High-Performance Practice Series, Ep. 3: 4 Places Your Practice Is Quietly Losing Money (And How to Fix Each)

[00:00:02] Welcome to the Private Practice Owners Club. Your hosts and coaches, Nathan Shields scaled his practice and exited for millions, while Adam Robin went from working 60 hours a week in one clinic to scaling to multiple clinics while working less than four hours per week remotely. This podcast is meant to share with you exactly how they did it and how you can build a business that supports the lifestyle that you truly desire. And don't forget to join the Private Practice Owners Club community on Facebook, where we are obsessed with providing

[00:00:32] even more resources that help owners just like you win the game of private practice. Hey, it's Nathan. Quick heads up for all the private practice owners who are listening. If you've been listening to the podcast for a while, you know that it took me at least 10 years of grinding in my own clinics before I finally figured out how to scale and sell my

[00:00:56] four practices for seven figures and about three times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit systems and actually my role as the owner. That's exactly what we're going to be working on together with you at the High Performance Practice Conference this fall in San Antonio, Texas. From October 15th through 17th,

[00:01:22] Adam, Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor and medical practice owners who want to build clinics that are profitable, scalable and best of all, don't depend on them 24 seven. We'll dig into simple profit and KPI frameworks, real leadership and culture work and practical systems you can take home and plug in

[00:01:48] with your team. So if you're doing roughly six to seven low figures a year and you want your clinic to feel more like a real business and less like a job slash cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them too. You can get all the details and grab your seat at the link in the show notes. All right, let's get into today's episode.

[00:02:14] Hello and welcome to the Private Practice Owners Club podcast. I am your host, Nathan Shields. Got my partner, Adam Robin with me today. How are you doing, Adam? Oh, it's good as somebody can do on a, what is it, Wednesday? On a Wednesday after July 4th, after the parties are over. Good as you can do on a Wednesday for sure. Yeah, right. Gotcha, man. Well, this is, I think this is our third episode. Yeah, episode three of the High Performance Practice series, all leading up to our conference in San Antonio,

[00:02:43] October 15th through 17th, the High Performance Practice Conference. Make sure you go to the registration page, ppoclubevents.com to get details all about how to improve profits, your freedom, build out your purpose. A ton of great speakers, multiple tracks this year compared to other years. Really excited about what we're building out, but go to ppoclubevents.com to do that. Bring your leadership team, divide and conquer so they can get value in training as well.

[00:03:11] A lot of good stuff that's going on, but this series of episodes is very similar to what we've done in the past in terms of building out your playbook for your business. We thought this would be super valuable for everybody to go over different aspects of the business and review how you can make your business more profitable, efficient, high-performing, right? Gotcha. And Adam, I mean, you still have practices. I don't have practices anymore, but you're living it right now, right?

[00:03:38] Oh my God. We are living it. It is, it is, uh, listen, if you're running your practice the way you used to run it, you're, it's not going to make, it's not going to work. You know, like you're going to have to make changes. You're going to have to make the hard calls. You're going to have to find ways to be more efficient, more productive. And I think not to be too, too much of a Debbie Downer, but like I've had a many calls with practices that are closing their doors,

[00:04:05] many more so more recently than I think maybe I've ever had. I had an email yesterday from somebody who's like, how do I dissolve my LLC? Totally. Yeah. Yeah. So like it's in the, it's happening and it's good news and bad news. The good news is there are, there are opportunities for you to pivot and change. And the only way to do that

[00:04:29] is to elevate your skills and your understanding and your perspective around how to do it. And is it going to be one YouTube video or one course or one conference that's going to change? Do that? No, it's going to be the accumulation of all the things that you consume that get you there. So like get your butts to the conference, listen to the podcast, learn some new skills. If you want to keep your practice afloat, cause you're going to need it. Yeah. Cause episode number three is going to be

[00:04:52] about billing practices and provider revenue really tied to some financial stuff. Last, last episode, we talked about how to maximize and your scheduling to make sure that the providers are productive, seeing what they're supposed to see in order to generate the revenue that they need to generate. So you can break even and generate a profit and that kind of stuff. This one's a little bit more specific to a direct correlation to making the most off of those visits after the schedule has been

[00:05:22] sufficiently utilized, maximized, right? Yeah. So getting into it, I think, you know, I did a presentation at PPS last year about how to increase cashflow in your, in your company. And maybe we can use that framework just as a starting off point because the three areas or the four areas that I talked about were number one, know your numbers. Number two, deal with the front desk.

