Your billing company can’t claim what you never wrote down

That figure is real and it is worth every cent you pay for it. But it measures one thing only: how well the bureau recovers money from the claims it actually receives. It says nothing about the money that was already gone before the file landed on anyone’s desk.

We run a company that does this work, so let us be straight about its limits.

Your bureau codes what you give it. If a procedure was performed and written down, a skilled credit controller will find the right tariff and the right modifier and press the medical aid until it pays. The good ones are very good at it, and a careful bureau will even catch a whole case that never reached it and come asking you about it. What none of them can recover is the detail inside a record that was never captured in the first place. The femoral nerve block you placed under ultrasound guidance, on a high-BMI patient, late in a long list. If that line never made it onto the sheet, it does not exist as far as the claim is concerned. There is nothing to code.

THE REAL VALUE OF A CLAIM IS SET LONG BEFORE YOUR BILLING COMPANY EVER SEES IT.

It is set in theatre, in the few seconds you have to record what happened, usually while you are already thinking about the next patient. By the time the record reaches the bureau, the ceiling on that claim is fixed. A brilliant credit controller can help you reach the ceiling. Nobody can raise it.

This is where most practices lose money without ever seeing it go, and the coding is rarely the cause. The record was already thin by the time it reached the credit controller.

The doctor who reconstructs a record from memory at the end of a list is not being careless. He is doing what the day allows, in the only window it leaves him. The difficulty is that memory is selective about what it drops. It keeps the big events and lets the small ones go, and the small ones are very often the supplementary procedures and modifiers that carry the money. You remember that the case went well. What slips is the extra block you placed, the times you never wrote down. Those are the details a claim is built from.

I find this uncomfortable to say, because it points straight at the limits of my own industry. The billing company is the most visible part of the revenue chain, and the first thing a practice blames when collections come up short. But the largest leak sits upstream of us, at the point of capture, in a place the billing office cannot reach.

If you want a clearer picture of how the economics of your practice are shifting — and what you can do about it — we’d be happy to talk.

Werner du Plessis is the Chairman of Medvest Capital, a practice management and administration company that has worked with private medical practitioners across South Africa since 2013.