[00:00:16] Hello everyone, welcome to the second episode of one of my favorite podcasts, which is The ProfitRx with Josh Fertel. This is where we learn how to turn financial aches and medical practices into profits. Our first episode did very well. Josh, how do you feel about that?

[00:00:40] Josh Fertel, Ph.D.: Oh, I feel very excited about it. I'm glad that we were able to get some kind of information out there and maybe have that be the start of continuing education and some goodwill for our providers so that they can be successful and do the best that they can. How are you feeling for this second episode? Josh Fertel, Ph.D.: I'm excited to add on to what we talked about before, what we spoke about last time, and maybe do a little bit deeper dive on some of the things.

[00:01:07] Josh Fertel, Ph.D.: And some of the things that I've seen in between the episodes that I've come across in the past few weeks. Josh Fertel, Ph.D.: That's awesome. Well, episode two is Diagnosing Revenue Leaks, Spot-Hidden Opportunities in Your Practice. Is that so? Josh Fertel, Ph.D.: Yes, that's what we do. Josh Fertel, Ph.D.: Let's go and dive into the first question. I'm guessing, well, you're very young, so this was not long ago.

[00:01:33] Josh Fertel, Ph.D.: But do you remember the first time you walked into a practice and spotted a massive revenue leak that they had no idea about? Could you tell us what the issue was and how you solved it? Josh Fertel, Ph.D.: First of all, very young. I'm not getting the very young thing, but that's okay. Josh Fertel, Ph.D.: You're very young. Very young. That was probably like five, ten years ago. No more.

[00:01:56] Josh Fertel, Ph.D.: Okay. The thing that really transformed the way I look at things happened early on in my business, and it was a revenue leak that I noticed, not from going into a practice, but just from having a conversation. I think I spoke about it in the last episode, but let me really get into the details of what happened. Josh Fertel, Ph.D.: Medicare has a program called Chronic Care Management, and it is a wonderful program.

[00:02:25] The thing behind it, the thought process behind it with Medicare is that if we have our older patients, 65 and older, in between their visits to the doctor every six months, every year, let's monitor them. Let's make sure that they're doing all the things that they're doing to lead their best life. Josh Fertel, Ph.D.: So, for example, once a month, we will reach out to them and we will say, you know, are you taking your medication? Are you eating right? Are you doing some type of exercise?

[00:02:55] All the things that go into being healthy and keeping them out of the hospital, which is Medicare's plan for having this. It's a win-win-win. It's great for everybody. It's great for the patients because in between their office visits, the practice is reaching out to them just to check on their well-being. How are you doing? What can I do for you today? Do you need a refill of your prescription? What is it that's going on with you? Are you sad about something? Did anything happen in your life?

[00:03:23] And that connection really creates the bond between the practice and the patient. The patient feels great about that. It's great for the provider because Medicare actually pays the provider to offer this service. There is some profit in it. So, along with that connection that they're building with their patients over time, there is revenue that's involved. And then finally, it's great for Medicare because if they pay out a little every month to the provider to check on these patients,

[00:03:51] it's essentially trying to keep them out of the hospital where the giant bills are going to come. So, for Medicare, it's a great plan. It's a great service. I love it. I speak to all of my practices that are in the family medicine, internal medicine about it. So, to answer your question now, when I first met a provider who had about 250 patients on this program, and he was using an outsourced company to do the monitoring monthly.

[00:04:21] And we talked about the math of what he was paying and what Medicare was paying for them. The company was charging $42 every time they spoke to somebody once a month. Medicare, at that time, was reimbursing about $62 per patient for the same amount of time. So, there's a $20 profit sort of built in. The only thing is Medicare only pays 80% of that $62.

[00:04:50] So, now you're at $48. And the other 20% is paid by a secondary policy, which some of the patients might not have. Also, like anything else, there are claims that are turned down. So, the company that was doing it, the outsourced company, was getting their $42. It did not matter when the doctor got paid or if he got paid at all. At the end of the year, we said, okay, we took in this much.

[00:05:18] We paid out this much to the company. And there was so little left over. And I knew right away, I was like, you're not making any money on this program. It's a great program. Don't get me wrong. It's doing what it's supposed to do. But you're supposed to benefit from this somehow as a business. And so, I said, give me a week. I want to learn everything I can about it and I'm going to come back to you. So, that's what I did. I started going online. I read every possible thing I could.

