In one single word how a private consultant surgeon can achieve the financial reward for all his efforts.
Every single time you perform an outpatient clinic the details are passed on.
Invoices can then be raised and sent to either an insurance company or self-funding patient for payment.
Every single time.
Do NOT make the mistake of collecting them ready for “later in the month” because “later” never comes. Or at the very least you are risking an issue coming up which will either delay or cause invoices not to be raised at all.
Instead after every outpatient clinic the details are passed over for invoicing. I’ve got some clients who actually take a photograph of their clinic list on their smartphones and send it to me securely. It’s a ritual with them.
Is it any surprise such private consultant surgeons get paid quickly? Other MHM clients have the clinic list (s) sent over every Friday afternoon without fail. They get paid quickly too.
It’s a ritual for them.
Contrast that with another MHM client who sends all the data over infrequently.
Sometimes at the end of each month or more often than not every couple of months or so.
This client does not get paid as frequently as the others.
The reasons are somewhat obvious.
Ritual is also applicable when dealing with excess or shortfall payments. The moment you are notified, you MUST action them for the longer they are left unattended the danger of non-payment increases.
I check every single remittance advise a private medical insurance company sends in. Any and all shortfalls/excess deductions are actioned the very same day.
It is a ritual.
Religiously – MHM check every single piece of data BEFORE an invoice is submitted for payment.
The policy number is checked to see if it has changed.
The patient’s date of birth and postcode is checked to see if that has altered.
The CCSD code is checked and the fee also checked against the appropriate insurance company’s fee schedule.
If there is a discrepancy, it is corrected.
Then – and only then – is the invoice submitted for payment. Religiously.
So how does just doing these two things contribute so much to a private consultant surgeon achieving his rewards?
Both cut down the opportunities for payment to be delayed, queried or not made substantially.
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What follows is absolutely real and why medical invoicing can be more troublesome than it need be.
One of my guys ran an outpatient clinic last Thursday
The clinic list arrived with me on the next day. There were 8 patients: 3 initials and 5 follow-ups.
Within 30 minutes 7 invoices had been produced and delivered to the various insurance companies but that final EIGHTH invoice caused significant issues. Why?
The patient’s insurance details had not been recorded correctly.
So I rang my client’s medical secretary and ask if she knew what they were. The FIRST phone call – I’m told the patient is with insurance company A but did not know his policy number. Length of the phone call: 5 mins
A SECOND phone call was necessary. This time to the insurance company. I was on hold for 11 minutes to this particular insurance company which is about normal for an insurance company. Some are 4 – 5 minutes. With some, you are on hold for considerably longer.
Once I got through however despite having the correct name, date of birth and postcode I was informed the patient’s policy had lapsed.
Length of the phone call: 11 minutes plus 5 minutes = 16 minutes.
A THIRD phone call was made. This time to the patient. Answer machine so I left a message to call me back. He did. The patient confirmed it was totally the wrong insurance company. He told me the correct insurance company but did not know his policy number!
Length of phone call(s) 5 minutes
A FOURTH phone call to the other insurance company. Placed on hold for TWENTY-THREE minutes! Finally, get through and I’m advised the correct policy number, etc. Invoice raised.
The total length of phone calls: 49 – FORTY-NINE MINUTES!!
There is no problem with spending 49 minutes on the phone; none whatsoever.
But just consider the problem if the medical secretary at the same time as that had patients trying to speak to her? Or she had correspondence to get out? Or she had clinics to book?
She would have struggled for sure.
Finally, consider how much easier it would have been if the patient had been asked to bring a copy of their insurance details with them when they registered.
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Don’t say – “all the details should be obtained”.
Say “all the details MUST be obtained”.
In other words, turn “should” into a must. But why is this so important? And why must you do it every day?
Many clients have asked why mhm obtains payment so quickly from insurance companies or from a self-funding patient.
The number one reason is that I don’t use the word “should”.
I use the word must.
And that is why it is so important – the consultant surgeon gets paid quicker. When I work alongside a medical secretary – the most underappreciated person in any medical practice normally – I emphasise the absolute need to get all the patient’s details.
