This is what you need to know about getting insurance claims paid
Financial float in insurance refers to funds retained by insurance companies through the difference between collected premiums and paid claims. Insurers invest this surplus to generate profits. Payer-provider adversity arises when insurance companies delay or deny payments, impacting medical providers. ClinicMind’s EHR and billing technology help providers streamline billing processes, identify and fix claim errors, and efficiently manage payments, reducing delays and disputes.
What are insurance panels?
Credentialing, or getting on an insurance panel, is crucial for healthcare providers. It boosts reputation, expands the client base, and facilitates referrals. Steps include researching insurance companies, gathering necessary data, registering with CAQH, and submitting applications. Streamlining the process is possible with expert solutions like ClinicMind, making the process more efficient for quicker access to insurance reimbursement.
Internal Vs External Billing
Medical professionals must handle billing efficiently. While in-house billing may seem ideal, it comes with numerous challenges. Training, salary, compliance, and accountability issues can affect productivity and costs. Third-party billing services are a cost-effective alternative, with trained staff, expertise in compliance, and greater efficiency. ClinicMind offers full-service billing solutions, ensuring transparency and coaching to optimize revenue for your practice.
What to Consider When Setting Your Therapy Rates
Setting therapy rates in private practice involves balancing overhead, personal income, and future goals. Avoid mirroring competitors’ rates and relying solely on insurance reimbursement. Gradually increasing fees for new clients while grandfathering existing clients’ lower rates may lead to inconsistency. Ethical rate increases require transparent communication and notification. Adapting rates to market changes is vital for financial growth.
How You Can Avoid Common Costly Mental Health Billing Errors
Mental health practitioners often grapple with common billing issues. Insurers might deny claims due to perceived duplicates. DSM-5 and ICD-10 code disparities can complicate billing. Partial payments for patient care activities occur, adding administrative work. Providers might discover patients are out-of-network only after claim submission. ClinicMind offers solutions: billing for diagnostic assessments and office visits on separate days, expertise in DSM-5 and ICD-10 code conversions, and the benefit of outsourcing billing to address these challenges.
4 Factors That May Affect the Cost of Chiropractic Care
When back and neck pain affects your quality of life, you may consider visiting a chiropractic clinic to resolve it. While this type of treatment can greatly improve some spine and neck issues, you may have concerns about the cost if you do not have medical insurance or if your plan does not cover such visits. However, the cost of chiropractic care can vary widely, and there are several factors that may affect the price you pay out of pocket. 1. The Base Fee Most chiropractic clinics charge a base fee, which is often called the office visit cost. This is the amount of money the clinic charges for a basic visit where they collect your personal and medical history and when the chiropractor discusses your pain with you, as well as what may be causing it. You will likely pay the base fee each time you visit. 2. X-Ray Costs Before mapping a treatment plan, your chiropractor may order a course of X-rays to determine whether your back or neck pain is caused by something he or she may be able to view and diagnose. Issues such as compressed or slipped discs may show up during X-rays or an MRI. These tests may cost several hundred dollars, so it is important that you discuss any future costs with your clinic before they proceed, as well as any payment options they might offer for such tests. 3. Therapy Choices Your chiropractor may offer you several different types of therapies when it comes to planning your treatment. These might include ultrasound, hydrotherapy, and laser treatments to target and treat the source of your pain. A chiropractor such as one from AmeriWell Clinics will likely discuss each option with you and help you understand the cost and benefit of each so you can feel at ease about your future treatments. 4. Your Lifestyle You may be able to reduce your chiropractic costs by adhering to your treatment plan and your chiropractor’s recommendations. For example, if he or she wants you to avoid jogging because of the impact it has on your spine and recommends walking or another type of exercise, following your advised treatment plan, could reduce the number of sessions you require and save you money. The cost of chiropractic care can vary widely depending on the type of pain you experience and treatment needed, but your local chiropractor may have payment options for you. Reach out to a nearby clinic today for further advice and information.
