What They Dont Want You To Know Chapter-1
PART 1 What Insurance Companies Don’t Want You to Know Chapter 1 Insurance Companies’ Strategy: How They Really Make Their Money A lot of doctors I speak to think insurance companies have it out for chiropractors because they hate what we do. But I can tell you that it is not about our philosophical approach to health and wellness or musculoskeletal conditions. They really do not care about any of that. What they care about is whether they will pay or not pay. The insurance process is currently so automated that I can assure you that there is not a person sitting at a desk in the insurance company holding on to your money because they do not like chiropractors. An insurance company is big business. Just like any other business, it is made up of three things: People Process Technology They use those three things to make as much profit per unit as possible. In this case, the unit is an insurance claim. That being said, you will soon start to see that they actually love chiropractic, just not for the reasons we may hope for. For years, I thought insurance companies made their money by collecting premiums and then not paying claims. That meant they would increase their profit per claim substantially. But if you think about it, if insurance companies simply denied claims, they would look really bad in the eyes of their customers, the patients. What they really want to do is make it look like they are trying to pay claims but the doctor is simply not cooperating in some way, shape, or form. The name of the game is slowing down payment or taking the money back after they’ve already paid the claim and the customer is satisfied—that is, an audit. Think about the audit from the customer’s (the patient’s) perspective. They are covered for a visit or visits, and then they get a letter from the insurance company stating that their doctor is being audited. Their visit is still paid, and the insurance company looks like the good guy. But the doctor looks like the bad guy. We’ll look at this more in a bit. But there is more to the story. How They Really Make Their Money—Paradigm Shift To begin to understand insurance companies’ motives and, more importantly, what you can do about it, you just need to follow the money. Here is a little known fact: More than 50% of insurance companies’ profits come from interest. This is also known as float—or interest on money that should have been paid to you but was somehow delayed.
Software Support Pitfalls – Chapter 14
Chapter 14 Software Support Pitfalls Where Software Support and Training Go off the Rails Software companies are notorious for overpromising and underdelivering. After you’ve paid for the software and start using it, you realize you’re not getting the support you need. At Genesis, we’ve identified what the problems really are: Having to stop your busy day and call the vendor every time you need support Wasting time on hold Leaving voicemails and sending emails that disappear into a black hole Forgetting that you sent the email or left a voicemail until days later when you need that problem solved again No way of knowing if someone is going to get back to you with an answer Getting their call when it’s not convenient for you What You Really Need What you really need is help when and where you need it. Usually, that’s in a specific part of the system. You need help relative to that problem in that part of the system. You don’t want to search the entire help system just so you can find the answer you need. You need the answer to your specific question right then and right there. What about new staff members? Who trains them? How often does that happen? You start on a system with the staff you have, and then you get a new team member. Who trains that person? Usually, the person who left is the person who knew the system the best. So how do you get the new staff member into the system and proficient in the system right then and there without you or someone else being responsible to train them? Genesis provides consistent training. If we didn’t, you wouldn’t get the most out of the system. I hear this all the time about other systems: “I don’t really use all of it. I don’t really know all of it.” This is an important concept. You need to be able to improve how you use the system over time, especially with Genesis. During the onboarding process, it’s easy to get the basic training on Genesis, but there’s so much more to Genesis. We make sure you get more and more out of the system as you go. The Onboarding Phase What data can be transferred from other systems? I get this question a lot, so it’s worth taking a minute to go over it. Patient demographics—name, birthdate, phone numbers, email address, mailing address—can be exported from most other systems and uploaded to Genesis. What cannot come over from other systems? The short of it is that data are stored differently in each system. They include billing and accounts receivable information (although you can add what the patient balance was in your old system), care plan