an invoice out in the first place.
It is the number one complaint a private consultant gets from patients about his/her billing process.
It’s also a critical element in identifying one of the major causes a consultant has overdue and outstanding debt
What is it?
Handling payments are just as important as all the other sections of a billing process.
And it’s fairly easy to get it right. But if you get it wrong, you will have major issues. If you think about it it is the other end of the billing process journey. The invoice goes out. The payment comes in. That is what makes it important.
Handling payments should be tackled as follows. When payments are made to you either by an insurance company or a self-funder they must be recorded. They must be reconciled against your debtor’s ledger the same day.
In the real world, this isn’t always possible. In that case, reconciliation must be at least weekly.
Should you choose not to handle payments correctly, you can easily send a reminder to a patient who has already paid. That will make your practice look unprofessional.
All insurance companies will send a remittance. Or you can access your remittance(s) online. It is a very simple matter of reconciling them against the funds received and then recording the payment on your sales ledger.
If you send a reminder to an insurance company and they have already paid that too will make your practice look unprofessional.
There is however another critical reason why YOU MUST PAY CLOSE ATTENTION to payments.
The remittance advice which accompanies a payment will detail any shortfall or excess deduction in the amount actually paid to you.
A real-time example: MHM generated £1,191 worth of invoices recently for a client and sent them electronically to a single private medical insurance company. Payment will be made on Friday this week but is only for £851. WHY?
Because the deduction of £340 is a mixture of shortfall/excess amounts.
In other words around 30% or £340 of the invoice value will NOT be paid.
30% is generally speaking around the level of shortfall/excess amounts that will be deducted from a payment you will receive. It can, and does, varies from week to week.
In most cases, this is the first opportunity you will have to identify such items. We’ll be talking about how to handle shortfalls and excess tomorrow but at this precise point, you must start with the basics.
Are you handing payments correctly and does this process confirm how much you have been paid either in full or in part?
When you are paid and the details appear on the remittance, you must tackle the issue of shortfalls/excess.
If you do not keep a very careful eye on which invoices have been paid in full, you will almost certainly not keep an even more watchful eye on shortfalls/excess.
And that will have a huge impact on the amount of money you think is owed to the practice. You could easily be owed LESS than you think which would appear to be positive but could turn out to be a major problem.
If you don’t handle payments made efficiently, you could have all sorts of shortfalls/excess amounts that have never been identified and thus never actioned.
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What do I look for? Precisely where the Practice is now.
When? The very first day
It seems the most obvious place to start. It is. But numerous times a practice doesn’t really know what is happening in terms of invoicing and billing. That, if you think about it, is crazy. It may well be the practice principals think they are owed too much money but seldom do they consider the three most fundamental question of all before they may reach their conclusion.
In any event “think” is not good enough. You need to know. You MUST answer three fundamental and parallel questions FIRST.
How much are you owed?
Do you know how much? How can you be so sure it is the total amount you are owed? Does it include every single piece of work undertaken in the practice?
In other words, is there a sales ledger (sometimes known as a debtors ledger)?
You would be surprised how many times I’m told the figure is £X based on a sales ledger the practice accountant produced four or even five months ago for the last financial year end of the practice. All that does is confirm the position a number of months ago. That is not good. The data should be no more than 30 days old i.e. if it’s Nov 26th today then that data should be no older than October 31st.
Therefore you need to ensure the information really does confirm how much you are owed. Does it?
If the data is “out of date” then that may indicate it too is inaccurate. For example: if the sales ledger indicates most of the money is overdue then the supplementary question of “who says?” springs to mind. For certain, taking the above example of a report being between four or five months old, some of the amounts WILL have been paid either in full or partially. How many have been paid? Have such amounts been allocated to the sales ledger? Was such an allocation accurate?
Therefore you must make sure the information you are looking at is the most recent that is available. Is it?
For example, I recently reviewed the sale ledger of a private practice covering three surgeons who were firm of the opinion they were owed “a fortune” by the various private medical insurance companies. Yet when the analysis was completed between 20-30% of the overdue balances were actually down to shortfall and excess payments. They aren’t due from any insurance company; they are due from patients.
Therefore you must make sure you really do know who owes you the money. Are you sure?
Look at it this way: you may have the greatest sat nav on the planet in your car but if it cannot confirm precisely where you are, don’t bother telling it to route to Glasgow. Or London. Or Birmingham. It won’t get you there!
