0090 Billing Insurance with Jeremy Zug of Practice Solutions

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1 0090 Billing Insurance with Jeremy Zug of Practice Solutions You re listening to the Abundant Practice Podcast. Where we work through the stuck places folks hit while building their private practices. Each week we dive into a practice building through different lenses. You ll get trainings, listen in on mini-consultations and conversations with other consultants. Each month there is a niche deep dive where we flush out a niche from a marketing perspective. Plus every now and then we throw in a Where are they now episode, and check in on the clinicians who were on before to see how the advice played out. When relevant, the show notes will include a worksheet for you to bring the content into your practice or life. Because I love you listening, but I want you to take action, too. This podcast is sponsored by the Abundance Party, where for only $39 a month you get courses on honing your niche and marketing your practice, scripts for the business side of things, monthly trainings, a chance for a one on one with me, and a much more intimate Facebook group. Where I currently respond to every post. You can check that out at Abundanceparty.com. Alright, onto the show. If you want to keep your practice organized, Responsive Therapy Notes can help. They are simple, secure, EHR platform that you manage notes, claims and schedules as well as share documents and request signatures. Plus, you get great unlimited customer support for help whenever you need it. To get two months free, visit therapynotes.com, create an account and enter the promo code Abundant. If you are looking for an EHR with great unlimited customer support, get two free months of therapy notes by visiting therapynotes.com. Creating an account. And entering the promo code Abundant. Welcome back to the Abundant Practice Podcast. I m your host Allison Puryear. And I m here with Jeremy Zug of Practice Solutions. Practice Solutions is a really cool company that I wanted to introduce you guys to. But we ll start out with kind of where they started. So first, welcome Jeremy. Thanks for being here. Jeremy : Hey thanks Allison. Thanks for having me on today. Appreciate it. Allison: Absolutely. So, tell us a little bit about your origin story. Or your back story about how Practice Solutions came to be. Jeremy: Yeah. So, this starts when I was 14 and a freshman in high school. I got my first job working at a community mental health center. And at that time the electronic health record we had was pretty poor. So, we still made paper charts. So, my first job there was making paper charts. And then from there, from working in the administration part, billing front office type work, and then at 18 I got to work at a residential group home for adults as well as a day treatment support staff. And that was really [unknown 2:28] work so I decided to go get a degree in counseling in Chicago and while in Chicago I worked as a biller for a private practice in downtown Chicago. Just sort of doing the same thing I knew how to do. And then, after I got

2 married and moved to Michigan, Katherine and I saw a big need here for outsourced billers in the mental health world. So, we started Practice Solutions. Allison: Awesome. Jeremy: Yeah. Allison: What made you think. what is your why, I guess, behind your business? We talk about that a fair amount with Abundance. The thing that drives us, the thing that makes us excited to do it, that kinds of stuff. Jeremy: Yeah. We have a big why here. And part of this is just our foundation in caring about mental health providers across the country. I think the best why is summed up in this story about this provider that I recently worked with where we were doing some work. Trying to figure out the billing processes. Why aren t the numbers making sense? And at one point in the process we just asked, why are we here? Why are we doing this? The therapist gave this really touching why about she has this disabled child at home. She needs to spend more time with the child. She s missing her child s life, basically, because of the billing. And then wasn t making money to support the medical expenses. And that is really a great picture of what we re trying to do here. We are trying to add value to practices so that practice owners can achieve their financial and personal goals. And we do that by taking off a tremendous administrative burden off their plate, so they can go and do those things. We re trying to enable practice owners to achieve their goals. Allison: I love that. And I think about how I talk about outsourcing a fair amount. And I ve worked with a lot of therapists who think there is all this insurance stuff they need to do to get paid. But it feels burdensome and it doesn t feel like what they want to be doing, so they cruise around Facebook instead. And then they, for months, they might not get paid the money that they need to get paid to have a business. When I think about the important things to outsource, I think about like what are the things you keep putting off? What are the things that are preventing you from bringing in money into your business? And so often I see people who are like, I know how to do it, but I just don t want to. At the end of the day, it s the last thing I want to do. And then we re looking at the reason you aren t having any money is because you re not submitting that. You would be building your business right now. And if there s a block, even if you know how to do it, by all means, pay somebody to do it! It just makes sense. Jeremy: Totally. And it totally makes sense. And it s between, billing on average costs providers between 8 and 10 hours of work a week. And 8-10 hours, if I were to add a money value to any provider s time, it s far more than what they are going to pay a biller. I mean, that s a tremendous amount of work. And when you are up to your eyeballs in clinical work, the last thing you want to do is worry about billing and the revenue cycle management piece. Cause there s a whole field there that folks don t want to do.

