Let the experts fit the bill

Outsourcing private practice medical billing and collection is increasingly the simplest and most effective route for consultants in private practice. Simon Brignall examines the reasons why

When most people need a specific service, they seek experts to help – just like a patient with a knee problem searches for a knee surgeon with years of experience to ensure they get the best care. Consultants in private practice should be the first to appreciate that a similar rule applies to their business. The medical billing side of private practice can prove challenging to new and established practices. Even for the most successful, a full review of their finances often brings to light issues that need sorting.

Outsourcing this vital function is increasingly common. With over 30 years in the sector, Civica Medical Billing and Collection has been well positioned to see this growing trend and the changes in the sector. We now partner with over 1,800 consultants, groups, clinics and hospitals across the UK.

New consultants especially favour outsourcing because it allows them to focus on growing their practice rather than having to worry about administrative issues. Practices of all specialties and sizes find benefits.

Free to focus on the patient

The most important, and generally overlooked, benefit from outsourcing is that it frees your medical secretary to focus on the patient’s clinical journey without having to worry about the business side of the practice. Outsourcing allows this key relationship with the patient to be warm and convivial, leaving the billing company to focus on the financial side of the practice and those difficult discussions about money.

This provides many benefits to the practice such as:

• Improves the patient experience
• Engenders better patient reviews
• Frees the secretary to be able to respond to new patient inquiries.

All of this translates to a valuable increase in practice revenue. Expertise is key Consultants spend years in education and training to become experts in their specialty, but when they start out in private practice, they find running a business often presents challenges they are unprepared for. Even busy practices running for many years can still find this difficult. Procedures are often not as robust as they should be or, even more importantly, are seldom routinely followed.

I still come across consultants who do their own billing. It is not a valuable use of their time or experience. I would argue that if you are going to spend time billing, then it is surely better to spend those hours more productively by focusing on seeing patients and leaving the billing to experts.

Most billing companies’ fees are calculated against received income, so their business model means they are incentivised to ensure they always bill the optimal amount on your behalf and that these invoices are settled as soon as possible.

Improved cash flow and reduced bad debts

One of the main reasons practices contact us is that they are facing problems with their cash flow arising from their outstanding debt.

These challenges can be the result of a variety of reasons, including:

• Invoicing delays
• Problems with payment reconciliation
• Lack of a robust chase process
• Poor practice financial data
• Lack of visibility
• Limited patient payment options.

We often meet with practices where they have been writing off 5% in bad debts every year and sometimes this can be as much as 10% if they have found it hard to stay on top of things. Our robust procedures manage these issues and can often provide a range of payment pathways that better meet consultants’ needs. Our bad debt level is under 0.5% across our clients.

Medical billing is complex

Medical billing is complex and requires experience and training. Some countries require a medical billing qualification to carry out this task.

There are over 2,000 Clinical Coding and Schedule Development (CCSD) procedure codes as well as diagnostic codes to choose from and each insurance company has its own price list and rules about how these codes can be billed. There are even formulas that are applied when billing multiple codes, and these can vary between insurance companies.

The CCSD schedule is updated monthly, so keeping on top of it can be challenging. Failure to do so can mean the practice loses income or, worse, results in issues with the insurers from incorrect billing that can lead to derecognition if not adequately addressed. We still see practices losing out on income due to billing errors.

Chasing outstanding debt requires a specific skill set which not every medical secretary has, and this is often the reason invoices are not pursued.

Functionality for a modern practice

Outsourcing can be the easiest way for practices to offer a range of new functionality to meet modern patients’ needs. These new payment pathways not only improve the patient journey but improve practice finances.

Our clients are offered:

• E-billing of private medical insurers and patients
• 24/7 payment collection
• Text message chasing
• Invoicing and collection of self-pay patients in advance
• Same-day invoicing and collection via our Client Self-pay Module
• Settlement of multiple outstanding invoices with one payment
• Payments links for your website.

Staffing problems

Staffing issues can be one of the most challenging things to manage in a private practice. Many inquiries we receive are from consultants who are finding billing difficult to manage due to a secretary’s retirement or absence.

Outsourcing often provides a simple yet effective solution and benefits doctors’ practices where binary decisions about staffing are needed due to fluctuations in patient activity or group size. It means consultants always have the capacity of the billing company available to meet specific needs.

Lack of visibility

Consultants commonly complain they do not have easy access to upto-date accurate financial data about their practice. Yet all practices rely on this information as the first step in the chase process. Difficulties getting this data also means consultants are unable to make informed decisions about their practice.

Our clients can access a full array of reporting tools to review their practice data via our software. They can get their information 24/7 and see reports detailing the amount invoiced, payments received, patient activity and aged debt. These can be viewed based on a range of criteria as well as at a summary or granular level.

Consultants’ concerns

Most billing companies work on a cost structure calculated against received income not on what you invoice. It is always good business practice to have a cost structure correlated to money received, as both the pandemic and recent spike in inflation has highlighted. I have examined why outsourcing has proved to be a popular choice for many practices, but it is only fair to discuss some of the concerns consultants raise.

Some comes from a perception that the practice is giving up control, and I fully appreciate that worry. It is best addressed through transparency. You should know what the billing company is doing for you. And that’s where access to practice data is key because this allows you to review a company’s performance and establish trust to allow the partnership to flourish.

Other consultants worry about upsetting their secretary. Often that is more in the mind of the doctor than in that of their PA. I have found the billing, and especially the chasing side of private practice, is not something medical secretaries enjoy. That’s why they are often happy to relinquish responsibility for this task. It is important to make sure you know how the billing company operates, its workflow and who will be responsible for your practice. This ensures a smooth transition.

A strong foundation is the base of any partnership and our onboarding process, called ‘intensive care’, is managed by a senior personal account manager to establishes a good working relationship with doctors’ teams to ensure this this happens. Outsourcing is a well-established and growing trend. If you feel it might benefit you, then do contact a medical billing and collection company.

This article was originally produced for Independent Practitioner Today.