Insurance companies use medical coding to detail a medical procedure.
For example: an Orthopaedic surgeon will understand what a Multiple arthroscopic operation on the knee (including meniscectomy, chondroplasty, drilling or microfracture) is.
That is a lot to put on an invoice!
The CCSD code W8500 will identify the procedure.
Put this code on the invoice instead.
Codes can be found on the CCSD website:
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the major healthcare insurers.
The Group’s purpose is to maintain a common standard of procedure codes.
A CCSD code is imperative IF a surgical episode is required.
The patient should quote the code to his or her insurance company when pre-authorisation is being requested.
However, be warned.
The example above of W8500 does not come with a suggested fee.
The rate for each code is up to the individual insurance company. You need to contact them to discover what fee they will pay for each.
When an invoice is sent to the insurance company, the code should appear on the invoice. It will reconcile to that expected.
If you do NOT use CCSD codes payment will be delayed if made at all!
Without a CCSD code, you will not be able to invoice electronically anyway!
pete@medicalhealthcaremanagement.co.uk
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For the simple reason, cash does not flow.
Cash has to be managed.
Around this time of year, I take calls from consultant surgeons who in view of their impending tax payments require an increase in cash collections.
It’s happened every year since MHM was formed. The normal instruction is to increase the cash flow. Immediately. Simple enough. I can do that.
Existing clients don’t call because invoices have already been generated for them and they’ve already been paid for their work.
Their cash has already been maximized.
The real problem faced by potential clients though was highlighted this morning when a consultant surgeon referred to needing an outstanding cash flow “purge” within his practice.
This highlights to me a more fundamental underlying issue. Let me explain.
A consultant surgeon – just the same as any business – should know how much he is invoicing both in terms of patient numbers and the value of those patients.
If he is invoicing correctly and ensuring he gets paid he can also, therefore, calculate his revenue receipts.
he wasn’t a consultant surgeon but sold another service or product, he should be able to perform the same calculation.
So he knows how much he is or should be invoicing. Providing he proactively manages his practice.
If you think about it, most consultant surgeons already know their overheads too. They know how much their room rental is. They know how much the staff cost.
And they know how much their professional indemnity costs (too much before you ask).
Of course, there are other expenses but fundamentally they already know their expenditure.
They know their total costs.
Therefore they know or should know how much they are spending too.
Enter stage left Mr. Micawber:
He knew a thing or two about how to run a private medical practice did Charles Dickens.
For one thing, he knew cash doesn’t just flow into it.
It has to be managed.
pete@medicalhealthcaremanagement.co.uk
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There are only 24 hours in a day.
All of my guys are incredibly busy.
I’m amazed at the volume of work they get through in a single day.
They are either on-call, doing a ward round or in theatre. Then they have to see their private patients.
That explains why most of them call me either very early in the morning or in the evening.
It doesn’t bother me.
It’s my job to fit in with them and make their life easier.
Recently, however, I was asked to review the private practice of a consultant who was having serious difficulties generating any cash into his practice.
And following my question to his long-suffering medical secretary, it didn’t take long to establish why.
The question was: what is the biggest problem you have this week. The reply said it all:
“I never get a response to the queries or receive the information I need after I’ve asked Mr. Surgeon. He always seems too busy to deal with the things I need”
Yet most of the information the med-secretary needed was fundamental to generating cash into the practice.
For example: two clinic lists from last week were still unprocessed (result: no invoices sent out) or remittances from an insurance company (no idea who had or hadn’t paid) or the post Mr. Surgeon picked up and put in his bag one day last week (it had cheques from patients in it)
So I spoke with Mr. Surgeon and asked him what he thought about it.
His response was a classic:
“I just don’t have time to deal with all that. My private patients are paying to see me so they must come first”
The stark reality is he is right enough to be dangerously wrong.
He is right as regards putting the patients first but he needs to ensure his administrative support is first rate too.