data, images such as X-rays, and so on. The key to getting really great support with Genesis starts in the beginning with the onboarding process. Transitioning to a new system is never easy. There’s a lot that has to happen. Each new Genesis practice is assigned an onboarding manager who is dedicated to making sure everyone in the practice gets the training they need and that the practice is on track for the go-live date. Transitioning to Genesis usually takes six to eight weeks. On the first video call, the onboarding manager reviews things like these: Practice style, goals, and the go-live date Generating logins for each staff member System setup such as appointment types, fee schedules, hours of operation Mapping out the training steps for each staff member Sending test insurance claims Applicable third-party integrations such as credit card processing Each staff member’s required training tasks and how to use them Showing the owner/office manager how to track the staff’s training progress Where to find help in the system and how to reach the support team The schedule for future onboarding calls After the Onboarding Phase Training tasks Training tasks are role-specific for the practice, which means a CA’s tasks are different from an office manager’s tasks and a doctor’s tasks. Each staff member gets a series of tasks, one at a time. Each task is on a specific part of Genesis they will need to know. The task contains a training video and other explanation content, if needed. As staff members complete their training tasks, the Genesis team reviews them for accuracy and completion. If there are questions or corrections that need to be made, all of that is logged inside that specific task—sort of like a chat transcript. If screen-share training is needed on that task, there is a link the staff member can click on to schedule the session with the next available Genesis team member. That is a key step in the process that ensures everyone is “getting it” before the go-live date. In some cases, it also helps reassess if the go-live date is still realistic or needs to be adjusted. You’re starting to see how we’ve eliminated unnecessary phone calls and emails and improved results, accountability, and tracking. Showing the owner or office manager how to track the staff’s training tasks is the key step in transitioning to this new type of technology. In essence, this step is training the owner/office manager how to manage their staff using Single Point Management for everything in the practice moving forward. New Staff Members New staff training is vital to the ongoing success of a practice. Most software companies are unaware when a practice adds staff. At Genesis, we know exactly when that happens. In essence, we treat each new staff member the same way we did in the onboarding process. We proactively reach out and make sure their training tasks are mapped, ensuring a smooth transition to your office. Keep in mind that since Single Point Management is sending them tasks anyway, they are well aware of the things they need to do every day in your office. All you and your staff have to do is teach them how you would like them to
What Software Companies Don’t Want You to Know About Your Data Security and Liability – Chapter 13
Chapter 13 What Software Companies Don’t Want You to Know About Your Data Security and Liability 8 Secrets of Software Companies and the Truth You Need to Know I have spent close to 14 years building cloud-based software for doctors. I was a pioneer in that area. Patient data security was always at the top of my list of concerns. Many software companies have been spreading misinformation about data security and your level of exposure. I stop short of calling them lies because based on what I hear software companies saying, it is probably more a lack of knowledge and experience. As a doctor, that bothers me. What if I had listened to them and then realized later how much they were actually costing me? Here are eight facts software companies do not want you to know: There are two types of systems There are basically two types of software systems: client server and cloud- or Web-based. Client server means the server and data are stored in the doctor’s office. Then other computers in that office connect to that internal server. All the computers and the server have to have software installed on them. The software needs to be updated on a regular basis. Examples are ChiroTouch and Platinum. Cloud- or Web-based means the server and data are stored in the cloud—or more accurately, stored on a server that is in a data center connected to the doctor’s practice by the Internet. The software is also stored on those servers. You can think of it like the online version of QuickBooks. Genesis is a cloud-based product. You still own your data if it is stored in the cloud Here is where the misinformation starts. Client server software companies have been telling doctors that if their data are on a cloud server, they don’t own them. There’s no other way to say it—it is a big fat lie. You always own your