As a medical practitioner, how you bill for procedures and consumables can have a huge impact on your bottom-line. For example, a pilot study on profitability we did in 2015 with a sample of 10 General Practitioner (GP) practices on our books found that consumables were often under-claimed or not claimed at all, and that procedure lines were often missing. This had a big impact on their bottom-line.

There appears to be two key reasons for procedures and consumables not being claimed for:

• Lack of knowledge. Knowing which codes to use is time-consuming and frustrating especially if administrative staff have not been given sufficient training.
• Cost implications. Many doctors worry how these costs will affect their patients without knowing the impact of absorbing these costs is having on the day-to-day running of their practice.

Fixing the problem

By assessing the most common type of claims submitted by these GPs, we were able to devise unique claim templates which allowed procedures and consumables to be included in the claiming. For example, looking at one of the pilot doctors before he started using these templates, the most commonly missed procedure was ‘Urine test’. After the ‘Urine test’ was automatically included in his claim templates, it brought in an additional annual revenue of about R9 000 in 2015. Similarly, his most commonly missed consumable before he started using the templates was ‘Voltaren injections’. Once ‘Voltaren injections’ were added to his templates it brought in an additional annual amount of R8 400 in 2015. Taking into account all procedures and consumables that were now being claimed for, this doctor grew his overall bottom-line by just over R80 000 for the year.

Most commonly overlooked procedures and consumables

Below are some of the most commonly used procedures and consumables that our pilot group were not including in their claiming. Although your practice is unique, and the list is limited, you might nevertheless recognise a few. Do you overlook them too?

*Unit prices are based on the average values our doctors received for these procedures and consumables.

Bottom-line

As a doctor, you might feel it necessary to exclude procedures or consumable costs to help cash-strapped patients. But claiming in full for the services you perform is essential for the health of your practice and should essentially come out of your patients’ day-to-day medical savings. Furthermore, it need not be an admin burden either, especially if you have the right practice management software and time investment from your partner to ensure claims are setup to incorporate the correct procedures and consumables.

*The pilot study is being extended to a greater sample to see if the trends/types of claim items already discovered is consistent, or if there are others that we can identify for the market.