When discussing medical invoicing many private medical professionals say to me “I want more of a consultation than that” It is one of the statements I hear more frequently than others.
The following example however illustrates how a consultation fee is established confirms there is little the consultant can do about it once the fee is set.
The medical professional concerned only recently applied to be recognised by the private medical insurance. That is not too difficult a process in itself. MHM spoke to the consultant. When recognition is being applied for , we pointed out fees should be checked carefully. The consultant was extremely well qualified. She had held a substantial NHS post for a number of years. Her specialism was in high demand. The private medical insurance policy was keen to offer her recognition. They wanted to refer patients to the consultant also. The recognition was thus granted.
MHM were subsequently asked to handle the medical billing side of her practice. To do so we needed to know how much her outpatient consultation fees were. The consultant did not however know what the consultation fees were. Alarm bells started ringing immediately.
Consultation fees would have agreed and would have been detailed to the consultant by the insurance company concerned as we had said. So we called the insurance company and quoted the newly acquired provider number.
The insurance company, per normal, were keen to point put the consultant had agreed to adhere to their published fees.
It is always amusing when “fair and reasonable” is quoted to me because it depends on what the consultant thinks is “fair and reasonable” against what the insurance company think is “fair and reasonable”.
What happens if the thinking differs between the two parties concerned? And that is precisely what happened in this example.
The insurance company deemed that £100 was a fair and reasonable fee for a consultation.
The medical professional deemed that £175 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge a consultation at £175.
And that is what happened.
Despite the medical professional objecting strongly to a consultation fee of £100 and insisting a “fair and reasonable” fee was £175, the invoices were reduced in value.
It mattered little to the insurance company that the MHM client had colleagues who were both charging and getting paid £175. Before I asked the question I knew this was to be true. It was true because the colleague concerned had many years more experience. It mattered even less to the insurance company that a second colleague was paid even more than £175 for a consultation. This was because the second colleague was in a completely different specialism!
MHM’s client had, sadly, based their practice business plan on a consultation fee of £175. They had done so because they had asked colleagues how much they were paid. They had then assumed such fees would equally apply to them.
MHM, per normal, had no issue calling the insurance company concerned and arguing the case on behalf of the medical professional. It was an argument that was never going to be won. The simple reason remained that at the point of recognition the MHM client had accepted the fees. It mattered little the client hadn’t fully understood what was being offered.
Sure enough the insurance company stood firm behind its agreement with the consultant.
The moral of this sorry tale is best summed up by the above heading.
I’m not suggesting you shouldn’t challenge fees for consultations or indeed a surgical episode. But don’t put yourself on the back foot by accepting fees and then challenging them afterwards.
As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!
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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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It is not a “nice to have” anymore. It is a necessity.
Consider the following real MHM clients. Surgeon A is a very forward thinking. Surgeon B can’t even update his Iphone [keeps forgetting his password]. Both performed a similar number of surgical episodes and outpatient consultations in March 2017. Every single one was invoiced.
Today is April 28th.
Client A – shortfalls / excess against his March work totalled about £1,600. Today he has £42 worth of excess and shortfalls still outstanding.
Client B – shortfalls / excess against his March work totalled about £1, 510. Today he has £967 worth of excess and shortfalls outstanding.
Both had their shortfalls / excess invoiced to their respective patients in precisely the same way. Client A saw a 98% success rate in collection of shortfalls / excess. Client B only saw a 35% success rate.
Surgeon A – I take on-line payments.
Surgeon B – I do NOT take on-line payments.
You should see his website! You can see his availability by clicking on his on-line diary. You can’t book a consultation but you can see where and when his clinics are for the next two months.
He has a website too (took me 8 months to convince him to get one). He does NOT like on-line payments. He doesn’t trust them. I’m not allowed to use the MHM on-line payment facility.
For Surgeon B I’m going have to chase down his patients more than Surgeon A. Doesn’t bother me. I’ll collect Surgeon B’s excess and shortfalls eventually. I get paid the same amount for both clients. It costs both of them the same. I just have to put more effort in for SurgeonB to get my fee – big deal (not). So I’ll have to make numerous reminder phone calls for Surgeon B. For client A I’ll have to make a phone call or two.
