Chiropractic Practice Management and Quality Time in Our Marriage – Kestner, DC
Hi, I’m Dr. Jason Kestner, my wife and I are currently in a practice in Nashville, Tennessee and I know a lot of people probably talk in terms of finances and what Billing Precision does for them. We’ve both been with Billing Precision now for about three years ever since we’ve opened our practice and in terms of truly understanding what it does for us actually in our adjustment base, you can actually do the notes in that right there you know while the patient’s in there. So that just makes it to where after hours you’re not having to sit down and spend hours doing this and when I look at it from you know not necessarily from a financial standpoint but from just what it’s done for our marriage because now we have quality time together, that’s just amazing. So you know I can almost thank Billing Precision for our marriage in a sense how great it is but with that said you know it’s just been really easy in terms of working a practice years ago and we had that note, the card notes, travel cards and just to have to try to keep up with those, it was just insanity. So now it’s just made my life easier, my wife’s life easier, and it’s just been great having Billing Precision on board. The Billing Precision software has been re-branded as Genesis Chiropractic Software.
Billing Network Effect – Dr. Chris Zaino – How Billing Precision Levels the Playing Field with the Insurance Companies
Dr. Chris Zaino says, “There’s a lot of things that are involved in building a great successful practice but there’s a lot of things that kind of get in your way and one of them is insurance.” A lot of times the insurance, the whole insurance structure of collecting money or working with it even though we want to use it when we can, and our patients want to use their insurance. The whole game of the insurance scheme is tilted in their favor. So that when it comes to profiting you might think, oh they make their money off the premiums. OK but it’s not the premiums alone. It’s called the float and the float is that, that they’re holding the money, delaying payments so they could put in, get interest, or reinvest it, and it will make 50% of their profit. Then add auditing. You know their audit is about, for every dollar they spend, they’re going to make about 13 dollars back. They statistically know this down to a science, they have a science to this. So if you’re just a local practitioner and you don’t have the right team involved with this, getting those funds back to where it should be, which is in your hands. This is what’s happening, so this is why you need a, really a trained force to do so. Now you finally realized what’s really going on. Sad part is you could look back, and even that billing person you have, I know they’re great and they’re wonderful but you realize that you’re absolutely unqualified to really deal with this and it’s impossible to do it alone so…but here, Billing Precision we’re going to level the playing field. The only way you could do that is having a sophisticated technology and automation using a massive group of people. They’re doing tens of thousands of claims and you’ll never know when Medicare or any type of insurance company starts to tweak their system. The only way you could tell is by looking at trends and immediately you could see that trend start to happen and once they find that, they know exactly how to counter it and level the playing field to your benefit. –Dr. Chris Zaino
Is Your Chiropractic Practice Management System Built Backwards? Part I
By Dr. Brian Capra In my experience managing billing operations for over 300 practices across the country seeing between 100 and 1500 patient visits per week, I have had the opportunity to see the best of the best chiropractic practice management systems. https://youtu.be/Ru04iTKFp3I The more I see the more I realize they are all built in the same way, however different they seemed on the surface. They all had the some or all of the following components. Scheduler Notifications SOAP Notes Custom X-rays Paperless Electronic Billing Component Care Plan Management While every good chiropractic practice management system should have all of these components, the above mentioned features are relatively easy to build. There are some much more complex issues that face today’s chiropractic office. If the doctor does not have a system, technology and people in place to handle them effectively it could cost him not only tens or thousands of dollars but possibly criminal investigation and jail time. These Issues are: Maximized Insurance Collections 100% Transparency into the billing process (weather in house billing or with an outsourced billing company) Audit Warning System (Post Payment Insurance Audit) Compliant SOAP Notes and documentation Practice automation in order to decrease staff overhead Today Insurance billing and collections is simply becoming infinitely more difficult with each passing year. Insurance companies are not only making things more complicated with copays, deductibles, coinsurance, allowables, medical necessity, etc. but they are also changing the rules as they go. They change diagnosis code hierarchy without warning. To top it off the changes are not the same state to state or in some cases region to region. They randomly change the allowable rate. Without technology in place to tell you when any one of these things occur any biller can and will be easily overwhelmed as changes occur faster than they can stay on top of them. The bottom line is decreased overall collections and an accounts receivable that spirals out of control.
