Medical Billing debts of £1000’s? Follow these 5 steps and regain control of your debts and medical billing.

Timeliness is vital in medical billing

It’s really important to maintain a good relationship with both your patients and insurers so your medical billing and collections processes need to be in good order. You need an electronic system whereby all your clinics, procedures and operating lists are billed accurately and as soon as possible.

Most insurers will either insist or prefer that you utilise Healthcode’s automatic verification system. So, if you’re not using a third-party patient management system connected to Healthcode, you’ll need to log on Healthcode to do your medical billing or risk delays and failures. You can still raise bills using vitality et al’s billing systems for free, but authorisation and verification can take a bit longer.

But that’s not the end, you also need to make sure that any bills that fail verification by Healthcode are followed up immediately.

So how do you achieve this? Whoever does your medical billing, whether it’s you, your long suffering significant other or your medical PA will need accurate information. Demographic information, procedure codes, insurance authorisation codes and policy numbers have to be 100% accurate or they won’t pass through HealthCode’s verification system.

Why a robust medical billing process is needed

If you’re busy with patient care, you may not notice the failure and weeks down the line. You’ll be wondering why you haven’t been paid. It’s easier, albeit irritating, to deal with failures immediately rather than weeks down the line. That’s because you may have to track down the patient about any changes. Don’t forget they may be tricky to find, especially if they travel abroad. Or, you may have to submit a query to an insurer’s email help line or on a dedicated online portal.

Sorting out these problems with policy numbers or authorisation codes may take a while.

If it takes too long to get the correct information your insurer may refuse to pay the bill. They may say that it took too long to send the invoice. Six months (in the case of Vitality) may sound like a long time, but you’d be surprised how that time can fly by. The situation is made worse if you don’t have a robust system in place and only look at your debts when the accountant starts asking.

So, here’s the scenario: Your accountant has been in touch and wants your end of year information next month. Rather than hand over a load of, possibly, out of date information, here’s what to do as a bare minimum to prevent headaches being paid forward.

How to tackle a medical billing backlog

1. Reconcile all outstanding insurance remittances.

One thing to remember is that although on paper it looks like you have 20-30% unpaid medical bills, in reality you’ve probably had a lot of this money, you’ve just not accounted for it.

To find out if this is the case, check you’ve received and actioned all the remittances from all the insurers with whom you are registered. Hospitals will also send remittances for all self-pay patients whose payments they have collected. One quick way of pinpointing whether you are missing any is to run a report of your aged debt filtered by insurer.

If you have a gazillion for Bupa, chances are you have not reconciled them on your accounting system, so you need to log on Bupa’s provider portal and locate the missing ones. You’ll need to do this for all your insurers. Get these paid off on whatever system you are using and rerun your aged debt- hopefully it should look a lot healthier.

2. Ensure all medical billing shortfalls and self pays have been paid.

A lot of your patients will need to pay you for a ‘shortfall’ at some point. Although their insurer will let them know, not all your patients will pay immediately. That’s why it’s important to reconcile your remittances as soon as you get them. As soon as you’ve reconciled them, you’ll need to email or contact all the patients who owe you money to remind them how to pay. Otherwise, you run the risk that they use your name as the reference for their payment and that’s a whole new world of pain! Quite often they’ll be happy to pay over the phone. Remember to action the payment on the system so you don’t chase them for the same payment!

For self-pays who may have paid using BACs or credit card you’ll need to go through all your bank statements and locate and process all payments. You may well be left with a few ‘funniosities’ ie payments where the references don’t tally. You’ll need to turn detective at this point. Digging out your clinic lists from the days before may show you who had ‘xx’ procedure in clinic for £nn. Then a process of elimination may allow you match the payment on your statement to the right debt. If you’re not 100% sure, a sensitive call to the patient may be needed. They should be able to see the payment on their account and be able to satisfy you that it was indeed them that paid you.

3. What to do with medical billing queries

When you reconcile remittances from insurers some payments or partial payments will be unpaid. Look for an explanation in the form of a foot note or code you can check to find out why the insurer has withheld payment. Review these messages as soon as possible. Some will be instructing you to approach the patient for payment, others will say you can’t ask the patient to pay. Revisit what you billed, chances are, you made an error and will need to amend your records to avoid an incorrect write-off.

Sending out reminders

You should be sending out reminders each week for unpaid bills and shortfalls. However, if you’ve let things slide, it’s a good idea to make sure you’ve done steps one to three before sending out any reminders. Again, make sure you make it very clear how to pay and what reference to quote.

You’ll need a system where the patient is sent a first reminder at a set time after the invoice is sent, say seven days. A second reminder can be sent after a further seven days and a third after fourteen days. A lot of third part patient management systems automate this for you. this is ideal because you just have to press a button.

Depending on the individual circumstances you may want to write to your patient debtor again or call them after the third reminder explaining about the debt and how they can pay.

At this stage, if they still haven’t paid and you are not comfortable with the legal complexities around mediation and sending the debtor a Letter Before Action, you may want to engage the services of a reputable debt collector. They should have an in-house solicitor who can do this for you. For more help on this try this government website.

Speaking to your patients

Depending on the level of your outstanding payments, once you’ve taken steps one, two and three, call your patients and ask for payment. Clearly, it requires sensitive handling; some patients or their relatives, speaking on their behalf will be either very poorly or dealing with a very poorly family member.

If you want to keep a distance between you, as the provider of their care, and the money situation, you can ask your medical PA to make the call. They’ll be used to dealing sensitively but firmly with patients and may be better placed to make the call.