Acupuncture and Chiropractic Insurance Billing & Practice Management

When I post here it’s obviously about insurance issues. Not this time, this time I want to write about my company, and about yesterday. You see yesterday was National Medical Biller’s Day, but here it was just another day as usual. I want to acknowledge the dedication and hard work of everyone who works here with me. They make getting here in the morning a pleasure and being here special. At a recent weekly meeting we were talking about how our company is growing and one of the billing reps said “There’s a vibe here Mori we’ve got to make sure we never lose that vibe!” Every one of us INSTANTLY knew what she meant.

At our office we have six billing representatives, medical billing is their career choice and they all went to school for this profession, they interned here for free for a month for the privilege of hopefully being hired. They work to bring in revenue for our clients and they take their job seriously. All started out not billing but doing aging, moved to verification and finally became billing representatives handling client’s claims and issues. Because of their training they can do any position here and pitch in when needed. Anything I’ve asked them to do, they get the job done, and I am honored to work beside these hardworking individuals.

We have a verification specialist whose job is to call and check on benefits for our clients. He is young, came with a few years’ experience and also considers medical billing his career. In the future he will work his way up to be a billing rep. He is nice and polite says things like, “Thank you Ma’am” to insurance reps that have probably never heard the words before. At first I wanted to train him to stop that because it takes too much time. But I realized just like everyone else who works here, he taught ME a better way to do things- polite is always right.

We have a computer programmer on staff that programs our proprietary software and handles all IT computer related issues. He does things he wouldn’t have to do if he worked at a tech company; he sets up printers, installs software as well as creating our systems that set our company apart from typical services our size. He’d make more money at a tech company but he stays because he knows his skills have changed this company, his programming has immediate use and I think he really likes being part of this team.

Our newest member got her bachelors degree last year in communications and I don’t think then she imagined she’d be working here. She is our Aging Specialist. It was amazing how she fit right in, literally from day one; she’s sped up our processes and works hand in hand with the reps. I tried to figure out why as we’ve grown the hiring seems more seamless, because sadly in the beginning of growing this company a lot of people didn’t make the cut. I realize now that hiring is an art, and one I will constantly be learning, however I don’t take the credit for how well we function together. I truly believe it is because of the culture we’ve created. This organization is made up of the people who work extremely hard, help each other out and aren’t afraid of innovation and together we have a vision for what we want this place to be. I’m not perfect and we all make mistakes but it’s easy to see we’ve created a place where we all want the same things. We want to do the best job we can for our clients and we all believe what we do makes a difference.

So Medical Biller’s Day came and went… But I know it really isn’t about a day, to me it’s about the people who work here, and it’s about the culture we’ve created, it’s about providing stellar service and feeling we make a difference to our clients. I am grateful to work alongside employees I consider true professionals, we’re going to make sure we “never lose that vibe we’ve got going here”, that’s going to last a lot longer than just a single day.

I guess I haven’t written in a while, well it isn’t because I don’t have much to say, because those that know me know I ALWAYS have something to say…

For providers across the country, I know people are really concerned about “Obamacare” and you know what I say, really what are you worried about? If you KNOW you are providing GREAT service, if you know you are giving patients what they need, no matter what laws are passed, etc. you are going to be okay. I think Obamacare IS going to be good for alternative practitioners because they provide great services at lower cost and with less issues.

What you guys have to worry about is getting on the train. Understanding that you are going to have to get on board with things you may not know about. EHR, ERA, EFT, or even ICD-10 or even CPT codes. OK, I said it, you’re going to have to go mainstream with other providers. Yes they use “codes” to describe what they do, but don’t you? OK, be a “cash only” provider, be a barefoot doctor, but you sure as hell aren’t going to see the amount of patients that someone who takes the time to find out how to be mainstream. Cash providers make a big deal about giving their patients a super bill, but don’t know what codes mean or the fact that ALL benefits are diagnosis specific. So they give their patient’s false hope- here is a super bill that you can turn into your insurance company to get reimbursed – but guess what happens? They DON’T get reimbursed! Because you don’t know what you are doing. Growlllll..

I haven’t written for a while, but my ideals haven’t changed one bit just because I’VE BEEN BUSY! Have you? You need to know what you are doing, or don’t bother. Enough said.