The reason Mr. Surgeon is having difficulty generating the cash due is in him not dealing with such issues as the missing clinic lists or not passing over remittance advice.
Mr. Surgeon needed to make very sure, the support facilities of the practice were dealt with.
The word “support” suggests these things can be demoted to a “Too busy to deal with that and they are not that important so I’ll deal with it later” category.
Eventually, they catch up with you.
In the case of Mr. Surgeon, they were the reason he was struggling to generate cash into his practice.
Compare and contrast that with another real-life MHM client: Mr. B Surgeon.
He is very different from Mr. A Surgeon save curiously they see a similar number of patients each week and are in theatre on the same day too (but in different parts of the UK)
Mr. B Surgeon will send his clinic list the day he sees his patients.
His theatre lists arrive the same day too.
All of which means his invoices are out the proverbially electronic door within 24 / 36 hours.
In the unlikely event, there are queries, a response comes back to me either that same day or at the latest the next. His cash flow is many, many times greater than Mr. A Surgeon.
In case you are wondering why I don’t have such issues with MHM clients its because every single week my clients take their post or clinic lists etc scan them to me and promptly proceed to forget about them thereafter.
pete@medicalhealthcaremanagement.co.uk
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It matters little if the consultation was face-to-face or, as is more relevant in a post Covid-19 world, excess will still be deduced.
And that means, the consultant has to do something about them
The responsibility for the collection of such items rests very squarely on the consultant himself.
Consider excess and the cause of excess?
When the patient obtains private medical insurance there will be an amount – excess – agreed on the policy.
The exact amount of the excess will depend on how much the patient pays for his/her policy.
Generally speaking the higher the premium, the lower the excess.
It’s just like car insurance, if you agree to a £500 excess, the premium will be lower than if you only agree £100. That’s fine – until you come to make a claim on your insurance.
Private medical insurance carries the same principles.
So, when the patient comes to see you and you claim the cost of your services off their insurance company there could well be excess for which the patient is liable.
The consultant is responsible for the collection.
Not the patient’s insurance company.
pete@medicalhealthcaremanagement.co.uk
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It’s amazing how many don’t pay attention to remittance advice.
They should.
I downloaded remittance advice for an MHM client yesterday.
One of them, provided by a certain insurance company, was for 11 separate invoices with a total value of £2,400.
But the payment made against the value of the invoices was only £1,950.
Pretty standard stuff. The difference was almost certainly excess.
Except it wasn’t
Whilst £350 was in respect of excess, the remaining £100 had been deducted because we had charged the wrong fee.
No, we hadn’t.
We had charged the correct fee for the appropriate CCSD code and the insurance company had made a mistake.
They had reduced the value of the invoice incorrectly by mistake.
A quick call to the insurance company later and the mistake was put right.
Next week’s payment will include the £100 incorrectly deducted.
This isn’t the first time this particular insurance company has made this mistake. Indeed it is the 5th time so far this year.
£500 deducted from an MHM client for no valid reason!
And that’s precisely why remittance advice is not only more useful than you think and why you should check them carefully.
They aren’t just pieces of paper your accountant wants to see every so often.
They also aren’t just to tell you if and when an excess has been deducted.
The purpose of remittance advice is for you to check you have been paid the right amount for your professional services.
Obviously, you don’t have to check each one.
If you don’t like money or getting paid the right fee, you don’t have to.
Yes, you do.
pete@medicalhealthcaremanagement.co.uk
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A question, which was asked recently at a private practice seminar MHM were presenting at.
Interestingly the question was asked by a consultant surgeon who had started his/her private practice two years earlier.
He said excess was the responsibility of the patient’s insurance company.
They would collect excess or shortfall amounts from the patient on his behalf.
Sadly this is absolutely NOT the case at all.
The responsibility for the collection of such items rests very squarely on the consultant himself.
Consider excess and the cause of excess?
When the patient obtains private medical insurance there will be an amount – excess – agreed on the policy.
The exact amount of the excess will depend on how much the patient pays for his/her policy.
