Another day arrives. Its time to invoice yesterday’s clinics.
This is a good example of not paying sufficient attention to the clinic list. It almost cost the consultant £60. The patient was marked down as a follow-up. An invoice for £144 will be sent to the patient’s insurance company.
According to MHM, the consultant had never seen this patient before. A quick phone call established that this was actually a new patient so a £204 invoice was required for an initial consultation and not for a £144 follow up.
Who was responsible for making the mistake isn’t really the driver. It is important of course but mistakes happen. Of more importance is having a process to identify and correct the error.
Before it costs you £60.
All you have to do is outsource the invoicing to someone who checks absolutely everything.
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Some insurance companies decline to accept invoices that are sent more than six months after the consultation or surgical episode. Fair enough, they should have been invoiced.
BUT…
A statement was received today from a certain insurance company containing an entry reclaiming £620 paid to an MHM client in December 2018.
Whilst that was before MHM started managing the client’s medical invoicing, a phone call to the insurance company was made anyway.
All part of the service.
20 minutes later the insurance company concerned confirmed the payment of £620 had NOT in fact been made to the client in December 2020!
In other words, they were totally wrong to deduct money from the MHM client. The insurance company is paying back to the MHM client £620 at the end of the month. We’ve just saved the client £620 – result.
Hang on a second.
This particular insurance company does indeed decline invoices over six months old. Yet it makes deductions from an MHM client going back not months but years.
And the deduction was wrong anyway.
ALWAYS check the payment remittances from an insurance company. 99% are correct but that last 1% can be worth hundreds of £s!
How many of you have had this happen to you? More importantly how many of you realise it has happened?
pete@medicalhealthcaremanagement.co.uk
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Have you ever thought how long a pre-authorisation is live?
Or how many didn’t realise some insurance companies deem pre-auths do have a life span?
For example:
I was asked to invoice for a surgical episode, which took place last week. The patient had the right pre-authorisation reference. The CCSD code was correct too. However, the pre-auth code was dated August 2021. This particular PMI decreed the code was only valid for 45 days.
So what’s the solution?
Call the insurance company and explain why the surgery took place so long after the issue of the pre-auth reference.
Funnily enough, another MHM client asked us to invoice against a pre-auth reference of a similar age to the above example. There was no issue in this example because the insurance company concerned deem pre-auth to be “live” for six months.
But why there was such a big delay between the issue of the pre-auth and the episode? There might be a reasonable explanation.
However, if the code was issued 6 months ago and the episode took place a week later, you may be asked questions.
Some insurance companies will automatically decline if an invoice is submitted for payment six months after the episode.
See what I mean. Both pre-authorisation and invoices have a life of their own. Clinic and surgical episodes should be invoiced within seven days at the maximum.
How many of you are NOT meeting this deadline?
pete@medicalhealthcaremanagement.co.uk
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It’s amazing how many people don’t back their IT systems up. When they have an accident, they have a serious accident.
One guy kept all his correspondence and notes on his laptop and only on his laptop. No problem at all until the day his laptop died on him. This specific problem was not resolved of course by him immediately going out and buying new equipment.
All the data was on his now-defunct laptop. Luckily a computer specialist was able to extract the hard drive and more importantly the data on the hard drive. It only then did he consider the implications of the accident that would have followed if the computer specialist had not been able to do that!
One of the first things MHM suggests to new clients is if they don’t have backups to go out buy an external drive and back everything up. MHM equipment is backed-up every 15 minutes onto an encrypted offline storage device. Every night the external drive is placed in a fireproof safe. At the weekend the exercise is repeated. MHM clients don’t have to back up any of their invoices and billing correspondence anyway.
Have you considered how you back paper invoices up?
The first thing to ask is why do paper invoices exist in the first place? With the exception of self-funders or an invoice for excess or shortfall, they shouldn’t. But you’d be surprised at how many consultants still send paper invoices unless the insurance company concerned specifically dictates online invoicing only.
