I took a phone call from a medical secretary yesterday morning who had read the post regarding consultations not being covered under a patient’s policy. She had a number of declined invoices which were outstanding from this year and indeed going back into 2014. She was intrigued to know how she could identify the precise reason for the rejection and what she could do about it. Perfectly valid points.
But, very respectfully, she was viewing the issue from the wrong starting place.
The medical secretary was asking if there was any way she could identify the issue before the invoice has been submitted? Other than asking the patient how many consultations are allowed under their policy, there isn’t really a way to do this. Its just the same as the excess amount on a policy. The patient WILL know.
The reality however is declined invoices cannot be identified until they have actually been declined. For example, it is pretty standard for an insured surgical episode to be followed up by a post operative consultation. The insurance company concerned will meet the cost of such a follow up consultation. Note however, we are referencing here a SINGLE follow up consultation.
MHM dealt with an example of this last Friday.
An MHM client had performed surgery on an insured patient in August and had seen the patient 2 weeks later for a follow up. All costs were met by the insurance company. But the patient remained concerned and requested TWO ADDITIONAL consultations. The client saw the patient therefore on two further occasions. Both were billed to the insurance company. And both were declined for payment by the insurance company.
They were declined because the patient’s policy stipulated only a single consultation was allowed under the terms of the policy. Thus MHM raised an invoice for the decline(s), sent it to the patient and it was paid by BACS yesterday.
And that is why I suggested to the medical secretary she was viewing the issue from the wrong position.
Even IF she can (and she can’t) identify when a decline is likely to happen, the starting point is why are there outstanding declined invoices dating from 2014 through to September 2015? Even worse, why have the patients not been contacted?
Thus knowing why an invoice has been declined is interesting but is nowhere near as important as having a robust process that firstly identifies declined invoices and then makes sure they are actioned.
If you want a courtesy copy of the invoice MHM uses to obtain payment of excess / shortfalls, please contact me.