It is depressing the number of times I hear potential clients criticising insurance companies.
In my experience the reasons normally cited are incorrect. Far from it.
I’ve lost track how often I’ve been told an insurance company won’t pay for something. Yet when I ask if the insurance company have actually been asked IF they will accept a charge, the answer comes back that they have not.
I have all the private medical insurance companies on speed dial. They need to be as I speak to most of them every single day of the week. There are many, many things I’m already aware of. There are also some things that I don’t know or more importantly that may have CHANGED.
I ask them all sorts. For example – I ask them to confirm a patient’s policy number. I ask them to confirm why an invoice has only been partially paid. Sometimes I ask them if I can or cannot charge for a certain medical episode. Which brings me neatly to the W9040 code.
I was invoicing for an orthopaedic consultant surgeon recently. His specialism was knees and during a follow-up consultation he administered a W9040. This particular CCSD code represents an injection into a joint or soft tissue.
The question arose if I could charge a particular insurance company for a follow-up consultation fee AND a fee for the injection. So I called them. The answer came back yes I could. I could charge £120 for the consultation and £50 for the injection i.e. £170. The insurance company would happily pay such an invoice.
Compare and contrast that with work I was performing for a dermatologist recently.
This time the question arose of a S5210 (an Injection into subcutaneous tissue). I’ve only recently started invoicing for this client and thus it was important to establish what could and could not be charged for. More specifically, would the insurance company accept an invoice for the follow-up consultation AND the injection? Yes they would. £125 for the consultation and £108 for the injection i.e. £233.
Remember however that I had asked ONE specific insurance company. When I asked others the same question, some would NOT allow the separate charge.
What was concerning was previously the dermatologist had not been charging for the S5210 at all. I actually asked his practise manager why this was so. The answer came back that the question had been asked of an insurance company before and the answer was no. The problem was that whilst the insurance company concerned did not (and still don’t) allow a charge, other insurance companies DID allow a separate charge. But nobody had asked the other companies. Instead it was assumed the decision covered ALL insurance companies.
Thus on numerous occasions insurance companies are wrongly blamed for their actions.
It was only by speaking with the individual insurance companies that I identified which ones would accept the charge and which ones would NOT accept the charge.
Insurance companies are NOT the enemy. If you call them, you may be surprised at what you are told. That is not to say you will always obtain a positive response but you may be pleasantly surprised.
Read more →
Recently I helped a medical secretary understand the noble art of medical invoicing.
Having your medical secretary handling medical invoicing isn’t something I’d recommend though for a number of reasons.
First and foremost, over the years medical invoicing or medical billing has become far, far too complicated to be left to the untrained.
This is not to say a medical secretary can’t understand how to invoice.
Of course, he or she can.
Given enough time and effort, and, training the ability can be developed.
The main reason I’m against it is simply time.
If you think about it there are only a certain number of hours in a working day.
Into those hours a whole multitude of tasks has to be done.
In the case of your medical secretary most likely she’ll have to answer the phone, book clinics, answer emails, meet patients, take down patient details and generally act as the first port of call for any issue within your practice.
And then sometimes is added the task of medical invoicing.
Invoicing an entire clinic list does NOT take that long. Providing there are no interruptions and all the details are correct.
Add numerous interruptions (the phone rings, the hospital want to alter clinic times or YOU want something) and medical invoicing will prove difficult. Then throw in incorrect patient insurance details – even MISSING patient insurance details – and the thing becomes a nightmare.
First off and for the record, she was – and still is – very, very good at her job.
I spent enough time to train her and demonstrate what to do if the patient’s records were missing, where to find a CCSD code, how to find the correct fee from an insurance company.
I also trained her on how to allocate cash and deal with shortfalls and excess amounts deducted by an insurance company.
She got it.
All of it.
She was more than capable of handling any medical invoicing.
She actually did the invoice correctly.
Right up to the point she had to do it on top of her other aforementioned duties.
I did warn her this might happen. My fears were shared both with her and with the consultant.
The consultant was of the opinion that provided all the details were correct, there should not be a problem.
What was really significant was the med-sec telling both of us she was simply running out of time.
She would start the invoicing process first thing in the morning.