For example: make sure the details are correct, make sure the patient’s policy number is correct, make sure the patient’s date of birth and postcode are correct.
When should this be done? NOW. It should be done every single time you have a patient in front of you or are reviewing a patients details.
Once all the details are correct – as they must be – the chances of getting paid increase dramatically.
This isn’t done in an aggressive manner at all.
In fact, 99.9% of all med-secs understand the reasons why and are only too glad to help.
Most likely because most med-secs do not like “accounts” or “having to chase for money”
In other words, it is a state of mind. It is a state of mind supported by the very strict adherence to a number of routines.
Actually the word routine itself is not a strong enough.
It’s a discipline.
It is the discipline to make sure all the details are obtained when the patient registers.
It’s the discipline to make sure the clinic list is sent down to me every single week.
And finally, it’s a discipline to make sure all the invoices are raised, checked and delivered either to an insurance company or direct to a self-funding patient.
And that’s why mhm clients get paid so quickly.
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All MHM clients are very dedicated individuals. Having spent approximately 15 years of training and to become a consultant surgeon, they then go on to work incredibly long hours.
They do so because they actually love what they do.
All at some point, however, have taken the decision to start a private practice.
It’s unlikely they would be my clients otherwise if you think about it. They start a private practice because they wish to make more money doing what they love. To have any other objective is either (a) silly or (b) engaging in self delusion.
There is no shame in admitting you start a private practice to make more money.
At that point however your private practice becomes a business.
As I’ve blogged many times, it must, therefore, be run as a business. A business with more than a little social conscience but nonetheless still a business.
Yet, sadly, many consultant surgeons make the mistake of believing their practice/business will grow and make them rich if they continue doing what they love to do. Sadly that is not true for doing what you love seldom leads to long-term financial success.
And that means, as much as you love being a Private Consultant Surgeon, you must measure the performance of your practice/ business.
This is the point the private consultant surgeon realises he/she must learn to understand financial analysis i.e. the numbers. It’s not all that complicated actually.
Supplying data to your accountant every year isn’t the same as understanding the numbers behind your practice though.
Let me give you a real example.
I was contacted recently by an established private surgeon who, he claimed, appeared to be working all the hours God sends but said he was always broke.
It didn’t take long to work out why.
The first good indicator was a complete lack of financial analysis other than a tax report a little over one-year-old. No debtors ledger was available so the surgeon didn’t have any real idea how much he was owed.
It transpired both patients and insurance companies were only invoiced monthly.
So I took the last six months worth of clinic lists and checked how many had or had not been invoiced. Quite a lot had not.
I did the same with surgical episodes with the same result. This was followed by an investigation into how much had not been paid even if invoiced.
But it was also a simple case of adding up the total revenue generated for each month, calculating the total costs (room rental, monthly indemnity insurance premiums, secretarial costs etc) and subtracting one from the other.
Even if any type of provision was made for tax liability was ignored (bad move!) the results were not encouraging.
The really bad news is that the consultant looked very blank when I asked which percentage of patients were referred to him from which source i.e. how many GP referrals, private referrals, recommendations from previous patients, insurance company referrals etc.
It was clear this particular consultant had no real idea of how his practice or business was performing.
And that was and still is a very dangerous place for any business to be.
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I had a really illuminating conversation with a guy who called me recently. He ran a marketing business and was a specialist in using Twitter.
Basically, the guy told me he’d been looking at my website for some time.
He had been monitoring the number of Tweets I sent out. He’d been reading all the blog articles – they were brilliant.
Appealing to my vanity – really you shouldn’t but it got my attention.
Actually, he’d found my details because he was a Tweet follower of and ‘tweeted” on behalf of a consultant surgeon who in turn was a Tweet follower of me.
Thus he’d be watching MHM for some time.
He was confident he could dramatically increase the mhm social media “footfall” and its Twitter presence by sending out at least 10,000 tweets a day on my behalf.
As he had done to his consultant surgeon client, he charges for his services as he rightly should. There is no problem with a price being attached to the service.
I genuinely have no objection to paying a price for a service.
Most people expect it for free or as near to free as is absolutely possible.
But I’ve always followed the mantra if you think an expensive professional is costly, try using a cheap or even a free amateur.
