Transcript
Marla: Welcome to the Practice Growth Podcast where we are helping clinician owners, clinicians, and students stay ahead of the latest trends in the industry. It is a pleasure to have you on our show today, Josh.
Josh: Thank you, Marla. I'm happy to be here
Marla: I'd love to hear a little bit about yourself and how you got into billing.
So if you can tell me all about you.
Josh: Yeah. I am a COO of a few clinics. We are part of the Fusion Network based out of New Hampshire. So we have the Sport and Spine Fusion, MSO, and I basically do all the RCM for those clinics as well as being the COO of doing operation types of things.
My partner is Chris Campbell, so I'm a partner in owning those clinics and, him and I both decided to start a company where we would bill for other people and teach them how to bring billing in, much like we have our own.
Marla: Great. So you really saw the transition of being a clinician to an owner, to a multi-practice location, understanding RCM revenue cycle management and saying, frustrations is why I've started this billing company.
Josh: And that's exactly right. Our journey started like everybody else. We're like we're seeing all these people, but we're not getting paid. Where's all the money? That's always the question we hear with our clients. I feel like I'm seeing everybody. We're just not getting the money, and I think we should get, we had the same problem.
So Chris has been a owner for 20 years. He's been a PT for 30, and when I came in, I just became his practice administrator. And he, in a lot of ways, his company was 20 years old. He had great culture, he had great employees, and a great standing in the community. But what I uncovered and what he talked about with me is there was some revenue issues, like reimbursement and the EMR we were with, we had an outsource biller, right?
And I felt like I was doing a lot of the billing on my own, and I was just trying to learn through this whole thing. With that, I asked a lot of questions of them and my knowledge they just kept gaining knowledge because I had to try and make ends meet. And then we decided to switch EMRs to Prompt.
Now as Prompt has a very robust billing platform that you can do. So we decided to bring billing in-house at that point. And I said I'll take it on, and that's how we started the venture of doing billing in-house. And then we were like, we could do this for everybody else.
We could teach them, they don't have to go through the struggles that we're going through or that we went through. And all of the times we're like, where's our money? We can bring this to people. Have them bring it in-house and then, get the money they deserve. So that's how OTPI, Optimized Transition Partners, became a thing.
Marla: Wow. And RCM and billing, it really is the bread and body of your clinic. If you're not getting paid, you could be doing phenomenal quality care, but you're not gonna be able to run your business without that billing end.
Josh: That is exactly right. That is one of the largest things that when we go into these clinics, because we work with clinics across the country, and it's always the same things, right?
It's never we go in and I open up this closet and there's this big scary monster of a problem because it's not that it's it's a lot of like death by a thousand cuts. There's revenue leakage there. There's some there. And when you have outsourced billings, sometimes it's very hard to get the feedback of where that's coming, right?
It's not as transparent as if you had been asked. Now when I say that, please know, we offer both. So we do third party point too. So I'm not trying to get everybody to bring it in house. Sometimes it doesn't make sense, but it's just a little bit more transparent and you can be more nimble and proactive in a way because you're getting a lot more feedback and you're as to what's working operationally and what isn.
Marla: So tell me a little bit more, you say you go in there and I almost think of, when those shows where they go into restaurants and they uncover what's going on. So when you go into PT practice, what do you find is the majority of some of those billing issues that you uncover?
Josh: Yeah.
One of the biggest things we know industry-wide, two thirds of denials come from up, right? Just right from the get go And many times those are things as simple as demographics. Let me give you a specific example of how simple something is. Somebody's card has a middle initial on it, and when they put them into the system, they only do the first and last name.
They don't put the middle initial in, so it doesn't go on. The HCFA goes to the insurance company and that's denied or rejected, and you don't get that money. So when those things continuously happen, they add up. And with outsourced billers, if there's not a whole lot of communication back and forth as to what's going on or how to correct it, you just see that happen over and over again.
So that's one of the biggest things when we first step in, are the seemingly simple, very small things that they just didn't know and they don't know what they don't know. And that's always what it is. I always try to say, no one tells you these things, so please don't feel bad.
