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
How they are legally allowed to collude
Hi everyone, Dr. Brian Capra here from Genesis Chiropractic Software. Today I’m gonna talk to you about how insurance companies are actually legally allowed to collude against we chiropractors to actually keep our money, gain interest on that money and use that money to actually use it to audit more chiropractors, taking more money back from us. Last video I talked to you about how insurance companies actually make more than 50% of their profit on interest. Interest on your money. So they should’ve paid you right after you adjust that patient. There’s nothing technically preventing them from actually paying you at the time of service. They do not and then it, in most states, they have usually about 30 days to process a claim. Not necessarily pay you, but process the claim, right? They have actually been able to rig the laws in their favor to do this. They are actually protected by the law. I am going to share with you some secrets I have learned over the past 15 years while running a chiropractic billing software and chiropractic billing service company. I hope you enjoy this little nugget. So why is it that on Wall Street, way more complex transactions happen every single day, but yet it’s the law that everybody involved in those transaction must be paid before the end of the day. Why is it that the law on Wall Street, but not for us or we? So, there’s a very simple uh answer to that which I can’t bel- I couldn’t believe it when I found this out. It turns out that insurance companies are legally allowed to collude against physicians. So, it’s not really just us, it’s everybody. Every physician. The, actually the entire healthcare uh, profession or industry. Insurance companies are allowed to collude. We’ve heard a lot about collusion these days, right? Um, you know in politics. This is actually real collusion. This actually happens and it’s, by law it’s on the books. It’s, it’s no secret out there. As a matter of fact, if doctors were to all get together, if every chiropractor in the country were to get together and say, “From now on, adjustment is for whatever code, is $60.00 and we will never take less.” That’s actually illegal. That’s called a monopoly, right? You may remember Microsoft went through a massive what’s called antitrust case back in the day when they were seen as having a monopoly on the personal computing world, right? Um, it’s, it’s a real thing in a uh, capitalist economy that a company by law cannot monopolize an industry. They can’t be the only provider of a good or service and once they do that, they have so much power that they have full power over dictating the price of that good or service. So that’s, that’s against the law. It’s called antitrust law, it’s very well documented, you can Google it and you’ll find a billion different antitrust cases. It’s very important for it to be there in our economy. Um, so what insurance companies have done is the opposite of, of what is a monopoly. A monopoly again is provide, is being the only provider of a good or a service, product whatever, what have you. Inscur- insurance companies are the opposite of that. There’s a word for it, it’s called an oligopoly. Google it – oligopoly. Um, and what you’ll notice is that, that’s when there’s only one buyer of a good or a service. Right now, over 70% of lives in this country are covered by three insurance plans and you’ll probably know if you’ve done any reading on this, every time a little insurance company pops up, they get gobbled up by one of the big dogs out there. And in doing so, since there’s only one buyer out there of chiropractic adjustments if you would, one payor, um they dictate the, the the price of an adjustment and obviously you’ve seen what happens when that, when that’s the case, your payment or reimbursement continues to go down over time. God only knows what would happen if we had a single payor system um, and left it all up to the government. ‘Cause here’s what actually happened. So, we wanna know why we don’t get paid right after our adjustment when technically that could happen, um, and probably save everybody a whole lotta money. And why the insurance companies want to be able to wait 30 days to process a claim and then have a denial process and hopefully you never remember to, to get that claim, to follow up on denials… Hopefully they make the co- the process so complicated, you never even submit the claim to begin with. That’s actually happening. We’re gonna get more into the tactics that they actually use to make the, to drag out the timeline for a claim to be processed in my next video, we’ll go into very specific tactics. In this video what I want you to understand is that it’s actually legal for insurance companies to collude. Why do they wanna collude? They wanna control the market, gain the profit and continue to use that money to reinvest in their own company and in lobbies. Once they have the lobbies, once they have the collusion and the power, they lobby to gain the law and actually legally in 1945 gained one of eh the only industry or one of the only industries um exempt from antitrust law. So insurance companies are one of the few and only industries in the country that are exempt from collusion. The antitrust laws that everybody else in every other company has to abide by including chiropractors and physicians, all physicians across the country cannot do what insurance companies do to us. It’s a pretty amazing fact. So, what do they do? They can collude, they consolida- they collude by consolidation and gain power. Once they gain the power, they can