But if I were Surgeon B I’d be irritated if I were still owed £967 for my March work.
I spoke with him yesterday and came out with my “dinosaur thinking” comment (again). I described what was happening with Surgeon A. Per normal he laughed. He pointed out that whilst he was not planning on becoming extinct just yet, he still didn’t like the idea of on-line payments.
If you want to use MHM to reduce the number of excess and shortfalls you have outstanding, email me at the address below:
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Last month another insurance company said it is no longer accepting paper invoices.
For years, MHM has argued paper invoices should be avoided. We have instead used the option offered by the majority of medical insurance companies. We submit invoices electronically. It has saved a fortune in postage costs.
They are produced much quicker and cheaper than in paper.
The amazing thing is that some private medical insurance companies still allow paper invoices.
Invoices for self-funding patients should always be mailed to a patient.
It is bewildering that consideration should still be given to sending one to an insurance company. Regardless of whether it is allowed or not.
MHM supports those insurance companies who insist invoices are sent electronically.
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Surgeon A is an ENT consultant surgeon. He performs an E1910 on two different patients and bills both patient’s insurance company £1,600 each.
Patient ONE’s insurance company fee structure is £1,600. Patient TWO’s insurance company fee structure is £1,945 for the same episode.
By invoicing Patient TWO’s insurance company £1,600 i.e. the fee he gets from Patient ONE’s insurance company, the surgeon has undercharged.
The surgeon will be paid £345 less than he should.
A similar issue was faced by Surgeon B. He is a gynecologist with the same issue. Surgeon B performs a Q0800 on two different patients who are insured by separate insurance companies. He invoices both insurance companies at £636 each.
Patient ONE’s insurance company’s fee structure is £636 however whereas Patient TWO’s insurance company’s fee structure is £800.
Surgeon B, by using the fee structure for Patient ONE only has undercharged and been paid £164 less than he should.
Both carry on billing not realizing that the fee depends on whom the patient is insured with and different private medical insurance companies publish different fees for the same surgical procedure.
We checked four different medical insurance companies this afternoon in order to confirm the fees for an E1910. The fee was £636, £676, £775 and £800.
We then turned to Surgeon B and the medical code of Q0800 and found the fees were, dependant on which of the four medical insurance companies we checked, £636, £676, £775 and £800 respectively.
Don’t set fees at the level published by a single insurance company.
Check which fee is paid by which insurance company for the same procedure. Do not assume they are the same because they may not be.
A surgical fee can and does alter between private medical insurance companies. It can also alter over time.
In every single case, it’s always worth checking the fee structure paid by the patient’s insurance company. Do not assume it is the same across all private medical insurance companies.
Invoice for two different codes in the same surgical episode incorrectly and it’s easy to get into even more trouble. For example Insurance Company X may allow 100% of the higher value code and 50% of the second but Insurance company Y may allow 100% of the first but only 33% of the second.
Imagine what happens if all episodes are billed at 100% and 33%.
Immediately you’ve lost 17% of your second fee!
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It is a very bad idea in fact.
For example: a couple of weeks ago – actually it was Mothering Sunday to make matters worse – a private medical consultant happily sitting at home got up to answer the door bell.
He was not at all amused to be greeted by one of his patients standing there. The patient had called round to pay the excess off on his private medical insurance policy.
Mrs Consultant Surgeon was, understandably so, even LESS amused.
The next day my phone rang. I spoke with a very sheepish client. For months I’d been saying he should alter the address held by all the insurance companies with whom he was recognised. It should be changed to MHM’s address for correspondence and / or remittances – no charge in either case. But he was reluctant to do so as he wanted remittances and cheques to go straight to his home.
As a result his patient knew where to send the payment. His patient also realised this was the Consultant’s home address.
The Consultant was suitably contrite as the very issue I had flagged as potentially happening had actually happened.
A patient had gone to his home address. For all the right reasons you could argue. Nonetheless the consultant now saw the potential for an issue.
He was seriously unhappy about patients finding out where he lived.
Sadly this is not the first time, I’ve come across this. It’s not the insurance companies fault either.