[00:05:45] I figured out how it worked, what was necessary, who could make the phone calls, and how often, the timing of everything. And I came back to him and I said, okay, here's what we're going to do. I'm going to take over. We're going to make all the phone calls. Because when you get paid, after you get paid from Medicare, whatever that amount is, that's how you're going to base up my fee on it. And that's how we're going to figure it out. So, it didn't burn his cash flow.

[00:06:11] He got paid exactly what he was supposed to and paid out exactly what he was supposed to do. Seven times in his pocket for the year. He makes seven times what he did the year before, after we took him for doing the same service and just fixing the math. And that's like having an extra provider in the office. And I'm guessing at the same time, he was building a connection with his patients. The patients love it.

[00:06:39] You know, realistically, when you're higher up in age, you're not getting out of the house as much. Right? So, to have somebody call you to check in on you. And your kids do not call you. Right? You know, just the emotional, right? The emotional connection that comes. Forget about everything else. Forget about the physical. Emotional. When you're getting called, like somewhere around the holidays or Thanksgiving or Christmas, you know, and you don't.

[00:07:05] And there's somebody that's checking up on you and making sure that you're okay. Just think how happy that makes a patient. So, dollars aside, it is a wonderful program. And when I come across a practice that's not doing it, whether they're a client or not, I was like, why are you not doing this? There is no downside to it. So, that's my favorite thing. And that is the first real difference maker that I stumbled upon when I opened my business.

[00:07:35] Well, Josh, I mean, it was clear to me last time we talked, and I can see it even more now, you do so much more than just medical billing. We try. How do you make sure your clients are aware of every way you could help them in truly optimizing and generating more revenue? No, that's a great question.

[00:08:01] And when you form the partnership, when we form a partnership, it wouldn't make sense for me to start changing everything, right? Because that would, if I was in the other shoes, wait, wait, wait, I've been doing this a long time. Don't come in here and start telling me what to do. So, I have to earn that trust over a couple months, and we show them what we can do, and we see that we can make a difference in their cash flow and their profitability.

[00:08:29] And then I can suggest, you know, there's extra things that we can do here. We should build these extra codes and perform a couple of extra services when you're with the patient. And that's going to bring in $10, $15, maybe $20 more per patient. You know, that adds up. Even though it's little, that adds up. But I would never go in and say, okay, today's my first day, and you're going to change this, this, this, and this. People look at me like, who does this guy think he is?

[00:08:56] You know, so you have to earn that trust and respect from our clients that they'll listen to what we have to say. And when we suggest something, usually we don't have any pushback after that. Well, actually, I do believe that suggesting always works better than imposing. Right. And, you know, we back it up with data, right? We can back it up with data. Here's another client, you know, erase the names. Here's what they were doing. Here's what changed over the course of a couple months or a year.

[00:09:26] Here's what they were doing. And all we did is this one little thing. And with practices, sometimes it really just comes out to one little thing or two little things or three little things. And it multiplies and it snowballs over time. So, you know, you multiply it out. If you're seeing X number of patients every day and you're able to add on $10, whatever it is, you know, for the same amount of time for a couple extra minutes more that you're spending with the patient. And it just works. The math works. And it's all bottom line.

[00:09:55] You've already, you know, it's the same amount of time, same amount of energy, same amount of staffing to go into that one appointment. Josh, you know, I love funny anecdotes and I know our listeners love those. And we did get a few on our first episode, but I really want to get into more on this episode.

[00:10:15] So tell us one of the craziest or most expensive revenue leaks you've ever discovered in a practice that you were shocked like, oh my God, this is not happening. You know, the biggest revenue leak by far and the biggest hurt on the cash flow is when the patient is not being charged what they're supposed to pay when they come for the visit.

[00:10:45] Nowhere ever, the supermarket, a plumber, I don't care who it is, can you get work done or go buy something and pay later on 90 days later? No one. But for some reason in the medical field, we think it's okay. Right? Because I guess, you know, we want to make sure the patient gets taken care of. So we're going to do, we're going to look the other way. But the fact of the matter is business wise, it doesn't make sense. The patients are there, right? They know they have a deductible to pay. They know they have a copay. They know.

