All MHM clients are very dedicated individuals.
Having spent approximately 15 years of training and finally becoming medical professionals, they go on to work incredibly long hours.
They do so because they actually love what they do.
All at some point all 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 anyway.
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 money.
As I’ve blogged many times previously a private practice must be run as a business – a business with more than a social conscience but nonetheless still a business.
Yet, sadly, many consultant surgeons make the mistake of believing their practice 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 you must measure the performance of your practice.
This is the point at which the private consultant surgeon realizes he/she must understand financial analysis i.e. the numbers.
It’s not all that complicated. 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 medical professional. He claimed 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.
He didn’t have any real idea how much he was owed.
Indeed 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 case of adding up the total revenue generated for each month, calculating the total costs (room rental, monthly indemnity insurance premiums, secretarial costs, etc). Then one was subtracted from the other.
Even if any type of provision was made for tax liability was ignored 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.
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.
pete@medicalhealthcaremanagement.co.uk
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Most consultants when they first start a private practice, consider how best they can set their fees.
In the case of self-funders, there is nothing to stop you charging any consultation fee you like.
Save of course if there are other consultants in your area then their fees will influence that which you charge.
Effectively it is up to the patient whether they chose to accept that fee or not.
In reality, in the case of an insured patient, it is not the consultant who sets fees.
It is the patient’s insurance company.
Consideration of fees for an insured patient should be viewed from two distinct areas:
1: Consultation fees
2: Surgical Fees
Consultation fees (for both initial and follow up) will be agreed at the point of recognition by the respective insurance companies of the medical professional e.g. consultant surgeon, anesthetist, etc.
The insurance company with whom your patient is insured will always set surgical fees.
You may feel the fee is too low and therefore try to charge more.
Almost certainly your invoice WILL be rejected.
Keep sending invoices in for fees greater than that allowed by a particular insurance company and you run the risk of being de-recognised.
It’s not a good idea to be in such a position.
Whether it is right or wrong for insurance companies to hold such power over the setting of surgical fees is for another article.
I have very firm views on it but at this point, the stark reality is that the insurance companies do hold most of the cards.
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I had a discussion with one of my clients a few weeks back.
She was very firmly of the opinion patients should able to contact her secretary or her practice at any time of the day.
Respectfully, I disagree.
Patients may indeed be demanding on occasion but the idea of 24/7 is a step too far.
For example, MHM opens it’s phone lines from 7 am Monday to Friday. It closes it’s phone lines at 8 pm Monday to Thursday and 1 pm on a Friday.
However, during those hours the telephone is answered. And answered quickly. None of this “press button one for payments, press button two for appointments, press button 3, etc!
MHM never has done that and it never will.
Instead, the phone is answered.
Interestingly on more than one occasion, I’ve had a caller say to me “Oh a human being has answered the phone!”
Outside of those hours, there is an answering machine with a message stating when we are open and if a message is left we’ll get back to you within the hour.
There is also an answering machine if all the phone lines are in use. Calls are returned within the hour.
Not one single patient has ever complained about that.
Patients are human beings.
They are also human beings concerned with their health.
That’s fairly obvious but worth repeating.
It’s worth repeating because they deserve to be spoken to and not forced to just process their health inquiry electronically.
None of that means I’m against online bookings. Nor am I against using an answering machine. Far from it.
But only outside “normal” working hours.
Once patients are aware of when they can contact a practice and if they are confident, they will be looked after they will be happy.
That is precisely what I said to my client.
Sometime later she called me and agreed.
There is no requirement for 24/7 access.
But there is a BIG requirement for patients to be able to access her practice efficiently during “normal” working hours.
pete@medicalhealthcaremanagement.co.uk
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A CCSD code is used by insurance companies to identify a medical procedure.
An Orthopaedic surgeon, for example, understands what a Multiple arthroscopic operation on the knee is.
But it’s a lot to put on an invoice every time you produce one!
Put the CCSD code W8500 on the invoice instead. It will identify that specific procedure.
So where do you find a code?
A CCSD code is found 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, Vitality and Simply Health.
The group’s main purpose is to maintain a common standard of procedure codes. The codes reflect current medical practice and are published as the CCSD Schedule.
The various insurance companies will, therefore, recognize such codes.
Whilst the example W8500 above will be recognized, it does not come with a suggested fee.
The fee payable for each code is up to the individual insurance company concerned.
To find the correct fee for the code, the insurance company concerned should be contacted.