You’re out of school – finally. Now you can start the business of making a living. OR You right smack dab in the center of making a living – Why would either of you need to learn more? BECAUSE it’s absolutely required that to be as successful as you need to be you have to be constantly learning something new. Change as they say is inevitable. It just happens. NOW if you are not learning and growing you definitely are not changing. It’s called – “Getting BY.- Does that even sound successful?

Just out of school you don’t have the skills of the old pros, those guys that have seen and done it all, how do you get there? Well you can practice for 20 years, or you can take some classes BY those very same guys! How about the old farts that think they know it all. Well that is also a dangerous place to be, just because your medicine may be 100s to thousands of years old, there’s something called evolution that continuously takes place, right? And because of that if you aren’t learning and growing in a very real sense you too are taking a back seat to the young and the restless that want to learn more. Here’s a tool to what you should be learning:

Just out of school – Learn something OLD, from someone old. Yes, someone NOT in your demographic. Question them about the old school ways that things were done.

You guys who have been around the block awhile – GO listen to a YOUNG person, a really young person, so young you can’t imagine they’d have anything they could possibly teach you.

Guess what? You’ll both be surprised.

YOU should be able to find any item you need to get your work done, and you should be able to do it relatively quickly. So when I ask you for your progress notes, why can’t they be faxed over on the same day? What about when an insurance company asks you for your notes? Can you turn around and send them back? Especially if you know that you are not going to be paid until you do. Well in my mind there are only two reasons why you are not responding to such a request:

1. You are a mess – you are disorganized and have files everywhere. ((You are probably not in HIPAA compliant either.)) OR

2. You didn’t do adequate progress notes. I mean MAYBE you wrote something down, some chicken scratch that included the patient’s name and the date of service, maybe even a one or two word sentence about the visit. But you just couldn’t be bothered with any more than that. You aren’t going to be paid for your time, so why should you? Or you just feel it isn’t necessary, the old school practitioners weren’t required to write things down, hell maybe the old guys couldn’t read or write, right?

The bottom line is it’s really all about excuses. Why you can’t be organized? EVERYONE can be organized, some more than others, but it can be done. Truth be told in both situations you are just plain lazy. I can’t stand lazy. Pick another occupation if you want to be lazy, like…. Well I just can’t think of a job that requires lazy…

If this is you, how did you get here? Have you always been a mess? Well if that’s the case, keep it at home, NOBODY has to know. Your work environment is a reflection of your inner self, so it’s a good reason to be neat. And if you aren’t writing notes, ask yourself WHY? Usually you’ve been in practice a while, you were a cash provider and nobody really ever asked for them. Well times are achangin. And even if you give a super bill you MUST MUST MUST document what you did. So start now.

I recently learned about this term. While it sounds exotic, it really is a quite easy concept to grasp. It is a person’s ability to see themselves as in control of their world. In other words people with a high degree of Internal Locus will find themselves in a difficult situation or position but they don’t blame the world for their problems or situation, instead they are able to focus an internal drive to rise above the given situation. You see, in spite of any situation they don’t feel they were put upon, instead they feel they are IN control.

Entrepreneurs as a whole tend to have this quality, and subsequently, tend to be able to take the punches that are bound to occur in stride as they work their way through the ups and downs that is running a business.

Think about it? Do you tend to stay “down” for a long period of time after something not necessarily positive or in your favor occurs? Do you literally – “blame the world?” OR consequently when a “bad” thing happens do you think – I’ll show them, or I’ll fix this, etc? The ability to not only rise above a less than ideal situation is a good indicator of a ones overall ability to take control of their destiny. – Something certainly required by any business owner, OR provider of service.

Think of it this way – If you blame the world, then it’s the world’s fault, it may NOT be your fault but there’s also NOTHING YOU CAN DO ABOUT IT. Suck it up, take it on the chin, get back up and go back at it and well, there’s no fault, there’s no blame, there’s just a person who fixes the problem and moves on – ON to bigger and better things! Which one are YOU?