own data. It doesn’t matter where the server is. You can access your data if you switch software companies Of course you can. Client server companies have been telling clients just the opposite for years: “If you ever leave that company, you can’t access your data again.” It is a scare tactic—misinformation—for several reasons. First, if a company ever held your patient data and would not give you access to it, it would be illegal. By law, cloud-based systems must store PHI (protected health information) for seven years (or whatever the legal requirement is for your state). Your ability to access data if and when you switch software companies is actually much better in the cloud. We’ll look at that in more detail later. If you are going to go with a cloud-based solution, you should make sure the company has extensive experience and a long track record. Do not choose a cloud-based company that just happens to pop up or a client server company that suddenly decides to build a cloud-based version of their product. Even though they seem similar, they are very different. I can tell you this based on 15 years of experience with cloud-based technology. A cloud-based company cannot hold your data hostage if you leave Maybe software companies are unaware of this, or maybe it’s another case of misinformation. Or maybe they have no clue about running a business. But I have my own opinion. There are legal and contractual protections against exactly this. From that perspective, your data are more than safe should you decide to go with a cloud solution, assuming it spells that out in your agreement with them, which it should. The truth is that we are all in business, so let’s think about this pragmatically as well. Imagine what would happen from a PR standpoint if a cloud-based system withheld access to a former client’s patient records. It just doesn’t make sense. In the age of Twitter, Facebook, and other social media outlets, withholding access to a client’s data for no real reason, legal or not, would be just plain stupid. Most cloud-based systems have a clause in their contracts that covers former clients who need to gain access to patient files. Again, consider the alternative. You buy a new client server system. You use it for a few years. You decide to go in another direction. Maybe you choose to move to the cloud. Five years later, a patient has a legal case unrelated to your practice and requests records that were on your old client server system from seven years ago. By law, you are required to provide them. You go into the dark recesses of your office where your old server is. Hopefully, you still have a computer connected to the server. In any case, you haven’t fired up either of those babies in five years. Who are you going to call? How will you get the records? What if the server doesn’t even turn on? If you don’t have a computer hooked up to that computer, you’ll need to do so. Will a new computer be compatible? In any case, it will need to have the software installed on it. If you don’t have the software anymore, do you think that old software company will actually give you a license? What if they were bought out in the meantime? (By the way, there’s a reason all those client server systems are getting bought out.) My data are safest on the cloud PHI data are some of the most valuable data on the black market. This is the question you should be asking: Where will a hacker most likely try to get that data? You might think it makes sense for them to go to a large data center where the most data are stored. But here is the correct answer: They will go where it is easiest to get the data. We know the hardest place for a hacker to try to get data My software is cloud-based, so our data are stored
The 3 Biggest Mistakes when Choosing Software – Chapter 12
Chapter 12 The 3 Biggest Mistakes when Choosing Software Mistake #1: Rushing I totally understand that most doctors get into the software search because they’ve finally hit a breaking point. They can’t stand something about their software, and they want a quick fix. Maybe their software company got bought out or is going out of business. It’s a lot like what patients experience. They are in pain and just want a “crack,” thinking that will solve their problem and prevent it in the future. This is where you get taken advantage of. You get on a call with ChiroTouch, ChiroFusion, or Platinum, and they immediately jump to all the fancy features specific to the “pain” you came in with. They show you a very low price, and your problems are solved—at least you think they are. The cause of your real problem is still there. You have decreased collections, lower patient retention, less compliance, and your staff is still running to dozens of reports missing steps, losing patients—and you are managing by fire. Switching systems is a decision you only want to make once. You don’t want to rush. A mistake could cost you thousands of dollars. And even though you may be losing thousands per month, it is hard to justify spending more money. Switching systems is