There are many reasons an invoice for a follow-up consultation submitted to an insurance company may be declined for payment.
Over the last couple of days, some – using real examples – have been illustrated. Consultations not allowed under the policy is one. Only two consultations allowed under the policy is another.
As stated earlier this week, it is extremely difficult to judge in advance if any invoice – for a consultation or otherwise – will be declined.
The final example, however, cost a group of three surgeons £1,350 over a six month period and represents one where it is extremely likely to judge in advance if the invoice WILL be declined. And it is an area you CAN do something about.
MHM was approached to conduct a review of the billing process for the three surgeons. There was much to be concerned with but the analysis of declined invoices highlighted ONE specific issue and related solely to follow up consultations.
All three consultants were submitting invoices for follow up consultations that had happened within TEN DAYS OF A SURGICAL EPISODE.
The consultants were providing the consultations in an effort to provide an absolute first class service to their patients. That is just as it should be. However, generally speaking such invoices will automatically be rejected by the majority of insurance companies because they are within ten days of the surgical episode. And that’s precisely what happened here. But why did it cost the consultants £1,350?
It cost the consultants £1,350 because the insurance companies (note plural) all stated they would not pay for a consultation within ten days of treatment and further the charge could not be passed on to the insured i.e. the patient.
Certain insurance companies may well allow a follow-up within ten days but most will NOT. Clearly the immediate solution is not to perform a follow-up within that time span. That is precisely what MHM advise the three consultants to do. Later feedback to MHM from the consultants confirmed the number of declined invoices for follow consultations had reduced dramatically.
However, there are occasions when a follow-up within ten days is necessary for medical reasons. What is to be done then? The answer lies in the last three words: FOR MEDICAL REASONS.
Prior to submitting an invoice to an insurance company for a follow-up within ten days, MHM advised the consultant’s practise manager to telephone the insurance company and advise WHY the consultation had taken place i.e. state the medical reasons. Thus it transpired on the much smaller number of consultations required within ten days of a surgical episode, the insurance companies concerned happily paid the invoice in full.
But have YOU considered WHY your invoices are being declined?
More importantly, have you considered YOU may unknowingly be contributing to the problem yourself?
Comments to: pete@medicalhealthcaremanagement.co.uk
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