How to beat insurance companies at their own game – The “claim” lifecycle
Hey everyone, Dr. Brian Capra here. Tonight we’re going to start getting into how we’re going to beat insurance companies at their own game. So I’m going to quickly review something here, just kind of a little bit more of a schematic. This is my first screen sharing, so hopefully this is working for you right now. What we’re going to do is first of all talk about just overview of what we’ve already spoken about. Number one, insurance companies, we know how they get money, they get premiums from either employers or just patients out there that buy health insurance on the market, right, so they get premiums. Then what happens is the doctor over here, poor doctor on the right hand side over here, submits a claim to the insurance company. The insurance company delays reimbursement. We’re going to go into more depth about this, but we’ve already kind of talked about how the whole process is rigged in this way, where, how do they delay reimbursement? Part of it is just preventing you from getting the claim out to begin with. Forget the fact that they get the claim and deny it and all that stuff, but making complex coding systems and all that is part of the issue. So delays in reimbursement. They collect money. So as soon as they don’t pay you at the time you saw the patient, interest starts accruing on the money that’s yours still sitting in their bank account. So they’re going to collect that money, that interest, that’s called the float. They’re going to put that money, they actually reinvest that, there’s some very complex financial mechanisms that they use, so they’re going to reinvest that. Then they take all of those profits combined, they either keep the profits, they invest in better systems, technology, automation, and also invest in audits. All right. Eventually, hopefully they pay us, but then we have denials and underpayments, et cetera, that we have to deal with. So this is just kind of, I put together a quick overview. What I’m going to start talking to you about right now, we’re going to go into a lot of depth about each one of these steps, is how are we going to beat … What I talked to you last video about was how are we going to use their people, the types of person that they use, or our people? When I say people, our staff, our teams, how are we going to start to reposition those things, use them in a different way, use different types of people, leverage technology, automation, artificial intelligence, and leverage different processes to basically beat them at their own game? We’re going to go over a quick overview and I’ll come back to this and go into more depth that the way you beat them at their own game is on the claim level meaning every single claim you have to beat them at it. All right, so the claim starts when a patient actually checks in the door into your office, and then we see the patient, create a document, and we got submit the claim to insurance. I’m going to get back to cash in a second here so don’t get scared there. The claim is accepted by the insurance company. The AI, I’m going to go in depth about this, artificial intelligence looks for errors, submits it back to the office. We have EOB posting, secondary claim submission, secondary EOB posting, same process to find claims that need followup. The claim is fully processed, now we have a patient balance. If it was a cash patient, we just bypass all those steps and the claim, whether it’s cash or insurance, a claim is a claim. There’s a diagnosis code, there’s procedure codes, there’s the associated fees that go with those procedure codes for, you can have a different payer system even for cash patients. But we wind up with the patient balance and then we have all kinds of automation and technology that we can use to get that patient balance down to zero as fast as possible. So the name of the game is to leverage people, process, and technology to get that timeframe from time of service, the time the patient was seen in your office or checked in, to the time you have a zero balance for that patient. Obviously for insurance, that gets more complicated. So I’m going to go into more depth, little bit step by step in the next video. Stay tuned. Thank you very much. Again, this is Dr. Brian Capra From Genesis Chiropractic Software, and I will see you soon
How to beat insurance companies – people process and tech – automate, focus, measure
Hi everyone, Dr. Brian Capra here from Genesis Chiropractic software. And another video in the series here, I’ve been building on, each one building on the ones before. Last week, last I was on I was talking about how we can use people, process, and technology to beat insurance companies at their own game. Something that we’ve been doing at Genesis for close to 15 years now. So I’ll try to give you kind of a, some of the context here. What we’re going to focus on with people, process, and technology are three things. Automate. Automate everything possible. In order, in doing so, by automating everything possible, and we’ve automated literally using artificial intelligence, automation, aggregating data across thousands of providers, we’ve been able to automate more than, I think it’s 62% to 72% more automation in Genesis than any other system. When