It is depressing the number of times I hear potential clients criticising insurance companies.
In my experience the reasons normally cited are incorrect. Far from it.
I’ve lost track of 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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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 £175.
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 £175. 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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There is always a reason why you aren’t getting paid. And the number one reason is that no invoice has been sent.
Take, for example, the consultant surgeon I was working with recently. The issue as he saw it was that his cash flow seemed to be totally uneven and much less than he expected.
Something causes it to happen.
If you leave invoicing until later it’s very easy not to invoice at all. It can happen also if you leave invoicing until “tomorrow”.
Many times, I’ve been called in to examine and review the billing process of private medical practice and discovered an issue with invoicing frequency. So why is “tomorrow” “Friday” or “when I get the chance” the worst possible words for me to hear? Normally they are a big clue as to the reason why the practice is not getting paid as much as it should.
If you want to ensure your practice is paid promptly, the first place to start is raising an invoice.
Once a week is not helpful. In one extreme example, a practice was invoicing at the end of each month. No wonder there was a problem.
The danger in invoicing only on a set day a week is if something happens that day – for example, the consultant needs a clinic booking urgently or a patient needs a letter immediately, then the invoicing gets left behind. And that is normally the cause of the problems.
If invoices are raised daily should something happen to delay that ONE day’s invoicing, it is corrected the very next day.
Let me give you a real-life example.
Wednesday, September 30th a consultant ran an outpatient clinic and saw five patients. Three follow-ups and two initial consultations. £850 worth of consultations. Yet invoices were not produced for this work until Tuesday, October 13th – one day short of two weeks later!
Is it any wonder the consultant was extremely dissatisfied with the practice cash flow?
It didn’t take long for me to identify that on twice previous occasions over the previous few months one entire clinic list had NOT been invoiced (worth £725) and three initial consultations (worth £600) had also not been invoiced. In the case of the initial consultations, insufficient insurance details had been obtained at the point of registration.
In all £1,325 worth of invoicing had been missed.
But before we go any further do NOT blame the medical secretary. She has enough to do. The phone rings. Patients arrive. She has numerous letters to type. She has to book clinics. Theatre slots need to be arranged. That is precisely what she should be doing. She is there to ensure the “front of house” runs smoothly.
The error, if you will, is then expecting her to fit invoicing in around all that or, as was suggested to me, in her “spare time” WHAT SPARE TIME? She hasn’t got any.
In the above example, the solution was obvious. Either get someone in to process all the invoices and the cash receipts or outsource it.
A private medical practice is a business.
It must be managed as a business.
Without putting too fine a point on it, failure to ensure the invoicing and accounts process is not 100% efficient is pretty much guaranteed to lead to the business having cash flow issues.
pete@medicalhealthcaremanagement.co.uk
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I trained a medical secretary in the noble art of medical invoicing recently.
Having your medical secretary handling medical invoicing isn’t something I’d recommend for a number of reasons. First and foremost, over the years medical invoicing or medical billing has become far too complicated to be done on an ad-hoc basis.
This is not to say a medical secretary can’t understand how to invoice. Of course, he or she can. Given enough time, effort and training the ability can be developed.
If you think about it there are only a certain number of hours in a working day.
Into those hours a whole multitude of tasks has to be done. In the case of your medical secretary most likely she’ll have to answer the phone, book clinics, answer emails, meet patients, take down patient details and generally act as the first port of call for any issue within your practice. And then sometimes is added the task of medical invoicing.
Invoicing an entire clinic list does NOT take that long – provided there are no interruptions.
Add numerous interruptions (the phone rings, the hospital wants to alter clinic times or YOU want something) and medical invoicing will prove difficult. Then throw in incorrect patient insurance details – even MISSING patient insurance details – and the thing becomes a nightmare.
She was – and still is – very, very good at her job.
I spent enough time to train her and demonstrate what to do if a patient’s records were missing, where to find a CCSD code, how to find the correct fee from an insurance company. I also trained her on how to allocate cash and deal with shortfalls and excess amounts deducted by an insurance company. She got it. All of it. She was more than capable of handling any medical invoicing.
She was very good at medical invoicing. Right up to the point she had to do it on top of her other aforementioned duties.
I did warn her this might happen. I did share my fears both with her and with the consultant. The consultant was firm of the opinion that provided all the details were correct, there should not be a problem. But there was.
What was really significant was the med-sec telling both of us she was simply running out of time.
