Do you ever feel like a hamster on a wheel, constantly battling insurance challenges as an in-network provider? Are delayed revenue, reduced liquidity, and increased debt leaving your practice strained and overwhelmed? You're not alone. This episode is a beacon of hope, promising to equip you with the tools and strategies you need to conquer these common hurdles. We expose the top seven insurance challenges that have been sabotaging your performance and arm you with efficient billing and coding practices, accurate documentation, and tactics for a timely follow-up on outstanding claims.
Fear not, we don't stop at identifying the problems. We dive headfirst into solutions to financial and billing challenges that often come as part and parcel of insurance reimbursement delays. By highlighting the importance of financial preparedness, diversifying revenue streams, and negotiating contracts with payers, we open doors to a more stable, efficient, and prosperous practice. The complexities of billing and coding are untangled as we urge you to learn and implement necessary skills - all for the betterment of your practice.
Navigating the world of insurance can be a daunting task. That's why we dedicate this episode to unmasking the considerations you should make when selecting an insurance provider, keeping your business needs and goals at the heart of it all. We guide you on how to analyze and negotiate reimbursement rates, engage in fruitful negotiations, and diversify revenue sources. But the journey doesn't end there. We also shed light on barriers in taking insurance, such as client confusion and frustration, and how to navigate these emotionally taxing obstacles. With a focus on proactive education, transparent communication, and clear expectations, we are here to empower you and your clients. Together, we can ensure everyone is aware of their role in the insurance process, fostering a smoother, more efficient healthcare journey for all.
Do you ever feel like a hamster on a wheel, constantly battling insurance challenges as an in-network provider? Are delayed revenue, reduced liquidity, and increased debt leaving your practice strained and overwhelmed? You're not alone. This episode is a beacon of hope, promising to equip you with the tools and strategies you need to conquer these common hurdles. We expose the top seven insurance challenges that have been sabotaging your performance and arm you with efficient billing and coding practices, accurate documentation, and tactics for a timely follow-up on outstanding claims.
Fear not, we don't stop at identifying the problems. We dive headfirst into solutions to financial and billing challenges that often come as part and parcel of insurance reimbursement delays. By highlighting the importance of financial preparedness, diversifying revenue streams, and negotiating contracts with payers, we open doors to a more stable, efficient, and prosperous practice. The complexities of billing and coding are untangled as we urge you to learn and implement necessary skills - all for the betterment of your practice.
Navigating the world of insurance can be a daunting task. That's why we dedicate this episode to unmasking the considerations you should make when selecting an insurance provider, keeping your business needs and goals at the heart of it all. We guide you on how to analyze and negotiate reimbursement rates, engage in fruitful negotiations, and diversify revenue sources. But the journey doesn't end there. We also shed light on barriers in taking insurance, such as client confusion and frustration, and how to navigate these emotionally taxing obstacles. With a focus on proactive education, transparent communication, and clear expectations, we are here to empower you and your clients. Together, we can ensure everyone is aware of their role in the insurance process, fostering a smoother, more efficient healthcare journey for all.
the top seven common insurance challenges that in-network providers face. Let's get into it. So insurance based practices can face specific challenges due to the complexities of dealing with insurance companies, regulations, patient needs, all of the above, and here are the most common challenges and ways to resolve them. I'm so excited to get into this because, well, insurance, although it's a love hate relationship, I also love being able to provide accessible care. It's deeply aligned with my values and I want to encourage folks to consider it. And so, while we're talking about the top seven common insurance challenges and we are talking talking about the challenges that we face, it's helpful to understand what might be the biggest things so that you're going to face. So you can then think about well, is that okay with me? Can I handle that? Do I want to conquer that challenge Right? So knowledge is power. It's super helpful to have that education, and so I want to provide that for you. And then, on top of it, after we talk about those challenges, I'm going to talk about how we can overcome those and how there's solutions to that. Okay, a big big thing here, too, is, if you are considering taking insurance, don't do, don't go about that alone. It's educate yourself, get a mentor, learn, listen to podcasts like this right, because you can avoid a lot of distress and really reduce your amount of stress, and I wish I would have done this a lot sooner, specifically around insurance and got got mentorship right, but, yeah, so you can conquer it. So this is going to be a helpful starting place if you are thinking about insurance but you're not sure, and you've heard horror stories. I hope that you take a lot away today.
