Charges against doctors

The new financial year is coming and there are important billing issues to address for many practices. In the first of two articles, Garry Chapman sets out the key areas to put right

3d render illustration big piles of paperIt looks like the year ahead is going to be another one of change for all independent practitioners across the entire spectrum of the market.

Taking this into account, it is the perfect time to take stock of the way that the medical billing and collection process works within the practice.

I have highlighted what I consider to be the main billing issues to address with five covered in this article and the remainder in next month’s issue of Independent Practitioner Today.


There are still a lot of consultants working in private practice who operate their billing process either manually or on a word processing and spreadsheet platform.

To make matters worse, these software programmes are typically being run on laptops, notebooks or PCs that are never backed-up.

This means that if the device is either lost or the software becomes corrupt, then the finances of the consultant are put at risk from both a monetary and tax perspective.

One of the first issues that a consultant should address is to ensure that they set up the running of their private practice on a sound basis with the correct infrastructure.

This would involve having a robust auditable system in place to facilitate the financial elements of the practice, including the ability to raise invoices, reconcile payments and the facility to chase the outstanding invoices in an efficient way by phone and letter.

There should also be a system in place to collect payments from self-pay patients. The best system would involve having the ability to collect money by a debit or credit card, which means that the practice would have to operate a credit card pin and chip system.

Terms and conditions

Another area which is very rarely addressed correctly within a private practice is to have the terms and conditions written down and presented to the patient prior to any treatment taking place.

This would typically take place in a patient registration form and cover areas such as pricing, shortfalls and any payment terms applicable, including where the consultation is not attended.

It is important for the consultant not to forget that although they are treating the patient medically in the same way as they do in the NHS, the key difference is that it is being done privately and therefore the patient should be liable for any costs irrespective of what insurance policy they hold. If the terms and conditions are clear, then it helps both the practice and the patient.


This is an area which we find to be the one that gives most consultants the biggest headache.

The reason for this is that it is a very difficult area both within the insurance market as well as the self-pay sector.

The consultant has to decide if they are going to adhere to each price schedule of the insurance firm. All insurers have their own specific prices for each CCSD code and these can differ by up to 100%.

On top of this, they have to decide what rate they are going to charge for their consultation fees. In some cases, the contract the consultant has signed with the insurer will dictate what they can charge for both the CCSD codes and the consultation fees.

Where the contract does not do so, they need to decide what to charge, and this also includes the self-pay sector for both consultations and CCSD codes.

If the consultant gets this wrong, it can lead to being incorrectly priced within the market and therefore a loss of patients because the pricing is too high or to the loss of thousands of pounds due to the pricing being too low.

Our experience is that consultants typically do not charge correctly. This is because they have either not done enough research when setting the pricing in the first place or they have not reviewed the pricing on a regular basis.


Once the consultant has decided on the pricing policy for the practice, they will need to make sure they keep abreast of all the CCSD changes for the codes that they use within their own specialty.

These changes can occur on a monthly basis. New ones to get to grips with can either be replacement codes, brand new ones or a change of description involving the use of multiple codes billed together.

All of the above can also have an impact on what can be charged dependent upon each insurer. In our experience, ignorance in this area can often lead to under-charging for procedures carried out within the practice.


Once all of the above has been addressed, then the practice needs to raise the invoices promptly. Unfortunately, in our experience, it is not uncommon for the practice to be many weeks behind in raising invoices.

This is typically due to the pressure of other work within the practice or where the consultant has not got around to doing it themselves.

Well, this really should be classified as a criminal offence, as it actually puts the practice at risk particularly from a cash flow perspective. The longer time left before the invoice is raised also increases the risk of having bad debts.

Garry Chapman newThe practice should set the goal of billing within 24 hours of any treatment carried out, which will ensure good cash flow and help minimise bad debts.

  • Next month: In my next article, I will cover the remaining five billing issues to address. In the meantime, you can either start on addressing the billing issues highlighted above within your practice or you can contact a professional medical billing and collection company to assist you in solving these issues.

Garry Chapman (right) is managing director at Medical Billing and Collection