A simple solution is available within MHM. All invoices etc are saved as a PDF document and stored in an encrypted format offline.
It’s always better to back up before or in case you have an accident
pete@medicalhealthcaremanagement.co.uk
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Many times, consultant surgeons have approached MHM because they, as consultant surgeons, don’t like asking patients for the money.
And from a certain point of view, this is exactly how it should be. New MHM clients don’t, however, remain MHM clients if they are in the profession just for the money. That said, what happens if you don’t ask for the money?
Firstly, most private patients are insured. Therefore MHM is asking for payment from an insurance company and not a patient. Secondly, if there is an excess or shortfall etc, most patients will pay such excess when they are asked.
If you don’t or are afraid to ask for the money there is a high possibility you won’t be paid for it.
Private practice is a business. It may be a business where patient welfare comes first, second and third as it should and in certain cases a patient should NOT be asked to pay but fundamentally a private practice is a business.
Ask for the money.
pete@medicalhealthcaremanagement.co.uk
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What a truly awful expression!
It was said to me recently by a medical secretary who was struggling to get all her invoicing done.
Her belief was that she had only many hours in the day and it was difficult to get everything done in those hours. Therefore invoicing was completed when time allowed.
In other words, it was a low priority. There were more important things to do.
I’m sure there were. But it depends on what you decide is a priority and what is not.
I’m in the office at 8am and I finish at 8pm. Monday to Thursday that timespan is there every day. Friday it’s 7am to 1pm.
The day actually starts the evning before when I list in my Ical all the task for the following day.
The tasks ALWAYS start with invoicing clients clinics from the previous day. That takes top priority because MHM gets paid to make sure it’s clients get paid which starts with raising an invoice.
So that task can take me a few hours; somedays it may take me a whole morning. But it’s done everyday.
A medical secretary has other things to do as well. Dealing with patients is one. Typing clinic letters is another. And the phone keeps ringing too.
She has to do those things because they are priorities.
But if time doesn’t allow her to raise invoices, then the practice won’t get paid. It is a simple as that.
It’s not time that is dictating if a practice gets paid, it’s setting priorities that dictates if a practice gets paid.
Isn’t a strange that one of the first things to be kicked down the list of things to do is raising invoices? That is unfortunate considering getting paid is important because if the practice doesn’t it won’t be around for long.
And here’s the dilemma.
Everything is important. Dealing with patients. Typing letters. Answering the phone. And even raising invoices. They all have to be done.
The problem starts though when any one of them is neglected at the expense of another.
In that situation the very worse thing you can do is carry on regardless and muddle through somehow.
That inevitably leads to disaster.
pete@medicalhealthcaremanagement.co.uk
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Anybody ever watched the movie “Jerry Maguire” and the immortal quote – show me the money!
Clearly a guy I recently bumped into at a medical conference hadn’t. He was the Practice Manager for a large hospital group.
His complaint was the lack of cash from insurance companies coming into the business.
His solution had been to analysis the internal administrative process of the hospital; make sure everybody knew their role and when to do it.
He ended up with a very comprehensive PowerPoint presentation.
Indeed he had spent four months doing just that.
After four months nothing had changed really.
I couldn’t help but think about his thought process.
He had gone around writing reports and compiling analysis rather than actually speaking to the insurance companies and finding out what the problem was from THEIR end?
In other words WHY they were not paying him?
If he had done so he would have immediately realised his practice was not invoicing correctly.
If he had asked the insurance companies they would have told him just that.
Only then could the practice start to review and possibly change the process to make sure they did get paid.
Start with the basics. Or as Jerry Maguire would say:
pete@medicalhealthcaremanagement.co.uk
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It takes an amazing amount of determination and resilience to become a consultant surgeon. Years of study, sacrifice and long, long nights.
Finally you make it. Then one day decide to start a private practice i.e. a business.
The issue however is that such determination can lead some to think they know how to manage a business.
Due in no small part to their determination and resilience, their ego gets in the way.
That can be a problem when an issue comes up they do not know the answer to.
