Lagging behind in your office work?

Simon BrignallUncategorized


Lagging behind in your office work?

If more doctors reviewed their incomes, it would show them it’s time to find new ways of running their private practice because their business efficiency is no longer what it was.

RUNNING A PRACTICE in private medicine even only a decade ago was relatively simple.

Of course, back then you would have found it difficult to find someone that would agree with that statement.

But now, when you look at the big changes that I’ve set out below, I think most consultants would agree.

Private medical insurers

Running a private practice in 2009 was mostly based around insured patients. People who had private medical insurance had peaked at 12.4% of the population.

Dealing with the insurance companies was a painless process; the invoicing was sent by post with no time limits being enforced.

Most of the insurers would pay fees that they would term customary and reasonable and there were some that did not even publish a fee schedule.

This meant that the practice could set its own fees and oversee its own pricing policy

Patients’ experience

More than 70% of insured patients had their policy as a benefit through their employer. This meant they were not preoccupied with costs, as their policy typically met all the costs.

The number of shortfalls or policy excesses they incurred were low. Consequently, dealing with patients was a relatively simple process, so the amount of interaction was at a low level.

Back then, self-pay patients did exist but the NHS was in a different place regarding waiting lists and the level of care patients received, so most people did not need to look outside it to get the treatment required.
Those who did so generally did not need to worry about private treatment costs.


All this meant the medical secretary or practice manager could find time to deal with the practice’s demands. There was no industry policing; they did not have to publish fees nor meet deadlines for billing, and the patients were not so demanding.

Our company Medical Billing and Collection (MBC) was established in 1992 and only had 50 clients in 16 years of being in business. Outsourcing the billing and collection was just not recognised as an adopted business model a decade ago.

What changed?

On 15 September 2008, Lehman brothers bank filed for bankruptcy and this set off a chain of events which has changed the face of private practice in the UK beyond recognition.

This event started with what many economists called the worst financial crisis since the Great Depression of the 1930s and it became known as the Global Financial Crisis.

All the highlighted points below would have had a significant impact on the practice on their own. But add them all together and you can see why the running of a private practice has dramatically changed.

Private medical insurers

The practice now has a multitude of different dynamics to deal with on the insurers’ front. A key area has been around the fees a practice can now charge.

The main changes are:

  • Reduced doctors’ fees across the board from the majority of insurers;
  • Reduced acceptance of using multiple codes, thereby limiting fees;
  • Fee-assured schedules enforced by many insurers;
  • A constant downward pressure on fees, continuing to this day.

On top of the fee reductions and multiple code changes, the majority of insurers require the practice to submit the invoices electronically and within a given time frame or they will reject the invoice totally and refuse to pay.


The Clinic Coding and Schedule Development Group (CCSD) fee schedule was introduced in 2006 and, since then, has become a major part of running a private practice. Each month, a list of changes is published which can include old codes being deleted, new codes added and combination rules changed.

This all needs to be kept on top of by the practice, particularly as each insurer can decide to accept the schedule in whole or in part, meaning that they can have their own rules – and that is frequently the case.


Self-pay The self-pay sector has increased dramatically, with growth starting slowly in 2010 and increasing exponentially over the past few years. There are many reasons for this, but the main ones are:

  • Long NHS waiting lists;
  • High premiums on medical insurance, making patients selfinsure;
  • Fixed-price packages making it easier to choose treatment at a competitive price;
  • People wanting choice for their treatment and choosing to use their disposable income.

The patient has also become much more demanding. Over the past ten years, the use of the internet has become widespread and the all-pervading presence of Dr Google means that everyone has become an expert.

Email use is now prevalent in everyday life, particularly with the advent of smartphones, and patients communicating this way want an immediate response. If they do not get a reply, they resend the email and that means more activity for the practice to deal with.

It seems everyone has a mobile or smartphone these days, meaning patients can call the practice anytime during the day. So interaction levels with the patient are at an unprecedented level


In 2014, the results of the Competition and Markets Authority investigation into the private healthcare market were published, resulting in a fundamental change to the way information must be made available.

This, combined with the introduction of the General Data Protection Registration (GDPR) rules regarding data protection around patient information, has added another layer of complexity for the practice to deal with.

If we accept running a private practice has become far more dif-ficult and complex over the years, then what is the answer?