[00:11:15] And the way that it slides by is a mystery to me. And it's not just one practice. It is every practice. Now, I think I've discovered what the answer is. The front desk person who it's easy to say, why didn't you collect this? Why didn't you collect this? Why didn't you collect this? We're not spending enough time with that person so that they believe in the job that they're doing.

[00:11:42] They don't have the bond with the practice owner or the doctor that's there. And I've seen it and I've asked about it. And I say, you know, sometimes I'll sit with a doctor and they don't know the name of the front office person. Right? But this is someone who's responsible for 20%, 25%, 30% of your income is coming from that front door and the cash that's coming in. Forget about how it handles your cash flow. Forget about all that. That's a person.

[00:12:07] So this person, you know, this is a person I would be hugging all day and take out to lunch and making sure that they have coffee from Starbucks every morning because this is a person that I want to believe in the practice. Right? I want them to believe in the value of what I'm doing as a doctor, what we're doing to help our patients and just feel part of the team, not just somebody that was hired. And, you know, here's your job. Collect. Oh, you can't collect. We're going to find somebody else. You know, teach them.

[00:12:37] And spend the time with that person. Have them ingrained in the theory of what you're doing or the way you think about things. So I think it's that. Like I said, you know, when I first got in, just like everybody else, you know, oh, here's a hired person. They're making X amount of dollars. This is their job. Right? You know, it's not easy asking people for money. Right? It's not easy. Even though they know they have to pay, it's not easy to do. But you got to feel it. You have to feel like part of the team.

[00:13:06] And it is the responsibility of the practice owner, the head doctor, whoever it is, to make that person feel important. And I think that makes the difference. Now, is that an anecdote? I don't know. But it is really just something that's been kicking around in my head. It's not black and white. Right? There's a lot that goes into it. And that person really needs to be, really just feel part of the team. And I think that would make a change. I love what you're saying. But I need an anecdote.

[00:13:36] Tell me, like, that time you said, oh, my God. Something I said, oh, my God. No name names. Just the situation. Because the situation. Many times I'll get a phone call from someone, a practice that almost it's desperation. Right? Their old billing company has been negligent is the best way to put it.

[00:14:06] And if it just stopped doing everything. And it's gone on so long that why, you know, my thing is like, why did you let this go on so long? Right? If I didn't get my paycheck from my employer for the first week, I was like, oh, something's wrong. Maybe they'll pay me next week. But if it's like 90 days later and I haven't gotten my paycheck, something's wrong. What are you doing? You know, let's figure out what's going on here and why this happened. Now, I'm not saying that it comes to zero.

[00:14:30] But if you start to see your bank account starting to go down everything and, you know, you're not paying, you know, your bills out of it, but still it's going down and not coming in the way it's supposed to. You know, you got it. You got to jump. Right? Yeah. You have to do it. So I've seen it twice this year within the past six months. What were the one practice was having to start going, take out loans to hit their, you know, to pay their employees because the things weren't coming out. I was like, what are you doing different? We're not doing anything different. Okay.

[00:14:59] So the problem is in the back end, right? The money's not coming in. And then they'll say, oh, you know, we don't see anything. I was like, well, no, obviously that's what the problem is. You know, but we're too late. We're so far down the road here. This is something that you should have been doing. And I've seen it twice now where, you know, one person, they had to refinance their house to take out money to pay all their bills because something went down. So I was like, let's just get into this. And what we did is we went in and we went backwards.

[00:15:26] Not only did we start from when they hired us, but we went backwards and tried to find everything we could to make up the difference. And yeah, it's shocking. Like I said, twice in the past six months, I saw this, that things get out of hand because nobody's paying attention. Whoa. Yeah. That's ridiculous. Yeah. Well, we're talking about money that doesn't come through the door. Right. Can you write down what happens behind the scenes when claims get denied?

[00:15:55] Yeah. And how much that can cost a practice annually? Nobody wants to work for free. Right. Nobody wants to work. Nobody doctor wants to see a patient and then not get paid for it. It's our responsibility to make that happen. Right. We watch the news. We see insurance companies. We know what insurance companies jobs are to do. Deny claims. Any kind of insurance doesn't matter. Their job is to deny claims. That's how they make their money. By not paying or by paying late.