And that happens to me. Just as it does to everyone else from time to time.
So what do I do?
I put my ego to one side and find someone to ask who DOES know how to deal with the issue.
It is a huge mistake to carry too much ego into a private practice and become afraid to ask because it’s perceived as a weakness. That’s utter nonsense.
In fact quite the reverse.
Recently, MHM was approached by a consultant who displayed all the signs of an ego getting in the way of running a practice.
Rather than ask how medical billing should be done correctly, he insisted it was undertaken in the way HE thought it should be done.
Save there was and is no way, invoices could be processed that way.
It mattered little that the consultant thought it was a “stupid” way to process his invoices.
What mattered was it was the way the insurance companies insisted on.
The reality was the consultant concerned didn’t know how to process an invoice. That in itself is not a problem.
The real problem was that he wasn’t prepared to ask someone else how to do it correctly.
His view was that he hadn’t spent years at med school and put in a huge amount of effort only to be told he didn’t understand how to do such a simple job as raising an invoice.
No wonder his cash flow was so poor.
His achievements in becoming consultant surgeon were amazing. He had literally come from nothing and pulled himself up by his bootlaces.
Sadly however – and to his financial cost – he hadn’t left his ego at the door when he started his business.
Asking for help doesn’t show a weakness.
Actually being prepared to ask for help is a strength.
pete@medicalhealthcaremanagement.co.uk
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I love it when a mistake happens or when something goes wrong.
It means I get the chance to look at what went wrong and more importantly WHY it went wrong.
That means I can stop the same mistake happening again and therefore I get better.
For example: I was sent a clinic list yesterday that was incomplete. the patients address was not correct. The insurance details were incomplete too.
It said (as an example): The Avenue, WV11 2BQ
It didn’t state the house number. Nor did it state the geographic area
The patient’s policy number was also missing. It just said AXA.
Bottom line: I can’t invoice it. My client can’t therefore get paid.
When I called the newly appointed medical secretary to point these errors out, she told me nobody had told her how important that data was.
So what did I expect to happen? I hadn’t taken the time to make sure she understood how important complete data is.
She thought instead it would be quicker just to get the basic details. On this point she is right.
She is in fact right enough to be dangerously wrong.
Getting complete and correct patient details upfront takes a lot less time than having to ring the patient (twice as it turns out) and then emailing me with the correct information.
She had to perform the task THREE times as opposed to once when the patient presents at reception.
Thus she learned how to do the job better.
And I learned to make sure a medical secretary knows who important it is to get the right information.
Win – Win situation really.
And all because we made a mistake the first time.
pete@medicalhealthcaremanagement.co.uk
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It’s great when a patient pays cash – on the way out he or she produces a roll of £10 notes and pays in full. It happened just before Christmas last year to an MHM client.
Couple of items to remember, however.
1. The consultation still needs to be invoiced – unless of course, you want HMRC to raise serious eyebrows (and you DON’T!!)
2. The cash has to be accounted for
It was this second point that caused a wry smile.
A sanity check picked up the consultation and an invoice to the self-funding patient was sent. With the result a most irate patient phoned MHM. So where was the cash?
Being just before Christmas, the MHM client had gone out and bought some ad-hoc Christmas presents with it. He’d clean forgotten the extra £150 in his wallet was actually practice money. It should always be treated as completely separate from his own personal money and banked into the separate practice account he has as you should have too! But he’d forgotten.
Thus the MHM client today had to take out of his own bank account and pay into the practice account £150 prior to MHM emailing a receipted invoice to the patient.
It was a very nice bottle of Merlot though – I really enjoyed it.
pete@medicalhealthcaremanagement.co.uk
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One of my major bugbears with medical practice is the ability to answer the phone.
Sounds simple. It is!
Yet many practices do not answer the phone. Instead, the call goes to an answering machine and then one of two things happen.
The call is never returned.
The caller rings another consultant.
The new patient wishes to see a consultant. Most likely he or she will have a choice of whom they see. It could be you or it could be a competitor. It is not a given they will choose you.
