Free Help & Advice
This page is for UK medical professionals, medical secretaries or practice managers working in private practice.
Whether you are starting out in private practice or you are looking to streamline your established practice, we want to help. Collectively, in our team we have over 200 years of medical billing and admin experience!!!
There are three ways to get help and advice.
- The quickest way to get a personalised answer is to Email us via the Contact Us form on our website with your question and one of our experts will get back to you.
- The second choice is to go to the other pages under Free Help & Advice and see if the answer to your query is already there.
- You can also use the search function on each page.
If you cannot find the answer you seek here, please either use the search box, or email us using the Contact us form on this page, and we will get back to you.
Medical Code
You will need to tell BUPA about all the CCSD codes, including diagnostic tests, that you are likely to perform when you register with them.
If you do not, then BUPA may not authorise the patient’s treatment.
You will also need the CCSD codes when you begin your clinics, as your patients need codes to authorise their treatment.
The hospital will also require a CCSD code for every outpatient test or procedure.
These are the codes used most widely by the UK private medical healthcare industry. Without them, your invoices will probably be rejected by most of the major insurance companies as the insurance companies link codes to remuneration rates. Without the procedure code(s) we are unable to raise an invoice as we are not medically trained.
For self funding patients, the CCSD codes are used by the Private Hospitals when you perform a procedure.
There are two coding systems in common use in Private Practice.
The first is the CCSD coding system. It is owned and managed by a group of insurance companies who regularly update the codes. Click on https://www.ccsd.org.uk/ccsdschedule/ccsdschedulechapter/ to find out more.
The second is for NHS work performed in a Private Hospital. It is the HRG coding system, and is usually administered by the Hospitals themselves.
Medical Fees
It depends on how comfortable you are with discussing the financial aspects of the treatment.
If you are comfortable, then do so, but bear in mind that patients will often not take in most of what you say on the cost, especially if they have just received some challenging news about their problem.
If you are not comfortable, as is the case for most Consultants, or if is not appropriate, then you will need to set up a separate process to cover that discussion away from your clinic.
This can be achieved by a call from you, your secretary (if they are happy to discuss finances), or a billing agent.
Some patients will need to ask in order to determine whether or not they are fully covered. Some will need to know to see if they can afford your treatment. In both cases the patient is then able to make an informed choice.
The key here is to minimise surprises.
The BMA (British Medical Association) and FIPO (Federation of Independent Practitioner Organisations) both recommend agreeing fees in advance with the patient wherever possible. This can be easily achieved by publishing them on your website.
You do not need to know all your fees, if you have a point of reference somewhere else. Such as a website, an insurance company fee schedule, or a knowledgeable person. But be careful if you do quote your charges, because the patient will remember what you said and you may be bound by that answer.
There are several questions that you need to consider when setting your fees.
- What are your competitors fees?
- What fees have you agreed with the Insurance Companies?
- Do you have a niche, where you are the only Consultant with that skill?
- How many other similarly skilled Consultants are at the same location, or in the near geographical area?
- Do you want to align with, or base on, an Insurance Company Fee Schedule?
- What is the cost to you of undertaking that particular treatment? Is it worth your while?
It is also complicated by the varying positions of the insurance companies.
- For BUPA and AXA PPP, have you entered into an agreement on your fees, if so you will be bound by that agreement, unless you withdraw from it and de-register with these insurance companies.
- For some insurers, there will be no cap, but they may point out to the patient that your fees may not be covered in full and offer another lower priced Consultant to the patient.
- For other insurers, they will set their remuneration rates at a rate they consider reasonable, and it is up to the patient as to whether or not they are willing to accept your rates.
Start by finding out what other Consultants charge, you can often do this by asking them, checking on their website or contacting the hospitals where they practice.
Bear in mind that it is illegal for you to agree your charge with the other Consultants, as that constitutes a price fixing cartel.
Medical Insurance Company Registration
The Data Protection Acts are not there to stifle business, they are there to ensure that data collected is used and protected appropriately, and managed according to the purpose for which it was collected.
That means you can share data with your secretary, the insurance companies and other parties, such as Hospitals, Accountants and Billing companies like HytheHopes. But you should only share the data that is absolutely necessary for them to undertake their role. For example, at HytheHopes, we do not get to see clinic letters, as they are not relevant to producing an invoice. We only need the codes for the treatment performed, the history and the outcome for the patient make no difference to how we can do our job.
Technically, you are the Data Owner, and the other parties are the Data Processors. Most of legal requirements around the data apply equally to all parties.
You have a legal duty to register with the Information Commissioners Office.
In the NHS, the legalities of the Data Protection Act are overseen by the Trust. In private Practice you are responsible for the Data that is collected about your employees and your patients.
It is very simple to do, log on to the ICO website, look up a few of your colleagues who employ staff and then determine whether a similar listing covers your needs. A registration fee may apply.
At HytheHopes, we always look for best value rather than cost.