Why am I writing about Negotiation? Because I feel understanding negotiating and how it relates to business can make a difference in your practice and how you perceive your business. Because- if you have a practice you ARE in business. (I believe I might have said this before…:)

There are many times you will negotiate as a health care practitioner. For space, for associates, for materials, etc. Sometimes even cash patients will ask for “deals” or plead lack of finances for not being able to get treatment or follow a treatment plan. Frankly most of us HATE negotiating, we want to have a price and stick with it, we don’t want push back or get into what we view as confrontation. I was like that. BUT… – what if we thought about it differently? Just for a moment, what if the sticker price WAS in fact negotiable AND it could be a win/win for both parties? Been to the store lately? Seen something called BOGO (by one get one free) or the MANY variations- buy two get the third free? etc. Right now our economy is one where it is possible to negotiate for lots of things AND feel good about it in the process.

NOW, it all depends on your pricing. You really have to think about this, especially for cash pricing, and obviously you can’t do it for anything related to insurance. WHY? Because you aren’t giving the insurance company the chance to negotiate… But back to the cash realm- Start thinking about Win-Win when someone asks for something more. Think WHY do they want? What can you give or yield on? Think WIN WIN because in the end YOU really do win.

When people ask for advice they don’t ask – WHICH software should I get, it’s more like should I get THIS software or THAT software? Now the truth is – they’ve already decided – they just want someone to agree with them. Let me explain:

If you are asking ME a question, I’m thinking you WANT MY opinion. YET, when I tell you, a. you should spend more money and get something that has MORE capabilities, b. you’re going to have to upgrade and it’s going to take time for you to learn new stuff … OMG – there is a MILLION reasons why you can’t do that. REALLY… the cheap version is the better for you (in YOUR opinion- the SAME opinion you had BEFORE you asked me! OR – the easy version is better for you – (the ONE you won’t have to actually learn anything NEW to use.) You’ll talk and talk before I give up and say, yeah – you know that really cheap, crappy software sounds like that’s really what YOU need! OR, yeah, you know you can just keep using what you have because it’s working for you. Do I believe this: HECK NO! But I tried to explain WHAT I know, you really just wanted validation, and if that’s what you what well that’s what you’ll get.

I am going to be FRANK – Being successful, making more money requires ALWAYS being open to change. It’s not the easy road, I know. As I get older I find it’s hard to embrace learning a new software, a new way of doing things. I also don’t like to spend more money. BUT I’ve also found new technology makes things EASIER so ultimately it’s worth the time to learn a new way to do things, and with technology I know to stay current you have to spend money. If you ask me – I’ll tell you what I think, but if you fight me, and give me excuses as to why what I suggest won’t work for you, I’ll be just like most people and tell you what you want to hear. – It’s obvious you just want me to agree with you, and it sure is easier to be agreeable with someone who doesn’t want to change.

So – if you ask me – Should I spend the money to upgrade – YES, you probably should. Am I going to have to LEARN new things and do things differently than I am right now- YES you are. OH – but things are kind of working the way they are? AND you found a cheaper way to do things that doesn’t require you being uncomfortable – AHHHH, yeah, that sounds fine FOR YOU. It would just NEVER work for me!

I just talked to an acupuncturist who went on Saturday to make a house call, took him over a half an hour to get to the patient’s place, once in the elevator of the building, he gets a call – the patient was canceling the appointment! The practitioner wanted to know if he could bill the patient for his time and just how much could he bill for. You know what I told him?

“Don’t bill the patient.” Now obviously he doesn’t need my blessing to bill this patient, and in fact he can send a bill for any amount he wants, however it is my opinion is he shouldn’t bill the patient and I’ll tell you why. This patient canceled his appointment less than 5 minutes before it was about to begin – Do you really think he’s going to pay this bill? What the acupuncturist should do is determine WHY the patient did this in the first place. The reason he did this was there were NO expectations set about the visit. There needs to be CLEAR communication right from the beginning about what you will do and won’t do as well as your office policies regarding payment. This is just as necessary (perhaps even more) when the patient is being seen OUTSIDE the office as when he comes in for a treatment . Here is how this situations should have been handled:

At the time the appointment was scheduled, the patient should have been faxed or sent a copy of the financial policies. Your policies should spell out in writing that missed appointments without 24 hr notice will be charged at the going rate. Since services are to be paid at the time of treatment the patient should also give his credit card information as well since there will be no opportunity to run the card at his home. These policies immediately stop any patient from canceling without notice. NOW what if the patient won’t sign or volunteer his credit card info? Well you have to ask yourself- why? It certainly is a reasonable EXPECTATION to expect to be paid for your time, right? If the patient doesn’t see it this way, do you really want him as a patient?

