Ensure you benefit from the recovery

Simon Brignall discusses the lessons every practice can learn from the rollercoaster impact of the pandemic

MANAGING Covid-19’s impact has defined our professional and personal lives over the past year, and independent practitioners will be dealing with its ramifications for some time.

It is noticeable that each successive lockdown had less impact on our client doctors’ incomes than the last and there has been strong demand for Medical Billing and Collection’s services as restrictions relax. There are two areas that every practice can review to ensure they are best positioned to benefit from the recovery.

1. Self-pay

Plenty of articles have detailed the fall in patients accessing care across all specialties from cardiology to cancer.

Recent reports suggest NHS waiting lists could rise from under five million now to anywhere from six to ten million patients this year.

Headlines about record waiting lists have always translated into a large demand for private healthcare from patients unprepared to wait.

The major trend of the last decade was the growth of the self-pay market and we fully expect this sector will continue to form a significant portion of the recovery supported by this demand.

Managing self-pay
Considering the self-pay sector’s importance, it is vital to ensure these patients are dealt with correctly from both a billing and collection perspective.

Urgency is often lacking regarding the billing of self-pay patients and, more importantly, the collecting of outstanding money.

This frequently means a large amount of outstanding debt – either chased intermittently or not chased at all – resulting in debts that quickly mount up to significant sums of money.

Typically, we see a lack of robust procedures in place to deal with these patients and the provision of a simple-to-use payment facility.

It is important that your practice has systems in place to deal with the various types of self-pay patients you are likely to come across.

UK self-pay
For UK self-pay patients, you need to have a published price list or to have notified the patient of their fee in advance.

It is good working practice to also confirm both the methods of payments available as well as when payment is due, so patients will not only know to expect an invoice but also understand how they are to pay.

Medical Billing and Collection (MBC) offers a variety of methods tailored to a practice’s needs. These are:

  • E-billing of patients after their treatment by email, which includes a link to our payment portal enabling the patient to pay 24/7;
  • E-billing and collection of payment ahead of their treatment;
  • Collection by the practice on the day via our client self-pay portal.

When you are invoicing patients post-treatment, you will need to put in place a robust chasing process where the patient is contacted for payment after an agreed period and ensure this is routinely followed until collection.

Failure to implement and adhere to a chase policy is the most common reason why debt levels increase and can lead to cash flow difficulties.

"For UK selfpay patients, you need to have a published price list or to have notified the patient of their fee in advance"

Overseas patients

If you are going to see a patient who is not a UK resident, it is even more important to make sure your fees and method of payment are made clear. Once the patient leaves the country, it is extremely difficult to ensure these invoices are paid.

When we deal with overseas patients, it is generally standard practice to collect money in advance.

Where a payment is collected by the hospital, we raise an invoice to the hospital for doctors’ fees.

It is important to follow up with the hospital’s finance department to ensure these payments are made to the practice because these can easily get delayed or missed.

"When we deal with overseas patients, it is generally standard practice to collect money in advance"

2. Insurance shortfalls

Even the most efficient practices find chasing insurance shortfalls and excesses challenging. Often these invoices make up a significant proportion of their outstanding debts.

This is because most patients do not review the terms of their insurance policy and assume all costs will be met by their insurer.

So when they receive an invoice for an outstanding balance not covered by their insurance company, it can quite often come as a shock to them.

Ignore invoice

We find many patients ignore the invoice, thinking that it is either a copy of what has been sent to the insurer or that their insurance company is liable.

This is why it is important to follow up with the patient directly and explain why they have received an invoice.

A large part of our work is liaison between the insurer and the patient to ensure it is clear who owes the money.

Some patients contest this with their insurer, believing the company is liable, so it is important to tackle issues quickly to minimise delays.

Once the patient accepts the money is owed by them, then the outstanding balances needs chasing.


It is always important for practices to regularly review their fees. Understandably, the past year’s events mean a fee review was not high on priority lists, but if you have not done this for some time, it is worthwhile. Many consultants find this a stressful exercise, so it gets deferred.

Consultants need to decide whether they will adhere to each private medical insurance company’s price schedule for procedures and, if they do, they must know the price list for each one. Each has its own specific price for every code provided by the Clinical Coding and Schedule Development group (CCSD).

Fees for an individual procedure can vary by as much as 100%, so its important to ensure you have the current correct tariff.

Consultation fee rates also need to be decided. Sometimes the contract that the consultant has signed with the insurer will dictate what they are required to charge for both the CCSD codes and the consultation fees.

The review should include the self-pay sector for both consultations and procedures. This is an area where you have complete autonomy to set a fee that reflects both the demand for your services and your experience.

Get this wrong and you can miss out on patients because the pricing is too high. Even worse, you can lose thousands of pounds due to pricing being too low.

Our experience is that consultants typically do not get this right because they have either not done enough research when initially setting their pricing or, more commonly, they have not reviewed their pricing regularly, if at all. In many cases, it can be years since their pricing was last reviewed and updated.

Taking time to review these two key areas of your practice will ensure that, after a rollercoaster year, you are able to benefit from the increased demand for your services. The simplest and often best way of doing this, of course, is to contact a medical billing company with years of expertise in this area. Then you can focus on patient care.

Simon Brignall is director of business development at Medical Billing and Collection.