But they're always like, I feel so stupid that I didn't know that no one should feel that way. Because no one gives you a playbook of how to do this, right? No. When you first start out, you have no idea. It's very ambiguous. It's very mysterious in a way, right? The insurance makes all the rules, but they don't really tell you any of the rules, not the nitty gritty anyway, that really matters.
And those are the small issues, we see that just build up. And that's always, I think, the biggest wants. If if those things are happening and they keep building up, then you're just not getting the revenue you're supposed to be getting. Another thing I like to say when we go in there, is trying to get the front, the back and the billing, all the talk simultaneously.
It's very hard to link those up. One you have different levels of knowledge. Two, it's not that nobody wants to do the right thing, it's just they don't always know, okay, so if I put this type of information in the front, how does that affect going to the back? And then how does that affect in the RCM?
That roundabout knowledge isn't always there. So what we like to do is provide that knowledge for everybody within your practice. So now everyone knows the lifespan and lifecycle of the claim, and it creates an atmosphere for it to be very seamless and a one-time go with almost everything, right?
So what we try to do is when we go in there, we try to get the rejections down immediately, and then we try to get their denial rate a low 5%, usually around 3, 2%. You're never gonna have zero, fortunately. That's just the name of the games, but as low as possible. And then people just see revenue start flowing in.
And so that's the first step is just correcting those really simple issues and identifying them, of course, right? We do an audit of their system and then we identify those and we teach operations on how to fix those which then lessens the burden are on your RCM team. Everybody thinks it's this big task to bring it in-house and it can be; however, I usually say it's going to be like three weeks to maybe a month of chaos.
And then you're gonna realize very quickly oh, because our operations are so seamless, there's really not a whole lot we have to do on the back end other than post these claims accordingly. Because they’re not getting denied. There's no issues with going through and getting.
Marla: So putting in that front end work and setting it up, the process, the procedure, having the right tools, then it really, like you said, runs and you just put the right people in the right place.
Josh: That's exactly right. And with our experience in the clinics and owning clinics you're really getting executives for hire. And we'll help in all processes, operations. We've talked to every clinic team as a whole for every client. Now we're not, we don't say we have to do that, but we say, Hey, it's an option.
And they all opt in on that. And that's the next step, right? So now we've fixed all the issues as much as it can be. There's always gonna be some, but, so we've cleaned up that portion of it. Now we talk to the clinical team and we talk about how to compliantly bill. Or the most reimbursement, right?
How to bring your plan of care along and elevate it in a way where you're going towards CPT codes that you should be going towards. And those are reimbursed at a higher rate. I, because we're supposed to be getting them there, right? That's what the insurance would like you to do. Getting 'em towards those functional CPT codes, doing the neuro stuff, getting all that done.
And we just discussed with the clinical teams. Look, this is how you stay compliant doing this. And with this will elevate your paid per visit. Now we have first time clean claims plus an elevated pay per visit. It's inevitable that you're gonna have more rep coming in. And again, all of this is possible because of the transparency you have when you bring billing in.
So you can really give that feedback almost immediately to adjust what you need to do those things. Great.
Marla: And I know you said the clean claims rate, the CPT codes. What else are some key performance indicators or metrics that owners should be looking at to see if their billing is good or maybe needs some help?
Josh: Yeah, and I think AR is one that's talked about all the time. The problem with that is you can ask your billers how the AR is. And it could be bloated if things aren't handled right. There's some AR out there that's not really out there. You got the response, but it's just some hanging AR that wasn't written off appropriately or adjusted off.
So that, yes, while that is a great key performance indicator a big one would be turnaround time. If they can tell you that clean claim rate, your denial rate like we had talked about. And then also things like what are your front end collections percentages at time of service. So when it comes to patient responsibilities, sometimes that's one third of your revenue every month.
And depending on your payer mix and the very early portions of a year where all everything resets, deductibles, and things like that, it could be half of your revenue. So I always tell everybody that, look, you could be doing everything right. And not collect that patient responsibility at time of service, and you're gonna be struggling in, that's a huge key performance indicator. Are we collecting 90% or better at time of service? Are we collecting towards deductibles? Are we basically estimating what their deductible's gonna be? That's a huge thing that people should be doing. Typically, they're not, because they don't want to over collect.
