While increases in demand from self-pay patients often grabs the headlines in private healthcare, it is the activity generated from insured patients that forms the backbone of many a successful private practice.
At Civica Medical Billing and Collection, we continue to see an increase in demand in Q1 2026 from this important patient group. With this in mind, we can see the importance of managing the billing of insured patients effectively to the financial health of a medical practice. Especially, as for many independent healthcare providers, patients whose care is funded by the private medical insurers (PMIs) make up the majority of the cases they treat and for some practices they can represent as much as 95% of their billing volume.
The importance of revenue cycle management
Effective revenue cycle management for all patient types is the foundation of any successful practice and, with the complexity surrounding the medical billing of insured patients, the need for robust efficient processes is even more key.
Insurance company medical billing is challenging with more than 2,000+ CCSD codes to choose from which are updated on a monthly basis. Each insurance company has their own fee structure and rules around the invoicing of multiple codes which need to be kept up to date.
Older consultants can be on different contractual terms than their younger colleagues and the burden of the administration and collection of outstanding monies resulting from insurance excesses, co-payments and coverage limits falls on the practice.
Partnering with a medical billing company like Civica Medical Billing and Collection can revolutionise your practice as they deliver expertise, efficiency, and modern payment solutions while at the same time freeing the healthcare professionals to focus on delivering exceptional patient care.
The most common complaint we hear from practices is around the administration and chasing of patient shortfalls. At Civica Medical Billing and Collection, we maintain an average bad debt rate that is less than 0.5% and for most practices it ranges between 0.18-0.3%, which is a 90% improvement on the average bad debt rate we see.
What is Revenue Cycle Management?
Effective revenue cycle management (RCM) means ensuring that you are managing all of the following steps in the billing process.
- Insurance policy verification
- Timely E-billing of PMIs and resolution of EDI (electronic data interchange) errors
- Payment reconciliation
- Claim rejections
- Invoicing of patient shortfalls
- Effective credit control of both insurance companies and patients
- Offering a range of simple secure payment solutions
- Comprehensive financial reporting
As RCM encompasses the billing process from invoicing through to payment collection, it is important to manage the entire process effectively to achieve the desired result. Any break in the chain can result in delays or lost income. At Civica Medical Billing and Collection, our approach is straightforward which is why our fees are based on received income which means we share the same objective.
PMI Invoicing
Timely invoicing is a key objective for all patient types, as it not only reflects on the professionalism of the practice, but it means issues are highlighted sooner increasing the chance they are resolved quickly.
In recent years, many of the main UK PMIs have introduced rules dictating fixed time periods following on from treatment date in which invoices need to be received. Should the practice fail to adhere to these deadlines, the insurance company will deny payment and the practice will have no option to seek recompense from the patient and so this revenue will be lost.
If there is a delay in sending the invoice, there is also the risk that the policy benefit limit is exhausted by claims from other consultants which only increases the administration burden on the practice.
Additionally, there has been a major push by the PMIs to require invoices to be sent electronically. While this has resulted in quicker claim assessment and reduced payment turnaround times; electronic invoicing is not foolproof, and so submission errors need to be addressed.
At Civica Medical Billing and Collection, we send all invoices insurance claims electronically and we aim to invoice within 24 hours of receipt of the billing data.
Why use a billing company like Civica Medical Billing and Collection?
At Civica Medical Billing and Collection, our service is built on a solid foundation of UK-based Dedicated Account Management which means that you benefit from both our more than 35 years of experience in the sector and the workflow tools we have developed to streamline the RCM process.
Our experienced account managers understand the intricacies of the billing process across the various PMIs, including the variations in coding rules, fee tariffs, insurance policies, and compliance regulations, ensuring that we maximise your billing revenue. At Civica Medical Billing and Collection, we have seen increases in revenue of up to 25%.
At Civica Medical Billing and Collection, we understand that where your medical data is processed is as important as how this takes place which is why our service is focused on UK-based Dedicated Account Managers who are responsible for the entire RCM pathway for the practice’s they support.
We also appreciate that medical billing errors can lead to rejected claims, delays, and, even worse, lost revenue. By opting to partner with a professional medical billing company who is focused on this key role, your practice will significantly reduce errors and ensure claims are processed correctly. By proactively managing denied or rejected claims with insurance companies, our account managers ensure that the maximum compensation is obtained under the policy.
In the case where consultants carry out complex work that is outside of the general scope of the coding principles/tariffs, we will undertake the fee uplift process on your behalf.
Next steps
With more companies providing private medical insurance to their employees, the insured patient will remain the main stay of the independent healthcare sector. Take time to consider if your practice is managing them effectively. Partnering with a specialised billing companies like Civica Medical Billing and Collection can offer the necessary expertise and functionality to meet the needs of the modern private practice.
Simon Brignall is Head of Sales and Accounts at Civica Medical Billing and Collection.
