How to beat insurance companies – people process and tech – automate, focus, measure
Hi everyone, Dr. Brian Capra here from Genesis Chiropractic software. And another video in the series here, I’ve been building on, each one building on the ones before. Last week, last I was on I was talking about how we can use people, process, and technology to beat insurance companies at their own game. Something that we’ve been doing at Genesis for close to 15 years now. So I’ll try to give you kind of a, some of the context here. What we’re going to focus on with people, process, and technology are three things.
Automate. Automate everything possible. In order, in doing so, by automating everything possible, and we’ve automated literally using artificial intelligence, automation, aggregating data across thousands of providers, we’ve been able to automate more than, I think it’s 62% to 72% more automation in Genesis than any other system. When we automate, then we can focus. We can focus on the things that actually get you paid. And that doesn’t have to be just insurance, it’s cash as well. Focusing you and your team on just the tasks that get you paid, and I’m going to go a little more in depth about that.
And then once we automate and we’re able to focus, then we can measure. We can measure how much work was actually needed to be done, how much work was actually completed, the quality of the work. And then we can also start to measure not just our own performance as an individual practice but also see the trends across the entire profession as far as what insurance companies are doing trend-wise so we can continue to battle, build more automation, more rules, better artificial intelligence, to beat them at their own game. I have a really cool example of how we’re able to actually beat insurance companies at their own game, specifically in New Jersey.
So, what am I talking about with automation? I’m going to just start with insurance claims. This is going to expand into way more than that. It’s going to expand into the patient experience, and patient retention. Of course other things that affect your revenue. Let’s talk about insurance. So we’re going to automate everything, right? We’re going to automate benefit verification. We’re going to automate, like we do in Genesis, and maybe I’ll post some videos of some of the documentation, but we’ve now built an even better documentation system that’s been released this year in beta, it’s starting to get to full production right now.
Where the documentation is completely automated from the intake form into the exam form into the daily note in every document after that. Where we can take out all the manual steps that you have to do right now. And as well, on your daily notes from visit to visit make it super simple for you to make changes and updates to that.
So, benefit verification. Documentation of every single visit. Not only documenting, but the next step in actually collecting insurance is making sure that you create a claim. Well, in a lot of systems, in a lot of technologies out there, it’s kind of two different processes where you create your document, then you create your claim, and hope you don’t get audited later. What we’ve done with Genesis is make the document, create the claim. Meaning that what’s documented in your visit actually generates the claim, the codes, the diagnosis codes, the procedure codes, the modifiers, the time units, the diagnosis linking. All those things so that literally in seconds while you’ve seen a patient you can create, your claim is actually created, and it’s compliant, meaning that it’s actually supported by your document and submitted to the insurance company in real time.
Then if for some reason you tweet something or things didn’t work properly, it’s going to go through a huge, huge rules engine where we have millions of validations, or rules, or artificial intelligence rules that are going to scrub that claim. This is not clearing house scrubbing. This is Genesis level scrubbing with millions of rules that we’ve learned, you know, tens of millions of claims over the years. All right? So now we’ve got the claims that maybe need a little bit of tweaking before they go out. Just focusing your team on correcting them if need be. The claim submission, like I just said, is real time. EOB posting is now automated, right? Secondary claims go out automatically, secondary EOBs come in automatically, and post.
And then we’re going to talk about probably the most important difference with automation, using automation, to make sure you’re keeping those insurance companies accountable and make them pay the second, the first time, the first minute that you have something that you can legally do to make them pay as soon as possible. Making sure that comes right to you. What do I mean by that? We know, just go back and watch the previous videos, and how they’re legally allowed to create these laws and rules, and that we have 90, I’m sorry, 30 days to pay you and get an EOB back to you. Making sure that they pay on that day. Really we know that they should pay at the time you see the patient, or right after you’re finished seeing the patient, right? But we know the laws aren’t quite that way. So when we get that EOB back, if there’s something that needs to be followed up on, it has to be done that second.