And what we help do is we help set SOPs, standard operating procedures, around those things so that they can collect with confidence and that they're not going to over collect and they owe a whole bunch of money or anything like that. So those are some of the key performance indicators. Indicators you really want to look at when it comes to billing is denial rate, turnaround time.
Percentage of reimbursement is a big one. Election at time of service. And then rejection rate is big too because if they're getting rejected, they're not even getting to the payer to be adjudicated and first time go percentage if they can tell you that. Because denial rate and that are not always one.
Marla: Okay. And so with those 6 metrics, can you give us, for each one, this is the high end where you shouldn't be, and this is where we wanna get you to. So yeah, the listeners can really know and evaluate their business and say, where am I on these metrics?
Josh: Yeah so rejection and denial rate should be pretty close together, 5% or less.
You're doing really well, I always tell people, if you're looking on your dashboard and it's 5%, don't even dig any deeper. That's great. That's a great metrics to have. You need to waste your time digging deeper on those 2 KPIs. Turnaround time, it varies. Obviously if you have a lot of third party or workman’s comp it can be a little higher.
But I would say within, if we just took Medicare commercial plans, those types of things, it should be 15 days or less. Really should even workman’s comp, getting things like Jopari or Marrick or some of those other things that can help out with those. It should be in the 20 or less right?
If you have things that are like, oh, our turnaround time's, 25, 30 days. There's a big problem there that needs to be looked at. And then, if your first time go claims rate again, that could be, I would want that maybe just a little 10, certainly below 10%. Not like you want 90% or better, right?
So for first time go for that is what I would look for there.
Marla: Great. Great. That's super helpful. And I think that helps people to be able to, especially brand new clinic owners, evaluate their billing and their RCM. Can you give some examples of tools that you help people learn how to use in their EMR or even external and those standard operating procedures?
What are you guiding them on and what makes it easier for people to bill correctly?
Josh: Yeah. I think one of the biggest things is, as therapists, a lot are what I like call bleeding hearts, which is amazing. That's what makes them amazing at their job, right? I think some need a mindset shift into business, right?
And you want to continue seeing these patients. One of the biggest SOPs that I create for, or try to have every single client create is, if someone owes us $200 or more they can't be seen that day till they pay. It sounds very harsh. You're denying care. Here's the problem. If you don't do that, and I've seen where patient responsibility, there's $60,000 sitting there and they're going, where's all my money?
It's right there. It's right there. That's one SOP that you know, you can put in place to help with the time of service collection. The other one is I don't over collect. Once you get about $150 worth of credit, stop collecting Wait until some of that is used and then start collecting again.
So then you're not paying back a whole bunch of patients. Oh, we over collected deductible is satisfied. Here's $500. No one wants to do that. So those are the kind of SOPs and structures you can put in place. Another one is cards on file. We already know that you should absolutely have an insurance card on file and their driver's license.
But the other one is, putting a policy in place where it's a debit or credit card on file. That can get hard to do. But what I always say too is you want to make SOPs for the 95%. Because there's always what ifs and there's always, every time we bring it, it's always this person won't like that.
Okay, that's one person, right? You're always going to have people push back. So you know, it's, you want, you don't want to get caught up in making SOPs around that 5% pushback. You want to make the SOP and the policy based on the 95% and then handle those what ifs and the pushback on a case by case basis.
So that's another thing that I always say when you're thinking about these things, what makes the most sense for the majority of what you're going to do and then put that into place. One of the things I say in our clinics all the time to our front desk and our patient care coordinators is it's always your job to present the problem, but never to argue.
So at least present it. Tell them, Hey, we require a card to file. If there's a little back and forth for maybe a minute, that's fine. But then if they really insist, they don't want to, okay, go ahead. You can go to your visit, have a great session. And then they'll just tell me and I'll talk with the patient or my lead administrator will, and just explain why we had that policy.
