Trends in the private market
Independent Practitioner Today asked medical billing expert Gary Nials (right) what notable trends he had seen in 2016 and how he thought these would play a role in the year ahead
The self-pay market has seen a general and notable increase in terms of volume and pricing, and there seems nothing to indicate this trend will stop in the near future.
This has especially been the case in London, which continues to be an attractive destination for both workers and tourists alike, with plenty of UK and international patients willing to pay for convenience and quality.
An increase in the self-pay market has also come about through more varied private medical insurance (PMI) policies.
This can be through co-sharing policies, different excess charges or through shortfalls.
From the billing and collection perspective, this means money needs collecting from a patient, and, at times, an unsuspecting patient. So being able to cater for this in your practice is more important than ever to ensure you maintain steady cash flow owing.
PRIVATE MEDICAL INSURANCE
Most private practices will rely on private medical insurance work to form the basis of the business.
This is the case throughout the UK and shows no sign of slowing, although it has been changing.
Change has mainly been seen in the different levels of cover and different types of policies which, as touched on above, has mainly led to more co-payments with patients.
The difficulty with this is patients are not always aware of the charges they will be liable for, even though they are ‘insured’, and often it is left to the practice to have to break this news to the patient.
This is rarely a pleasant experience. However, the sooner this discussion is had, the better and ideally moved on to the patient/ insurer to discuss/argue over rather than the patient/practice, which should always be more medically focused – especially for insurance work.
Embassies continue to be busy, in London especially, despite increasing competition from other major UK cities such as Manchester as well as other countries such as Germany.
Perhaps of significant note is the way embassies in London have increased the reviewing of consultant fees.
In the past, a Letter of Guarantee was just that: a letter that guaranteed payment – with few questions asked. But in the past 12 months, we have seen a more pro-active approach by some embassies, much like the large private insurers such as Bupa and Axa PPP, to be more concerned with consultants’ fees.
In many ways, this could be seen as a sign of the times, with the oil price hurting a lot of the rich Arab states, who have long been providers of much of the embassy-backed medical tourism into London.
Regardless of the reason, this is something consultants need to be aware of looking ahead, with more transparency of fees being an increasing requirement of doing work with certain embassies.
This continues to be an important part of private practice work across the UK – especially for the more experienced practitioners.
Terms of business continue to be an important part of doing medico-legal work. Payment terms range from 28 or 30 days to payment only on settlement of the case and everything in between.
This increases the need for practitioners to be aware of their terms of business with clients and to have a robust system in place to deal with these variances.
Otherwise, your accounts might look good on paper, but as you enter the New Year and the tax year-end looms, your accountant might start asking awkward questions – and even the taxman too.
In fact, each area of private practice carries with it its own unique problems when it comes to billing and collection. Often a busy practice will ignore such issues as long as the bills are still getting paid.
So be aware that – as with any business – strong cash flow is key, and any good accountant worth his or her money will tell you just that.
Perhaps a New Year’s resolution, looking ahead, could be to review your billing and collection process and make sure it is in good working order.
That might mean putting a more robust process in place to ensure timely collection, which might even require more staffing. Or you could always consider outsourcing to a billing and collection company.
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