When applying for recognition by a private medical insurance company it is advisable to quote a different address from your home address. It is standard practise at MHM when we take on a new client to amend the address for correspondence etc to Hilton Hall. It doesn’t cost anything.
If it is, for example, a request for more information from the client, we scan and email the document to them. When we receive a remittance from an insurance company we scan it and send it to the consultant anyway.
More likely we need it more than they for the simple reason it will contain, where applicable, notice of excess or shortfall and we have to action them anyway.
Make sure however, if you do scan and send the document, it is password protected otherwise there is a risk you could fall foul of the Data Protection Act!
Cheques are received practically every single day at MHM. They are recorded on the client’s sales ledger, we take them to the appropriate bank and pay them straight into the client’s own bank account.
The other advantage of all this is that the client has LESS to deal with. Most MHM clients have more important things to do than process pieces of paper anyway.
It’s not that difficult to amend the correspondence address for a private medical professional. In fact, it took less than one hour to get this particular client’s details changed for ALL insurance companies.
Much better than having a patient ring your door bell on Mothering Sunday – or any day for that matter.
But at least the private consultant’s Mother-In-Law stuck up for him apparently and that did make me smile.
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In the world of medical billing and invoicing sooner or later it is realised the most efficient way of doing something is to do it once and to do it right first time. For example:
MHM recently completed a project for a private hospital. The project was to investigate why various private medical insurance companies were not paying.
One insurance company was proving to be particular troublesome. An analysis of a complete month’s invoices soon identified why. This particular insurance company required all invoices to be submitted electronically. No problem with that.
Except the data on which the invoice was raised was incomplete. For example, the patient’s date of birth or policy number or pre-authorisation was either missing or was incorrect. Each and every time this caused the invoice to fail at the point of logging electronically with the insurance company. Thus the invoice was not actually passed to the insurance company for payment. Instead it was put in a “holding” pile.
In other words the invoices were not being done “right” so to speak at all.
They were having to be done two or three times.
To resolve the problem, it was imperative to make sure ALL the details were correct so invoices could be correctly processed and not placed in a “holding” pile. It was vital all the details were 100% correct. That was, or so it appeared to be, the root cause of the issue. But why was this proving so troublesome?
It transpired medical secretaries were of the opinion the hospital receptionist were responsible for getting it right. The hospital receptionist said the medical secretaries were responsible. Then they both claimed the person who actually raised the invoice was responsible.
The reality was that nobody was making sure the data was right and this was before the correct CCSD code was being identified and used.
The spat had caused, over the previous six months, the hospital to be short of many tens of thousands of pounds. Indeed the holding pile was not only greater than the value of an average daily outpatient appointments, it was STILL growing.
Skip forward a few months. The receptionist obtains the details and checks them. The medical secretary ensures all the details are recorded on patient records accurately and checks them again. The person responsible for medical invoicing highlights on a daily basis ANY invoices which can’t be processed. The holding pile is now less than 0.5% of a MONTH’S worth of invoices.
Is this overkill?
Cash in-put into the hospital from this ONE insurance company has increased by around 160%. It’s not overkill at all.
Do it once and do it right!
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Sometimes even a consultant surgeon does not understand how valuable his time is.
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. One prefers a Saturday morning. It doesn’t bother me. It’s my job to fit in around 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”
The situation was despite leaving messages on his phone or emailing him, seldom did Mr Surgeon respond. He was too busy. Yet most of the information the med-secretary needed was fundamental to generating cash into the practice. For example: two clinic lists a week ago (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)
Find the cause
So I sat down 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”
I agree with him.
Sadly therein lies the cause of the issue.
The reason Mr Surgeon is having difficulty generating the cash is due to him not dealing with such issues as the missing clinic lists or not passing over remittance advices.
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.
Sadly they can’t.
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.
The little things matter too
Mr Surgeon is a very safe pair of hands and the patients love him. He’s a nice guy too. But he needed to change ONE SINGLE THING in the way he works. He needed to put aside an hour a week to make sure he’s covered all his administration too.
So he did.
And within a month Mr Surgeon was pleased to see not only more cash coming in to his business but that he wasn’t being chased by his med-sec so often.
