A week in the life of a bill chaser
With increasing numbers of private doctors seeking help to recover fees and prevent future shortfalls, Independent Practitioner Today asked Simon Brignall to keep a diary about the variety of issues he deals with for consultant clients
An early start to the week and the familiar sight of traffic congestion on the M25, but I still make my 8am appointment.
I am meeting with a cardiologist who has a common billing problem. He has been referred by a colleague who uses us.
He explains that since his practice secretary retired a few years back, he has had a series of secretaries and is concerned that the billing and chasing has gone awry. His last secretary was often off sick before finally resigning.
The final straw was when his new secretary realised the billing had not been raised for several months.
It is obvious the lack of continuity has cost the practice. Most importantly, I let him know that we can help. He is clearly relieved and asks me to meet his new secretary to discuss how she will be sending us the data for the unraised billing and the outstanding invoices.
I leave at 9.30am with all the paperwork signed, so we can get to work as soon as possible.
Back at our office late morning, I a hand-over meeting with the account manager who will be taking the practice through our ‘Intensive Care’ process.
It is important that I detail all the issues raised at the meeting so procedures can be put in place to address them.
As we are close to the deadlines to submit invoicing with some of the insurers, the practice needs to ensure that this data is prioritised so that the consultant does not lose out on this income.
Today I am presenting to a group of urologists who have been given a recommendation about our services by another group we partner with.
Groups have all the same issues that we see with individual consultants, but they are often amplified due to the amount of work.
The requirement to manage different pricing schedules for eachprovider and the various payment arrangements at the locations they work at means that things can get out of hand very quickly.
I take the time to establish the structure of the group, and how they currently operate, so that I can tailor my presentation to show the most effective way we could work with them.
The group currently has seven consultants and expects to grow to ten over the next few months. This means they will soon outgrow their current administration arrangements.
The fact we only charge a fee against what we collect – so our costs are cor related against received income – is well received.
The group’s lead consultant informs me that the binary nature of decisions around staffing have been difficult, as the group has expanded. They will let me know their decision by the end of the week and I am hopeful.
I am in London all day today and my first meeting is at 8.30am with an ENT surgeon who called me last week.
The consultant explains that his wife has been doing his billing for 15 years but has finally had enough.
She is finding it very difficult to keep abreast of all the changes taking place: from updates to private medical insurance fees for procedures to the requirement by some insurers to raise invoices electronically.
The raising and chasing of invoices in relation to shortfalls is definitely not something she relishes.
The often-touted complaint that patients would not do this in a restaurant or hotel is aired. If I had £10 for every time I heard this complaint, I would be a wealthy man!
I explain how we operate and that our service is tailored to the needs of the individual consultant. He decides to start using our services straight away.
I think his wife will be very happy to pass this responsibility to us. It’s been a good start to the week with two new consultants joining us.
My remaining meetings today are with existing clients. I have a review meeting with a physician whose practice is ready to come out of our intensive care process.
When she joined, she had concerns about how easy it would be get information to us from her practice management system and there was also more than £75k in aged debt that had been steadily increasing.
The meeting went well, as she confirmed that her secretary was finding the transfer of the detailed clinic list surprisingly easy and I was able to update her that we had managed to collect 87% of her bad debt at this early stage.
I head off in a positive mood. My next meeting was with of one of our surgeons who has a large successful practice. This is an unexpectedly long meeting, as his next patient had cancelled and now he wants to go into the fine detail of the practice.
I had brought a couple of reports with me, but we ended up accessing his data using his log-on to our reporting tool to obtain additional reporting.
We looked at the frequency and value of his most common procedures with self-pay patients, as he wanted to review his fees.
He mentions that he felt that his GP referrals had declined and so I show him a year-on-year comparison of his referrals.
We found that one GP had dropped off quite considerably and he indicated that he would call them to check to see if there had been any issues.
It is very important to monitor and maintain these important drivers of a private practice and I know he will address this.
We review his self-pay pricing and he asks for the agreed fee increases to start from the beginning of next month.
Tonight, I am presenting at an event at the King’s Fund in London called ‘How to improve your private practice’.
There are a range of presenters covering all aspects of running a private practice including billing and collection, marketing, social media, website design, software, accounts and tax planning.
There is a Q&A session at the end and I find myself being called on to answer many questions around billing, such as ‘how far we can go back when chasing outstanding invoices?’ to ‘can we collect money up front?’.
I let them know we can legally go back six years and collecting money up front is something we do and is very common with consultants who manage foreign selfpay patients.
The range of people at the event was a good mix of established consultants, clinic practice managers and new consultants and I find the evening to be productive with some promising leads.
I have a train to catch to Liverpool to a meeting with an ophthalmologist. When I spoke to him initially, it was clear his problem was a backlog of outstanding invoices.
In our meeting, the consultant elaborated that he was embarrassed to say he was owed at least £150k. I assured him that we have consultants come to us with even higher amounts.
In fact, we have had individual consultants who are owed as much as £400k and some clinics have had amounts close to a £1m.
I explained how we could help him collect his backlog and also how we could work with him moving forward. He is particularly impressed with the fact that we only charge on what we collect and not what we invoice.
I add that, as we share common goals, this means this problem will become a thing of the past. He was happy to proceed and so completed our induction forms there and then.
I head back to Liverpool Lime Street Station in time to make my train back to London. Good news as I am checking my emails on the train; there is one from the group that I presented to on Monday, which says they wish to go ahead. I agree a meeting next week to finalise the paperwork
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