Insurance companies use medical coding to detail a medical procedure.
For example: an Orthopaedic surgeon will understand what a Multiple arthroscopic operation on the knee (including meniscectomy, chondroplasty, drilling or microfracture) is.
That is a lot to put on an invoice!
The CCSD code W8500 will identify the procedure.
Put this code on the invoice instead.
Codes can be found on the CCSD website:
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the major healthcare insurers.
The Group’s purpose is to maintain a common standard of procedure codes.
A CCSD code is imperative IF a surgical episode is required.
The patient should quote the code to his or her insurance company when pre-authorisation is being requested.
However, be warned.
The example above of W8500 does not come with a suggested fee.
The rate for each code is up to the individual insurance company. You need to contact them to discover what fee they will pay for each.
When an invoice is sent to the insurance company, the code should appear on the invoice. It will reconcile to that expected.
If you do NOT use CCSD codes payment will be delayed if made at all!
Without a CCSD code, you will not be able to invoice electronically anyway!
pete@medicalhealthcaremanagement.co.uk
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For the simple reason, cash does not flow.
Cash has to be managed.
Around this time of year, I take calls from consultant surgeons who in view of their impending tax payments require an increase in cash collections.
It’s happened every year since MHM was formed. The normal instruction is to increase the cash flow. Immediately. Simple enough. I can do that.
Existing clients don’t call because invoices have already been generated for them and they’ve already been paid for their work.
Their cash has already been maximized.
The real problem faced by potential clients though was highlighted this morning when a consultant surgeon referred to needing an outstanding cash flow “purge” within his practice.
This highlights to me a more fundamental underlying issue. Let me explain.
A consultant surgeon – just the same as any business – should know how much he is invoicing both in terms of patient numbers and the value of those patients.
If he is invoicing correctly and ensuring he gets paid he can also, therefore, calculate his revenue receipts.
he wasn’t a consultant surgeon but sold another service or product, he should be able to perform the same calculation.
So he knows how much he is or should be invoicing. Providing he proactively manages his practice.
If you think about it, most consultant surgeons already know their overheads too. They know how much their room rental is. They know how much the staff cost.
And they know how much their professional indemnity costs (too much before you ask).
Of course, there are other expenses but fundamentally they already know their expenditure.
They know their total costs.
Therefore they know or should know how much they are spending too.
Enter stage left Mr. Micawber:
He knew a thing or two about how to run a private medical practice did Charles Dickens.
For one thing, he knew cash doesn’t just flow into it.
It has to be managed.
pete@medicalhealthcaremanagement.co.uk
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Top up (or GAP) invoices = asking the patient to agree to pay the difference between a consultant’s fee and the fee an insurance company is prepared to pay.
The discussion concerning them seems to take place more in whispers than anything else.
And sometimes they are even deemed to be almost a taboo subject because they don’t exist.
But they do.
So, and for the record:
I have no problem issuing them on behalf of my clients.
Why and when?
Consider the case of a real consultant surgeon whose patient is quite happy to pay, for example, £852 for a surgical episode.
But the patient is insured with XYZ Insurance.
XYZ will only pay a “customary and reasonable fee” of £639.
The fee was £852 but due to “market conditions” XYZ has reduced it by 25%.
Thus the consultant may now as part of his recognition protocol only charge £639.
Most consultants actually perform the same procedure throughout the month.
Empirical evidence using MHM clients confirms they all perform, in their own specialism obviously, the same code(s) on average 5 times a month.
If that code happens to be the one reduced by £213 each time, the reduction in revenue is over £1,000 each month.
In the original scenario though, the patient has chosen to see that particular consultant.
His/her decision has zero to do with fees.
That is the consultant the patient has chosen.
If the patient is advised the fee for their procedure is £852 but their insurance company will only pay £639 towards it and then if they – the patient – is asked beforehand to pay the difference and agrees, where is the problem?
Ah no, say the insurance company, you can’t do that for that is above our stated fee schedule so you are risking your recognition with us if you do.
This article is not about if they are right to potentially withdraw recognition if fees are not adhered to.
Neither is it about whether XYZ Insurance is right to reduce the fee.
The first thing consultants will all do is be deeply unhappy about the reduction.
The second thing they will do is attempt to mitigate the loss somehow or another.
And the second point is the more relevant one.
Many times I hear from insurance companies the market is contracting and cost has to be taken out to make the private medical insurance offering more attractive.
But why is the cost reduction, or so it appears, being continually directed at the consultants?
Yes, I am aware that certain fees have gone up but overall fees have come down.
I’m equally opposed to those consultants who insist on ignoring insurance companies’ fee structures for every single procedure and/or episode.
I’m also very focused on taking costs out of any business so I can see where the insurance companies are coming from.
