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Going Cash

 In chiropractic software

Hey, everyone. Dr. Brian Capra from Genesis Chiropractic Software once again. Tonight I am going to talk to you about going cash facts, myths, pretty straightforward, pretty simple, very misunderstood out there in the profession. I understand how we wound up in this situation. Tired of dealing with insurance companies, tired of submitting claims and following up on claims and dealing with having to resubmit claims and submit documentation and all the rigmarole. I understand it 100% why you’d want to quote unquote go cash. Quick quote from Ayn Rand. If you don’t know Atlas Shrugs, read the book, watch the … There’s movies now you can watch. So watch the movie. It’s really cool. “Contradictions do not exist. Whenever you think you are facing contradiction, check your premise. You will find that one of them is wrong.”

So I’ve talked to a lot of doctors that thought going cash would kind of keep them safe and make it simple, and they wouldn’t have to document as much. They wouldn’t have to use the coding as much and all that stuff. But now we know that’s just not the truth anymore. State boards are requiring Medicare-level documentation and coding even for cash patients. So it’s not even the insurance companies anymore. This has become a standard of care. You’ve probably heard that kind of terminology before. Standard of care means it’s just required because you’re a doctor and it’s expected of you.

So what does that mean? So let’s talk about going cash. Obviously insurance companies ideally never have to pay you, right? So we think by going cash and submitting superbills to pay or giving superbills to patients that we’re kind of playing along with the game. That’s not the game. That’s not what they’re looking to do. They’re going to have to pay the patient anyway, so that’s really not the problem. So there’s really no such thing today, and don’t shoot the messenger, as a cash practice anymore. There was a long time where you can kind of get away with that, but it’s just not the truth anymore. Number one, you have to submit claims to Medicare for Medicare patients. That’s the law.

So right off the bat, I know a lot of the cash doctors say you’re cash, and I know you know that you have to submit to Medicare. So you just submit to Medicare and that’s it and everybody else gets a superbill. I understand that scenario there, but again, state boards now require Medicare … So number one reason that cash doesn’t really exist, you have to submit claims to Medicare. Number two, state boards now require Medicare-level documentation and coding even on cash patients. So you have to do it anyway. The only difference is whether or not you have to submit claims, follow up on claims, and so on. The third and probably biggest reason that there is no such thing as a cash practice is even if you give superbills to patients today, insurance companies can still come back and audit your documentation for those claims to support that it was actually done.

So what they’re going to do is tell the patient this is denied, ask your doctor for documentation. If you don’t provide that documentation, you’re in trouble. If you do provide that documentation and it doesn’t support that, you could also be in trouble because what are they going to do? They’re going to report you to your state board, which in my opinion is an even bigger problem than an audit. You get audited, worst case, you have to pay a bunch of money back. Obviously there’s legal fees involved. That’s never … it’s not fun. There’s a big distraction. It’s a nightmare. But I would say a bigger problem is actually getting reported to your state board. Why? Because now it’s your license and your livelihood. So the insurance companies have figured out every single possible scenario to tighten the screws. You know, there’s the old Godfather quote, “Just when you thought you were out, they pull you back in.” That’s because there’s really no such thing as a cash practice.

Now a little light at the end of the tunnel. The wrong question, what we should not be asking ourselves … I know how we, as this profession and how we think, we just want to save people, we just want to save their lives, we’re just trying to serve people. We just want to adjust. I get it. I’ve been in the same, you know, your shoes. I was the same way, except today the game is just a little bit different. Even if you want to see cash patients, and we work with CHUSA and other companies that do cash discounts, legally doing cash discounts. That’s great. When they are in the cash portion of their care plan. When they’re not and it’s medically necessary, insurance is still in the game. So that means the state board and/or the insurance company is in play.

All right, so the wrong question is how do we see patients to avoid documenting and coding requirements? Can’t do it anyway. So that’s the wrong question. The wrong premise, right? Ayn Rand. You’ve got to check your premise. It’s just wrong. You can’t do it. The fact is we can’t do it, so state boards are now requiring it all.

The correct question, what we should be asking, how can I see patients regardless of their payer, whether it’s insurance, because at some point in their care, they’re either insurance, they’re allowed to get covered by insurance or they should be covered by insurance or they should not, right? Meaning that they’re not in acute care or not in active care. So how can we see patients regardless of the payer and have systems in place that make it feel like, for the doctor, for you, for your team, like a cash practice as far as the amount of work required on your end?

Okay. It’s never going to feel like … If you’re a cash practice, it’s not going to feel 100% like that. But you also got to remember that insurance got so complicated, it shouldn’t feel like that either, where it’s so much extra of a burden on your practice.

So the second question we should be asking is how do we convert patients to lifetime care regardless of who is paying for care at any given point. Okay. So those are the kind of questions we should be asking. So I just wanted to shoot this quick video out, help you understand. Please don’t shoot the messenger. It’s a real thing. Obviously I run Genesis Chiropractic Software. I didn’t start this whole thing to build a billing company. This was about saving more lives, about building technology to streamline and automate things because I’m just like you. I at the time was accepting insurance, and had a lot of cash patients and convert a lot of cash patients to lifetime cash. I just wanted to make that insurance portion extremely streamlined so that I had to do very minimal amount of work.

So up next I’m going to talk about … we talk about people, process, technology, and how the insurance companies are leveraging that kind of thing to really tighten the screws on you and really squeeze you into a place where it’s costing you tons of money to beat them, and they can identify who’s going to be audited and all that stuff. We’re going to talk about the other side of the game.

I see Dr. Shawn Leatherman just joined. So, kudos to you. Dr. Shawn, give me a comment or a like or whatever you can do. But what I am going to talk about next, in my next, my upcoming videos is how do we use people, process, technology. For example, how can we leverage the same outsource companies that they’re using … thanks Dr. Shawn … that they’re using so that when somebody calls on your claims, that they’re getting paid a dollar an hour and we’re getting paid a dollar an hour. So we’re paying both our teams a dollar an hour, if you would. How do we leverage and level the playing field and beat them at their own game? And it can be done.

Ten years ago, I shouldn’t say 10 years ago, 20 years ago, could not be done. Technology didn’t exist. Today we have it. So people, the processes in place, the automation, the technology, the artificial intelligence that they have, and they’re gathering data across hundreds or hundreds of thousands of doctors. We now have the same platform available to us to be able to automate, use artificial intelligence, leverage manpower, and beat them at their own game. That’s what I’m excited about. And at the same time, what we can do is streamline things to such an extent that you’re seeing patients regardless of who’s paying for the care. That means cash, insurance, what have you, and it feels just like a cash practice or as close as possible to that.

So thank you so much. I hope you have patience with me so we can go into some of this other stuff and we’ll talk. We’re going to talk about Genesis and how the technology that we have now in the platform of artificial intelligence and automation has made this a reality where we can beat them at their own game. So thank you so much. Have a great night. I look forward to seeing you, not seeing you, hopefully you join me on the next video. Thanks guys. Have a great night.