also draining on your team, so even if you switch and then realize you’ve made a mistake, it may be too much on your team to ask them to switch again anytime soon. Lessons: Take your time. Look for solutions, not features, to your real business management problems. Do not buy on price alone. Remember all the hidden costs that occur without automation and Single Point Management. They are real. Mistake #2: Old Technology Platinum, ChiroTouch, and others are built in a software language that is the equivalent of Sanskrit—ancient. It means they are limited to the functionalities of that language. Future improvements will be extremely limited. Cloud-based systems have many advantages. The software language can be improved over time with no interruption to your system. It is like repairing a plane while you’re flying it. Genesis literally has a completely different language now than when we started. That means that new capabilities will be added, and you will never realize it. It means better integrations with other technologies. It means your data are more secure (see the next chapter for more on this). Don’t forget that it also means you are joining a network of doctors using data to beat insurance companies at their own game. No cloud, no centralized data, no research. Lesson: Go with the cloud and join a system like Genesis that is using collective data analytics to help the profession. Mistake #3: Price vs. Cost There is a huge difference between price and cost. A flip phone’s price is less, but the cost of not having a smartphone is huge. A phone is just one of the many examples out there. You get on a demo system, they show you a low price, you buy it, and it costs you for the rest of your career. Proven return on investment (ROI) Why don’t they ask you about your practice—your goals, your dreams, your patient volume, your no-show rate, your reschedule rate, your accounts receivable numbers, your collections, your documentation time, your management hours? If they did, they could tell you how much your current solution is costing you, right? Then you would know what kind of return you would get on their price. Software is not like a car. It is not an expense. It is more like a house, which is more of an asset. You should be able to calculate what your return will be if you buy it. The reason you never hear this conversation is because other systems were never built for ROI. They were built for a quick sale. They are not looking at before-and-after data across thousands of users, especially if they are not in the cloud, since that would be impossible. They simply could never tell you what your ROI would be. Even a cloud-based system without Single Point Management could not give you an ROI. Any claims they make about improved collections and efficiency are anecdotal at best. With Genesis’ Dream Practice Analysis, we do just that. We look at where your practice is, and we can show you what the real cost of your current system is or another one you are considering. If your accounts receivable are high, retention is low, collections per visit are low—what is that costing you? How much time is your staff spending doing things that Genesis will automate? What is that costing you? A true cost of ownership is what you want. Slow down and take the time to do it. Price is a relative number and should always be looked at in the context of cost. Lesson: Software should never cost you anything. You should get an ROI on your investment (the price). You should be looking for a software that can prove an ROI specific to your practice.
What to Look For in a Billing Company – Chapter 11
Chapter 11 What to Look For in a Billing Company As we have seen, Genesis has automated everything with the exception of following up on claims that need a phone call. So the word billing in billing company really does not apply anymore. We are really a follow-up company. For clients who keep things in-house and use Genesis, they really do not have a billing department anymore. They have a follow-up department. What You Do Not Want Sometimes it is easier to think about what you do not want rather than what you do want. We’ve already covered what you do want and why. Here is what you do not want in a billing company: No automation, just lots of experience You do not want a company that does not have automation and just says they have lots of experience or are really great billers. Genesis has been in the business for 14 years and processes millions of claims for practices all over the country. We have many expert certified coders (hundreds, actually) with lots of experience on our team. You might be saying, So what? One biller does not know more than what insurance companies have built into their AI. What happens tomorrow when the insurance company changes tactics? Are billers looking at data across thousands of practices and millions of claims? Are they building new automation and AI to fight back against insurance companies’ tactics? Can one very experienced person follow up on millions of claims? No accountability I used to