Billing problems rarely announce themselves on day one.
They tend to surface weeks later, when claims are rejected, payments cannot be matched to accounts, or patients query balances they were not expecting. By then, the practice may already be under pressure. Expenses have begun, but income is delayed or uncertain.
The best time to establish sound billing processes is before the first consultation. These medical billing tips for new private practices will help doctors create a clearer path from treating a patient to receiving and recording payment.
Before submitting claims, make sure the practice has the registrations and identifiers required for its structure and discipline.
This may include confirming your professional registration, applying for the appropriate practice number and ensuring that your details are recorded accurately. The Practice Code Numbering System has separate application routes for general practitioners, specialists, other healthcare professionals and different practice structures. Its public application page explains what is required.
Check that the practice name, address, banking information and provider details are consistent across your records. Small discrepancies can create problems when claims are submitted or payments are processed.
Registration is not something to leave until the first patient has already been seen. It is part of preparing the practice to trade.
Every practice needs a clearly defined owner for the billing process.
In a small practice, it can be tempting to treat billing as one of several duties handled by a receptionist or administrator. The difficulty is that billing competes with calls, appointments, patient queries and the daily demands of the front desk.
If billing will be managed internally, decide who captures charges, checks and submits claims, follows up rejections, allocates payments and reports on outstanding debt. There should also be a contingency plan for leave, illness or staff turnover.
If you intend to outsource, appoint the billing partner early enough for proper onboarding. Medi Practice’s guide to choosing the right medical billing partner explains what to look for.
Whichever approach you choose, the principle is the same: billing must belong to someone.
Many billing problems begin with information captured before or during a patient’s first visit.
Names, identity numbers, contact details, medical aid membership numbers and dependant codes should be checked carefully. Referral and authorisation information must also be recorded where relevant.
Create a standard process for collecting this information, checking it and updating it when necessary. A few minutes spent verifying details can prevent days or weeks of delay later.
Accurate contact information matters too. If a patient portion remains after the scheme has processed the claim, the practice needs a reliable way to issue the account and explain the balance.
A new practice must decide what it will charge before it begins treating patients.
Set fees for consultations and procedures, and understand how those fees compare with medical scheme reimbursement. If the practice charges more than the amount funded by a patient’s option, decide how the difference will be explained and collected.
Clinical work must also be translated into billing information that a medical scheme can process. Claims may require ICD-10 diagnosis codes as well as procedure, tariff or other relevant item codes.
Coding should reflect the patient record and the service delivered. It should never be based on guesswork or selected simply because another code appears more likely to secure payment.
The practice also needs a process for identifying services that require pre-authorisation, referrals, motivation letters or supporting documents. An otherwise valid claim may be delayed when the necessary approval or documentation is missing.
Patients should understand the practice’s payment terms before an account becomes overdue.
A written billing policy can explain fees, payment methods and how medical aid claims are handled. It should also make clear that scheme payment depends on the patient’s option, available benefits, authorisation requirements and applicable scheme rules.
Patients should know how co-payments and other shortfalls will be treated. They should also be told when payment is expected for services that are not covered.
Clear communication does not make every financial conversation easy, but it reduces surprises. It also gives reception and billing staff a consistent basis for answering questions.
Use plain language. Patients are more likely to respond constructively when they understand what they have been charged, what the medical aid has paid and why a balance remains.
Submitting a claim is only one step in the billing process, but timing matters.
Scheme rules generally allow claims to be submitted until the last day of the fourth month after the month in which the service was provided. That window should not become the practice’s timetable. Claims should be checked and submitted as soon as possible.
The practice also needs a routine for tracking claims, resolving rejections, responding to scheme queries and resubmitting corrected accounts. Patient balances should be identified and communicated promptly rather than being allowed to age unnoticed.
Once money is received, it must be matched to the correct claim and patient account. Remittances, patient payments and bank deposits should then be reconciled so that the practice can see what has been settled and what remains outstanding.
Medi Practice’s article on payment allocation and reconciliation explains why this is such an important cash-flow control.
A full diary can create the impression that the practice is doing well. Reliable billing reports show whether the work is actually being converted into income.
At a minimum, a doctor should be able to see what has been billed, what has been collected, which claims have been rejected and how much remains outstanding. Reports should be understandable and reviewed regularly enough for problems to be addressed early.
Data protection must also form part of the practice’s billing arrangements. Billing involves personal, financial and clinical information. Access should be controlled, information should be transferred securely, and responsibilities should be recorded clearly when an external provider handles data on the practice’s behalf.
The article on compliance risks in medical billing covers these responsibilities in more detail.
Choose processes that will continue to work as patient numbers increase. A system that depends on memory or one overextended person is unlikely to scale well.
Good billing is not something to add once the practice becomes busy. It is part of establishing the practice.
Clear responsibilities, accurate information, suitable fees, correct coding, timeous submission and reliable reporting give a new practice a stronger financial foundation. They also reduce avoidable pressure on doctors, staff and patients.
The aim is straightforward: every valid account should be recorded, submitted, followed through and accurately reflected in the practice’s financial information.
1. When should I set up billing for my new practice?
Billing arrangements should be in place before you begin seeing patients. This allows time for registrations, onboarding, fee-setting, patient documentation and claim procedures to be checked before the first account is submitted.
2. Should a new practice manage billing internally or outsource it?
Either approach can work if the necessary expertise, capacity and controls are in place. Consider the cost of internal staff, the need for continuity, coding knowledge, reporting requirements and the time required to manage rejected or unpaid claims.
3. What causes most early claim rejections?
Common causes include incorrect patient or medical aid information, unsuitable codes, missing authorisations, incomplete supporting documents and late submission. A consistent checking process can prevent many of these problems before a claim is sent.
4. What information is needed for a medical aid claim?
A claim generally requires accurate patient and member details, the scheme and membership number, provider information, service dates, and the relevant diagnosis and procedure or item codes. Some services also require authorisation or supporting documents.
Still have questions?
If you are starting a private practice and would like support putting reliable billing processes in place, get in touch with Medi Practice through our website. We would be happy to help.
Medi Practice is a Medical Billing Services Company located in Paarl, Western Cape. With clients throughout South Africa, Medi Practice provides medical billing services nationwide as well as in neighbouring countries.
info@medipractice.co.za
42a Main Road, Paarl, 7646
+27 (0)21 202 1685
Monday to Thursday: 08:00 – 17:00
Friday: 08:00 – 14:00
Public holiday: closed