When an invoice is then sent to the insurance company for payment, the code should appear on the invoice. Both the code and the fee will match that expected by the insurance company.
If alternatively, you do NOT use CCSD codes payment will be substantially delayed if made at all!
pete@medicalhealthcaremanagement.co.uk
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The normal item when I get asked to review a consultant’s invoicing process is the potential for weakness in the area of records on his/her part.
Sometimes, I’m presented with a carrier bag full of invoices, remittances, and receipts.
My favourite though remains the cardboard box stuffed full of pieces of paper.
That was the filing system.
Close examination of the pieces of paper in the cardboard box suggested they were invoices.
Many in fact did not have an invoice number on them.
Indeed the majority did not actually have the word INVOICE printed on them either.
That can be a problem when I come to reconcile payments against such payments IF they’ve been paid at all.
That is important because it’s difficult to contact an insurance company and discuss invoices for one individual patient if the invoice does not show a specific invoice number.
In fact, the only way you can tell them apart is if the values are different and they are on different dates.
It’s always best to have a unique reference number on an invoice i.e. an invoice number and a date.
And don’t forget to print the word INVOICE on it.
At least that way, you stand a chance of knowing which ones have or have not been paid.
Then the hard part starts as you begin to look at what is or is not on the invoice and get a feel for what was likely to be paid anyway and what was likely to be rejected due to total lack of detail.
Normally this is followed by a request to see clinic lists and the process of obtaining the right data off the clinic list for submission to the insurance company.
There is also an additional cost to not keeping accurate records.
When it comes to tax time, it’s going to take a lot longer – and thereby cost much more – for your accountant to do the necessary computations.
At worse you could end up paying too much tax.
All because records aren’t kept correctly.
Please keep accurate records if only because it means you stand a much higher chance of being paid!
Please email me if you want details of the bare minimum records you should be keeping for invoicing purposes.
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This issue came up recently with a consultant surgeon.
What is the difference between benefits and fees and how are fees accounted for against a benefits package?
Consider the total benefits payable under a patient’s policy. For example, the benefits payable is £100.
It could be more. The fees mentioned below could be higher too.
Against such a benefits package, fees are deducted thus:
Initial: £20.
£20 is paid out. The total benefits figure reduces to £80.
Subsequently, the patient requires surgery. £50.
This is also paid.
The accumulator reduces to £30.
Finally the hospital tenders their account: £20. The gasman submits his: £10. The benefits accumulator, therefore, reduces to ZERO.
The benefits package is equal to the fees.
However….
If the initial is £21, the surgery £51, the hospital £21, and the gasman £16 then the total fees = £109. Against a total benefits package of £100.
Thus, if fees exceed the total benefits a shortfall will be created.
pete@medicalhealthcaremanagement.co.uk
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I spent some time yesterday looking at the invoicing of a consultant surgeon.
I noticed that the invoices for initial consultations going out to one particular insurance company were being charged at exactly the same fee as for follow-up consultations i.e. £125 each.
Instead, they should be £175 for initial and £125 for a follow-up.
So… £50 multiplied by the number of errors spotted so far over the first month I’ve checked (9) = £450!
The bad news is that this has been happening for, so far as I can tell at the moment, for at least the last four months.
Potentially, £1,800 worth!
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A couple of examples recently where consultants who have tried to base their fees on the best rate available.
Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400.
He decrees he will charge PMI Company 1 the PMI Company 2 rate.
Great idea.
Right up to the point PMI company 1 receives the invoice for the higher amount.
They will decline to pay that fee.
Most likely they will shortfall it.
But, replies the Consultant, no problem.
The patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t.
Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable.
Carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling.
Continue doing it over a number of months and for sure eyebrows will be raised.
Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain the same by “inappropriate billing” is not the smartest way to go about it.
pete@medicalhealthcaremanagement.co.uk
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Every time I give a presentation to consultants wishing to start a private practice it’s pretty much guaranteed, I’ll get asked about having a website.
In particular, I’ll be asked – do I need one?
Short answer: YES!!
Ah! – Comes the response from a fellow presenter with a very well established practice – I don’t have one.
I don’t need one.
That may be so because he is well established.
But for someone just starting out being on the private hospital’s website, just being on the PMI website or on a directory of consultants is not enough.
Neither is, although still a big source of referrals, having patients referred only by a GP.
Patients are very switched on.
They will trawl the Internet looking for whom they consider being a suitable surgeon with whom to book a consultation.