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 afterwards.
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I argue with medical insurance companies all the time.
Let me, however, be very specific about when and why I argue with them. I argue with them when I think they are wrong or when I think they have made a mistake.
A real example will illustrate why and when to argue with an insurance company.
MHM has a client who performs a specific test at a consultation with a patient. He has done so on more than one occasion obviously and with patients holding cover provided by all the major insurance companies, I’ve invoiced for him many, many times. Per normal MHM won’t reveal who the client is, his specialism or indeed the true value of his charges. For the purposes of this example please assume the charge is £125 for the consultation and £75 for the test.
The invoice was raised and sent electronically to the insurance company. It detailed all the correct details i.e. patient’s name, complete address, date of birth, policy number, pre-authorisation number. The correct CCSD code for both the consultation and the test were used. It also indicated the correct price for each and a total value for the combination involved. In other words xxxx (the consultation) = £125. The yyyy (test) = £75. Total value = £200.
Surprisingly, when the remittance arrived electronically from the insurance, only the consultation had been paid. A note appeared on the remittance advice stating it was not possible to charge for a consultation and that particular test at the same time.
Except, you can.
Before picking the phone up to call the insurance company concerned I first visited the insurance company’s website. The codes were correct. The fees for each code were correct. There was no indication that the combination could not be charged alongside each other whatsoever. I was pretty certain even before I’d checked that I was right but it doesn’t hurt to check. I could have been wrong. More likely it could have been that the rules had been changed.
Establishing the facts is vital when raising invoices for medical billing. Actually its true of all commercial situations but is dependant on what is deemed to be a fact. What some claim to be facts turn out to be anything but sometimes. In this case, though the facts were as I thought them to be. It was perfectly acceptable to charge the two codes together. Only then did I call the insurance company.
Having passed the normal Data Protection requirements i..e patient identifiers etc, I asked WHY this particular charge had been reduced? It was explained to me that the combination was invalid. It was unbundled as they say. Except I insist it was valid, was not unbundled and further, the insurance companies OWN website said the combination was permissible. The phone went quiet for a while and then I was told the insurance company was wrong and I was right. The £75 would immediately be paid to the consultant involved.
Despite what you may think it is not unusual for an insurance company to make a mistake, admit they have made a mistake and then rectify it straight away.
Don’t, however, call an insurance company and twist the facts. By that I mean don’t call them and say their fee isn’t right and should be much higher. That is not a fact, it is an opinion. When faced with a combination of codes that can’t be charged together do NOT separate them into two invoices one being sent on a Monday and one on a Tuesday. Don’t unbundle in other words. Insurance companies may make mistakes but they aren’t stupid.
Its very much a case of “picking your arguments” and challenging an insurance company in the right way and on the right subject.
But is also very, very much a case of noticing that the insurance company have made a mistake and asking them to rectify it. The number one statement made to me by private consultant surgeons is that fees are too low (I agree for what its worth) and that insurance companies are really, really difficult to deal with. They are not.
As regards fees, however, if you want to increase your fees the first port of call is actually to check you have a) charged the right amount to begin with and then b) making sure you ARE ACTUALLY PAID the right amount. In the example above the £75 wasn’t lost, it was paid to the medical professional concerned.
Look at it this way. His total charge was £175. If I hadn’t noticed the £75 had been deducted in error, he would have received 43% less than he was perfectly entitled to be paid!
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To successfully perform medical invoicing or medical billing there has to be a degree of focus on the task itself.
In fact, there has to be a total concentration on the expected outcome. But what is the outcome
The outcome is always the same. Getting an invoice paid. The total focus must be applied to this outcome at the expense of other items. Making sure the private consultant surgeon is paid is the task and therefore total focus must be on that. The problem arises when the total focus is not possible.
For example: in the middle of invoicing for 12 consultations and 4 medical episodes on behalf of a private consultant surgeon the telephone rings. More often than that, however, is an email alert pinging up! Even worse than that is the person responsible for medical billing decides, as they don’t really enjoy doing that specific task, and do something else instead. The other distraction from focus is, of course, other people’s demands.
