If you get the basics right many problems with getting paid aren’t allowed to happen. The basics mean the absolute minimum and mandatory requirements in order to present an account for your services. The basics are as follows:
Patient’s full name
Patient’s full address
Patient’s post code
Patient’s date of birth
Policy number of the insurance company concerned
Pre-authorisation number issued by the insurance company
Correct CCSD code
But it doesn’t stop there.
Your invoice should always have on it:
Your name and address
Your provider number
A unique invoice number
The date of the invoice
The date of the treatment / consultation
The right CCSD code
14 points. But if you don’t get all 14 on your invoices you make it harder for the insurance company to pay you!
If anybody wants a blank invoice that does satisfy ALL the above, go to the freebies tab on this website! If you are billing electronically – and you should be – you’ll still need the vast majority of the 14 points.
But the proof of the pudding is very much in the eating. Have a guess at what are the TWO major reasons an insurnace company does NOT pay your invoice?
1. you haven’t sent one (crazy but true)
2. you haven’t included the right information.
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Take for example, a patient who requires an injection which may be performed by a private orthopaedic surgeon at an outpatient consultation.
Thus you raise an invoice for, as an example, £185 [£90 for the consultation and £95 for the injection] Please be aware for the purposes of this article the values are fictitious!
Upon receipt of the invoice by the patient’s insurance company, the value is rejected; as you CAN’T charge both for a consultation and an injection on the same invoice on the same day. You can charge for one or the other but not both. So you are paid £90 for the injection only. What is interesting is that the immediate reaction from some consultants could well be to charge just for the injection and argue that is the right thing to do. That said, its already been suggested that the alternative and better way would be to have the patient attend an outpatient consultation on, for example, March 10th and then attend for the injection on March 25th. See the patient twice in other words. In such case the consultant CAN charge for both.
Not sure that’s in the patient’s best interests though but if the aim is to max revenue its certainly in the best interests of the consultant. I’m certainly not saying its right or wrong. I am saying it’s an option.
Where it gets really tricky, is that some insurance companies WILL let you charge for a consultation and an injection at the same time. Others will let you charge for some injections at a consultation but not all injections. Some, as mentioned, will not allow a charge for consultation and injection regardless if they happen at the same event.
And don’t forget not only do different insurance providers pay different rates for consultations; they also pay different rates for the injection too.
Gets a whole lot worse when the injection is pre-authorised as the fee for a consultation is higher than that for the injection, the orthopaedic surgeon charges for the consultation only yet the insurance company is expecting an invoice for the injection.
Unless you check each consultation and injection episode with the insurance company concerned, you will be! More likely you will actually undercharge at some point in time. For example: if the insurance company DOES allow a fee for consultation and injection, if you charge only for one sooner or later?
You’ll be out of pocket.
Feel free to drop me (Pete) an email if you’d like to learn how to avoid the perils of unbundling.
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My website designer related a really interesting tale to me this week.
He designs websites for all sorts of businesses including consultant surgeons but was confused. He’d checked the traffic to all his client’s websites and the numbers were good. Curiously though, the traffic to some medical websites indicated a significant difference from those of other medical websites. He couldn’t understand why.
That night he mentioned this to his wife and asked her the question why. Took her all of 10 seconds to notice that traffic to the website for gynecologists was higher than that of the others. And therein lay a clue to the answer apparently. In her view, women were much more likely to check out their consultant’s websites than we males. Really??
Later that week, I asked my better half the same question. And got exactly the same reply (and a bewildered look for not spotting the obvious too)
So an exercise first undertaken some years back was repeated. The patients of the various consultant surgeons were asked if they had looked at the consultant’s website. Sure enough, women – regardless of the specialism – were shown to be significantly higher than men when it came to reviewing the consultant on-line.
Then my friend and I both made a fatal mistake.
We both asked our respective partners if that was due to women being nosier than males? BAD move!
We were both, “politely advised” it was more likely to be because women generally speaking take much more of an interest in their health and weight than we males etc.
Sexist but true??
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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 2013. 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 2013!
In other words, they were totally wrong to deduct money from the MHM client. The insurance company is paying back to the MHM client the £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.
Moral of the story?
ALWAYS check the payment remittances from an insurance company. 99% are correct but that last 1% can be worth hundred 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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Take this ONE client as an example.
Out of 15 consultations 4 (four) came back with excess / shortfall deductions totalling £575 in one week. 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 last year, the number of shortfalls / excess were roughly half this figure both in percentage and value terms.
The question as to why this is happening is not the concern. The concern is what are you going to do about it for if 23% continues the downside and potential loss to the consultant is significant. There is only one real way to ensure the patient makes good the excess / shortfall and mitigates this risk.
And that is to phone them.
Sure you can write letters and even email but nothing gets a response like a ringing telephone. Most patients are unaware of the issue (yes I know when they open their policy they are made aware of excess values) 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 because 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 shortfall / 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 shortfall / 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 is this case reduce to £13,800 per annum. Thats a chunk of change in anybody’s book still.
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 2014. 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 shortfalls etc and their views on remedies.
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