EHR & Financial Synergy

Today we're going to talk about something a little bit more complicated than we usually do. Usually, we talk about just billing, we talk about just scheduling, or we talk about just documentation. Today, we're going to combine both the documentation and billing and you're going to see visits kind of come up here a little bit, so we’re going to touch on scheduling too. We're really focused on the link between our EHR and our billing. This came up because we were recently at a seminar at Alpharetta, Georgia and so we were working with Dr. Steve Peyroux and Dr. Brent between Stem Cell Institute and Physicians Business Solutions. One of the really interesting things, this incredible thing going on there with regenerative medicine and, you know, we're really, really humbled to be working in this field with them but one of the interesting questions was, you know, I'm working harder than ever and I'm not making any more money or at least I'm not making any more money on the areas other than regen, right? I put regen in and suddenly we're making all this great money with the stem cells and we're doing a really great job there. However, one of the issues we're having is we're not doing any better on the other side of the business with our regular visits, you know, chiro, rehab, etc.

So the question becomes "Why is that happening? And what can we do to fix it?" So, we're going to do our four Q&A to explore these questions because this is how we approach every strategic issue. This is a strategic issue because we're talking about a large scale problem across entire specialties within the clinic. The stem cell side is going very, very well and that's one aspect, but the other aspects feel like we're working as hard as we ever have but it's not getting any better or at least the results are not there. So it's very easy to quickly fire off and say, "Well, I'm not getting paid enough for my claims," or "My friend, Dan, isn't collecting money the way they're supposed to be." However, all of those things are kind of shot off the hip and we don't really know what the issue is. What we want to do is actually use our numbers. We want to actually understand this from a stat perspective. To do that, we need an organization. So, the first thing we're going to do is use our four Q&A.

The problem that we have which is described, the opportunity, the question becomes looking at the stats and seeing what are the issues and what are their values? You might find that actually, yes, insurance companies may be underpaying us but we might find that the vast majority of those underpayments are very little and they don't even add up to very much. That might be a $500 a month problem and it should be solved but we always want to solve problems in priority, or in order of descending dollar amount. We might find that that is a smaller issue compared to, for example, we're spending all of this time with patients from one carrier because we're still in network with that payer instead of marketing more heavily to another segment. Or maybe personal injury is a big part of my clinic and I just found out that we're not sending out demand letters on time, right? That brings up a whole other can of worms with regards to personal injury and making sure you have a process. The really important aspect here is that we're coming at this from a stat perspective and then prioritizing solutions based on the highest dollar value strategic issue.

When it comes to following up on claims, insurance claims and day-to-day tactical issues this is a very, very important distinction. We don't want to do that day-to-day or from issue-to-issue because we don't want to miss out on anything. In other words every day, every tactical item should be resolved but strategically we want to solve issues from highest dollar value down. In order to do that, we need to understand what they are. Once we understand what they are, then we need to determine, okay, how am I approaching this issue? Am I approaching it objectively? Am I approaching this issue from the standpoint of, here are the numbers? You might find out that it's actually something that you're doing operationally that needs to be fixed. A lot of the time what we find with owners is that they're constantly putting themselves into the clinic and getting in the way of the staff that are trying to get their work done. The staff feels very busy because they're getting pulled in multiple directions and the owner feels very busy because they're pulling their staff in multiple directions. The end result is that less work gets done and less money comes in but we feel like we're working harder than ever. Overall, it ends up being kind of a lose-lose because we're approaching this from an emotional perspective.

What we want to do is separate the emotion out of this equation and focus on the statistics. That is a difficult thing to do, right? We want to really do that by first addressing the dollar amount here. If we determine that we've got $50,000 a month in potential regained revenue, right, so that's $600,000 a year, we really want to look at that and say, "Does it matter if I'm the one that needs to change or does it matter if I need to replace a staff member? Does it matter if one of these other things needs to happen if it results in an improvement in that stat?" Probably not, right? If I'm the owner and I'm the problem and that's the reason these stats aren't going up faster we need to really focus on that from a stat perspective.

When we approach this, generally, we're going to have three different ways of approaching. We can do nothing, right? So we can kind of just assume that it'll fix itself and not deal with it and see what happens. Some clinics do this and often times it results in failure because once a stat tends to level out what ends up happening is the stat starts to drop. Once the stat starts to drop then we're kind of in a red zone. So, doing nothing tends to result in negatives over time. We can add staff but that's also likely going to add cost. There are situations where that's a good idea, but if our issue is that we're not collecting enough, we don't necessarily want to try that approach first. The reason being that, if there is not enough money coming in, then you're spending money you don't have and consequently it is going to become really challenging to keep paying the staff that you do have.

Automation tends to be the most interesting and the first thing that you want to try. Automation means that in the technology there needs to be some kind of tool or function that helps me to, once I understand the statistics related to this issue, come up with action items to resolve those things. For example, it could be that my issue has to do with the number of visits versus the number of claims. I might be checking in lots of visits for care. I might be treating lots of patients and simply not generating the charges, and so, we've got lots of visits and nobody is paying for their treatment. It's not the patient's fault because the patient's coming in, they're doing everything they're supposed to be doing but nobody is telling them that they owe money, right? It could be that we've got all these things in line but we've got co-insurances that are coming back after responsibility and so now we're dealing with the insurance side.

The first one was cash. Now we're talking insurance. On the insurance side, we may not be collecting what patients owe after their claims settle. A lot of the times there are simple solutions for that. For example, keeping a card on file was a really strong thing that you can do using a certified solution for credit card management so that you're not manually keeping track of that because that's illegal. Also, making sure that you can automatically take any money that's owed to you from a patient at the conclusion of care so that they don't feel like you're constantly coming after them for money. Streamline these processes so that you don't feel like you're chasing your patients for money when you should be chasing them for a better quality of life.

When we talk about the link between our documentation and our billing it's really important to understand that when we check-in visits, we want to look at whether or not the number of visits that we're checking in is the same as the number of notes that we've got at the end of every day. We need to be able to look at that daily, weekly, monthly, quarterly, and yearly. We need to be able to look at that periodically, strategically and say, "Is this in line or do I have clinicians that are not doing the work they're not supposed to be doing?" If they're not, I need to figure out a way to get this done. You may also discover when you approach this issue, that there is another issue that is preventing your clinicians from addressing this and that you need to deal with it.

Next on the agenda is the number of claims, the charge entry. Now, we say claims so we could say charge entry if it's cash, claim if it's insurance. The important thing is that the number of visits to the conclusion of every day equals the total number of charges that either become cash, where the patient owes it directly, or insurance and goes out to a payer. Those numbers need to equate so that we know that every visit is accounted for. That is the first thing that you want to address in the clinic. There are other stats that you might want to look at too, but these are the first two that are really important regarding EHR and billing, to assure you that the operational side of the clinic is running smoothly.

Now, remember when we talk about any organization you've got people, process, and technology. It is important that you have the right people in place. We assume that you have the right people in place. We assume that the processes you have in place are strong. We assume that the technology that you have in the clinic allows you to make these comparisons and helps you by automating some of the tactical decision making so that day-to-day all of this happens at the highest possible SLA or percentage of correct actions. Remember that resolving issues is generally strategic, where you're trying to find out where any holes are and you can plug them to make sure things run much more smoothly.