So what will be their reaction if they can’t make an appointment because no one answers the phone or can be bothered to go elsewhere?
They will call another consultant.
By all means have the option available for the patient to book online. I’m all for it. But don’t just rely on that.
We are in the people business.
And people like dealing with people. More accurately, they like to talk with people.
So answer the phone and talk to them.
It is inevitable that your phone will be engaged at some point or your practice will be closed for the weekend. Hopefully, the patient will leave a message.
But make VERY sure that call is returned.
If you don’t, potentially you will lose a new patient.
And if you don’t attract and keep new patients, frankly your practice is dead.
pete@medicalhealthcaremanagement.co.uk
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I called one of my friends early one evening recently. His phone went straight to voice mail. Curiously he didn’t call me back with half an hour or so per normal. He called me this morning instead. He explained why.
Every Wednesday, he and his wife have a “date night”
They switch both of their respective phones off.
No emails, text or ring tone interrupting them. They spend time talking to each other.
And that got me thinking.
A couple of years ago I started doing something similar.
At the end of each day, I’d put my phone on silent and switched my emails off too. Why?
Because each day I need time to review any opportunities/problems I’ve got to deal with the next day.
It also means I can think about an issue at length, leave it overnight ready to be re-thought about on the next day. That stops me making knee jerk reactions and allows time to have a fully considered opinion ready.
Rarely will you get an immediate reaction from me.
My response to an issue has, therefore, been thought through.
Yet many medical practice managers or indeed consultant surgeons running a practice, don’t stop and think through an issue.
They are too busy.
But alternatively, they are too busy because they don’t stop and think through the issue.
Sadly I see this all too often when I go meet a potential new client.
Many of the issues they are facing 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.
For example: recently I blogged about a group of gynecologists in the West Midlands who, in an effort to stop issues with self-funding patients decided ALL self-funding patients must pay in advance.
Immediately the problem with self-funding patients stopped. Because there weren’t any self-funding patients anymore.
This was a solution to the problem. It worked. Sadly, however, it had some unpleasant side effects i.e. no patients.
Clearly, they hadn’t thought through the consequences of their decision.
They had reacted.
Yet the reaction caused another problem i.e. no more self-funding patients. That was unfortunate as 23% of their practice was derived from self-funding patients.
The above example is indicative of the cause of many of the issues within that particular practice.
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 practice manager and the three consultants to change their mindset though was much more difficult.
They did change though because they had seen a 100% reduction in self-funder outstanding invoices.
Sadly this was at the expense of a 100% reduction in self-funder patients.
They changed not just because I knew the answer. They changed because they 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 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.
As a bonus, it stopped the problem with self-funding patients who were DNA too!
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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MHM sort of cheats when we say we are an outsourced medical biller.
We don’t share premises with our consultant surgeons nor are we next door to the hospital. Neither do we speak to them every single morning when they walk through the door. We are – literally – miles away from our clients. And so we cheat.
It matters little that we are, in one case 160 miles away from the client or in the case of another 16 miles. We could, in fact, be 16 feet away. The result would be the same. We speak to our clients every day in the first few months. Then it tails off to say twice a week. Then it becomes once a week. One client speaks to us approximately every few months.
Why do we let this communication tail off? Actually, it doesn’t.
It just changes.
At first, there are hundreds of things to do. There is a lot to understand, and, usually many issues to resolve. As time goes by though and as the process kick in the number of issues reduces and the need for very frequent contact reduces in turn. We also know that consultant surgeons always seem to be chasing the clock.
But if communication comes to a full stop then that’s when the problems start.
Every week a FULL analysis of where the medical invoicing and outstanding accounts stand is produced and sent to the clients. Some read it. Some email and phone with questions. After a passage of time and because the cash is flowing in, most ignore it. Yet still, a weekly report is sent out. Without fail.
But..then we cheat even more.
Sometimes, and especially true since Covid-19 appeared in the world, we hold a zoom call with them (sometimes for no more than an hour) to chat through problems, and, get to understand how they feel about things.