She would start the invoicing process at the end of each day around 5 pm (I taught her well) but before she had even blinked (her words) it was 6 pm and time to go home. So she tried to work faster.
Sometimes she’d undercharge a surgical episode. Sometimes she would omit to charge a consultation because she hadn’t got time to stop and correct the patient’s details that were wrong.
So she tried – and I truly admire her determination – to “fit” the invoicing in around all her other duties.
The whole invoicing process collapsed! It was fascinating to hear her talk about invoicing taking an hour each day when straightforward but take “ages” when it was not. She literally was losing track of time.
If that wasn’t bad enough losing track of time was having a knock-on effect.
She simply didn’t realise that other tasks she had to complete each day weren’t getting done.
Of course, this tale is all very interesting but what is the worth in it?
The worth comes from realising WHY the cash flow had suffered, WHY existing patients were starting to complain the phone wasn’t being answered and WHY new patients couldn’t make an appointment!
There are only a certain number of hours in a day.
Try and cram into those hours more than you can successfully achieve and you could very easily find your private practice in difficulties.
In other words, if you lose track of time, sooner or later you will lose money too.
pete@medicalhealthcaremanagement.co.uk
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Earlier this year another of the major insurance companies said no more paper invoices.
For a number of years, MHM has argued paper invoices should be avoided. We take advantage of the offering by the majority of medical insurance companies. We invoice electronically. It saves a fortune in postage costs. Invoices are no longer being sent in one large envelope per insurance company every week.
Never mind that we don’t have to post invoices out five times a week instead – with five times the cost of a weekly posting either.
They are produced much quicker and cheaper than in paper form.
The amazing thing is some private medical insurance companies still allow paper invoices to be sent to them.
Invoices for self-funding patients should always be mailed to a patient. It is bewildering however that consideration should still be given to sending a paper invoice to an insurance company. Regardless of whether the insurance company allows it or not.
MHM supports those insurance companies who insist as part of them granting recognition that invoices to them are electronic only.
pete@medicalhealthcaremanagement.co.uk
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It is depressing the number of times I hear consultant surgeons complaining about insurance companies.
In my experience the reasons normally cited are incorrect.
I’ve lost track of 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.
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.
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.
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 more times than not you may.
pete@medicalhealthcaremanagement.co.uk
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All MHM clients are very dedicated individuals. Having spent approximately 15 years of training and finally becoming a consultant surgeon, they go on to work incredibly long hours.
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. 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.
At that point however your private practice becomes a business.
As I’ve blogged many times previously, it must 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 will grow. It will make them rich if they continue doing what they love they do. Sadly that is not true.
That means, as much as you love being a Private Consultant Surgeon, you must measure the performance of your business. This is the point the private consultant learns to understand financial 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 private surgeon. 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 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 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 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.
pete@medicalhealthcaremanagement.co.uk
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They are not just for tax reasons. They are not just to keep the accountant happy. There is a time-critical reason too.
Remittance advice will confirm the values that have been paid. It is a mistake to assume that the invoice will be paid completely. It may not be.
For example and taking one remittance received by an MHM client.
Of the ten invoices paid, four of them were subject to excess deductions.
This is why remittances should be checked. And before they are stored for tax reasons or to keep your accountant happy.
In the above example, each invoice detailed on the remittance was reconciled against a debtors ledger. Only then was the payment recorded. It was then the number of deductions was identified. In this example, the total came to some £350.
The next step is to identify why the deductions have been made.
Whilst all four deductions were correct and were in respect of excess amounts it is surprisingly common for a deduction to have been made in error.
In the recent past, one MHM client had an invoice for surgery deducted in full because the patient’s policy had expired. At least according to the patient’s insurance company it had expired. It had done so after the date of the surgery. In this case, at the date of the surgery, the policy was “live”
Consequently, the insurance company was wrong to decline the invoice for payment.
A call to the insurance company concerned quickly identified and confirmed the insurance company was in error. The invoice was immediately cleared for payment. Insurance companies do make mistakes. Not many thankfully but they do happen.
If the deduction is correct then immediate action should be taken to contact the patient and a request made for payment – by the patient – made.
So the number and reasons why deductions have been made by a private medical insurance company can easily be identified and subsequently actioned on behalf of the consultant surgeon.
pete@medicalhealthcaremanagement.co.uk
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All of my guys are incredibly busy. I’m amazed at the volume of work they get through in a single day.
