[00:00:16] Hello everyone, I am so happy to welcome you to The ProfitRx, this new show by Josh Fertel. We are going to be talking about how we can turn the financial aches of medical practices into profits. And I am telling you, I have been talking to him and there's not a better person that could tell you about how to make profits in the medical practices than Josh Fertel.

[00:00:44] I'm going to start by welcoming him. Thank you so much for being with us. Thank you so much for this. Yes, thank you, Ursula. I'm very excited to get this thing kicked off and share whatever it is that I know. How do you feel in front of a camera? Are you comfortable with everything? Everything's fine? Yes, I've done this before. I'm good to go.

[00:01:07] I can tell. Okay, so let's go and begin. I'm going to start with a first question, of course. That's how we started. Let us go back in time. I would like to know where you were born and raised. If you always wanted to be an entrepreneur, was either of your parents an entrepreneur? Let's go talk about your story.

[00:01:31] Okay, so I was born in Long Island, on Long Island, New York, way back in the 60s. My parents both worked. My mom worked also. She was a teacher's assistant and my dad had his own company. I don't really consider him an entrepreneur, though. The company was handed down to him, and he just worked it and never really wanted to grow it.

[00:02:00] So I didn't get that bug from him. And I think from an early age, I was taught to go to work for somebody, be an employee, have a stable job, get your health insurance, and this is the way you go through your life. So the entrepreneurial bug did not hit me until later on in life. I moved to Florida in 1992 and have been down here since. I love it. I went to, yeah.

[00:02:29] And why would you say, I mean, when did it hit you, the entrepreneur bug? When did you realize that the model was not what you wanted? I spent most of my career in the car business, and I worked for car dealers. I did every position. I worked my way from finance person to general sales manager to general manager, and I actually went to dealer school.

[00:02:59] So anything in the car business, I knew how to do. From the balance sheets and reading the reports at the end of the month, I knew how the whole industry worked. In 21, I had cancer surgery, of which I'm okay now, but I was out of work for two months. I fortunately did not have to go through chemo or radiation. I had surgery, and I wasn't allowed to do anything for two months.

[00:03:27] So there was no exercising or driving a car or going up and down stairs, and I didn't want to waste the time. I wanted to learn something new, and I wanted to be in the medical field, and I was too old to go to med school. But my whole life had been in business, in big business, and I wanted to learn about the business side.

[00:03:52] And I took a class on billing, and I took it online, and about six weeks or so through AAPC, I got my diploma. And when the two months was up, and I was ready to go back to work, I was like, well, what do I do with this new knowledge that I have? I said, I'm going to try something new. And so I formed a company. I built a website. I started networking as medical billing and took off from there.

[00:04:20] So being an entrepreneur is very short for me. It's only been coming up on four years, but I love it. I love it. You say to yourself, why did I work so much building somebody else's business when I could have been doing this? And I'm not really a what-if kind of guy. I think that everything that you go through in your life leads you to a point where you can use that information. And I'm very happy that this is the point for me.

[00:04:49] Yeah, and things come when they're supposed to. That's exactly right. But what made you say, okay, yeah, you know what? I actually like this better than everything else. This is it. You're dealing with different people. So I had started an auto brokerage, and I was dealing with, you know, after doing it so long and knowing everybody in the industry,

[00:05:13] I was dealing with friends and family and their referrals and getting cars for them outside of the dealership. So working as a broker. And I lost my whole train of thought there. And dealing with a medical practice and provider and a facility, it's 180 degrees. You know, dealing, let's just say, you know, business to consumer. Now dealing business to business is not something that I had done.

[00:05:42] And that dealing in that space really excites me because it is different from anything that I've done in the past. I am pretty sure most of our listeners are asking themselves what I'm going to ask you because you spent decades managing dealerships. Yes. And a world that was focused on sales and profitability. Right.

[00:06:08] So I'm sure everybody's wondering because I am wondering, were there any business principles you learned in that industry that you now apply to medical practices? Yes. Yes. That's I have. I have a pretty simple answer for that. If you're, let's just say, a Toyota dealer and down in Florida, there's probably 10 Toyota dealers less than an hour away. And they all have the same car.