Are there any areas they think or feel should be better?
Are there areas where they thought it was worse than it actually turned out to be?
In short, a very open yet extremely robust management reporting process underpinned by the opportunity to meet virtually and ensure that issues don’t become major problems for both of us .
This leads to a healthy and frankly cash positive result all round.
So..what has YOUR experience of outsourcing been? What are YOU looking for?
I already know what you are looking for – a solution to your medical billing problems or, in simple terms, to get paid quicker with less hassle.
Let me know what else you are looking for, please?
pete@medicalhealthcaremanagement.co.uk
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There a few things I hear that automatically set alarm bells ringing when I look at the invoicing and billing process of a business.
“I’ll take a look at it next week”
“I’ll get round to it in a bit”
“I’ve been meaning to look at that”
The final of those items was said to me a few week’s back during a zoom conference.
I was sitting on a panel facing an audience of physiotherapists who wanted to ask what made a medical practice successful.
In amongst the various questions was one relating to how to monitor invoicing efficiency.
To me the answer is simple.
Before you can measure any part of a business, you must first establish a standard to measure against.
Which is precisely what I said to the questioner. I asked if he knew how many invoices he had raised last month and the total value.
But, I continued, to improve the performance of your practice you must make sure you know to a reasonable degree of accuracy how you are performing against a standard.
Now consider the issue of invoicing with a real MHM example.
One of my guys saw 25 patients between Monday, May 10th and Friday, May 14th.
Therefore I should be able to see 25 invoices.
That is an ultra-simple but totally effective control which makes sure everything is invoiced. The standard has been set because one invoice is required for each patient.
It also means of course at the end of May I can add up the number of invoices. I can also tell the client how many patients he has seen during May.
Then we can compare that number with the number for April and see if it is higher or lower.
The introduction of such a basic management control isn’t a nicety; it is an absolute necessity if you are going to manage the invoicing process or indeed the whole business effectively.
The audience member agreed fully. The alarm bells went off however when he said “I’ve been meaning to look at that for a while now”
He hadn’t because there always seemed to be some other problem to deal with.
That tells me his management controls aren’t as robust as they should be.
It also tells me he is suffering from one of the worst and easily avoidable causes of business failures out there:
Procrastination is even worse than having a backlog of invoices to raise because it diverts you from identifying a backlog is building up.
It is even worse than having no cash because it distracts you from raising the invoices and thereby getting paid.
Procrastination is the cause of the problem he has because various insurance companies have declined his invoices for treatment as the consultation was more than 6 months ago.
Do not leave it to look at “next week”
Set time aside every single week to make sure, you DO invoice and to make sure you review what is happening with YOUR money!
pete@medicalhealthcaremanagement.co.uk
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This is the one question I get asked more often than all the others.
The first thing to realise about increasing a fee is that you CANNOT increase a fee for all your surgical episodes. Nor can you increase a fee every time you perform a surgical episode.
Having said that it is possible on occasion to request an uplift in fee under certain circumstances. The question of time taken, however, to perform the actual episode is not in itself the first reason to request an increase in fee.
All insurance companies WILL consider a request to increase fee but the time duration of the episode is not the place to start.
It is the “what, when & how to ask” that is the most important item to consider.
What, for example, may be defined as a 50% increase in the stated fee.
Do NOT merely ask for a 100% increase in fee because the probability is that you will not get it!
When? The “when” may be defined as asking for an increase to be considered before an invoice is submitted.
How? This may be defined as having the correct information in order for the increase to be considered.
When MHM is asked to request a 50% increase in fee MHM asks its client to supply the following information:
a. The precise details of why medically the consultant feels his fee should be increased. In other words, a written explanation from the consultant as to why the episode was more complicated than anticipated. The consultant is also asked to provide a copy of his/her theatre notes.
b. Details from the anesthetist who provided his/her services during the episode
c. Copies of correspondence from the Hospital detailing the original schedule i.e. time allocated etc.