And talk to them. A lot of times they just want to be heard. So that's with any SOP that, that we have some of the SOPs surrounding collections are essentially for front end. You want to, again, present that problem always, that, hey, you have this copay, or you have that co-insurance. This is what that means.
And we'll go, we're going to collect it today. That's how you get to that 90%, which is the biggest thing. The patient responsibility. I really think so. So those are some of the things we instill and try to help our clinics, put into practice. I think those are the always the hardest ones is because they're dealing with the patients.
And we got into this job to help patients. And so it's very hard put SOPs in that are like that kind of goes against that.
Marla: Yeah. And I know as you said, we have bleeding hearts, all of us. And so it's hard to do that when the patient's directly in front of you. But if you have the tools and technology that automates that, I think it makes it a lot easier.
So give some examples of helping clinic owners know, do you have the right. Tools and technology to support these SOPs and what should be happening on that.
Josh:Yeah, and the biggest ones really are your reports, are they accurate, are they live? And those are the kind of things like, do you have the dashboards to be able to look at those numbers, really know what you're dealing with?
And if you don't, then you either need to create your own or maybe switch EMRs to somebody that does have those types of things for you. But those are the kind of, everything runs on metrics when we go in. And we deal with primarily Prompt clients. Prompt has the dashboards and the reports and everything to be able to do all of those things.
And regardless of any EMR you're on, though, you need to know that your dashboard is accurate. And then are there, so you have a dashboard, you have numbers. Is there an Excel spreadsheet you can pull from that dashboard to look deeper and actually deep dive into those reports? And those are the kinds of things we help with our clients with are analyzing this data and seeing where you are and how you're doing it.
And so if you have somebody in house that can do that's huge to be able to have those reports and that's where you wanna base things off those, that objective data, not subjective, not emotional, but what is the data telling us? Okay, let's shift and try and make it to where we need it to be.
There's always lead indicators to those KPIs, to the key performance indicators. And a lot of times, like if you're looking at your reports and you say, okay, we have a 10% denial rate. Now do you have the report to pull that tells you what denials they are? If you don’t, you may want to ask if it's outsource, biller, Hey, can you provide that?
Then you tell us what's our biggest problem, right? Because how do you fix something that you don't know about? So those are the kinds of tools you really wanna look for, and those are the kinds of reports that I would be looking for. We're asking your outsource billers for.
Marla: Yeah, and it makes perfect sense. Because when we do our therapy, we're always using data and evidence-based me medicine to make our decisions. So it's the same thing with
Josh: Yep, the same thing,
Marla: RCM, you need the data to make data backed decisions.
Josh: You need to diagnose your problem, right? And then you need to use the tools that you have available to seemingly fix that problem.
Yeah, you're a hundred percent right. That's exactly right. Take that.
Marla: Wow. I'd love to know a little bit more about when you recommend bringing billing in-house or outsourcing it, the positive and negatives to both. And also if there's a difference between the size of the clinic that you should be doing that.
Josh: Yeah. And so if I talk about Prompt directly, honestly I don't know that there's ever a time not to bring billing in house. We've worked with startups and we've worked with, people that have 10, 12 clinics and they have doing in house both ends of the spectrum. If you're not on Prompt, you're on other EMRs.
I think what it really comes down to is do you have the tools to utilize in order to do and then do you have the person identified that's gonna do that? Because a lot of people, you and I sitting here talking and people listening, they might be like I need a full-time bill.
You don't really, I like to say that anybody. Essentially you'll need a full-time builder when you get to about a thousand claims per week, right? So that's probably when you need a full 40 hour biller. If you have one clinic and you're doing 250, 350 claims a week, that's like a 25 hour job maybe, and if you’re on Prompt it's even less because of all the automation.
So if you have someone that is an admin that you think is capable of learning the billing to bring in house, you can certainly do that. Now, not everyone can do that without the right help, right? Or coach like with us, we've coached people that have no billing experience whatsoever, and I always say by the end of the five months with us, you will be an expert.
Billing for your clinics and your payer mix and who you're seeing. Not saying you can go around the whole country and bill for people, but you will be an expert in your clinics. So if you have that person identified and you have someone to help teach them those things you can do it at almost any level.