3 Allison: Yeah. And there was a time when I was taking insurance and I was fine with submitting the claims myself. But when something didn t go through for whatever reason, the idea of calling an insurance company and sitting on hold for an hour and a half. All of that, I would often just, depending on how busy or broke I was, just let it go. In a way that just doesn t make sense. Jeremy: That s right. Or you get an EOB back that says claim denied because it s not a covered service. And you re like, what do you mean? It s a 60-minute therapy session. What do you mean it s not a covered service, right? So, it s not a meaningful response. And that s exactly what we re talking about. Well don t let that money go to waste, because it s like a lot of money that you ll lose. Allison: Yeah. And especially over the course of a year. If its just one here or there, for instance, it still adds up. I think about a lot of the conversations had around insurance and the practice building space are not very positive. And most people that listen to the podcast know I m neither pro nor anti-insurance. I m real big on choose what is value based for you and works in your practice. Like this is your business and you re the one in charge of it. I m not here to make a value judgment on any of it. I ve taken insurance, I ve also not taken insurance. I m cool with it all. But I know a lot of people who are interested in taking insurance, but they are so intimidated by it that they don t even dip their toe in the water. They just assume its going to be too hard to get credentialed. Or too hard to build. Like its this monster. So, I would love for us to talk a little bit about the people who might be shying away because they are intimidated. Jeremy: one thing that we see, you know there are three big fears that we see with folks who are struggling with this. Those would be the fear of bureaucracy, what s the process, what do I need? What if I submit the wrong thing at the wrong time? How do I navigate the red tape? What s the path out of the wilderness? Then there s the fear of the unknown. That being what am I going to get paid? What s the rate schedule? What happens if a claim gets denied? Or rejected? What is a verification of benefits? And then there s the fear of just disorganization. How do I keep track of everything? What if I lose X? I can t find this document or that document. And it really hinders the process. Or you think it will hinder the process. So, those three big fears are what we see are stopping people from doing this. Even if they want to work with a certain population. Allison: yeah. And I think, in private practice, in grad school, any part of this process, like we re faced with, I don t know how to do this. Oh, I have learned how to do this. Or I don t know how to do this, oh, I don t have to, this is somebody else s job, or this can be somebody else s job. And I think about how these blocks, like you were talking about the fear of the bureaucracy, or the fear of the unknown, or the fear of disorganization. These are probably blocks that stop us in other places in our lives, not just when it comes to billing. And its often fematic. And how, if you re having some sort of reaction to anything billing related, looking and seeing where that also shows up in life, because it might help clarify that its not actually about the billing. Its about not wanting to be told what to do, or not wanting to get it wrong, whatever. So, I like

4 pulling in some of the personal growth piece. Because, I think it s a really relevant part of building our business. Jeremy: I would completely agree with that. We find that the revenue cycle management piece is, we ve seen a lot of personal growth in a lot of the practice centers that we work with. Especially the folks that are just launching into private practice, right? Where they struggle with, I ve sunk a fair amount of money and time into this. I ve gotten a degree and license. And then you hit insurance, and it s like I m supposed to pay the bills based off of somebody else s process? But one thing I would tell you is there are colleagues out there, there are companies out there, to help to still the information, to cut the ambiguity on this stuff so that you don t run into these blocks anymore. And revenue and business are the crucible for which a lot of folks grow. But I would certainly say that one, people have been down this road. So, if you are going down this road and you are running into some of these things, you are not the first one. And so there is some commadrie there to the sense that yeah, people have done this a lot. They have been going down this road. And we can certainly help with that. But I m sure there are colleagues that can cut some of the ambiguity out of this to help move this forward. Allison: Yeah. Absolutely. And for the people who are like, I think this is going to be too hard, I promise you I ve done it. I ve took insurance for years. It is not hard. It is just a matter of are you going to stay on top of it. All of it is figureoutable. Jeremy: that s true. I like that. Figureoutable. Allison: it s a Marie Forleo thing. I stole it from her. I should give credit where it is due. But, one of the things I really love about your company is you don t just do billing for people. You also show them how to do billing. Which I really love. Its very abundance based in my mind. Of like, you guys know that showing people the process is not going to hurt your company in any way. It s going to strengthen the clinician. Jeremy: well that s absolutely correct. So, the state of billing in the United States, for a long time has been me, the biller, has accumulated a ton of knowledge about how billing works. But I m not going to share it with you the clinician because I think that if I share it with you the clinician, you re going to replace me or do the job or me. So, I m just going to hide it. Shroud it in secrecy. Right? Just like the total black magic, billing model. Like you give me a document, and you ll get paid magically. But the problem is, you peel back the onion, the lack of accountability there is really damaging. Providers don t know how they are getting paid. They don t really know how their business works. They get paid, which sounds like a good thing, but they don t really know. And for us, we assume, we ll operate from a place of abundance, and peel back the layers a little bit and say, this is how this stuff works. And if there s a mistake somewhere, we ll fix it. We ll show you how you re getting paid. We re going to share the organizational knowledge across the board, so that we re not the keepers of the kingdom.

