Billing & Collections Update - What You Need To Know Now & In The Future With Will Humphreys Of In The Black Billing

[00:00:00] The First Thing That Is Obvious To Everybody Is AI, Artificial Intelligence.

[00:00:04] That Trend Is Something I Have Had On My Annual Strategic Plan For Five Years.

[00:00:09] Keep An Eye Out For AI, Keep An Eye Out For AI, And This Year It Came Like A Bull In A China Shop, Man.

[00:00:14] This AI Came In. And So You Should Be Asking Your Billing Company, What Do You Guys Use In Terms Of AI?

[00:00:20] And If They Say ChatGPT, They Are Losing You Money Comparatively To Other Companies That Are Leveraging AI Tools.

[00:00:29] Welcome. You've entered the Physical Therapy Owners Club Podcast, where your host, Nathan Shields, and other successful PT owners and leaders share their experience and insights on how to build successful PT businesses.

[00:00:41] They'll share the stories of their paths to success and show you how you can also obtain greater freedom and more profits from your business.

[00:00:49] That's what the PT Owners Club is all about. Greater freedom and more profits.

[00:00:54] There's plenty of room for you as well. So come on in and join the club.

[00:01:01] Hello, and welcome to the Private Practice Owners Club. I'm Nathan Shields, your host, bringing back my good buddy, Will Humphreys. How are you doing, man?

[00:01:08] I am so much better now that I'm back on the show, Nathan. Thanks for having me back, man.

[00:01:13] Yeah, it is. I hear you were kind of in a depressed state since you hadn't been on the podcast in a while. Is that what you're saying?

[00:01:18] Yes, I'm a middle child. So if I don't get attention on a regular basis, I start to introvert. And yeah, honestly, I love this show. It's so fun. It's always just fun being with you and you've got the greatest audience. Awesome.

[00:01:29] Awesome. Thank you. Thank you. Yeah, it's so good to reconnect and see where you're at nowadays because you have a lot of things on your plate. We've talked about Rockstar Recruiter in the past and how you help owners find providers.

[00:01:43] We've talked about virtual Rockstar and your influence and impact and providing virtual assistance to owners of clinics and other businesses. Right. And for the longest time, for the last five years, congratulations on your five year anniversary coming up soon in the black.

[00:01:58] Billion collections for private practice owners as well. You got a lot of stuff on your plate. So it's nice to actually reconnect a little bit.

[00:02:05] Yeah, I appreciate that. And definitely, without a doubt, I've been very grateful. I will say that someone told me once a coach said,

[00:02:11] if you can figure out how to run a private practice in the rehab space, PTO, TSLP, whatever, you can run any other kind of business.

[00:02:20] So it's kind of funny because I remember hearing that going like, oh, he's just being nice, but it's absolutely true.

[00:02:24] That's the reason I think I've been able, like you have, to do other things is because that foundation of what we learn, it's a really tough market, but it makes the best leaders of any business.

[00:02:35] Yeah.

[00:02:35] So yeah, it's been crazy to see how that's, and all these things are connected that I do.

[00:02:39] So it feels very spread out, but to me, it's like one thing, right?

[00:02:42] Yeah, yeah, yeah, exactly. And I forgot to mention, you're still working with multiple exits.

[00:02:46] Yeah.

[00:02:47] That takes a lot of time and energy, but today we want to focus on your experience with Billion Collections as a representative and as the founder slash co-owner of In the Black.

[00:02:57] It's nice to come back around because I don't think we've talked much about Billion Collections for a few years, frankly.

[00:03:03] Well, yeah, who wants to hear about it? It's extremely boring.

[00:03:05] Well, if you're listening already to this point, congratulations, you're an incredible leader because you chose something that clearly wasn't like a topic you were excited about, right?

[00:03:13] I can't wait to learn about medical billing.

[00:03:15] Yeah, but they have to address it. It's the lifeblood. It's where you get the cash flow.

[00:03:19] It's how you...

[00:03:19] Absolutely.

[00:03:20] And if you're turning a blind eye to Billion Collections, then you're just working naively and people are probably stealing from you, which is what happened to us.

[00:03:28] As has happened to us. Absolutely. We've had past billers, we won't mention their names, come back years later and go, hey, I'm really sorry I did that to you guys. That must have really hurt.

[00:03:39] Have you actually had people come back and apologize? Because I haven't.

[00:03:42] Yes, we did. Both of us did. You don't remember who it was, but I'm going to like, we're on the air.

[00:03:47] Oh, I think I do remember now. Yes, we did have one that I can recall.

[00:03:50] Yeah, totally. We're having a moment, audience. Thanks for letting us communicate on that. Yeah.

[00:03:54] But there were so many.

[00:03:55] There were so many broken hearts. We got, you know, whether it was an in-house person who falsified documents in one case in my world,

[00:04:02] or an outsourced business that like really promoted themselves on the, on the back end of a large EMR,

[00:04:09] no names in particular, that just never did the job they were supposed to do.

[00:04:14] I always felt like I was getting taken advantage of to some degree, right?

[00:04:17] Or just stolen the cash.

[00:04:19] Or literally ripped off.

[00:04:22] There's many ways.

[00:04:24] So many ways, the medical billing.

[00:04:25] So yeah, I'm glad that people are tuning in.

[00:04:27] Because like to your point, if we don't learn about these things, then we can't ever be in charge of our freedom and profits.

[00:04:34] It's a core element of how we live.

[00:04:35] I think a lot of owners turn a blind eye to billing and collections thinking I'm handing it over to the experts,

[00:04:40] whether that's hiring somebody and letting them, you know, do their job, which is what we did.

[00:04:44] And thinking they've got it handled.

[00:04:47] Or number two, they don't know what to look for.

[00:04:50] They don't know how to hold a billing and collections team accountable.

[00:04:53] So they, again, just stay ignorant, naive, and don't learn the billing and collections reports,

[00:04:59] how to read them, how to audit their own financials, how to audit their billing and collections efforts.

[00:05:05] So it's really hard for them to get into that space when they have so many other things going on.

[00:05:10] Yet, there's so much money to be lost at that point right there.

[00:05:14] Especially if you're missing out on over-the-counter collections at the time of service.

[00:05:17] If your aged AR is getting out of whack.

