MHM recently completed a project for a group of consultant surgeons. The project was to investigate why they were not getting paid.
One insurance company was proving to be particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company requires all invoices to be submitted electronically.
Except the invoices were woefully incomplete. For example, the patient’s date of birth or policy number or pre-authorisation was incorrect and each and every time this caused the invoice to fail.
To resolve the problem, it was imperative to make sure ALL the details are correct and invoices correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the cause of the issue.
Or was it?
Medical secretaries though the hospital receptionist was responsible for getting it right. The hospital receptionist thought the medical secretaries were responsible. Then they both said the person who raised the invoice was responsible rather than either of them.
The reality was that nobody was making sure the data was right.
The spat had caused each consultant to be short of many thousands of pounds. Indeed the holding pile was not only greater than the value of average daily outpatient appointments.
Worse it was also STILL growing.
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded on patient records accurately. The person responsible for medical invoicing highlights ANY invoices which can’t be processed. The holding pile is now less than 0.5%.
Is this overkill?
Cash input from this ONE insurance company has increased by around 160%. It’s not overkilling at all.
And everybody has realised a little pre-emptive medicine has stopped rubbish in = rubbish out issue.
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Consider when the patient has contacted his/her insurance company and been issued with a pre-authorisation number.
This does not mean, the insurance company will accept your charge.
This happened to an MHM client – a gynaecologist – a few days ago. We spoke to the insurance company concerned. They confirmed whilst they did indeed issue a pre-auth, this did not mean they would accept the charge. In fact, pre-authorisation had been refused.
Yet again the message came through loud and clear:
No argument from me on that one. It has always been so.
My issue though is why did the insurance company issue a “DECLINED” pre-authorisation?
If they were not prepared to issue a pre-authorisation then they should not have issued one at all.
This point was duly made to the insurance company. Their reply was poetic.
They had always done it that way.
I have the utmost respect for private medical insurance companies. Most are extremely efficient and willing to help. Whilst I’ve had numerous disagreements with all of them regarding fees etc, never have they implied or stood behind the “we’ve always done it that way” position.
But on this occasion, it feels very much like a case of stop wasting your breath!
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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.
A statement was received today from a certain insurance company containing an entry reclaiming £620 paid to an MHM client in December 2020.
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?
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Have you ever wondered how long a pre-authorisation number is valid?
How many didn’t realise some insurance companies deem pre-auths have a life span?
I was asked to invoice for a surgical episode from last week.
The patient had the right pre-authorisation reference. The CCSD code was correct too.
However, the pre-auth code was dated January 2021.
This particular PMI decreed the code was only valid for 45 days. Now what?
Call the insurance company. Explain why the surgery took place so long after the issue of the pre-auth reference.
It shouldn’t be a problem.
Funnily enough, another MHM client asked us to invoice against a pre-auth of a similar age to the above example. There was no issue in this second example. The insurance company concerned in this case deem pre-auth to be “live” for six months.
But have you considered why there was such a delay between the issue of the pre-auth and the episode?
Might be a perfectly reasonable explanation.
However, if the code was issued 6 months ago and the episode took place last week, questions will be asked.
Some insurance companies will decline if an invoice is submitted for payment six months after the episode.
Pre-authorisation 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?
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It’s amazing how many people don’t back their IT systems up so 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 and was not resolved by him 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 the consultant 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 suggest to new clients is if they don’t have backups they go out and buy an external drive. Then they can 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?
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
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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.
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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.
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.
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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:
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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.
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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.
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One of the most often asked questions is “how can I improve or increase my cash flow”.
The answer, as regards medical invoicing, is very simple to answer:
But what does that mean in reality?
It means aiming to be a winner
It means taking all the items that should be done and turning them into a MUST be done.
For example, I took a phone call from a consultant’s secretary this morning who wanted a favour.
She was struggling to get an invoice posted electronically.
She was trying to invoice BUPA.
Simple enough you may think but despite having a policy number, she could not process the invoice.
So how did it take me approximately 3 seconds to work out precisely WHY she couldn’t process the invoice?
She told me the policy number began BI-6000 etc.
That told me the policy number was not a BUPA policy number; it was a BUPA INTERNATIONAL policy number.
She was trying to invoice the wrong insurance company.
A quick fix to process the invoice, again online, to BUPA International and it sailed through. Sorted.
If standards had been raised to ensure that every single patient registration form had been completed correctly, this problem would not have occurred.
The invoice would have been processed the same day and payment made when required.
Instead, a shortcut had been attempted and the patient’s insurance company detailed incorrectly.