I also believe in Warren Buffet’s mantra of “price is what you pay, value is what you get”.
So I asked bearing in mind MHM clients are orthopedic surgeons, ENT surgeons, gynecologists, anesthetists, physiotherapists, and other medical professionals, how many consultant surgeons would receive the “tweet”?
In other words, how many would receive a Tweet that was relevant to THEIR needs?
My newly acquired friend wasn’t sure.
Instead, he stated that all the tweets would be seen by “professionals!
For example electricians, engineers, social media specialists and newspaper publishers” That is not to suggest such professionals are anything other than perfectly respectable occupations. Of course, they are.
I’m sure they are fully engaged in social media too and good luck to them.
But they are hardly likely to find the MHM offering suitable for them because they are not surgeons.
The crux of the matter, therefore, is why send 10,000 Tweets to anyone not within the same niche as me?
He did not or could not understand this point.
What he did understand though was his request that once MHM became one of his “clients” I would pass over to him the list and database of all my contacts who WERE consultant surgeons.
Just as the consultant surgeon mentioned earlier had done. Or so he claimed for he would not divulge the name of his client (about the only thing I was starting to respect my new friend about).
Many, many people from a variety of organisations have asked for this list.
A polite decline normally satisfies such a request but if pushed far enough its greeted with the immortal “which part of the word NO don’t you understand?”
Meanwhile, I still do not understand why sending 10,000 tweets a day out to anyone who is not in the same market as MHM will ever benefit MHM.
More so, if MHM’s marketing strategy – just the same as a consultant surgeon – pursues a pull marketing approach and not a push marketing one.
Actually, I asked the question. Never mind MHM sending 10,000 daily Tweets out.
Why would a consultant surgeon want to send 10,000 Tweets out a day to anyone who is not a potential patient?
But hang on a second?
My newly acquired friend claimed to have been studying and reading MHM’s website for some time.
Yet he was still to understand, MHM Ltd only works with consultant surgeons, anesthetists, physiotherapists, etc.
Either the website doesn’t make this clear (it does), he didn’t understand or he didn’t want to understand.
MHM is not likely to find more clients if it targets electricians, engineers, social media specialists or newspaper publishers. Nor is a consultant surgeon likely to find more patients if he or she Tweets the same audience.
No-one is suggesting Twitter can’t help a business. It can.
What I am suggesting is that in a specialist market, you need a specialist and not an amateur. In MHM’s world, many claim medical invoicing and medical accounts is easy.
Some have no issues at all.
Some have major issues and ring us.
Some however either don’t know they have major issues or bury their heads in the sand hoping the problem will solve itself.
It never does. Then they call a specialist in.
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I was asked to speak with a colleague of a current MHM client recently.
He was having problems with outstanding invoices both from insurance companies and from self-funding patients.
He, in turn, asked me to speak to the person who “looked after the accounts”. There were four consultants in the practice, all of whom were “looked after” by the same person.
That was on Monday, April 9th.
I duly called on Monday August 9th. And again on the 10th, the 11th, the 12th.
Then I gave up
Each time I heard an answering machine say “this is XXX of the YYY Clinic. I’m not here to take your call. Please email me on email@example.com. Note emails are only checked periodically. Or leave a message; please note I only work part-time”
So I left a message. I emailed too.
Nobody called me back.
Nor did I receive a return email.
Then I was naughty.
Every single day this week I have called. I emailed as well. Each occasion I left my name and said I thought I owed for a consultation and wanted to pay so would XXX call me back, please? Each email said the same thing. I wanted to pay.
Nothing. Not a sausage.
Skip forward to today Friday August 20th and I called the colleague of the MHM client and explained what had happened. His accounts person had been at work last week so he couldn’t explain why I hadn’t been able to contact his practice for two whole weeks!
For the record, I was not and am not looking to completely bury his accounts person.
That said, and also for the record, as I said to the consultant concerned, you can have the best invoicing, billing or payment process on the planet for all I care.
If you don’t make it easy for the patient to contact you and resolve issues/pay an invoice you will have SIGNIFICANT problems.
