Going to waste if you don’t bill properly

Consultants in private practice are continuing to lose out on money they have rightly earned. In the first of a two-parter, Garry Chapman gives an update on how bad management is costing many specialists thousands of pounds

Three years on from my Independent Practitioner Today article about consultants in private practice needlessly losing revenue I have to report it remains a big problem.
I visit practices on a daily basis and see it first-hand.
Now, I understand that the first priority for the consultant is the care of the patient and that this should always be the case.
But unless the consultant takes a long, hard look at the way the practice functions in terms of the billing and collection services, then they may not survive in private practice to treat the patients.
During the recent credit crunch and downturn in the economy, making sure that your finances are in order has become even more important.

Costs still rising
Many consultants are either billing less year on year or are, at best, standing still in terms of revenue generated, but they are finding the costs of running the practice still rising.
The market has also shrunk during this time with approximately two million people falling out of private healthcare over the past four years.
On top of this, the CCSD coding structures have also changed during this time and that has reduced the number of multiple codes that can be billed together.
As we all know, some private medical insurers have also reduced the fee reimbursement for many CCSD codes, which ultimately leads to reduced revenue for doing the same level of work.
Taking the above into account the focus must be on:

  • Making sure that invoices are raised in a timely manner;
  • Ensuring that every procedure is billed correctly;
  • Invoicing with correct codes for each private health insurer;
  • Collecting the money in a timely fashion to avoid bad debts.

We are constantly surprised how rare it is to find these fundamental business practices being carried out within the medical practice.
The reason we know this is because the majority of our clients are coming to us in various states of financial distress.
Some have huge backlogs of outstanding debts which quite often go back years.
Others have clinics that have not been billed for many months.
Some are years out of date with their fee levels and, in the worst case scenarios, there are doctors who have all of the issues described above.

Why does this problem exist?
That doctors are not getting paid all that they are entitled to can occur for a range of reasons.
Everything being left to the secretary is a common cause. The secretary, who is often the busiest person in the practice, is frequently expected to be a medical secretary, receptionist, personal assistant, sales ledger clerk, and insurance guru as well as a debt collector.
The individual with the combined skill set required to complete all of these tasks, as well as fit them all into a working week, is either a very rare breed or simply does not exist.
It is an impossible task for one person to cope with once the practice grows exponentially from what is typically a slow start.
In our experience, as the practice continues to grow the secretary is so busy dealing with the medical side of the practice that the billing and collection is the area that is most frequently neglected.
Running a practice over the last few years has changed dramatically and the administrative burden has grown during that period, meaning that the problems I identified in 2009 have only become worse – leading to more examples of consultants losing money.

Garry Chapman is managing director at Medical Billing and Collection


  • The doctors continue to see patients who have not paid for previous treatment and therefore continue to build up their debt, so they end up seeing patients who have no intention of paying. This means they are, in effect, working for nothing
  • When the practice has a lot of foreign patients who come to the UK for treatment, they tend to only stay for a short period of time either in a hotel or rented accommodation. By the time the invoice is raised and sent to the patient for payment, they have left the country and gone back to their home country. So it then becomes almost impossible to get paid for that work
  • Financial problems are not always apparent to start with because, as the practice grows, a certain amount of money will continue to flow into the bank account. That masks the real problem of the outstanding debt; this continues to increase and get older, which means it is less likely to be collected
  • Another factor affecting the timeliness and amount of re-imbursement is that healthcare systems are constantly changing. Government policies and regulations, billing rules, medical codes, new technologies and insurance products mean that the practice has to keep up with these changes, as they can affect a doctor’s re-imbursement or, worse, cripple a practice if not complied with

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