[00:16:23] So we are very aggressive in looking for denied claims. My whole team. Myself included. First thing I look at in the morning when I go to the bank accounts for my clients. And I see, did it go up or did it go down? And if it went down, I look for what was paid. See if it was payroll. Maybe they took payroll. Maybe they took it to burn. Maybe they paid for the email. It went down. Other than that, I look to see that it was up from the day before.

[00:16:51] And then that's the first thing I look at for all my clients every day. Then I go into the EHRs and I start looking at the claims that were paid the night before. And I look for the things that did not get paid. And once I find those, I alert everybody. Because I usually see them before they do. And maybe they do see them, but my team knows that I'm watching also. Which is the most important thing. Not micromanaging. It's just pointing out. Actually, I don't think I'm a micromanager, but I probably am.

[00:17:18] But I think when you're digging down to such minutiae and you're looking at hundreds, if not thousands of claims a day between our whole thing. If you can pick something out, there's a chance that it might slip by. The more eyes you have on something, the better it is. So I don't want to think it's micromanaging. Probably is. But if I see something that's not working, I was like, okay, what's wrong with this? How do we fix it? Show me how to fix it if I don't know how to do it.

[00:17:46] Because my team knows more than I do about fixing claims. So I'm trying to learn every day as to what to do. So we don't let it go too far. Right? Because if you let it go too far, like anything else, it's going to snowball. And then all of a sudden you have a pile of things that are 90 days old. And everybody has them. We try to keep everything under 90 days. Something that gets denied, we go ahead and we fix it as quick as we can. And we get it back out the door. But now you're talking about 30, 60 days from the time, date of service.

[00:18:14] So it's really just being on top of it, watching every day and attacking and fixing the claims. You're going to know how to fix them. Unless somebody's insurance was terminated or something weird happened like they didn't have a right authorization, which happens sometimes on some policies, it's going to get paid. You just got to figure out how to do it. Was the coding wrong? Was the modifiers wrong? Did somebody miss something somewhere? You know, if nobody's perfect, it's going to happen.

[00:18:42] But if we get it fixed quickly, that's the difference. So it's just being very aggressive every day to make sure that we're fixing the claims. No magic to it. Right? It's just a matter of being aggressive. I need to go back to something you just said. So you really do wake up and first thing you do is check your client's account? First thing I do. I actually have an order. I don't even check my bank account yet. I check their first.

[00:19:08] And how do you, I mean, do you remember, do you check it against the number you had the day before? Do you have numbers in your head? You know what? I don't write it down. But yes, I kind of know what it was the day before. And sometimes it'll be up by a thousand, sometimes it'll be up by a hundred, sometimes it'll be up a lot. You know, and then I'll go see what caused it. You know, and I'll look for the claims that got paid. But yes, absolutely. It's the first thing I do every day. Wow.

[00:19:35] So you've mentioned that practices often miss out on new or updated billing codes. Yes. So how can they stay ahead of these changes without the usual drowning in paperwork? Do you have any? Yeah, you can't. You can't. I don't mean to interrupt you, but it's impossible for them to do it. And it's not really for them to do. I mean, I don't want them spending their day doing, looking up the Medicare website and looking for new codes that are coming out. I want them to reach out to me.

[00:20:04] You know, if we have not reached out to them first, we just onboarded a new client who is a family medicine. And Medicare has what's called a G2211 code, right? Which is ongoing care for chronic patients. And you can add it to any office visit. And it's going to pay like $12. It's not a lot, but it's $12.

[00:20:31] And I noticed that they had never billed it on their Medicare patients. It's brand new. Still. They don't know about it. If nobody tells them, they're not going to know about it. But when we put our eyes on something, we say, okay, here's something new you can do. Every Medicare patient, we want you to spend a little extra time, go over their diseases, and we're going to put this code in. And now you're going to make an extra $12 on every patient from Medicare that you have. It is impossible for them to do. It is impossible for me to do it. There is no one person that's going to know all the coding, right?