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I took part in an on-line medical conference recently and one of the speakers – a well-established consultant surgeon and an incredibly safe pair of hands – stated during his presentation that a private surgeon could not charge for inpatient care.
He may well be a safe pair of hands but on that point he was wrong.
After the conference, I had a word and said he was incorrect. It IS possible to charge for inpatient care.
I couldn’t help but suggest to him that the mere fact there was a separate code for inpatient care indicated it could be charged.
Obviously, it may well depend on the insurance company concerned. In principle, however, it is possible to charge. I knew I was right because I’d actually charged for inpatient care for an MHM client a few weeks earlier. And the invoice had been paid.
But he wouldn’t budge.
He was right.
I was wrong.
Skip forward a few weeks and I received an email from my consultant surgeon friend confirming that I had been right all along and he had been wrong.
Why is it sad that I had been right?
Because my consultant surgeon friend has been in private practice for well over a decade and he’d NEVER charged for inpatient care.
More significantly though, my friend had not checked each month what could and could not be charged for.
That also begged the question if the fees he was charging had been checked with the same frequency too. He hadn’t so as a favour I checked for him.
The good news is that only 3 of his fees had altered.
The bad news is that one of them had gone up £107 five months earlier yet he was charging the old and lower fee.
Thus it is important not only does a Private Consultant Surgeon need to establish what he can or can’t charge for, it is just as important to check HOW MUCH you can charge for!
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It was an environment where chaos reigned.
There was a serious amount of money outstanding but it didn’t take long to work out why.
The problem was the practice principal for he insisted everything had to be done immediately.
And therein lay the problem.
Resolving every problem immediately didn’t allow sufficient thought as to what the problem really was. Nor did it consider the cause or consider the options.
Instead, the problem was receiving less than a minutes attention with the cause of the problem being ignored.
Any and all business require a plan.
Simple said the practice principal because the plan is to see as more patients.
It didn’t occur to him that practice management is important and a business plan is required.
It should not be subject to a stream of quick-fix solutions and absolutely not when the cause of the problem is not established.
Once a plan and goals are defined, the functions of the practice need to be split in two.
Primary and secondary.
The identification of primary productive areas and secondary non-productive areas is done using a value chain. Devised in the mid-’80s by Prof Michael Porter it is one of the simplest things to use. So, what is primary and what is secondary?
Primary: anything directly focused on your patients.
Secondary: anything not patient-focused.
Anything secondary should be outsourced. Thus practice staff will be free to concentrate on their primary area. Patients.
The extra time generated allows the practice to speak to MORE patients.
It’s a case of concentrating on what the practice aims are. If you measure your practice against a value chain, you’ll find the primary values are supported by secondary values.
Outsource secondary values and the practice becomes more profitable.
Yet numerous private practices make the mistake of not distinguishing between the two.
With the result, chaos reigns supreme.
The practice doesn’t work as well as it should with patients complaining the telephone isn’t getting answered. But they don’t care because they’ve already telephoned another consultant.
The practice principal disagreed. Secondary “non-productive” areas should be ignored. Concentrate instead on getting more patients. Always more patients.
He still insisted on solving problems immediately.
His only answer was to blame everyone else.
His 150 miles an hour approach might explain why the practice had gone through 4 practice managers in just over 32 months. It also helps explain why his patient numbers have gone down.
He hasn’t avoided the CHAOS FIELD.
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I left school more years ago than I care to remember.
Then as now I make sure I do my homework though.
The only difference is now I do it for private medical consultants some of whom are thinking about starting a private practice.
All of you have done your fair share of homework in the past.
The journey to becoming a surgeon is not exactly an easy one.
Lots and lots of work, study and long, arduous hours. There is lots of homework on the way too. Followed by even more work, study and long arduous hours. There is even more homework thrown in after that.
Then you are qualified.
But to start a private practice add on about five years of post-qualification experience and hey presto you decide to open a private practice!
That is more or less the path a surgeon (friend of a current MHM client) took.
I was asked to go chat with him about starting a private practice.
As the geographic area concerned contained a major urban conurbation, the population numbers were high. So that ticked the first box!.
There were three private hospitals within a 25-mile hospital too. The second box ticked.
