Reimbursement Rocks

I got the call on my cell phone as I was running through O’Hare Airport between flights. I could tell by the sound of the voice on the other end that this doctor was in distress. He believed he had just figured out that his insurance CA was embezzling. He felt guilty that he hadn’t been more on top of things and angry at the same time for this horrible breach of trust. We decided that he wanted to work with me and my team to unravel this and to help him hire and train a new person. I just returned last week from conducting the onsite visit, both for analysis and training. I have to say, my heart aches for this doctor. As I was working with some of the accounts known to have had money stolen from, I worked with the new team member in talking to patients about it as they came in. As I looked into their horrified faces as we explained what happened, nearly every patient said, “How could anyone do this to my sweet, kind, loving doctor?”

The truth is, the doctor didn’t just delegate his insurance department to another; he actually abdicated it to her. When team members or patients would ask about balances or other work to be done, this evil doer would say, “Not to worry, I’m on it”. But there was no follow up and no proof that it was done. Mostly, this was because there was no system in place. But it really bothers me when I find doctors that have so much trust in their CA’s that they simply accept their word as gospel truth. It’s embarrasing I’m sure for a doctor to admit they don’t know enough about that department to manage it. Now remember, I was a finanical CA for most of my career. I wanted my doctors to trust me and they certainly could. I treated their money as if it were my own. But, in truth, it’s their money, in their office and they alone should have systems of checks and balances in place.

It’s important to have competent staff; trustworthy staff. But remember, this is your livelihood and your income. Trusting that to a third party who is not your spouse is a tall order. (And, no I don’t advocate that you fire your staff and hire your spouse…that is a whole different can of worms!) It’s my opinion that all doctors should strive to learn all they can about that department. I taught a group of about 180 at a Medicare seminar in Missouri yesterday, and it was a little annoying to me the number of CA’s in the room who were sent by their doctors, while the doctor took the day off. I know some were holding down the fort at the office, but in this case, Medicare is so important, it should not be delegated without some knowledge of the program yourself as the doctor/owner.

So, what’s a PokeyHontas? Well, as we were talking about the unfortunate situation in this office and the person who was arrested and charged with embezzelment they just cringed every time they said this former team member’s name. We tried to come up with something else we could call them. We found out that this person was held in jail over the weekend. And as sad as that seems, it’s justice for the nightmare that was poured down on this doctor and the team. We went through many names: Evil-doer; Pokey Princess; and finally came up with the perfect name: PokeyHontas…. I hope you never have to have the nightmare of a PokeyHontas in your practice. Take control of your finanical department now before it’s too late!!

And gold to me equates to “cash”. Moolah! Bread! Dough! Dinero! Bird in the hand..worth two in the bush! Cash is King!

Why, then, do you think that as a profession, we’re so willing to extend credit to complete strangers (ok, relatively complete strangers) with no collateral and wait to be paid until some distant third-party insurer decides to pay us?

After 25 years in the profession, most of it behind a desk billing and collecting insurance, I’m more convinced than ever that without balance we can’t survive. I’ve watched over these years as doctors with all the eggs in one kind of basket, like Personal Injury, or Managed Care, have seen it dwindle to the point where I get a call saying, “throw me a life preserver!”. It breaks my heart to watch it.

Even though I’m known in the profession as the “coding queen” and “reimbursement goddess” (both titles I’m honored and humbled to hold), I still believe that balance is the name of the game. In this blog, we’ll explore all the options for reimbursement, and look at the various angles and ideas which we need to explore to achieve perfect balance. Insurance can and should be a part of practice. However, building your cash profit centers, like nutrition, pillows, braces, massage, decompression, spinal pelvic stabilizers, and most importantly, wellness care, will help assure that your practice will always have a cash foundation. What if we could call the money we get from insurance “bonus checks”? Strive to meet your monthly overhead with that money collected over the counter. In this blog, we’ll look at all the ways to do that, insurance billing and collection secrets, how documentation figures into the mix, compliance tidbits, staff training and more.

Reimbursement really does rock. Just ask anyone I’ve ever worked for about the Kathy Dance. Remember that obnoxious little dance Pee-Wee Herman did on his Saturday Morning program. Well something like that! When a check I’d been fighting especially hard for made it in the door, I would do the Kathy Dance around the office, and my doctor always knew it was a win.

Stand tall comrades! And visit back here often for fun and frolic in reimbursement land.