[00:21:00] But we have a team, right? And we have a team that is alerted all the time. My right-hand guy, Eric, he is a speaker for AAPC, all right? They are a coding and billing organization. He's a speaker for them. He goes around and speaks. He knows the codes. He knows what to share. And he says, this is important. This is not important. You're not going to inundate a doctor with every minutia of information, but we're going to say to him, let's start using this. Let's start using that.

[00:21:30] Start coding for this. This you have to stop. Telehealth is a big thing now. It's supposed to end March 31st. So we're waiting to see what happens with that. And so there'll be a new code out. There'll be a new way to do things. And we're already trying to be a little proactive to get that information out, although the information is not even out from Medicare yet. But it's up to us to make sure that the doctors know, like, they don't have time. You know, their days are filled.

[00:21:58] You know, in Spanish, we have a saying that's me. That's it. It's zapatero a su zapatos, which would be something like shoemaker. Go do shoes. Right, right, right, right, right. So everybody wants to speak to what they know. That's right. That's right. I mean, I couldn't go in and heal anybody. That I do know. Right. I can't do surgery. That I do know. I know how to get paid on surgery, but I don't know how to do it. And I expect the same from them.

[00:22:26] But we get paid. My company gets paid as a percentage of what we collect. Right. So that $12, a couple of dollars of that is going to trickle down to us. Right. We want them to maximize their profit. We want them to be a successful profit. So if we don't share the information, we're hurting ourselves also. We're a business just like anything else. We're hurting ourselves also. We want them to do well. And perform the services. I don't want to come across and say, just do this, this, and this.

[00:22:56] We're going to make more money. You know, take a little bit extra time. Make sure that you're, you know, spending a little more time with the patient and going over the things that you can go over. Counseling for obesity or depression. Or, you know, narcotics. Those are all things that need to be gone over once a year. And Medicare pays you for them. Because, again, that's another thing that keeps you out of the hospital. Yeah. And the truth is, the better they do, the better you do. Absolutely.

[00:23:25] The better they do, the better we do. That's been my philosophy since day one. Is that we're not on salary. We don't get a flat. Anything like that. We are partners. Small partners, but partners. Let's move on to a next question. Because beyond billing fixes, you often advise practices to rethink how they use their office space or staff.

[00:23:48] So can you share one creative idea that helped a client generate new revenue without adding more patients? Here's a change that we most recently made, Sue. I do not have the results yet, but I know they're going to be good. I recently visited a practice. And the scenario is there's an owner who's the provider. Provider who's the owner. He has another provider. And he has a nurse. Three providers in the sector.

[00:24:16] The 25 years plus, maybe 30 years in business, his medical assistant for the number for the head provider is one of the best medical assistants you'll ever see. He has everything ready for him. Notes, charts, everything's lined up. Documentation sign that he goes in. He sees the patient. And it's very easy transaction. All he worries about is patient care. Nothing else. Everything is done.

[00:24:41] The other provider who has been with him for maybe a year and a half is the exact opposite. He's a little lazy. He doesn't code correctly. And the worst of all, which we don't even talk about, is he doesn't sign his notes on time. That means he's delaying the payments. He's not getting paid because he's not signing off on his notes. He's not doing all the care necessary for the patient. He hired a medical assistant.

[00:25:09] So now that medical assistant is really learning from him as to how he does things and is kind of picking up bad habits. So what we did is we swapped medical assistants. So the new one is now with the seasoned doctor who does everything near perfectly. And he is showing her the way things to be done correctly. What he wants done, how it's supposed to be set up, everything that needs before he walks into the office.

[00:25:34] The great medical assistant now is going to be on top of the provider and showing them, okay, you need to do this. You need to sign your notes. Here's the chart for the patient. All you got to do is go this, this, this, and this. And it is a fabulous idea, which I actually came up with, with the, with the controller of the, of the practice. This, we just put it into play. So we'll see what happens in 90 days. I said, we're going to do this for 90 days. Let's see what the things are. I believe it's going to make a huge difference. Nothing has changed.

[00:26:05] No extra dollars were spent. Nothing. We just, we just put the round peg in the round hole. And I think the influence there is going to make everything better. The new medical assistant is really going to learn the right way. And I said to him, I was like, listen, you can keep going through medical assistants and hire and fire, or we can train one to do it the right way. Simple as that. And when we train that person to do the things the way you want to do, and then we go back and give, and she goes back with the other doctor. That's going to make him better. So that's my favorite thing.

