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.
About The Author Dr Brian Capra
About the Author Dr. Brian Capra graduated in 2002 and started his practice in Princeton, New Jersey. After a short time, he built a practice of approximately 400 visits per week with a mix of cash and insurance. He wanted to outsource his billing and focus on what he felt was most important—getting new patients and taking great care of them. After several attempts to outsource with less than optimal success, he had a chance encounter with two gentlemen. One was a Wall Street technology executive from the largest bank in the world, and the other was a computer science Princeton graduate. Together they opened Dr. Brian’s eyes to a new reality in technology and automation. Using artificial intelligence (AI) and patented technology as well as providing real insight into how the insurance industry really works, they showed Dr. Brian what it would take to beat insurance companies at their own game. Dr. Brian implemented the new methodology, and his insurance collections immediately increased 40%. Seeing the amazing results, Dr. Brian realized that the new methodology could also be used for other parts of the practice, including patient retention and compliance. He felt compelled to bring it to the rest of the profession. In 2004, the three men formed a partnership and began developing the Genesis Chiropractic Software and Billing Network. It was—and still is—the only cloud-based platform that leverages patented AI and automation to help providers streamline their entire practice. Across the country, thousands of users have seem dramatic improvement in their patient retention, revenue per visit, and compliance, as well significantly lower overhead and staff management hours. Practices that use Genesis range from 100% “cash” practices to multi-discipline offices seeing anywhere from less than 100 visits per week to more than 3,000 visits per week. They enjoy the flexibility of outsourcing their billing or keeping their billing in-house with an unprecedented level of control, transparency, and accountability. From the Author My intention in this book is to pull the proverbial curtain back and help you see what the insurance companies are really up to—what their real motivation is. I promise you, you’ve never heard this information before. At first, it might surprise you. It might make you feel overwhelmed, frustrated, and powerless. Stay with it. There is something you can discover in this book, and there is something you do about insurance companies. Beating them at their own game is not as scary as it sounds. It can be done in less time and with less stress and money than it is costing you right now. Just like we teach our patients, all you need is a new paradigm. If you are going to win at anything, you need to know the rules of the game, and you need to know your opponent. The more you know, the better your chances will be to succeed. The problem I see is that most doctors are taking a checkers mentality in a chess game. I aim to end this and empower you with the tools and know-how to beat the opponent at its own game. Dr. Brian Capra President/Founder – Genesis Chiropractic Software
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