5 Allison: which I love. I really love that. Well, can you teach us some of what you ve learned about working with insurance that would make it easier for folks? Jeremy: Absolutely. So, I would research the process. So, let s say you want to get on a Blue Cross/Blue Shield panel in your state. The first thing to know is Blue Cross/Blue Shield is not a national organization. They are franchised. So, the Blue Cross/ Blue Shield franchise in your state sets their own policies and procedures. And they all have little quirks and nuances about how they do things. Right? So that s the first thing to understand. And each of them have a little bit of a different process in how they do things. So, the first thing you want to do is get on the phone with a colleague in your area whose gotten on the panel. Or get on the phone with the company you want to get in network with and ask them what their process is. And you want to take really detailed notes. And then the next step of that would be just reorganize your expectations. In the sense that taking insurance can be a good thing. It can be a smooth thing. You can make a decent amount of money on it. But I would say that there is some paperwork involved. A lot of paperwork. And there is a fair amount of waiting. So, once you know the process, then align your expectations to the process. So, for example, most Blue Cross Blue Shield credentialing processes take between days. But Etna, for example, can take 180 days, like 6 months of your time, you can wait getting on an Etna panel. So, allot yourself enough time. One place we really see providers get stressed, like I was on an the other day where somebody said, I m opening my doors October 17 th, if I submit my application today am I going to be in network? The answer is like well, depends on the insurance company. But probably not. Right? You have to allow yourself plenty of time to do the paperwork. To wait on the processing time. And then, I would also ask about fee schedules. Learn the process of how to get credentialled but know what the pot of gold at the end of the rainbow is going to be. Right? Is that worth your time? That can vary, we can talk about that. Allison: Dramatically. That can vary so dramatically. And I used to think the fees were based on cost of living. But I am a thousand percent clear that is not the truth. Jeremy: that s right. There s actually a very complicated calculation, and there is an equation for this I could share that with you if you wanted to, but its really complicated. And they come out with their fees. Allison: Yeah. Would you share that complicated thing just to give people kind of an idea? And this is not to say that if you can figure out this math, that it is going to be the same across the board for all insurance companies. Because that is not the same. But just to show folks how weird it is. Jeremy: Yeah. So, all insurance companies start with the Medicare rates. Which are called relative value units. So, essentially the payment plan under the Medicare fee schedule which is the National fee schedule. But then, what happens is they take a work relative value unit which reflects the time and intensity associated with furnishing a health care service. So, they take the