[00:26:34] I'm hoping that I could give you some results in the next couple of weeks, but there's no doubt it's a perfect scenario. So talking about perfect scenarios. Okay. If you design the perfect financial dashboard for a practice owner, what are the top three numbers they should check every single day? Okay. That's fair.

[00:27:02] So we're talking about perfection now. In no order, or in no particular order, the first thing you got to do is, you know, how many patients are we seeing every day? Right? That's the bread and butter. That's what's coming in. Are we have our schedules filled? How many offices do we have? Are we seeing, you know, 10, 15, or 20 patients a day? You know, 15, 16 is two an hour. Is that done? Do we have three providers? Is that almost 50 patients a day?

[00:27:31] So patients per day obviously is the main thing because that's where the income comes from. Second thing I would do is I would look at, you know, at the billing. I would say, okay, what do we have that's coming in? What is it that's old that hasn't been paid? Let me go ahead and question my biller as to what's going on. Is something wrong on either side? Is there a discussion that has to be made? Are you billing things on time? Are we coding things wrong? What's the hold of there? Why are things getting old? That's important too.

[00:28:01] And you have to look at your expenses. I, you know, I have a client and after, you know, doing a little work together, I was like, I was talking to his insurance agent who does his workers comp and his payroll is astronomical. And that's another thing I want to start looking into for him is why do you have so much payroll? Do you have too many people?

[00:28:25] So I have this idea of what is my total revenue divided by how many employees I have, total employees, including the office staff, which is where the burden will be. So that's kind of what I think. So what's my, what's my payroll? Where are my expenses really hit? And it's always going to be on, on, on staffing. Where's my cash flow at? But most importantly, probably is, is how many patients are we seeing? Right? Because if you're going to see two patients a day, three patients a day, 10 patients a month, it doesn't matter what the rest of the numbers are. It all starts with revenue. And then it goes from there.

[00:28:57] That's it. You know, that, that, that would be a, does this thing. Patients per day is probably the number one thing. That's perfect. You, I remember we talked, we kind of talked about it on our previous episode, how so many providers were leaving money on the table by not using new or underutilized Medicare codes. Right. Um, we had lots of questions about that.

[00:29:25] So I'm wondering if you could share some codes that are often missed and how providers can capitalize on them. Apologize up front for not knowing the exact coding. No worries. But, um, you know, we, we've already mentioned a few of them today, right? There is the code G2211. I know that one by heart. That is the one for continued care through Medicare. Medicare. Uh, Medicare has the counseling codes. You counsel for obesity, right?

[00:29:55] Because Medicare wants people to be in shape. Keep them out of the hospital, prevent diabetes, um, prevent all the things that happen with, with being overweight. Uh, depression. Right. We're going to counsel for depression. How are you feeling today? What's changed in your life? Is there something wrong? Uh, you know, are you happy? Right. Have a conversation with, with your patient while they're sitting there. Medicare and, and know from there and Medicare will pay you to do that. Um, you know, do you smoke? Right. Tobacco.

[00:30:24] Do you do whatever or anything else? Do you smoke? Are you a smoker? Okay. Let's talk about that. Why want you to quit smoking? Here's the reasons why. Have a counseling session for that. These are all things that should be done every time somebody walks into your office. Uh, and it's underutilized for sure. Um, you know, medication, you know, have we, um, have you gotten your, you know, flu shots? Have you gotten, you know, um, you know, your, I'm on your COVID shot if you're, you know, if you're into that kind of thing.

[00:30:53] Um, are there all these things done? You know, obviously the doctor would have that, but we want to go over and make sure that you want it. Anything you do essentially, that's going to keep, uh, the patient healthy. Right. Living their best life. Medicare has a code for, and they're going to reimburse you to keep these people out of the hospital. And it trickles down to the others, um, you know, to the commercial payers too. So, you know, I, I can't possibly rattle off all the codes to you.

[00:31:23] Uh, but there are just, you know, at least half a dozen that could be done at every, every visit. And that could bring in 30, 40, $50 more per visit on top of just the regular, you know, sick patient care or, or annual wellness visit. You know that I've been reading a lot about it and I do remember some because they seemed, I don't know, uh, for some reason they signed my attention. RPM. Yes. I think it's remote patient monitoring. Right.

