Intensive Care for Unpaid Bills

Garry ChapmanUncategorized


Intensive Care for Unpaid Bills

Not being paid for work you have done is a huge pain for many consultants in private practice. Robin Stride visits a ‘financial hospital’ where specialists go to have their medical billing and collection woes cured

Intensive-Care-for-Unpaid-Bills-ImageOuch! There is one shared ailment driving patients to this particular ‘clinic’. Financial distress.
It can be a few thousand pounds, or tens of thousands and even hundreds of thousands.
Here, the patients’ case notes have a common theme of identity – they are all consultants, from all specialties and all parts of the UK.
And they are all seeking the same cures – recovery of unpaid invoices for their private work, a review of their billing and then a dose of the correct medicine to allow them to focus purely on the medical side.
I am being given a conducted tour of the newly-opened larger premises of Medical Billing and Collection, just off the north-west side of the M25 motorway in leafy Buckinghamshire.
When the patients keep coming, the clinic grows – and this company is no exception. They don’t like to say how much they have got back for doctors – their competitors are reading this – but it is running at tens of millions of pounds a year and they think all the signs are that this is set to increase in the years ahead.
We never saw any doctors when we were there because their individual treatment plan does not necessitate a personal attendance.
It is more likely they will get their own consultation at a location and time of their choosing to discuss their own personal ailments.
What we did see was the bulk of the now 35 full-time staff beavering away at computer screens and on the phone as they did their daily rounds of curing consultants’ existing billing ailments and preventing new symptoms from rearing their head.

Intensive care
It was explained that when someone new comes to the clinic, they are placed in ‘intensive care’ until the immediate issues and nuances have been resolved and they are ready to be passed over to their own account manager.
We also saw a lot of empty space ready for the new employees who are expected to be joining. Medical Billing and Collection (MBC) has space to double its workforce to cope with the consultants that are joining them on a weekly basis.
Research suggests that only about 10-15% of consultants in private practice currently use a company to sort out their billing, which means that there is a lot of potential for growth.
The people at MBC see this figure changing all the time as more and more specialists take action to improve business performance and to treat what are often longterm sicknesses that have built up to crippling proportions over a number of years.
Another reason for the optimistic growth outlook is the number of ‘NIPs’ – new independent practitioners – who call in a firm to do their billing for them right at the very start, so they and their medical secretaries can concentrate on the business of seeing patients.

Battling with the books
It appears they are far less inclined than the previous generation of consultants to go back home late at night after seeing patients and to then spend more hours battling with the books.
This is how many have run into their financial problems in the first place. DIY billing was not cost-effective and so was often not done properly, leading to late payment, underpayment or worse – no payment.
We never saw any one from the sales force on our visit either. It turned out they do not have a sales force. Word of mouth has always been the big driver for their clinic – like it is for many consultants in private practice.
Getting consultants’ bills settled can be touch and go, though, especially with patients from abroad who manage to slip out of the UK without settling up. Once they are out of the country, then consultants can expect to kiss their money goodbye.
One of the more unusual and effective ‘cures’ for an apparent imminent bout of overseas payment blues involved a more dramatic intervention than usual, and going the extra mile. Managing director Garry Chapman recalls: ‘I got a phone call from one of our consultants saying he’d seen this patient and learned he was going to be disappearing out of the country in two days.
‘We sprang into action. One of my team then spent the entire afternoon chasing an interpreter and phoning the patient’s hotel.
‘Eventually, on that Monday evening, I drove from the office to meet the patient by the River Thames in London. There I collected £7,000 in £50 notes – in exchange for an invoice and receipt.’
One of the biggest reasons for the company’s success has been through the development of its own software which can be quickly adapted to the way that the market changes. This includes coping with the fee shifting patterns in the private medical insurance market and so ensures doctors receive the correct reimbursement.

Customised service
Another key factor is that consultants are cared for by individual account managers and each one, whether in a group or as an individual independent practitioner, gets a customised service based on their particular needs.
This will be governed by the type of work they do – for instance, some consultants only do foreign embassy work while others will specialise in the most complex cases.
Some might only see self-pay patients. Due to the variable nature of each practice, the account manager provides services tailored to its needs. An example of this can be where the practice is self-pay only and all the money is collected in advance prior to treatment.
On average, MBC says it achieves bad debts of less than half of one per cent across all its clients. Mr Chapman says: ‘It is a statistic we are extremely proud of and we work very hard at maintaining year on year.’ He says they only charge on what they collect so that they share the same objectives as the practice.
When asked about other ailments, Mr Chapman explains:
‘Most private practices we go to see don’t bill correctly. That could be through lack of knowledge about how to use the codes or they may not know they can bill for a local anaesthetic, say, when they do a procedure.
‘It can also be a lack of understanding about how much to charge for a particular procedure, as the fee can differ by up to 100% for a particular CCSD code. We’ve had many people who didn’t realise that the price per insurance company could be so different.
‘We have increased their revenue by up to 25% in some documented case studies. The majority of clients that join us have a backlog.
We are typically very successful at collecting the majority of it.
‘Everybody’s different, but to give you an idea, I’ve had single practitioners coming to me with a backlog of £50,000, £150,000 and £400,000. The consultants quite often don’t know how much they have outstanding until something happens that focuses their attention on it and that makes them call us in when they realise they are in financial distress.’
On the day we met, he had just been dealing with a practice which was owed more than £300,000.
There is no such thing as an average, but bad debts can run between 5%-20% among many private practices and the roots of the trouble often go back years. They can get into difficulty at any time, from when they start in private practice or even 20 years later.

Varied symptoms
The ‘symptoms’ that force consultants to take stock of their finances and call for treatment are varied, but might include changing circumstances, such as mounting school fee bills, large tax bills or even a divorce.
As well as getting money back for clients – a huge amount of it by card payments which patients can do online 24/7 – the consultants’ account managers also get involved in many aspects of the practice when dealing with either insurers, hospitals and patients.
Ultimately, they all revolve around collecting the correct amount of money on behalf of the practice.
Account manager Lynne Glasson negotiates with insurers
about charges for complex sur-gery and liaises with both them
and patients to see fees are agreed
before treatment. She tells Independent Practitioner Today: ‘I’ve done a couple in the last week where the insurer was offering £5,000 but agreed to pay £8,000.
‘Another insurer was offering the consultant £3,000 but the consultant wanted to bill at £5,000. We settled at £4,250 and the consultant was happy with that.
‘As long as you can justify the complexities before the operation, then I find the insurers generally OK with the amount that you are asking for.’
Fellow ‘fixer’, account manager Sarah Barratt, estimates as much as 70% of her call time is taken up with patients compared to 20% with insurers and only 10% withdoctors and their secretaries.
There might be the worriedspouse of a patient who has died, someone who was unhappy with their treatment and does not want to pay, or someone who has run out of insurance benefit, or a patient complaining about the lack of cover under the insurance policy that they have.sp
General manager Garry Nials says: ‘A lot of consultants come to us for our general expertise in the market – what can they bill for, how much and, just as important, what they cannot bill for. Often we have found they have been charging too low; for instance, using one insurer’s schedule for all their patients, whereas it can differ from insurer to insurer. ‘With some of the backlogs, it makes one wonder how they made any money in the first place. So often they have done the work – and then just not followed it up.

  • 01494 763 999
  •   Medical Billing & Collection
         Connery House
         Repton Place
         Buckinghamshire HP7 9LP

More than Just a Billing Company