But before she had even blinked (her words) it was6 pm and time to go home.
So she tried to work faster.
And that’s when the mistakes started to creep in one after the other.
Sometimes she’d undercharge a surgical episode.
Or she would omit to charge a consultation because she hadn’t got time to stop and correct the patient’s details that were wrong.
So she tried – and I truly admire her determination – to “fit” the invoicing in around all her other duties.
The whole invoicing process collapsed!
It was fascinating to hear her talk about invoicing taking an hour each day when straightforward but take “ages” a day when it was not.
She literally was losing track of time.
She simply didn’t realize that other tasks she had to complete each day weren’t getting done.
Of course, this tale is all very interesting but what is the worth in it?
The worth comes from realizing WHY the cash flow had suffered, WHY existing patients were starting to complain the phone wasn’t being answered and WHY new patients couldn’t make an appointment!
All three of those are crucial for the bottom line of any private medical practice.
There are only a certain number of hours in a day.
Try and cram into those hours more than you can successfully achieve and you could very easily find your private practice in difficulties.
In other words, if you lose track of time, sooner or later you will lose money too.
Read more →
My Top Three Assumptions when there is a knock on the office door are:
What on earth has that got to do with medical invoicing I hear you ask?
Maybe not the first two (definitely not the 1st although the 2nd may have possibilities). The 3rd, however, is very relevant for you really need a positive attitude when you are invoicing for consultant surgeons.
All my guys (and girls) are lovely. They really put some serious hours in. Seldom do they seem to sleep (a throwback to being at med-school and being a “junior” hospital doctor).
Joined up writing is an issue too – I’m being serious!
It is the joined up writing part where you need positive thinking. I once enquired of one of my clients as to why all medical professionals seem to have poor handwriting.
He responded that a Doctor’s ability to write legibly is surgically removed at med-school. Works for me.
I can’t really insist my guys and gals improve their handwriting. But I can and do urge them to send me the clinic lists produced by the hospital instead of writing them out again.
Why re-write something when you can scan the original anyway?
Consequently, that is what they do.
This leads me to have a positive outlook because I know the information I need will arrive in a format I can use to raise invoices correctly.
It also means from the consultant’s point of view once I have the data all the patient details will be checked. All the fees will be calculated. Invoices WILL be raised. I don’t even have to attempt to read the writing.
All in all, a very positive thought.
My clients, therefore, think positively regarding when and if they are going to get paid.
In reality, however, I don’t for a nanosecond believe in the concept of positive thinking.
You may, for example, have numerous positive thoughts that it won’t rain today. Your thoughts will have absolutely no impact at all on the weather and you may (or may not) get wet.
What will have an impact is if you have an umbrella with you? If it doesn’t rain, you won’t need the umbrella. Should it rain, you will.
If you have PREPARED and made sure whether it rains or not, you are in a position to handle it. You have taken ACTION.
It is just the same with medical invoicing.
Don’t just have positive thoughts that all your work is being invoiced.
Have positive thoughts that you will get paid the right amount and on time.
Take positive ACTIONS to make sure your invoices are being raised to ensure you do get paid the right amount and on time.
Read more →
Most consultants are concerned, quite rightly, with how and why a patient has chosen to see them. Before asking the question why and how does a patient choose you as a consultant an early question is asked. Why have the patients taken out private medical insurance originally?
There are three major reasons.
Empirical research on the patients of MHM clients indicates whilst most private healthcare originates via a patient’s employer, even if the insurance is paid for privately, the number one reason for holding private healthcare cover is to avoid and cut short NHS waiting lists. This is the primary reason patients have private medical insurance cover.
But whilst private health cover gives a prompt access to treatment, the second reason for having private healthcare insurance is that it offers the additional benefit of when and where the patient may be treated. Aligned to this is the ability to recover, if surgery is necessary, in a private suite, which is more convenient to both the patient and his/her family.
Thirdly, and finally, private insurance offers a choice of a consultant to the patient.
Before considering why a patient should choose to see you as a consultant, it is equally useful to consider why the patient has private medical insurance in the first place.
The major reasons patients choose to take out or receive private medical insurance are, in the main, three:
Read more →