They may still ask their GP for an opinion. And then be concerned if the GP recommends another surgeon because the surgeon is a friend of the GP.
What does the GP do if he doesn’t know a suitable surgeon?
Yep – he goes to the Internet too.
The bad news is that it is not just a case of building a website.
I call it the “build it and they will come” principle.
Websites need to be maintained and refreshed – at least every six months.
Then there is the question of social media.
MHM doesn’t build websites nor do we manage social media for its clients.
It’s far too complicated.
We just pass on the requirement to one of our partner organisations.
Based on the analysis of MHM clients with a website and those without, it is pretty clear those with a website see more patients.
You sure you can’t be bothered with all this Internet stuff??
How many of you still rely on GP referrals only?
pete@medicalhealthcaremanagement.co.uk
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At a medical conference recently a friend of mine was discussing the future of the private practice industry and what lay ahead.
My colleague shared the view that the “younger” newly appointed consultant is more adaptable to the direction of change in the private practice.
Thus they were a major driver in how the industry moves forward.
I say they are entrepreneurs.
Let me explain why.
Certainly newly appointed consultants cannot look forward to a hefty NHS pension at the end of their career.
The younger consultants are also facing a squeeze in fees from private medical insurance companies.
Not to mention they journeyed through a number of years to reach the position they are in now.
Yet they find themselves in an increasingly competitive market.
The market is more competitive than those who came before them.
The younger consultants are, so the evidence suggests, much more open to a business-orientated approach than before.
They have to.
In other words, the newly qualified consultant still has a mortgage to pay, mouths to feed, etc so is much more receptive to being an entrepreneur.
Say what you may but the fact remains the private medical healthcare environment is changing.
Just as the NHS healthcare environment is changing.
At the forefront of such changes will be the newly qualified consultant surgeon.
To adapt or take advantage of such opportunities as may arise, the new qualified are using technology as never before.
For example, they are much more amenable to the use of internet-based technology for marketing and PR.
They have to be entrepreneurial.
To prosper, let alone survive, they must invest in technology.
What is interesting is that they are more willing to do so than ever before.
To succeed with a private practice requires a significant amount of seriously hard work.
This is not to suggest the application of medical skills is not important.
It is.
Additional skills
But what is equally important are entrepreneurial skills.
Marketing, financial expertise, and business managerial skills for example.
These should not be assumed to be easy.
They now have to be acquired.
Consider that a consultant – newly qualified or otherwise – works within the NHS.
The NHS provides a support infrastructure including premises, secretarial support and, crucially, a constant supply of new patients.
In the private sector, none of these items will be supplied.
The consultant has to go out and actively find them for himself.
And that is why the consultant surgeon should be viewed as an entrepreneur.
Does anyone have a different view? I’d be delighted to hear from you.
pete@medicalhealthcaremanagement.co.uk
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One of the most common remarks I hear from my guys is the number of patients they see in the NHS.
They literally have patients queuing up to see them.
Such a comment is normally followed by the opposite when discussing a private practice.
This, for me, confirms the absolute difference between the public and private sectors.
In the NHS, a consultant surgeon does not have to do much in order for patients to be delivered to them.
In the private sector, the opposite applies.
In the private sector a consultant surgeon, because fundamentally a private practice is a business, MUST attract a patient.
He must engage in pro-active marketing.
He must ensure it is known his practice is there.
First of all, however, he must comprehensively understand WHY a patient is choosing to go private.
It is not merely the case of a patient wanting to be seen private because he or she has private medical insurance.
It is understanding WHY the patient has private medical insurance. I, for one, dispute it is because private care is better than NHS care.
More likely it is because the private patient wishes to be seen quicker.
Even so, a consultant surgeon MUST engage in marketing.
If the patient can be seen at the private practice quicker than at an NHS location but the patient is unaware the private practice exists then all bets are off.
Therefore a marketing plan of some description is an integral part of a private consultant surgeon’s business plan.
And therein lies the reference to the first and absolute cultural difference between an NHS practice and a private practice.
In an NHS practice, patients will be delivered to the consultant surgeon without him even asking.
In private practice, patients will not just be delivered. They have to be attracted to the practice or more accurately to the business.
Note the use of the word BUSINESS for a private practice is a business.
This is not the time to discuss which marketing strategies will and do work best for a private consultant surgeon.
This blog is more concerned with highlighting that due to the differences between the NHS and the private sector, a private consultant surgeon has no choice but to have a marketing strategy.