And I think it's always gonna be a little bit more cost effective to do it that way. Now obviously if you're a smaller clinic and you have to hire a full-time biller, right? Because that's what you think you have to do. That might not be cost effective. That might be when you want to look for an outsourced solution, even if you needed a part-time, it may not be cost effective.
You'd be paying that person more than you would the outsource billing team. So it's hard to put an exact number on it. I think it is a case by case basis. But for example, most outsourced billers are anywhere from four to 6% in your total revenue.
Marla: So if you're higher than 4 to 6%, you're probably spending too much on your outsource biller?
Josh: I would say so. Or maybe they're offering things like eligibility and benefits checks and authorizations. I'm always skeptical about that. I think, I call auths denials, clinic killers because you can never get them back. So I am very hesitant to let them go outside. But yeah, so you're right, if it's over 6%, that's a little much.
I'm not really sure what they're offering at that point to have such a high rate. I think 6 and under, that's pretty standard. One other thing you can ask the outsource billers is do they have any KPI incentive reductions? So for one thing that we offer, and I think some others do, is if you get your, auth denial rate below 5%.
We actually take an entire percentage point off your invoice. So it's it takes away 1% of whatever we invoice. Here's the thing, if you're reducing admin stress on us, we want to truly partner with you, we're going to give that back to you. And I always look at it on the business side of things.
Look, if you're bringing in more money per month because your denial rate is down, we're actually making same on my end, or a little bit more at a lower percentage. And we're not working as hard to get that. So of course I want to kick that back to the people. So that would be one thing I would ask outsourced billers that you're looking at. And I think there are some that do that.
So do they have KPI incentive? You hit one. Do they reduce your invoice? So yeah. When it comes to that's where you want to look at between in, in-house and outsourced is. I can pay this person, right?
But it's going to cost me more than the outsource. Now if you're close, this is another thing I would look at. What's your ROI? No one cares about your money more than you, right? And if you think about a percentage, $10,000 to you at 6% is $600 to them. So if that $10,000 is very hard to get, is the ROI for them outsourced?
To go get that money, really their top priority or $10,000 to you, that could be your profit or you're breaking even in that, right? So even if the in-house biller has a little bit more, you may actually be getting a lot more in revenue by doing that and going that route right now.
Of course, if it's a really imbalanced, yeah, no, if you want to find the best outsource builder you can. Maybe ramp up. And then once you're able to, have that person bill in house, then you make the switch.
Marla: Got it. Got it. Yeah. And I love hearing how you're saying, hey, if you're first time clinic owner, maybe start with that outsource.
You don't have the right person yet. And as you start to scale, that's when, and have more claims. That's when you really should think about bringing in-house. And being able to create the process, the systems have the learning, and then just catapult from there.
Josh: Yeah, I think that's exactly right.
And I think, the other thing you want to look at too, one thing I would look at is are our operations down? Do we have our operations down? What, if you keep getting reports from your house force village and yeah, your denial rate's below 4%, it's great. You get all those KPIs in order and you're like, we're doing really well.
When you go to bring it in house, it's that much easier for that end. You don't want to give them a chaotic system. That's recipe for failure. So those are some of the other things that you would want to look at, as you scale, like you were saying. Okay. Do we have this down?
Are we making enough money to make it make sense? Okay. Now let's transition in house.
Marla: Great. And as clinics start to scale, when would you recommend them to add an in-house, a second biller, a third. What is the algorithm to say, this is when you have good tools and process in place?
And maybe if you have more than that, then you probably should re-look at learning how to get things a little bit more operationally better.
Josh: If your EMR allows for like a productivity report for your biller and that they're very productive and then you want to listen to feedback, oh, hey, how's it going?
Are they overworked? Are they being, do you constantly get emails like, Hey, we’ve got to work on this 'cause I'm seeing a lot of this and it's really overwhelming. And then again, you see their productivity way up. So you know, they're not just sitting there. Nothing. Maybe that's the time to get like somebody to help out as simple.