Speaker 1:Alright, without further ado, let's get into the first of the seven most common insurance challenges that in network providers face. Number one insurance reimbursement delays. Alright, so in the healthcare industry, when you're dealing with insurance reimbursement delays, it can be very stressful. Providers often have to wait for extended periods of time before they receive payments, and by extended I mean sometimes it is very extended, like months, and sometimes it's a month. But you do have a delay because you have to submit the claim to insurance, wait on it for to be either denied or approved, right, and then move forward with either charging the client or getting the payment from the insurance company. Okay so, but either way there is a delay, whereas if you're self pay and cash pay only, you receive that whenever you choose whether it's day of the service, day after day, before the service, and you know you're going to be provided, and when you're going to be. You know you know when you're going to be provided with that, with that payment. Okay, so these delays can impact the financial health of healthcare practices, potentially leading to significant cash flow issues. So how this can impact you through cash flow issues, I'm going to explain.
Speaker 1:Cash flow issues in healthcare practice can have really like a cascading effect on various aspects of your business. So when insurance reimbursements are delayed, it can result in delayed revenue, reduced liquidity, increased debt and strain on your operations. Let's get into that a little bit more Before we get into the resolution. Remember there are resolutions for this. I don't want to scare you too much, just want to present you with the realities. So what can impact your cash cash flow issues, or how can it impact your cash flow issues?
Speaker 1:Well, delayed revenue, as mentioned. So it takes longer to receive the payment from insurance providers and this can delay and make it challenging to cover operating expenses, including staff salaries, rent supplies, whatever it might be. It also reduces the liquidity. So delayed reimbursements can reduce the practices cash reserves, making it difficult to invest in, maybe some necessary things that you need to invest in, like technology or supervision, or expansion and growth. Additionally, increased debt can happen from these cash flow issues because, to cover some of these financial obligations or business obligations you have to, you might have to resort to adding additional debt to your business, which can lead to increased interest payments, a lot of stress and really negatively impact your practice's financial stability. And, lastly, it puts a strain on your operations when you have cash flow issues. Delayed reimbursements disrupt the efficient operation of the practice, potentially affecting the quality of patient care, of staff morale, of your morale, of the way you want to do things right, increased stress a lot.
Speaker 1:So, yes, it can cause significant issues and one of the biggest challenges is dealing with these insurance reimbursement delays, but there are quite a few resolutions that you can put into place and be aware of, so that this impacts you very little. So, to address the challenge of these delays and prevent potential cash flow issues, you can provide or, I'm sorry, you can implement the following strategies we're going to go over, which are efficient billing and coding practices, accurate documentation, timely follow up on outstanding claims, financial preparedness, diversifying your revenue streams and negotiating contracts with payers. So look, I just listed six and I only listed with the issues and the challenges for four issues that you can experience. So if you wanted to compare those two, look at all these resolutions you could do and to avoid that strain and that impact, alright. So number one implementing efficient billing and coding practices. You want to ensure that your billing and your coding are accurate and they're up to date and you have good, good systems in place with billing and you're coding correctly. So this is all about your billing processes and your billing training, which we'll do other episodes on on how to bill and considering doing in house billing. But that would be having efficient billing. So, whether that is someone externally doing your billing or if you're doing your billing, you want that to be timely, you want that to be organized, you want that to be accurate, you want to reduce mistakes, you want to have systems in systems in place to decrease energy and time spent on billing. You want to regularly train and educate staff or your person or yourself on doing those, those billing and knowing those billing requirements, and you want to have an EHR and electronic health record that is going to help you facilitate that coding and billing accurately. Okay. So number one for that resolution is to avoid the delays and payments. You have to know what you're doing with billing to prevent problems that can go wrong with doing billing and coding inaccurately. Okay so a good biller externally and knowing how that's going and not being out of the dark with that, but also being, if you're doing your own billing, doing a good job, being educated, having systems being organized, is going to be key, key, key, key. I would say that's number one for how you resolve this problem. All right.
Speaker 1:Next one Timely following up on outstanding outstanding claims. So when you do bill and you have an outstanding standing claim that might have been denied or rejected, you want to follow up that up on that as quickly as possible, because it always it already takes a while to get your claim back from insurance. So you want to get that outstanding claim or get that denied claim after those 30 days it processed 15 to 30 days, whatever it might be, some take longer and right away you want to resolve and follow up on that claim that was denied so that you can resubmit it quickly. So you're it's not in just sitting there without being reissued and resubmitted to then get that reimbursement. Okay, so that's going to really help. So how you do that is you make sure you have good policies in place, good systems in place, whether it's an external bill or you. You want to be following up on those daily, if not every other day, so those are not waiting. Okay, so you can kind of put those timely follow up on outstanding claims. You can put that under efficient billing, I guess, but we I just created that as a separate point here.