They are either on-call, doing a ward round or in theatre. Then they have to see their private patients. That explains why most of them call me either very early in the morning or in the evening.
It doesn’t bother me.
It’s my job to fit in around them and make their life easier.
Recently however I was asked to review the private practice of a consultant who was having serious difficulties generating any cash into his practice.
And following my question to his long-suffering medical secretary, it didn’t take long to establish why. The question was: what is the biggest problem you have this week. The reply said it all:
“I never get a response to the queries or receive the information I need after I’ve asked Mr. Surgeon. He always seems too busy to deal with the things I need”
Yet most of the information the med-secretary needed was fundamental to generating cash into the practice.
For example: two clinic lists from last week were still unprocessed (result: no invoices sent out) or remittances from an insurance company (no idea who had or hadn’t paid) or the post Mr. Surgeon picked up and put in his bag one day last week (it had cheques from patients in it)
So I sat down with Mr. Surgeon and asked him what he thought about it. His response was a classic: “I just don’t have time to deal with all that. My private patients are paying to see me so they must come first”
The stark reality is he is right enough to be dangerously wrong.
He is right as regards putting the patients first but he needs to ensure his administrative support is first-rate too.
The reason Mr. Surgeon is having difficulty generating the cash due is in him not dealing with such issues as the missing clinic lists or not passing over remittance advices.
Mr. Surgeon needed to make very sure, the support facilities of the practice were dealt with.
The word “support” suggests these things can be demoted to a “Too busy to deal with that and they are not that important so I’ll deal with it later” category.
Eventually, they catch up with you.
In the case of Mr. Surgeon, they were the reason he was struggling to generate cash into his practice.
Compare and contrast that with another real-life MHM client: Mr. B Surgeon. He is very different from Mr. A Surgeon save curiously they see a similar number of patients each week and are in theatre on the same day too.
Mr. B Surgeon will send his clinic list the day he sees his patients.
His theatre lists arrive the same day too.
All of which means his invoices are out the proverbially electronic door within 24 / 36 hours.
In the unlikely event, there are queries, a response comes back to me either that same day or at the latest the next.
His cash flow is many, many times greater than Mr. A Surgeon.
In case you are wondering why I don’t have such issues with MHM clients its because every single week my clients take their post or clinic lists etc scan them to me and promptly proceed to forget about them thereafter.
pete@medicalhealthcaremanagement.co.uk
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It is a very bad idea in fact.
For example a couple of months ago – actually it was Mothering Sunday to make matters worse – a private medical consultant happily sitting at home got up to answer the doorbell.
He was not at all amused to be greeted by one of his patients standing there. The patient had called round to pay the excess off on his private medical insurance policy.
Mrs. Consultant Surgeon was, understandably so, even LESS amused.
The next day my phone rang. I spoke with a very sheepish client. For months I’d been saying he should alter the address held by all the insurance companies with whom he was recognized. It should be changed to MHM’s address for correspondence and/or remittances – no charge in either case. But he was reluctant to do so as he wanted remittances and cheques to go straight to his home.
As a result, his patient knew where to send the payment. His patient also realized this was the Consultant’s home address.
The Consultant was suitably contrite as the very issue I had flagged as potentially happening had actually happened.
A patient had gone to his home address. For all the right reasons you could argue. Nonetheless, the consultant now saw the potential for an issue.
He was seriously unhappy about patients finding out where he lived.
Sadly this is not the first time, I’ve come across this. It’s not the insurance companies fault either.
When applying for recognition by a private medical insurance company it is advisable to quote a different address from your home address. It is standard practice at MHM when we take on a new client to amend the address for correspondence etc to Hilton Hall. It doesn’t cost anything.
If it is, for example, a request for more information from the client, we scan and email the document to them. When we receive a remittance from an insurance company we scan it and send it to the consultant anyway.
More likely we need it more than they for the simple reason it will contain, where applicable, a notice of excess or shortfall and we have to action them anyway.
Make sure, however, if you do a scan and send the document, it is password protected otherwise there is a risk you could fall foul of the Data Protection Act!
Cheques are received practically every single day at MHM. They are recorded on the client’s sales ledger, we take them to the appropriate bank and pay them straight into the client’s own bank account.
The other advantage of all this is that the client has LESS to deal with. Most MHM clients have more important things to do than process pieces of paper anyway.
