I’ve been reading a really interesting book.
The book goes into some detail on how decisions are made.
What the process is?
Which factors are included?
Why are some factors excluded?
When is a decision made?
Why has a decision been made?
Fascinating stuff.
I could read about things like that all day. Probably because I’m sad.
Establish the Facts
The book reminded me though of a group of surgeons who commissioned a review of their practice recently. The issue concerning them was the amount of money they were owed and the ineffectiveness of the attempts to reduce it.
Consequently, I spent a couple of hours looking, listening, probing and establishing the CAUSE of the issue.
Or as my old mentor and teacher used to say to me every single time I was given a project: ESTABLISH THE FACTS.
In the case of the group of surgeons mentioned earlier, this itself was problematic.
Whilst it was very easy to establish the practice was owed huge amounts of money, it was not so easy to establish WHY. That is until I witnessed how the practice was being run.
In one single month, there were 36 separate consultations worth £4,500 which could not be invoiced. Why?
The root of the Problem
Because the senior consultant surgeon had instructed the medical secretaries not to ensure the patient’s details were correctly obtained at the point of registration.
It was more important, in his view, that the patients were registered quickly and professionally.
No argument from me on that point. However, that one single decision taken without thought as to the full consequences was the cause of numerous issues.
The consultant surgeon concerned took great pride in his ability to take instant decisions.
It never occurred to him though that you don’t always have to take an instant decision. Indeed most of the time it is better not to.
Decisions and Consequences
Notwithstanding that, when I spoke to the senior consultant he would not accept the need for the correct details to be obtained.
In his view the details being obtained were sufficient. That is fine IF his view is correct. Sadly it is not correct. His view, very respectfully, was not the one that mattered.
The view that did matter was the one held by the various insurance companies to whom an invoice would be sent.
They held power. In other words, if their standards were not being met then they would refuse to accept an invoice let alone consider paying it.
In the case of the group of surgeons I was working with, the invoices could not be raised because much of the mandatory data needed was missing.
On The Back Foot
Many times I’ve argued with an insurance company. Not one single insurance company but all of them at one point or another.
My job is to ensure my clients get the very maximum they can for their work.
If an insurance company make a mistake – it actually happened last week with one of my guys when the insurance company rejected an invoice as being a duplicate of another invoice (it wasn’t) – then I go into bat and argue the case.
Normally I win too.
But I will never object to an insurance company insisting medical invoicing is done correctly.
There are no excuses for doing it incorrectly.
The only outcome if a consultant surgeon does not ensure that his or her invoicing is done correctly is simple: the insurance company won’t pay.
Returning to the group of surgeons mentioned earlier, it was clear WHY they were not getting paid. They were not invoicing correctly.
And that is the one topic I’ve always driven right at.
Instead, the consultant surgeon concerned was issuing immediate instructions at the medical secretaries in the practice when faced with an invoicing problem to “ring such and such straightway” or “go to reception and get this done before anything else” or “immediately do this instead”
The Real Cause
But the decisions he was taking were themselves causing subsequent issues.
He had forgotten or was ignoring the necessity to get things right the first time. For example: when the patient registers with the practice make sure you get ALL the patient’s details correct.
“That is only a small item so can’t be that important” came the response from the Consultant Surgeon concerned.
To his credit, he agreed to stop firefighting and concentrate on getting the details right first time
In the first month, the number of episodes which couldn’t be invoiced fell to 1. The value which could not be invoiced fell to £125.
Cash input into the practice shot up an amazing 756%
All because instant decision making has stopped.
All because the invoicing was now being done correctly.
pete@medicalhealthcaremanagement.co.uk