If standards had been raised to ensure this was checked and spotted the invoice would have been immediately processed.
There are no shortcuts if you want to get paid.
As it happens in this case the issue was already a week old before I took the phone call.
Thus an increase in cash flow – the outcome desired by the private consultant – was not being reached.
However, if you stop to think there are two questions:
When the patient was registered, why wasn’t the check performed to ensure the right insurance company was recorded because it should have.
What should have happened was the standards had been set too low.
If it becomes a case of the patient MUST be asked i.e standards are raised then this specific problem is never allowed to arise.
And that’s what I mean by raising your standards.
So why is this even more crucial as we work our way through 2020?
Because more and more private medical insurance companies are insisting invoices be submitted electronically.
The issue is not one of is that the right thing for them to do or not.
The real issue is that it is happening and standards must be raised to ensure you CAN invoice electronically.
In other words, if you don’t have all the right details it is much, much harder to process an invoice electronically.
You will instead have to re-contact the patient and get the right details.
Therefore it makes more sense to say you MUST get the details upfront and you must RAISE YOUR STANDARDS to the point of saying – the correct details MUST be obtained and checked.
I’ve even witnessed where an invoice can’t be processed because the postcode has been recorded as W01 (numeric) when it should say W01 (alpha) Incidentally.
Many times I’ve said insurance companies are not the enemy.
Even if I frequently disagree – I do on a daily basis sometimes – with some of their fees plus other items they do which are seriously irritating, all insurance companies will pay a private consultant IF (and only if) ALL the details are correct.
In other words, invoices must be raised to the correct standard.
Never quit. Aim to be a winner instead.
If you want to increase or improve your cash flow, the very first thing to do is to raise your standards in the area of invoicing.
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I called one of my friends early one evening last week. 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.
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MHM sort of cheats when we say we are an outsource company.
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 two weeks.
Another every couple of months or so.
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.
Once a week – every Friday – an 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.
But..then we cheat even more.
In the pre_Covid 19 days we went to see clients every three months if necessary and sat down with them (sometimes for no more than an hour) to chat through problems, meet their med-secs, 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 physically meet and ensure that issues don’t become major problems for both of us 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 getting paid quicker with less hassle.
Let me know what else you are looking for, please?
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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!
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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.
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Working for consultant surgeons is fun.
However, since one particular private medical insurance company decided to outsource their help desk or their “advisors” late last year, there has been a marked reduction in their level of customer service from it.
Considering the people calling them are either consultant surgeons or calling on behalf of a consultant surgeon, that is pretty bad.
Indeed the average time on hold for this particular insurance company, for example, is now well over 10 minutes.
That’s pretty awful considering it used to be less than a minute.
What is ironic however is that now I have a choice of music to listen to.
For example: would I like to listen to classical music, pop music, jazz or rock music? I decided on classical as it happens and am currently listening to Bach. I like Bach.
But it has got me thinking…
Isn’t being given the option of what to listen to missing the point entirely?
This is an even worse option than being told my “call is important to us” and then the call is unanswered.
Shouldn’t the aim be to answer the phone call rather than offering a choice of music to listen to?
All private consultant surgeons sooner or later will need to speak to an insurance company.
Whether this is at the point they are attempting to gain recognition or to check a fee is correct is not relevant.
Sooner or later – particularly if you are billing an insurance company – you have no choice but to speak to them.
But is it absolutely necessary to call?
That is my favourite question to ask.
The first port of call so to speak is always to consider if an action is necessary. In other words, what is causing that action to be necessary and can anything be done to prevent the necessity of the action?
In the case of speaking to a medical insurance company, in theory, many of the calls should not be necessary.
If an invoice is raised and submitted correctly for example then payment should – again in theory – just flow through. Reducing the necessity of speaking to an insurance company is always a good aim.
It is the very reason I check remittance advice sent by an insurance company most carefully.
They record many of the details as to why an invoice, for example, hasn’t been paid either in full or partially.
For example: if a partial payment has been made the reason why will be detailed on the remittance advice.
Thus the number of calls required to a private medical insurance company will be reduced.
Nonetheless, the fact remains there will ALWAYS be an occasion to call an insurance company. It may be, for example, that the fee has been reduced and you don’t know why.
The point is there may be genuine reasons why it IS necessary to speak to an insurance company.
Contrast this however with another insurance company I’ve spoken to this morning. I called them and was told I was on hold, was caller number 3 and the estimated hold time was 4 minutes.
Fine; I can live with that.
It is up to me whether I’m prepared to wait in line or call back.