It’s not that difficult to amend the correspondence address for a private medical professional. In fact, it took less than one hour to get this particular client’s details changed for ALL insurance companies.
Much better than having a patient ring your doorbell on Mothering Sunday – or any day for that matter.
But at least the private consultant’s Mother-In-Law stuck up for him apparently and that did make me smile.
pete@medicalhealthcaremanagement.co.uk
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I’m often asked who is actually responsible for paying an excess or a shortfall.
Interestingly the question was asked recently by a consultant surgeon who had started his/her private practice two years earlier. He was of the opinion that such excess was the responsibility of the patient’s insurance company. They would be collecting excess or shortfall amounts from the patient on his behalf.
The responsibility for 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 – or excess – agreed on the policy. The exact amount of the excess will depend on how much the patient pays for his/her policy.
Generally speaking the higher the premium, the lower the excess.
It’s just like car insurance. If you agree a £500 excess, the premium will be lower than if you only agree £100.
That’s fine – until you come to make a claim on your insurance.
So, when the patient claims the cost of your services from their insurance company there could well be excess for which the patient is liable. You, however, are responsible for collection.
The patient’s insurance company is not responsible.
The consultant who asked the question called a few days later.
To his horror, he had over £5,000 worth of uncollected excess in the previous two years unpaid which nobody was collecting.
The real question however is:
pete@medicalhealthcaremanagement.co.uk
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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.
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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Working for consultant surgeons 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 10 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 the than that, 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 2017, 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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One of the most often asked questions is “how as a private consultant surgeon 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 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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A common mistake made by a private consultant surgeon is undercharging for their work. This is alarming when most consultant surgeons wish to increase their fees.
This always spins off into a debate regarding private medical insurance companies being the enemy. Fees are always being reduced with the private surgeon being paid less and less. That may be true sometimes. It is not the right place to start, however.
The right place to start is to make sure you are charging the correct fee. Such fee may be less than you want of course but, many times, be more than he thought you were entitled to.
Take the example of an orthopaedic surgeon who contacted MHM to process her medical invoices recently. She thought her consultation fees were too low. That also may be correct. But that was the consultation fee the insurance company was prepared to pay.
The orthopaedic surgeon was unaware some of the insurance companies were prepared to pay a fee for minor procedures carried out at a consultation. They would pay a procedure fee together with a fee for the consultation. Whilst some insurance companies weren’t prepared to pay both fees, some were. Instead, the consultant had been charging ONLY for the minor procedure. She had not been charging for a consultation as well.
The same situation was equally applicable to a private dermatologist just as it was applicable to a GI surgeon. It is not therefore applicable solely to orthopaedic surgeons. It is applicable to many specialisms. The issue, therefore, becomes one of: am I charging the right fee?
To confirm the fee is correct a review of procedure codes and the fee for the procedure code should be undertaken. Both may then be compared against the fee structure of the private medical insurance company concerned. Each code and combination of codes must be checked against the fee schedule of the private medical insurance company. The often stated assumption that all insurance companies pay the same fee for the same procedure code should be rejected.
Take the example of a repair of the primary repair of Achilles tendon. Insurance company A pay a fee of £336 whereas insurance company B pay £405 – £69 more! The orthopaedic surgeon concerned was of the belief insurance companies paid out the same fee. She had UNDERCHARGED by £69 as a result.
To return to the original issue of charging a consultation fee alongside a fee for a minor procedure, take a look at injection into soft tissue. The same insurance company paid a fee of £108. The orthopaedic surgeon in question was unaware that a follow-up consultation could be charged in addition to the fee for the injection. Another £150 on top of £108! Thus the correct charge was not £108. It was, in fact, £258
To further illustrate the point a dermatologist may charge the very same insurance company, £91 for curettage of skin or lesion. He or she may also charge a follow-up consultation fee in addition. If the follow-up consultation fee is £100 (and it is for the MHM client concerned) the fee for the WHOLE event has doubled!
Thus the most common mistake in medical invoicing is not realising that fees can and do differ between insurance companies and also that some, not all but some, private medical insurance companies will actually and quite happily pay MORE for your work than you may be aware of.
pete@medicalhealthcaremanagement.co.uk
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All MHM clients are dedicated individuals. Having spent approximately 15 years of training and finally becoming a consultant surgeon, they then go on to work incredibly long hours.