The #1 way insurance companies make their profit
I want to talk to you today about what insurance companies really don’t want you to know. And then I have a checklist. We’re going to go down 10 things. I’m just going to cover one today. And I think, when you understand this one thing, you’ll probably get, and understand, that there’s a lot more to it than you realize. So, what insurance companies don’t want you to know. When I first started chiropractic, first of all, I own Genesis, a software company and chiropractic billing service. Scheduling, documentation, billing. We’re a billing service, I own a billing company. When I started chiropractic and chiropractic practice I had no idea about anything about billing, coding, documentation. Audits were just starting to happen. But I quickly realized what a big need that was. So I started to dig in and I actually went out and found some people outside of the chiropractic profession, in the finance world, in the technology world, in the artificial intelligence world, that’s how I wound up with Genesis as a company. But what I started to realize is that insurance companies are just like every other company. They’re made up of people, process, and technology. They want to turn a profit. But what I did not realize is how they actually make their money. I used to think that it was just simple. They collect a bunch of premiums from patients and they don’t pay insurance claims. That’s of course one way, but there’s actually much more to that. When we’re talking about how they make profit, over 50% of insurance company’s profits are made on what is known in the financial world as the float. Float is interest. Float is interest on money that is not yours. In this case, your money, the chiropractor’s money. So the insurance company is making interest on your money and it’s not their money. When is is not their money? It’s really interesting because in the real world, on Wall Street for example … again, my partners today, in Genesis, are from the financial world, from Wall Street in technology. On Wall Street, every time a transaction happens on Wall Street, by the end of the day everybody has to get paid. All the parties involved in any transaction and on Wall Street, a transaction can be infinitely more complicated than an insurance claim. Diagnoses codes, procedure codes, all that good stuff seems complicated to us, but on Wall Street they’re way more complicated and by law everybody has to be paid by the end of the day and the technology exists to make that happen. So you understand the technology exists today for you to be paid the moment or the moment after you’re finished adjusting the patient. All right so, when you start to realize that insurance companies are actually making more than half of their profit on the interest that should be on your money. The interest on your money. Meaning, after you see the patient, that next moment the money is technically yours. Everything after that is bologna. We’re going to start talking about all this stuff in a little bit more detail and how they actually … First of all, think about these things. How do insurance companies get to rig the system so that they have thirty days, for example, to pay your insurance claim? Why are there diagnosis and procedure codes? Why are there modifiers? Diagnosis code linking? Why is there the ability to deny your claim, medical necessity, documentation? Why does all that stuff exist? So, what I’m going to start to talk to you about over the next few days is all the little details that we take for granted as we think is normal, or they should be there, or it’s for the patient’s benefit, or medical necessities all about the patient, or about the performance of the doctor, or about the results that you get is really a bunch of nonsense actually. Actually the moment that you adjust that patient that money is yours. Insurance companies make more than half their profit on interest on your money. So I’m going to talk to you about, again, over the next few days, the top ways they’ve actually been able to rig the system, put this in place. Then eventually, maybe I’ll get into a little bit more about Genesis and how we’ve actually … helping doctors leverage technology, and automation, artificial intelligence, and processes, and people to actually beat them at their own game. We’re the only company that’s been able to do that with artificial intelligence patented. Not to talk about Genesis, I just want to help you understand how insurance companies, what they’re really up to. It’s a business and it’s their right to run it and the rules are what they are so if we want to change them, we either got to change the rules or we got to learn to learn how to play by the rules and beat them at their own game. Hope for this was a little bit helpful. Again, insurance companies are making more than half their profit on interest on your money sitting in their bank accounts.