Tomorrow: we’ll look at how invoices are being raised now, what they contain and how they are sent out.
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An email arrived last week asking me to call a prospective new client.
He’d been reading my blogs and wanted help to grow his practice.
In particular, he wanted a review of the performance of his practice and asked if I would call and arrange to go see him. In his email, he said he thought he should be seeing more patients and his current patients should be paying quicker too.
I don’t even charge for this as occasionally there are only minor items that require attention.
So I called the telephone number provided and was promptly put on hold.
Nobody expects to have a phone answered immediately every single time. It’s not normally a problem.
Or is it?
Where I did have a problem with this particular call was being told “your call is important to us” every 15 seconds whilst listening to Bach, and I like Bach.
Whilst listening I looked at the consultant’s website.
It was very good and promoted the consultant really well. Details of his practice were impressive. The photograph of him on his website was very professional. The contact page was really good.
A “Frequently Asked Questions” page was very comprehensive. A “contact us” page contained phone number, email address, and location. They were all available for the patient to see.
Meanwhile, I was still being told “your call is important to us” and was listening to Bach.
Then I started to think about it from that point of view.
If I’d have been a patient wishing to make an appointment I might well have hung up by now and called another consultant.
The patient may have been referred to that particular consultant by his/her GP or even by an insurance company so from that point of view the patient remains on hold and waits.
But what would happen if the patient had not been referred to the consultant by a GP or an insurance company?
In other words, he had a choice.
All patients have a choice.
A private consultant surgeon is in the service industry. It may be medical but it is still a service. And that means the service must be first class. Not just first class medical treatment.
The level of customer or patient service is a big factor in the patient’s choice.
Every single part of the patient’s journey, therefore, MUST be 1st class.
That most definately includes having the phone answered promptly.
It’s the little steps that matter when you are running a business and a private medical practice is a business.
Charge the right fee.
Make sure you invoice quickly.
Take steps to collect all outstanding shortfalls and excess amounts.
If the practice is difficult to contact the number of patients will drop.
When I finally got through and spoke with the consultant we agreed to meet next Wednesday.
One of the items for discussion will be his patients struggling to actually speak to his practice in the first place.
If you want a quick review of your practice send me an email!
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I left school more years ago than I care to remember. Then as now I make sure I do my homework though. The only difference is now I do it for private medical consultants some of whom are thinking about starting a private practice.
All of you have done your fair share of homework in the past. The journey to becoming a surgeon is not exactly an easy one. Lots and lots of work, study and long, arduous hours. There is lots of homework on the way too. Followed by even more work, study and long arduous hours. There is even more homework thrown in after that. Then you are qualified. But to start a private practice add on about five years of post qualification experience and hey presto you decide to open a private practice! That is more or less the path a surgeon (friend of a current MHM client) took. I was asked to go chat to him about starting a private practice.
As the geographic area concerned contained a major urban conurbation, the population numbers were high. So that ticked the first box!. There were three private hospitals within a 25-mile hospital too. The second box ticked. When I checked the number of consultants at each hospital (Google is a mine of information) there were 22 at the first, 15 at the second and 15 at the third. The third box ticked.
I’d done my homework and established there was a demand for my surgeon’s specialism within the area.
The surgeon, when we spoke, was really pleased to hear the results and was in no doubt my homework confirmed he would be able to start a successful private practice.
It was that last item – the number of consultants already in place – that concerned me.
Could it be that the demand for his specialism was already being satisfied by the 52 consultants already providing his specialism? My surgeon friend would have to compete with those consultants. He would have to market himself to potential patients and see enough patients to make his private practice pay. His fees from private insurance companies would have to be sufficient to cover his costs AND make a profit. He would have to provide all the support facilities to run his private practice which would cost money. Then he would, of course, have to pay tax on whatever was left.
Let me be clear I was NOT saying don’t start a private practice. I was suggesting that the demand for his specialism might already be satisfied by his competitors. He should, therefore, be fully aware of the difficulties he would face BEFORE he started his private practice.
All because I had done my homework.
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Banks are desperate to phase out cheques.
This is due to the cost of processing a cheque from the bank’s point of view.
Yet the decision was taken not to, as planned, phase out cheques completely by 2018.
It just is not going to happen. Cheques it would appear are here to stay.
But still, a number of consultants are reluctant to accept debit/credit cards.
Many MHM clients have endured problems with obtaining payment from self-funders and/or payment in respect of shortfalls and excess payments.