[00:05:48] Number three, managing your billing collections team. And number four, optimizing your billing via the providers and their billing practices. Okay. So we can use that framework to build off and maybe go step-by-step. Does that sound like logical to you? Sounds like a perfect idea. Okay, cool. Yeah. So when we're talking about some of the numbers that you need to know, I think everyone's going to, I shouldn't say everyone, most people are going to know their average reimbursement per visit, right?

[00:06:19] You'd think so, but yeah. What do you hear when you ask people what are their, what's their average reimbursement per visit? Are you getting ranges or you're like, ah. Yeah. I would say they either don't know it. Like, you know, it's more like, oh, I'd have to look back and see, you know, like that kind of thing, or they just don't know it, or they're assuming they know it because they looked at an AOB or two

[00:06:46] and they just kind of know an average. But when you actually calculate it with a more objective position, you'll realize like when you factor in the denial rates and the, and all the things that, and the misvisits and the non-payments and the write-offs, it's a lot lower than you might think, right? Cause you as an owner, like it's hard to look at the numbers and look at all the problems. And so we tend to inflate what we think it could be. That's all your margin. That's not really there.

[00:07:15] You know? So those are the two things either. They're, they don't know it or they're, they're not measuring it really, really cleanly. Yeah. So that's a measurement that I would expect someone to calculate on a monthly basis based on last month's revenues, but also know what the average is for the trailing six to 12 months. Yeah. Yeah. For sure. For sure. And compare last month's average reimbursement to that trailing six

[00:07:40] to 12 month average, right? Down to the penny. I remember saying, if you're giving me a range of like 88 to $95 a visit, then you don't know your average. Like you said, you might have a little bit of hope inflating that number, but it's imperative to know the number and figure it out. Right. And to go a little bit deeper. Well, I'll say this first. A lot of people know their average reimbursement per visit. What I would wonder, I would love to see the metric on this. How many people know their

[00:08:10] cost per visit? Right. Yeah. That's one that it's easier to calculate that one too, though. You would think it'd be easier to calculate. And you could probably even ask your CPA or bookkeeper just send that number to you. And that's, that shouldn't fluctuate all that much unless you're going to take on another provider, buy a big piece of equipment, have three payrolls in a month, you know, those kinds of extraneous experiences, but that number should stay relatively flat.

[00:08:38] Right. And of course, knowing the difference between your cost per visit and your average reimbursement per visit is going to show you your margin, right? That Delta. So reimbursement per visit cost per visit, but I would go deeper into the reimbursement for a visit. And part of the course that I provide has a worksheet and it asks you what's your reimbursement per visit. Now let's break down your top pick them five to eight providers, insurance providers, insurance payers.

[00:09:06] What is your average reimbursement per payer? Right. So that is really telling because you should know who your highest reimbursed payers are, who your lowest reimbursement payers are. And a lot of us, I'd like to use the example that a lot of us like to assume that say you've got the typical United healthcare, $65 per visit flat rate contract. And so you might say, if Adam or I asked you, what's your average reimbursement on United healthcare? You'd say, yeah, 65 bucks.

[00:09:36] Is it, are you taking into account the denials that United healthcare might've taken out? Are you taking into account any patient balances that weren't paid, right? Deductibles that weren't paid at the time of service and you're still fighting for maybe some cuts from United healthcare for this code or that code or wrong modifier here or there. It probably doesn't end up being $65 per visit. And you should know that. I remember one of my clients went through the course. He figured out

[00:10:04] his United healthcare payment ended up being like $58 and 35 cents instead of 65 when you consider all the denials, right? So knowing a reimbursement by provider and then comparing that again to the cost per visit helps you really make some more educated business decisions, objective business decisions, right? You're looking at that pretty tightly right now. You're looking at all these

[00:10:29] financial numbers, right? Yeah. I mean, it's a, just when you think you got it figured out, Nathan, all of a sudden you don't, you know? So I will say that the numbers are a blessing and a curse, you know, because a lot of, like you said, the decisions that you need to make are in there.