[00:06:37] They all have the same silver Camry that anybody can buy. And I would say to my salespeople, why are they going to buy from you? Everybody has the same product. They own it for the same price. They sell it for the same price. Why are they going to buy it from you? And then you'll learn it's not the product that you have. It's how you handle your client.

[00:07:00] Asking the right questions, being there when they need something, answering the phone, holding their hands through the process. Listening. Right. Listening is the most important thing. Where is the problem that needs to be solved? And, you know, I'm not the only billing company in the world. There's, you know, thousands of them. And so what sets us apart is our customer service, I believe. And that is what I learned from the car business.

[00:07:30] You know, when backdating myself a little bit, when the internet came around and the consumer became so much more educated, it wasn't a matter of being your typical what you picture as a car salesman. And you really had to morph into a different person that was more, you know, customer first. And using those skills, I think that's what's made us as successful as we've been so far. Yep.

[00:08:00] Because in the end, people don't want to feel like it's just a transaction. Right. They want to feel that there's more to it. Right. And I'm dealing with our clients on a daily, weekly, monthly basis. Again, you know, selling a car, you sell them a car. Maybe you'll see them again in three weeks if you do, you know, three months, excuse me, three years if you do the right thing. But this is an ongoing relationship that we have, which we hope we always call it like lifetime relationship. We're trying to make it. And so you have to be there.

[00:08:30] Right. You have to be there to answer the phone. You have to be there to answer the emails. And I put a lot of pressure on my team to make sure that we are the best connectors that we can be. Because anybody can, you know, submit a claim. Right. But it's giving the feedback and solving the problems and making sure our clients, you know, thrive. That's really our purpose.

[00:08:58] So many people think of medical billing as just claims and coding. Right. But you did see something different. So could you talk about how you viewed this problem and what was that uh-huh moment when you realized that you could actually make an impact? That's fair. And I probably was one of those same people that thought that in the beginning.

[00:09:27] I was introduced to one of our clients that we still have from an attorney down here. And he said, please call this provider. He's been in business. He's had his practice for a while. And financially, he's just, you know, being average. Just have a conversation with him. See what you can find out. And this was early on in my business here. This was early on within the first few months.

[00:09:55] And this doctor told me about chronic care management now. Chronic care management very quickly is Medicare's way of taking care of seniors in between appointments. You know, it's an outreach to the senior community to make sure they're doing everything correctly to keep them out of the hospital. So this provider had an outside company that was providing the service for them. And he was telling me how they did it. And then he started getting into the numbers because Medicare does pay the provider for this service.

[00:10:26] And in 15 minutes, I was like, you're not making any money. I was like, the outside company is making the money. Let me do some homework and I'm going to give you a call back in a week. So I sponged up every possible thing I could find about chronic care management, how it works, the benefits of it. And it is a win-win-win. And I came back to him. I said, OK, here's what we're going to do. I'm going to call these patients for you.

[00:10:55] And this is how it's going to work. When you get paid by Medicare, then you're going to pay me. Not before. Fast forward now two years. He is making net to him seven times what he was making with the other company. So it just boils down to being able to look at things through a different lens. Right. Providers, unfortunately, are not taught to be business people. Right. They're taught to heal people.

[00:11:25] So if somebody can come in and see something that might be different or something that doesn't look right and can point it out. It's a benefit for everybody. Patience included. So, aside from this story you just told us, is there a story in these four years that has moved you particularly? Something that you've achieved that you're very proud of? Something that...

[00:11:54] That was a good... That's a good story. The one I just told. That was really my aha moment, like you said. I'm kind of a guy that never really gets too satisfied. Unfortunately, it's kind of a curse, I suppose. And, you know, I know what my team and I are capable of. And I know we're not there yet, but I know that it will happen.

[00:12:19] So, you know, just trying to do a better job every day and helping each practice that we deal with every day find that one little thing that they might be able to do better. Or some one other service they might be able to add on that would make them more profitable and deliver better patient care. That makes us happy. And we do that.