outsource to a company that would send me lots of reports every month. Guess what? I never had time to look at them. If you cannot see top-down reporting of their work in real time, forget it. How many claims need follow-up today? What is your AR > 120 days? Then drill down into reports from there if you want to or need to. That’s what Genesis offers. Billing companies love to talk about their reports and how they log into your system. No good. No control, no transparency, no accountability. You will wind up not trusting them. They don’t outsource follow-up I know what you’re thinking. I don’t want to speak to someone in India. Of course not. We would never ask a client to do that. With Genesis, you always speak to a resource in the United States. But we do want the insurance company to speak to someone in India (or another country). Why? Because they are doing the same thing. Remember how we said they have unlimited manpower? If we are going to beat them at their own game, we must do the same. Outsourcing your claims follow-up while still giving you transparency is one of our secret weapons. We have hundreds of follow-up resources in other countries driving insurance companies crazy every day. They are managed by resources here in the United States. They are only paid when you get paid. They use another software If they are using another software, then no thank you. I shouldn’t have to explain all the reasons that this is a deal breaker. Your practice management end must be tied to your billing and follow-up if you want real control, transparency, accountability, and a chance to beat insurance companies at their own game. Even if you are using another cloud-based system, it is not enough. That would mean the biller is using the same exact system. But what about Single Point Management? Yes, control and transparency. Low fees and what they mean A billing service should be charging only a percentage of what you collect from the insurance company—not on copays and deductibles. You want them to have all their incentive focused on getting the money you deserve from insurance companies. The average fee for this in chiropractic is between 6% and 10%. The number varies based on what your average collection per claim is. Anything lower is a big red flag. It means they are probably not going to follow up on every single claim and that they will just take the easy money. Since most of them have junk technology, you’ll never really know. The low fee also tells you they are not investing in technology and are most likely using the system you already have and logging in remotely or using some other system. See #4 above. That’s a deal breaker. Some billing services advertise a very low percentage, but then you find out it is a percentage of what you charge. Some of our clients actually want this for some reason, and we do it. However, you’d better make sure you have a way to see everything they have done on any claim and have a way to know they are following up on every single claim that needs it. Some charge a lower percentage but take a percentage of everything you collect, including cash, copays, and deductibles. Watch out for that one. Another pitfall of low fees is that no system (except Genesis) can track underpayments. So while they give you a low percentage, you never really see the income from your underpayments. They just do not have the technology or enough workers to go after that money for you. It could cost you tens of thousands of dollars per year. If you do not keep insurance companies accountable, they will continue to take advantage, and it will only get worse.
When Should You Outsource? – Chapter 10
Chapter 10 When Should You Outsource? Disclaimer: I own Genesis. Many of our clients outsource their follow-up to us. You might think that makes me biased. The truth is that many of our clients keep billing in-house as well. Each practice is different. Genesis makes a profit in either case, so my real incentive is to make sure every practice has real control over their insurance department and that we offer the best option for them. Since we offer both in-house and outsourced support, Genesis clients have the option to switch back and forth as their needs change. Step 1: Choose the Right Technology As you can see, if you do not have Single Point Management with everything integrated in the cloud, you are behind the eight ball. Step 2: Gain Control, Accountability, and Transparency Leveraging the Genesis system means you can see exactly how many claims need follow-up at any given time, from anywhere. You can see if your accounts receivable is within normal limits. What is within normal limits? The national average for AR >120 days is 17.7%. That means that on average, any given doctor does not collect 17.7% of the money he or she should from insurance companies. Statistics prove that if it takes you longer than 120 days to collect money owed to you, the chances of ever collecting it go down to almost 0%. With Genesis, you see how many claims need follow-up each day (and if your staff is keeping