we automate, then we can focus. We can focus on the things that actually get you paid. And that doesn’t have to be just insurance, it’s cash as well. Focusing you and your team on just the tasks that get you paid, and I’m going to go a little more in depth about that. And then once we automate and we’re able to focus, then we can measure. We can measure how much work was actually needed to be done, how much work was actually completed, the quality of the work. And then we can also start to measure not just our own performance as an individual practice but also see the trends across the entire profession as far as what insurance companies are doing trend-wise so we can continue to battle, build more automation, more rules, better artificial intelligence, to beat them at their own game. I have a really cool example of how we’re able to actually beat insurance companies at their own game, specifically in New Jersey. So, what am I talking about with automation? I’m going to just start with insurance claims. This is going to expand into way more than that. It’s going to expand into the patient experience, and patient retention. Of course other things that affect your revenue. Let’s talk about insurance. So we’re going to automate everything, right? We’re going to automate benefit verification. We’re going to automate, like we do in Genesis, and maybe I’ll post some videos of some of the documentation, but we’ve now built an even better documentation system that’s been released this year in beta, it’s starting to get to full production right now. Where the documentation is completely automated from the intake form into the exam form into the daily note in every document after that. Where we can take out all the manual steps that you have to do right now. And as well, on your daily notes from visit to visit make it super simple for you to make changes and updates to that. So, benefit verification. Documentation of every single visit. Not only documenting, but the next step in actually collecting insurance is making sure that you create a claim. Well, in a lot of systems, in a lot of technologies out there, it’s kind of two different processes where you create your document, then you create your claim, and hope you don’t get audited later. What we’ve done with Genesis is make the document, create the claim. Meaning that what’s documented in your visit actually generates the claim, the codes, the diagnosis codes, the procedure codes, the modifiers, the time units, the diagnosis linking. All those things so that literally in seconds while you’ve seen a patient you can create, your claim is actually created, and it’s compliant, meaning that it’s actually supported by your document and submitted to the insurance company in real time. Then if for some reason you tweet something or things didn’t work properly, it’s going to go through a huge, huge rules engine where we have millions of validations, or rules, or artificial intelligence rules that are going to scrub that claim. This is not clearing house scrubbing. This is Genesis level scrubbing with millions of rules that we’ve learned, you know, tens of millions of claims over the years. All right? So now we’ve got the claims that maybe need a little bit of tweaking before they go out. Just focusing your team on correcting them if need be. The claim submission, like I just said, is real time. EOB posting is now automated, right? Secondary claims go out automatically, secondary EOBs come in automatically, and post. And then we’re going to talk about probably the most important difference with automation, using automation, to make sure you’re keeping those insurance companies accountable and make them pay the second, the first time, the first minute that you have something that you can legally do to make them pay as soon as possible. Making sure that comes right to you. What do I mean by that? We know, just go back and watch the previous videos, and how they’re legally allowed to create these laws and rules, and that we have 90, I’m sorry, 30 days to pay you and get an EOB back to you. Making sure that they pay on that day. Really we know that they should pay at the time you see the patient, or right after you’re finished seeing the patient, right? But we know the laws aren’t quite that way. So when we get that EOB back, if there’s something that needs to be followed up on, it has to be done that second. I’m going to show you how this applies to the follow up being done the second it’s due. It doesn’t just apply to insurance claims. It applies to every part of the patient life cycle. The no shows, the no future appointments, the care plans. I’m going to talk about that in other videos. But now we have identified the claims. I mean, we, the technology and the artificial intelligence, is actually
Going Cash
