People Process and technology and the audit

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Hey everyone, Dr. Brian Capra here from Genesis Chiropractic Software and Billing Network. Tonight I’m going to talk to you about how insurance companies leverage people, process and technology to beat the heck out of us and really kick us when we’re down, take our money and use it to audit other chiropractors. People, pretty simple one actually, a lot of their work is outsourced. We’re going to talk about automation with technology where they’re able to actually automate so many things where they don’t even need people. But when they do need people and you call, who do you get? You’re actually talking to somebody in India.

So what do you think they’re paying them? They’re paying them maybe a dollar an hour. They’re paying them for your team member to call them. Hopefully it’s not you because it’s even worse if it’s you. But if you have a staff member calling them, maybe you’re paying them whatever you’re paying them, 12, 13, 14, 15, maybe more dollars per hour. That’s what you’re competing against. That’s the cost that they know they’ve got you beat as soon as you pick up that phone.

Just by picking up the phone, you’ve lost. That’s the simple of it. That’s people, super simple. Process, let’s talk about your process. I have some notes. So forgive me if I’m looking down at my notes. Let’s talk about your process versus their process and how much manual labor there is on your end and how much manual labor there is on their end. Remember now, you’re paying somebody 15 bucks and hour. Let’s say they’re paying somebody nothing, well very little relatively for their manual steps.

Let’s look at how many manual steps you have compared to them. So manual steps, benefit verifications, pre-certification, hunting and pecking for codes, modifiers, diagnosis code links, units, ordering your diagnosis codes, all that beautiful stuff. Documentation of your visit, submitting the claim, correcting claims that were wrong, posting EOBs, submitting to secondary insurance companies, finding unpaid, underpaid and denied claims, calling and following up on those claims, submitting supporting documentation when they ask for it, resubmitting claims, collecting patient balances, which is like a job in and of itself.

Think of all those manual steps. You would need somebody to do them and you’re paying them whatever you’re paying them per hour. Let’s use 15 bucks an hour as an example. Now let’s look at the insurance company’s manual steps. Again, they’re leveraging all these things. Every business is made up of three things, people, process, technology. All they do is say, “How are we going to make it cost way more in people,, process and technology for the doctor than it will for us?”

Not to mention, they have unlimited money. So let’s look at their manual steps. Answer the phone, when you call to follow up for an unpaid, denied underpaid claim, if you call, or if you call for benefit verifications, or if you call for pre-certs, then the other manual step is auditing you. That’s pretty much it. Why? Let’s talk about technology.

They, again, have unlimited money and they have a huge database of doctors submitting claims to their database. They have massive amounts of money to invest in technology which includes automating all those steps, automating certain steps, and then using artificial intelligence to find the doctor that’s most likely to lose an audit. They look for trends. They look for trends in claims, your codes, your documentation, your follow up on claims, denials and underpayments and all that, or lack there of, if you don’t follow up. They automate the claim receipt. So they’re not actually having somebody receive a claim anymore and then process the claim. It’s just getting to them and it’s being processed through their technology in an automated way.

They’re automating the claim receipt, the denials, the payments, the underpayments, the pre-certs, the ID of candidates for audits. So they’re automating all of that. Forgive me, I just lost my page here, so give me one second. They’re automating also, identifying the candidate, the people who are most likely to lose an audit because they have all of this mass amounts of data. This technology is spitting out, “Hey, this is the list of doctors that are most likely to lose an audit.”

The insurance companies are not paying people to audit you. They’re not paying auditors in most cases. Those auditors are paid a percentage of what the actual settlement will be. There’s no loss for them. They don’t lose money, other than the technology they’ve invested in, once they find you and outsource you for an audit for the most part.

I don’t want to oversimplify that. There’s a little bit more details. For the purposes of this video, just want to make sure you understand that once they outsource that and that person is getting basically a commission on your audit. Then there’s the audit, and now you have costs associated with that for yourself.

Obviously, just the costs of hiring a legal team, but how about the fact that they send letters to patients saying, “Hey, FYI, your doctor is being audited.” How about a new patient killer or practice killer and attrition risk for your practice where patients are getting letters from their insurance companies saying, “Hey, your doctor is getting audited.”

I’ve heard stories of clients that went through audits before they joined Genesis where they actually showed up at the patient’s home and knocked at the door at night waking the children up and saying, “Hey, did this doctor do this? Did you get these services at this doctor’s office? Because they didn’t support the proper documentation.”

Just showing up at the patients’ houses. You also obviously have the legal defense. Those expenses are going to climb. You’re facing losing your license because once you get audited, there always a chance that … The best case is actually just the audit from the insurance company. Once they report you to the state board, you’ve got a whole new problem where you’re actually risking losing your license. Obviously it’s a huge distraction that ways on you. It’s an emotional burden. And for every time they audit a chiropractor, they expect, I think I said 14 to one last video. I’m looking at my book here. It’s 13 to 1 return on investment.

So every dollar they spend on an audit, they expect $13 back. Question would be to you, if you had a marketing strategy that gave you a 13 to one dollar return on your investment, how many dollars would you invest in that marketing strategy? All of them is the answer. All your dollars go to that marketing strategy because if you get $13 back every time you spend one, it’s a no brainer.

Why do you think audits are going through the roof? Hope you understand a little bit more as we’ve gone through these videos here. Please go back and watch them in order because the next one is really important. It’s about going cash and the myths and the facts about going cash. I have the quote here. “Just when you thought you were out, they pull you back in.” That’s from The Godfather. He’s trying to get out of the mob and they keep pulling him back into the mob. How the insurance companies have actually started to rig the system, it’s actually becoming more and more prevalent especially for you cash doctors out there. Pay attention to the next video.

If you’re just kind of tuning into this and you think, “I’m safe,” or you’ve heard some of these videos, think, “I’m cash. I’ve kind of solved the problem,” make sure you watch the next video. You’re going to want to make sure that you’re aware of the things that are happening to even cash practices now. Not by the insurance companies anymore, but the exposure is actually in some ways even bigger. Stay aware. Stay tuned. Watch these videos. Share these with your friends if you could. If you can comment or like or whatever, I guess that helps my SEO, but whatever.

I’m really here just to give you some what I think is important information. A lot of this stuff that I learned years and years ago, I had an inside track on this stuff so I learned this. A lot of the reasons why I started Genesis, it’s not about collecting insurance for me. It’s about automating things so much so whether your patient is insurance or cash or what have you, you’re process doesn’t change. No matter who is paying for the care, you can practice like a cash practice.

Hope this helped. Stay tuned and I’ll see you tomorrow. Thanks.