MHM once had a client who one morning called 8 times within 35 minutes and then afterward complained his medical billing wasn’t being done speedily enough. It didn’t take a genius to work out that the 8 phone calls were actually a total distraction from raising the very invoices he expected to be raised during the morning.
It doesn’t really matter what the distraction is even though with modern technology advancing so much over the years, the likelihood of distractions has increased ten-fold. For example, I may be in the middle of a task and my mobile pings to say an email has arrived. It may also ping because a text has arrived. The opportunity for distraction(s) is enormous. Yet these distractions can remove focus from the planned outcome.
They can stop processing an invoice correctly, resolving an issue that is preventing an invoice getting paid or they can even stop an invoice being raised in the first place.
Modern technology is great. It enables MHM to communicate with its clients speedily and efficiently. It enables clients to provide data to MHM equally efficiently. It also enables MHM to raise invoices electronically and deliver them to a private medical insurance company at the push of a button. But it can also be a blessing in disguise if MHM were to let it distract from focusing on the job in hand. Thus it is worth repeating that the planned out is for the private medical professional to get paid. That is what MHM is there for; nothing else.
If the technology on occasion stops that, then remove the technology for a while.
This may sound revolutionary but in the real world, ignoring technology when the technology actually prevents achieving the planned outcome is not as silly as it sounds.
For example: when I’m raising medical invoices for a client – every single morning invoices are processed at MHM – I switch my email off. Thus there are no distractions caused by emails arriving. Before anyone raises the question of an email being important, may I suggest that in reality whilst emails may indeed be important seldom are they time critical? They are normally requests for data, asking a question or the arrival of a remittance from an insurance company.
All three examples are important but they are not, despite what people may claim, time critical.
My favourite example of this is the person who was tasked with locating new premises for MHM and emailed me one morning last year but when I didn’t immediately respond, telephone after 15 minutes to confirm if I had received his email. This despite the instruction to email details to me and being advised I would respond later that week. As he couldn’t even follow that instruction, he immediately lost the opportunity of finding new offices for MHM!
The world will not end and a private medical practice won’t immediately collapse if an email, a phone call or even a text are not immediately responded to.
That is not to say a patient inquiry should not be immediately answered. In the case of a patient calling then absolutely they should. Have someone designated to answer the phone. It look’s awful if a patient calls and the phone isn’t answered.
But don’t have the same person responsible for medical billing AT THE SAME TIME for if you do the phone calls and/emails will provide the distraction to caused the planned outcome to be missed.
Medical billing is not the easiest thing to do in the world. It requires concentration and an attention to detail. If the outcome is expected to be prompt and complete payment of an invoice for medical services, then focus should be directed to just that. You know what happens if I switch my email off during the morning or I have the text alert set to silent? Nothing.
Except I raise numerous invoices for clients, resolve issues with insurance companies and make sure MHM clients are paid.
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In terms of medical billing or medical invoicing that perhaps is one of the statements I hear from private consultant surgeons more frequently than others.
The following example however really illustrates that despite the rejection of the fee, examination of how the fee was established confirms there is very little the consultant can do about it.
Applied for recognition
The consultant surgeon concerned only recently applied to be recognised by the private medical insurance. That in itself is not too difficult a process. MHM spoke to the consultant and pointed out fees should be checked extremely carefully when recognition was being arranged. The consultant was extremely well qualified, had held a substantial NHS post for a number of years and his/her specialism was in relatively high demand. The private medical insurance policy was keen to offer recognition and refer patients to the consultant also. The recognition was thus granted.
Yet despite the warning by MHM fees were not checked.
MHM were subsequently asked to handle the medical billing side of the consultant’s practice. In order to do so we need to know how much the outpatient consultation fees were for even we can’t charge if we don’t know how much to charge. The medical professional did not however know what the consultation fees were and the alarm bells immediately started ringing.
Fees incidentally that they would have agreed to and would have been detailed in the pack supplied to them by the insurance company concerned as we had advised. So we called the insurance company and quoted the newly acquired provider number.
As usually, the insurance company were keen to point put the consultant had agreed to adhere to the published fees.