3 mistakes when buying software
Hey everyone, Dr. Brian Capra here from Genesis Chiropractic Software on a beautiful Saturday, June 1st, 2019 down in Boca Raton, Florida. Some things came to mind today as we finished up the month. Today, I wanted to to just quickly throw some ideas out there on just some of the mistakes I see people make when they are buying chiropractic software, the biggest decision making process mistakes that I see the doctors make. We’ve been really enjoying just an amazing growth rate at Genesis. I mean, I think a lot of it has to do with people’s just finally getting what it’s all about to be in the cloud. That used to be a thing that people were worried about, and today it’s the first question they ask to make sure that we are in the cloud. We pioneered a chiropractic software in the cloud. We started that over over 15 years ago, so finally people are coming and making sure that you’re in the cloud today, opposed to the past where they were worried if you’re in the cloud. So we’re growing like gangbusters but just like your practice probably, you finish your month, let’s say, and you look at your numbers and you see all the new patients that came in and you wonder why, you know, the people that converted and then you want to know what happened to the ones that didn’t. Just like your practice, not everybody’s a fit for Genesis. That’s okay, but it’s the ones that you know that could have benefited from what you did or what you do but didn’t sign up, so it’s always frustrating for those people. Like, what were they thinking kind of stuff. I always analyze that. I’m obsessive about that kind of thing. There’s a few mistakes I see very, very commonly made. We’re talking about a software that runs your entire practice, every process and detail in your practice. This thing is supposed to automate. It should save you or even increase your income, increase your revenue. It should make things way more efficient, so it should save you and your team lots of time. It should give you peace of mind when it comes to compliance. I mean, it should improve your patient retention and your patient experience, and decrease the number of no shows and patient attrition, and increase your patient referrals. That’s what it should be doing and what I find surprising, probably one of the biggest, if not the biggest mistakes I see people make is rushing through the process. It’s really strange. Here’s what I think happens. I think you get the idea something frustrates you about your current software. You know, you get that pain just like your patients do, and you right away it’s a rush to find a better one. I know that people are rushing when the first question they ask is how much it costs. It’s kind of like when a patient walks in and they’re like, “Well, how much does it cost?” And you’re like, “Well, I don’t even know what’s wrong with you yet. I’ve got a lot of work to do once I assess,” and you’ve got to go through that song and dance and try to have a reasonable conversation. Well it’s like, you know. This is the software that if you’re going to make a decision, even if you want to make it relatively quickly in the next month or so, this should be the last time you make that decision. Probably the reason you want to leave the software you have is because either you’re rushed and weren’t sure that this was really the right fit for your practice or the software is just outdated or something like that at this point. You want to make sure that the software is the right fit for your practice, so you really want to give time. One of the things, every software has a calendar, and a scheduling system, and a notes system. We believe our systems are better for those type of things, the feature for feature, but what makes it unique? What makes Genesis unique, for example? Don’t you want to take the time to learn what makes this different so when you’re comparing, yeah, you want to check those boxes off: scheduler, documentation, billing, let me see the billing. But you want to know what makes this thing unique and what’s frustrating for us at Genesis is that not that we don’t get the opportunity to tell people about us, it’s that they don’t get the opportunity to know just because they’re rushing. They don’t even want to get on a phone call. They don’t have time for a 30 minute phone call to learn. So, one big mistake is the rushing process. Take your time, do your homework. One of the things we do for our prospects is actually go through in detail asking you lots of questions about how you practice, what types of processes you do. What type of practice? Are you a family practice or a PI practice? Are you a workers’ comp practice? Do you want to go high volume, lower volume, maybe you’re more of a nutrition kind of consultation type practice or more cash as opposed to insurance. We take a good amount of deliberate time to make sure we understand what it is exactly that you do. You know, a lot of software companies are going to cater to the fact that they know you’re in a rush and they expect that you think that you’re going to make a decision on one call, so what they’ll do is feature dump on you. Feature dump, feature dump, and and all the bells and whistles, and you don’t get into the deeper questions that they should be asking and that you should be asking, give you a quick price at the end and a special promotion, and hopefully close
