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.
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
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