Even when a cheque has arrived, it must still be taken to a bank and paid in. And that is precisely why MHM has always advocated that a consultant must be able to take payment over the telephone.
In certain cases, dependant on the size of the practice, they should also be able to take payments online.
Yet this presents a dilemma for the consultant who believes rightly or wrongly that he/she cannot afford to accept payments over the telephone.
To MHM this is a false economy because frankly, we’d rather meet the cost of processing a debit or credit card payment ourselves than the client not get paid at all.
That is precisely what we did.
And it’s why MHM clients have a low number of outstanding self-funding patients and a low number of outstanding shortfall/excess amounts.
Just imagine the situation when the patient calls and offers to pay the account only to be told the consultant can only accept a cheque or a BACS payment?
In this scenario we are, at that precise point, actually refusing the offer of payment from a patient.
That cannot be a sensible approach for private medical practice, as a business, to take.
If the private practice is a business (of course it is) then it must conduct its business in an efficient manner.
To do otherwise leads to inefficiency and thereby a reduction of maximum profit available. As long as the payment methods are not to the detriment of the patient.
We once infamously advised a potential client, we were NOT prepared to charge the patient an extra 5% if paying by card.
The answer to the question is a resounding yes!
Indeed, whilst writing this blog I looked at my own cheque book. I’ve written out ONE cheque since October 22nd, 2014. All payments made by MHM have been by BACS, standing order or debit card.
Yet I must have processed hundreds of debit card and credit card payments over the telephone on behalf of MHM clients in respect of self-funding invoices and/or shortfalls and excess amounts.
Do you need to take card payments over the telephone?
Well, we do for our clients anyway!
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A little over a year ago, a group of surgeons based in the south west of England contacted MHM. In an effort to reduce a large number of issues with outstanding self-funding debtors, they had decided to ask new self-funding patients to pay for their initial consultation in advance.
I have to say my initials thoughts were this would absolutely stop any issues with self-funders. It would do so for one very unfortunate reason. There would be no self-funders at all because they had refused to pay in advance anyway. The patients went to see other consultants instead.
And that is exactly what happened.
Hence the phone call to MHM with an instruction to establish a process whereby issues with self-funders were substantially reduced but not at the expense of turning patients away.
If you’ve read previous blogs you’ll already know how to process self-funders and the major reasons behind outstanding self-funder debts.
The MHM process does not, and absolutely should NOT, suggest asking the self-funder to pay everything in advance!
It is not the way to solve the problem.
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Two codes AB1234 £619.00 and XX2468. £124.50. Total £743.50.
It came, as somewhat of a shock to be told therefore the amount being paid to the MHM client was only £24. How can this be???
Basically, because someone at the insurance company deducted a £100 excess but by mistake recorded the AB1234 as excess also.
So instead of being paid £743.50 less £100 excess i.e. £643.50 the MHM client was out of pocket by another £619.50.
As a result, a phone call to the insurance company followed and the insurance company accepted they made a mistake. In the real world, insurance companies do make mistakes.
Took 30 minutes to sort it all out but think about it. That 30 minutes mean you are getting paid what you are entitled to.
Are you confident your fees are being paid correctly and mistakes aren’t being made?
How do you know? Have you checked?
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A shortened version of a recent conversation with a well established private consultant surgeon.
Very recently one of the major PMI players announced a further reduction in payable fees. Definitely applicable to newly recognised consultants in January 2015, the fee reduction does not apply to those recognised previously. Ot at least it didn’t.
But it does now.
The immediate retort from another very well established MHM client was to pass any reduction on to the patient. That’s all well and good but not if she is fee assured with the insurance company concerned. I actually checked just to be sure. Yep; if a fee reduction is passed on to a patient by a fee assured consultant, the consultants recognition may be put at risk.
None of the above means MHM agrees with insurance companies reducing fees – even though market forces may on occasion be the root cause of such reduction. By all means argue with the insurance company. And I already am.
But…don’t rely solely on that argument and assume the argument fees should not be reduced will be successful. It might. There again it might not.
Instead make sure you are charging the very maximum you can. Make sure you are charging for everything you do. If the surgery takes twice as long as expected, request an uplift fee. If a double consultation is required, charge for a double consultation. Its not as difficult as you may think it is.
And don’t forget to do a sanity check each month. If you think a 20% reduction in fees is bad, consider the 100% reduction if you fail to charge an entire consultation.
