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
People Process and technology and the audit
Hey everyone, Dr. Brian Capra here from Genesis Chiropractic Software and Billing Network. Tonight I’m going to talk to you about how insurance companies leverage people, process and technology to beat the heck out of us and really kick us when we’re down, take our money and use it to audit other chiropractors. People, pretty simple one actually, a lot of their work is outsourced. We’re going to talk about automation with technology where they’re able to actually automate so many things where they don’t even need people. But when they do need people and you call, who do you get? You’re actually talking to somebody in India. So what do you think they’re paying them? They’re paying them maybe a dollar an hour. They’re paying them for your team member to call them. Hopefully it’s not you because it’s even worse if it’s you. But if you have a staff member calling them, maybe you’re paying them whatever you’re paying them, 12, 13, 14, 15, maybe more dollars per hour. That’s what you’re competing against. That’s the cost that they know they’ve got you beat as soon as you pick up that phone. Just by picking up the phone, you’ve lost. That’s the simple of it. That’s people, super simple. Process, let’s talk about your process. I have some notes. So forgive me if I’m looking down at my notes. Let’s talk about your process versus their process and how much manual labor there is on your end and how much manual labor there is on their end. Remember now, you’re paying somebody 15 bucks and hour. Let’s say they’re paying somebody nothing, well very little relatively for their manual steps. Let’s look at how many manual steps you have compared to them. So manual steps, benefit verifications, pre-certification, hunting and pecking for codes, modifiers, diagnosis code links, units, ordering your diagnosis codes, all that beautiful stuff. Documentation of your visit, submitting the claim, correcting claims that were wrong, posting EOBs, submitting to secondary insurance companies, finding unpaid, underpaid and denied claims, calling and following up on those claims, submitting supporting documentation when they ask for it, resubmitting claims, collecting patient balances, which is like a job in and of itself. Think of all those manual steps. You would need somebody to do them and you’re paying them whatever you’re paying them per hour. Let’s use 15 bucks an hour as an example. Now let’s look at the insurance company’s manual steps. Again, they’re leveraging all these things. Every business is made up of three things, people, process, technology. All they do is say, “How are we going to make it cost way more in people,, process and technology for the doctor than it will for us?” Not to mention, they have unlimited money. So let’s look at their manual steps. Answer the phone, when you call to follow up for an unpaid, denied underpaid claim, if you call, or if you call for benefit verifications, or if you call for pre-certs, then the other manual step is auditing you. That’s pretty much it. Why? Let’s talk about technology. They, again, have unlimited money and they have a huge database of doctors submitting claims to their database. They have massive amounts of money to invest in technology which includes automating all those steps, automating certain steps, and then using artificial intelligence to find the doctor that’s most likely to lose an audit. They look for trends. They look for trends in claims, your codes, your documentation, your follow up on claims, denials and underpayments and all that, or lack there of, if you don’t follow up. They automate the claim receipt. So they’re not actually having somebody receive a claim anymore and then process the claim. It’s just getting to them and it’s being processed through their technology in an automated way. They’re automating the claim receipt, the denials, the payments, the underpayments, the pre-certs, the ID of candidates for audits. So they’re automating all of that. Forgive me, I just lost my page here, so give me one second. They’re automating also, identifying the candidate, the people who are most likely to lose an audit because they have all of this mass amounts of data. This technology is spitting out, “Hey, this is the list of doctors that are most likely to lose an audit.” The insurance companies are not paying people to audit you. They’re not paying auditors in most cases. Those auditors are paid a percentage of what the actual settlement will be. There’s no loss for them. They don’t lose money, other than the technology they’ve invested in, once they find you and outsource you for an audit for the most part. I don’t want to oversimplify that. There’s a little bit more details. For the purposes of this video, just want to make sure you understand that once they outsource that and that person is getting basically a commission on your audit. Then there’s the audit, and now you have costs associated with that for yourself. Obviously, just the costs of hiring a legal team, but how about the fact that they send letters to patients saying, “Hey, FYI, your doctor is being audited.” How about a new patient killer or practice killer and attrition risk for your practice where patients are getting letters from their insurance companies saying, “Hey, your doctor is getting audited.” I’ve heard stories of clients that went through audits before they joined Genesis where they actually showed up at the patient’s home and knocked at the door at night waking the children up and saying, “Hey, did this doctor do this? Did you get these services at this doctor’s office? Because they didn’t support the proper documentation.” Just showing up at the patients’ houses. You also obviously have the legal defense. Those expenses are going to climb. You’re facing losing your license because once you get audited, there always a chance that … The best case is