Generally speaking the higher the premium, the lower the excess.
It’s just like car insurance, if you agree to a £500 excess, the premium will be lower than if you only agree £100. That’s fine – until you come to make a claim on your insurance.
Private medical insurance carries the same principles.
So, when the patient comes to see you and you claim the cost of your services off their insurance company there could well be excess for which the patient is liable.
The consultant is responsible for the collection.
Not the patient’s insurance company.
The consultant who asked the question called a few days later because of this horror, he had in excess of £5,000 worth of uncollected excess in the previous two years unpaid and due to him which nobody was collecting.
The supplementary issue, however, is why were the excess amounts allowed to build up over two years without anybody noticing?
pete@medicalhealthcaremanagement.co.uk
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Every single consultant I’ve ever met is dedicated to patient care and the best possible outcome for his or her patient.
But sadly that has little to do with the outcome of the practice as a business.
They may think it does.
But it doesn’t.
Patients reviews are ALWAYS good and they reflect the clinical outcome.
Potential patients do actually read them and take the decision to see a consultant based, in some part, on good patient reviews.
But other than that, there are numerous other items impacting the business outcome.
Planning has a HUGE impact on the outcome.
Specifically, if you don’t have a plan you won’t be able to know if you have achieved the desired outcome anyway.
But what needs to go into the plan?
Sounds crazy but the aim of the plan should be to achieve the outcome, yet you can’t reach the outcome until:
a) you define what the outcome should be
b) you define the plan to achieve the outcome.
Just talking about it won’t be enough. It never is.
Unfortunately, far too many consultants start a private practice without deciding what their desired outcome is. Instead, they make reference to “making more money” or “seeing more patients”
But the smarter ones start by saying I want to make, for example, £5,000 a month (outcome) so I need to see at least 20 patients during that month.
It matters little if it’s £5,000 or £25,000.
What matters is they have a defined outcome with a plan to get there.
Then they start giving immediate thought and planning on how to see 20 patients a month.
None of which has anything to with clinical outcome!
pete@medicalhealthcaremanagement.co.uk
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I didn’t say I was against remote consultations!
Following yesterday’s post, I received phone calls and emails claiming clearly I was against remote consultations.
But I never said that!
What I said was that I don’t think remote consultations are a vehicle by which a private practice will grow.
Specifically, there is insufficient data upon which to believe they WILL grow a private practice. It’s far too early to make that claim.
Whilst they are easier for the private consultant to perform, and more crucially, enable to patient to be “seen”, that does not in itself mean the patients will want them.
I suspect many patients much prefer a face to face consultation over a remote consultation anyway.
Could it be patients are happy with remote consultations because they have been told to stay home?
That said I freely admit I could well be wrong but maintain it is far too early to reach a conclusion either way.
There’s another aspect to this.
What fee will the consultant receive for a remote consultation?
At this point in time, all insurance companies are paying precisely the same fee for a remote consultation as a face to face consultation.
Quite right too.
But that does not mean, in the post-Covid-19 world they will continue to do so.
Prior to the lockdown, fees for remote consultations were substantially lower than those for face to face consultations.
At some point, it is inevitable that insurance companies will resume their previous fee structures.
All of which means as a growth opportunity, remote consultations could well be less attractive than first thought.
But remote consultations should remain an option in the post-Covid-19 world.
As such they should be offered to patients.
But they won’t be the panacea to private practice as suggested.
pete@medicalhealthcaremanagement.co.uk
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Recently, I was talking to one of my clients.
She was unhappy with the fees she was getting from insurance companies.
Sadly she was also unhappy about how often she got paid too.
Therefore she wanted me to contact all insurance companies and do something about it.
Unfortunately, not only had she agreed on her fees, she had agreed on the payment terms too.
When she applied for recognition with the various insurance companies towards the end of 2018, she thought to give it a year and she would be able to increase her fees.
Sadly, this was never going to happen.