Chiropractic Office – Billing Precision Building a Successful Practice – Dr. Troy Dreiling
A lot of doctors ask questions like why is growing a practice so hard? Why is taking care of patients so hard? And there are three things you really got to focus on. Number one, we got to focus on treating the patients. Number two, we got to focus on growing the practice well, how you do that; marketing and different things like that to grow the practice. And then lastly is getting paid and being in compliance. We love treating patients. As doctors we just love to treat patients; that’s why we got into chiropractic what we got into this profession to take care of patients. We don’t care if it’s hard. We love to serve the patients but there are some skills we’ve got to work on and focus on and develop so we can continue doing what we love. So growing your practice is a learned skill, you just don’t come out of school open the doors and patients flood to you. You’ve got to develop how to grow and how to focus on implementing and growing your practice. Getting paid, that’s a challenge in today’s economy and market, getting paid for your services. Some of the patients don’t want to pay; they don’t want to pay your full fee your full service. Insurance companies don’t want to pay. Well speaking of that, insurance companies make money on the float, meaning, you’ve taken care of the patient, you’ve provided services and if you’re billing insurance they get paid or they make money on floating the money that they owe you and, you know, the game is interesting. It’s stacked towards the dealer, meaning the insurance company, they do different things to help them hold on to their money so that they don’t have to release it to you, after you’ve provided the service, you’ve worked hard, you’ve taken care of the patient, the patient is satisfied, but yet they’re floating the money they owe you. That’s why if you want to succeed, if you want to save more lives, if you want to help more sick people get well in your office, we have to have the documentation system, that’s no nonsense, that’s fast, it’s compliance. Secondly, we have to have a scheduling system that can keep patients on track, that can help you see what people are missing. And then lastly, we want to level the playing field and at the end of the day know and rest assured that that billing is going to be taken care of and that check’s coming in the mail sooner than later, not on the float, not on the time that they send you paperwork to try to, you know, slow down the claim but you know you’re on top of your game. – Dr. Troy Dreiling
Dr. Chris Zaino – Changing History One Patient At A Time – Part 2
Dr. Chris Zaino chose Billing Precision because it was developed and will continue to evolve with these values in mind. He chose it because it gives him the best chance at accomplishing his goals and living up to the responsibility he has been entrusted with. Specifically, Billing Precision ensures that no visit gets left behind: That with every missed visit, the practice is alerted in real time. The Visit itself is never deleted unless the patient is discharged. When a patient is contacted for missed visits there is a log of each call and reason for missing. When the patient comes to the next visit the system alerts the staff and the visit is rescheduled. This means the missed visit is physically moved from the missed date to the new date. In some cases Dr. Zaino has the patient come back later that day. Worried about a patient slipping by the front desk? No problem the doctor has a missed visit warning system at the table. When he sees this he apologizes that the staff let them get by without rescheduling the visit and how important it is to make that visit up. Dr. Chris Zaino refocuses the patient, wlaks them to the front desk and makes sure that visit is rescheduled. When a patient becomes a habitual misser, Dr. Chris Zaino makes the decision. Typically he will have a refocus session with the patient and remind them of goals and each others roles and expectations. When a patient continues to miss it is handled on a case by case basis. Often Dr. Chris Zaino will dismiss them from care. When you have systems and technology in place you keep both the doctor and patient accountable. If and when a patient is discharged because of the inability to meet the expectation they do not leave with a bad taste about your practice. They leave knowing that whatever result they did get was proportional to their commitment, not to the efficacy of chiropractic or the congruency of the practice and its message. They realize you are for real and are not only more likely to return but many times these patients will refer others that they think can commit to getting results. Dr. Chris Zaino explains how closing the “back door” allows him to spend less time getting new patient to replace the ones they were losing and focus on the delivering the highest quality care and patient experience possible. With a practice this size billing, collections and compliance can be almost impossible to manage. Having one integrated technology, process and billing service that manages your patient lifecyle, is vital at any volume. With the increasing complexity in coding rules, ever growing insurance audit business, and busy lifestyles of patients, not managing any one component will lead to lost efficiency and revenue. Dr. Chris Zaino explains how his practice was “gushing blood” in all areas and how Billing Precision has helped stop the bleeding. Some important aspects of Billing Precision which allow him to do this are Real Time Billing with integrated compliance and coding warnings at the table Table-side documentation that can be updated in real time in under 10 seconds No show management and automated patient check in Web based transparency to all practice, billing and compliance statistics 24×7. Care plan management including expected collections threshholds and reports. Full audit trail of all actions taken by practice staff and/or Billing Precision teams Integrated credit card and recurring payment tool Email marketing campaign manager. Automated appointment reminders. Many thanks to Dr. Chris Zaino, Whitney Zaino and their amazing team at Abundant Life Chiropractic. We are excited to be even a small part of mission as big as this.