[00:10:52] And unfortunately, none of them are easy. And, but if we avoid those hard decisions, then it's ultimately the thing that leads to our, so the only other decision to make out at that point is to slow, slowly go out of business, right? So it's like just by being willing to confront the number and to force yourself to make a decision, even if it's hard. And sometimes the decisions are

[00:11:18] really hard, man, like dropping a low paying insurance or firing, that's laying somebody off. Like we don't want to do that, but like, sometimes those are the things that we're forced to confront. I think that if you'd be willing to confront them, you'll find that there's always opportunities to improve it, but you got to, but you actually got to measure it. Just to provide some real world experience here. I've yet to come across someone who's dropped a

[00:11:42] low paying insurance that has regretted it. What they found is they found ways to fill the schedule with other high paying insurances and improve their net revenue per visit. And so those are hard and almost everyone I know that that has done that it's not been an easy decision to make. No, it's very hard. But after doing so and going through the process, and if you email me, Nathan at ppoclub.com,

[00:12:12] I can give you an SOP on how to drop a low paying insurance. Maybe give you some guidance so you're not doing it from scratch. I'd be happy to share that with you. But there is a way to do it properly and well so that you can offset any possibility or concern that you might have that you're going to get some kind of kickback from physicians or the surrounding community. It's possible and people have done it

[00:12:37] and they've done it in a positive light and it's worked out well. So that is a hard decision, but it is possible. Right. Yeah. I'll say you'll be really surprised at what opportunities become observable when you have no other choice. You know what I mean? Like when you, when you force yourself to have no choice, you know, you'll, you'll find an option, you'll find a solution. And sometimes, like you said, it's, it's the

[00:13:01] dropping the low payer. The other thing to consider as we're talking about metrics to follow here in terms of billing practices and revenue and whatnot is we talked about it last episode, so I won't delve into it too much, but we talked about knowing your break even and knowing how many, how many dollars you need to generate each week, not you need to crack every month, how many visits you need to see

[00:13:25] every week in order to cover expenses plus 10%. So that's kind of built into this as well. So you should know those things. If we're going to talk about knowing your metrics from a high level perspective, you need to know your break even numbers, regardless of industry. I find myself sharing that with people outside of the PT space as well. So moving on to the second section and talking about the front desk, this is where I bring up front desk first. And the reason I do so in my

[00:13:54] presentation is bringing up the front desk as a place to work in the, in your operations and find or find an increase in cashflow is because it's the easiest way to generate the most cashflow, making the most difference. If your front desk isn't working so well and not collecting at the time of service and not scheduling efficiently and maximally making changes there will show up

[00:14:20] in your bank account balance the fastest, right? You've had a really good handle on the front desk for a number of years. Now you've got a solid playbook. Would you say that having a really well oiled front desk eased a lot of concerns and frankly led to any pop in revenue? Yeah, maybe so. Well, I think if you just understand how the practice works, right? And listen, I'm still

[00:14:50] somebody that's learning more and more about it, but the front desk really is like everything, everything starts there. So you mentioned like collecting over the counter payments, which is 20, 25%, maybe even 30% of your revenue sometimes. Especially if you consider like January and February, it becomes a large portion of your revenue. Yeah. Right. So like huge revenue driver there, like making sure you're collecting over the counter

[00:15:18] well, and you're tightening that up huge. Number two, schedule efficiency, right? So like they are the, they are the gatekeeper to your productivity levels with your providers and ensuring that you're understanding what those break, we talked about that last episode, right? Like what that break even is and what that schedule actually needs to look like in order to ensure or to fail proof you're hitting your break even. That's number two. Number three is one we don't talk about too much, which is

[00:15:45] ensuring that you're, it might not be your main front desk person, but somebody in that admin team is verifying the insurances accurately with precision and entering patient data into the EMR with precision and accuracy and ensuring that that authorization process is dialed in and being tracked. All of that impacts the back, the back office, right? The billing team, right? And so that, that, that, those are the things that minimize those denial rates and ensure that that AR stays clean. So

[00:16:15] there's a lot of money that's all built right there. And it's like, if you don't have that, right, a lot of times I see practices that are like, Oh, my billing, my biller is not doing a good job. Let me go get onto my biller maybe, but maybe you're not focused on the right thing. Maybe it's more on the front end, right? That where you can clean that up. And so just all of that to say, like cleaning up those systems and having those metrics, the right person

