Are billing firms worth the cost?
The £64,000 question – and answer

Mr Simon Owen-Johnstone, an orthopaedic upper-limb surgeon working exclusively in private practice at London Bridge and The Lister Hospitals, describes how outsourcing helped to recover money he was owed from an unpaid bills problem and helped his business grow.

Billing-Firms-Worth-Cost---ImageI began private practice as a consultant orthopaedic surgeon in 2004. I started at a hospital near my NHS base and, initially, I only needed a little admin help.
Soon I was introduced to a secretary who looked after a number of small practices like mine. She did everything clerical for me:
appointments, bookings, typing and billing.
As my reputation developed, I expanded my practice to London Bridge Hospital. Business there grew more rapidly and soon outgrew the arrangements that had been sufficient only a few years earlier. I needed my own secretary.
It was only during the transition that I discovered nearly £79k owing to me that the previous system had not been robust enough to control.
As I didn’t want to burden my new secretary with the problem, I spent hours trying to sort out the mess; I sent some reminders and chasing letters myself, but it appeared hopeless. Outsourcing was the answer.
I met Garry Chapman of Medical Billing and Collection (MBC), contracted their services and was greatly relieved to hand over a huge pile of papers.
My account was initially in MBC’s ‘intensive care’ as new managers set about reconciling my records with those from the insurance companies.


Recovering the backlog
We exchanged lots of emails, and, over about a year, they managed to recover all but £15k of the backlog, some of which was six years old.
Having taken sufficient action to chase the backlog, the true bad debt could then be written off, with my approval. The income tax I had already paid was then recovered.
Together with tackling the bad debts, MBC handled the ongoing billing. My secretary had simply to email clinic and theatre lists from the Practice Manager software, and my support team ensured the invoices were all paid.
Having such a stable practice structure in place ensured my practice continued to grow steadily so that, in 2011, I chose to leave the NHS and work solely in private practice. The billing company has been able to advise me on all aspects of my practice billing to ensure that I am now billing efficiently.

My recommendations
I think the figures speak for themselves.
If your practice bad debts are greater than the MBC fees, you are already losing money.
To this figure, add the cost of business lost because the phone was engaged as your secretary chased debts. Don’t forget that having your secretary do the billing isn’t free just because you have already paid for him/her.
Don’t worry about getting accounts straight first. I felt awkward handing over the accounts that were in a disorganised mess, so I spent hours trying to straighten them, largely out of embarrassment. I should not have bothered: it didn’t matter and I didn’t help.
Don’t worry about losing control.
You remain in complete control of practice finance; someone else just does the legwork.
What I would also pass on to other consultants from all this is not to let your practice outgrow your arrangements.
It is important to scale your business structure as turnover grows. A share of a secretary who does everything is fine to begin with, but the arrangements need to be reviewed to ensure they are appropriate to the practice.
Equally, if there is a deficit in billing capacity, get billing help, not more secretaries. Do it now. I think your practice, accountan and secretary will thank you.

Outsourced billing is not free, so what do I get for my money?

  • I get paid for all the work I do, not just some of it
  • Work is invoiced the day MBC receives theatre and clinic lists
  • Aged debts are actively chased and insurance excesses are pursued
  • My bad debts are almost zero, but any I do have can be legitimately written off for tax purposes
  • My secretary is able to answer the phone and run my practice, because she is not bogged down with time-consuming credit control
  • Outsourcing is so efficient that it is cheaper to buy credit control from them than have my secretary do it
  • My secretary maintains a wholly positive relationship with patients. Someone else does the unpleasant money-chasing
  • A secure website allows me to see business finances real-time, monitor my business and produce figures for my accountant
  • Weekly email and texts inform me invoicing has been done and money received
  • MBC handles all cheques and electronic payment: I don’t need a card reader, nor do I have to visit my bank
  • Most importantly, the headache of credit control has vanished

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