At some point, however, they take the decision to start a private practice. They start a private practice because they wish to make money. It is silly to have any other objective. There is no shame in admitting so.
A private practice, however, is a business.
As I’ve blogged many times, it must be run as a business. A business with more than a little social conscience but nonetheless a business. Yet many consultant surgeons make the mistake of thinking their practice will grow without effort. It will make them rich if they continue doing what they love to do. Sadly that is not true. Seldom does doing what you love seldom lead 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 business. This is the point the private consultant surgeon realizes he/she must learn to understand financial analysis. 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, however.
For 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 lack of financial analysis other than a tax report a little over one-year-old. No debtors ledger was available. Therefore he did not 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 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.
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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I had lunch last week with a consultant who was keen to grow his practice.
We’d known each other for a while. Indeed we had begun speaking when he had not achieved his 2018 goals. Because they were actually wishes. More money. Increased number of patients. Sadly even if they had been specific goals, the chances are he wouldn’t have achieved them anyway. Why?
In any business, 20% of what you do, results in 80 % of your profits. It does not have to be 80/20. It can be 60/40 or 70/30. But the overriding rule is that some things contribute more to a business than others. Flipping that on its head means 80% of what you are doing could only be resulting in 20% of your profits.
That is precisely what the private consultant surgeon was facing.
This consultant had private practicing rights in three different hospitals. On the two days a week he opened his clinics or attended theatre, he drove to hospital A. After this clinic, he got in his car and drove for an hour to Hospital B. Once his clinic at Hospital B was over, he got back in his car and drove for another hour to Hospital C. After that clinic he went home.
He also had a 6-week waiting time to see him at Hospital A.
At the very least, he was driving two hours each day. Once on a Tuesday and once on a Friday.
Which in my view, at his normal hourly rate of £250 per hour, equaled £500 worth of lost revenue. Twice a week equates to £1,000. Looked at another way, 20% of his day was generating him precisely ZERO.
His answer to the question of WHY? was met with the standard – “that’s where the patients want to see me”
When the issue was looked at from another angle, however, it transpired the waiting list was highest at the hospital nearest to him. Hospital A. Indeed he saw the fewest patients at hospital C i.e. the one furthest away. He saw a few more patients at Hospital B than at Hospital C but nowhere near as many as at Hospital A. Hospital A incidentally, accounted for 70% of his referrals anyway.
In January 2017, he gave up his practicing rights in hospital C. Fearful of too much change – sensible man – he maintained his rights in Hospital C. The hour he’d saved by not driving to C was used to see more patients at Hospital A. The number of consultations increased. The additional revenue generated was very welcome.
Curiously such was his reputation that patients who would have seen him in Hospital C drove to see him in Hospital A.
In May of 2018, he gave up practicing at Hospital B. As before he used his “driving time” to see more patients at Hospital A. 70% of his referrals still came from hospital A. But patients could be seen much quicker. That in itself was attracting more patients. No more 6-week waiting list because he had an additional four hours a week to see them.
By the end of last month, he was seeing more patients than he had seen during the whole of 2017. He was also making more money.
He had stripped out anything that didn’t contribute to revenue
His targets were more specific. He had achieved his goals. Sort of.
He did not know if he had seen as many patients as he wanted to because he hadn’t set a specific number
He also didn’t know if he was making as much as he should have been because he hadn’t set a specific target.
pete@medicalhealthcaremanagement.co.uk
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Every so often I take a phone call from a self-funding patient or an insured patient who requires a receipt for their payment. They need a receipt so they can claim the money back from their health cash plan provider.
For example, patient visits a physiotherapist, pays for their treatment, MHM issue a receipt on behalf of the Physiotherapist. The patient claims the fee back from their Health Cash plan provider. Alternatively, the patient is insured but outpatient appointments are not covered under their policy.
Health Cash Plans are designed to ease the financial burden of having such regular health checks. Dentistry or a visit to the opticians for example. They are NOT the same as a private medical insurance policy.
So why are they relevant to the consultant surgeon?
Well on some occasions it has indeed transpired that the patient’s private medical insurance cover does NOT include outpatient appointments. Therefore 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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Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them. Before asking the question 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 originally?
There are three major reasons.
Empirical research on the patients of MHM clients indicates whilst most private healthcare originates via a patient’s employer, even if the insurance is paid for privately, the number one reason for holding private healthcare cover is to avoid and cut short NHS waiting lists. This is the primary 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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