Dr. Chris Zaino on Patient Compliance – Changing History One Patient At a Time
Who is Dr. Chris Zaino? This video is one of the best introductions: It is essential to the survival of a practice and chiropractic in general that doctors realize how important it is to manage the patient experience and perspective of their care. Too many times doctors spend all of their time focused on education and the initial “conversion” of the patient and forget to stay congruent with the message they sent. This alone will force patients that would have otherwise been great, referring patients, to second guess their decision to choose chiropractic care and its efficacy all together. When a patient misses an appointment and it is not met with a sense of urgency by you and your staff, a subconscious or conscious message is perceived by the patient that there is no real value in the adjustment. The value is decreased, they will not get results, their interactions from that day forward with everyone they meet will never be what they could have been. When we keep our patients accountable to the care we recommend the opposite is true. In either case history is altered and shaped. It lies in the your hands to make sure you do the most with the opportunity to shape history for the better. The way you train your team, develop procedure, and even the technology can make all the difference. Having “bad systems” or no systems cost millions of dollars and destroys the patients perspective of chiropractic and alters history. Dr. Chris Zaino understands these facts better then anyone I have met. Spend 2 minutes with him and you’ll know it. More to come…
Chiropractic SOAP notes – Audit Risk and Billing Management – Dr. Troy Dreiling
I want to talk about why SOAP notes and your documentation is so critical and why we need it fast. In a high volume busy office, it’s important that you’re on top of your documentation. You know, so many doctors spend more time documenting than the visit takes, which can delay the process of submitting your claims, actually can even throw you into an audit or a compliance risk, and so being able to document fast, effectively, and efficiently is key. A third of all doctors in our profession will be audited this year and so it’s important to be on top of your documentation every single day so that you don’t delay your payments, you don’t set yourself up for an audit risk or a SOAP notes compliance violation. So Billing Precision solved this huge problem by eliminating reading and writing. So when your patient comes in to the adjusting room it comes up on the dashboard, you just hit a few buttons touch screen everything’s eliminated, reading, writing, it’s all there, so now your documentation takes ten to fifteen seconds. You can bill at the table, stay compliant, and stay on track. The billing’s done right there at the table. This changed my practice; better yet, the documentation has audit, proof, notifications built-in. Did you bill this diagnosis for a number of visits, have you billed the same procedures, have you changed things, are you in compliance with different insurance companies, it’s all built-in into the system. So if you’re interested in documenting on the fly fast being compliant, keeping on track with your patients, making sure the money’s there, go ahead and check out Billing Precision, go to their website, schedule a consultation and meet with a Billing’s specialist to see if Billing Precision is right for you.
Chiropractic Billing Expert Interview – Dr. Brian Capra – Part I
Dr. Brian Capra, a graduate of Life University, has been a practicing chiropractor and office automation expert. He routinely visits chiropractic offices around the nation while receiving raving feedback from his clients. The following two-part interview with Dr. Brian provides a behind-the-scenes look at his work. Yuval: When did you become interested in chiropractic? Dr. Brian Capra: I became interested in Chiropractic just before graduating with a bachelors in biology. I have always enjoyed studying complex systems. I loved learning about how life is formed and how amazingly efficient is the human body. Most business systems are crude approximations of the amazingly efficient systems in the human body. Chiropractic maximizes that innate intelligence to do what it understands infinitely better than any human mind. To think that we can outsmart this intelligence with a pill, potion, or lotion is naive. Removing interference and maximizing the potential of life, relationship, or business is what has intrigued me most about Chiropractic. Yuval: What attracted you to office automation? Dr. Brian Capra: The human body uses automation to manage millions of processes every second. The autonomic nervous system is a good example. Imagine having to memory-manage every heart beat and breath throughout your day. That job alone would keep you so preoccupied you would forget to go get food and water for you survival. On the business side, the insurance companies continuously add things to manage to the practice. If these new things are memory-managed, the efficiency of the practice suffers. Ultimately, patient care, practice capacity, and profitability shrink. I’m concerned about where chiropractic profession is going in terms of profitability. I feel like most practice owners are indifferent and apathetic, while the ship is being steered by people who do not have our best interests at heart — out-of-control payers and incompetent billers, to name two. We are at an absolutely crucial and unprecedented point in our history where technology enables the insurance companies to underpay us, profile us, audit, and take back the little money was paid … But many billing companies do not have the processes, the technology infrastructure, or the talent required to face the challenges posed daily by the insurance companies. And the practice suffers substandard reimbursement, overworked practitioners, burnout. I can’t tell you how many times I have heard a doctor say “how can I keep up with notes, billing, etc.” The answer is simple: use your chiropractic training, use the principles that keep your own body functioning. Yuval: Why did you decide to start Billing Precision? Dr. Brian Capra : The simple reason: I needed a billing solution for my own practice, I experienced second rate service first hand for too long, and I knew of no solution that would be good enough for rapid development of my practice and that I could trust to change as the insurance industry changed. I knew that lots of people feel the same way but I could not wait anymore for somebody else to do it for me. When I graduated, I went to learn from some of the most influential doctors, including Dr. Lerner, Dr. Loman, and Dr. Nalda. In addition to outstanding clinical training I also learned from them how to approach building and managing my own practice. I learned the importance of discipline and the potential of adequate infrastructure. I also saw how frustrated they were with the lack of integrated solutions: everything about running the office seemed to require memory-management, from scheduling the patient, to tracking care plan compliance, to managing outstanding balance. I feel that most practice management solutions are built backwards or incomplete. They just keep reinventing the wheel. Another Scheduler, Custom notes, Automated check in. My feeling on this is SO WHAT??? Is the system checking you for compliance? Is it making sure everyone is billed? Are your notes really going to protect you against an audit? A good system must also manage patient education and community outreach. Part of our mission is to bring an industrial strength billing service and a practice management system, including a patient relationship management system, and help build the overall patient capacity of the practice.