When I checked the number of consultants at each hospital (Google is a mine of information) there were 22 at the first, 15 at the second and 15 at the third. The third box ticked.
I’d done my homework and established there was a demand for my surgeon’s specialism within the area.
The surgeon, when we spoke, was really pleased to hear the results and was in no doubt my homework confirmed he would be able to start a successful private practice.
It was that last item – the number of consultants already in place – that concerned me.
Could it be that the demand for his specialism was already being satisfied by the 52 consultants already providing his specialism?
My surgeon friend would have to compete with those consultants.
He would have to market himself to potential patients and see enough patients to make his private practice pay.
His fees from private insurance companies would have to be sufficient to cover his costs AND make a profit.
He would have to provide all the support facilities to run his private practice which would cost money.
Then he would, of course, have to pay tax on whatever was left.
Let me be clear I was NOT saying don’t start a private practice.
I was suggesting that the demand for his specialism might already be satisfied by his competitors.
He should, therefore, be fully aware of the difficulties he would face BEFORE he started his private practice.
All because I had done my homework.
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Not getting paid doesn’t happen by accident.
Something causes it to happen. There is ALWAYS A CAUSE.
If you leave invoicing until later (Friday for instance) it is very easy not to invoice at all. It can happen also if, for whatsoever reason, you leave invoicing until “tomorrow”.
Tomorrow turns into never.
Many times, I’ve been called in to examine and review the billing process of private medical practice and discovered an issue with invoicing frequency. So why is “tomorrow” “Friday” or “when I get the chance” the worst possible words for me to hear?
Nine out of ten times such an approach is a big clue as to the reason why the practice is not enjoying the level and frequency of cash it should be.
If you want to ensure your practice is paid promptly, the very first place to start is raising an invoice. It is crucial. And invoices should be raised DAILY!
Once a week is not helpful.
The danger in invoicing on a Friday or a Monday or only on any set day a week is if something happens that day – for example, the consultant needs a clinic booking urgently or a patient needs a letter immediately, then the invoicing gets left behind.
And that is normally the cause of the problems.
If invoices are raised daily should something happen to delay that ONE day’s invoicing, it is corrected the very next. There is no backlog.
Let me give you a real-life example.
Thursday July 8th a consultant ran an outpatient clinic and saw five patients. Three follow-ups and two initial consultations. £850 worth of consultations.
Yet invoices were not produced for this work until Friday July 30th, – almost three weeks later!
Is it any wonder the consultant was extremely dissatisfied with the practice cash flow?
It didn’t take long for me to identify that on twice previous occasions over the previous few months one entire clinic list had NOT been invoiced (worth £725) and three initial consultations (worth £600) had also not been invoiced.
In the case of the initial consultations, insufficient insurance details had been obtained at the point of registration and remedy had been left until “later”!
In all £1,325 worth of invoicing had been missed.
No wonder cash flow was poor.
But before we go any further do NOT blame the medical secretary. She has enough to do. The phone rings or she has to meet and greet the patients. She has numerous letters to type.
That is precisely what she should be doing for she is there to ensure the “front of house” runs smoothly.
The error, if you will, is then expecting her to fit invoicing in around all that or, as was suggested to me, in her “spare time” WHAT SPARE TIME?
She hasn’t got any and nor should she.
In the above example, the solution was obvious. Either get someone in to process all the invoices and the cash receipts or outsource it.
Private medical practice is a business. It must be managed as a business; end of.
Without putting too fine a point on it, failure to ensure the invoicing and accounts process is not 100% efficient is pretty much guaranteed to lead to the business having cash flow issues.
DON’T LEAVE IT UNTIL FRIDAY – DO IT NOW!!
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I had a zoom call with a surgeon recently about surgical fees.
His view was they were too low and a certain insurance company was, in his view, trying to reduce the number of consultants they recognised by keeping fees low.
He went on to explain that since he had been recognised, his fees had always been decreased and never increased.
Curiously he was the second person to make this point in the same week although the second person had heard a rumor surgical fees had gone up.
So when I finished the zoom call I picked the telephone up and called the insurance company concerned.
The insurance company knows me well.
They should do.