Occasionally emergencies do arise. You use your discretion to charge the patient (or not) depending on the situation- however YOU are now in control.

When you are clear about your expectations your time will be valued and not wasted.

Most people know that I am not a fan of insurance companies. In a nutshell – They make too many mistakes when it comes to acupuncture claims. However quite a few times – they get the blame when actually it’s the patient’s fault. Yes, I said it- claims don’t get paid and the patient is to blame – The reason? Many people WITH insurance don’t know what they have. They are more concerned about their copay then to take the time to see what is covered in their benefits package. However when their claims aren’t paid, they are the first to blame their insurance carrier.

Insurance is a product. You buy a carton of milk, well you’ve got so much milk, a quart or a gallon. People pay MUCH more money for their health insurance but aren’t clear about what they’ve purchased,. They feel they’ve purchased “peace of mind”, that their bills will be paid and they will save money – BUT it just isn’t as simple as that. The consumer has to look at WHAT they have purchased, OR – what their employer is providing them, doing that can take work, and frankly some people are too lazy to do that work.

I have lost count of the number of times I’ve heard a patient say – “I’ve got GOOD coverage” – (Yeah, but you’ve just made an appointment for acupuncture and it doesn’t cover acupuncture). I’ve also had people assume they had NO acupuncture benefits, when in actuality they had great coverage, so it works both ways. These assumptions happen because patients don’t take the time to find out about their own coverage. They lost “their book” – the Summary Plan Description they were given when they got the coverage. Well then PICK UP THE PHONE, call member services and ask – By LAW benefits cannot be a “well kept secret”. Every plan has a Summary Plan Description that explains in common language WHAT is covered and WHAT is not. The SPD IS the bible of coverage. Every patient should be aware of their SPD – but most aren’t. IF they can find the book, they’ll look at the first few pages to find out how much is it going to cost them without realizing they need to make sure that the care they want IS actually covered.

There are plenty of laws in place to insure carriers follow what is written in the SPD. If you buy insurance every state has a Department of Insurance that oversees insurance companies so that get what you pay for. If your benefits come from your employer, the Department of Labor has created offices that will also assist a patient so that he can utilize his benefits- BUT every patient must KNOW what he has in the first place, and a lot of times that’s where the problem starts.

Most practitioners start out solo, answering their phones, treating their patients, ordering supplies and before too long they need to hire an office person. This new person does all the things that the practitioner isn’t necessarily the best at or he never would have gone into the patient business in the first place. This is the absolute correct thing to do – take care of your patients, and let someone else take care of everything else. It’s the next step that starts the whole thing heading in a bad direction.

Just because you did EVERYTHING AND treated the patient doesn’t mean you can treat the patient and leave everything to someone else. Start by making a list of all of those things:

Answer the phone, take messages and book appointments. Greet patients, handout paperwork, handle patient folders. Create super bills, collect cash and run credit card payments. Call patients to reactivate and remind them of their appointments. Clean up, dust and maintain the office. Verify patient’s insurance.Bill insurance, post payments.Call on accounts receivable. Create end of the month reporting. Check inventory and reorder as necessary.

This list can go on and on. I know assistants who do these things AND many more including going to post office and office supply store as well as take gowns and towels to laundry etc. I’ve seen offices that included vacuuming, dusting and emptying trash included as duties etc.

Looking at this list there is a clear dividing line between people oriented duties and detailed tasks. What I end up seeing is offices that settle for less, giving jobs to people that aren’t particularly good at them, just because, not realizing:

The person interacting with your patients should be a people person. The person answering the phone should really LIKE talking to people and making people happy. The person making the appointments should be a customer service professional that tries to make a good fit for patient and time. ANY job duties that require patient interaction require an extrovert that is service oriented and friendly. The part of the job they love is spending time with your patients.

The person handing anything financial should be a detailed person. Verifying insurance, billing and follow up require an almost anal maniacal attention to detail. You don’t want adjustors to like this person; you want them to fear them. They like it when things match and everything is collected and organized. The part of the job they love is when everything is in its place and the bottom line is where it should be.

To me it’s clear – you need two people, (perhaps they can be part time) or you need to outsource the financials.  By trying to force one person to be two different people it’s clear to me either your patients aren’t getting the best experience they should or your are possibly losing money.  Neither scenario is ideal.