Hey, everyone. Dr. Brian Capra from Genesis Chiropractic Software once again. Tonight I am going to talk to you about going cash facts, myths, pretty straightforward, pretty simple, very misunderstood out there in the profession. I understand how we wound up in this situation. Tired of dealing with insurance companies, tired of submitting claims and following up on claims and dealing with having to resubmit claims and submit documentation and all the rigmarole. I understand it 100% why you’d want to quote unquote go cash. Quick quote from Ayn Rand. If you don’t know Atlas Shrugs, read the book, watch the … There’s movies now you can watch. So watch the movie. It’s really cool. “Contradictions do not exist. Whenever you think you are facing contradiction, check your premise. You will find that one of them is wrong.” So I’ve talked to a lot of doctors that thought going cash would kind of keep them safe and make it simple, and they wouldn’t have to document as much. They wouldn’t have to use the coding as much and all that stuff. But now we know that’s just not the truth anymore. State boards are requiring Medicare-level documentation and coding even for cash patients. So it’s not even the insurance companies anymore. This has become a standard of care. You’ve probably heard that kind of terminology before. Standard of care means it’s just required because you’re a doctor and it’s expected of you. So what does that mean? So let’s talk about going cash. Obviously insurance companies ideally never have to pay you, right? So we think by going cash and submitting superbills to pay or giving superbills to patients that we’re kind of playing along with the game. That’s not the game. That’s not what they’re looking to do. They’re going to have to pay the patient anyway, so that’s really not the problem. So there’s really no such thing today, and don’t shoot the messenger, as a cash practice anymore. There was a long time where you can kind of get away with that, but it’s just not the truth anymore. Number one, you have to submit claims to Medicare for Medicare patients. That’s the law. So right off the bat, I know a lot of the cash doctors say you’re cash, and I know you know that you have to submit to Medicare. So you just submit to Medicare and that’s it and everybody else gets a superbill. I understand that scenario there, but again, state boards now require Medicare … So number one reason that cash doesn’t really exist, you have to submit claims to Medicare. Number two, state boards now require Medicare-level documentation and coding even on cash patients. So you have to do it anyway. The only difference is whether or not you have to submit claims, follow up on claims, and so on. The third and probably biggest reason that there is no such thing as a cash practice is even if you give superbills to patients today, insurance companies can still come back and audit your documentation for those claims to support that it was actually done. So what they’re going to do is tell the patient this is denied, ask your doctor for documentation. If you don’t provide that documentation, you’re in trouble. If you do provide that documentation and it doesn’t support that, you could also be in trouble because what are they going to do? They’re going to report you to your state board, which in my opinion is an even bigger problem than an audit. You get audited, worst case, you have to pay a bunch of money back. Obviously there’s legal fees involved. That’s never … it’s not fun. There’s a big distraction. It’s a nightmare. But I would say a bigger problem is actually getting reported to your state board. Why? Because now it’s your license and your livelihood. So the insurance companies have figured out every single possible scenario to tighten the screws. You know, there’s the old Godfather quote, “Just when you thought you were out, they pull you back in.” That’s because there’s really no such thing as a cash practice. Now a little light at the end of the tunnel. The wrong question, what we should not be asking ourselves … I know how we, as this profession and how we think, we just want to save people, we just want to save their lives, we’re just trying to serve people. We just want to adjust. I get it. I’ve been in the same, you know, your shoes. I was the same way, except today the game is just a little bit different. Even if you want to see cash patients, and we work with CHUSA and other companies that do cash discounts, legally doing cash discounts. That’s great. When they are in the cash portion of their care plan. When they’re not and it’s medically necessary, insurance is still in the game. So that means the state board and/or the insurance company is in play. All right, so the wrong question is how do we see patients to avoid documenting and coding requirements? Can’t do it anyway. So that’s the wrong question. The wrong premise, right? Ayn Rand. You’ve got to check your premise. It’s just wrong. You can’t do it. The fact is we can’t do it, so state boards are now requiring it all. The correct question, what we should be asking, how can I see patients regardless of their payer, whether it’s insurance, because at some point in their care, they’re either insurance, they’re allowed to get covered by insurance or they should be covered by insurance or they should not, right? Meaning that they’re not in acute care or not in active care. So how can we see patients regardless of the payer and have systems in place that make it feel like, for the doctor, for you, for your team, like a cash practice as
How insurance companies use your money to audit other chiropractors