But not at the expense of continually reducing a consultant’s fee and thereby reducing his profit continually AND the patient’s right to a choice.
Top Up or Gap invoices are a reaction to consultants continually seeing their fees being eroded.
I haven’t said I completely agree with them for they should be unnecessary.
What I am saying is that I understand why I’m being asked to produce them and when.
Consider an actual quote to me recently from a very well established consultant surgeon.
An orthopod who has been in private practice for over 10 years:
That, perhaps, sums up precisely why some MHM clients are asking me to produce Top Up or GAP invoices.
pete@medicalhealthcaremanagement.co.uk
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There are only 24 hours in a day.
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 with 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 spoke 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 advice.
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 (but in different parts of the UK)
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 matters little if the consultation was face-to-face or, as is more relevant in a post Covid-19 world, excess will still be deduced.
And that means, the consultant has to do something about them
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.
pete@medicalhealthcaremanagement.co.uk
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It’s amazing how many don’t pay attention to remittance advice.
They should.
I downloaded remittance advice for an MHM client yesterday.
One of them, provided by a certain insurance company, was for 11 separate invoices with a total value of £2,400.
But the payment made against the value of the invoices was only £1,950.
Pretty standard stuff. The difference was almost certainly excess.
Except it wasn’t
Whilst £350 was in respect of excess, the remaining £100 had been deducted because we had charged the wrong fee.
No, we hadn’t.
We had charged the correct fee for the appropriate CCSD code and the insurance company had made a mistake.
They had reduced the value of the invoice incorrectly by mistake.
A quick call to the insurance company later and the mistake was put right.
Next week’s payment will include the £100 incorrectly deducted.
This isn’t the first time this particular insurance company has made this mistake. Indeed it is the 5th time so far this year.
£500 deducted from an MHM client for no valid reason!
And that’s precisely why remittance advice is not only more useful than you think and why you should check them carefully.
They aren’t just pieces of paper your accountant wants to see every so often.
They also aren’t just to tell you if and when an excess has been deducted.
The purpose of remittance advice is for you to check you have been paid the right amount for your professional services.
Obviously, you don’t have to check each one.
If you don’t like money or getting paid the right fee, you don’t have to.
Yes, you do.
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 said excess was the responsibility of the patient’s insurance company.
They 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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Every single consultant I’ve ever met is dedicated to patient care and the best possible outcome for his or her patient.
But sadly that has little to do with the outcome of the practice as a business.
They may think it does.
But it doesn’t.
Patients reviews are ALWAYS good and they reflect the clinical outcome.
Potential patients do actually read them and take the decision to see a consultant based, in some part, on good patient reviews.
But other than that, there are numerous other items impacting the business outcome.
Planning has a HUGE impact on the outcome.
Specifically, if you don’t have a plan you won’t be able to know if you have achieved the desired outcome anyway.
But what needs to go into the plan?
Sounds crazy but the aim of the plan should be to achieve the outcome, yet you can’t reach the outcome until:
a) you define what the outcome should be
b) you define the plan to achieve the outcome.
Just talking about it won’t be enough. It never is.
Unfortunately, far too many consultants start a private practice without deciding what their desired outcome is. Instead, they make reference to “making more money” or “seeing more patients”
But the smarter ones start by saying I want to make, for example, £5,000 a month (outcome) so I need to see at least 20 patients during that month.
It matters little if it’s £5,000 or £25,000.
What matters is they have a defined outcome with a plan to get there.
Then they start giving immediate thought and planning on how to see 20 patients a month.
None of which has anything to with clinical outcome!
pete@medicalhealthcaremanagement.co.uk
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I didn’t say I was against remote consultations!
Following yesterday’s post, I received phone calls and emails claiming clearly I was against remote consultations.
But I never said that!
What I said was that I don’t think remote consultations are a vehicle by which a private practice will grow.
Specifically, there is insufficient data upon which to believe they WILL grow a private practice. It’s far too early to make that claim.
Whilst they are easier for the private consultant to perform, and more crucially, enable to patient to be “seen”, that does not in itself mean the patients will want them.
I suspect many patients much prefer a face to face consultation over a remote consultation anyway.
Could it be patients are happy with remote consultations because they have been told to stay home?
That said I freely admit I could well be wrong but maintain it is far too early to reach a conclusion either way.
There’s another aspect to this.
What fee will the consultant receive for a remote consultation?
At this point in time, all insurance companies are paying precisely the same fee for a remote consultation as a face to face consultation.
Quite right too.
But that does not mean, in the post-Covid-19 world they will continue to do so.
Prior to the lockdown, fees for remote consultations were substantially lower than those for face to face consultations.
At some point, it is inevitable that insurance companies will resume their previous fee structures.
All of which means as a growth opportunity, remote consultations could well be less attractive than first thought.