Just as a consultant must have a robust infrastructure to support the business (secretarial support, invoicing, banking, etc), it is equally as important to have a marketing strategy.
Look at it this way, if any business does not have a regular number of customers or clients (in the case of a medical practice PATIENTS) then inevitably the business will not succeed.
pete@medicalhealthcaremanagement.co.uk
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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them.
Before asking the question of why and how does a patient chooses you as a consultant an early question is asked.
Why have the patients taken out private medical insurance originally?
There are three major reasons.
Empirical research indicates most private healthcare originates via a patient’s employer. And the main reason for holding private cover is to avoid NHS waiting lists.
This is the primary reason patients have private medical insurance cover.
The second reason for having private healthcare insurance is that it offers the benefit of when and where.
Therefore, the patient can choose.
Aligned to this is the ability to recover post-surgery in a private suite and that may be more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you, it is useful to consider why the patient has medical insurance anyway.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
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We are in the people business.
That means you can’t run a private practice by email. Nor should you for we are dealing with people.
Reluctantly, that lead to one of the MHM clients having to dismiss his secretary in October 2019.
I’m one of the worst for trying to do things as efficiently as possible.
If I can’t see the point of doing something efficiently, I won’t do it.
But that does not mean I won’t answer the phone and speak both to patients and/or clients for they deserve some respect.
Ultimately, they pay my fees so they definitely deserve my respect.
It may not be the most efficient way of spending my time but nonetheless, if I don’t, I don’t make money. Simple really.
Yet the secretary referred to earlier didn’t understand that.
She was firmly of the opinion EVERYTHING could be done by email.
From answering a patient query to booking a patient consultation, everything had to be done (literally) by email.
When I called, the phone wasn’t answered. There was a message advising me to email her instead.
Potential or existing patients heard the same.
When she did reply – by email obviously – (normally the next day and that bugged me), her answer was often ambiguous. Thus another email was sent.
Another 24 hours and I received a second email that may or may not have resolved my issue.
Quite frankly if I had been a patient looking to book a consultation with her surgeon, I would not have been impressed that nobody could be bothered to even speak to me.
When I finally got to speak to her and complained she never answered the phone her response was magical.
She hadn’t got time to answer the phone because she had all these emails coming in.
So I risked certain death and pointed out, she was getting all these emails BECAUSE she wasn’t answering the phone.
Between January 2019 and September 2019, this particular MHM client’s practice hadn’t grown; indeed it had got smaller.
So much smaller that the client could no longer afford to employ a secretary and, instead, asked his wife to take over.
His wife started to answer the phone AND answer emails.
The number of emails reduced dramatically.
Patient numbers for October, November and December 2019 increased.
Thus far in 2020, patient numbers are going up again.
Therefore proving…
p.s. what inspired me to write this particular blog was a phone call I took from a patient this afternoon. I answered the phone and the very first thing the patient said was?
“Oh. You are a human being! I thought I’d get connected to a machine and have to press numerous buttons”
Think about that for a second, please?
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I left school more years ago than I care to remember.
Then as now I make sure I do my homework though.
The only difference is now I do it for private medical consultants some of whom are thinking about starting a private practice.
All of you have done your fair share of homework in the past.
The journey to becoming a surgeon is not exactly an easy one.
Lots and lots of work, study and long, arduous hours.
There is lots of homework on the way too.
Followed by even more work, study and long arduous hours.
There is even more homework thrown in after that.
Then you are qualified.
But to start a private practice add on about five years of post-qualification experience and hey presto you decide to open a private practice!
That is more or less the path a surgeon (friend of a current MHM client) took.
I was asked to go chat with him about starting a private practice.
So I did my homework.
As the geographic area concerned contained a major urban conurbation, the population numbers were high.
So that ticked the first box!.
There were three private hospitals within a 25-mile hospital too.
The second box ticked.
When I checked the number of consultants at each hospital (Google is a mine of information) there were 22 at the first, 15 at the second and 15 at the third.
The third box ticked.
I’d done my homework and established there was a demand for my surgeon’s specialism within the area.
The surgeon, when we spoke, was really pleased to hear the results.
He was in no doubt my homework confirmed he would be able to start a successful private practice.
He looked at me quizzically when I expressed my doubts
It was that last item – the number of consultants already in place – that concerned me.
Could it be that the demand for his specialism was already being satisfied by the 52 consultants already providing his specialism?
