A review of over 600 general practitioners indicated that a practice’s medical aid claim sending behaviour impacted their cash flow from both patient and medical-aid payments.

Two distinct practice profiles have been observed for sending medical aid claims
When analyzing medical aid claim sending behaviour, we found that there were differences between two profile types, and split the data accordingly to observe the differences in trends:

• High medical aid claim -volume practices: 
  practices that send over 200 medical aid claims per month.
• Low medical aid claim -volume practices: 
  practices that send between 50 and 100 electronic medical aid claims per month.

How same-day medical aid claiming impacts cash flow

High medical aid claim -volume practices send on average 46% of their claims on the same day of the consultation. On the other hand, small medical claim-volume practices only send 25%, or one in four electronic claims on the same day. Sending claims on the same day of the consultation is essential for catching medical aid payment runs. Better yet, sending claims while the patient is still at the practice (known as Send Now claiming) is of vital importance especially when it comes to collecting patient liable amounts. This is because patients who are informed of outstanding amounts while they are still at the practice are more likely to pay before they leave; thus ensuring your cash flow is absolutely current. We touch more on the importance of informing patients of outstanding amounts while they are still at the practice in our previous edition.

The impact of three days after consultation claiming: the most devastating impact on cash flow

After three days, high medical claim-volume practices have sent a much higher proportion of their claims, where smaller medical aid claim -volume practices have only sent half. The benefit these higher claim volume practices receive is that they are able to secure funds from the medical aids faster, as they catch the payment runs on time.

Improving processes in this respect ensures better cash flow from medical-aid liable amounts. For example, if a claim for a Medscheme patient seen on Saturday is only processed on a Tuesday, you will only know the following Monday if there is a patient liable amount, by which time the patient has already forgotten about the consult. Furthermore, you will only be paid for that consult on the following Friday- that is almost 2 weeks later.

We have identified 4 possible reasons why practices are taking longer to submit claims. However, through a proper practice audit, we have proved that practice setup can be improved to help staff to restructure their processes so that they can send claims to medical aids sooner.

Successful practices recognise that they have two revenue streams

Sending medical aid claims on the same day of the consultation means the predictability of funds in your bank account. This is because you will hit all payment runs in a week, improving your cash flow coming from medical aids. However, the 2nd revenue stream that closes your cashflow loop is patient liable amounts. When you send claims while the patient is still at the practice (Send Now behaviour), you increase the likelihood that patients will pay and pay sooner.

By improving your medical aid claim sending behaviour you will receive prompt payment from both cash flow streams and are therefore able to start earning immediate interest on money earned. A Rand received 30 days after the consultation can be worth 5%-10% less than a rand received on the day. Spread over many patients, month-after-month, this seemingly small amount can cost your practice thousands of rands each year.