MHM will then call the insurance company concerned and advise them a fee increase is being requested.
It will tell the insurance company a fee increase from say £500 to £750 is being requested. It will advise the insurance company all the information is available and ask to where the supporting documentation is to be supplied.
Only then will an invoice be raised and submitted. It is then a question of checking the invoice every single week to ascertain the status of the invoice.
By following the above process MHM has on numerous occasions obtained an increase in the fee for its clients.
Without following the process, you probably won’t get an increase in your fee.
pete@medicalhealthcaremanagement.co.uk
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A group of surgeons I know is having problems getting paid by insurance companies.
Not just an individual insurance company but all insurance companies.
More specifically or so the surgeon’s practice manager claimed, there were many invoices unpaid by insurance companies 3 months after the consultation or episode date.
This was all the fault of the insurance companies who simply do not want to pay.
To be clear this was not the surgeons complaining the fee had been reduced or was incorrect.
This was a case of the surgeons not being paid at all.
I found this odd as in my experience ALL the insurance companies I deal with pay well before 3 months have elapsed.
The practice manager therefore altered the patients’ terms and conditions to read “patients will be asked to pay anything not settled after three months from the date of consultation”. This is, in his words “a long stop” and would prevent the issue arising.
I’m not convinced however putting such a plaster over the wound is the correct action to take.
I’m definitely not convinced a “long stop” will prevent the problem because it will allow the invoices to become three months old and then do something about them. More importantly, it is based ON AN ASSUMPTION
It assumes the invoices are being delivered to the insurance company within three months of the consultation (or for that matter surgical episode date) anyway.
I raised the following two points with the consultants and their Practice Manager:
The patient is ultimately liable for payment anyway.
The contract is between the consultant and the patient. Not the consultant and the patient’s insurance company.
Whilst it is useful to insert the “three months” clause it would have been better to add it was ultimately the patient’s liability anyway as well.
Is the “three month’s clause” not missing the point entirely?
WHY aren’t the invoices being paid within three months?
It’s this second point that is the more relevant of the two.
Insurance companies are NOT the enemy.
Of course, I disagree with many of their fee reductions.
I also disagree when they decree certain multi procedures are now deemed to be part and parcel of each other.
They also make mistakes sometimes. The reason for my disagreement is obvious.
I’m here to get the maximum amount of revenue for my clients.
Anything that reduces such revenue is not good.
Nonetheless, insurance companies should not be treated as if they are the enemy.
Insurance companies WILL settle a claim within 3 months. I can honestly say I don’t have a single invoice for one of my clients sent to an insurance company still unpaid after three months by the insurance company.
So why are the group of surgeons referred to earlier having problems and introducing the “three-month” rule?
Without even drilling too far down into how and when the surgeons were invoicing, I can tell you the probable cause and why they subsequently feel the rule is necessary.
That is why the invoices are not being paid earlier than the consultants are currently experiencing.
It is all about getting it right the first time.
First time means having a clinic list or a theatre list invoiced promptly with all the details required by the insurance company appearing correctly on the invoice.
Putting the effort in upfront always generates the best results.
It may be tiresome and it may be an inconvenience to have to stop, make a phone call so you DO have the correct details but it pays in the long run.
Its also all about 30 days after the invoice has been transmitted to an insurance company if it is still unpaid, getting them on the phone and asking if there is a problem.
If there is, it gets sorted immediately.
An invoice should not be allowed to be dated more than three months from the episode or consultation date.
Consider it this way.
If you invoice quickly and invoice correctly, the number of potential issues which may delay payment reduces considerably.
You simply must make it easy for a private medical insurance company to deal with your invoices.
I actually said that to a consultant surgeon recently who wasn’t sure he agreed until I asked him if he liked money or not?
I rest my case.
As regards the consultants who have now introduced the “three-month rule” the rule itself should be entirely unnecessary.
The cause of the problem should be examined and steps are taken to prevent the invoices from becoming more than three months old.
pete@medicalhealthcaremanagement.co.uk
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I’m a really, really impatient person. I like everything done yesterday.