We consider value as the benefits minus the costs, and to do this we assign an amount to each benefit.
We often find people in all walks of life focus only on costs and make decisions without considering all the factors.
Sometimes it is hard to evaluate the amount for a benefit or cost, such as extra time with your family, but if you can the best deals will be open to you.
If you bought your car on price alone, what car would you be driving?
It is also important to remember that some companies or traders, not all, will add an amount to their charges so that they can appear to be flexible on their prices, so be prepared to negotiate!
We know that there are plenty of companies out there that can build a good quality website, at a reasonable price, and within a reasonable timescale.
But from our perspective, the biggest challenge is finding someone who can design the website, who understands you and your customers, and can deliver a scientific approach to website creation.
We would recommend that you have a website for two major reasons.
The first is to advertise yourself and the skills that you possess, this would be part of your marketing strategy. There is also the opportunity for your potential patients to start to get to know you.
The second is to provide information to your patients on your service, the types of conditions that you treat, and your charges.
Before you interview and appoint a secretary, you need to determine the scope of the role.
In private practice, the following tasks are some of what may need to be covered.
- Booking appointments, although Private hospitals often offer this service at no cost.
- Preparing clinic notes
- Typing clinic, GP, insurance company and patient letters. A number of consultant outsource this activity.
- Sending out letters.
- Retrieving Results
- Receiving and making calls regarding clinical matters.
- Collating and Recording your expenses
- Issuing Invoices. This can be outsourced to a specialist billing company such as HytheHopes.
- Receipting payments received. This can be outsourced to a specialist billing company such as HytheHopes.
- Chasing Outstanding invoice amounts. This is often outsourced to a specialist billing company such as HytheHopes, along with Invoicing and receipting. There are also companies that also specialise in chasing difficult outstanding amounts.
When appointing a secretary, be mindful that he or she may need to be available to patients, GPs and insurance companies during the day.
Some Consultants offer this work to their NHS secretary, but the person may be limited by what they are allowed to do during their time in their NHS role.
Some insurance companies insist on someone being available to answer the phone during normal working hours and have access to relevant information.
As you are now operating independently of the NHS, you are responsible for ensuring that you have sufficient legal cover in the event of a problem. Insurance Companies and Hospitals may insist that this is in place, and may advise you as to how much cover you will require.
You will need to estimate your likely Private Practice income and provide this information to determine the premium. Choose and Book work undertaken in Private practice should be excluded from your estimate, as this is covered elsewhere.
The insurance companies will check your listing on the GMC website when you register with them to ensure that you are qualified to undertake Consultancy in your stated specialty.
They will also check whether you have any warnings or suspensions logged against you.
Here is a checklist of what else needs to be in place before you start.
- Ensure that you are entered on the GMC Specialist Register for your specialty.
- Obtain MDU cover or equivalent for your private practice.
- Design your support team, including the roles of clinical and financial secretary
- Determine who will fulfill the role of clinical secretary
- Determine who will fulfill the role of managing your expenses
- Determine who will fulfill the role of financial secretary (Billing & Collection)
- Determine how you will market yourself
- Register with the Information Commissioners Office
- Consider Practice Management software.
Firstly, may we offer our congratulations on your appointment.
Secondly, before you can register with an insurance company, you need to acquire some practising rights, so determine at which Private Hospitals you wish to practice.
Some criteria that you may wish to consider when assessing the Hospital.
- The distance between your home and the Hospital, relevant if you need to make emergency visits
- The number of other Consultants who are from the same specialty as you, how much competition is there, and do you have any advantage over them, or do you have a niche
- Is the hospital in your catchment area, will the GPs and patient know about you and your skills
- What facilities does the Hospital provide for your specialty, do they provide or will you be supplement their facilities with your own
Apply for admission rights, at a minimum of one Hospital, as soon as possible, this may take several weeks to approve and will be the limiting factor on when you can start seeing patients.
Medical Marketing
As you may be aware, BUPA now include a decision for selecting which three consultants they offer to members on the ‘Open Referral’ product. BUPA do not disclose how they make that decision.
Are you also aware that the order in which consultants appear on the BUPA finder website, finder.bupa.co.uk, which can be searched by patients directly, is influenced by the information that is contained in your personal entry.
Again Bupa do not disclose how the list is sorted, but you can amend your entry to boost your position.
If you haven’t already, I recommend that you visit the Bupa website finder.bupa.co.uk, key in your speciality and hospital postcode and then see where you appear in their list.
If you are not at or near the top, you could be missing out on referrals and I suggest that you examine what your competitors have put that gets them up there.
If you are not even on the first page, you almost certainly are missing out on referrals.
If you have any questions about this, we would love to help where we can.
You will need to develop a strategy to ensure that your name appears as a primary choice for the potential patients.
It may also extend to solicitors if you are planning to undertake Medico-Legal work.
An important route to your potential patients is through GPs. The hospital may help you organise GP talks and introductions. They may also organise evenings where patients can come and ask you questions about potential treatment.