Billing Payment Delays – #1 Payer’s Tactic to Increase Insurance Profits at Provider’s Expense
Q: Do insurance companies benefit from payment delays? A: Yes, they do. Payment delays are directly proportional to profits: the longer is the delay–the higher is the profit. In some cases, half of their profit margin originates on the float, such as Aetna in 2006: Premium 7% Interest on Premium 7% Total 14% Insurance companies have often accused doctors of submitting incomplete and inaccurate claims and justified the delays because of the time needed to discover fraudulent claims. But some states found plans guilty of and penalized them for intentionally delaying payments in order to profit from the “float”. For instance, as early as in 1999, United HealthCare paid Georgia $123,000, and Coventry HealthCare of Georgia (formerly Principal Health Care of Georgia) and Prudential HealthCare Plan of Georgia – nearly double that amount. A quick review of basic insurance financial performance metrics helps understanding the above dynamic. An insurance company offers clients a premium based on the expected cost of caring for them, plus a markup for administrative costs and profit. Accordingly, most analysts use three metrics to measure payers’ financial performance: Administrative Cost Ratio (ACR): The ACR is the ratio of administrative and sales expenses to the total income from premiums. Medical Loss Ratio (MLR): The MLR is the ratio of medical expenses to income from premiums. Investment Ratio (IR): The investment ratio is equal to net investment income divided by revenue from premiums and fees. For example, Aetna showed the following performance in 2007: Premiums and fees $25,500 million MLR 72% ACR 21% Combined Ratio 93% Implied Operating Margin 7% Note that other factors also influence profitability, especially legal fees. But an insurer can actually turn a profit even if the cost of administration and insurance claims exceeds the premiums it collects. It does so by investing income on the float in stocks and bonds between the time when a client pays a premium and the time when the client needs payment for his or her medical expenses. In the above example, adding up MLR and ACR, we see that without any investment, Aetna would earn 7% profit on its premiums alone. Nonetheless, Aetna does take advantage of the float, and earns about 7% net interest income on the premiums, bringing its total profit margin to around 14% (ignoring taxes and other revenue sources). References: Annual financial statements (wikinvest.com/stock/Aetna_(AET) September 24, 2008) Wayne J. Guglielmo, “Prompt-pay laws are finally getting teeth,” Medical Economics, Jan 22, 2001).
Chiropractic Patient Compliance – Patient Loyalty Management – Dr. Troy Dreiling
Let’s talk about managing your practice and growing your practice and looking at patient loyalty. That’s key. If you have loyal patients, that’s going to help you keep a stable practice, keep a solid practice. It’s going to help you grow, going to help you provide better for your family, have a great living. Three things. Number one, appointments. You got to have patients, and they got to have appointments whether it’s twice a week, three times a week, daily. You’ve got to keep on track with those. If they’re missing, billing precision will let us know they’re missing. We follow up 15 minutes later with a phone call. We can put a note in there. We can reschedule them for the next day so we can keep on track with the patient’s commitment to your visit frequency. So, a patient no-show is not just a missed visit. It’s a loss of compliance with the patient. It’s a loss of patient loyalty, and it’s a downturn. And so, the key with billing precision is managing those no-shows. The system does it very easily, very simply to keep us on track. You’ve seen a high volume of patients. You have a 120 schedule and a 30 missed. I mean that’s 25% of your practice that disappeared that day. Secondly is if they are missing, we can track that. We can follow, and then, we can look at patient loyalty and see where they’re going. You can also set up patient call reminder so you’re reminding patients automatically of their visits. So, you can continue to build that success with practice. You went to school for 8 to 10 years to become a doctor. You need some tools to help you become more successful. And lastly, this has happened many times. Patients were coming in, they’ve got an unpaid balance, nobody asked them, they didn’t say anything. Billing Precision, the computer I swiped in, it will have the front desk, “Hey, you’ve got an outstanding balance. So, it does it automatically for you. Just with a click of a button, if the credit card is set up in there, you can bill it. Right there, go. You charge to credit card. So, you’re collecting these unpaid balances on a regular basis. So, putting the appointments in, keeping on track and no-shows, and collecting any unpaid balances. Those are the keys to having a more successful, more profitable practice.