But like I said, if you have a really efficient EMR, you have very good processes and procedures down, your denial rates below 5%. They should be able to handle a thousand claims as a full-time builder a week. So then if you're starting to get over that, maybe that's when you just want to, keep a lookout for okay, are they still handling this?
And keep an eye on your KPIs, right? Those six we identified, they start going south. Maybe you need some help. I have get back to where it needs.
Marla: Great. And I assume you really guide practices of all sizes. So as they start to get really big do you help them decide when people should just be focusing on one art of the billing?
Josh: Yeah. Yes. There are times we dealt with a client that was out in Texas and they had three billers because they were large and sometimes there's certain ways you can break it down. Okay, so this person just posts, right? They post response, this person works on denials and this person works on rejections, exceptions, and all that.
Or you can go, this biller has these clinics, this biller those clinics, right? And at a certain size start to do some of those things. Because I always say, if it's everybody's problem, it's nobody's problem. And everybody thinks they'll handle it. That person will handle it.
So yes, you would start wanting to break down your team into very specified groups as to what they're doing. We actually helped with that. We picked individuals, helped them work that out as to who would do what. And it was a little bit of an emergency situation. Like they had switched EMRs, and their team didn't grasp it.
We lead the EMR transition. Now this was a team full of experienced billers, right? And you can be like they should be able to handle that. But a shift like that can be jarring sometimes if you don't have everybody on board. And so we came in and just got their billers comfortable with the system and creating workflows with that.
And, just like I said, identifying people to do certain jobs. And before you knew it, their revenue turned around, I think within the first month. And it just went up. So again, it's those little things, right? They just weren't used to the system. They didn't have the workflows proper in that system.
So things weren't going out. They weren't coming back like they had, before. So yeah, that's, those are the kinds of things that you can do or look at and then just tweak a little bit. It's for your revenue.
Marla: That's great. That's fantastic. And as we said, we didn't go to school for billing as a clinicians.
Or even business ownership. So it's great to be able to have that guidance and understand when we should be doing it in-house, what should be the next step, the CPT coding and all of the above, what we could be teaching our clinicians to make that like better.
Josh: Yeah. Yeah. You're so right about that.
I used to be an assistant to an orthopedist and he said his mentor told him that the easiest part is the medical stuff, right? That's the easy we go to school for that. The hard part is the billing, right? So it's across all, it's not just PT. You're right, they don't teach that in the curriculum ever.
And some places, if it's inpatient, you're not really worried about it. They have whole teams and whole divisions that help with the billing and all of that stuff. But when we move into, outpatient, it's a little smaller. You have to be a little more knowledgeable about what you're doing.
I think I was out at PPS actually, so the private practice sector, and I was actually at a Prompt lunch. There was a gentleman sitting next to me and one of the best things he said was as an outpatient, you eat what you kill. Like it's not handed to you. You really have to be scrappy and know what you're doing in order to get everything that you should be getting.
The most difficult part of it at the billing.
Marla: That’s exactly right. And what are you most excited for in the future of billing? What are you looking towards? What are things that you know are gonna really help advance? The mundane tasks that happen in billing that technology is solving now.
Josh: Yeah. I think one of the biggest things is obviously AI. Across all spectrums. When you can put certain parameters and boundaries into your system and then have that AI helps you be very efficient. It's pretty amazing and I'm very excited for that. To be able to basically tell it like, Hey, this is what we should expect from this assurance.
And every time you get that, it just posts it for you and it posts it correctly. It balance bills the patient correctly, it puts it in the right spot in EMR. That's pretty amazing. And then if it doesn't do that, it leaves it there for a biller to look at, Hey, there's an issue here.
So that's very exciting and I think it's going to change a lot. I think billers that, now I say can do a thousand claims a week, maybe it goes up. And it still reduces stress of that biller. But then also, it reduces admin costs for clinic owners nationwide, which is huge.
Because reimbursement keeps going down seemingly. And it's also, we're struggling to be able to treat patients right? So the least administrative burden you can put on your people, that's the most. And that's what I'm most excited for, is to see some of that.