The major points of difference which make running a private practice so difficult today when compared to a decade ago are highlighted below.

  • On average, the self-pay sector has become the largest source of revenue and activity in private practice when compared to individual private medical insurers and it continues to grow at a fast rate
  • Patient expectations are much higher and with the use of email/ internet, the patient can be in contact with the practice on a 24/7 basis creating unprecedented levels of activity
  • Increased compliance within the health sector with the publication of fees and medical competence via the Private Healthcare Information Network (PHIN)
  • Practice manager/medical secretary must deal with a multitude of administrative tasks and is expected to be an expert in everything – which is unrealistic
  • In 2008, the average invoice value we raised was £270.16
  • In 2018, the average invoice value we raised was £202.89

The last point means that, over this period, there is a staggering drop of 25% for carrying out the same treatment, while at the same time dealing with all the increased compliance, administration and levels of patient activity has greatly increased the running costs of the practice during the same period.

Outsourcing admin
If consultants want to address the issues that the practice is facing daily, then they need to decide how they can change things to enable the practice to work faster, smarter and be more efficient. One way is to outsource certain tasks currently done by the practice.

Areas a practice can consider include a transcription service where the dictation by the consultant is outsourced to a company who will transcribe the letters and send back for approval prior to sending them out.

Another area is to outsource the phone calls. As most practices have only one phone line, you can outsource the overflow calls to a designated organisation.

But the area which saves most time and money is the billing and collection.

” Using a specialist organisation means the consultant reduces the amount they must invest in both time and money in administration “

Medical billing and collection

The main option to consider for reducing the secretarial workload is outsourcing your medical billing and collection to a specialist organisation.

Otherwise billing and collection takes up an enormous amount of time and requires the secretary to liaise with the patient about both medical and financial matters, which, for most secretaries, is not ideal.

Many consultants feel their secretary will not like this, but from our experience, that is not true. While some secretaries are initially reluctant, once the transition has taken place, they would not want to revert, as it removes a huge burden from their shoulders.

Using a specialist organisation means the consultant reduces the amount they must invest in both time and money in administration.

They will also not have to spend valuable time learning and keeping abreast of the changes in the CCSD schedule. They can maximise time for their patients – and generate further income.

Consultants may be nervous about outsourcing their finances, but they need to balance that feeling against the benefits and the amount of time the secretary would save without needing to carry out the billing and collection tasks.

Outsourcing benefits include:

  • The relationship between the consultant and the patient is kept purely at the medical level, which ensures the relationship is not tainted in any way regarding the commercial aspects.
  • Expertise in both medical codes and the nuances of each insurer about how the codes should be used ensures the billing revenue is optimised.
  • Expertise in ensuring that all the relevant information is present and correct when raising the invoice means there are no delays in the insurer or the self-payer accepting the invoice.
  • Resources to ensure no delays in raising invoices so they can be chased in a timely manner and give you the best chance of minimising bad debts.
  • Resources combined with an efficient process in place for chasing unpaid invoices, following up on shortfalls and dealing promptly with any problems with claims. This results in vastly improved cash flow combined with bad debts being greatly reduced.
  • A variety of management and tax reports which can be tailored to the requirements of each practice.
  • Practice disruption, such as secretarial absence for sickness or holiday, does not affect the allimportant billing and payment collection, and continuity is assured.

Many consultants need to decide if any action is needed to ease the workload on their secretary.

Carrying out your own health audit will help you decide this.

  • How much time is spent in dealing with each aspect of the daily tasks
  • When was the last time your practice reviewed the codes it uses
  • When fee schedules were last reviewed
  • How much money you are owed and how old the debt is
  • Which patients owe you the most money and when they were last chased
  • Whether you are behind with administrative tasks such as billing, typing letters and responding to patient emails

The last point means that, over this period, there is a staggering drop of 25% for carrying out the same treatment, while at the same time dealing with all the increased compliance, administration and levels of patient activity has greatly increased the running costs of the practice during the same period

” Outsourcing should never be seen as a reflection on any secretary’s ability to manage the practice “

Health audit

Secretaries are extremely hard working and loyal to the practice they work for and outsourcing should never be seen as a reflection on any secretary’s ability to manage the practice.

It should be seen as simply another tool to assist in running the practice and at the same time freeing up valuable time to spend on the other important patient facing tasks.

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