Which is why I go incredibly slowly to start with.
When I begin to raise invoices for a consultant surgeon, for example, I’ll check I have the right provider number. I’ll check all the online systems and EDI protocol are 100% accurate. Is the consultant’s address correct?. I’ll check the insurance company has the right BACS payment details.
What I’m actually doing is reducing down to absolute zero as many reasons as I can possibly think of that will prevent the invoice being raised correctly.
What happens if I don’t take this approach?
Invoices come flying back. They don’t come back straight away of course.
It may take weeks before I’m notified there is a problem. Then I have to work out why it went wrong, get all the details to put the error right, actually put it right and then resubmit the invoice.
Then I have to wait again for the invoice to be reprocessed. Eventually, the invoice gets paid.
One absolutely true example. Recently MHM project managed a group of three surgeons in the Midlands. All three were seriously considering closing the practice as they were not making any money. They were not getting paid as they should.
The senior of the three was responsible for invoicing for all three each week.
Just under 50% of the invoices he produced came back unpaid. The insurance companies concerned requested more details or raised query against them.
The senior consultant complained he hadn’t got enough time to keep sorting these things out. He had to raise invoices as quickly as possible. He tended to view any medical invoicing problem from the “quickest fix” point of view. To use his words “I only want to be a surgeon and not a whatever-you-call-it”
My kind of guy. Don’t talk about it. Get on with it. Play to your strengths. Save that is precisely what he was not doing.
He jokingly told me his blood pressure was sky high due to the constant stream of invoice problems.
Yet it was this “quickest fix” approach that was the cause of his blood pressure. Many times his quick fix in one area (get them on the phone or treat the patient as a self-funder for example) caused a problem in another area. Then he had to fix that.
This was leading to a six /seven-week delay before invoices were accepted by insurance companies on top of the agreed payment terms.
It took me two months to re-map the process, test, amend it and bed it in. In month three we started to see the results. Invoice failure rate had dropped from roughly half to below 6%. Cash flow had doubled. The time with which the three consultants got paid decreased from around every 75 days to about 50.
All three consultants were happy. Imagine the surprise though when I told them that wasn’t good enough?
I thought we should see at least a 98% acceptance rate and to be paid every 30 days. And I wanted to achieve that as of yesterday starting with raising the invoices every single day rather than weekly. The invoice process was robust. There were very few errors. There were few reasons why we shouldn’t be paid.
Told you I was impatient.
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An MHM client recently performed a certain surgical episode. The surgery was something he’d done many, many times before with invoices being sent and paid.
Pretty standard in other words.
One particular insurance company paid £300 for the procedure. Before sending the invoice I’d checked per normal this was the correct fee.
It was.
When the payment remittance arrived from the insurance company I was, therefore, most puzzled to see the fee had been reduced to £240.
It was not a shortfall. It was not excess. Therefore any shortfall could not be passed on the patient.
According to the remittance supplied by the insurance company, the fee of £240 was in line with the normal published fees.
Except according to the insurance company’s own website, it wasn’t.
So I called the insurance company and asked them to explain.
The reply was wonderful. The fee had obviously been reduced between the date I had invoiced and today.
I have a view on that argument and it is not a positive one.
However, as I pointed out, my client had performed the same surgical episode on different patients both before and AFTER this one. A fee of £300 had been paid in all cases.
Also, I have more than ONE client who, as it happens, perform the same procedure although in different parts of the UK and been paid £300 since the date of this episode as well.
Still not to be beaten, the insurance company suggested the specific consultant surgeon I was dealing with as regards this case had agreed, as part of his updated recognition process, to accept a lower fee i.e. £240. That came as complete news to me! It came as a shock to the Consultant Surgeon too!
So I called the insurance company back save this time I asked for my normal contact there.
After the normal pleasantries, I explained my predicament.
The phone went quiet for a while but then my contact came back on the line with the immortal “Oops – we got that one wrong”
It’s a good job I was paying attention.