[00:12:44] We don't do it every day, but every week, every month, we see something that could be changed. And it could be in a process. It could be in a service that's being done. It could be an expense that they have that they probably shouldn't be paying or they can do better on, insurance, things like that. So every time, it's those little wins. Let's just put it that way. And we enjoy that. We always feel good about that and high fives remotely when something good happens.

[00:13:15] In these four years, you've worked with so many practices. So we need to know what is the number one financial mistake that most providers are making today. What I call the biggest leakage, you know, it happens really at the front desk. I think the front desk is neglected.

[00:13:42] You know, you have this person and that's an important job. This is the person who needs to smile at the patients and who needs to make eye contact with the patients. And they're also asking for the money when the patients come in. Copayments, deductibles. 25, 30% of a practice's income comes from patient payments and patient responsibility.

[00:14:09] So it has to be treated with the same respect as money that's coming in from insurances. And I think a lot of times, it's not really the person that I blame. The more I think of it, the more I dive into it, it's the relationship between the practice owner, the office manager, and that person. Does that person believe in the value of the service that's being provided at that office?

[00:14:38] Where they can say, you know, you have $20 in responsibility for this. And they can say that knowing that they're not acting like a collection agency, but they're acting part of something bigger. And so I think it's the interaction and that person knowing that they're important to the practice that makes their job easier. Because it is such a vital part that nobody talks about. You know, they talk, they'll say, oh, I need to find a better person.

[00:15:08] This person's not doing this. And I don't think it's always the person. I think it's the way that they are enmeshed in the practice itself. And if they feel like part of the team, and like I said, if they value the service that's being given. Human beings, all of us, find it kind of hard to take advice. We hardly follow advice. And I think when it comes to financial advice, it's even harder.

[00:15:35] So how do you sugarcoat everything into making practices take your advice and realizing that it's the right thing to do? Yeah. You have to earn that. Right. I can't just go into a practice and say, oh, you're doing this wrong. You're doing this wrong. You know, you have to earn their ear. Right. Right. You know, because they're getting pitched a million different ways every day.

[00:16:05] It's a billing company or it's a medical equipment company. And they're getting, you know, lunch brought to them every day by somebody trying to sell them something. And everybody's everything is a sales pitch. I'm not a sales pitch guy, even though I was a sales in my whole life. I'm not a sales pitch guy. You know, let's let's just have a conversation. Tell me what your problem is. Tell me what you think is going wrong and let's together just have a conversation about it.

[00:16:31] And and when it turns into a conversation as compared to me dictating what I think, people are more receptive. Right. It's a give and take. We're in this together. You know, my company, we we collect a percentage of the of the monies that we collect for the for the for the practice. So I say we're we're partners. Right. I'm a small percentage partner here. You know, if you do better, I do better. And if you get paid, I get paid.

[00:17:00] If you don't get paid, I don't get paid. So, you know, I make sure they know that that's the way I think. And and when they know that and when they're comfortable with that, they'll listen to pretty much anything that we tell them. That's about it. So tell me, I've heard that you talk a lot about hidden revenue. Yes.

[00:17:24] So what is an example of a small change that led to a big, big financial turnaround for a client? Small change that led to a big financial turnaround. I'm taking notes, even though I'm not a practice. You know, so the small changes come in processes. All right. That's where it starts. And like I said, having the process and the relationship with the person that's sitting at the front desk. Number one.

[00:17:54] Number two, that while I have the patient and I'm diagnosing the patient, what else needs to be gone over here? Does this person have a problem with weight or they have a problem with sugar or do they have a problem, you know, mental problem that needs to be discussed? Depression. And as we're adding all of these things, we're getting all this information. Again, Medicare and insurance companies are going to pay you to find this out.

[00:18:23] And the reason is, is that if we take care of the little things, it's going to save the big things. Right. That to me is how Medicare works. You know, and then you employ services that provide the care to the patient that will also bring in extra revenue. And we're not talking about a ton of revenue for these things.