Marla: Yeah. Because really that's just people clicking a button to get it to the next stage. And that should no longer happen. And I know at Prompt we’re doing a lot of that as well, where there's automation, there's alerts, and then it just happens to the next stage. And only the ones you need to focus on are the ones that come into your bucket.
Josh: That's exactly right. Yeah. That's what I tell our clients is, I actually shut all the automations off in Prompt to begin with because I want them to learn how to do everything manually. I want them to learn the systems and the processes inside and out, right?
But then when we get towards the transition portion of our contract the last two months we start to perfect the automation and create it within the Prompt system that it can perfectly do everything for them.
To get rid of the redundancy, like you said, of somebody just hitting a button. I don't even have to look at this. It's fine. So that's where we go eventually. And then they're like, oh my God, this is amazing. I just gained like 10 hours back in my week that I don't have to do.
And yeah, it's very exciting.
Marla: That's so smart that you do that, because it's really people understanding and they've got that learning.
Josh: That's exactly right because with the automation, it's amazing for efficiency and effectiveness. However, it does mask a little bit if you don't know where to look, maybe some of the problem.
So when we strip that away, first, you're really going in there manually, getting under the hood and looking at this, figuring out, okay, why is this doing this? And so again, once your system is very clean, you know all the fundamentals, you know everything to do. Then we turn on the automation we create it.
So it's perfect for the system. And then everything's working very, cohesively and that's where we see the best outcome.
Marla: And for people who don't have that automation or using different EMRs, do you help them set up those processes and those pathways externally to their EMR?
Josh: Yeah. We don't work with a whole lot of people in other EMRs, to be honest with you. We have worked with many, but we do that. It's, honestly, it's the same. It's the same. You do everything manually and then maybe it's, like you said, outside of the EMR racking certain things, doing certain things, using certain tools those kinds of things.
If you're EMR design, so again it's very custom. Every clinic we go into is different. Like all the tiny problems are the same, but the way to fix them, they're all different. So when we get in there we do, we try to provide the tools with whatever they're working with.
Marla: Great. And what is, let's say, fearful about billing coming out in the future?
I know insurance companies are starting to use AI to reject claims. Tell me a little bit about that.
Josh: yeah. So again, I think everybody's fearful of reimbursement. Like eventually this is gonna be like we just, we can't make a profit. There's no way, unless we're not compliant.
And then we will get hit with fines and we'll get hit with other things, right? If we're not doing it by the book. So that is a worry. What I love to see now though is a lot of people going to Washington, talking, trying to correct those things and. Just bring awareness of what's going on.
That's hugely important, I think. And yeah. Insurance companies using the same thing to make it more efficient and effective for them to deny right or reject. I think one of the biggest things is, again, switching into business mindset and then with the billers, having them have a tenacity to go after insurance companies.
If you're doing everything right, if they're not doing what they need to do correctly, you need to report into the state. If they're workman’s comp, you need to report them to DOL, right? Like you can't just sit there and accept what's going on. You really need to know, hey, if this isn't correct, I need to report them and have them looked into.
So that's another thing we tell our clients and I kind of work them through. Because every state has an insurance commissioner, right? Yeah. And that's how you can battle back. If you know you're in the right, you really should go and do those things.
Marla: And maybe even dropping the insurance companies cohesively as a industry.
Josh: Yeah. All together. That's that's exactly right. I say that too. When we work with startups, I'm like now you're in the brotherhood. Just know every bad contract you take affects everybody across the nation and it's hard to think like that when you're first getting in because the mindset's always I'm just going to accept everybody because I need to get patients in here.
And I would caution everybody listening to this, don't do that. It is a very bad strategy. Once they have you and you're in, if you think you're going to just start to renegotiate, I have news for you. It's not happening. It's only going down. It's only going down. And you never have more leverage than before you're in with them.
Once you're in with them it's pretty much gone. I would say really look at your contracts. Here's the other thing is you can't make up a bad contract by volume. And what I mean by that is if it costs you to treat that patient, either break even or be more than you're getting in reimbursement, every time you see that patient, it's actually a detriment to your practice.