[00:31:53] TCM. CCM. We do, we do that. We, we do provide that service. It's what we talked about earlier. Uh, RPM is essentially the same thing, but more electronic. Okay. Uh, you know, the patient will have a scale that they step on and they'll take a digital reading. They'll have a blood pressure monitor. It'll take a digital reading, uh, glucose monitor. So they do more things digitally. They're both great programs.

[00:32:19] RPM actually pays a little bit more, but there is an investment from the doctor up front. Okay. To get these supplies to the patient. Right. Uh, so I don't want doctors spending more money. Right. I don't, I want you, I want to provide, I want them to get the satisfaction of more income without having to outlay with no downside to it. The one downside with RPM is that 16 months out of a year, out of 16 days out of the month,

[00:32:48] the patient has to have a recording. If they don't have 16 days, you don't get paid for that month. So it's a little bit of a, so there's a little bit of a challenge there because there is a, you know, there's an expense for all this equipment that you're providing to the thing. So RPM is a great program when it's done perfectly. Um, it actually probably benefits more than chronic care management. I don't want to see the doctor have to outlay anything for, for any more expense. Let's just do it and bring the money in and, and pay as it comes in.

[00:33:17] But both great programs both do the same thing. You know so much, it's ridiculous. So, uh, you've seen healthcare billing change over the years. Uh, you've seen how it's changed, where he, where it was, where it is. So, you also know where it's going. So what's the next big opportunity you think practices should be preparing for in order to stay profitable? Okay. So everybody's going to answer and say AI, right? Everybody's going to say AI.

[00:33:46] Uh, you know, uh, maybe I, maybe I'm just, of course I'm an old guy. I have my thoughts about AI. I, I get it. I get how it's supposed to help, but it's a garbage in garbage out situation, right? Especially when you're talking about a patient, uh, AI is not going to diagnose a patient. AI is not going to suggest other codes to you. It's not going to say, oh, you did this. Why don't you try doing this? I don't think it will. Um, will it make it easier to put the notes in the system? Yes.

[00:34:15] You know, if you can just talk to the computer, this patient has this, this, this, and this, and it could jot it down. It can do that already. We already have that technology. Um, will it help with getting claims paid? I don't believe so because if there's AI on the billing side, there's also AI on the insurance side. So you're not going to have two computers fighting against each other as to which one is right. You know, it's going to take human interaction. Uh, but certainly AI is going to make it easier.

[00:34:44] For the provider to have the documentation, um, near perfect. They're absolutely going to have to add to it and subtract from it with the other, the services that they're providing. Uh, because you have to give, you have to feed that information to it. Will it break everything down and diagnosis, um, you know, put the right diagnosis with the right code to the right diagnosis? Yes, it can do that. They can do all that stuff now. So it'll make the provider side easier.

[00:35:13] Billing side, because we're getting the information probably a little bit quicker and a little bit clearer. It'll make it on our side, you know, make it easier for us. But as far as the codings, uh, the modifiers and the diagnosis and what goes together, you know, we're definitely, um, there's definitely going to still need human interaction with that. I, I haven't been doing this for 10 years or so, but I know it's not that long ago. Everything was done by paper, you know, and now everything is electronic. Uh, so you get to see everything on the screen, you get to scrub and do make everything is,

[00:35:43] you know, perfect and clean so that you could submit it to the payers and get paid quickly. Uh, that's, you know, that is the beauty of what's happened to anybody that I've spoken to that's been doing this for 15 years remembers that when it was on paper and they're, uh, you know, they, they still get used to doing it electronically, but those are the biggest changes probably. Josh, we did talk about it, um, uh, a few questions ago, but I do think we need to go

[00:36:12] deeper because I, I mean, I know people are going to want direct answers on this one. So I'm going to go and ask you about what you've mentioned about the, the struggle with patient collections. Okay. Um, we talked about it. Uh, we talked about how complicated it can be and we talked about how important it is to actually get paid. Right.