[00:05:21] If denials aren't being processed appropriately.

[00:05:24] If things are getting denied.

[00:05:26] If CPT codes aren't getting, are getting denied.

[00:05:28] Or diagnosis codes are getting denied.

[00:05:29] And that information is not getting passed on to the providers.

[00:05:32] So many ways you can lose money.

[00:05:34] We've lost them all different ways.

[00:05:36] But that's where in the past, I never recommended outsourcing billing and collections based.

[00:05:42] Yeah, totally.

[00:05:43] Until, frankly, until you started your own billing and collections company.

[00:05:46] And you guys did it the right way.

[00:05:48] Which to me means frequent communication.

[00:05:52] Reviewing the reports together with the owner to show them exactly what the metrics should be.

[00:05:58] Here's the baseline expectation you should have.

[00:06:00] Whether it's for us as your billing and collections company.

[00:06:03] Or another billing and collections company.

[00:06:05] These are the standard expectations.

[00:06:06] And so you go so far as to communicate not only what the metrics are, but what you should expect.

[00:06:13] And if you guys are below average as to why.

[00:06:17] And here's what the reports are telling us.

[00:06:18] And I really appreciated that because I never experienced that until Katie came on board to our clinics.

[00:06:24] And really helped us out understanding billing and collections.

[00:06:26] And really making it significantly better.

[00:06:28] And then took her information and knowledge over to your company at In The Black.

[00:06:33] And so you guys do a great job in that regard.

[00:06:37] And so, and I think, correct me if I'm wrong.

[00:06:39] I think we're seeing a couple other billing collections agencies that are doing a pretty good job.

[00:06:43] Because I know you know who those players are.

[00:06:45] They seem to be doing better, if I'm not mistaken.

[00:06:48] There are.

[00:06:49] I think, you know, kind of like a state of the union of where medical billing is as an industry.

[00:06:52] Is that it's really important to have good billing companies to outsource to.

[00:06:57] Because it is such a difficult part of our business.

[00:06:59] I mean, look, when I ate for years, I think it was like five to ten years.

[00:07:03] I didn't even know what a profit and lot statement is.

[00:07:07] Now I have a handful of multi-million dollar companies.

[00:07:10] So when I remember the shame of like not knowing my numbers, not understanding the process, but feeling like I should have.

[00:07:16] So just kind of talking to billers and companies like kind of like I know what I'm talking about, but having no clue.

[00:07:21] Again, until Katie really came in.

[00:07:23] And now, like the industry is changing.

[00:07:25] The market is changing.

[00:07:26] And I love it because it's changing.

[00:07:27] I'd like to think that in the black had some influence on that.

[00:07:30] And to some degree, one of my favorite things that Katie told me back in the day is she's like, listen, when we grow, we're going to screw up.

[00:07:37] And let's do this.

[00:07:38] Let's guarantee what we do.

[00:07:39] So that if we ever make a mistake that actually costs the PT or OTs, the owners, if it costs them money, let's guarantee it to where we'll pay them out of pocket.

[00:07:48] So this is how transparency is a big value for me.

[00:07:51] We had one client in the last five years that we screwed up really bad, Nathan.

[00:07:55] We lost them over $20,000 because we were growing so fast.

[00:07:59] And we paid them $20,000, even borrowed some money to make sure they got that money and were made whole.

[00:08:07] So, yeah, like to me, it's like if you're running people's money, why wouldn't you guarantee it?

[00:08:11] So like we started doing those things and those types of things had never been done before.

[00:08:15] So I'm really proud of Katie and her team because I believe some of those things are starting to bubble up in other companies as they grow and they function.

[00:08:22] Because like at the end of the day, medical billing is so complicated.

[00:08:25] I was about to like swear out of nowhere.

[00:08:27] Like I don't swear at all.

[00:08:28] My kids would be like, dad.

[00:08:29] But like literally it's so complicated.

[00:08:31] It is so much harder than I even realized as I got into it with these medical billers.

[00:08:35] And it's so needlessly and it's getting worse.

[00:08:38] It's like the state of the union from the other side, the payer side is that they're making it more complicated.

[00:08:43] Their goal is trying to make it more complicated on a day-to-day basis.

[00:08:48] So it's insane what these companies and people have to figure out.

[00:08:52] So, yeah, no, I agree.

[00:08:53] You know, back in the day, I wouldn't recommend outsourcing it.

[00:08:54] And I still believe there's a good place for an in-house biller.

[00:08:57] I think there's great situations.

[00:08:58] If you've already figured that out, great.

[00:09:00] Good for you.

[00:09:01] You started another business that's ultimately saving you money.

[00:09:04] But at the end of the day, for anyone else, like having an option to outsource it to is phenomenal.

[00:09:08] And I'm glad to say that, like you said, there are more companies bubbling up that I believe in.

[00:09:13] Well, this is where I'm coming from now when it comes to bringing someone in-house, hiring that billing a collections person versus outsourcing it.

[00:09:21] And you tell me if you're feeling the same way now.

[00:09:23] And I think you have some bias, but you're also able to step back and see from a greater perspective.

[00:09:28] Yeah, for sure.

[00:09:28] The other thing is that anyone who's newly opened their doors, don't bother trying to find somebody.

[00:09:36] Just hand it over to the experts that you can trust and especially people like you who are willing to communicate.

[00:09:42] The worst billing and collections companies are the ones that simply send over the reports on a monthly basis and have little to no communication with you in between.

[00:09:50] Absolutely.

[00:09:50] Absolutely.

[00:09:51] Right.

[00:09:51] And I know that's exactly what you don't do not do.

[00:09:54] You guys actually talk through that and talk to the owners through the process and the reports on a regular basis.

[00:10:00] But for anyone who's opening a clinic, don't bother.

[00:10:05] Just hand it over to a good billing collections expert who can actually or who will actually train you on the reports, what the numbers should look like, what they do look like, and where the issues are that they see and what they're doing about it.

[00:10:17] Instead of trying to put all your trust and find that needle in a haystack, that's going to be the perfect biller for your company at that time.

[00:10:23] Is that where you're at?

[00:10:24] And then once you get to a certain point where you have multiple clinics, then it's probably worth your time to bring in like a billing collections team.

[00:10:33] Absolutely.

[00:10:33] I believe and I do believe that not one size fits all.