But remote consultations should remain an option in the post-Covid-19 world.
As such they should be offered to patients.
But they won’t be the panacea to private practice as suggested.
pete@medicalhealthcaremanagement.co.uk
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I was chatting with a friend recently regarding his view that remote consultations were the way forward.
Covid-19 will seriously change the face of private practice in her view. More specifically, it will demonstrate remote consultations are the way forward to grow a practice.
In my friend’s view, more consultants are now willing to provide video consultations that ever before.
And further, in her view, all the consultants she had spoken to and asked were enthusiastic about the electronic consultation offering.
When asked if they would offer more and more electronic consultations most said they would.
They see it as a way to grow a private practice.
I’m not disputing the view Covid-19 will change many things including the face of private practice.
But I don’t see it, in a post-Covid-19 world – as a catalyst for remote consultations.
For one thing, we are in the midst of an unprecedented situation.
By all means, consider the reality of where we will be afterward but it is far too earlier to make sweeping predictions.
Further still, it is unrealistic to make the forecast that electronic consultations will become widespread based on six weeks of evidence.
But what is a wory is of whom was the question asked.
Only the private consultant.
The patient wasn’t or hasn’t been asked.
I’m not suggesting for a single second patients will or will not be willing to have their consultation electronically.
I’m saying is that it is wrong to say electronic consultations are the way to grow a private practice. You must first establish if the patients would be prepared to accept electronic consultations rather than face to face consultation.
pete@medicalhealthcaremanagement.co.uk
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I never anticipated this. There again nobody did.
In all my years of running a private medical practice, at no time did I consider a UK wide lockdown.
The only “emergency” situation I planned for was for a client to be unable to practice due to breaking his leg!
Seriously.
I called it my “Bust leg” scenario.
In essence, it assumed the consultant couldn’t physically journey to a hospital.
In such a situation, the only thing you could do was conduct electronic consultations. That may be by telephone or Skype etc.
New patient numbers would fall off a cliff but at least follow-up consultations would be conducted.
I actually had to arrange this once. The consultant fell over and broke his ankle. So we arranged for telephone and Skype consultations.
It worked and worked well.
It never occurred to me though that a UK wide shutdown would not only prevent a patient from attending a hospital but they were too scared to leave their own homes.
So the very first thing I did when the shutdown came into force was speak to every single private medical insurance company.
The reasons are obvious.
I wanted to make sure all MHM clients were able to hold and get paid for electronic consultations.
I’m pleased to say most already were and with the support of insurance companies, all the remaining ones were immediately allowed to follow suit.
It’s easier to say what was NOT next.
Absolutely not a debate on how long the shutdown would last.
There was and still is no point because only the Government can decide how long.
The second item was to alter the view a private practice was closed. Only one of my clients actually closed. She did so for the most unfortunate of reasons. She was diagnosed positive for this xxx bug.
The most important requirement was to make sure patients – existing or potential – knew or could easily establish, the practice was NOT closed.
MHM isn’t closed either!
It may have moved from Hilton Hall to temporary offices.
But it’s still here.
I just love the concept of temporary offices though because, in reality, it’s now operating from my “home office”
Otherwise known as the spare bedroom.
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 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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Recently, I was talking to one of my clients.
She was unhappy with the fees she was getting from insurance companies.
Sadly she was also unhappy about how often she got paid too.
Therefore she wanted me to contact all insurance companies and do something about it.
Unfortunately, not only had she agreed on her fees, she had agreed on the payment terms too.
When she applied for recognition with the various insurance companies towards the end of 2018, she thought to give it a year and she would be able to increase her fees.
Sadly, this was never going to happen.
Certainly, she could ask the question but it was doubtful she would get an increase.
And that’s precisely what happened.
There is not a lot she can do about it.
Nor can I.
So instead she wanted the payment terms amended.
Two of the insurance companies paid her within a few days.
Others paid her once a week.
The remaining insurance companies paid her monthly.
She wanted ALL insurance companies to pay her within a few days.
This is never going to happen either.
The reality is, just as it is with fees, the insurance companies are in the driving seat.
They are not going to amend their payment terms.
Even more so when the consultant agreed to the terms originally.
I’m all for arguing with insurance companies.
But I won’t pick an argument that I know every well I won’t win. There is no point.
If you agree to your fees and your payment terms, you pretty much are stuck with them.
Sorry!
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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I really had to laugh at one of my clients.
Great guy with an absolutely dry sense of humour.
He’s also from what I call the “brain the size of a planet” school.
He was explaining his requirement for multiple CCSD codes to be pre-authorised in respect to a procedure he intended to perform the following week.
He explained why, due to the patient’s condition, he wasn’t at all sure which procedure and/code he would actually perform.
There were multiply big words in his explanation which I couldn’t even pronounce let alone spell in a blog post.