[00:16:41] and the right system and the right team in place to keep that tight is going to really, really help you. It's going to make it such that you can be less optimal on the coding and the billing side and still be okay. Like you can absorb error, right? I love you. I love that you brought up those three things. The first thing, or I'm sorry, the second thing regarding scheduling optimization, we talked about that last week and their responsibility for that. But the first one you talked about over

[00:17:08] the counter collections, man, that has to be dialed in totally that money. If you are leaving money on the table by letting people walk out the door, having not paid their responsibility at the time of service studies show that you're losing 50 cents on every dollar on average, right? So if they have a hundred dollar deductible, they need to pay for this visit and they walk out the door. You can expect

[00:17:36] to collect 50 bucks and you do that a number of times every week, you're going to be losing thousands of dollars a week. I'm pretty confident. I can say that if you're not collecting at the time of service at a 95 to a hundred percent clip, and hopefully you're doing that with credit cards on file for every patient, then you making that kind of change and getting the overcount of the collection rate up to that number as close to a hundred percent as possible will increase your

[00:18:02] revenues, approximately 10%. Pretty confident. I could say that because like you said, those over the counter numbers make up 20 plus percent of the overall revenues collected. So huge jump there. And you also brought up something that I haven't talked about enough. And I need to add this to my presentation. It was like, Hey, are they putting in, are they getting the authorizations that they need in a timely manner? Are they getting the proper verifications and inputting that into the system to make

[00:18:31] it easier for billers to do their job properly? Like there's plenty of visits out there that are going unpaid because we have expired authorization or we weren't tracking the number of authorization visits. Well, and now they came in for their seventh visit on a six visit off. Yeah. Like that's free money going out the door or that expired plan of care that the doctor hasn't signed yet.

[00:18:56] I mean, you want to be covered. So there are efficiencies that need to be maintained all through that front desk or office management space that lead to really big leaks in your bucket and they can be operationally fixed should be a huge focus of anyone that's having concerns regarding the efficiency and production of their company. Yeah. I think that if I can speak to that just a little bit, not to harp too much

[00:19:24] on it, but the front desk is confusing or for a growing practice. If you've never been a student of this and you're trying to juggle a growing team and cashflow crunches, and you're trying to manage a caseload, it's heavy. It's a lot. It's a lot. Right. And so I think I'm kind of talking through this real time, but I believe that the first step is to just to understand how it works. Like you mentioned,

[00:19:53] like you have to understand what matters and what outcome you need at each of those roles, right? The front desk schedule and over the counter, right? Verifications accurate on time, authorizations reports running every day, accurate on time. Right. And if you can just imagine it from a systems perspective, right? Then you can start saying, okay, I need this type of person at the

[00:20:19] front desk. I need this type of person on the, on the outside. I need this type of person on the, on the verification side, people who are good at these types of skillsets. Right. And so I see a lot of people who either don't understand the system, right. And don't understand what good looks like from objectively, or they don't understand how to get their team to do what they want them to do.

[00:20:44] Right. They're dealing with, Oh, this is the way we've always done it. Right. Or I'm already wearing out like leadership, maybe some cultural issues for sure. Right. And so if that's you, if you have a weakness in your, in your, in your systems component, you got to learn the systems, you got to learn the systems. You got to educate. This is, we've got to build the systems. So you got to go into your office with a pen and become a student of building the system, which is like terrible,

[00:21:10] but that's what you got to do. You have a people component issue. The only options you have is to elevate your leadership skills, learn how to enroll people into your vision and be willing to let them go if they don't want to follow you. Right. Right. And so if that's you, hopefully that lands for somebody who's listening. If you're trying to diagnose how to fix your issue, it's probably you. And one of those two components need to be addressed or both. And you know, that's where the,

[00:21:37] the outcomes live, right? Yeah. It's either systems or people, either systems or people. Exactly. Will and Michelle in our clinics used to always say we need to train them up or train them out. Yeah. Train them up, give them all the resources they need, give them the training they need. If they're unwilling to follow them, follow those processes, then train them on what it looks like to work somewhere else. Yeah. Yeah. It's hard, but you can do it. All right. So the third part

[00:22:05] is managing your billing collections team. And this is a, I say it all the time. It's a weak spot for owners because we don't know how to, we typically don't know how to manage the billing collections team. We want to offload that to somebody like just send out the bills, collect the money. That's simple and easy. We'll just hand that off to you. And hopefully my bank account looks good at the end of the month. Right. And that's where a lot of money can get lost. If you're not staying on top of