My surgeon friend would have to compete with those consultants.
He would have to market himself to potential patients and see enough patients to make his private practice pay.
His fees from private insurance companies would have to be sufficient to cover his costs AND make a profit.
He would have to provide all the support facilities to run his private practice which would cost money.
Then he would, of course, have to pay tax on whatever was left.
Let me be clear I was NOT saying don’t start a private practice.
I was suggesting that the demand for his specialism might already be satisfied by his competitors.
He should, therefore, be fully aware of the difficulties he would face BEFORE he started his private practice.
All because I had done my homework.
pete@medicalhealthcaremanagement.co.uk
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A couple of examples recently where consultants who have tried to base their fees on the best rate available.
Take the consultant who realises that PMI company Num 1 pay £300 for a procedure whereas PMI company 2 pay £400.
He decrees he will charge PMI Company 1 the PMI Company 2 rate.
Great idea.
Right up to the point PMI company 1 receives the invoice for the higher amount.
They will decline to pay that fee.
Most likely they will shortfall it.
But, replies the Consultant, no problem.
The patient is ultimately liable for any shortfall.
I know of one consultant who even puts on his website “we use PMI Company 2 rates to calculate our fees and therefore there may be a shortfall which you will have to pay”
Yes, the patient is liable for a shortfall BUT not when the consultant is fee assured he isn’t.
Most likely a letter addressed to the Consultant will arrive sooner or later from PMI Company 1 pointing out that such “inappropriate billing” is not acceptable.
Carry on doing it and recognition is at risk.
It’s incredibly similar to unbundling.
Continue doing it over a number of months and for sure eyebrows will be raised.
Even if there is no “fee assured” status PMI Company 1 will be well aware of regular and consistent charges that are in excess of their published fee schedule.
Notwithstanding the above, of course, consultants want the best possible fee for a procedure but attempting to obtain the same by “inappropriate billing” is not the smartest way to go about it.
pete@medicalhealthcaremanagement.co.uk
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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them.
Before asking the question of why and how does a patient choose you as a consultant an earlier question is necessary.
Why have the patients taken out private medical insurance?
There are three major reasons.
Empirical research for MHM clients indicates whilst most private healthcare originates via a patient’s employer, the number one reason for holding private healthcare cover is to avoid and cut short NHS waiting lists.
This is the main reason patients have private medical insurance cover.
But whilst private health cover gives prompt access to treatment, the second reason for having private healthcare insurance is that it offers the additional benefit of when and where the patient may be treated. Aligned to this is the ability to recover, if surgery is necessary, in a private suite, which is more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you as a consultant, it is equally useful to consider why the patient has private medical insurance in the first place.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
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I was at a medical conference recently and one of the speakers – a well-established consultant surgeon and an incredibly safe pair of hands – stated during his presentation that a private surgeon could not charge for inpatient care.
He may well be a safe pair of hands but on that point he was wrong.
After the conference, I had a word and said he was incorrect. It IS possible to charge for inpatient care.
I couldn’t help but suggest to him that the mere fact there was a separate code for inpatient care indicated it could be charged.
Obviously, it may well depend on the insurance company concerned. In principle, however, it is possible to charge. I knew I was right because I’d actually charged for inpatient care for an MHM client a few weeks earlier. And the invoice had been paid.
But he wouldn’t budge.
He was right.
I was wrong.
Skip forward a few weeks and I received an email from my consultant surgeon friend confirming that I had been right all along and he had been wrong.
Why is it sad that I had been right?
Because my consultant surgeon friend has been in private practice for well over a decade and he’d NEVER charged for inpatient care.
More significantly though, my friend had not checked each month what could and could not be charged for.
That also begged the question if the fees he was charging had been checked with the same frequency too. He hadn’t so as a favour I checked for him.
The good news is that only 3 of his fees had altered.
The bad news is that one of them had gone up £107 five months earlier yet he was charging the old and lower fee.
Thus it is important not only does a Private Consultant Surgeon need to establish what he can or can’t charge for, it is just as important to check HOW MUCH you can charge for!
pete@medicalhalthcaremanagement.co.uk
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Working for a consultant surgeon is fun.
However, since one particular private medical insurance company decided to outsource their help desk or their “advisors” late last year, there has been a marked reduction in their level of customer service from it.
Considering the people calling them are either consultant surgeons or calling on behalf of a consultant surgeon, that is pretty bad.