[00:10:36] So there might be situations based on people's backgrounds.

[00:10:39] Like we have a couple of clients who work with us who probably could have hired someone and brought them in house when they opened their practice because they were directors.

[00:10:46] Each of them were directors for a large company that taught them really well.

[00:10:49] But it was funny because, yeah, you know who I'm talking about.

[00:10:52] But these guys were like also really smart and thought, eh, we just don't want to deal with it.

[00:10:55] It's a thing.

[00:10:56] It's a totally different.

[00:10:58] So much energy.

[00:10:59] And by the way, some people are more naturally inclined.

[00:11:01] So people who are naturally inclined, no matter where they are, they should bring an in-house biller in.

[00:11:05] But to start out, here's the problem though, Nate.

[00:11:07] People who are starting out now, I learned this.

[00:11:10] It takes just as much effort on my end as a billing company to bring in somebody who generates $5 million in annual revenue as it does to bring in.

[00:11:19] It actually takes more work to bring someone on who's never seen a patient before.

[00:11:23] Oh, really?

[00:11:23] It's bizarre.

[00:11:24] You would think it'd be $5 million times more work, but it's not because when you're getting someone, you're helping someone get set up.

[00:11:31] So here's the problem.

[00:11:32] And people who are starting out, a lot of times, they don't meet the minimum threshold.

[00:11:36] To qualify as a potential client, at least a lot of the bigger companies that I've worked with, they used to send me referrals for people.

[00:11:42] All the ones they didn't want, I had someone slip and tell me they were called trash referrals.

[00:11:47] The PTs or OTs or whoever was starting their practices, the ones who were under $100,000 a year, even if they'd been in business for a while.

[00:11:55] But if they were starting out or if they were under $100,000, the threshold, I think, is actually higher than that.

[00:12:01] I think you have to be making more than $300,000 for them to look at you in some cases.

[00:12:04] But if you're in that smaller group, it's a lot of effort to bring them on.

[00:12:07] And so they're oftentimes not even being addressed.

[00:12:10] And so you get these owners coming out not knowing what to do, thinking they should find someone for 4%, like who's going to charge only 4% or 5% when they realize what they need is a high-quality company that's going to take on that investment.

[00:12:21] And maybe charge for the first few years a little bit more because it doesn't matter, you're not making much anyway, just to get you on top of it.

[00:12:28] And then as you scale, then you can look at other options and even like, you know, negotiate down your costs or bring someone in-house if you get to that size.

[00:12:35] What is that range that they should expect to pay?

[00:12:38] Is it 7%, 8%, 10%?

[00:12:40] Yeah.

[00:12:41] If you're starting out, you should be leery of anyone charging you $6 or less.

[00:12:46] If you are established, if you're like half a million in revenue and above, industry norms are anywhere between 5.5% and 8.5%.

[00:12:53] I've seen that across the different companies that are out there.

[00:12:56] And the biggest thing is how they deliver on their promise.

[00:13:00] It's PTs that go to a billing company and say, hey, they're charging me 4%.

[00:13:04] Why don't you charge me less?

[00:13:06] It's like going to a physical therapist saying, oh, I've tried physical therapy before.

[00:13:09] There's such a dramatic, I mean dramatic difference between medical billing companies in terms of what they offer.

[00:13:15] Do they do insurance verification?

[00:13:16] Do they provide credentialing?

[00:13:18] Do what kind of, like you mentioned, what's their communication look like?

[00:13:20] Do they offer a guarantee?

[00:13:22] Like is their coaching baked in?

[00:13:23] There's all these combinations of things.

[00:13:25] So it is hard to answer the question of what percentage, but I would say if you're a new company and you're starting out,

[00:13:31] the differential in your income between a 5% and a 7.5% is very minimal compared to the quality of the company.

[00:13:38] You should be looking at quality of company.

[00:13:40] If you're going to guarantee that you're going to collect what you should get, that to me would be worth a point or two.

[00:13:45] Well, let's extrapolate that.

[00:13:47] If they're at $200,000 a year in revenue, 2.5% is what?

[00:13:52] $5,000?

[00:13:53] Am I right?

[00:13:54] Yeah.

[00:13:55] I'm going to do it right now.

[00:13:56] So $200,000 and you're looking at 2.5% is $5,000 a year.

[00:14:00] Yeah.

[00:14:01] And if that means a greater experience and more education and people who are actually willing to stay on top of your billing and not just do the bare minimum,

[00:14:09] that's more than worth it, right?

[00:14:10] That's what you're saying is that that $5,000 gets paid back big time.

[00:14:14] Yeah.

[00:14:14] That number changes as they get bigger.

[00:14:16] Once they hit like a million in gross revenue, absolutely.

[00:14:19] That percentage makes a totally different deal.

[00:14:22] In that same analogy, obviously we're looking at five times that amount.

[00:14:26] So five times five.

[00:14:27] Now we're talking about 25 grand of annual difference.

[00:14:29] So then you start looking at that percentage.

[00:14:31] But for people who are smaller and starting out, they absolutely need to look at high quality and not worry as much about that percentage as long as the company can deliver on their promises.

[00:14:40] Now that stays consistent no matter how big the company.

[00:14:43] But at the end of the day, like most people, the bigger challenge is having someone take you on.

[00:14:47] And I'd be leery of someone who's taking a new client on for 4%.

[00:14:51] I almost guarantee they're going to have a horrible experience and lose their shirt.

[00:14:54] Well, you know what really turned us away.

[00:14:56] I remember back in the day when we first tried to outsource was that outsource billing company, their customer service interactions were horrific.

[00:15:05] They were not aligned with our values as a company when it came to customer service relations and collections.

[00:15:12] And so that's one thing that we didn't mention is what's the customer service relationship going to be like for your patients?

[00:15:20] Going on the cheap side of things on collections.

[00:15:23] Like are you paying a little bit more just to save that relationship with your patients?

[00:15:27] Because frankly, that's the last interaction your patients are going to have more than likely with your company is the financial balance payment.

[00:15:36] And if that's not a good experience, no matter how good your therapy was, they can turn everything negative.

[00:15:43] Absolutely.

[00:15:43] And anyone who's gotten successful in physical therapy know that.

[00:15:47] They understand the power of being able to provide that customer service around the financial pieces.

