Charging affairs at the embassy

If you are thinking of expanding your private work to provide services for embassies, then there are some essential billing and collection matters you need to be aware of, warns Garry Chapman

With the increasing number of consultants entering the private sector, many are looking at alternative ways of increasing the size of their private practice.
It certainly makes good sense to review your practice on a regular basis and there are many areas outside of the traditional private medical insurance (PMI) sector where a consultant can operate and generate additional revenue.
This is important for a variety of reasons, but the main one is the same for any business: diversification.
It is important for any business to have revenue streams from a variety of sources so that if a particular source of income tails off the effect on the business is minimised.
That, in turn, makes the practice more robust.
When an analysis was made of the invoices we raised over the past 12 months, it showed that the PMI market only accounted for 55% of the total amount.
The remaining 45% was split between other organisations such as:

  • Embassies;
  • Hospitals;
  • Solicitors (for medico-legal work)
  • Other commercial organisations.

Here I will focus on embassies and what you need to know from a billing and collection perspective if you are thinking of expanding into this sector.
The embassies are mainly in London and therefore you will have to operate within this geographical location in order to take advantage of this sector.
While there are over 50 embassies within London, the majority of the patients come from the big four which are Kuwait Health, Kuwait Military, United Arab Emirates Medical and Qatar.

Complex conditions
There are some important things you need to consider before deciding to enter this arena.
Typically the embassy patients that you will see will have complex conditions and this is one of the main reasons why they travel to this country.
When you see the patients for the initial consultation, they will normally be accompanied by an interpreter. So that fact, combined with the probability of dealing with a complex case, means that the consultation is likely to take longer than normal.
So you do need to allow more time.
Before seeing the patient, it is absolutely crucial that you obtain a LOG, which stands for a letter of guarantee.
This document will authorise treatment for the patient and must be in your name. Without this document, it is very unlikely that you will get paid for any treatment that is carried out.
The final important point to note is that with the embassies, payment can take a long time.
That is therefore an important factor for consideration, particularly in terms of cash flow.
Due to all these factors, it is absolutely crucial that you get your practice prepared correctly from the very first contact with these embassies.
Otherwise you could end up doing a lot of work and either not get paid at all or end up waiting a long time for payment which could have an adverse effect on your practice.

Garry Chapman is managing director
at Medical Billing and Collection

Unfortunately, in our experience, many consultants start seeing embassy patients without due consideration to the points that I have highlighted below:

It is absolutely vital that a letter of guarantee (LOG) is obtained prior to any treatment that is carried out; this document will vary slightly depending upon the embassy that is issuing the document.
It will typically specify the patient’s demographic details along with the appointment date(s) and the reason for the treatment as well as specifying the consultant and the location.
There is normally a set of terms and conditions covering the LOG and you must always submit this document in conjunction with your invoice to the embassy in a timely manner to ensure the best possible chance of receiving payment.
Some embassies also require a medical report along with the invoice and LOG. If this process is not followed, then you run a much greater risk of working without getting paid.

How much do you want to charge for your treatment needs careful consideration. Your fees could be for consultations such as initials and follow-ups, inpatient care, inpatient consultations and intensive care.
It could also be for any CCSD codes that you are going to perform and, in particular, when you carry out a complex procedure or operation which is not accurately described by a CCSD code.
Your fees should take into account all the points previously mentioned and whatever you decide, it needs to be clearly articulated to the embassies before you start to see their patients to avoid any misunderstanding after the treatment has been carried out – and to avoid dealing with disputed invoices.

You will need to be prepared for extended payment cycles and allow for this within your practice, particularly where you are likely to be paying tax to the HM Revenue and Customs (HMRC), even if you have not collected payment.
This could have a devastating effect on your cash flow if you haven’t planned accordingly.

Even when all the above is done, you will still need a robust system in place to chase for payment on a continual basis to ensure that your money is collected.
The embassies are always busy, particularly the ones mentioned above, and it is not uncommon for them to have a backlog of invoices waiting to be paid.
The reasons for this vary. But, ultimately, it is down to the sheer volume of patients that they have to deal with. And if you are not constantly chasing them, it is likely that your invoice will slip down to the bottom of the pile.
Should you continue to have issues collecting payment with a particular embassy, then you need to think long and hard about taking on other cases from them or you could end up effectively paying the HMRC to do work for the embassy.
Chasing the money on a continual basis is the hardest part of this whole process, as most practices are not geared up for this specific aspect.
It is both time-consuming and requires a specific skill set; it is rare to find a practice which has the time to chase these invoices on a continual basis, even rarer that they have the skills in house.
The alternative is to use a professional billing agency to gain control of this crucial aspect.

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