As they are one of the major players in the industry and as all my clients are consultant surgeons for whom I raise electronic invoices and send to numerous insurance companies it’s almost certain I’m going to speak with them every single week.
I asked them to confirm the fees for both consultants.
In the case of the first surgeon, he was factually incorrect.
His fees had increased earlier this year and he was charging the wrong fee.
The argument that the new higher fee was still not enough is different from the fact his fees had in fact INCREASED as he and I discussed after I called him back.
But I did urge him to check his surgical fees were correct as of August 2021.
The situation with the second surgeon, however, was more disturbing. Not only had his fees increased, but he was also blissfully unaware they had been increased.
Instead, he had carried on charging a lower amount both for initial and follow up consultations.
He was most unamused to realise he had so far in 2021, undercharged by just over £1,000.
I wasn’t being cruel therefore in suggesting both consultants went out and checked if their surgical fees had altered too.
Funnily enough, both having gone on to read my recent blogs on this issue, they emailed me this week asking if I would be good enough to check their fees every single month.
Check your fees or get somebody to check them every single month!
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MHM was recently engaged to review the billing process of a hospital with a remit to find out why insurance companies weren’t paying.
One company was proving to be a problem and an analysis of the invoices soon identified why. This company required invoices to be sent on-line.
Except the invoices were inaccurate with, for example, the patient’s policy number being wrong. The invoices could not be submitted on-line for the details were wrong.
Instead, they were put in a “holding” pile.
To resolve the problem, it was vital to make sure the details were correct.
That was the cause of the issue.
Or was it?
It turned out medical secretaries thought the receptionist was responsible but the receptionist thought the medical secretary was responsible.
Then both claimed the person who raised the invoice was responsible. The reality was nobody was responsible.
The holding pile was greater than the value of daily outpatient appointments and it was growing.
The receptionist obtains the details. She then checks them. The medical secretary ensures all are recorded accurately. She checks them again. The person responsible for medical invoicing highlights ANY which fail.
The holding pile is now less than 1%.
Is this overkill?
Cash input from this ONE insurance company has increased by 160%.
It’s not overkilling at all.
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Ever wondered why MHM clients get very regular payments both from Insurance Companies, Private Hospitals and self-funding patients too?
It is down to the above discipline – the ritual – both on the part of MHM and on the part of its clients.
Specifically, every single time an MHM client completes an outpatient clinic or is in theatre the detail is sent to MHM. Some clients send them daily, others send them weekly. But send them they do.
Then it’s a question of ritual.
Every single morning at 8 am, I have the daily discipline of picking up the clinic or theatre lists from the previous day. And then they are invoiced to the insurance company concerned or direct to the patient.
Monday to Friday this is the first job every single morning.
It is a RITUAL.
So how does this daily discipline help MHM clients?
It means payment has been requested on behalf of MHM clients. This in turns means insurance companies are able to process the invoice for payment. Does this sound far too simple?
Well, in reality, it is very simple.
It is literally a question of RITUAL LEADING TO VERY REGULAR PAYMENTS TO MHM CLIENTS.
Paradoxically, I know many medical secretaries who instead raise invoices “on a Friday afternoon” or “after I’ve typed my consultant’s letters”.
The inevitable happens.
On a Friday afternoon, the telephone goes berserk or something comes up that prevents the invoicing from being completed.
Because there is no ritual, the consultant does not get paid as quickly as they think they should. Indeed I was talking to a med-sec last week who was telling me she has a three-month backlog in uninvoiced outpatient clinics.
She wasn’t happy that at 10.20am on Thursday, August 12th I had a backlog of ONE clinic dated from the previous day.
I wonder how many times I’ve said “invoice right = get paid right” over the years?
I dread to think.
But invoice right = get paid right does not just mean having the patient’s details, coding, and fee right.
It means making sure an invoice is generated as soon as MHM is asked to do so and it means making sure it is delivered to the body responsible for paying it.
It is a discipline.
And it is a discipline that leads to MHM clients getting paid as quickly as they do.
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This issue came up recently with a consultant surgeon.
How are benefits and fees accounted for against a patient’s package?
Consider the total benefits payable under a patient’s policy. For example, the benefits payable is £100.