[00:15:52] So that's another area that I think is getting better across the board.

[00:15:56] But I will say like the major players in the medical billing game, we haven't taken a new client on.

[00:16:02] We didn't take a client on for a year and a half.

[00:16:04] We just started taking clients on again a few months ago.

[00:16:06] And the reason we didn't do that or we stopped taking clients was because we did grow so aggressively that we thought, you know what?

[00:16:12] We don't want to lose our quality.

[00:16:13] And we saw that with so many other bigger names in our industry that people were coming to us saying they were great at first.

[00:16:18] And then they started like the customer service went out the window.

[00:16:21] The customer service is always the greatest indicator if that company is going to be a long-term fit or not.

[00:16:26] The second you lose that customer service, that means they've evolved in a way you probably got to get ahead of.

[00:16:31] Either you need to be more aggressive in getting them on the phone because a squeaky wheel does get the grease in a medical billing company or you need to start looking at other options.

[00:16:39] Yeah.

[00:16:40] And so as you're looking forward or experiencing, what are you experiencing now in the billing and collections industry?

[00:16:46] That is what's changed?

[00:16:47] I mean, it's been a few years since we've talked about the billing and collections experience.

[00:16:51] What are some of the things that you're noticing that are changing?

[00:16:54] Or what are some of the trends that you're seeing that we're going towards?

[00:16:58] Yeah, I've seen a couple of things.

[00:16:59] The first thing that is obvious to everybody is AI, artificial intelligence.

[00:17:04] That trend is something I've had on my annual strategic plan for five years.

[00:17:09] Keep an eye out for AI, keep an eye out for AI.

[00:17:11] And this year it came like a bull in a china shop, man.

[00:17:14] This AI came in.

[00:17:16] And so you should be asking your billing company, what do you guys use in terms of AI?

[00:17:20] And if they say chat GPT, they are losing you money comparatively to other companies that are leveraging AI tools.

[00:17:27] Right.

[00:17:27] Oh my gosh.

[00:17:29] So it's crazy because insurance companies are using artificial intelligence to make the process harder to get reimbursed.

[00:17:35] So it's making it X.

[00:17:36] So you can't, it's not, you know, you've got to fight fire with fire.

[00:17:39] And at this stage, I would say more recently, when this is at the end of 2024, when we're filming this, maybe it's coming out in 25 early part.

[00:17:46] But like at this time, when we're recording this, like the billing companies are winning the game.

[00:17:50] I'm seeing people get reimbursement.

[00:17:53] Like, no kidding, Nate, like, you know, a DSO or dates of service outstanding.

[00:17:57] The time it takes for you to get paid from the day that a patient walks in the door, industry standards like 60 days, right?

[00:18:02] Sure.

[00:18:03] I'm seeing 20.

[00:18:04] I'm seeing crazy quick turnarounds because companies that are leveraging AI for companies that are leveraging AI.

[00:18:10] The AI component is a game changer.

[00:18:13] And, you know, I used to think of any company, medical billing company that used to outsource overseas as a bad thing.

[00:18:18] And what I'm learning is if a medical billing company is using another company overseas to leverage overseas help, that's usually the kiss of death.

[00:18:27] But if they're using their own virtual assistants, like if they're, if they're training them and they're employees of the company,

[00:18:34] that's actually an indicator of a company that's able to provide better value.

[00:18:38] So it's the AI thing is the biggest thing.

[00:18:40] The virtual assistant thing is another because, as you know, it was my billing company that got me started doing virtual assistants for PT owners and OT owners because, you know, I was doing it for my own company.

[00:18:48] It was going so well.

[00:18:49] People like help me.

[00:18:50] And I was like, no, I'm too busy.

[00:18:52] And then they said, please, we'll pay you.

[00:18:54] And I went, what?

[00:18:54] And now we have a hundred and at the time of this recording, we have 115 virtual assistants across over 76 clients across the country.

[00:19:02] Right.

[00:19:03] That's amazing.

[00:19:04] So don't look at their overseas billers as like the red flag that it used to be.

[00:19:08] Look at whether or not they're, it's all about the relationship.

[00:19:11] Does that person, first of all, are they talented?

[00:19:14] Doesn't matter where they live.

[00:19:15] Do they have a good relationship with you?

[00:19:17] If they do, then that's what matters because you can find people, Americans, honestly, in some cases in the medical billing space are some of the hardest people I've had to hire and train.

[00:19:25] So we have a great American team, no question, but they are like diamonds in the rough.

[00:19:30] Anyway, so I think those are the two bigger trends that they should be asking their companies about and learning about because I don't know how someone who has in-house billing learns how to leverage AI the way that these larger companies are bringing it.

[00:19:41] That's why I think outsourcing is going to ultimately reign supreme.

[00:19:45] Great.

[00:19:45] Yeah.

[00:19:45] How can you expect your, let's be generous, 35 to 65-year-old biller to stay on top of all the AI technology that they need to understand?

[00:19:55] What we're frankly doing, what the billing companies frankly are doing, as you explained it, they're gaming the system, right?

[00:20:01] And as you gain the system with, by leveraging AI, you can get faster turnarounds and that AI is learning the denial rates and what CPT codes and diagnosis codes are getting denied.

[00:20:13] So that they make the changes necessary or make recommended changes to the billing and diagnosis codes in order to get greater reimbursement in a faster period of time.

[00:20:23] And if you're leaning on that person who did their billing and coding course 10 years ago, handle all of that, all that's coming down the pipe in real time.

[00:20:35] Yeah.

[00:20:35] You're behind the curve.

[00:20:36] Absolutely.

[00:20:43] If you fail to plan, you plan to fail.

[00:20:47] Hey, it's Q4 2024.

[00:20:50] It's time to put your foot on the gas.

[00:20:51] It's busy season guys, and your goals are within reach.

[00:20:56] But if you're feeling unclear on what to do next, it's likely due to a lack of planning.

[00:21:02] Listen, if you want to be a great company, you have to do what great companies do.

[00:21:06] Post an annual strategic plan with your team.

[00:21:09] Setting aside one to two days to map out the entire year ahead has been the single most impactful habit I've developed in my business.

[00:21:18] That's why Nathan and I are offering exclusive strategic planning sessions for practice owners ready to make 2025 their best year yet.