Certainly, she could ask the question but it was doubtful she would get an increase.
And that’s precisely what happened.
There is not a lot she can do about it.
Nor can I.
So instead she wanted the payment terms amended.
Two of the insurance companies paid her within a few days.
Others paid her once a week.
The remaining insurance companies paid her monthly.
She wanted ALL insurance companies to pay her within a few days.
This is never going to happen either.
The reality is, just as it is with fees, the insurance companies are in the driving seat.
They are not going to amend their payment terms.
Even more so when the consultant agreed to the terms originally.
I’m all for arguing with insurance companies.
But I won’t pick an argument that I know every well I won’t win. There is no point.
If you agree to your fees and your payment terms, you pretty much are stuck with them.
Sorry!
pete@medicalhealthcaremanagement.co.uk
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Most consultants when they first start a private practice, consider how best they can set their fees.
In the case of self-funders, there is nothing to stop you charging any consultation fee you like.
Save of course if there are other consultants in your area then their fees will influence that which you charge.
Effectively it is up to the patient whether they chose to accept that fee or not.
In reality, in the case of an insured patient, it is not the consultant who sets fees.
It is the patient’s insurance company.
Consideration of fees for an insured patient should be viewed from two distinct areas:
1: Consultation fees
2: Surgical Fees
Consultation fees (for both initial and follow up) will be agreed at the point of recognition by the respective insurance companies of the medical professional e.g. consultant surgeon, anesthetist, etc.
The insurance company with whom your patient is insured will always set surgical fees.
You may feel the fee is too low and therefore try to charge more.
Almost certainly your invoice WILL be rejected.
Keep sending invoices in for fees greater than that allowed by a particular insurance company and you run the risk of being de-recognised.
It’s not a good idea to be in such a position.
Whether it is right or wrong for insurance companies to hold such power over the setting of surgical fees is for another article.
I have very firm views on it but at this point, the stark reality is that the insurance companies do hold most of the cards.
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I had a discussion with one of my clients a few weeks back.
She was very firmly of the opinion patients should able to contact her secretary or her practice at any time of the day.
Respectfully, I disagree.
Patients may indeed be demanding on occasion but the idea of 24/7 is a step too far.
For example, MHM opens it’s phone lines from 7 am Monday to Friday. It closes it’s phone lines at 8 pm Monday to Thursday and 1 pm on a Friday.
However, during those hours the telephone is answered. And answered quickly. None of this “press button one for payments, press button two for appointments, press button 3, etc!
MHM never has done that and it never will.
Instead, the phone is answered.
Interestingly on more than one occasion, I’ve had a caller say to me “Oh a human being has answered the phone!”
Outside of those hours, there is an answering machine with a message stating when we are open and if a message is left we’ll get back to you within the hour.
There is also an answering machine if all the phone lines are in use. Calls are returned within the hour.
Not one single patient has ever complained about that.
Patients are human beings.
They are also human beings concerned with their health.
That’s fairly obvious but worth repeating.
It’s worth repeating because they deserve to be spoken to and not forced to just process their health inquiry electronically.
None of that means I’m against online bookings. Nor am I against using an answering machine. Far from it.
But only outside “normal” working hours.
Once patients are aware of when they can contact a practice and if they are confident, they will be looked after they will be happy.
That is precisely what I said to my client.
Sometime later she called me and agreed.
There is no requirement for 24/7 access.
But there is a BIG requirement for patients to be able to access her practice efficiently during “normal” working hours.
pete@medicalhealthcaremanagement.co.uk
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I really had to laugh at one of my clients.
Great guy with an absolutely dry sense of humour.
He’s also from what I call the “brain the size of a planet” school.
He was explaining his requirement for multiple CCSD codes to be pre-authorised in respect to a procedure he intended to perform the following week.
He explained why, due to the patient’s condition, he wasn’t at all sure which procedure and/code he would actually perform.
There were multiply big words in his explanation which I couldn’t even pronounce let alone spell in a blog post.