[00:22:33] it and holding your billing collections team accountable. And so there's a few metrics that we track and you can add to these, I'll just highlight some of the main ones. And then you can share what you're looking at when you're talking to your billers, but we're going to look at, okay, what was collected, but then comparing that what to what you expected to be collected. And this is where your average reimbursement rate comes into play. So if we're looking at,

[00:22:58] what are we in July, you're looking at June numbers. So you would take May visits times that average reimbursement rate and say, this is what we should have collected in June. Right. That there are some variables in there. Right. But it usually falls within about five to 10% of that projection. It should be pretty tight. So you can say, okay, you were supposed to collect $80,000

[00:23:22] and you collected 72. You're 10% off. Tell me what's missing here. Was, is there a hiccup in the billing cycle? Was there an insurance payment that didn't come through that you're expecting where there are excessive denials? There's a lot downstream from that that you can start looking into, but comparing that actual versus projected is a top line number that's that you can build off of and start studying. Second one being denial rate. We want to see that first pass denial rate to be less than,

[00:23:52] 10%, ideally less than 5% for a really good biller. Right. Does that sound about right? I think it's going to depend on like how many insurances you're in network with, what part of the country you're in. There's going to be some variables, but you know, like you, you want to be, I like to see under 4%. That's like super good, but like, yeah, under five is still good too. I think the point is just have a number, have a benchmark and keep it there. You know? Yeah. The beauty of having the meetings with your billing collections team is

[00:24:17] unfortunately, I don't think a lot of owners are having meetings with their billing teams. They're just collecting, they're getting the reports maybe via email with some bullet points, and maybe there's some weekly interactions here and there, but no, having a standard meeting, we sit down and bullet point by bullet point, we go through these reports, right? What was collected, what was collected versus projected? What was the denial rate? And all of these have subsections as to

[00:24:46] why the number is what it is. And I'm expecting them to report to me, like, this is, you are my vendor. You are my employee. This is your time to report to me how well you are performing, right? And establishing that relationship. I think that perspective can get out of whack for some owners, some owners, I think that they are at the mercy of the billing company and they don't, because they don't know what to do. They don't know how to hold them accountable. So like, well, just tell me what to do and we'll do it. And the billing collections team can just

[00:25:15] say whatever they want, right? But holding them to a standard and then holding to the agenda and those metrics, starting with, like we mentioned, those two, a third one that I think is standard is looking at the AR aging report, accounts receivable aging report, and expecting that, let's just say we need 80% of the accounts receivable to be sitting in the zero to 60 day category.

[00:25:39] Yeah. I mean, if you want to get detailed, I like to see 80% in zero to 60, 5% in 60 to 90, 5% in 90 to 120 and 10% 120 and above. But you could even shrink that down and just say, we want 80% to be in the zero to 60 day range. And I'll take motor vehicle accidents or liens or no fault, whatever you guys call them across the country. I'll take that out of the accounts receivable

[00:26:07] because we know that's going to take 18 to 24 months or longer. We'll take those, that AR out of it and then look at the rest of it. So if you would look off those three numbers, I think you're doing pretty well in terms of managing your billing collections team. Is there anything I'm missing? I think, I don't think there's anything you're missing, but I've had the opportunity to have to learn this stuff even more this year. So like, so I've got all kinds of stuff I can teach right now. I don't think that's an opportunity that most people have.

[00:26:39] So I think everything's driven by the denial rate, right? It's like, well, there's two numbers that are going to be three numbers that are going to be driving the performance. Number one, denial rate, right? How, and that's going to really be driven by three main things. Number one, accurate verifications and accurate patient data at the front desk. Number two, accurate authorizations being submitted on time and nothing lapsing. And then number three is making sure that

[00:27:07] you are scrubbing the codes that don't belong inside the EMR for that insurance, right? So recognizing which codes are not being, are not covered and scrubbing them in the EMR so they don't go out on the claim. Right. That's really the three things. If you get those three things, perfect, you'll have 0% denials unless the insurance just wants to play screwball with you. Right. So if you have a denial rate issue, it's one of those three things. It's not, you have bad insurance is you have bad systems on the front end. So fix that and you'll fix your