[00:21:28] We'll fly to your practice for two days and help you get crystal clear on your goals so every day next year starts with purpose and focus.

[00:21:38] Imagine waking up knowing exactly what to do and how that clarity would impact your team and your work.

[00:21:45] We're only taking 10 businesses for 2025, and spots are first come, first serve.

[00:21:50] This promotion runs to the end of the year, so if you're serious about growing in 2025, check the show notes and claim your spot today.

[00:21:58] This could be the most important decision you make next year.

[00:22:01] Think about it.

[00:22:06] Again, the companies are coming into our industry.

[00:22:09] Some of them are getting heat because they weren't born in the physical therapy industry, but they're coming into the PT industry,

[00:22:15] coming from revenue cycle management, which is like the more professional term for a medical billing company.

[00:22:20] They're coming in from revenue cycle management from other healthcare industries going,

[00:22:24] wow, physical therapy isn't a $36 billion PT industry.

[00:22:29] PT OTs and SLPs make up a $600 billion musculoskeletal industry in the PT OT space, at least.

[00:22:37] And so for them, they're trying to capitalize on our niche.

[00:22:40] It's kind of a validating thing for PT owners and OT owners that are like, should I stay in this?

[00:22:45] Absolutely, because look at these large companies who have huge books of business who are like, no, let's go target PT.

[00:22:51] OT.

[00:22:51] Let's go get those guys because they know where we're going or what we could at least go to.

[00:22:56] Oh, I'm out there on the runway with the flags.

[00:22:58] When you say that, like, please come this way into our industry.

[00:23:03] We are so many decades behind.

[00:23:06] I don't care that you're out.

[00:23:07] I welcome the fact that you're outside of our industry because we are so slow and we are so not technologically savvy that we need someone to come in and actually change things up.

[00:23:18] Dude, you and I used to have PTs that we'd have to show them how to log into their emails.

[00:23:21] And that, like, that was, like, not that long ago.

[00:23:24] What we're really talking about is the equivalent of going from paper notes to EMR.

[00:23:30] Yes.

[00:23:31] Now we're talking about, and I feel the same way about the scribe components that are part of EMR.

[00:23:37] Like, it's time to stop typing your notes.

[00:23:39] Oh my gosh.

[00:23:40] And use the AI scribe.

[00:23:42] And it's time to leverage AI for billing.

[00:23:45] Like, that's the transition that's happening right now.

[00:23:48] And there's going to be early adopters.

[00:23:49] And those guys are going to crush it.

[00:23:51] And then it's just going to take time for everyone else to kind of toe the line and feel like, oh, wait, that's doing that well for you.

[00:23:57] I never thought it could.

[00:23:58] And you're five years late, right?

[00:24:00] Absolutely.

[00:24:01] And so that's what we're going through.

[00:24:03] Well, I feel like we're the Danish and we're being liberated.

[00:24:06] We're waiting for Americans to liberate us during World War II.

[00:24:08] It kind of feels like that in the sense that we're all like, welcome.

[00:24:11] Thank you.

[00:24:11] Yay.

[00:24:12] We love hamburger.

[00:24:13] You know, it's like one of those things where we need this as a disruptive tool in our industry because has it ever occurred to anyone listening?

[00:24:19] The fact that insurance companies, you know, what did UnitedHealthcare make last year?

[00:24:24] Like how many tens or hundreds of billions?

[00:24:25] Oh, they'll make 20 to 30 million billion dollars in profit.

[00:24:29] 20 to 30 billion.

[00:24:30] So what kind of data do they have on our industry?

[00:24:34] And why do you think they give a crap about they want to keep you so suppressed?

[00:24:38] They want to keep you reimbursed as little as possible because they know the truth that if we were like the movie Ants and we all came together and fought it together and we started, you know, charging what we were worth, we would save our patients billions of dollars.

[00:24:52] We would make significantly more, by the way.

[00:24:54] But the biggest people who would lose would be the insurance companies.

[00:24:57] So we always think of ourselves as like this, like, oh, we're a service that gets referred out to, but they don't know.

[00:25:01] PT owners don't know.

[00:25:02] OT owners don't know that we are the single greatest threat in the healthcare industry of taking down the insurance companies.

[00:25:11] And so if something happens to me in the next week, I want or after this is released, I want it to be known.

[00:25:16] So you went outside and we're not sure.

[00:25:18] Like, it's a big deal, guys.

[00:25:19] Yeah.

[00:25:19] So like AI, great.

[00:25:21] It's a weapon for us.

[00:25:22] We have this weapon to help you get free.

[00:25:24] In the short term, it increases your profit and your income and your freedom, right?

[00:25:27] But are you even using it?

[00:25:29] Are you aware of what your PT?

[00:25:30] Ask them.

[00:25:30] Send out a note.

[00:25:31] Do you guys use AI?

[00:25:32] What type of tools do you guys use?

[00:25:34] How does that look?

[00:25:34] Because I've seen companies come through.

[00:25:36] There are companies that are really leveraging it more than me, even, who work with larger clients than we have.

[00:25:42] We're the opposite in the black.

[00:25:44] We don't work with people above a certain size because we know that's above our ability to deliver the value they deserve.

[00:25:50] So we refer out on those clients and they have tools for larger clients that we don't need and we don't use.

[00:25:58] So it's really interesting to see how AI isn't like a cool thing, but it's like, if you're not using it, where are you?

[00:26:04] What are you doing?

[00:26:05] And then they have all these other tools now that are coming in like scribes and stuff to help offload the other stuff.

[00:26:09] And compliance.

[00:26:41] And I think that people who are slow adopters there, they're just going to be slow.

[00:26:45] I mean, it's just how it is.

[00:26:47] Or bankrupt.

[00:26:49] Or they'll be listening to a totally different podcast on how to flip houses.

[00:26:52] I don't know.

[00:26:53] Right.

[00:26:54] But you know that insurance companies are going to take that same AI data on optimal treatment and compare that to what you're doing and possibly start denying if you're not doing the most optimal treatment.

[00:27:06] And that's how far it could go.

[00:27:08] I'm not saying it will, but those are possibilities.

[00:27:10] And we can see how AI is infiltrating a lot of the organizations.

[00:27:14] And it's especially going to infiltrate.