6 relative value unit associated with the time it takes Allison to perform the service. Then they add that to the practice expense value unit, which would be the cost of maintaining a practice. Renting an office, supplies, equipment, staff. Then, they add that to the malpractice relative value unit, which is essentially the cost of you holding a malpractice insurance plan, right or policy. Then, they add that to the geographic cost indicators. So, they look at, you know, your area or your region. What that takes. And then they multiply that by a conversion factor. That is to determine the payment rate for that particular service. So, it s the sum of the geography, the practice expense, the malpractice, and then the amount of work it takes you to perform a service. Multiplied by the conversion factor. And that s how you get your fee schedule unit. Those numbers change every year. So, if that s not complicated enough for you, that s how that works. Right? So, there are a lot of acronyms there, and I could share an infographic with you later how that works. But its really complicated. And the fee schedules are considered trade secret. So, they vary very widely. Allison: Yeah. And it could be the kind of thing where if you re in a very expensive place in California, you might be getting paid half of what someone who lives in a small town doing the same type of therapy as getting paid getting paid by the same insurance company. It is bananas. Jeremy: Bananas. Yeah. Then, you look at let s say, insurance X pays you $60 a session. Which sounds great. $60 an hour is fantastic. But as you scale into a practice, as you grow your practice, your margins, your profit margin starts to shrink. Right? And all of a sudden $60 an hour sounds like a really bad payment, right? And at the cost of sounding greedy, well I need to get paid $100-$125 per hour. Just to keep my doors open. Allison: Yeah. Jeremy: Yeah. So, it s very important to look at that. And then, the last thing to really help out with the whole insurance process is, think about your business from a process perspective. Systemize everything in your practice. First of all, don t take every insurance company under the sun. because that s just that much administrative paperwork to deal with. But also think about when a patient calls or contacts you, how are you going to get their insurance information? How is that insurance information going to be converted to a claim through your EHR or are you doing it manually or are you working through a billing company? How do you know the patient is covered? How do you know that you are in network? All of those things can be systemized? And almost automated. So, if you can do those things. Research the process. Reorganize your expectations. And then systematize your practice, the insurance thing will be a breeze. It will be very easy for you. Allison: Yeah. Like, I love the idea of systematizing everything in your practice. It s something I preach a lot, too. Because reinventing the wheel every time someone calls, is a huge waste of your time. And makes it kind of an awkward conversation. Can you imagine if you call your

7 doctor s office to set up an appointment and they were like, okay, so yeah, next I need your insurance information. You know? Jeremy: Yeah, right. Exactly. Allison: Its like you re a business. Even if you are the one answering the phone there s a certain level of professionalism around the system stuff. That will make people a lot more confident coming to see you. Jeremy: Yeah, and I feel like the whole systematizing thing is a whole other field of study. But like we have some practices that have us connected to their intake form from their website. So, they fill out, the patient fills out an intake form via the website, its HIPAA encrypted, gets divided to us and to the practice. And then, by the time the patient comes in, they know what they should be charging. Copay, coinsurance. Without a human being ever having to talk to the patient. That s like the best system ever. Because nobody has to talk to the patient. The patient can get assigned to a clinician. And then, you re in and going. Allison: Yeah. Absolutely. So, is there anything else you feel like folks should know about billing or practice solutions or anything like that, that would be valuable for folks? Jeremy: I would say the one thing about billing. The way that you do your billing, whether you do it yourself, the DIY folks, you do it inhouse or you outsource. There are definitely things to look for. And I would say this, the biggest thing to look for is value. Be able to justify the cost of however you re doing your billing. So, if you do somebody inhouse, you find a friend or whatever to come into your office for hours a week to do your billing. How are you justifying their value? Are they saving you time? Are they really good at what they do? Are they keeping your cashflow coming in very smoothly? Are they actually finding money from denials to justify their cost? Conversely, right, if you outsource, are you paying by the claim, by the hour or percentage? And what s the value to each of those? Each practice is a little different and they all have different metrics of what is valuable to them. I would just say look at the value, quantify the value that outsourcing, and billing has an impact to your practice. Allison: I love that. Well thank you so much. And you guys can check out, I ve got my own little page over there at Practice Solutions. You can go to practicesolutions.com/abundance. You can check them out. You guys have great information on your website. I feel like it s easy to navigate and appreciate. Billing doesn t sound like the most fun thing to check out. But I think you guys do a really good job of making it feel like an inviting place. So, I appreciate that. Jeremy: Thank you. Yeah. We have plenty of resources on our blog, too, about [unknown] and eligibility checks and denials and all that kind of thing. So, there s definitely plenty of content there that if you want to learn more about billing, you can go there and read some of the content that we ve produced. But yeah, thanks Allison! Allison: Absolutely. Thanks so much for being on, Jeremy. I ll talk to you soon!

8 Jeremy: Yep. If you are looking for an EHR with great unlimited customer support, get two free months of therapy notes by visiting therapynotes.com. Creating an account. And entering the promo code Abundant. Thanks for joining us on the Abundance Practice Podcast. Check out this week s show notes for relevant links, resources and homework. If you re new to private practice, check out the free checklist you need to get started at Abundancepracticebuilding.com/checklist. And if you need more support, check out the Abundance Party at abundanceparty.com. See you next week!

Episode 6: Can You Give Away Too Much Free Content? Subscribe to the podcast here.

Episode 6: Can You Give Away Too Much Free Content? Subscribe to the podcast here. Hey everybody! Welcome to episode number 6 of my podcast. Today I m going to be talking about using the free strategy