Simon Brignall, Head of Sales and Accounts at Civica Medical Billing and Collection, discusses how following medical billing best practice will increase practice revenue, optimise cash flow and improve the patient experience.

For independent healthcare providers, medical billing is much more than an administrative task, it is a critical part of the patient journey and the financial resilience of your practice. Yet it is also becoming increasingly challenging. Medical billing is complex as each private medical insurance (PMI) company has its own coding rules and fee schedules.  Self-pay patients require modern payment pathways and chasing payment can quickly absorb valuable clinical and administrative time.

Good billing practice should aim to achieve the following objectives:

  • Make payment straightforward for patients and payors
  • Optimise revenue
  • Improve cashflow and minimise bad debts
  • Provide transparency and control over practice finances

 The following principles provide a practical framework for doing both.

Capture accurate information at the outset

Many payment delays begin before treatment takes place. Incomplete patient details, inaccurate insurer information, missing authorisation numbers can all lead to delays, rejected claims and avoidable follow-up work.

Best practice is to verify the patient’s demographic, contact and funding information at the earliest opportunity. For insured patients, practices should record the insurer, membership and authorisation details, and for self-pay patients, the expected charges, payment terms and options should be clearly outlined.

A patient registration form combined with a pre-treatment checklist helps prevent errors and identifies missing information that can be then obtained from the patient.

Bill promptly and correctly

It stands to reason that the longer a practice waits to raise an invoice, the longer it will wait to be paid. Invoicing should take place in a timely fashion with a focus on accuracy as well as speed. Procedures must be coded correctly and charges aligned with applicable tariffs, contractual arrangements and insurer rules. Regularly reviewing insurer fee schedules and keeping pace with monthly changes to the CCSD (Clinical Coding and Schedule Development) code schedule can help practices avoid underbilling, rejected claims and unnecessary disputes.

At Civica Medical Billing and Collection (MBC), our checking process provides a valuable audit point to identify missing or incorrect information before an invoice is submitted. This “right first time” approach reduces unnecessary adjustments and protects both income and the patient relationship. We also routinely update our records to reflect any changes to the CCSD schedule or updates to the PMI tariffs.

 

Medical billing

Offer convenient, secure ways to pay

Private patients increasingly expect the same convenience when paying their medical bill that they receive in other parts of their lives. Practices should offer a range of simple, secure payment options that are available at all times of the day.

Civica MBC’s service provides patients with a range of 24/7 payment options either online or over the phone. These include digital solutions such as Google Wallet, Apple Pay or Open Banking.

This includes pathways for collecting money ahead of treatment, on the day via our Client Self-pay module or post treatment depending on your needs.

Manage outstanding debt consistently

It is important to have a robust chase process that is routinely followed. Practices need a structured credit control process with clear stages, timescales and ownership. Early, polite reminders are more effective than allowing balances to age, and unresolved insurer claims should be investigated promptly to seek resolution. 

Insurance shortfalls and excesses should be identified and invoiced promptly to patients alongside a clear explanation. Many patients are surprised to discover they have an unfunded liability because they may not be familiar with all the terms of their policy. Communication should therefore be informative, respectful and sensitive and you should keep accurate records of each interaction and any agreed next steps.

Practices should have access to reporting to monitor aged debt by patient, insurer and invoice type. This will ensure that any issues around recurring delays can be identified and steps taken to address the issue. 

Reconciliation and access to meaningful reporting

Reliable and regular invoice reconciliation is essential. Every payment needs to be matched to the correct invoice with discrepancies investigated quickly. As well as being a key stage in identifying insurance excess or shortfalls, it will also aid the management of group practices where often payments may need to be allocated across different consultants or have been paid into different bank accounts.

Private healthcare, like any other business, benefits from data transparency. Civica MBC’s  Dashboard ensures our clients have 24/7 access to timely financial management information. Including an array of reporting such as:

  • Invoices raised
  • Payments received
  • Aged Debt/Bad debt
  • Location/patient type
  • Patient activity

Reporting is available at both summary and detailed levels to allow for better informed decision making.

Protect data and maintain strong governance

Billing records contain sensitive personal data including clinical and financial information and as such any systems should use appropriate security controls, and staff should understand how to handle data safely. Practices should also maintain clear audit trails and documented procedures for corrections, refunds, complaints and disputed invoices.

Governance includes business continuity. A resilient billing operation should not depend on one person’s knowledge or availability. Documented workflows, appropriate oversight and sufficient capacity help ensure that invoicing and collection continue during absence, periods of growth or sudden increases in activity.

Civica MBC is ISO27001 and Cyber Essentials certified and our service is built on a strong foundation of UK based Dedicated Account Management.

Consider the value of specialist support

For many healthcare providers, maintaining all these capabilities internally can be challenging. Outsourcing to a specialist medical billing company can add experience, capacity, purpose-built technology alongside modern payment solutions all while improving the financial health of the practice.

Civica Medical Billing and Collection service has more than 35 years of experience of partnering with more than 2500+ consultants, groups, clinics and hospitals. Each practice receives its own UK based Dedicated Account Manager which combined with our ‘intensive care’ onboarding process ensures we better understand the nuances of your practice. 

Civica MBC’s billing expertise has seen increases of revenue of up to 25% and the combination of our credit control processes and simple to use payment options ensures that we optimise your practice cashflow. Civica MBC has an average bad-debt rate of less than 0.5%, and as low as 0.18% for many practices. 

By partnering with experts, you are free to focus on delivering amazing care to your patients and growing the practice. 

Put your practice on a healthy foundation for growth

Medical billing works best when it is incorporated fully into the practice rather than seen as an administrative headache. Accurate data capture, prompt invoicing, convenient payment routes, consistent debt management, reconciliation and access to reporting all contribute to a more professional private practice and an improved patient journey.

To see how your practice could benefit from partnering with experts, contact a professional medical billing company such as Civica Medical Billing and Collection  and transform your private practice.