It would only be in theatre, when he would know the procedure he was going to perform apparently.
Have you any idea how much of his explanation I understood.
None of it.
Moreover, I don’t need to.
All I needed to understand was as follows:
2. what are the proposed codes?
From that, I could call the relevant insurance company and confirm the patient details.
Then I could advise them of the codes in question, the date of the procedure and what I’d do post-procedure.
After the procedure, I’d have the consultant tell me which codes he performed.
Then I’d have him send me a letter addressed to the insurance company explaining why.
Following that, I’d have the theatre notes and the anesthetist’s notes sent to me.
And then I’d forward the whole lot to the insurance company.
Simple really.
And that is precisely what happened.
Once I’d done that, the insurance company agreed for the codes to be invoiced, in the right order and at the right total fee.
It’s even better now for the MHM client is being paid next week.
One happy consultant surgeon.
Skip forward to yesterday, when the consultant called me.
He’s very grateful he’s getting paid and in full too.
But he couldn’t understand why I could do all that without understanding what the codes actually meant in medical terms.
Basically, because I don’t need to know.
And I’m certainly not prepared to spend the next 12-15 years at med-school learning all about surgery until I do
No, all I need to understand is what codes, when and then I’ll tell you how much.
The consultant made me smile though when he thought it a much better idea if he stuck what he did best and let me stick to what I know best in the future.
pete@medicalhealtcharemanagement.co.uk
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The old nutmeg has come around again!
This time it was a call from a consultant who was so fed up with DNA, he decided he’d sort it.
Whilst he was at it, he’d stop the constant problems he’s having with excess deductions too.
And, I’ll wager, DNA and excess are a pain in your ass too.
His decision?
From January 1st, 2020 all non-insured patients were required to pay in advance.
Those who were insured were required to leave card details so in the event of any excess the card would be automatically debited.
Sadly I see this all too often when I go meet a potential new client.
Many of the issues he faced have their source in a previous decision.
The previous decision itself could well be based on a decision before that one even.
One of those decisions in the chain was almost certainly not thought through.
But he had indeed stopped the problem with self-funding DNA patients
Because there weren’t any self-funding patients anymore.
Clearly, he hadn’t thought through the consequences of his decision.
He had reacted instead.
Yet the reaction caused another problem i.e. no more self-funding patients.
That was unfortunate as 23% of the practice was derived from self-funding patients.
The above example is indicative of the cause of many of the issues that particular consultant faced with his medical billing.
It was relatively easy to put the self-funding issue right because I’ve faced that specific challenge a few hundred times previously (email me for how).
Getting the consultant to change his mindset though was much more difficult.
He did change though because he had seen a 100% reduction in self-funder outstanding invoices.
He changed not just because I knew the answer. He changed because he realised when I faced that issue previously, I’d allowed myself sufficient time to give it serious thought and consideration before reaching a decision.
I’d implemented a course of action that didn’t put patients off by asking payment in advance but did reduce the number of outstanding self-funder invoices.
And that is why it is important to put the time aside and think through an issue before deciding on a specific course of action.
pete@medicalhealthcaremanagement.co.uk
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This is actually happening now.
MHM, on behalf of a client, recently invoiced a private medical insurance company for a T7915 performed on January 23rd.
Per normal, MHM checked the fee schedule of the insurance company and confirmed the correct fee was £750.
Only then was the invoiced raised for £750
It came as a surprise today however to see a lesser amount of £620 has been paid.
£130 less.
It is even more surprising to read on the remittance the reason why it is less!
‘We cannot pay this amount in full as we do not cover consultations made within 10 days of a surgical episode”
Yes, I know you don’t.
But the fee is for the procedure alone and nothing to do with a follow-up consultation.
Moreover, £130 is the fee for an initial consultation and not a follow-up consultation.
So I’m currently on hold to the insurance company concerned and have been for the last 35 minutes waiting for them to even answer the telephone.
In fact, I’ve been on hold so long, I can draft this blog post before they even get round to answering the phone!
If remittance advices aren’t checked, insurance company errors like this will be missed and you will be out of pocket.
This time £130 out of pocket.
Further, I’m not in the slightest bit interested in hearing a recorded message telling me how busy an insurance company is.
Nor am I interested in being told: “our team is working hard to get to you”.
What I am interested in is how an insurance company can make such a basic mistake as this?
When will the insurance company answer the phone so I can sort this out?
And how many more mistakes are there like this where ultimately the consultant pays the price and is out of pocket?
This is why it’s SO important to check every single payment made to you.
are you??
pete@medicalhealthcaremanagement.co.uk
p.s. after 42 minutes the call was answered. It will now take 15 working days to respond to my query. THREE WEEKS!!!
But I’m told it won’t take 3 weeks, it takes 15 working days.
I give up.
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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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