Just as you must make sure you use the right code for a consultation, you must ensure you use the right fee to accompany that code. This becomes even more crucial when you are charging for surgical episodes.
It is a statement of fact that not all private medical insurance companies pay the same fee for a surgical episode. Indeed most do not. Using ONE single code as an example:
Q0790 = Laparoscopic Total Hysterectomy
The fee for that individual code varies across the 6 major private insurance companies from between £550 to £690; some £140 difference.
So where does the problem arise?
If the fee offered by insurance company A is £550 and this is inadvertently used for ALL insurance companies then the consultant will, yet again, UNDERCHARGE by on average £100 per episode. Bearing in mind most consultants perform the same surgical episode through out a month (normally several times) the loss to the consultant will soon rack up to around £700 a month. This is precisely what happened to a gynaecologist. He contacted MHM and post becoming a client was delighted to see his cash flow had increased solely because we were now charging the correct fee each time. And that is why the MHM fee checker is so useful to clients for it enables both MHM and their clients to establish precisely how much should be generated.
Taking another example: T6780 = a primary repair of achilles tendon.
The fee for a T6780 ranges between £750 and £386; some £364. Once again if the wrong fee issued the orthopaedic surgeon could very easily find himself £2,248 out of pocket.
Thus not only is it vital the correct code is used, the code must be checked against the insurance company concerned and adequate steps taken to ensure the correct fee is charged.
To do otherwise will lead to the loss of hard earned income.
pete@medicalhealthcaremanagement.co.uk
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