I’m going to show you how this applies to the follow up being done the second it’s due. It doesn’t just apply to insurance claims. It applies to every part of the patient life cycle. The no shows, the no future appointments, the care plans. I’m going to talk about that in other videos. But now we have identified the claims. I mean, we, the technology and the artificial intelligence, is actually taking the claims. “This one needs to be followed up on,” and routing it to a special screen called a follow up workbench where a biller, and now we know that the terminology, biller, is kind of a misnomer, right? They’re not actually billing. They’re actually there to just follow up. We can do, everything else can be automated.
So now we’ve identified the claims. With one number in your system, you can see, in Genesis, anyway, you can see how many claims need to be followed up on by the end of the day. That’s if you’re doing things in your own office, your own follow up. If you have somebody to do that for you. If you don’t have somebody to do that for you, you can outsource that to Genesis, which I always suggest, and I’m going to tell you why in a second here.
You can outsource that work to Genesis. Traditionally, that’s always been a scary thing to do. I know I was doing that before I started Genesis, and I always never really liked outsourcing. I felt like I lost control. I felt like I lost transparency. I wasn’t sure that they were doing their work. Well now, with Genesis, you click on that number, you can see everything. Those claims that need to be followed up on before the end of the day, you know if they’re actually completed or not completed, or they’re followed up on or they weren’t followed up on, and you see a full auto trail of every conversation that was had on every single claim. So you keep control, you keep transparency, but you’re able to outsource. And I would, I argue this all the time, in that way, with Genesis, whether you have it in house or you’re outsourcing it, you have more control than you have right now by keeping it in house.
So the other reason why that is important, why I feel it’s more important especially for our profession as a whole to outsource that, not just to any billing company. Obviously I’m talking about Genesis. But outsourcing it such that what I spoke about in previous videos, well, the insurance companies are leveraging people, process, and technology, well, they’ve automated so many steps that they’re only focused on a few things that have a huge return on investment, right? When you’re calling them to follow up on a claim, you’re speaking to somebody in India, you’re losing that battle the second you pick up that phone paying your staff somewhere around $15 an hour where they’re paying less than a dollar an hour.
Well, with Genesis, we’ve been able to outsource all that follow up work to India. Right? So now we’re paying the same, and sometimes the same companies are in similar buildings, as Blue Cross Blue Shield or Aetna, now we’re beating them at their own game. We’re leveraging massive amounts of manpower because we have the technology and automation. Now we can beat them at their own game and give them a huge volume of phone calls. We’ve had insurance companies actually complain to our clients that we call them, in other words, our billers call their insurance company too often to follow up on claims because they’re just not used to it. Well, too bad. They made the rules, they set up the technology, we’re leveraging it against them, and we’re going to get paid the second we’re due, it’s due for us to get paid. In this situation, our clients are due to get paid. Right?
So now we’ve talked about automation. The focus is, focus on what gets you paid. What gets you paid in the insurance world, we’ll talk about other parts of your practice, is following up on the claims. It’s not claim creation, it’s not EOB posting, it’s not benefit verification, it’s following up on the claim the second it’s ready to be followed up on. And so since we’re able to automate and focus, now we can measure. We can measure how much work there was, how much work was completed, how much work was not completed, if any. We can focus on the quality of the work, right? So after the fact we can look at the claims that were processed, and we do this at Genesis, where we randomly sample audit the number of claims that were completely processed, and actually look to see if there was any mistakes. That team that we have that does the quality control looks at random samples of claims. And when they do that, they only get paid when they find mistakes. They audit our own follow up teams. So our follow up teams are broken into teams, and the ones that are performing the highest get the next Genesis client that comes on board. And they have to compete to survive.
So we have the quality work. Also by using this level of automation that’s in the cloud, where claims are getting processed, thousands and thousands of claims across thousands of doctors across the country, so much data is coming through one centralized database. Just like insurance companies are looking for trends in which doctors are actually doing their job properly, they’re looking for doctors that are documenting or coding properly, and the outliers, they’re pulling out. And those are the people that get audited. Well, now, we’re looking at insurance companies across the entire country and looking up their trends and seeing what they’re doing. Sometimes they change something. We have to build a countermeasure into the artificial intelligence.
