Creating invoices might seem as a obvious part of the billing cycle. There is however a set standard to create a valid “claimable” medical aid claim or patient invoice. Whether its a medical aid patient or cash patient a invoice must be created and send to the relevant party responsible for payment. Let’s look at the  important component that make up your parcatice’s patient accounts and why you need our services.

  • Patient Invoices

  • Medical aid patients

  • Private patient accounts

  • Statements for patient treatment

  • Practice billing policy

  • Practice setting makes a difference

  • Coding structure

Patient accounts getting you frustrated?

Are you spending hours a day doing “admin”, wasting your time on the phone following up on patient accounts. Outstanding debt can weigh down your practice like a rock sinking you closer to the bottom. If you’re trying to manage your practice’s patient accounts by sending out emails, invoices, statements & phone calls – you’re doing it wrong.

Have you had some patients refusing to pay your account, or surprised by your ‘unexpected’ bill that was not covered by the patient’s medical aid – not because of your prices, but because of their benefits that their medical aid option actually covers. Some patients just don’t pay for your medical services just because they don’t understand the financial system of medical aids. They justify not paying, by just saying “that’s’ between you and the medical aid – I’m not paying a cent.” This is more common than yo might think.

You need an expert that knows how to handle these types of scenarios. Having a skilled professional explain why the medical aid doesn’t cover your treatment, is the first step to regain your patient’s trust. The next step is to get your patients to pay your account, truly understanding each patient’s situation.

Patient Account services
Billing & Account services

The Financial transaction

Patients are resistant to the medical process because it’s the “unknown”. Patients are fearful when they walk into your practice, not knowing what’s going to happen in treatment, what’s the diagnosis, and then ultimately – “this is probably going to cost a fortune”. We ask patients to walk in with a blank cheque, this is frightening. You need a master negotiator to clear out any uncertainty about your practice’s process. This includes the financial aspect of payment, whether cash or medical aid. Understanding what happens next is crucial for your patient’s customer experience at your practice.

Just like in the field of medicine, professionals stay in their field of expertise & knowledge. Practitioners must focus on treatment & care for your patients. The financial transaction must be handled by a skilled professional that knows how to explain why the medical aid doesn’t cover a certain treatment, or handle each case with calmness to grasp the patient’s circumstances & offer payment options. When to be more firm or compassionate takes time to learn.

Our admins can deal with any problems or questions about your services to give your patients clarity on their accounts.

Our Accounts services for your Practice

Patient invoice

What is a patient invoice? A patient and medical aid invoice is a document issued by the practice (the seller) to a patient or medical aid (the buyer). The invoice is each individual bill for each consultation. A patient invoice indicates the product or services, quantities and agreed price for the product or service. Without a proper invoice a physiotherapist cant be paid for treatments. Invoices are created according to the SAMA (South African Medical Association) guide for billing for medical services.

Creating and sending patient invoices is the way we collect payments from medical aid and cash patients. It is very important to make sure correct patient information is obtained when a new patient visits the practice for the firs time. For example medical aid patients must provide correct and valid medical aid and personal contact details otherwise it can result in non-payment. The same applies to private patients, without proper patient information the invoice can’t be send to the correct person for payment.

Physiotherapist Billing system & invoices
Medical aid Patient account

Medical aid patient

The first important step of creating a medical aid invoice or claim is to get the correct information from the patient. We get the information from the patient on the first visit to the practice when they fill in our patient registration form. It can be a electronic or paper form. When treating a patient both parties agrees to certain binding terms and conditions. An exception is created by both physiotherapist and patient. The patient agrees to pay for a service provided. The “contract” is between the physiotherapist and the patient – not the physiotherapist and the patients’ medical aid.

The account remains the patients’ responsibility if the patients medical aid partly pays or rejects the claim, then the patient must settle the outstanding amount with the practice.  With this being said, faultless billing allows for seamless processing of claims and reduced rejections.

For example, according to medical aid rules they allow 4 moths or 120 days from the treatment date for claims to be submitted. If the claim was billed late due to bad billing habits or a mistake from the practice then the member may not be held responsible for that account. Our system ensures that none of your claims ends up in limbo.

Any mistake make on the part of the patient, practice codes or billing format must be amended and resubmitted for payment. Errors slit in every now & then, it’s not a train smash, but needs to be fixed – fast.

An acceptable reason for making a medical aid claim patient liable will be : benefits depleted, patient not active on the medical aid due to suspension or cancellation of cover, patients plan type or scheme rules doesn’t provide physiotherapy cover or limits are reached.

Electronic claims for Patients

Electronic medical claims are called EDI. Physio Billing submit medical aid claims via EDI. The medical scheme receive the claim immediately. Most medical aids provide live claim feedback. On most claims we know within minutes if a claim is accepted for full or part payment or rejected. Depending on the claim response we can start following up on claims faster if there is a problem with payment, whether with the medical aid or the patient.

