Sponsored by Genesis Chiropractic Software
If you’ve had to work with the insurance companies, and operate in the third-party payer system, you’ve probably noticed that the relationship you have with them isn’t exactly fair.
It isn’t, and that’s by design. They’ve rigged the game to benefit themselves at your expense.
For one thing, while they could afford to pay your invoices promptly, they prefer to pay you weeks after your claim. Holding your money back like this is called float, and insurers and banks employ this technique to earn interest with your money before giving it to you.
Another thing the insurance companies do is collude with one another to fix premiums and payout rates. In most industries this is illegal, but insurers have excellent lobbyists and they’ve arranged anti-trust exceptions for themselves.
The burden of filing claims and resolving problems is squarely on the health care provided. In the event of discrepancies, the patient will be inclined to blame the provider and not the insurer, because the patient doesn’t see the paperwork nor the process. The game isn’t fair.
Indeed, the sheer complexity of coding and submitting claims seems to be designed to increase the odds of the doctor and billing staff making mistakes that the insurer can use to deny or reduce payouts. Another weapon they have is the audit. Because while it’s just you and your patients from your perspective, they can—and do—compare you with your colleagues. If you’re billing more, submitting certain codes more than others, the insurers’ software will raise red flags and target your records for closer scrutiny.
Cashing out
Given the above, it’s little wonder so many doctors want to transition to an all-cash practice that can ignore the insurers altogether. But even if you manage this, you’re still burdened by your state board to document medical necessity and code patients’ charts to at least the level required by Medicare.
An effective solution, ideally, would be one that lets you operate with the ease of an all-cash practice no matter who is paying, and one that helps you transition patients from urgent care to lifetime care. With the right systems in place, both cash and insurance are equally manageable, and compliant processes are seamless.
Remember the insurers’ secret weapon, the audit? They usually control that framework with software. They might have an adjuster who spots a suspicious claim and opens an investigation. But it’s far more likely that their AI and algorithms are flagging practices for a closer look.
Fight fire with fire
By the same token, this is one way you can start to level the playing field—with software. EHR and practice management software companies do the same things insurers do in looking at patterns of use and statistical data, but the difference is that they use this information to improve compliance and reduce friction for the end users.
What’s more, if you have a large patient base, more than one clinic, or more than one provider under your roof, you can aggregate and analyze your own data, too. The right software will never forget a claim, and will work reliably and tirelessly at less cost than manual processing.
Software can also check claims and records for completeness, spotting missing elements, flagging overdue accounts, and maintaining HIPAA compliance. And one more thing: Different insurers have different procedures, interpretations, and idiosyncrasies in how they prefer claims be submitted. It takes billing staff a long time to master these differences. Software can effortlessly transition from billing Blue Cross to Aetna to Humana, and do it correctly every time.
When it comes to reporting, you and your staff don’t have time to manually review every case you’re handling. What you want to focus your attention on are the exceptions, the cases where your attention is required. These might be patients who need to be reschedule, payments overdue, a missing EOB form, something where a physical intervention is necessary.
Another streamlining advantage you get from automated systems is that all user actions have a username and date and time stamp. You can always see who did what and when. In actual practice, doctors who automate their processes and manage them the way big corporations do see increased revenue, increased compliance, and better patient retention.
Starting your search
By now, if you are doing everything manually or your software doesn’t handle the key elements mentioned above, you may be looking to make a change. What should you be looking for in an end solution? First of all, don’t rush. Take your time and make the right decision. You only want to do this once.
Many software systems in the field are based on old code and legacy systems. Your solution should be up to date and state of the art. Cloud-based systems have the advantage of being HIPAA compliant and constantly upgraded.
And don’t forget ROI. A solid vendor will have metrics and be able to analyze your practice to estimate at which point the software will be paying for itself. Lastly, look for top-notch customer service. The software industry is rife with tales of tech support that never answers the phone and emails that go unanswered. Training for the use of your software should be included and tailored to your needs
About Genesis Chiropractic Software
Genesis Chiropractic Software was created by Brian Capra, DC, who partnered with technology experts in 2004 when he failed to find a comprehensive software solution for his practice. Since that time, Genesis has grown into a multifaceted practice support system that uses AI and algorithms to help users streamline their processes, improve patient retention, increase revenue per visit, and maintain regulatory compliance while freeing up staff and management.
Practices that use Genesis software range in size from small solo clinics to large multi-site groups. The software supports third-payers, all-cash practices, and every combination imaginable.
A key strength of Genesis Chiropractic Software is that it combines EHR, practice management, and billing software in one seamless package in which each component is used to inform and improve the functioning of the others. For example: Billing performance beats the national average by 50 percent.
Genesis is a Certified Modular EHR — Ambulatory and is ICD-10 compliant. It supports “single point management” decision making, so that instead of lengthy reports, the user sees the number of action items that must be taken, promoting relentless efficiency and focused activity. It can even handle management of patient financing and retail sales. The company aims for this to be the last piece of software you purchase for your practice.
SOAP notes and matching claims submission routinely take 15 second or less, and patient management features include scheduling and reminders. Schedule a demo today and learn how easily you can tilt the playing field in your favor against the insurers and spend more time doing what you love: providing excellent patient care.
877-601-5986 • genesischiropracticsoftware.com