Fair and Reasonable
It is always amusing me when “fair and reasonable” is quoted to me because it depends on what the consultant thinks is “fair and reasonable” against what the insurance company think is “fair and reasonable”. More specifically what happens if the thinking differs between the two parties concerned. And that is precisely what happened in this example. More specifically how it defined a “fair and reasonable” consultation fee.
The insurance company deemed that £100 was a fair and reasonable fee for a consultation.
The medical professional deemed that £175 was a fair and reasonable fee.
And thus the consultant instructed MHM to charge a consultation at £175.
MHM pointed out that it would indeed charge £175 as instructed HOWEVER all that would happen is the insurance company would reduce the value of the invoice down to the £100 that had been originally agreed.
And that is precisely what happened. Despite the medical professional objecting strongly to a consultation fee of £100 and insisting a “fair and reasonable” fee was £175, the invoices were reduced in value.
Don’t start the battle
It mattered little to the insurance company that the MHM client had colleagues who were both charging and getting paid £175. Even before I asked the question I knew this was to be true. It was true because the colleague concerned had many, many years more experience. It mattered even less to the insurance company that a second colleague was paid even more than £175 for a consultation. This was so because the second colleague was in a completely different specialism!
Sadly the MHM client had based their practice business plan on a consultation fee of £175. They had done so because they had asked colleagues how much they were paid and assumed such fees would equally apply to them.
MHM, per normal, had no issue calling the insurance company concerned and arguing the case on behalf of the medical professional. That said it was an argument (a battle if you will) that was never going to be won. The simple reason remained that at the point of recognition the MHM client had accepted the fees. It mattered little the client hadn’t fully understood what was being offered (despite the fees being detailed in the recognition pack sent to the client).
Sure enough the insurance company stood firm behind its agreement with the consultant.
Assumption leads to problems.
The moral of this sorry tale is best summed up by the above heading. I’m not suggesting you shouldn’t challenge fees for consultations or indeed a surgical episode but don’t put yourself on the back foot so to speak by accepting fees and then challenging them afterwards. As painful as it is for the MHM client, it really is as simple as that.
Check your fees before you agree to them!
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Working for a consultant surgeon 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. Thus is has not been so much fun. 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 to 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.
At this precise point I’ve been on hold for 13 minutes!
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 being unanswered. Shouldn’t the aim be to answer the phone call rather than offering a choice of music to listen to?
Is it necessary?
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 the than that, 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 advices 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 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 in 2017, I did consider WHY they had outsourced? It would appear the reason is financial. It’s cheaper.
Cheaper isn’t always the best.
It was once said by an extremely wealthy man that price is what you pay and value is what you get. I agree whole heartedly. 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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There a few things I hear that automatically set alarm bells ringing when I look at the invoicing and billing process of a business.
“I’ll take a look at it next week”
“I’ll get round to it in a bit”
“I’ve been meaning to look at that”
The final of those items was said to me last week at a medical conference in London.
I was sitting on a panel facing an audience of physiotherapists and other medical professionals who wanted to ask what made a medical practice successful.
In amongst 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 precisely what I said to the questioner. I asked if he knew how many invoices he had raised last month and the total value he had invoiced in the same period. Sadly he didn’t know either.
But, I continued, to improve the performance of your practice you must make sure you know to a reasonable degree of accuracy how you are performing against whatever standard you decide is the most 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 16th, and Friday, January 20th. Therefore I should be able to see 25 invoices. That is an ultra-simple but totally effective control which makes sure everything is invoiced. The standard has been set because one invoice is required for each patient.
If I only have 23 invoices I have a problem!
But it also means of course at the end of January I can add up the number of invoices and also tell the client how many patients he has seen during January. 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, in this case, the invoicing process or indeed the whole business 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!
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One of the most common remarks I hear from my guys is the number of patients they see in the NHS. They literally have patients queuing up to see them. Such a comment is normally followed by the opposite when discussing a consultant surgeon’s private practice.
They want to see and need to see MORE patients.
This, for me, confirms the absolute cultural difference between the public and private sector.
In the NHS, a consultant surgeon does not have to do much in order for patients to be delivered to them.
In the private sector the precise and exact opposite applies.