[00:18:47] We might be talking about $5, $10, $15, you know, a visit, but then you add them up over a month and a year and it snowballs. So if you're taking extra time to take care of these patients, you're going to get reimbursed from the insurance companies. A lot of providers don't know this. You know, we will see a provider and they will code for an office visit and then that's it.

[00:19:18] Okay. Hard to survive as you're a solo practitioner, just coding office visits and not having the extra services and providing the extra services for your patients to increase the revenue for the work that you're doing. So those are little things and they turn out to be little dollars here and there, but over the course of a year, that's a big difference.

[00:19:43] And if you've been going along for a couple of years and all your bills are getting paid, everything extra that you can add onto it is going to your bottom line. Going right in your pocket. You've already paid all your bills. So this is extra. So extra services and knowing what's available and knowing how to code these things are the little things that add up to big money. Then you have services like chronic care management. You have services like allergy testing. You have services like respiratory testing.

[00:20:10] And again, other things that provide more patient value and are reimbursable. I look at things through a business mind. I am not a medical person. I didn't go to medical school. I know all these things benefit the patients. So they're win-win. They benefit the patient and they benefit the provider. So anything that we can introduce, we suggest. You need to do this. You have this opportunity. Do you want to explore it more?

[00:20:40] And we can connect them with people. So I am not a practitioner, of course, but I do know how my mind works and how my anxiety works. And I guess it is like that for most people. So when you start going on a diet and they tell you, you're not going to lose 20 pounds in three weeks. You got to take it slow. It's the little things. Exactly.

[00:21:07] Or when you start saving and it's been a month and you realize that you've only saved, I don't know, $50. Right. It's very easy to get disappointed because one is always expecting more. So how do you manage expectations? How do you manage expectations of practices like, hey, this is not going to be like from one day to the other. This is going to take time. Bear with me.

[00:21:35] You show them at the end of the month. You say, look at this thing that we changed and look what it did. And maybe it brought in $100 or maybe it brought in $200. Maybe it brought in $1,000. But you show them that the work that they're doing, the extra work that they're doing is paying off. Right. And no matter what that amount is, they're going to see that, you know what? There's something here. And not all of it is an instant quick fix.

[00:22:05] You know, here's, you know, thousands of dollars in your bank account. You know that up front. You know, this is going to be an extra $10 per visit. So maybe it's an extra $100 a day. Now multiply that, you're working 20 days a month. So there there's $2,000 more in your bank account at the end of the month. Nobody's going to be upset about that.

[00:22:27] But yes, you know, when you're talking in, I don't want to say pennies, but when you're talking about, you know, tens of dollars and not thousands of dollars. And you show them, look at here's here's a list of everybody that we got paid for this service that you provided this month. So maybe we can do five more patients next month. There's 10 more patients after that. They see it. They see it. You know, you know, I think we're all creatures.

[00:22:56] We have to, you know, if we see something in front of us, it makes it a lot easier. Absolutely. So now that we're talking about money on the table. Okay. Where, and I know you spill your guts here. Where do most practices leave money on the table? You know, a lot of the things that that that I just said. But really, if there was a. Okay.

[00:23:25] Making sure that you have your coding correct. Right. You want to code the best you can. We're here to back it up to make sure it's done correctly. We actually had a provider whose EHR was automatically defaulting to a nine nine two one two service, which is like a 15 minute visit. Unfortunately, this was a surgeon. And these were these were initial consultations.

[00:23:53] There's no way a surgeon doing initial consultation for 15 minutes. So we caught that. We said, wait, your EHR is defaulting to the lowest amount possible. How much time are you really spending with these patients? And it'd be like 45 minutes or an hour. So now you're going from a two one two to a two one four to two one five. And that's about a seventy five dollar hundred dollar difference. Right. For the same amount of work that he's been doing, but wasn't receiving the full amount.

[00:24:20] We found that pretty quickly when we took over. So making sure you have accurate coding, making sure you have somebody behind you checking it before they hit the submit button. You know, are the modifiers there? That's a good place to find money. And of course, the second place to find money, like I said before, is to make sure that the patients are paying their deductibles and their co-pays. They know they have to pay them. Tell them before they come in.