On Physio Billings billing software we are able to confirm and load medical aid patients against the global patient database. Automatically the correct details are populated for example, member number, plan type, dependent code and so on. Correctly loaded medical aid patients prevent unnecessary claim rejections due to invalid patient information.

Physio Billing submit medical aid claims electronically in the format & sequence required by the medical aids to ensure payment of the claim.  Billing is done according to the billing guidelines of SAMA the HPCSA (Health Professions Council of South Africa) and medical aids.

Physio Billing understands the importance of getting remuneration for services rendered. It is standard procedure for us to follow the billing rules and guidelines to assure speedy first time payments from medical aids.

Patient management system
Billing Services for private medical practice

Private Patient account

Private patients accounts are billed and invoiced just like medical aid patients. The only difference is the account is not paid by the medical aid to the practice. A specific person or entity is liable for the payment. It is recommended that cash patients settle their account immediately after a session via cash or card payment.

Cash patients helps with the practice cash flow. Although paying via EFT is also acceptable, very few patients have the self discipline to manage their own account and keeping up with payments.

There is a misconception that private patients don’t have to be issued with a proper invoice. Some cash patients claim back from their medical aids in private capacity. Physio Billing provide cash patients with the same legally compliant invoice as medical aid patients. We also sends a statement to the patient of their payment.

Every patient must be issued an account, irrespective

The faster you receive payments using card facilities, cash

Legal requirements for services rendered – consent that they will be liable for the payments of treatment

Private patient accounts goes to the person or entity who will be responsible to pay the account

Like a child receiving treatment or company that agrees to pay for treatment.

Statements for patient treatment

A Statement is a summary of a patient’s bill that displays the details such as total amounts paid or due by the patient. It includes all service dates , amounts charged per procedure code with full descriptions. These statements give the entire financial status of the account to the patients and the practice. Updated statements are sent to patients via email. Most practices are completely paperless.

Detailed allocations are done on medical aid statements sent to patients. This means that when the medical aid receives a claim they will reject / accept/ or partially pay each claim line or procedure code. Any codes rejected by the scheme will become member liable. The statement for a medical aid patient will give amounts paid by the scheme and rejection reasons per code if not covered in full.

Sending regular updated statements to all patients is a very important way of communicating important financial information. Patients can’t pay outstanding amounts if they are not aware of it.

Physiotherapist billing company & invoices
Secure Patient & Practice Accounts

Practice billing Policy

In short a practice Billing policy is your practice’s policy to bill medical aid tariff, above or below scheme rate.

Deciding your practice billing policy is one of the most important decisions, it will have a direct affect on your practice income. The billing policy must be decided by the directors in advance. Once the billing policy is in place it has to be applied consistently. For example if the practice billing policy is to charge scheme rates, you have to charge all patients at their medical aid rate. Normally the billing policy will consist of two parts. Medical aid patients and private patients. Your billing policy might also be determined whether you have a cash only practice, or accept cash and medical aid as payment.

All patients will be issued with a detailed invoice and statement regardless if you have a cash only practice or medical aid/ cash practice. The patient must still be able to claim back from their medical aid if they want to or use it for tax purposes.

Benefits of charging scheme rates is medical aids pay the practice directly. So it helps with a steady cash flow. It also assures full payment of claims if the patient still has benefits available. If you charge above scheme rate there will always be short payments that need to be settled by patients. It’s also a selling point for a practice if they offer the service to claim on behalf of a patient, as most patients find it inconvenient and time consuming to claim back themselves.  A lot of patients choose their providers based on if they are charging scheme rates or not.

Although there is no clear law on how much a physiotherapist may charge, there is a guideline and prices must be fair.

Inconsistent billing practices might raise a red flag at the medical aid. You don’t want to be audited by any medical aid. They can backdate incorrect payments made to the practice going back years and hold the practice liable. Physio billing advice and assist you with your billing practices according to the correct guidelines to prevent this from happening.

Practice setting makes a difference

Whether your practice is located in-hospital or out of hospital makes a difference.

Authorization for treatment – Auth code

Separate allocation of fund

Out of hospital account – only if you have benefits or allocated funds in your medical aid plan. Savings accounts are used for all services outside the hospital.

Coding structure

There are only a few treatment codes that can be used.

These treatment codes are rarely updated even thought treatment techniques expand drastically.

Your treatment must fall within the restrictions of these treatment codes to adapt treatment guidelines.

Unfortunately billing codes does not take into account the practitioners expertise & years of experience. Medical aids remuneration is set according to the code value not the practitioner applying the treatment.

Reasons why so many practices use our services

Our patient account services will make sure you don’t have to.

We’ll help you build a Successful, Sustainable Private Physio Practice!

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