[00:27:16] Well, it already has been a part of the insurance companies.

[00:27:19] We just need to be leveraging it as well.

[00:27:21] Yeah.

[00:27:22] The way it's working, too.

[00:27:23] Here's how AI is used.

[00:27:24] So people are like, well, how does it make a difference?

[00:27:26] So this is how it works.

[00:27:27] You have a patient who has a certain insurance.

[00:27:31] You submit the claim.

[00:27:32] It gets rejected.

[00:27:33] You're currently an American biller or whatever.

[00:27:36] Your biller if they're overseas, whatever.

[00:27:37] They take that claim.

[00:27:38] They find out why it was rejected.

[00:27:39] There's a percentage of those rejections that come through that are just ridiculous.

[00:27:44] There's, you know, I won't mention.

[00:27:45] Yeah, they literally, in some cases, we will send the same claim exactly 12 hours later because we know every 100% of those claims are going to get rejected based on that we forgot information that we didn't forget.

[00:28:00] Think about that.

[00:28:00] We already know it, so that's part of how we play this unbelievably.

[00:28:04] But what would you say?

[00:28:04] Like 33% of claims just get denied for whatever reason?

[00:28:07] Actually, the number is really close to 30%.

[00:28:09] That's really, did you just like pull that out of your head or?

[00:28:12] I'm really smart, but I'm just saying.

[00:28:15] I just assumed.

[00:28:16] I think I actually heard that one time.

[00:28:18] Like for, like, it's just standard.

[00:28:20] They're just going to deny 30% of all claims, no matter if they're appropriate or not.

[00:28:24] And so you have to know that game if you're a billing company.

[00:28:26] That's why when PT owners or OT owners get upset and they call their billing company, like, hey, what's going on here?

[00:28:30] It's like, how do I sit down and explain all this to them?

[00:28:33] So it's easier for them to be like, yeah, just look at your percentage of collections and forget.

[00:28:36] Don't worry about it.

[00:28:37] It's easier for them to not communicate because communication opens doors of confusion for owners.

[00:28:42] And then you, as a PT, as a medical billing company, you feel like you're wasting a lot of time calming them down because other companies are going to screw them.

[00:28:51] And like you're wasting that time educating them when you could be spending that time getting that money.

[00:28:56] There is a balance I've learned between those two.

[00:28:58] You have to communicate with your owners.

[00:29:00] You have to give them what the information they need.

[00:29:02] But when they get to a certain, there's a certain anxiety level of people that I just won't, I won't bring on anymore.

[00:29:06] I've got people who legitimately will email every time it dropped their collections dropped by a very marginal percentage for any small length of period of time.

[00:29:15] It's like we don't have time to run your account if we're calming you down constantly.

[00:29:18] Right.

[00:29:19] But going back to the example, so 30% get rejected because of this.

[00:29:23] And then you get denials.

[00:29:24] OK, we're just not doing it.

[00:29:25] They have to fight those denials.

[00:29:27] And so here's how AI works.

[00:29:29] The AI programs that I've seen that I really like, they know you can teach the program if this, then that.

[00:29:36] This insurance, when this occurs, this is the immediate follow up and it's automated.

[00:29:42] It's not a human being getting to it, leaving notes.

[00:29:45] It happens in real time instantly.

[00:29:47] So that's why it's so much faster is because a human, it doesn't take all the human element out.

[00:29:52] The humans still need to program the AI interface to say, OK, this insurance rejected or denied the claim based on this reason.

[00:30:01] So when that happens, I want you to do this and this and this.

[00:30:05] So it takes that first rejection or denial.

[00:30:08] It takes some effort by the human being to program that into the AI.

[00:30:13] But once it's done, then the AI just handles it until the next new reason occurs, which, by the way, is what the insurance company's AI is constantly creating.

[00:30:22] OK, they figured out how to solve this.

[00:30:25] How evil is this?

[00:30:27] It's Skynet versus Skynet and Terminator.

[00:30:30] Yeah.

[00:30:30] And it's so like not even hidden.

[00:30:32] It's like if Skynet versus Skynet were playing tennis against each other in the open, you're all watching it because, you know, I said this before on your show.

[00:30:39] If in today's world, you can't make a statement without irritating half of the country based on their political stance.

[00:30:44] But you can say insurance companies are evil and everyone goes, yeah, that's right.

[00:30:50] You can say this really heavy comment and people just go, yeah, totally.

[00:30:54] And I don't do I believe the human beings in it are bad?

[00:30:56] No, I think there's a lot of disillusioned human beings who think that insurance companies are doing something valuable to their communities, which they're not.

[00:31:02] It's really about them not wanting to pay.

[00:31:05] And when you own a medical billing company, it's actually beyond shocking how blatant it is that they're just like, no, you never sent that over.

[00:31:11] I'm like, yeah, you do that 100 percent of the time.

[00:31:13] So clearly you're lying.

[00:31:14] Right.

[00:31:15] So anyway, AI is helping combat that.

[00:31:17] And so as so you need human beings who are constantly updating the AI interface to change the rules and regulations.

[00:31:22] And as long as you have those two things working in tandem, then they can stay on top of the insurance billing and even do better than we've ever done before.

[00:31:28] It's pretty for now, at least.

[00:31:29] Yeah.

[00:31:29] I don't know all the players in that AI space.

[00:31:32] We did have one of our sponsors was the Thelous at the conference.

[00:31:35] And so they were a sponsor of ours here for the next year.

[00:31:38] And I had a Facebook live with them.

[00:31:41] And it was amazing some of the stuff that they're doing.

[00:31:44] And they're not done.

[00:31:45] It's not like they figured it all out.

[00:31:47] There's more for them to do.

[00:31:48] Right.

[00:31:49] And they even took part of my presentation that I gave in September in Clearwater so that they could assess it and see how they could implement it into their AI to do exactly what we're talking about.

[00:32:01] Like, hey, this insurance company with this, you have to build these codes and only use these CPT codes or these diagnosis codes and these CPT codes.

[00:32:09] And they want to automate that.

[00:32:11] Right.

[00:32:12] And that's the way that they're going.

[00:32:13] And it's going to make things so much simpler.

[00:32:14] But a shame to say that Thelous is out there to do a lot of this work.