[00:27:36] denial rate. The second thing is going to be, are your, is your billing team submitting, actually submitting the claims on time, right? Like time to submission, right? So I want to see like 10, 24 hours, submit, submit, like out the door. If you're waiting two weeks down the road to bill, that's just going to pile up into your AR, that kind of thing. Right. And then the third thing is going to be your therapist not completing their documentation on time. Right. I might not necessarily

[00:28:04] mess with your denial, but that's going to help. That's going to drive your AR, right? Right. So if you clean those things up, you should have low denials, clean AR, right? For the most part. And so I think it's good to know those three metrics, but I think it's going to be important for you to understand at least from a high level, which, what are the things that actually drive performance on

[00:28:28] those metrics? Even if you're outsourcing, how do you lead that team to actually execute on those things? Well, right. And so I just wanted to kind of like paint that picture for everyone so that they can see low denial rates. Right. Because here's the thing. If your denials are high, if you have 10, 15, 12% denial rate, that's going to all bleed into the admin overload of your front of your billing department. Totally. They're going to be scrambling. So the resubmission time is going to be lagged.

[00:28:58] That's going to be, and then like, it's just like your patient balances. The chances of you getting paid on every time you have to resubmit, your chances are going down and down. You don't have to timely filing issues. Right. And so you got to clean up the front end in order to hold your billing department accountable. And then as long as you have a really good revenue per visit metric, you should be able to project well and understand how to keep the, all those things in check.

[00:29:22] I love the detail that you shared because knowing this much detail about your metrics really gives you a clear idea of what's coming in the future. You can project well, right? Project well. And you can diagnose well, right? Diagnose well. So if you go to your biller meeting and the bill is like, Hey Adam, I got bad news. We only collected

[00:29:46] 90% of what we projected. Like what was our denial rate? I know exactly what question asked. What was the denial rate? Nour rate last month was 12%. Okay. I want to see verification logs, authorization logs. I want to see the things like show me, right? You got to lead it. You know what I mean? So like you, if you got to be just good at business, you got to be good at that practice, right? Or you have to have a billing department who can teach you those things.

[00:30:14] Hey, it's Nathan quick heads up for all the private practice owners who are listening. If you've been listening to the podcast for a while, you know, that it took me at least 10 years of grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures and about three times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit systems and actually my role as the owner.

[00:30:43] That's exactly what we're going to be working on together with you at the high performance practice conference this fall in San Antonio, Texas from October 15th through 17th, Adam Robin and I are hosting a three day hands-on event for PT, OT, speech, mental health, PEDS, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend

[00:31:09] on them 24 seven. We'll dig into simple profit and KPI frameworks, real leadership and culture work and practical systems you can take home and plug in with your team. So if you're doing roughly six to seven low figures a year, and you want your clinic to feel more like a real business and less like a job slash cage, I'd love to see you're there. Frankly, I'd love to see you bring your leadership

[00:31:34] teams as well, because we will have breakout sessions for them too. You can get all the details and grab your seat at the link in the show notes. All right, let's get into today's episode. Well, and I was going to say, if you know those numbers, then you can train them on that. And then they come to you with our denial rate was high because X, Y, Z before you even ask the question,

[00:32:00] that's the kind of relationship I'm expecting from my billing collections team is yeah, this month we're down in revenue because of the denial rate. And our denial rate is high because of this. And this is what we're going to do about it. I mean, when you can get your billing collections team to that level, like, Hey, we saw the problem before this meeting, we've been dealing with it before then. And this is how we're dealing with it. And this is what we're expecting to do about it. And this,

[00:32:26] and if that doesn't work, here's our plan B, right? That's what I want to know. Then that's what you need to know, right? Because you shouldn't be the solution to all those. You should be over time, either they come well-equipped and expert enough to give you that information, or they've worked with you enough that they know they can foresee what questions you're going to give them. And you've led them to the point where when you come to this meeting, it's not enough to tell me that the denial rate was

[00:32:55] high and then be crickets. That's not okay. You're going to tell me why it's high and what you're doing about it. So we can talk about that, right? Because yeah, you shouldn't be the one finding this out during the course of the meeting. Totally. So this is a great topic. And this is like, if you understand this stuff, like bake this into the contract that you sign