Whilst the question of where fees will go will be considered in future blogs, its important before even thinking about your fees to make absolutely sure you are charging the right fee already. You’d be surprised how many aren’t!!!!
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MHM sort of cheats when we say we are an outsourced medical biller.
We don’t share premises with our consultant surgeons nor are we next door to the hospital. Neither do we speak to them every single morning when they walk through the door. We are – literally – miles away from our clients. And so we cheat.
It matters little that we are, in one case 160 miles away from the client or in the case of another 16 miles. We could, in fact, be 16 feet away. The result would be the same. We speak to our clients every day in the first few months. Then it tails off to say twice a week. Then it becomes once a week. One client speaks to us approximately every two weeks.
Why do we let this communication tail off? Actually, it doesn’t. It just changes.
At first, there are hundreds of things to do. There is a lot to understand, and, usually many issues to resolve. As time goes by though and as the process kick in the number of issues reduces and the need for very frequent contact reduces in turn. We also know that consultant surgeons always seem to be chasing the clock. But if communication comes to a full stop then that’s when the problems start.
Once a month a FULL analysis of where the medical invoicing and outstanding accounts stand is produced and sent to the clients. Some read it. Some email and phone with questions. After a passage of time and because the cash is flowing in, most ignore it. Yet still, a monthly report is sent out. Without fail.
But..then we cheat even more.
We go and see the client every two to three months and sit down with them (sometimes for no more than an hour) to chat through problems, meet their med-secs, and, get to understand how they feel about things. Are there any areas they think or feel should be better? Are there areas where they thought it was worse than it actually turned out to be?
In short, a very open yet extremely robust management reporting process underpinned by the opportunity to physically meet and ensure that issues don’t become major problems for both of us leads to a healthy and frankly cash positive result all round.
So..what has YOUR experience of outsourcing been? What are YOU looking for?
I already know what you are looking for – a solution to your medical billing problems or, in simple terms, to get paid quicker with less hassle.
Let me know what else you are looking for, please?
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I’m a really, really impatient person. I like everything done yesterday.
Which is why I go incredibly slowly to start with.
When I begin to raise invoices for a consultant surgeon, for example, I’ll check I have the right provider number. I’ll check all the online systems and EDI protocol are 100% accurate. Is the consultant’s address correct?. I’ll check the insurance company has the right BACS payment details.
What I’m actually doing is reducing down to absolute zero as many reasons as I can possibly think of that will prevent the invoice being raised correctly.
What happens if I don’t take this approach?
Invoices come flying back. They don’t come back straight away of course.
It may take weeks before I’m notified there is a problem. Then I have to work out why it went wrong, get all the details to put the error right, actually put it right and then resubmit the invoice.
Then I have to wait again for the invoice to be reprocessed. Eventually, the invoice gets paid.
One absolutely true example. Recently MHM project managed a group of three surgeons in the Midlands. All three were seriously considering closing the practice as they were not making any money. They were not getting paid as they should.
The senior of the three was responsible for invoicing for all three each week.
Just under 50% of the invoices he produced came back unpaid. The insurance companies concerned requested more details or raised query against them.
The senior consultant complained he hadn’t got enough time to keep sorting these things out. He had to raise invoices as quickly as possible. He tended to view any medical invoicing problem from the “quickest fix” point of view. To use his words “I only want to be a surgeon and not a whatever-you-call-it”
My kind of guy. Don’t talk about it. Get on with it. Play to your strengths. Save that is precisely what he was not doing.
He jokingly told me his blood pressure was sky high due to the constant stream of invoice problems.
Yet it was this “quickest fix” approach that was the cause of his blood pressure. Many times his quick fix in one area (get them on the phone or treat the patient as a self-funder for example) caused a problem in another area. Then he had to fix that.
This was leading to a six /seven-week delay before invoices were accepted by insurance companies on top of the agreed payment terms.
It took me two months to re-map the process, test, amend it and bed it in. In month three we started to see the results. Invoice failure rate had dropped from roughly half to below 6%. Cash flow had doubled. The time with which the three consultants got paid decreased from around every 75 days to about 50.
All three consultants were happy. Imagine the surprise though when I told them that wasn’t good enough?
I thought we should see at least a 98% acceptance rate and to be paid every 30 days. And I wanted to achieve that as of yesterday starting with raising the invoices every single day rather than weekly. The invoice process was robust. There were very few errors. There were few reasons why we shouldn’t be paid.
Told you I was impatient.
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