The money chase

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How outsourcing can fit your bills

A big difficulty for many new and established consultants in private practice are billing and collection issues – whether they work as an individual or a group. Findlay Fyfe examines the scale of the problem

Consultants entering private practice quite often start on their own, so have a steep learning curve when setting up and running the business on top of NHS responsibilities.
Doctors’ check-list includes:

  • Deciding whether to engage a medical secretary. Due to start-up costs, consultants often begin by carrying out
  • Finding a location to practice;
  • Arranging medical indemnity or insurance;
  • Registering with private medical insurance companies and hospitals;
  • Marketing themselves to find their first patients

Once this is all sorted, you have to decide what you are going to charge.

Now this might seem quite straightforward, but many doctors quickly find there are more issues to consider than hey initially realised.

For example, do you want to simply match a colleague’s fees, which is an obvious option, or differentiate yourself at the start, based on factors around your experience, location and specialty?

Avoid undercharging

What you do not want to find out later is that you have been undercharging, or worse still, not charging at all for work carried out.

A mistake we found in the past was a consultant’s secretary had charged all insurers at one insurer’s rates, not realising different insurers will accept different fees for similar work and procedures.

In some cases, there was up to a 100% differential, costing the practice tens of thousands of pounds over several years. Another common mistake we find is the incorrect billing of multiple procedure codes because each insurer has their own specific rules about how the invoice total is derived. If these are misunderstood, you could be missing out or billing incorrectly – and that can cause you problems with the insurers.

Online portals

Increasingly, private medical insurance companies are wanting billing information sent through online portals, so either you or your secretary need to understand how to do this and set aside time to manage this process

This method is known as electronic data interchange (EDI) and there are many reasons why you get EDI failures, such as incorrect information.

These EDI failures need to be managed. You might be surprised how many patients give wrong details. A common mistake is wrong insurance membership details or not realising their policy has expired.

We have also had many practices where these EDI errors were ignored – which means the insurance company never received the invoice.

There is also an increasing amount of excesses and co-share policies built into medical insurance cover, meaning that even if patients are insured and payments – known as a benefit – are made, there will still often be invoices which need to be sent to the patient and chased.

This requires robust procedures to be in place and is generally something that gets put off when a practice is busy.

Quite often, the patient is not aware of their liability and it is extremely common for us to find that shortfalls make up a large proportion of a practice’s aged debt and can go back years.

Of course, you may decide to do embassy and/or medico-legal work. But these invoices tend to be paid much later than insured and self-pay invoices and that will require your secretary to diarise to follow-up on these.

Once payments are made, they need to be reconciled against invoices – especially if a payment is made for multiple invoices.

Multiple locations

I suspect you have gathered that this is plenty of work for consultants working in one location and with one secretary to oversee, outside the day-to-day managing of the most important person in all this: the patient.

However, if you decide to work at multiple locations, if your secretary is not engaged exclusively by you, you could have multiple secretaries, meaning multiple versions of the above process to be managed or data coming from various systems.

It is also important to remember that, come your tax year-end, you will need to amalgamate all your invoicing and collection information into one.

If one of your secretaries is better at the billing and collection than another, that can make doing your accounts – well, let’s just say – time-consuming

Group practices

Group practices are becoming increasingly common and for many good reasons. These include specialty coverage, holiday coverage, economies of scale and basic strength in numbers.

They come in all shapes and sizes. In virtual groups, consultants still act as independent practices and the group may have a website to channel patient flow to more organised structures such as a chambers or limited liability partnerships, with the cost of administration and marketing being shared by the group members.

But with no obvious group format, groups can fail to evolve due to variations in opinion as well as different expectations and perceptions of what each party is ‘bringing to the table’ from the start.

If in a group, you will still have many of the same issues of being on your own to contest with. The added dynamic will be the increase in volume of business, so you will need to be keeping a closer eye on your billing and collection – what might be monthly becomes weekly or even daily.

There will also be the need to distribute money to each consultant based around the format the group has decided. It is normal practice to have one of the consultants to be responsible for either doing this or making sure it is done.

Like any business, groups can expand or contract depending on circumstances. Decisions around administration can result in binary decisions about staffing which can impact the fixed costs of the group, especially when you factor in the risks of key person dependency

Whoever is undertaking this task will need to manage each consultant’s insurance provider numbers and their various pricing structures and billing rules.

Clinics and hospitals

With clinics and hospitals, you will more likely have account departments who manage the billing and collection, but, in our experience, the same problems exist.

There is the additional concern of staff turnover and continuity planning, holiday and sickness and, again, general key person dependency problems.

There is also the issue in areas of high property value around the opportunity cost, in that the space
dedicated to this function could be better employed as a revenue generating area for the clinic.

Outsourcing option

Outsourcing this key billing function can provide a solution to these problems, providing on-tap capacity to allow consultants to grow and evolve their private practice with a simple cost structure that is based on received income.

At MBC, we specialise in managing the billing and collection side of private practice – becoming a seamless extension of the practice. Increasingly, practices are realising the benefits of separating the medical from the financial side – leaving them free to concentrate on treating the patient and keeping discussions on a purely medical basis.

Many secretaries either find they struggle to find the time to do the billing and especially the chasing of invoices or, like the consultant, do not like mixing the medical with the financial side as well as having the awkward discussions if invoices are disputed.

If you are interested in learning more, email us at for a free consultation.



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

More than Just a Billing Company


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