[00:32:19] And they've got a lot of power behind it.

[00:32:21] That's who I refer to, by the way.

[00:32:23] If someone comes to me that's above our size, we refer them to Thelous now.

[00:32:27] And we've sent over 20 companies over there.

[00:32:30] And every single one of them have reported it's been a positive experience in a way that like.

[00:32:34] So we talk about like referrals and stuff like that.

[00:32:36] There's a company that's coming.

[00:32:37] I've been kind of referring to them a little bit throughout this deal.

[00:32:40] And I think they're phenomenal.

[00:32:42] I really am a big believer in what they're doing in our industry.

[00:32:45] Yeah, I was really happy to get them on as a sponsor because I think they're doing great things.

[00:32:50] And they have a great potential to make some really positive changes in the industry.

[00:32:54] But I know you're also talking about a special promotion that you want to put out to the podcast audience.

[00:32:59] What do you want to share with us?

[00:33:01] Yeah, we're really excited to announce that we've launched what's called the Accelerator Program at In the Black.

[00:33:06] So the Accelerator Program is meant for those companies that are smaller.

[00:33:10] We understand that they're not very profitable for a medical billing company.

[00:33:14] The reason we're doing it is solely because my partner, Katie Archibald, her passion was before we started In the Black,

[00:33:21] her dream was to help people start or scale their companies to a million dollars.

[00:33:25] So we started In the Black with that in mind.

[00:33:27] And so we haven't taken new clients for a year and a half because of all the things we've talked about.

[00:33:32] And what she realized that she's really good at is that she's really good at helping people get to that million dollars.

[00:33:38] And so now listen, we are very niche.

[00:33:41] This isn't for most of the people listening.

[00:33:44] Absolutely.

[00:33:44] It's for 10 companies in total that make less than $800,000 a year.

[00:33:50] So if you're making more than $800,000, thank you for listening.

[00:33:53] If you know anyone, pass it along.

[00:33:55] But ultimately, we are only able to take...

[00:33:57] We have a base book of business that we've built over five years.

[00:33:59] We just aren't able to bring on bigger people at this point.

[00:34:02] We really have to figure some things out from a leadership perspective to guarantee the results.

[00:34:07] Like I said, we pay people money literally if we ever screw up an account.

[00:34:11] And that account, by the way, that $20,000 I mentioned, that was the only time that's happened.

[00:34:15] We've had a handful of like $1,000 to $2,000 over the years when we've made some bad hires.

[00:34:19] But I just...

[00:34:20] I'm really proud of that.

[00:34:21] We have never, ever lost a single penny of our clients' money ever.

[00:34:25] And the reason I know that is because we've paid it out of our own pockets when it's happened.

[00:34:28] It's not that it hasn't happened.

[00:34:30] It's that...

[00:34:30] And what do you think that does, Nathan, to our team when they see us paying money out of our company?

[00:34:36] It changes them.

[00:34:37] Like they're like, no way am I going to...

[00:34:38] Well, people get fired is what happens.

[00:34:40] So what happens to the team is people leave.

[00:34:43] But the idea is that we want to help 10 companies over this next year, 2025.

[00:34:47] We want to make these strategic partnerships.

[00:34:49] We want to help them over that first year.

[00:34:51] And then after that year, if they want to go to like an Othellis, great.

[00:34:54] Like we really...

[00:34:55] And then we'll bring on a couple more people to replace them.

[00:34:58] Our intention of using this accelerator program to get bigger within the market.

[00:35:02] Why?

[00:35:03] I'll tell you right now.

[00:35:04] We're at a level of profitability and success that is really good for my partner, Katie.

[00:35:08] I'm really focused on virtual rockstar, which is the virtual assistant side that's growing really well.

[00:35:13] So it's one of those things where she's happy where she is.

[00:35:16] She doesn't want to be bigger than she is.

[00:35:17] So we're just every year, we're going to have...

[00:35:19] We're always going to have 10 clients and only 10 clients.

[00:35:22] Once we have that, we're not accepting anyone else.

[00:35:24] And that's not a sales pitch.

[00:35:26] That's the truth.

[00:35:26] Once those people graduate to that million-dollar mark, then absolutely, we're going to bring in some more people.

[00:35:31] So if you are listening and this is you, get over here.

[00:35:33] Because the core team that we have, these are the best of the best human billers you'll ever face that leverage AI within their own scale.

[00:35:40] And our clients, guaranteed, are going to have the most mind-blowing experience.

[00:35:44] Like it's not even a question because it's her.

[00:35:46] And I know the other people that are the 10 employees that we have, they are each mega rockstars that I've worked with for, in most cases, for five years.

[00:35:54] And they will be the one overseeing your account, teaching you about billing, helping you scale your practice to get to that millionaire level.

[00:36:00] So if you're feeling this or if you know someone in this, please send that over.

[00:36:04] And if anyone refers, we have a very generous bonus that we would give you if you refer somebody over there.

[00:36:10] And how do they find you?

[00:36:11] So you can go to will at in the black billing dot com.

[00:36:17] That's will at in the black billing dot com.

[00:36:20] Just send me an email.

[00:36:22] Yeah, I'm interested.

[00:36:23] It's honestly, it's not as matter of it won't be a sales call.

[00:36:26] The first thing I'm going to do is send you an application.

[00:36:28] Again, this isn't for most.

[00:36:29] This is like not for 95 percent of your audience.

[00:36:31] It's a very small niche.

[00:36:32] So for those, we're going to send an application out.

[00:36:35] Don't be offended if we don't get a call right away.

[00:36:37] We've already been in the vetting process of just refining it down and then we'll get on a call where we'll teach you all about it, all the costs and everything.

[00:36:44] Now, a few years ago, you were still willing to do some billing audits.

[00:36:48] Are you still offering that?

[00:36:49] Is that a resource or?

[00:36:51] Absolutely.

[00:36:51] That's a free service we'll do all the time.

[00:36:53] I'm just not doing them anymore.

[00:36:54] Oh, OK.

[00:36:55] But your company will.

[00:36:56] You're not.

[00:36:56] Yeah, it's called a profitability.

[00:36:58] It's a profitability.

[00:36:58] It's a profitability audit.

[00:36:59] If you're like, hey, well, I just don't know.

[00:37:01] I don't care how big you are.