[00:33:22] at the beginning of the billing engagement, right? So it's like, this is how our meetings are going to run. These are the metrics that I'm going to run. This is what I'm going to expect. This is the week, like preload all of that into the agreement with your billing company so that you can hold them accountable to that, right? You know, so many times, and I made the mistake. We just kind of enter into this relationship. We hope they're going to do the best. And next thing you know, we don't read the fine print and we get in trouble. Right. I think it all comes down to empowering the owner

[00:33:52] to know their business. Well, that is really what's going to drive the high performance practice. You've got to know it. If they know their business, if they know your business better than you do, that's the problem. Yeah. You brought up documentation time. You have an AI scribe now. Is there any reason why providers shouldn't have their documentation down in a timely manner? Is there any excuse

[00:34:15] that's acceptable at this point? Apparently there is. Yeah. We have AI scribe. I'm not going to sit here and say that it's easy to be a therapist. It's hard. It's hard work. It's a, it's a labor of love. And that goes for you as an owner that goes for your team. And the last thing we want to do is

[00:34:37] just like beat our team up with rules, but I think you can support your team well and care for them and also have some expectations. And they're like, Hey man, I love you. Part of the job, it's going to be part of the job that this documentation is done by Friday or like just, or we're going to have a problem. And so I've been pretty vocal about the cultural issues that I've had

[00:35:01] in my practice over the last six to 12 months. And I would say 90% of it is tolerating behavior that we shouldn't have, you know? And so going into that leadership component, like you are going to get what you tolerate and there's never going to be enough time. There's never going to be enough money. There's never going to be a convenient circumstance. You're going to have to decide

[00:35:26] to eat the frog, have the hard conversation and fire if needed. Hopefully you don't, but like you got to hold, you got to hold that line. Right. So, you know, I'd say no, elevate your leadership skills and enroll your team. I got it. Last part in terms of billing practices and increasing provider revenue in general, the fourth section I'd have you look at is training your providers to bill optimally for the services that they provide. A lot of providers come out of

[00:35:56] school. They don't know the difference between AMA and Medicare billing. You might not know which contracts have AMA versus Medicare billing requirements, knowing the difference, training them on how to do it appropriately, knowing which CPT codes reimbursed better than others and how to ethically justify the usage of those codes, depending on the purpose of the therapy that's provided.

[00:36:25] So that you and I both know that we could have a patient do some body weight squats. And depending on how we document that, you can build it three to four different ways, right? And training your team on how to best document for that and also how to generate the most value for the services they provide. Right. In that kind of training, there are trainings online, Goenda Medbridge. I'm sure other

[00:36:55] people have written lengthy to a lengthy extent, how to build separately for AMA and Medicare, but that's the kind of training that have you built that into your onboarding processes or maybe some annual trainings or quarterly trainings that you do with your team. Yeah, got to. And I would say never assume. So one of the mistakes that I made is with this situation

[00:37:23] is like putting myself in a box and thinking there's only one way you can do it when what you can write. And so it's kind of like there have been times even in my practice and even more recently where I felt like, oh, we've scheduled this way. We build this way. This is the way we have to do it. And I never really like explored other possibilities enough. And it actually ended up costing me a lot of money. And so if you would just like, don't do that and get on the phone with other practice

[00:37:51] owners that are kind of maybe outside of your sphere of competition and just be like, how do you guys handle this? How do you guys handle that? What do you guys do for that schedule? How does that work? How does your team land for that? And just start asking, be more curious. You'll probably find some unique perspectives on how people are being creative with how they both schedule and create and deliver in a different way, right? That can allow you to create more of an angle on the way

[00:38:16] that you bill. And so I would just encourage you guys to do that as well as like looking at the wind of stuff online and like becoming another, another thing, like becoming a student of the problem, right? Becoming a student and learning that you might be leaving some money on the table, right? Yeah. Two things to share is I did a podcast interview with Lance Gross leading up to last year's conference, and he's got probably close to 20 clinics now admitted that he spent about

[00:38:42] 40 hours, this particular topic, how to bill properly, ethically, optimally for PT services and spent about 40 hours putting a training together for all of his providers across the 20 clinics. He said he spent that time and then rolled it out, did the trainings, trained the clinic directors, they trained the providers, held them accountable. And over the course of the year, that made a $1.4

[00:39:11] million difference in their revenue based off similar visit numbers just by doing that. So I would think that'd be a great return on investment, 40 hours generating $1.4 million, right? That's pretty good. Hey, take my wife to Disney world, man. We'll stay on site. We'll go, we'll do the whole thing. Is that how much it costs now at Disney world? I think it's $1.4 million.

