The art of the Chase

Simon BrignallUncategorizedLeave a Comment


The art of the Chase

Having a stopstart approach to billing and collection generally proves ineffective. Findlay Fyfe says it is picking up the phone and creating momentum in chasing invoices that gets results

With costs continuing to rise –think medical indemnity – and private fees generally under continuing pressure, few practices have the luxury of being able to let invoices go unpaid for any great length of time before the painful consequence is felt.

So it is essential that any private practice has robust procedures in place with respect to raising invoices and ensuring that they are systematically chased. Discipline and routine are key ingredients to achieving this.

Failure to chase debts could mean that you are working for free or have issues both around cash flow as well with HM Revenue and Customs. Remember– tax is due on invoices being raised and sent, not on money being received.

In light of this, I have a quick question. How soon does your practice manage to process and send invoices after treatment? Is it hours, days, weeks or even months in some cases?
Ideally, your practice will be sending out the invoice the same day as treatment or the day after;certainly within 24 hours.Remember, the quicker the invoice is raised, the better the chance it will be paid in a timely fashion.

Struggle with billing

Even if you are big enough to have an accounts department,unless you have fit-for-purpose software and long-serving staff who are familiar with the practice’s systems (see our earlier Independent Practitioner Today article on Key Person Dependency,November 2016, page 21), you can easily struggle with the billing and collection process.

Increasingly, private medical insurers only take invoices by electronic data interchange (EDI),such as Health code or Bupa online; Vitality being the late stone to adopt this approach exclusively.

The process of submission for each insurer needs to be understood as well as its individual pricing and coding rules.

If data is entered incorrectly,which includes patient details,this electronic process generates error messages that need to be actioned. Another key ingredient therefore to any collection process is actioning problems and quickly. It is all too easy in a busy practice to set aside billing and collection issues.

We continue to be surprised how practices fail to prioritise getting paid for work carried out. Don’t get me wrong: some do, but still many do not.

Dipping in and out

Dipping in and out of this vital part of any practice just does not work. For embassy and medicolegal work, you might only need to chase every few months, knowing payments will take longer.

However, with self-pay and private medical insurance work constituting the backbone to most private practices in the UK, payments should be made within weeks and, at the most, a month or two of treatment. If not, you should be asking why

Picking up the phone and calling a patient or the payer is a fundamental part of the process to getting your bills paid.

If nothing else, it ensures the invoice has been received and allows any queries to be raised early on.

With private medical insurance policies, there are increasing amounts of co-payments as well as the standard excesses, which are often discovered by the practice only once the private medical insurance remittance advice and/ or payment has been received.

Again, the sooner the patient is made aware a payment is due for their treatment, the better.

Lack of resources

The problem is many practices do not have the resources or spare time to do this. As a result, practices are having to wait much longer than they should to get paid and, in extreme cases, have to write off money because they have either fallen foul of private medical insurance rules – six months in some cases – or simply given up on chasing money owed.

Email and the post are not nearly as effective as the phone. Key to this, as mentioned earlier, is momentum – which means sending invoices and making phone calls, multiple times if needs be, to get a response and, in effect, get paid.

Now, I understand that the first priority for the consultant or GP is the care of the patient and this should always be the case.

But unless the practice takes a long hard look at the way it functions in terms of the billing and collection process, it may not survive in private practice to treat the patients.
Often the secretary, who will be responsible for sending the invoice and chasing it up through to collection, will have many other things to do throughout the day, such as dealing with patients,writing letters, answering email sand/or the phone, being an agony aunt or marketing


The focus of every practice must be on:

  • Making sure that invoices are raised and sent quickly
  • Ensuring that every procedure is billed correctly
  • Routinely chase invoices in a disciplined fashion
  • Monitor and respond to EDI error messages
  • Reconciling remittances against invoices
  • Chasing any excesses or shortfalls/balance payments
  • Making phone calls rather than just using email or post


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

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