up) and your % AR > 120 days in real time. The Genesis average Across thousands of users, our average client % AR > 120 days is 7%. Many are 0%. Do the math: 17.7% – 7% = 10.7% increase in collections when using Genesis. Step 3: Decide What’s Best for Your Practice and Be Flexible You may already have a superstar biller. Leveraging Genesis will make their life easier and more efficient. My personal opinion is always to outsource because a great biller could also be great at doing other things in your office like helping get new patients. That being said, if you keep things in-house with Genesis and, God forbid, something happens to your biller and you need to outsource, it is as easy as flipping a switch. Genesis can take over right where the biller left off, with no fall in income. You can even outsource some billing such as Medicare only, for example, to Genesis. Step 4: Track the Results Regardless of what direction you go, with Genesis you always have a simple way to see if your billing department is up to par. You are no longer in the dark. You have more control and accountability than you have with any other in-house solution, even when you outsource with Genesis. The choice is yours. You are in control
Streamlined Interface – Chapter 9
Chapter 9 Streamlined Interface You might be thinking this all seems complicated. There is some truth to that. Winning isn’t easy, but the work it takes is not all on your shoulders. The smartphone is more complicated than your old flip phone, but you were willing to do what it took to learn the new interface because of the tremendous value it brought to your life. Genesis is like that smartphone, and it’s also like an iceberg. There is a lot to it, but most of the work is hidden—automated—and you do not have to look at it. For the office that uses Genesis, there are only a few places that you need to get used to interacting with it. Some of these are similar to what you are used to with other software, like the keypad on your smartphone. Then there is what is different. Here is a breakdown of what is the same, what is similar, and what is different. What Is the Same? Features that are the same are more advanced with Genesis, but there is a smaller learning curve. Scheduling Reports Patient information and transactions What Is Similar? Documenting your visits. What Is Different? The biggest difference is what we call the workbench. That is where you and your staff find all the tasks Genesis is bringing to you. Remember, these tasks are mission-critical for revenue, patient retention, and compliance. The fact that you do not have to find them anymore means you’ve just saved a ton of time every day for you and your team. The fact that in many cases Genesis is finding things that are frequently missed means your business will grow. There is no more wasted time looking for work in reports. There is no more wasted time doing work that could be automated. Now you just do the work that comes to you and make sure everyone did their work by the end of the day, just by looking at one number. If you can make this little but massively important shift in how technology is being used to beat insurance companies and serve more patients in a compliant way, you will experience a new level of freedom and satisfaction you would have never thought possible before. The following chapters are questions Genesis receives all the time. Many times, there are misconceptions about how various software platforms address these issues. For example, the traditional problems that doctors encounter with outsourced billing services no longer exist when they use Genesis. Many older software companies say that cloud-based software is less secure or that cloud-based software prevents doctors from owning their patient data. I am not sure if they are purposely not telling the truth or if they simply do not know the truth. In either case, you should know the truth about cloud-based software, so I’ve included a chapter dedicated to that.
Taking Chiropractic to the Next Level – The Research Now We’ve Got ’Em – Chapter 8
Chapter 8 Taking Chiropractic to the Next Level – The Research Now We’ve Got ’Em Working together by leveraging technology to decrease overhead, save time, increase patient retention, simplify compliance, increase collections, and keep insurance companies on their toes is great. But it is not enough. We can do more. The cloud gives us (our profession) one more very important advantage: research data. We can now enter our patients’ subjective and objective findings into one standardized, centralized system. Each visit is paired with coding and reimbursement data. Now We’ve Got ’Em It is now possible for us to show that chiropractic is the most cost-effective way to improve not only musculoskeletal conditions but overall health and well being. The possibilities are endless. Genesis has teamed up with universities, researchers, and organizations to do just that. Note: As a provider, you never have to share your patient and reimbursement data for research purposes if you do not want to.