[00:24:48] You know, your responsibility is going to be twenty dollars when you get here. There's no surprises. And I feel like they're, you know, they're paying for something that they're not getting. I, you know, I would tell somebody, you know, if you go to the food store and you're not going to walk out and say, OK, I'm going to pay you later. You know, you're providing a service. Patients know they have a deductible and they know they have to pay it. So make it easy. Give them a call the day before. Say, we'll see you tomorrow. You owe twenty dollars when you come in.

[00:25:17] And it's nice and smooth. Again, that's like twenty five percent, twenty five percent of thirty or thirty percent of income. And it's cash that's sitting right there in your account that day. Think about what that does for your cash flow as compared to waiting three or four weeks for an insurance payment. Those are two major things. Absolutely. What without without disclosing something you shouldn't?

[00:25:42] What has been the most challenging thing that you have had since you started this business? The most challenging thing that I've had since we've started. Well, OK. I've been doing this for four years. I do not know nearly as much as the people that I'm surrounded by, the people on my team.

[00:26:12] Finding those people that has probably been the biggest challenge. And we have gone through people. I have had people where it just doesn't work out and we do work remote. So you want to make sure you have somebody, you know, people that are invested in the company. You know, I try to be more leader than owner. And they see I put in the work that they do. But they have more knowledge than than I'll ever have as to as to the nuance of coding.

[00:26:41] And it is it is an art. My second in commandment is 29 years old and doing this for probably seven, eight, nine years. And he loves it. How a 29 year old could love medical billing? I don't know, but he does. And he's all he loves the technology behind it. You know, if if payments aren't going out correctly, he loves finding the problems. So and I don't think I'm alone when I say this is that having the right team is the most important thing.

[00:27:10] And it is the most challenging to find the right with the right thing. And and it's taken me time to build this team. I've had the same team together probably now for about almost a year and very excited about it. We add on as we need people, but we're very slow to hire, as they say. And and that's worked out the best. But initially finding the right people that had the knowledge to do this correctly and had the drive to do a great job. That's the hardest part.

[00:27:41] And what has been the most challenging case? The most challenging case there are as much as I like to think I'm a pretty good communicator and people speak to me. There are some stubborn people out there and they don't always want to listen to what you have to say. And sometimes when I say to them, you know, you have to sign your notes at the end of the day so that we can submit them.

[00:28:08] And they don't sign them for weeks or a month and then they get upset because they're like, well, where's my money? And we go back. OK, listen, here's a few hundred claims that we haven't been able to submit. And we've told you this. You have to, you know, when doctors, they have to get out of their own way sometimes and you have to hold them by the hand. And, you know, I'm as pleasant as possible until I say, you know what, this is what the problem is. You're hurting yourself. We're doing everything we need to be doing here.

[00:28:37] You're hurting yourself. So that's the one thing that I probably the one thing I come up against most is not we work with speed on our side. We submit our claims every day, every night, even when I'm done. If I see something that hasn't been, we submit every day. Right. So we want to provide it in our clients to be on the same speed as us. You know, we want to get the money moving because cash flow. Every business is all about cash flow.

[00:29:03] And if they if they're hesitant or if they're delaying us and from doing our job, it snowballs and infects everybody. That's probably the biggest thing they always have to keep going over. And how do you find a balance between not being a pushover and not being like, hey, you got to do this. Hey, you got to do this. Hey, you forgot to do this. And making sure that they remember to do it. I'll send a text. I will text them.

[00:29:32] You know, again, I want to go back to communication. Everybody has my cell phone. We do group texting. We have teams texting. We have HIPAA compliant texting. We want to be able to answer questions in real time. If a doctor has a question about what code they need to be using or if they're in network with a certain provider, we want to be able to give them that answer in minutes. And if there's anything that's micromanager about me, it's that the questions get answered quickly.

[00:29:59] So I will give them a little push in the morning. Dr. X, you know, do me a favor. Sign your notes. We want to get these things out. And usually it gets done. So it's not me, you know, jumping on them, calling them and harassing them like a debt collector. You know, just a quick little text in the morning and say, you know, we got this little issue. Let's keep our eyes on it. And I usually get a good response. Josh, can I call you Josh? You certainly can. Or Mr. Fertel.