It could be more. The fees mentioned below could be higher too.
Against such a benefits package, fees are deducted thus:
£20 is paid out. The total benefits figure reduces to £80.
Subsequently, the patient requires surgery. £50.
This is also paid.
The accumulator reduces to £30.
Finally the hospital tenders their account: £20. The gasman submits his: £10. The benefits accumulator, therefore, reduces to ZERO.
The benefits package is equal to the fees.
If the initial is £21, the surgery £51, the hospital £21, and the gasman £16 then the total fees = £109. Against a total benefits package of £100.
Thus, if fees exceed the total benefits a shortfall will be created.
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Sometimes, getting more patients isn’t always the right answer.
The right answer is to get paid for the ones you have already seen.
Over the last three months MHM has been working very closely with an ENT consultant. His sole aim is to see more and more patients.
That way, he will make more money and retrieve the dire financial situation he has found himself in.
Thus he has reduced his consultation time down from 30 to 20 minutes. Therefore he’ll see one more patient each hour.
But the cause of his financial problem is not he doesn’t have enough patients.
He is owed a considerable amount of money. He is not getting paid.
Seeing more patients and not getting paid for them, will not help!
He needs to get paid for the ones he has seen as well as the new patients.
A simple cause.
Invoices aren’t being raised after each clinic. Instead, they are being raised every Saturday morning when “it’s quiet”.
But the problem with that is not all invoices are being raised.
Many of the patient details are incorrect. But his secretary can’t correct the details because many of the insurance companies she needs to speak to to get the right aren’t open on a Saturday.
Or if she needs to speak to a patient, she may or may not be able to reach them by telephone.
The very first thing to do is to make sure the details ARE correct. That is much easier than it sounds.
Then, she needs to invoice every single day.
In doing so she will identify issues quickly. Then she must resolve those issues the very same day.
It’s only by doing so will the dire financial situation the ENT has found himself in will get resolved.
Seeing more patients but not being able to charge for them, won’t resolve his problem.
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This blog could easily have been called ‘YOU WON’T UPLIFT A FEE BY DOING THAT”
Recently a private consultant – the colleague of a current client in fact – called me with a problem.
Sadly it was a problem very much of their own making!
In an effort to increase fees, the consultant had decided that a surgical episode should be billed as follows: AB1234 £640 and CD2468 £75. So the total fee = £715.00 and on March 1st, 2021 the insurance company was sent an invoice for £715.0.
And promptly proceeded to reject it.
The fee for the AB1234 was and still is correct.
But with this particular insurance company offering 50% of a second code, the CD2468 fee was wrong to start with. It should not have been £75. It should have been £37.50. Great. Save the invoice would still have been rejected.
Why this time?
If the private consultant had checked they would have discovered that this second CD2468 code was deemed by the insurance company to be part and parcel of the AB1234 procedure.
Thus it was never going to get paid anyway and it was deemed unbundling to submit an invoice and charge for both items.
Skip forward to July,2021. The consultant – or more accurately his long-suffering secretary – has called, emailed and written to the insurance company because the consultant is still unpaid the £640 for the AB1234.
Hence the phone call to MHM.
For once even I couldn’t do anything about the multi-code element.
It very clearly states on the insurance company website that a consultant cannot invoice a CD2468 alongside an AB1234.
In fact, it also says so on the CCSD website.
It is deemed unbundling to do so.
MHM called the insurance company and has confirmed the original invoice has now been canceled and re-submitted an invoice for an AB1234 £640.00. It is being paid too.
Moral of the story?
You will NOT make more money by unbundling.
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They are not just for tax reasons. They are not just to keep the accountant happy. There is a time-critical reason too.
Remittance advice will confirm the values that have been paid. It is a mistake to assume that the invoice will be paid completely. It may not be.
For example and taking one remittance received by an MHM client.
Of the ten invoices paid, four of them were subject to excess deductions.
This is why remittances should be checked. And before they are stored for tax reasons or to keep your accountant happy.
In the above example, each invoice detailed on the remittance was reconciled against a debtors ledger. Only then was the payment recorded. It was then the number of deductions was identified. In this example, the total came to some £350.
The next step is to identify why the deductions have been made.