It would only be in theatre, when he would know the procedure he was going to perform apparently.
Have you any idea how much of his explanation I understood.
None of it.
Moreover, I don’t need to.
All I needed to understand was as follows:
2. what are the proposed codes?
From that, I could call the relevant insurance company and confirm the patient details.
Then I could advise them of the codes in question, the date of the procedure and what I’d do post-procedure.
After the procedure, I’d have the consultant tell me which codes he performed.
Then I’d have him send me a letter addressed to the insurance company explaining why.
Following that, I’d have the theatre notes and the anesthetist’s notes sent to me.
And then I’d forward the whole lot to the insurance company.
Simple really.
And that is precisely what happened.
Once I’d done that, the insurance company agreed for the codes to be invoiced, in the right order and at the right total fee.
It’s even better now for the MHM client is being paid next week.
One happy consultant surgeon.
Skip forward to yesterday, when the consultant called me.
He’s very grateful he’s getting paid and in full too.
But he couldn’t understand why I could do all that without understanding what the codes actually meant in medical terms.
Basically, because I don’t need to know.
And I’m certainly not prepared to spend the next 12-15 years at med-school learning all about surgery until I do
No, all I need to understand is what codes, when and then I’ll tell you how much.
The consultant made me smile though when he thought it a much better idea if he stuck what he did best and let me stick to what I know best in the future.
pete@medicalhealtcharemanagement.co.uk
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The old nutmeg has come around again!
This time it was a call from a consultant who was so fed up with DNA, he decided he’d sort it.
Whilst he was at it, he’d stop the constant problems he’s having with excess deductions too.
And, I’ll wager, DNA and excess are a pain in your ass too.
His decision?
From January 1st, 2020 all non-insured patients were required to pay in advance.
Those who were insured were required to leave card details so in the event of any excess the card would be automatically debited.
Sadly I see this all too often when I go meet a potential new client.
Many of the issues he faced 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.
But he had indeed stopped the problem with self-funding DNA patients
Because there weren’t any self-funding patients anymore.
Clearly, he hadn’t thought through the consequences of his decision.
He had reacted instead.
Yet the reaction caused another problem i.e. no more self-funding patients.
That was unfortunate as 23% of the practice was derived from self-funding patients.
The above example is indicative of the cause of many of the issues that particular consultant faced with his medical billing.
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 consultant to change his mindset though was much more difficult.
He did change though because he had seen a 100% reduction in self-funder outstanding invoices.
He changed not just because I knew the answer. He changed because he 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’d 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.
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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A CCSD code is used by insurance companies to identify a medical procedure.
An Orthopaedic surgeon, for example, understands what a Multiple arthroscopic operation on the knee is.
But it’s a lot to put on an invoice every time you produce one!
Put the CCSD code W8500 on the invoice instead. It will identify that specific procedure.
So where do you find a code?
A CCSD code is found on the CCSD website: www.ccsd.org.uk
The Clinical Coding and Schedule Development Group (CCSD) consists of representatives from the five major healthcare insurers – Aviva, AXA-PPP, BUPA, Vitality and Simply Health.
The group’s main purpose is to maintain a common standard of procedure codes. The codes reflect current medical practice and are published as the CCSD Schedule.
The various insurance companies will, therefore, recognize such codes.
Whilst the example W8500 above will be recognized, it does not come with a suggested fee.
The fee payable for each code is up to the individual insurance company concerned.
To find the correct fee for the code, the insurance company concerned should be contacted.
When an invoice is then sent to the insurance company for payment, the code should appear on the invoice. Both the code and the fee will match that expected by the insurance company.
If alternatively, you do NOT use CCSD codes payment will be substantially delayed if made at all!
pete@medicalhealthcaremanagement.co.uk
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Taking ONE real-life client as an example.
Week ending Friday, January 31st: out of 15 consultations, 4 (four) came back with excess deductions £575.
So for a total of £2,500 worth of revenue from outpatient consultations £575 or 23% came back short.