[00:39:38] Totally, man. And the second thing to your point is I met with an owner of a company that has over 110 clinics right now through the West and Midwest. And it's been a mix. Like some clinics do the 40 minute visits. Some clinics do the 30 and 60 minute visits. And like, even there, like whatever works for their situation and their payer mix. And there's like, so to your point,

[00:40:06] there's not one certain way that has to be done this way. What is certain is like, this is how you maximally optimize your care so that you can get the greatest reimbursement ethically. Yeah. There are some pretty certain ways on how to do that, but when it comes down to how many visits you schedule each and the eval timeframes and the what you name it, there's some flexibility there. And for some

[00:40:31] clinics that one way works better than another. Yeah, I agree. Yeah. So I said Coenda, Medbridge, I think BCMS has some trainings that you can look at in order for you to learn the difference between different billing procedures and the different CPT codes and how to justify for those. You as the owner need to be the expert. What I would recommend, and I don't know, tell me what you think about this, but I wouldn't recommend the owner be the one doing the training. I would recommend

[00:41:00] the third party or a peer within the organization be doing that training. Yeah. There could be some thoughts amongst the team as to, well, if you're just doing, if you're doing this training and telling us to build better, to make more money, then obviously it's just a line your pockets. I mean, there could be that default. This is, this is a really important topic. So I'm going to say, we're not recommending, we're not recommending you to roll this out. We're telling you don't roll this

[00:41:27] out as the owner. We're telling you, we're not giving you an option. Do not roll this out as the owner, right? I would recommend building some really close relationships with some really key people of influence in your company and aligning incentives through the form of some type of profit sharing or bonus compensation that makes sense. And that keep everyone that there's a shared

[00:41:56] interest and have them roll that out, but get them bought in and have them roll that out. It's a much better play for your culture and it'll be a lot easier to lift for you too. Yeah, for sure. Whether it's some video trainings backed up with some worksheets that you might create, having someone else be the in-person moderator doing the training themselves, it will make things go much smoother. That's for sure. Agreed. Very cool. Well,

[00:42:25] we covered the four sections. Is there anything you want to add for this? No, I think this is, I don't know what our next few episodes are about, but I think being, learning how to, we talked a little bit about renegotiating contracts and going out of network. Next time. That is actually our next one. Oh, perfect. Well, I'm going to leave it as a teaser then. Like, cause I'm learning about that stuff too. Like tune in next week. We'll, we'll, we'll talk through that.

[00:42:49] Yeah. I would say as we're looking through this, especially to that fourth point, tying all this increase in revenue, accountability, billing practices, best thing I can say is to tie it back to the values. We were doing all these things because when we do these things and we do these things well, we can live out our values and our purpose to a greater extent.

[00:43:14] Yeah. That's awesome. Right. So we might, there can be an obvious default or a natural default to this is all about making money, but if you're not able to connect what you're doing and why you're doing it to, this is how we fulfill our purpose better. This is how we have a greater impact in the community. This is in line with X, Y, Z values. Then it's going to feel like a money

[00:43:39] grab both for you and for the team. And that's the lot that's not good for culture. So I would make sure as you're doing these presentations, as you're going through it yourself, as you're talking to other team members, that you are highlighting the values that you're living by doing these things properly. It'll carry forward into a better culture all around for everybody. So I'll just share that last piece. So again, this is all leading up to our conference in October, October 15th

[00:44:07] in San Antonio, go to PPOClubevents.com to be part of the high performance practice conference, multiple speakers, multiple discounts for spouses and team members. We would love to see you guys there. So check out the webpage and then we'll talk to you next week about contract negotiations and pair relationships and get into that a little bit. So look forward to the next episode. Talk to you

[00:44:32] later, man. Bye to brother. Thanks for listening to the private practice owners club. If you enjoyed this episode, would you mind doing us a huge favor and leaving a review? This helps us get the podcast out to more clinic owners to help them create greater freedom and profits so they can own their future and visit our website, PPOClub.com to find more resources and connect with us. Thank you.