Whilst all four deductions were correct and were in respect of excess amounts it is surprisingly common for a deduction to have been made in error.
In the recent past, one MHM client had an invoice for surgery deducted in full because the patient’s policy had expired. At least according to the patient’s insurance company it had expired. It had done so after the date of the surgery. In this case, at the date of the surgery, the policy was “live”
Consequently, the insurance company was wrong to decline the invoice for payment.
A call to the insurance company concerned quickly identified and confirmed the insurance company was in error. The invoice was immediately cleared for payment. Insurance companies do make mistakes. Not many thankfully but they do happen.
If the deduction is correct then immediate action should be taken to contact the patient and a request made for payment – by the patient – made.
So the number and reasons why deductions have been made by a private medical insurance company can easily be identified and subsequently actioned on behalf of the consultant surgeon.
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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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An MHM client held one of his twice-weekly outpatient clinics recently. Nine patients; so there should be NINE invoices.
Except there are only EIGHT?
A quick look at the list indicates one of the patients is designated as inclusive care; no invoice required. But hang on a second, an invoice was raised for a surgical episode recently for this very patient and sent to an insurance company for payment. Indeed it’s been passed for the payment already.
How can the follow up be deemed inclusive care if the surgical episode was chargeable to an insurance company? Generally speaking, it can’t.
Simple explanation. The patient had been incorrectly designated as inclusive care for this clinic. Once the error is corrected, there are NINE invoices. Happy days. After all its only one episode
Make that mistake only once a week for a single month and you potentially lose over £500.
And that is why MHM checks the clinic list is right each time and every time.
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How can I charge more for my work?
This always spins off into a debate concerning how private medical insurance companies are the enemy. Fees are always being reduced with the private surgeon being paid less and less it is claimed. That may be true sometimes but is not the right place to start.
The right place to start is to make sure the private consultant surgeon is charging the correct fee. Such fee may be less than the surgeon wants of course but, many times, be more than he thought he was entitled to.
Take the example of an orthopaedic surgeon who contacted MHM to process her medical invoices recently. She was of the opinion her consultation fees were too low. That also may be correct. But that was the consultation fee the insurance company were prepared to pay.
In reality the orthopaedic surgeon was unaware some of the insurance companies were prepared to pay a fee for minor procedures carried out at a consultation. They would pay a procedure fee together with a fee for the consultation. Whilst some insurance companies weren’t prepared to pay both fees, some were. Instead the consultant had been charging ONLY for the minor procedure. She had not been charging for a consultation as well.
The same situation was equally applicable to a private dermatologist just as it was applicable to a GI surgeon. It is not therefore applicable solely to orthopaedic surgeons. It is applicable to many specialisms. The issue therefore becomes one of: am I charging the right fee?
To confirm the fee is correct a review of procedure codes and the fee for the procedure code should be undertaken. Both may then be compared against the fee structure of the private medical insurance company concerned. Each code and combination of codes must be checked against the fee schedule of the private medical insurance company. The often stated assumption that all insurance companies pay the same fee for the same procedure code should be rejected.
Take the example of a repair of the primary repair of achilles tendon. Insurance company A pay a fee of £336 whereas insurance company B pay £405 – £69 more! The orthopaedic surgeon concerned was of the belief insurance companies paid out the same fee. She had UNDERCHARGED by £69 as a result.
To return to the original issue of charging a consultation fee alongside a fee for a minor procedure, take a look at injection into soft tissue. The same insurance company paid a fee of £108. The orthopaedic surgeon in question was unaware that a follow up consultation could be charged in ADDITION to the fee for the injection. Another £150 on top of the £108! Thus the correct charge was not £108. It was in fact £258
To further illustrate the point a dermatologist may charge the very same insurance company, £91 for a curettage of skin or lesion. He or she may ALSO charge a follow-up consultation fee in addition. If the follow-up consultation fee is £100 (and it is for the MHM client concerned) the fee for the WHOLE event has doubled!
Thus the most common mistake in medical invoicing is not realising that fees can and do differ between insurance companies and also that some, not all but some, private medical insurance companies will actually and quite happily pay MORE for your work than you may be aware of.
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