Looking back to the same week in 2019, the number of excess was roughly half this.
The question as to why this is happening is not the concern.
The concern is what are you going to do about it.
If 23% continues the downside and potential loss to the consultant is significant.
There is only one real way to resolve this issue. Phone them!
Sure you can write letters and even email but nothing gets a response like a ringing telephone.
Most patients claim to be unaware of the issue but some think this is an issue between them and their insurance company.
In other words, the patient thinks they need to pay the insurance company.
They think the consultant gets paid in full by the insurance company.
There are variations on this but the crucial point for the consultant is not to establish why; its to ensure he recovers the excess efficiently.
But if telephoning the patient is the most efficient way to tackle the issue, it does not automatically follow its the easiest.
It has to be done professionally and with due diligence.
The long-suffering med-sec really won’t have the time to do this as professional and caring as she undoubtedly is.
I promise you faithfully, she won’t want to phone patients for money and will be thinking this is the least enjoyable part of her job.
There is an alternative though: do nothing.
Some patients actually will pay but this assumes they a) are aware of the excess and b) make it good straight away.
What if they don’t?
Assume it’s not £575 or 23% a week or £27.6k a year (£575 multiplied by 48 – not 52 weeks as you will have 4 weeks off a year).
Assume instead its 10% for 24 weeks (i.e. roughly half of the current numbers) and allows for some patients paying without being contacted.
The potential losses for the consultant, in this case, reduce to £13,800 per annum.
That’s a chunk of change in anybody’s book.
What’s significant is that at a number of client meetings recently I’ve asked what the client considered the biggest threat to the practice during 2020.
Most popular was a further reduction in private insurance fees.
That may indeed turn out to be a big problem.
But at this point, empirical evidence suggests its potentially leaving the back door wide open so to speak and enduring £13,800 worth of potential losses right off the bottom line.
I’d be really interested to hear from anyone who is seeing an increase in excess and their views on remedies.
pete@medicalhealthcaremanagement.co.uk
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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.
pete@medicalhealthcaremanagement.co.uk
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It is marvelous how some private practices manage to make ANY money.
Actually, in one recent case, I’m not entirely sure the consultant concerned was making any money at all.
More frighteningly, the consultant did know if he was or not.
He didn’t know because he spent most of his time stumbling from crisis to crisis.
Either he hadn’t got enough patients booked to see him or he’d never sat down and thought about how he could get more patients. Scary stuff.
When I looked at his billing, it came as no surprise to realise he was weeks behind.
Cash or a general lack of it was becoming a big crisis for him for each month he was forced to inject money into the practice.
He literally was stumbling from crisis to crisis.
As I drilled down through the clinic list one item stuck out.
There was a complete lack of patient details. What details were available, were inadequate. Not good.
The scary bit was the realisation there was no formal plan to stop this getting worse.
He hadn’t allowed himself time to think about how to stop the issue from happening because he was stumbling from crisis to crisis.
This was having a major impact not only on his practice but also on his staff.
They were mightily fed up with lurching from one disaster to another and thus they voted with their feet.
So I recommended to him he immediately – and I do mean now!! – put a process in place that makes sure ALL patient details are correct.
But…to do so he must STOP, demanding of his staff they “drop everything” and sort whatever today’s crisis was.
As he explained to me, his stated desire was to stop having to put money into the practice in order to keep it afloat.
Instead, he wanted to take money out!
A very simple and absolutely perfect goal.
Otherwise, why be in private practice??
But to achieve his desire he needed to do one thing FIRST.
He needed to stop stumbling from crisis to crisis.
or to quote his words and not mine he “needed to stop being a busy fool”
pete@medicalhealthcaremanagement.co.uk
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All MHM clients want to see more patients.
They want to grow their practice by taking advantage of the reported 7.5% per annum growth in self-funders.
Quite right too.
Self-funding patients are an opportunity to grow a private practice.
They want their practice to be a big practice.