In the private sector a consultant surgeon, because fundamentally a private practice is a business, MUST do everything he or she can to attract a patient. He must engage in pro-active marketing. He must ensure it is known his practice is there. First of all however he must comprehensively understand WHY a patient is choosing to go private. It is not merely the case of a patient wanting to be seen privately because he or she has private medical insurance. More accurately it is understanding WHY the patient has private medical insurance. I, for one, dispute it is because private care is better than NHS care.
More likely it is because the private patient wishes to be seen quicker.
Even so, a consultant surgeon MUST still engage in marketing.
If the patient can be seen at the private practise quicker than at an NHS location but the patient is unaware the private practise exists then all bets are off.
Therefore a marketing plan of some description, is an integral part of a private consultant surgeon’s business plan. And there in lies the reference to the first and absolute cultural difference between an NHS practise and a private practise.
A Private Practise is a business.
In a NHS practise, patients will be delivered to the consultant surgeon without him even asking.
In a private practise, patients will not just be delivered. They have to be attracted to the practise or more accurately to the business.
Note the use of the word BUSINESS for a private practice is a business.
This is not the time to discuss which marketing strategies will and do work best for a private consultant surgeon. This blog is more concerned with highlighting that due to the differences between the NHS and the private sector, a private consultant surgeon has no choice but to have a marketing strategy.
Just has a consultant must have a robust infrastructure to support the business (secretarial support, invoicing, banking etc), it is equally as important to have a marketing strategy.
Look at it this way, if any business does not have a regular number of customers or clients (in the case of a medical practise PATIENTS) then inevitably the business will not succeed.
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Yes you can but only with the insurance companies permission!
This question arose from a group of consultants who referred patients to each other but always seemed to have problems in getting the invoice paid. Following a conversation with the insurance companies who had received the invoices the cause of the issue became very clear.
The consultants assumed that the pre-authorisation confirmed the patient could attend a clinic with any consultant. This is not the case.
Pre-authorisation is usually against a specific consultant.
If you follow the process the patient is normally referred to a specific consultant by their GP. Alternatively of course the patient may contact their insurance company and the insurance company refers them to a specific consultant. In either case a specific consultant is involved. If the consultant them refers that patient on to a colleague for whatsoever reason, it is unsafe to assume the pre-authorisation for the second consultant will stand. It may not.
What do you do?
In a perfect world the patient should have already contacted their insurance company and asked if the pre-authorisation can be transferred to the second consultant. Normally this is not a problem. But what do you do when the patient hasn’t contacted their insurance company and you are ready to invoice.
The only sensible thing to do is to speak to the insurance company concerned and explain why. In other words, the insurance company up to the point they are notified of the appearance of a second consultant, is blissfully unaware of his/her involvement with the patient. Consequently when they receive an invoice from a consultant not recorded against the patient they quite naturally be confused and could either delay payment of the invoice or worse, and very easily decline, the invoice. If this happens you will have no choice but to sort it out anyway.
It makes much more sense therefore if you do need to refer a patient to a colleague or a patient has been referred to you by a colleague to make sure the patient’s insurance company is aware of what is happening. On the occasion(s) I’ve had to do this, it has resulted in either the issue of a new pre-authorisation against the second consultant or an amendment to the already existing pre-authorisation.
Insurance companies are NOT, as I’ve repeatedly said in numerous articles, the enemy. Nevertheless it is unreasonable to expect them just to pay out against an invoice from a consultant if they receive it from a completely different consultant to the one the expected.
You can transfer have a pre-authorisation transferred to a colleague but speak to the patient’s insurance company first please.
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Christmas wishes from MHM Ltd and a hope Santa Claus brings you everything you want.
We’ll be in the office for a few hours each day on December 28th, December 29th and on December 30th.
Other than that, see you in…
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Failure to get paid is not an accident. Something has always caused it.
There is always a reason why you aren’t getting paid. And the number one reason is that no invoice has been sent.
Take for example, the consultant surgeon I was working with recently. The issue as he saw it was that his cash flow seemed to be totally uneven and much less than he expected.
Something causes it to happen.
There is ALWAYS a reason.