The Paradigm Shift – Chapter 7
Chapter 7 The Paradigm Shift What if you didn’t have to go to reports anymore? What if, by the end of the day, you were able to verify only the exceptions that were not addressed by you or your staff? This is where we change the game and level the playing field. Every exception is mission critical. A missed patient visit is as important as an insurance claim that needs follow-up, which is as important as a note that was not created, which is as important as a care plan that is expired. Automation Automation does two things: Eliminates unnecessary manual tasks. Finds exceptions and brings them to you and your staff. No more digging through reports. Step 1 – Eliminate manual tasks. Genesis has 62% more automation than any other system. Eliminating manual steps means you and your staff only work on things that are necessary and that will give you a high return on investment compared to what it is costing you to do them. The cost to do unnecessary manual steps is calculated by the hourly wage of the person doing them times the time it takes to do them. That adds up to the hidden costs in other technologies. Benefit verification Claim creating from your daily notes and exams Claim submission in real time Claim EOB posting, even the paper ones Secondary, tertiary submissions Paper claim submission Patient balance processing Patient statements Failed claims (claims that need follow-up) identification Patient visit reminders Patients rescheduling visits Step 2 – Find the exceptions and bring them to you. Finding exceptions, which needs manual labor, is yet another hidden cost. In other systems, at best, you and your staff have to go to reports to find these items. Claims that need follow-up Not paid Underpaid Denied Documentation requests Inventory that needs to be reordered Patients who do not have a future appointment Patients with no care plan or with an expired care plan Patients with an expired pre-certification Visits missing documentation and/or claims Patients with an expired credit card Patients who are coming in for a re-sign or re-exam next visit and need care plans or other preparations Genesis Brings Them to You Yes. Genesis brings every exception to you or your staff in the form of a task or claim (if it is an insurance claim that needs manual attention). This is a game-changer because it focuses you and your team on the things that matter most—things that will actually get you paid, help keep your patients under care, and keep you compliant. The thing that gets you paid is following up on the claims that need follow-up. Everything else is just extra manual labor. They are a distraction, and the cost is high. Here are some examples: Example 1 – A new patient is checked in You haven’t completed your note or exam. Or maybe you have not submitted the claim that was created from your note. There is a task sitting there to remind you (complete note/exam, submit claim) before you leave for the day. Simultaneously, a task was created for your financial CA to verify benefits (which is one click) and create the financials based on your recommendations for care (created in your exam, step 1 in this example). Important Note About Tasks (before we go on to more examples) Tasks are critical action items that are specific to the patient they are related to. You can do anything from within that task. In the example above, you can click on the tasks and create your new patient exam inside the task, and it is saved on the patient account. At the same time, your CA can see the exam from their task and act accordingly. No more chasing files around the office! Two ways to see tasks Your own view – Shows you only the tasks you have for the day Team View – Shows you a list of your entire staff and the number of tasks they each own The team view is where you take your management to the next level. At any time, you can see exactly what the backlog of tasks is across your entire team, including yourself. Efficiency Because staff is not looking for work in reports anymore, they are much more efficient and actually doing meaningful work. Because they complete the task inside the task, they are not wasting time clicking all over the place. You do not need to look at dozens of reports anymore. You see one number. You see how many exceptions were not addressed yet. We call this Single Point Management. This is the verify step that is so often missed in the three key steps to business management. Accountability Everyone knows what everyone else has to do for the practice’s success. In every task, there is a full audit trail for every action and/or note made. A username, date, and time stamp are added to every action taken. No more he said/she said. Teamwork Now staff can lend a helping hand to someone who is overwhelmed for the day. You can identify team members who need more training, who are in the wrong position in your practice, or who are not a good fit for your office. Nothing is left undone at the end of the day—nothing! New staff members can see exactly what they are responsible for. You can embed videos in each type of task, training them in the process they should be following for each type of task. Example 2 – A re-sign visit is coming up A patient checks into your office, and their re-sign visit is coming up soon (let’s say three visits from now for this example). A lot of things have to happen to make sure that visit is effective at converting that patient to more care. You/your staff has to tell the patient what to expect. The re-sign/re-exam/X-ray visit needs to be scheduled. Maybe the patient has to fill in some paperwork before
Leveling the Playing Field – Chapter 6
