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
The Fatal Blow – Let’s All Go “Cash” – Chapter 5
Chapter 5 The Fatal Blow – Let’s All Go “Cash” So let’s give them the fatal blow—let’s all go “cash.” Not so fast! Do you really think they haven’t thought of that? But here’s their fatal blow: Make it so difficult for you to compete that you want to give up, only to realize that you cannot. Just when you think you are out, they pull you back in!—The Godfather You can get more in depth on this topic by visiting www.pricipledcash.com. There are several reasons why there is really no such thing as a fully “cash” practice. The “Cash” Myths A lot of doctors believe that “going cash” means that if they collect payments from their patient (and give them a super bill), they can avoid all liability, billing hassles, and documentation and coding compliance. Doctors believe they are more principled when they go cash. The “Cash” Truth State boards are now requiring Medicare level (or higher) medical necessity and coding. So you’re never really off the hook with documentation or coding. It is now a standard of care requirement, not just an insurance company requirement. You must submit claims to Medicare for patients in active care. It is the law. You cannot collect fees from Medicare patients up front for active care. Even if a patient pays you in cash and submits a super bill to their insurance company, insurance companies and state boards can still audit you (see the Principled Cash website). Patients want to use their insurance. A lot of cash practices give their patients super bills and have the patient submit the claim to their insurance company. We already know that insurance companies are a pain to deal with. Why would we think the customer experience is improved by asking them to do something that is a pain in the neck (no pun intended)? We’ll talk about how we can make this really simple for a practice later on, but for now, just keep this in mind. Patients want to use their insurance, and they do not want the hassles you are trying to avoid. One little denial from the insurance company, and they will just stop coming in, especially since the insurance company will likely blame you for the denial. Going cash means nothing in terms of principle. The way you measure principle and your ability to communicate it is by PVA (patient visit average). How long do patients stay in your office? More principled practices have patients convert to lifetime care regardless of who pays for that care at various points. I have been in cash-only practice for five years and practicing for over 10. We see a very high volume of patients. I have been using Dr. Brian’s systems before and after going cash, and I can tell you from experience, there is nothing like it. I would never practice without it again. —Chris Zaino Wrong Question The question we should not be asking: How can we see patients and avoid coding and documentation and other compliance requirements? It is a reality we cannot escape. Correct Questions How can we see patients, regardless of who is paying at any given point, and have systems in place that make it feel like a cash practice for the doctor and staff? How do we convert patients to lifetime care regardless of who is paying at any given point? Fight Back It’s a hard pill to swallow. They have you where they want you. So how can we band together and beat them at their own game? Here’s the short answer: We must change the way we are thinking about this game and the way we are currently fighting back. After all, insurance companies are playing chess, and we are playing checkers. I hope by now that you see I have been looking at this chess board for many, many years while others have no idea they are playing chess. Others are building services and technology, all based on a false premise or paradigm. This will all go away someday, or they can make it go away by “going cash.” “Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong.” —Ayn Rand It is an inconvenient truth and a reality. I am a realist. I never wanted to get into this field, but when I found this information, when I realized there was something I could do to help other chiropractors, I simply had to take action. I closed a very successful (yes, principled) practice to take on this battle. I found a way to actually beat insurance companies at their own game. I’ve spent 13 years and literally millions of dollars to make this a reality. I would have made much more money simply practicing and turning a blind eye. In that way, it has cost my family as well. I had no promise I would ever see a return on this investment. Today, thousands of users are leveraging this new methodology I put together to build large, principled, lifetime care, massively profitable practices. They are collecting both cash and insurance, while maintaining compliance with relative ease. They do this in as little or less time as it would take them to be a cash practice. We are in a time when chiropractors are struggling due to overwhelming demands. They’re not just insurance demands—they’re all the demands that go into managing a business, professionally and personally. After all, insurance companies are playing chess, and we are playing checkers. I hope by now that you see I have been looking at this chess board for many, many years while others have no idea they are playing chess. Others are building services and technology, all based on a false premise or paradigm. This will all go away someday, or they can make it go away by “going cash.” “Contradictions do not exist. Whenever you think that you are facing