Invoicing and collecting the money pose huge problems for many doctors building their practices and they are often owed many thousands of pounds before they ask for help. Findlay Fyfe presents an A-Z of billing to guide you to success
|A is for audit trail. Do you have a clear policy for communication and interaction with payment companies and patients to ensure you are tackling your practices invoices efficiently?|
|B is for benchmark. When taking on a new practice and typically yearly thereafter our experts at Medical Billing and Collection (MBC) will carry out a benchmark on the practice professional fees to show where there may be scope for review.|
|C is for the Clinical Coding and Schedule Development group (CCSD).Make sure your practice is up to date with new codes, unbundling and charging changes to codes. |
These are updated monthly.Failure to keep this updated could run the risk of your practice being deregistered by many private medical insurers.
|D is for Did Not Attend (DNA) or, more importantly, deciding what the practice should charge patients who do not turn up for the consultation.Additionally, you need to ensure that any potential charge is clearly detailed in the terms and conditions.|
|E is for embassies,If you chose to see embassy patients, be aware of the new lower pricing structures that embassies will now accept and understand that payment may take some time.This may mean you pay tax on the invoice before you have been paid.In addition, only see patients with a letter of guarantee (LOG), otherwise the embassy will not pay that invoice.|
|F is for fees and understanding what each private medical insurer will pay for each CCSD code. Payment rates will vary for each insurer and the differences can be as much as 100%.Ensure your practice is aware of what it can be charging to ensure you are maximising your revenue.|
|G is for the EU’s General Data Protection Regulation (GDPR).There are a lot of mixed messages regarding GDPR legislation and how to comply. Be clearm about what your requirement is as a practice and be sure any third party you work with is also compliant.|
|H is for HerMajesty ’s Revenue and Customs. Make sure that billing for the practice is auditable and organised so that figures can be easily generated for the tax returns.This will save time and give a sense of comfort should the taxman ever wish to come and inspect your practice; then the figures will be clear and easy to read.|
|I is for incorporated. Since the last round of income tax increases, a high proportion of consultants have gone from being self-employed to making their practice a limited company in order to be more tax-efficient.|
|J is for January, which is the best time to review the practice’s commercial side. Review any decisions that need to be taken on key commercial aspects such as fees, debts and internal procedures so they can be implemented before the start of the new tax year.|
|K is for knowledge. In private practice, it is important to have a keen commercial perspective. It is rare to find this among independent practitioners, so if it is not available, then outsourcing those key areas to obtain the required level of expertise should be seriously considered.|
|L is for limited liability partnerships (LLPs), which is an alternative to incorporation when forming a group of consultants who are going to work together and trade as one entity. |
Being bigger can have billing advantages – but bigger billing and collection problems if that part of the business is not functioning properly.
|M is for medical billing and collection. This should always be one of the main priorities within a practice. |
If the practice is too busy to correctly chase and address invoices, then it needs to consider outsourcing this vital area.
This should ensure that the bad debts are kept at less than 0.5% and that the codes are billed at the correct rate, leaving the practice to focus solely on the medical side.
|N is for new consultants entering private practice.With the reduced re-imbursement levels available to new consultants from insurers, it is doubly important that they ensure billing and collection is quick, accurate and efficient. |
When starting up in private practice, you should not be worried about any potential cash flow issues. But this becomes more prevalent as the practice and the overheads grow.
|O is for overseas patients and understanding that if the practice decides to see these patients, then they need to consider how to collect the money from them.|
Typically, the best way of operating is to get paid up front in advance of any treatment.
|P is for private med ical insurer. Ensure you are billing the correct fees to each insurer.Ensure that you renegotiate agreements when you can.|
|Q is for quote. Ensure when the practice charges outside of the private medical insurer fee schedule, or does complex work, that the patient is fully informed of all the costs so that they can liaise with their insurer to understand what it will cover and what the shortfall will be.You may need to supply supporting information to a private medical insurer.|
|R is for registration form.This should be part of any new patient process within the practice. It details all the patient demographics, including mobile number and email address as well as their insurance policy details.It should also have disclaimers if you are using a third-party company or wish to contact patients after treatment in a marketing campaign. Stay on the right side of the GDPR legislation.|
|S is for self-pay. This is the fastest-growing sector and has risen to a third of my company’s billing totals over the past few years. Now it is typically the largest or second largest part of most practices.It is important to set the fees at the right level to ensure both a good market share but also to ensure the best rates are paid.|
|T is for terms and conditions.Make sure your practice’s costs are transparent and that the patient is made aware of all known costs and potential liabilities. Should this be on the back of your registration form?|
|U is for undercharging, which – unfortunately from our experience – is happening in most practices.This occurs for a number of reasons and typically has been going on for a number of years. We find it is usually due to a lack of knowledge or understanding of the commercial market and how the insurers calculate their fee schedules.|
|V is for voicemail. Any practice where phone calls go to voicemail rather than get answered by practice staff could result in a loss of patients, which could result in loss of revenue. If this happens a lot, then the practice should consider having an ‘overflow service’, where any calls coming into the practice that do that get answered are passed to an external source where they are always answered.|
|W is for website. To take full advantage of the growing self-pay sector, every consultant should have a website. To ensure ongoing traffic, keep it relevant and keep it up to date.|
|X is for Xmas, when I reckon all consultants should take a well-earned break from private practice, if possible. It is the only time of the year when even the patients do not want to be seen unless it’s absolutely necessary.And it’s a time to recharge the batteries and look forward to the New Year.|
|Y is for you. And you need to take a business view along with your clinical view.This is where a third-party company can help add value to your practice and, of course, to make sure that the billing and collection side of your business is tied down and firmly under control.|
|Z is for Zzzzzzzzz. Sleep easy.This is the sound that the independent practitioner makes while lying back sleeping soundly knowing that the practice’s billing and collection is under control, there is no bad debt and the tax aspects of the business are under control.|