[00:30:27] No, 100% not. Okay. So Josh, if you let, I mean, I know there are lots of providers listening to us right now. Right. And I know they're listening and they're saying, okay, but there's so many things that I have to do. There's so many things I have to change. I have money that I don't know where it's going. I don't know how much money is coming.

[00:30:51] So what is one simple action that they can take this week, tomorrow, or today to start making smarter financial decisions other than calling you? Fair. The, um, look at your EOBs. Look at the payments that you're receiving. Um, the explanation of benefits. Look at the EOBs and then look at the zeros. Right.

[00:31:20] Look at the ones you didn't get paid on and say to yourself, why did I not get paid on that? And you, maybe, you know, the answer. Maybe you don't know the answer, but at least you can start there. And then you can reach out to somebody and say, okay, do you know why? I actually had this yesterday. It happened to me. A, uh, a friend of mine who's in the pulmonary world has had one of his clients, which we do not bill for, was confused because they weren't receiving what they thought they should be receiving for the services they were providing.

[00:31:50] I said, just send me an EOB. Let me take a look. No pressure. No, nothing. No, you don't have to use me or anything like that. Let me just try to help out my friend here. And I saw that the modifiers were incorrect. So they were not getting paid for all the services. I was saying, so go back to your billing company, change this, this, and this resubmit, and you should be able to get paid. So look at the things that you're not getting paid on. Look at your EOBs that you're not. The, the paid ones are easy. Maybe you can say, oh, I didn't get it. What I thought I was going to get.

[00:32:19] But the big money is the ones that you're not getting paid on. And you're always going to have zeros. No matter who you are, no matter how great you think you are, you're going to get zeros. But those are where you learn. So that's what I would do if I was a provider owner. Take a half a day. Don't see any patients. Sit down with the EOBs. Go to your office manager. Sit in front of you. Look at the zeros and see where you think there's going to be some changes. That's for the revenue.

[00:32:47] And finally, I would ask you, this is more of a personal question. Okay. What is the biggest lesson that you've learned in these four years of being an entrepreneur? It's a horrible lesson. And I kind of learned it in the beginning.

[00:33:05] Is that it's sad that providers, people who dedicate their lives to fixing people, people who've gone through school for five, six, seven, eight, nine, ten years of working and incurred debt are never taught how to run a business. Ever.

[00:33:26] So if they're not an employee of a hospital or a big group and they have their own office and nobody ever showed them how to do basic accounting or bookkeeping or taxes or anything. That's where my biggest value add is, I believe. You know, my personal value add. You know, it's, you know, I'm not afraid to share everything I know.

[00:33:54] You know, you get to be my age. You want to be able to think that you can teach somebody something. But that's the biggest thing that I see. And it's horrible. And I have a daughter who's a PA. And I said to her when she graduated, I was like, just go take a business class. I don't care if it's business 101. Just take a class so you know the basics of how to run a business. That's the thing. That's great advice. Yeah.

[00:34:20] So everyone, this is The Profit Rx with or by Josh Fertel. Thank you. This is the podcast where you are going to learn how to take the financial aches of medical practices into profits. Make sure you stay tuned because we have more episodes coming. You did very well. Very well. Thank you.

[00:34:46] Is there any message that you'd like to give our audience before saying farewell until our next episode? You know, feel free to reach out to me. I'm on LinkedIn. You have the link from the website here. If there's any questions I could answer, again, I'm not afraid to answer any questions. I'm a big karma believer. If I put out and I help people that I can, it's going to come back to me. No pressure. No, you're not tied to me for anything like that.

[00:35:15] But if I can, if I can help anybody in any way in this field, I'd be more than happy to. Thank you so much. And everyone stay tuned. Thank you. I told you. We're going to have many more episodes where we're going to learn many things about how to financially handle practices and turn aches into profits. And again, this is The Profit RRX by Josh Fertel. Thank you. This was great.