[00:37:02] If you're bigger than what we can take on, we'll still do a profitability audit for you because it serves people.

[00:37:07] And then we will make recommendations to other companies.

[00:37:10] And yes, I'll be very transparent.

[00:37:12] We will accept referral fees from those bigger companies so that we do make something on it.

[00:37:16] But if you come over and you're like, just we have an in-house bill or we're just not sure.

[00:37:20] I've done so many of those where I've gone.

[00:37:23] Actually, you've got a really good solution.

[00:37:24] I've said that not as much as people who need.

[00:37:27] I was going to say that's not the majority of the time.

[00:37:29] No, it's not the majority.

[00:37:30] But it's just to prove a point that like it's not just a technique.

[00:37:32] I'm legit.

[00:37:33] I don't care.

[00:37:34] I have zero desire right now to bring on billing clients who like, you know, I mean, trick them into coming.

[00:37:39] Like it's either it's a fit or it's not.

[00:37:41] And if they're doing well, I love giving that reassurance.

[00:37:43] Now they're doing fine.

[00:37:44] Maybe you could just train them on X, Y and Z.

[00:37:45] And I can give them some resources for people they can hire.

[00:37:48] But if they're just like totally like unsure and they're scared, I don't care how big the company is.

[00:37:53] My experts have worked.

[00:37:54] My team are experts who have worked in massive companies historically.

[00:37:57] We just don't want to take on large clients.

[00:38:00] So that for us, like that, you know, $10 million level and above, it's like, yeah, we can assess it, but we're not going to we're never going to want to bring that business on.

[00:38:07] Well, I think that's a huge value that I don't want people to overlook.

[00:38:10] Because how many decade plus we went just assuming that our billers were doing well and never could find someone to give us a true audit of our financials and billing and collections service.

[00:38:22] And so to just provide that, to look over someone's billing and collections reports is a huge service to find out, hey, this is where you're missing.

[00:38:31] This is where your billing collections person is missing the boat or, hey, they're doing pretty well.

[00:38:35] Just change these things.

[00:38:36] But I remember you saying back in the day, more often than not, you were finding opportunities to increase revenue up to 10% or more simply by making some recommendations.

[00:38:46] Yeah, it was it's scary.

[00:38:47] Even when people have kept their existing billers or company, it's rare that we don't find a 10% differential.

[00:38:54] And when you find it, it's gaping because you can get that money right now.

[00:38:58] It's sitting in there right now.

[00:39:00] You've earned it like it's already been earned.

[00:39:01] The work has been done.

[00:39:02] You just have to know how to get it.

[00:39:03] And that's that's so annoying for me as a previous owner.

[00:39:07] I feel like I'm constantly trying to do therapy for my younger self in those therapy days of like by helping them.

[00:39:13] Maybe I won't think about the millions that you and I lost over the years.

[00:39:17] Well, that service alone has an infinite return because they're paying nothing and they could you pay nothing and get another 10 or $20,000 by implementing a couple changes.

[00:39:27] Infinite return.

[00:39:28] And where do you find that?

[00:39:29] Right.

[00:39:29] Well, the funny thing is I used to do those audits and then I'd have to go get Katie and Katie would tell me what to say back on certain elements because I'm not a billing expert.

[00:39:35] I'm a really I'm an expert of overseeing a billing company, but because I know what metrics to measure and I know how I've learned after five years in particular and after 15 years of being in private practice, I get it.

[00:39:45] But the people who'd be doing the audits are these people who've been doing it for decades.

[00:39:48] These are people who will come in and just show you around every corner under all the rugs.

[00:39:54] Is that a penny or is that a pound that you're missing?

[00:39:57] Right.

[00:39:57] So, yeah, I'm excited that for anyone who's curious, please reach out to will at in the black billing dot com.

[00:40:03] Don't be offended if I immediately do an email intro to Heather or Shelley or any of these amazing leaders who can just totally help you.

[00:40:11] Cool.

[00:40:11] Anything else you want to share?

[00:40:12] Just that I love Nathan Shields.

[00:40:14] I love this podcast.

[00:40:15] I wanted to say if you have any sort of intelligence, you need to go to Nathan's next event, which is TBD.

[00:40:23] But his event in September, I've seen Nathan speak on stage.

[00:40:26] I know what he's doing over there with Adam Robin, the great Adam Robin.

[00:40:29] I think that's his nickname.

[00:40:30] Adam Robin, the great like Alexander, the great.

[00:40:32] But Nathan, like I just I can't wait to hear more about your upcoming event.

[00:40:38] And yeah, I love it.

[00:40:39] I'd love to have you on my show, which I'm now promoting.

[00:40:42] I'm just kidding.

[00:40:43] You can't go without promoting yours because you have the willpower podcast like you're not doing enough already.

[00:40:48] And so you're just showing us all up by doing all these things.

[00:40:50] I'm trying to be like Nathan Shields.

[00:40:52] And so, yeah, I'm excited because we'll do some collaborative stuff about your upcoming events and stuff.

[00:40:56] And I think they'll have those episodes we'll have on both channels so you can stick to this network for sure.

[00:40:59] But I'm just really grateful for you, man.

[00:41:01] I think what you're doing is phenomenal.

[00:41:02] I just want to say if you want any sort of if you really want some major benefit and value, go to Nathan's next event.

[00:41:10] That's awesome.

[00:41:10] Thank you so much for sharing.

[00:41:11] I appreciate that.

[00:41:12] Thank you, my friend.

[00:41:13] It was wonderful.

[00:41:14] Great to see you.

[00:41:16] Thanks for having us over for tea.

[00:41:18] Yeah.

[00:41:19] Thanks for having us over.

[00:41:20] It's great to be.

[00:41:20] Cool.

[00:41:21] Thanks, man.

[00:41:22] We'll talk to you later.

[00:41:22] Thanks, man.

[00:41:26] Thanks for joining us today in the Physical Therapy Owners Club, the resource for stability and freedom in your PT practice.

[00:41:33] Reach out and join the network today.

[00:41:35] Subscribe to our podcast, get links to social media, and access all of our episodes with show notes at ptoclub.com.

[00:41:43] Thanks for having us on the show.

[00:41:43] Thanks for having us on the show.

[00:41:43] And we'll be on the show.