As demand for private healthcare increases, what can you do to ensure your practice is ready to welcome more insured and self-pay patients and provide a seamless service? In this series, Product and Marketing Liaison and former practice manager, Desné Marston, breaks down the patient journey to look at how the admin side supports the delivery of great care and explains how we can help.
Fees
We understand that practitioners want to focus on patient care but we should start by talking about patient fees. These need to be set at a realistic level to secure the long-term future of your practice but they also need to be consistent and clear for everyone.
Setting fees
It’s generally up to you to decide what to charge for your services but here are some factors you’ll need to take into account:
- Overheads – How much you need to run your business and meet your personal obligations eg pay staff, indemnity costs, your mortgage
- Qualifications, experience and reputation – Those who’ve built up their practice over many years and with a good success rate could justify charging a higher fee than someone new to private practice. High fees might also attract some patients because they view them as reassuringly expensive while others may shop around
- Time and resources – This’ll vary according to the procedure and the level of service you provide (what’s included)
- Location – Consider what’s realistic and affordable for your target market. Fees are likely to be higher in a wealthy region such as London and the South East
- The insurer’s fee schedule – If you’ve signed a contract to treat patients as fee assured, you’ll have a contractual obligation to stick to the relevant insurer’s fee schedule
- Inflation – Keep your fees under review to take account of the cost of living
Communicating your fees
First and foremost, you have an ethical and legal obligation to be clear about your fees.
The GMC says
You must be open and honest in any financial arrangements, and must not exploit patients’ vulnerability or lack of medical knowledge when charging fees for treatments and services.
If you charge fees you must:
- tell patients, if possible before starting any investigation or treatment, including how much they need to pay for each investigation or treatment and when
- explain if you don’t know the total cost of each option (including any additional fees) and make sure the patient knows how to find out
- comply with the legal requirement to provide information about your fees to the Private Healthcare Information Network
The Competition and Markets Authority (CMA) imposed greater transparency on fees through its Private Healthcare Market Investigation Order which legally requires you to provide patients with comprehensive written quotes prior to consultations, diagnostic tests, or treatment and, for GMC-regulated practitioners, to submit your standard self-pay charges for consultations and procedures to PHIN. PHIN has published help and advice articles for patients on this subject and it’s worth reading these so you can reassure patients and answer their questions.
It’s also in your interest to keep prices clear as misunderstandings can lead to disputes and complaints of unfairness, such as when an insured patient is hit with an unexpected shortfall invoice.
Here are a few pointers:
- Publish your guideline prices for consultations, diagnostic procedures and treatments on your website (this should be in line with the prices you have sent to PHIN, if applicable). Be clear what’s covered by the fee, what is charged for separately eg inpatient care, prescriptions. Explain that all patients will receive a personalised quote after their consultation
- Set out your terms and conditions (T&Cs) where you can, such as on your website and in your confirmation letters. Include insured patients’ responsibility for paying shortfalls if their policy doesn’t cover the full cost of their treatment (see our next blog on onboarding patients for more on T&Cs)
- State whether you’re fee-assured and what this means. Explain that insured patients will need to contact their insurer before their appointment to check they have the right cover and obtain the necessary authorisation number
- If you offer finance terms to self-pay patients you must comply with the law which includes being authorised and regulated by the FCA. If you want to do this through a partner, ensure they are authorised and regulated with the FCA and take advice on what information you must include to meet your legal and ethical obligations. However, you don’t need FCA authorisation to allow a patient to pay an invoice in instalments
- Ensure your reception staff and invoicing team are fully aware of your pricing and can answer patient queries clearly and consistently
- Make the invoicing process straightforward by setting up a schedule of charges for each treatment and procedure you do (and where this differs by insurer, practitioner, location)
How we can help
Our Pricing Matrix enables you to record your fees for treatments and services, including differentiating for insurers and other payors and treatment locations which makes invoicing quicker, easier and accurate. Once you’ve entered the basic data on an invoice, click the calculator icon to automatically insert the correct fee for that procedure and payor type.
Discover More
To get started, select Guideline Pricing under the Accounting tab in ePractice and follow these step-by-step instructions or sign up for a free online tutorial with the Healthcode Academy We offer a 30-minute module – Electronic billing & collection | Module 1 – that takes you through everything, including the Pricing Matrix but if you just want to focus on creating your Pricing Matrix we offer a 15- minute bite-size option (select module 1C).
If you want to learn more about how we can help you manage this and other aspects of the patient journey contact our Business Development team. If you’re already an ePractice user and want to explore the system, check out our guides or book a free 1-2-1 tutorial with one of our friendly experts at the Healthcode Academy.
About Desné
Desné worked in the private healthcare sector at various sites in London for over 30 years. She has extensive experience and skills relating to all areas of practice administration, having been a practice manager from the early 90s to 2019 when she joined Healthcode.
Next time – Onboarding new patients