Indeed the average time on hold for this particular insurance company, for example, is now well over 30 minutes. That’s pretty awful considering it used to be less than a minute.
What is ironic however is that now I have a choice of music to listen to. For example: would I like to listen to classical music, pop music, jazz or rock music? I decided on classical as it happens and am currently listening to Bach. I like Bach.
But it has got me thinking…
Isn’t being given the option of what to listen to missing the point entirely? This is an even worse option than being told my “call is important to us” and then the call is unanswered. Shouldn’t the aim be to answer the phone call rather than offering a choice of music to listen to?
All private consultant surgeons sooner or later will need to speak to an insurance company.
Whether this is at the point they are attempting to gain recognition or to check a fee is correct is not relevant.
Sooner or later – particularly if you are billing an insurance company – you have no choice but to speak to them. But is it absolutely necessary to call?
That is my favourite question to ask.
The first port of call so to speak is always to consider if an action is necessary.
In other words, what is causing that action to be necessary and can anything be done to prevent the necessity of the action? In the case of speaking to a medical insurance company, in theory, many of the calls should not be necessary.
If an invoice is raised and submitted correctly for example then payment should – again in theory – just flow through.
Reducing the necessity of speaking to an insurance company is always a good aim. It is the very reason I check remittance advice sent by an insurance company most carefully.
They record many of the details as to why an invoice, for example, hasn’t been paid either in full or partially. For example: if a partial payment has been made the reason why will be detailed on the remittance advice.
Thus the number of calls required to a private medical insurance company will be reduced.
Nonetheless, the fact remains there will ALWAYS be an occasion to call an insurance company. It may be, for example, that the fee has been reduced and you don’t know why. The point is there may be genuine reasons why it IS necessary to speak to an insurance company.
Contrast this however with another insurance company I’ve spoken to this morning. I called them and was told I was on hold, was caller number 3 and the estimated hold time was 4 minutes. Fine; I can live with that. It is up to me whether I’m prepared to wait in line or call back.
Having formally complained to the medical insurance company in the first example that their customer service is not good four times so far in 2019, I did consider WHY they had outsourced? It would appear the reason is financial.
It’s cheaper.
It was once said by an extremely wealthy man that price is what you pay and value is what you get.
I agree wholeheartedly.
Cheaper isn’t always the best.
And time is money too. I’ve actually written this blog whilst being on hold and listening to Bach. So I’ve used the time to do other things too.
What would happen, however, if I was a private consultant surgeon with an already overworked medical secretary who had letters to type or worse still was on hold so patients couldn’t ring her?
That would reflect badly on my practice.
I’m all in favour of outsourcing. I would say that though because my business is intrinsically the provider of an outsourced facility to private consultant surgeons.
Even so, I get seriously frustrated at being told either my call is important – well answer it then – or I’m offered a choice of music to listen to. I don’t actually want either to hear either.
I want my issue resolved quickly and efficiently.
Cheaper and slower shouldn’t be an option.
pete@medicalhealthcaremanagement.co.uk
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It is depressing the number of times I hear potential clients criticizing 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 has 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 orthopedic 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 an 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 practice 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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A question, which was asked recently at a private practice seminar MHM were presenting at.
Interestingly the question was asked by a consultant surgeon who had started his/her private practice two years earlier.
He was of the opinion that such excess was the responsibility of the patient’s insurance company who would collect excess or shortfall amounts from the patient on his behalf.
Sadly this is absolutely NOT the case at all.
The responsibility for the collection of such items rests very squarely on the consultant himself.
Consider excess and the cause of excess?
When the patient obtains private medical insurance there will be an amount – excess – agreed on the policy.
The exact amount of the excess will depend on how much the patient pays for his/her policy.
Generally speaking the higher the premium, the lower the excess.
It’s just like car insurance, if you agree to a £500 excess, the premium will be lower than if you only agree £100. That’s fine – until you come to make a claim on your insurance.
Private medical insurance carries the same principles.
So, when the patient comes to see you and you claim the cost of your services off their insurance company there could well be excess for which the patient is liable.
The consultant is responsible for the collection.
Not the patient’s insurance company.
The consultant who asked the question called a few days later because of this horror.
He had in excess of £5,000 worth of uncollected excess in the previous two years unpaid and due to him which nobody was collecting.
The supplementary issue, however, is why were the excess amounts allowed to build up over two years without anybody noticing?
pete@medicalhealthcaremanagement.co.uk
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