You may wish to consider other innovative approaches.
There are a number of specialist Marketing Companies, but they vary enormously in the work that they do, so you would need to investigate them yourself.
Marketing is about putting your name in front of your potential customers, the patients.
For Medical Consultants it usually means the process of selling their services, knowledge of how to advertise their practice, study of how to give their practice a brand that patients will recognize quickly and much more.
Marketing for Medical Consultants is about building relationships with their patients.
Medical Accounts
We have taken over from, and worked with a large number of amazing secretaries who were relieved when the billing was taken away.
Secretaries have told us that they struggle because they do not enjoy handling the money side of the practice (ask yourself the same question, would you like to be handling the money side, and deal with patient and insurance company queries?), but more commonly is that your practice has grown, through your and their efforts, and priority is normally given to the clinical side of the practice.
We recommend that you ask your secretary what he or she really thinks about your Billing and Collection. You may be surprised at the answer.
Your accountant will have the best advice, but we do recommend one thing.
Before you open a company bank account, please ask the bank whether they will accept cheques made out to you personally.
In our experience, the name of most limited companies is different to that of the Consultant, and this presents a challenge when you receive a cheque made out to you personally.
There are several reasons why this happens, and it is not always practical to return the cheque to the sender, so you need to ensure that you have a bank account which will accept those cheques.
The easiest way is that your company bank account will accept cheques made out to you personally.
If this is not available, open or set aside a personal account, that is used exclusively for your Private Practice.
How you conduct your practice requires expert advice, and the best people to advise you are Accountants, and especially those with Specialist Medical knowledge.
We know of several ways to work in Private Practice, Sole Trader, Limited Company, LLP, and your accountant can advise which suits your practice.
Bear in mind that if you trade as a sole trader, you must register with HMRC within three months of starting or be subject to penalties.
Your choice of an Accountant can make a significant difference to the success of your Practice, depending on your needs.
The criteria that you may wish to consider are
- Do I need someone who can just take my end-of-year figures and process them into a tax return?
- Do I need someone who can advise me on trading status (Sole Trader, Limited Company, etc)?
- Do I need someone with specialist Medical knowledge?
- Do I need someone to become part of my team and support my Private Practice?
- Do I need someone who can take all my receipts and make sense of them?
Tax Returns
Your Accountant will tell you how much tax you are liable for, provided that they have all the information in good time.
But I would recommend that you start putting a percentage of your income away immediately, to ensure that you have enough cash available at the point you need to pay the tax.
We would recommend 40%, but you should confirm this with your accountant.
Submitting a tax return is not a straight forward affair, if you have more than one source of income.
Your Private Practice and an NHS salary would mean that you have more than one source.
Your Accountant will advise you when the tax year ends, when the tax return is to be submitted, and when they need the final information from you.
If you leave it too late and your tax return is submitted late, or you are unable to pay the tax bill, there are significant penalties.
Medico Legal
Medico-Legal work is not exempt from VAT, but you do not have to register unless your Medico-Legal income exceeds the VAT threshold.
You should check with your Accountant, as this threshold and the rules are subject to change.
If you are VAT registered, then you must display your VAT registration number on your invoice.
I am considering taking Medico-legal work as part of my Private Practice, what should I be aware of?
In terms of the billing there are some things you need to be aware of.
We are often aware that this particular type of expertise attracts premium charge rates.
You will enter into different agreements with different companies, some will be solicitors, some will be agencies and some may even be Insurance Companies.
Each will have their own terms and conditions, and you should be aware of them before you sign a contract.
Some Terms and Conditions that we are aware of are
- your invoice gets paid when the case gets settled. This could be years after you have delivered your service.
- Your invoice gets settled after a specified period of time.
- Your invoice gets settled if their client wins their case.
- You cannot approach their client for payment (the person who you treated or assessed), as it was the company that instructed you
Be aware that while you are waiting for payment, that some of the these companies have, in the past, ceased trading.
Practice Management Tools
I understand that I will need some software to support my practice. What can you tell me about that?
Before you select software, make sure that you have list of what you need from the software, alongside what you need from your practice as a whole.
Define the requirements which you absolutely must have, and those that would be very helpful.
Also you will need to have some knowledge of the processes that wrap around the software, so that when you implement it, you or your secretary know how to get the maximum benefit from it.
There are a number of suppliers, and what they deliver varies.
These are the common ones in use, we are unable to provide an opinion on them, as we have not used them all.
- Midex Pro
- DGL’s Practice Manager
- PPM
- Med+dbase
- Emma
- Healthcode
This list is not exhaustive, but do be cautious of overseas software, in particular American software, as it may not link electronically for British Insurers, and this is a requirement if you have registered since 2010, or have been accepted on Bupa’s Fee Assured Status.
Disclaimer: You are wholly responsible for decisions that you make using information on these pages. HytheHopes cannot be held responsible for the consequences of any decision you make based on information contained within this website.