And again, we hate talking about patients like that, right? But it's the reality of it. It's the reality of the business. We need revenue to keep the lights on, get better stuff to treat patients with, and grow so that we can treat more patients. And if you are accepting a contract that say pay say, pays you $70, but it's costing you $72 per visit or your practice for patients across the board, the more you see of that insurance, you can't make up for that.
It's just a deduction after deduction. Because it's costing you more to see them than you're getting So those are the kinds of things you really want to take into account too. When we talk about fears with insurance companies and things, bad contracts is one thing that is a fear, but you have the ability to stay out of them
Marla: That's great.
And honestly, at the end of the day, all we want is give that quality care. So if we have to see more volume because of the contract, that's not, that's doing us a disservice as well.
Josh: Yes.
Marla: Love that. Love that advice and think it's super helpful to everybody listening. Yeah. And then just. To in general, if you had to give everybody some advice of whether, some last minute pointers of whether you should go in-house or outsource, what's one thing you just want to tell everybody today?
Josh: I think the biggest thing is, what's going to make sense for your practice? Out of everything we've talked about today, can you really sit down and go, okay, we do outsource. That makes sense because of these things. We're not big enough yet. We don't have somebody identified that we think is for us.
We've vetted this outsourced billing company through and through, asked some of those questions we talked about today. Hey, do you have these KPI metrics? Can I ask you for them? Do you give them on a monthly basis for the month prior? Or those are the types of things you do? Does, if that's, if those things are all yeses, then that makes sense. Okay, outsource billing.
I think personally I would always be on the lookout for when we could bring it in, right? If I had to start my own practice today all over again. And originally I was like, yep, outsource makes sense. I would do that and then I would be looking for when, okay, when are we going to bring it in house?
Eventually it just makes sense to do. So that would be my advice is just. I think you can get complacent, even with outsource builders, you're like, it's good enough. But is it optimized? Could it be better? Could it be better? So don't get complacent, complacency kills.
Marla: Love that.
Josh: Keep reevaluating, keep reassessing keep running the numbers. And again, objectively, if it tells you to switch or it's a good idea, then go ahead and do, yeah.
Marla: And to give people some hope and encouragement. What do you see as the revenue uptick that occurs? You can give us a range, a percentage of when they do have let's say billing that's not operationally great or outsourced and then they bring it in house and clean it up.
Josh: Yeah. It's every client we've worked with has seen at least a 10% increase in revenue, sometimes 20% in revenue per month.
One of the biggest things too, I'd really want to touch on this is we didn't even offer outsourced until a bunch of people asked us they loved what we were doing. We can't do in-house, but we really want you guides. Can you do outsourced billing? We decided to do it. So we're like, okay, we'll do it.
One of the biggest things we see is lack of communication between outsource billers and clinic. So what we have done is you meet with your biller every week for a half an hour. It's there. If it doesn't need to be taken, then you need to do something else fine, but it's there for you. In order for them to give you the feedback, Hey, this is what we're seeing.
Here's your biggest amount, here's how you fix it. And then Chris and I meet with them too and do some of the billing or business billing consulting while we're outsource billing for them so that they. Don't put administrative burden on us with undue and unnecessary rejections and filed and things right.
And then we're also increasing their revenue. So if you can find an outsource builder that does that and has that kind of communication, that's huge. That's, yeah.
Marla: Yeah. And 10 to 20% increasing revenue is so important to get back to your therapist, to get back to your business, to grow more and to provide better quality care patients.
Josh: Absolutely. Yeah. Absolutely. Yeah, you can do all kinds of things with that kind of revenue. And we see it often, actually, every time we step away, I feel like there's an update down the road that they're like, oh, we're growing or We're opening up a new clinic. We hired two more PTs. So that's always great to hear.
That's always great to hear.
Marla: It's rewarding. This was fantastic. Tons of great tips for a small clinical owner, a mid-size, and for anyone that is just evaluating their billing and trying to get their business. And an even more seamless operationally spot so that they can grow and do what they do best.
Josh: Yeah. Thank you. Thanks for having me again.
Marla: Thank you.