A shortened version of a recent conversation with a well established private consultant surgeon.
Very recently one of the major PMI players announced a further reduction in payable fees. Definitely applicable to newly recognised consultants in January 2015, the fee reduction does not apply to those recognised previously. Ot at least it didn’t.
But it does now.
The immediate retort from another very well established MHM client was to pass any reduction on to the patient. That’s all well and good but not if she is fee assured with the insurance company concerned. I actually checked just to be sure. Yep; if a fee reduction is passed on to a patient by a fee assured consultant, the consultants recognition may be put at risk.
None of the above means MHM agrees with insurance companies reducing fees – even though market forces may on occasion be the root cause of such reduction. By all means argue with the insurance company. And I already am.
But…don’t rely solely on that argument and assume the argument fees should not be reduced will be successful. It might. There again it might not.
Instead make sure you are charging the very maximum you can. Make sure you are charging for everything you do. If the surgery takes twice as long as expected, request an uplift fee. If a double consultation is required, charge for a double consultation. Its not as difficult as you may think it is.
And don’t forget to do a sanity check each month. If you think a 20% reduction in fees is bad, consider the 100% reduction if you fail to charge an entire consultation.
Whilst the question of where fees will go will be considered in future blogs, its important before even thinking about your fees to make absolutely sure you are charging the right fee already. You’d be surprised how many aren’t!!!!
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The CLINICAL CODING & SCHEDULE DEVELOPMENT GROUP [CCSD] first appeared in 1997 following the appointment of a healthcare management consultancy group. The healthcare management group was commissioned to both streamline and improve medical codes within the private sector. Over 4 years later and following assistance from over 100 private medical consultants in almost 24 different surgical areas, CCSD codes were established.
CCSD codes are contained within 20 separate anatomical sections and comprehensively describe a typical surgical procedure as well as allocating a specific code against it. At this point, there are in excess of 2,000 different codes.
It is important to remember however that the fee for a specific code is not set by CCSD; the individual insurance company sets it. The CCSD website will enable you to locate a specific code but it won’t tell you the fee for it. For that, you need to contact the specific insurance company with whom your patient holds a policy.
So, how precisely do you find a code?
Go to: www.ccsd.org.uk and then click “CCSD schedules” Navigation is very simple. Enter the treatment description and up will come the code (s). For example:
Enter the word CONSULTATION in the CCSD schedules and you’ll be offered three.
20300 initial consultation
20310 follow up consultation
Enter the word FRACTURE and you’ll be offered around 30 different codes each relating to a specific anatomical section. Simply locate the section you practice within and the codes will be illustrated. The complicated part though is knowing the fee for each code from the individual insurance companies.
But be honest, how many of you knew what the initials CCSD stood for before reading this article??
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This specific issue comes up frequently when MHM is asked to review the outstanding accounts of a private consultant surgeon.
There are two reasons normally why the patient believes the hospital have taken payment for the consultant:
To overcome this, MHM recommends the client’s invoice bears the message “payment of this invoice is not covered by any debit / credit card details taken by the hospital” To further help prevent the issue arising, MHM recommends that when the patient makes the booking for the initial consultation, he/she is told an invoice will be sent to them after the consultation.
Over the last year, twice MHM has amended the surgeon’s invoice to include the above sentence. In both cases, the number of outstanding self-funder invoices reduced.
To resolve this issue MHM contacts the patient and request they check what was and what was not covered in the package. Payment of the surgeon’s initial consultation fee soon follows as the patient agrees the initial consultation fee is not covered. BUT again when the consultant’s secretary confirms all items with the patient, the patient should have been advised the initial consultation was not covered.
Actually, on this specific point why has the patient been advised the invoice for the initial consultation is still outstanding if appropriate.
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Monday morning comes round all too quickly and its time to invoice last week’s clinics.
This is a good example of not paying sufficient attention to the clinic list. It almost cost the consultant £50. The patient was marked down as a follow-up. An invoice for £100 was required for the patient’s insurance company.
According to MHM, the consultant had never seen this particular patient before. A quick phone call established that this was actually a new patient so a £150 invoice was required for an initial consultation and not for a £100 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 £50.
All you have to do is outsource the invoicing to someone who checks absolutely everything.
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This issue came up during a recent meeting with a consultant surgeon. More specifically how fees are accounted for against a benefits package and the possible creation of a shortfall.
Consider the total benefits payable under a patient’s insurance policy. For example, the benefits payable may be £100. Obviously, it could be considerably more as will the possible fees mentioned below.
To continue, however, against such a benefits package fees are deducted as follows:
The patient attends for an initial consultation at a cost of £20. Therefore the £20 is paid out and the total benefits figure reduces to £80. Subsequently, the patient requires a surgical episode at a cost of £50. This too is paid out and the benefits accumulator, therefore, reduces to £30. But of course, the hospital tenders their account (say £20) as does the gasman (£15). The benefits accumulator, therefore, further reduces to ZERO. Thus the benefits package is equal to the fees charged.
If the initial consultation fee is £21, the surgical episode fee £51, the hospital account £21 and the gasman’s account £16 then the total fees total is £109 against a total available benefit package of £100.
Thus, if when the fees are calculated against the benefits accumulator they exceed the total available, a shortfall will be created.
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