[00:36:38] So what's one effective strategy for improving self-paid collections without damaging the patient relationships? It's a great question. Simple answer. Let the patient know before they come in, not when they come in. Let them know the day before or two days before or three days before Mr. Jones, we're looking forward to seeing you on Thursday. As you know, you have a $20 copay.

[00:37:08] Uh, we're going to check and see if you hit your deductible for the year, but just know that the, you know, the $20 is going to be due when you come in. That's it. Mr. Jones knows he's going to have to pay $20. You know, maybe Mr. Jones will, will try to forget that he owes it, but he knows you've told him send a text message. A lot of text messages. We've, we've all gotten them. We're confirm your appointment and you can do it where they say there's a copay click here. It'll take it to their chart.

[00:37:35] Uh, you know, even older, um, you know, patients are tech savvy now, right? Cause we've all kind of grown up in this, in this era so they can go on their portal. They see what they owe, but let them know beforehand, right? If you call, it's a simple phone call a day before make sure, you know, try to set yourself up if you're that person doing it so that you're calling two or three days in advance of the appointment and let them know. And there's no surprises. Nobody's upset. Nobody's arguing in the middle of the waiting room and getting everybody else upset.

[00:38:05] It's a nice, easy transaction is probably the best way, but the number one and probably the only thing that needs to be done, let them know beforehand. Communicate. Well, I don't, I mean, I do think that instead of we sometimes as human beings tend to think that people don't want to pay and maybe it's not like that. Maybe they just forgot. I mean, maybe it's not that they are willingly not paying, but I mean, in the middle of chaos, they have a problem with their health.

[00:38:34] They probably forgot about it. So I think one important thing as well is to not to assume that they don't want to pay. Right. Oh, no, for sure. For sure. But like I said, if you have that conversation a couple of days before, if there's a question or if the person says, I don't know that, you know, then you can answer it then. Right. You can answer it then instead of when they're standing in front of you and you have a kind of an altercation going on right in the middle of the office.

[00:39:02] But yeah, just communicate. That's all it is. And who do you think should be in charge of that part? The front desk person or the doctor? No, that's certainly not the doctor. That's the front desk person. Even if there's a question about the bill, the doctor is not going to get involved in that. The doctor is not going to be involved in the money transaction. Well, they shouldn't be. So the front desk person should make the call.

[00:39:30] If there's a question, maybe transfer it to the biller. Get the biller involved so they can explain better than the front desk person. Oh, remember last time you were here? You know, we did not collect a copay. That happens. Right. So now, you know, you owe for two and just get this, get the conversation out of the way early. And so everybody's expectations are there when the visit happens. Josh, I'm going to move on to the last question of this episode.

[00:39:55] I do want to tell everyone to stay tuned for our next episode, but let's go to the last question. If you had just 60 seconds, I'm going to be timing you to share your number one piece of advice to help providers stop leaving money on the table. 60 seconds and the best advice you have. Okay.

[00:40:24] So here's my advice to every provider that owns a practice. Open your own mail. When you come in, go in 15 minutes early, open the mail. Look at the EOBs that you get. Look at your expenses. Look at the bills that are getting paid. Look at everything that's in your business. Right. Don't leave it for somebody else to do it and take care of it. Know what's going on. That's where you find the leakage. Right.

[00:40:51] And we want you to know, we want the provider to be cognizant of what's going on in their business. Simple that go in 15 minutes early, open your own mail and see what's going on. What's there and question things and question the people that are responsible for what's going on in there. That's the easiest thing to do. Josh, I do not agree with you. You do not? If you ask me to give one piece of advice to help providers stop leaving money on the table, I would say call Josh for help.

[00:41:20] Say that. But thank you for that. But you know what? Honestly, knowledge is power. I want you to know. I want them to know everything that there is to know, but not have it to the point where it gets in the way of what they're supposed to be doing, which is healing. Josh, thank you very much again for those who have just tuned in. Thank you. This is one of my favorite podcasts because Josh, he's so outspoken. It's so nice. This is The Profit Rx.

[00:41:50] This is where we learn how to turn the financial aches of medical practices into profits. This was episode number two. And stay tuned for episode number three. Please, Josh, say goodbye to your listeners. Thank you, everybody, for listening. And I look forward to speaking with you again. Thank you. Thank you, Ursula. Thank you. Thank you. Thank you.