Chapter 6 Leveling the Playing Field Vultron When I was a kid, there was a Marvel comic book called Vultron. There were basically five superheroes who drove around in their own individual robotic lions. When they came up against a really formidable opponent, they were able to join all their lions together and form one gigantic warrior-shaped robot. Of course, working together, they were able to defeat the enemy that would have otherwise destroyed them individually. Today, my son watches Power Rangers. It’s basically the same concept. Judo Judo is a very well-known martial art. The main idea is to use your opponent’s aggression or momentum against them. So when the opponent swings at you, for example, you move out of the way at the same time you push them or throw them in the direction in which their momentum was already taking them. Ultron-Judo Take these two concepts and smush them together. That’s how we beat them at their own game. We use their momentum and their own tactics, band together using a more powerful technology than we have individually, and destroy our formidable foe. As we’ve been learning about insurance company strategies and tactics, I told you about the three components of any business: People Process Technology We also discussed one very specific process they have: the audit. We have dived into each component and seen how insurance companies are really just leveraging people, process, and technology from a totally different perspective or paradigm than we are. People Insurance companies have unlimited cheap labor. Their highly paid staff only works on things that have a huge return on investment—audits, for example. We have been doing the opposite. We’ve been paying our highest paid employees to call insurance companies, verify benefits, enter charges, enter EOBs, and dig into reports looking for claims to follow up on. That’s gotta stop…if we wanna win. Process All these things—missed visits, new patient checklists, re-signs, inventory management, credit card charges, documentation, coding, EOB posting, charge entries, claim submission, failed claim identification, secondary submission, patient statements, cash patient statements—they all matter. And they are not going to go away. But we can certainly be more efficient and effective by using AI and automation. Asking your awesome biller to do a good job with inferior technology is like sending them into a nuclear war with a stick. Technology Technology—that’s a big one. Remember, insurance companies leverage huge databases, automation, and AI, forcing your people to follow every manual process at a huge cost to you, both in terms of money and liability. Buying technology that addresses only one component of your practice while not addressing the big picture is a mistake. Until 2004, there was no way to beat insurance companies at their game or even compete. No small practice could afford enterprise-level technology that could compete. Now there is a way. The Internet changed everything. Here is the new solution—Genesis. In 2004, we started a company built in the cloud. This was before the cloud was a thing to most doctors. If we are going to win, we need a paradigm shift in how we think about our businesses and how we play the game. It was a new approach, leveraging people, process, and technology to beat insurance companies at their own game, optimizing revenue, retention, and compliance in far less time, regardless of your cash/insurance payer mix. It is a new system and paradigm. It is smart, and it learns. It allows doctors to band together with one technology and use the insurance companies’ tactics against them.– Ultron and Judo, if you please. It has a life of its own. I named it GENESIS. Advantages With all of our clients submitting claims through one database, we could analyze data across all insurance companies all over the country—the same way insurance companies analyze us. The cloud provided more HIPAA compliance for patient data than traditional systems like ChiroTouch or Platinum (more on this later). We could now leverage AI and automation, just like the big boys, and alert doctors in real time about coding and compliance risks. Real-time transparency was achieved. Now a doctor could see exactly how many claims needed follow-up and in real-time accounts receivable numbers from anywhere there was an Internet connection. No more digging through reports, unless you have time for that sort of thing. Providers with more than one practice, or multi-specialty offices, could link them in the cloud and aggregate their own performance metrics. It was not just for insurance. We could also leverage automation to improve patient retention and staff efficiency, even for cash patients. Better technology development—on the fly—old systems are written in hieroglyphics. Cloud-based systems have the distinct advantage of being able to change the language as new ones are developed. It’s like building and refitting an airplane while it’s in the air. Billing Network: The Network Effect For the first time in the history of the profession, there was a billing network that any provider could join. When they joined, they were working with thousands of other users all over the country and contributing their data to the cause. (NOTE: In case you are wondering, no doctor could see another doctor’s data. Doctors maintain ownership of their own data.). It is a legal way to band together and fight back! Artificial Intelligence With patented technology, we now could leverage AI. It is the first step and goes hand-in-hand with automation. AI helps find exceptions. These are critical items that affect your patient retention, your cash or insurance collections, and your compliance. Here are some examples of exceptions—things AI can identify with zero work for you or your staff. Practice-specific A claim that is in the process of being created but is missing modifiers, linking, proper diagnosis codes, correct procedure codes A claim that is not supported by the daily note A visit that has not been billed out (even if it’s cash) or is missing a signed note A patient that does not