If you leave invoicing until later its 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 a private medical practice and discovered an issue with invoicing frequency. So why are “tomorrow” “Friday” or “when I get 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.
Invoices should be raised DAILY!
Once a week is not helpful. In one extreme example a practice was invoicing at the end of each month. No wonder there was a problem.
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.
Wednesday September 30th 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 Tuesday October 13th – one day short of two weeks later!
Is it any wonder the consultant was extremely dis-satisfied with the practice cash flow?
BUT NOT INVOICED AT ALL?
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 his cash flow was poor.
But before we go any further do NOT blame the medical secretary. She has enough to do. The phone rings. She has to meet and greet the patients. She has numerous letters to type. She has to book clinics. She has to book theatres. That is precisely what she should be doing. 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.
A private medical practice is a business.
It must be managed as a business.
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 LATER – DO IT NOW!!
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Many times I come across a consultant who is having problems getting paid by self-funding patients.
This is often followed by a reference to numerous reminders and sometimes even final demands being sent in vain to the patient. Despite all this, no payment has been received and the invoice remains outstanding. I’ve always found this curious as I have very few problems with self-funding patients.
The reasons my clients don’t appear to suffer as much as their colleagues are threefold.
Firstly, I make sure the invoice that is sent out is absolutely correct. The address is verified with the post office (the address and the postcode is checked against the Post Office “Postcode finder”). This is free and saves me worrying if the details are correct.
Secondly, if the invoice is unpaid after a set length of time I telephone the patient.
Thirdly and finally, I take debit card payments for my clients.
None of the above are exactly rocket science but if you strip down each stage you remove many of the reasons for a self-funding patient not to pay.
If you take each, in turn, starting with validation of the address, this removes the potential for the invoice to be returned undelivered. For example: how confident are you the address quoted is 100% complete and accurate? There are many occasions when an address has been shorted or a digit incorrect used in a postcode. It takes all of 30 seconds to check everything is as it should be. If it is NOT, then the opportunity to get it right presents itself. If you send an invoice out incorrectly addressed, and believe you me I’ve seen.
Permit me to give you an example of something that was actually mailed to me and never delivered recently because the postcode was wrong. It was a digit out. That doesn’t seem to be much of a mistake but it was enough to cause a failed delivery. The first I knew about it was when I called the sender to ask where the expected correspondence was. How many self-funders are going to call and ask where the bill is? Some might but good luck expecting that to help reduce the number of outstanding invoices for self-funding patients.
The second is perhaps the most important of them all.
By actually speaking to the patient two things are pretty much going to happen. You are either going to get paid or you are going to find out why the invoice hasn’t been paid. For example, the patient will either agree to pay there and then or, as in the latter case, explain they are insured, thought the payment would be taken from the debit card swiped upon registration or some other reason. It doesn’t really matter what the reason is. What matters is that I’ve been able to identify a problem. And then sort it.
Sorting it brings us neatly to the third reason my clients don’t suffer from excessive issues with self-funding patients. I take debit and credit card payments for them.
There is a freephone number on the invoices I send out to use if the patient wants to make a card payment. Or in the event, I have to speak to a patient I always ask for a card payment. 99.9% of the population have debit and/or credit cards. Thus the patient is encouraged to clear my client’s account whilst on the phone. Of course, there may be issues such as the patient genuinely believes the hospital have taken payment or the patient wants to check something. Not a problem with any of that save it needs resolving within a maximum of 36 / 48 hours because my client hasn’t been paid.
None of the above is bullying or harassing the patient; quite the reverse in fact. It confirms not only is the consultant a professional but he/she has an equally professional administrative function within the practice.
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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 following Monday. 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 patients insurance details had not been recorded on the clinic list.
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 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 any 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 phone call: 11 minutes plus 5 minutes = 16 minutes.
3. A THIRD phone call was made. This time to the patient. Answer machine so I left a message to call me back. He did. 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
4. 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.
Total length of phone calls: 49 – FOURTY NINE MINUTES!!
There is no problem in 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?
There are of course various on-line billing systems where you can look up all the details and speed things up considerably. But that is no excuse for not getting the details right in the first place. Each time and every single time.
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