Having formally complained to the medical insurance company in the first example that their customer service is not good four times so far, I did consider WHY they had outsourced?
It would appear the reason is financial. It’s cheaper.
It was once said by an extremely wealthy man that price is what you pay and value is what you get. I agree wholeheartedly.
Cheaper isn’t always the best.
And time is money too.
I’ve actually written this blog whilst being on hold and listening to Bach. So I’ve used the time to do other things too. What would happen, however, if I was a private consultant surgeon with an already overworked medical secretary who had letters to type or worse still was on hold so patients couldn’t ring her?
That would reflect badly on my practice.
I’m all in favour of outsourcing.
I would say that though because my business is intrinsically the provider of an outsourced facility to private consultant surgeons.
Even so, I get seriously frustrated at being told either my call is important – well answer it then – or I’m offered a choice of music to listen to.
I don’t actually want either to hear either.
I want my issue resolved quickly and efficiently.
Cheaper and slower shouldn’t be an option.
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It is dangerous for an insured patient to assume his insurance covers everything.
Often it does not. This will impact on how much you get paid.
Private medical insurance is designed for short-term issues. For example, an injury that suddenly happens and treated/cured relatively quickly.
A broken hand can be treated quickly. A diabetic problem may not.
Consider it this way.
Private medical insurance is in place to cover elective non-urgent issues.
If the condition was known before the policy was taken out, it may not, however, be covered.
But it does NOT follow that if the injury is short-term and treatable under private medical insurance cover, all parts will be covered.
It will depend on the type of policy held.
Basically, the higher the costs of the cover, the more covered. The lower cover may set a financial limit on how much can be paid out.
They may, for example, exclude consultations.
Whilst it may impact on the consultant surgeon it will be a sad day if a consultant even stops to consider if he/ she will treat a patient based on an insurance policy. They would not remain an MHM client if they did.
But what is the impact on the consultant?
For one thing, a budget type policy could easily lead to shortfalls. It may also lead to excess. It may result in the refusal of consultation fees.
This will lead to a requirement for the consultant to have such amounts collected from the patient.
Therefore what is covered is indeed relevant to the private consultant.
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In the world of medical billing, the most efficient way of doing something is to do it right the first time.
You don’t get paid.
My late Father drilled into me from a very early age:
Measure twice; Cut Once
Do it once and do it right
What has that got to do with medical invoicing? Everything.
MHM recently completed a project for a private hospital. The project was to investigate why invoices were not being paid.
One insurance company was proving particularly troublesome. An analysis of a month’s invoices soon identified why. This particular insurance company required invoices to be submitted electronically.
Except for the data on which the invoice was raised was incomplete. So the invoice could not be submitted.
For example, the patient’s date of birth or policy number or pre-authorisation was incorrect. This caused the invoice to fail at the point of logging electronically with the insurance company. Thus the invoice was not passed to the insurance company for payment. Instead, it was put in a “holding” pile.
In other words, the invoices were not being done right the first time.
To resolve the problem, it was imperative to make sure ALL the details were correct. That way invoices could be correctly processed and not placed in a “holding” pile. That was, or so it appeared to be, the root cause of the issue. But why was this proving so troublesome?
It transpired medical secretaries thought the hospital receptionist was responsible for getting it right.
The hospital receptionist said the medical secretaries were responsible.
Then they both claimed the person who actually raised the invoice was responsible.
The reality was that nobody was making sure the data was right.
The spat had caused, over the previous six months, the hospital to be short of tens of thousands of pounds. Indeed the holding pile was greater than the value of average daily outpatient appointments. And it was STILL growing.
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded in patient records and checks them again. The person responsible for medical invoicing highlights on a daily basis ANY invoices which can’t be processed. The holding pile is now less than 0.5% of a MONTH’S worth of invoices.
Is this overkill?
Cash input into the hospital from this ONE insurance company has increased by around 160%. It’s not overkill at all.
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That’s an interesting question. Many don’t appreciate that a private medical practice can fail.
And some do.
A private medical practice can fail for the same reason that ultimately any business fails.
It runs out of cash.
Whilst obviously there may be a lack of patient numbers or lack of customers in a “normal” business, it is the financial contribution patients make that matters.
Without a paying private patient the consultant will not generate any money.
If no money is generated into a private practice it will require more money putting into it than being taken out.
And that defeats the object of opening and running a private medical practice.
It is that simple.
Which is why it is even more concerning for a consultant to see patients and NOT invoice them.
The first rule of medical billing should be to guarantee that you actually raise an invoice and that invoice is complete in all parts.
Without doing so, your practice WILL fail.
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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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