Sadly, some make it hard for the potential new patient to make an appointment though.
For example, I called a client last Wednesday morning and nobody answered the phone. It wasn’t engaged; it just rang out.
The phone did not go to an answering machine. It just rang out.
Thus it was actually hard and not easy for a new patient to book a consultation.
If I had been the patient, frankly I’d have tried to book with another consultant.
It is not just the “small” practices that get it wrong. Hospitals get it wrong too. And so do insurance companies.
They all think big but act small.
There is one particular insurance company I speak with regularly who during the call have so much noise in the background, I literally struggle to hear what’s being said to me.
It matters little whether the practice, the consultant or the insurance company think I’m important.
What matters is that I hold the view I’m important.
I’m important because I want to make an appointment or resolve an issue that’s important to me.
I may only be ONE single potential patient but every single patient counts if you want to grow your practice or your business.
Your practice may have the best website ever.
The consultation rooms you use may be state of the art and look extremely professional.
Both suggest the practice is a big practice.
But if you don’t make sure every single patient feels they are the most important patient ever at every step of the way, you may not see more of them.
Every step of the way does not just mean in the consultation room, it means at absolutely every single step of the way.
One MHM client saw 126 patients in January 2020 with total revenue of around £35,000.
He hadn’t got time to see any more patients. His clinics are full.
His total revenue in 2019 came in at just over £350,000.
That makes his practice a BIG practice.
All because every single small patient is made to feel they are THE most important patient he has got.
pete@medicalhealthcaremanagement.co.uk
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The patient arrives for the consultation. He hasn’t obtained a pre-authorisation.
Yes, of course, you should. Patient care must come first.
But the patient does not have a pre-authorisation! It does happen. It shouldn’t but it does.
How should this be handled? Ask the patient to immediately ring their insurance company.
Say the consultation was on Friday, January 24th and the patient calls the insurance company on Monday, January 27th.
The patient should make sure the insurance company knows when it took place.
In this example, the patient did not tell the insurance company it was Friday before.
When MHM tried to invoice, it was declined.
The consultation was before the date upon which the pre-authorisation was issued.
If the patient holds an insurance policy, which will not allow the backdating you’ll have even more difficulties.
This is not the insurance companies being unreasonable.
The patient has incurred liability on behalf of the insurance company yet the insurance company knows nothing about it.
Ultimately the patient is liable for the consultation fee of course so an invoice is sent to the patient.
The patient rings up (normally quite upset) and points out they are insured and are covered for consultations.
Numerous phone calls between the patient, the insurance company later, the issue is finally resolved.
The invoice is submitted to the insurance company and its paid in full.
It would have been paid without the hassle IF the patient had been asked by the consultant to tell their insurance company when the consultation was for.
If this is happening to you, it’s an issue you can address. Otherwise, you may spend 15 – 30 mins just sorting this out!!
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 billing process of a medical practice.
“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 recently.
I was sitting on a panel facing an audience of medical professionals.
Among the various questions was one relating to how to monitor the invoicing efficiency of a medical practice.
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 what I said to the questioner.
I asked if he knew how many invoices he had raised last month and the total value of them.
Sadly he didn’t know either.
But, I continued, to improve the performance of your practice you must know how you are performing against whatever standard you decide is appropriate.
Now consider the issue of invoicing with a real MHM example. One of my guys – a private consultant surgeon – saw 25 patients between Monday, January 13th, and Friday, January 17th.
Therefore I should see 25 invoices.
That is an ultra-simple which makes sure everything is invoiced.
If I only have 23 invoices I have a problem!
But it also means of course at the end of this month I can add up the number of invoices and also tell the client how many patients he has seen this month.
Then we can compare that number with the number the previous year and see if it is higher or lower.
The introduction of such a basic, basic, basic management control isn’t a nicety.
It is an absolute necessity if you are going to manage the invoicing process effectively.
The audience member agreed fully but then the alarm bells went off 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.
Procrastination 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.
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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