Hey Ron, Dr Brian Capra here from Genesis Chiropractic Software. We have gone over the past couple of days a couple of high level things about insurance companies and your collections and your revenues. Number one, insurance companies make their money by collecting interest on the money that they should have already paid you, and they should have already paid you the day you saw the patient, so there’s no reason why we should be waiting weeks for check from insurance companies. Number two, we learned that the whole system is actually rig to allow them to create this environment where they can not pay or not even respond to you for 30 days. There is no reason why they should be allowed to do that. In order to do that, they had to actually collude against physicians and that there was a law made to actually make them exempt from antitrust law, allowing them to actually rig this whole system and make all these crazy rules. Now we’re gonna talk about some of the tactics, the actual real life examples of what they are actually doing. Now that we know how they make their money and that they’ve actually ranked this whole system, you’ll start to see that all this is really nonsense. Remember, they should pay you the minute you’re finished adjusting a patient. There’s nothing preventing them technically from doing that. Let’s make sure we’re keeping that in mind as we go through these things. I’m going to go over just some high level tactics that they use. Just generalities first. Then we’ll go a little bit deeper in. Number one, they make it difficult for you to get the claim to them. We’ll talk more about that. They make it difficult for you to prove that the claim was necessary. They pay very slowly, or they actually just respond to you very slowly. Every time you send a claim or resubmitted claim, it’s a slow response time. They pay you less than they should. That’s very sneaky. I’m going to get back into that a little bit later. And then after they’ve paid you and the patient’s already out of the picture, they’re going to take your money back. I’m going to keep on going through here, a couple more things. Another thing that they love to do, and this is, again kind of, if you ask me, very sneaky, very subtle. They put themselves between you and the patient. If you think about it, the doctor has to make the claim properly, right? You have to submit the claim, and I say doctor, your office, whoever, you have to prove that it was necessary. It’s your fault if it takes too long for the payment to come for their care. It’s your fault if you charge too much or more than is the allowable amount in that area. And it’s your fault if this claim comes back later on and it wasn’t necessary and they accuse, and you have to go through an audit and accuse you of fraud, that was all your fault. And so you think about patients getting EOBs and calling their insurance company, and they’re being told, “Oh yeah, the doctor hasn’t submitted. Oh yeah, they didn’t prove necessity. We’re waiting for documentation.” It’s been taking too long. Were they charged? Why is there a balance? The patient’s asking the insurance company. They’re just saying, “Oh yeah, they charge more than we allow.” The first call, we’re lucky if they call our office for balances. Right? We’ve got to keep these things in mind as we go along here. Let’s dive a little bit deeper. What are they allowed to do? They have 30 days to pay. Ridiculous right off the bat. There’s no reason why that should happen. They should pay you right away. Nothing preventing, nothing preventing them from doing that. Each patient’s coverage is different. We have tons of different plans and groups and all this stuff. Why is that? Why is it so complex? It’s not because it’s better for patients. It’s because it’s better for their interest gained on your money. They’re just trying to drag out this payment cycle as long as they can. Complex coding. Right? I have a list here. Diagnosis codes. You know the ICD-10 came out. That made it a hundred times more complicated, literally. The order of your diagnosis codes, in some places in some carriers, actually matters. Which diagnosis code you put first. The CPT code, obviously, with different levels, right, so you’re 989 codes and your exam codes all have different levels built in for you to be able to tell them which level of service you did. Does it really matter that much? The modifiers that go along with this, the diagnosis code linking, the units. We have time codes. We have one on one codes versus group codes. It’s really, it really doesn’t have to be that complicated. It’s there and they always love to tell us, “Oh, it’s so that we can track the, the patient’s progress ,and we want to make sure that it’s based on the quality of the care that the doctor’s giving and then we’re actually paying for the right care.” Then you got the HCA form, which has 9 million fields on it, all of which have to be filled out perfectly in order for that claim to be accepted on the other side. Obviously technology is helping that out. Then you have the EOBs. Every insurance company has, when you get denials, there’s denial codes and that’s their explanation. Every insurance company has a different code and different explanation that you’re supposed to know. And so again, it makes it very complicated for you to just to figure out why things were denied. Probably one of the most sneaky things that they do, and this happens a lot and in Genesis we see this a lot. We