Checkers Vs Chess intro
Hey, everyone, Dr. Brian Capra here from Genesis Chiropractic Software. Thank you for joining again. This is really starting to gain steam here. If you’ve been watching the other videos you know where I’m headed. If you haven’t, go back and watch at least the past six or seven videos. This is really going to start to come together for you. So there’s a very famous quote. We use it all the time in chiropractic. “We can’t solve problems by using the same kind of thinking we use to create them.” This is no different. We used to think that… Well, for a while, there was no insurance. Then we thought it was a great idea to take insurance, right? The Mercedes 80s, we’re making lots of money, so that was a good idea. Then we thought it was a great idea to go all cash. And somehow that made us more principled than other practices. Now we know that there’s actually no such thing as a cash practice. If you watched the other videos you’ll know what I’m talking about. I won’t reiterate that right now. But, yeah, there’s really no such thing as a cash practice as far as what you need to do. The truth is, we just need to do what’s right as doctors. And what does that mean? We need to document our visits. We need to code our visits and charge patients accordingly. And then we have to collect everything that is rightfully ours, whether that’s a cash visit or insurance visit, no matter what the case may be. This is not about collecting more money. This is about what’s doing right. This is about doing what’s right. So, so what? We didn’t get to make the rules initially, right? But we have to use our experience to learn a better way, just to start thinking differently, just like Einstein said. Just start using our brains, and take a step back, and not make rush, emotional decisions. Go insurance, go cash, what have you, all of the time. Every time you rush in one direction or another, what happens is, ultimately, our profession, our doctors, wind up in more trouble, and we don’t want that. We just want to do what’s right. We want to do what is going to free us up, what we love to do, take care of patients, serve more patients, save more lives, turn people onto chiropractic and what it really does for people, be able to serve that purpose in our lives. This is a nuisance, right? For sure, documentation, coding, billing, all that stuff is a nuisance. But there’s a better way to do it all. First it starts up here. We have to start thinking differently. Every business… So this is part of that. Every business, especially the biggest businesses in the world, every business is made up of only three main components ever, three, okay? One, people, I’m not going to go into details right now, but I’m going to go into this later videos, people. Two, processes. Three, technology. So our goal is to beat insurance companies. And as we know, state boards… Go back and watch the other videos so you know what I’m talking about. You want to beat insurance companies, you want to beat state boards at their own game. We’re not going to play tricks, we’re not going to use shortcuts, but we’re going to beat them at their own game. And if we’re going to win, here’s a thing, they’re playing… And by the way, state boards are really just a proxy for insurance companies in a lot of ways, okay? But they’re playing chess, while we’re playing checkers. So, if we’re going to beat them at their own game, we have to start playing with chess pieces. And, again, those three main pieces are people, process, and technology. So in the next few videos, I’m going to talk about the three main pieces, and go into more depth of what that actually means in your practice. What does that actually mean when you’re trying to win? And what seems like an insurmountable goal, we’re going to do it. We actually are already doing it. Just got to understand the principles here, just like chiropractic, it’s a principled thing. It’s never wrong, okay? So we’re going to use their own methods and methodologies to beat them at their own game. We’re going to use coding and documentation. They made the rule, we’re going to use it to beat them. I’ll get into more depth about that. We’re going to use technology, their technology, against them. And we’re going to use their manpower, their people, against them. So stay tuned. This is a short video tonight. I’m going to go into more depth about this. So stay tuned. And this is where it really starts to get good, if you ask me. I’m biased, this is my own video. But this is where we’re really going to start to talk about it. These are things you’re not hearing about. Genesis Chiropractic Software and Billing Network, it’s not about software, it’s not about billing, it’s about giving you freedom from these shackles of insurance or cash or what have you, constantly worrying about whether or not you’re going to wind up in trouble for what you’re doing. I’m going to start talking about the principle we’ve used and how we’ve used it. And I’m going to start talking more about Genesis in these videos, so don’t be alarmed. I’m not trying to just self-promote, but I just want to help you understand how we’ve done things and how some of our doctors are benefiting. So I appreciate you joining, appreciate you watching these videos. Thank you, everybody. I can see you guys joining and liking and thumbs up. Please keep on coming on. Comment if you would, I would appreciate that, and share this with your friends. Thank you
