As part of Medical Billing & Collection’s celebration of 30 years in the sector, Simon Brignall continues to highlight 30 key areas practices need to master to overcome the challenges to collect their money. Here are his next ten
The importance of infrastructure
11Start with a solid foundation
I often meet with consultants working in private practice who operate their billing process manually or on a mixture of a word processing, diary and spreadsheet platform.
Even when they use practice management software programmes, if they are not cloud-based, these are often run on laptops or PCs which are not backed up.
This is far from ideal from a business recovery perspective, because if the device is lost, the software becomes corrupt, the hardware fails and then the consultant’s record-keeping and finances are put at risk, with all that this entails.
When commencing private practice, one of the first things consultants should do is to ensure they have the appropriate infrastructure.
A vital element of this would involve having a robust auditable system to facilitate the financial processes of the practice.
This should include the ability to:
Raise invoices and take 24/7 payments;
Employ a robust chase process, including the ability to follow up on outstanding invoices using a range of communication methods.
If you are already in private practice, but currently do not have the appropriate infrastructure in place, then I recommend you put it at the top of your list of action points.
At Medical Billing & Collection, we use our own proprietary software, ensuring that even practices we partner with who rely on manual systems now have the infrastructure and functionality of a modern practice.
12 Have an audit trail
Whatever system you adopt, you need to ensure the billing for the practice is auditable and accurate so that figures can be easily generated for your accountant.
This will save time and give a sense of comfort should the taxman ever wish to inspect your practice, as these figures will be clear and easy to read.
It is worth noting that Her Majesty’s Revenue and Customs (HMRC) has often targeted the medical sector, as it has had a poor reputation for record-keeping.
There are not many of you who will be unaware of General Data Protection Regula-tions (GDPR) or have not had some form of GDPR training.
It is important to ensure your practice and any software you use conforms to these regulations.
14Know the state of play
Easy access to accurate and up-to-date practice data that can be reviewed using a range of parameters is vitally important.
This is because it is the first link in the chain for many key activities, such as the chasing of outstanding invoices or to allow you to conduct a practice review.
If you do not have access to this key data, then you are unable to make any progress in revenue management or make informed decisions about your practice.
Importance of being seen
15Ensure you stand out
It is important to review your presence online and ensure that whatever you find puts you in the best light.
Even if you do not have a website, you will find you are probably on multiple sites which may include the hospitals where you work and your Bupa profile.
Make sure the information displayed is up to date and ensure you have a professional profile picture. Many studies show patients are more likely to engage when there is a picture of a person they can relate to.
Where possible, and this especially includes on your website, remember your audience is prospective patients, not your colleagues. Tailor your messaging to your patients’ needs rather than as an attempt to impress your colleagues by detailing your CV or a list of your accomplishments.
Cracking the code of insurance billing
Once a consultant has decided on their pricing policy, they need to ensure they keep abreast of all the changes to the Clinical Coding Schedule and Development group (CCSD) codes applicable to their specialty. There are more than 2,000 procedure codes alongside diagnostic codes to choose from.
Changes to the coding schedules are implemented monthly. There can be replacement codes, new codes, changes to descriptions and the ability to bill multiple codes together.
All of this can also impact on what can be charged to each insurer. Lack of knowledge in this area can often lead to undercharging for procedures or billing problems with the private medical insurers (PMIs) that can delay payment.
Continuing to incorrectly invoice insurers can result in punitive action in extreme cases.
17Pricing is key
Each PMI can choose to adopt the CCSD schedule in full, in part or choose to use its own coding when necessary. Each has its own fee schedule for each code, and these are also subject to change.
So it is important to keep abreast of the latest fee schedule to ensure you optimise your income as well as to ensure you are not invoicing incorrectly. Persistent billing problems can cause delays in payments and, in extreme cases, derecognition by the insurer.
18Formula for success
If this was not enough, you need to understand the various formulas that can be applied for each insurer, dependent upon the number of codes used.
Here are some examples for the billing of multiple codes:
Example 1. PMI formula – If three codes are used, you multiply the price of the first code by 40% and add that figure to the price of the first code.
If two codes are used, then multiply the price of the first code by 25% and then add that to the first code.
Example 2. PMI formula – If three codes are used, you take the first code price and add 50% of the second code price and then add 25% of the third code price.
Example 3. As in example two, but you cannot charge for the third code.
You also need to understand what codes can be billed together, which is often referred to as the bundling and unbundling rules.
19Rules of the game
In conjunction with all the above, there are many PMI-specific rules you need to know to bill correctly.
These include, but are not limited to, the following:
One PMI will not allow a follow-up consultation or inpatient care to be billed within ten days of surgery, as they determine that the CCSD price includes the post-op element of care.
Another PMI will allow follow-up consultations to be billed without any time limits, but the number of inpatient care days which is included within the CCSD code can differ, depending upon the specific CCSD code performed in surgery.
All other PMIs will allow inpatient care to be billed without any of the above restrictions.
A PMI will only allow certain codes to be billed in conjunction with a follow-up consultation.
Time to present the bill
20Speed and accuracy
As the invoice is the first step in the revenue cycle process, it is important for a practice to raise its invoices promptly.
Delays in invoicing not only reflect badly on the practice, which can negatively impact the patients view of their treatment, but it also means the practice’s cash flow suffers. Remember that the longer the delay in raising an invoice, the greater the risk it results in a bad debt.
Some insurance companies now have strict time limits – typically six months – in which they need to receive an invoice otherwise they will not pay.
Another advantage of invoicing promptly is that any problems are highlighted earlier, which can often improve your chances of these being resolved.
As a good rule of thumb, the practice should set the goal of billing within 24 hours of any treatment carried out. This will ensure good cash flow and minimise bad debts.
Billing requires accuracy as well as speed. It is important there is a checking process to make sure the invoice is accurate and contains all the relevant information before it is sent to the relevant payment company or patient.
Mistakes made on invoices make the practice look unprofessional and can also lead to losses in income and impact cash flow.
Simon Brignall (right) is director of business development at Medical Billing & Collection, which is celebrating 30 years of partnering with consultants in private practice