A great example of this, I told you I would tell you about this earlier, and there’s many of these examples, a simple one was in New Jersey, for years, Blue Cross stopped paying for extremity adjustments. It’s a very basic thing. Well, the state association fought back, they were able to change the law, and now finally, chiropractors are going to get reimbursed for all of those extremity adjustments, and it was retroactive. But they knew, when they did this, they’ve already won, right? First of all, they kept all that money for years, gained interest on it. And they knew that most chiropractors were not going to go back in time and find all the claims and print all the claims and submit them to Blue Cross. Blue Cross literally had one person that was responsible for processing all of those claims that were going to now come in from chiropractors for extremity adjustments they had done over the years.
So they just knew we probably weren’t going to do that. But at Genesis, what we did for our clients in Jersey is we went back in history, we printed out, in a PDF packet, with the letter on top for Blue Cross Blue Shield, here’s all your claims, and we sent it to the doctor so they could sign off on it and send it to Blue Cross, and Blue Cross [inaudible 00:11:33] a stack of packets, PDF packets, of all of those claims, thousands of claims from our providers on the Genesis network, and so we were able to leverage technology and automation and help our doctors get paid tens of thousands of dollars, if not hundreds of thousands of dollars. All right?
So now we’ve automated everything. We’ve been able to help our doctors focus. Focus on what really gets you paid, and really even if you outsource, focus even more. And measure the results. Okay? So measuring is huge. The three levels of management of your business is quantify work, of any business. The three rules. Quantify how much work has to happen. That’s your processes. Delegate the work to the people, the right people. In your office, the people that do certain jobs in your office. And then actually measure that was actually completed. So, or validate, the actual word is validate.
So in order to validate how much work had to happen for billing, for example, you need to know the exact number of claims that needed to be followed up on that day. So now, with Genesis and our clients in our network, our billing network, it’s super easy for our doctors, our clients, to focus in on what gets them paid. And I argue that it’s not insurance, it’s actually focused on the patient experience. Creating an amazing experience. Having, turning patients into, from active care into lifetime patients. That’s what really generates a huge practice, a referral based practice.
So what I’m going to go into next is how we can use the same thing, people, process, technology, to affect and optimize the measurement and all the quality and everything as far as the patient experience goes. Right? So all the no shows, no future appointments, patient with care plans, creating a great experience for those patients. Knowing exactly by the end of the day how many things had to happen in your office specifically custom to your office, to create an amazing experience and know that at the end of every single day, your office, your team, did everything possible to optimize that patient experience. Great experience means patients stay longer, they get better results, they turn into lifetime patients that refer others. So we’ve seen with Genesis through some studies how patients at practices, new patients actually dip while their patient visits go up.
So what does that prove? Is that the amount of new patients they need becomes much, much less because the more they focus on that patient experience, the more exponential their practice grows. So this is a little bit longer. I’m looking at the side I’ve got a little quote, a little question from Sean Letterman. “Is the automation working right now for Medicare?” Absolutely. Actually probably the most important one. Medicare is the standard, right? So, standard when it comes to documentation is going to be Medicare. So your state boards are requiring Medicare more and more and more. This is the trend. If it’s not in your state right now. Are requiring Medicare level documentation even for cash patients.
But, as far as the automation for claim submission, EOB posting, identifying claims for follow up, et cetera, et cetera, et cetera, that whole process where now Genesis identifies the claims that need to be followed up on, absolutely exist for Medicare. It’s all payers. So I hope that helped, and you know, we’re going to get all the way through. By the way, that whole claim process doesn’t stop there. At the end of that claim process, there’s a patient balance. A patient remainder. We’ve even automated all that with Genesis. If the patient has a credit on the account, it’s going to zero out that patient balance by applying that credit. If it’s a cash visit, obviously the charge and the balance are zeroed out. If there still remains a patient balance, you can do even more automation. Email statements, we can print and mail statements for you, however you want to determine you want to follow up on patient balances in your practice.
But, doing all that automation is really just designed to collect every penny, for sure, but also take away the distraction of claim processing and collections overall and help focus you on the patient experience to build a huge practice, make a big impact in your community. So I hope this was helpful. I’ll go into some more of this tomorrow for the patient experience by itself. Thanks everyone, have a great weekend.