I really did have to smile.
pete@medicalhealthcaremanagement.co.uk
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Not exactly unexpected to see this today. Cigna have reviewed their consultation fees and reduced them.
Initial Consultations: £205
Follow up Consultations: £145
What is interesting is that virtual consultations will be paid at the same rate.
Pretty much in line with Aviva’s fee schedule.
See more at: www.cigna.co.uk/healthcare-professionals/fee-schedule/
pete@medicalhealthcaremanagement.co.uk
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A group of surgeons I know is having problems getting paid by insurance companies.
Not just an individual insurance company but all insurance companies.
More specifically or so the surgeon’s practice manager claimed, there were many invoices unpaid by insurance companies 3 months after the consultation or episode date.
This was all the fault of the insurance companies who simply do not want to pay.
To be clear this was not the surgeons complaining the fee had been reduced or was incorrect.
This was a case of the surgeons not being paid at all.
I found this odd as in my experience ALL the insurance companies I deal with pay well before 3 months have elapsed.
The practice manager therefore altered the patients’ terms and conditions to read “patients will be asked to pay anything not settled after three months from the date of consultation”. This is, in his words “a long stop” and would prevent the issue arising.
I’m not convinced however putting such a plaster over the wound is the correct action to take.
I’m definitely not convinced a “long stop” will prevent the problem because it will allow the invoices to become three months old and then do something about them. More importantly, it is based ON AN ASSUMPTION
It assumes the invoices are being delivered to the insurance company within three months of the consultation (or for that matter surgical episode date) anyway.
I raised the following two points with the consultants and their Practice Manager:
The patient is ultimately liable for payment anyway.
The contract is between the consultant and the patient. Not the consultant and the patient’s insurance company.
Whilst it is useful to insert the “three months” clause it would have been better to add it was ultimately the patient’s liability anyway as well.
Is the “three month’s clause” not missing the point entirely?
WHY aren’t the invoices being paid within three months?
It’s this second point that is the more relevant of the two.
Insurance companies are NOT the enemy.
Of course, I disagree with many of their fee reductions.
I also disagree when they decree certain multi procedures are now deemed to be part and parcel of each other.
They also make mistakes sometimes. The reason for my disagreement is obvious.
I’m here to get the maximum amount of revenue for my clients.
Anything that reduces such revenue is not good.
Nonetheless, insurance companies should not be treated as if they are the enemy.
Insurance companies WILL settle a claim within 3 months. I can honestly say I don’t have a single invoice for one of my clients sent to an insurance company still unpaid after three months by the insurance company.
So why are the group of surgeons referred to earlier having problems and introducing the “three-month” rule?
Without even drilling too far down into how and when the surgeons were invoicing, I can tell you the probable cause and why they subsequently feel the rule is necessary.
That is why the invoices are not being paid earlier than the consultants are currently experiencing.
It is all about getting it right the first time.
First time means having a clinic list or a theatre list invoiced promptly with all the details required by the insurance company appearing correctly on the invoice.
Putting the effort in upfront always generates the best results.
It may be tiresome and it may be an inconvenience to have to stop, make a phone call so you DO have the correct details but it pays in the long run.
Its also all about 30 days after the invoice has been transmitted to an insurance company if it is still unpaid, getting them on the phone and asking if there is a problem. If there is, it gets sorted immediately. An invoice should not be allowed to be dated more than three months from the episode or consultation date.
Consider it this way. If you invoice quickly and invoice correctly, the number of potential issues which may delay payment reduces considerably.
You simply must make it easy for a private medical insurance company to deal with your invoices. I actually said that to a consultant surgeon recently who wasn’t sure he agreed until I asked him if he liked money or not? Obviously, he said he did. I rest my case.
As regards the consultants who have now introduced the “three-month rule” the rule itself should be entirely unnecessary. The cause of the problem should be examined and steps are taken to prevent the invoices from becoming more than three months old.
pete@medicalhealthcaremanagement.co.uk
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