Speaker 1:Okay, the next thing you could do to resolve this issue would be being financially prepared for cashflow issues, for untimely reimbursement from insurance companies. Financial preparedness that's going to really help you and if you haven't had a problem like this, you want to anticipate and having a problem like this, because odds are you're going to encounter that problem where something happens with insurance, where they keep they start denying your claims, something changes, there's an issue and you're needing to pull from cash reserves and you want to prevent going into debt or taking out a loan or something like that. You want to be prepared. So you want to have excess cash. You, you want to have excess cash reserves or a line of credit or something to cover all those operational expenses and you want to know what your operational expenses are. What does it take to operate your business day to day and have those cash reserves just in case you need to pull pull from it during those reimbursement delays?
Speaker 1:Okay, next, one another resolve that you can do is diversify your revenue streams. Now, I have personally not done this, but I feel like I do the other things well where I, where I'm not worried about it, but something that can help you. If you're, if you're wanting that consistent income and just to like have that cashflow there, you can diversify your revenue streams in your practice. So, considering additional services that that your practice can provide, that it can create a stable, steady cashflow Okay, in a different way, in a diversified way. And lastly, you can negotiate contracts with payers. So when, when you get a contract with an insurance, you can negotiate that, and you can negotiate it when you, when you sign it and also after. It's easier to do before you sign, but you can negotiate more favorable contracts with those insurance companies that help to reduce the delays and ensure more predictable reimbursement timelines, okay. So by implementing all those six strategies, you can really mitigate the impact of the insurance reimbursement delays.
Speaker 1:I've had problems with delays that I have to pull from my my reserves consistently for a while while I'm figuring out what's going on. But really by having, by being prepared, knowing my numbers, understanding what's happening with billing, constantly training myself on billing and understanding how we can get better reimbursement, and for our clients and for ourselves, having very timely follow up and being on top of things being organized, you can do it. You can do it, trust me. If I can do it, you can do it. So don't get too discouraged with that first one. There's a lot of things you can do. You just want to be prepared. You don't want to retroactively be trying to fix or cope with this. You want to prevent it and be be ready. Okay, All right.
Speaker 1:The second one I'm going to go into, the second challenge when it comes to a network providers is going to be complex billing and coding. I know I just said you can do it, it's easy, like it's just a matter of doing it, but it of course there's complexities to it. So complex billing and coding can be a problem because it's not a big deal, because really accurate billing and coding are going to be essential. So there's a big learning curve and you want to ensure proper reimbursement and you want to do this correctly. But the intricacies of the process can lead to errors and claim rejections and when you start going, moving into, when you're doing billing inaccurately, it's going to really lead to stagnation and being behind and you don't want to get behind. So in proper billing, with the complexities of billing, are going to lead to errors and claim rejection. So that's going to create a lot of financial strain, a lot of administration, overhead, a lot of stress. So you can learn the complex billing and coding, but you want to be prepared and you want to learn it and you want to do all the education and mentorship possible so to make sure you're going to be doing this correctly and not starting and falling behind right away because you're not quite sure how to do it.
Speaker 1:So the resolution like this really is a journey and you just have to be willing to learn about it. So the resolution here is to understand that this is a journey. It requires education, it requires training, learning, a learning curve and you need to be willing to learn about it. Okay, you need to be willing to go through the process of understanding insurance and being prepared for challenges and being up to those challenges. All right. So what are the resolutions? Well, I'm going to go into about five of them oh, actually eight of them, but before I do I want to say, like the really the biggest resolution here is how you resolve the challenge of complex billing and coding is, if you are ready for the journey and you're willing to take the journey, you will learn. You have to be just willing to learn, willing to experience the challenges and to overcome them and to just be on that journey because you will figure it out. It's a learnable skill. Okay, it's a learnable skill. So I would say, if you are willing, you'll be able to figure it out.
Speaker 1:But let's go into some of the specifics of the resolution to effectively address this challenge and reduce the likelihood of errors with the complexities and intricacies, so we can reduce any kind of claim rejections, delays, admin headaches, the burden of it and let's adopt these several strategies we're gonna go over, okay? So the first one is gonna be what I just said, which is learning, and we'll add in staff training there. So learning and staff training. Number two implement good fit billing software. So know the different options for EHR. The billing software is where you're going to submit those claims and where everything's gonna be housed. So you want to make sure you're using one that's going to be the easiest for you, gonna be best fit for the type of practice you have. Reduce, like, maybe, some of these errors that you can come across with different EHRs, electronic health records something that can really help you systematize and reduce time for yourself. They're all gonna be really different, so you want to do your research.
Speaker 1:The next thing you can do is you can hire professional billing services. So this is actually something that, if you have a lot on your plate, I shouldn't say that. I don't want to say that. Okay, the option of hiring professional billing services. Let's talk about this Personally.
Speaker 1:When I started and it was just me and I was a solo practitioner I didn't have a group practice looking at billing. At that time, I was overwhelmed and busy and I was thought, oh, my goodness, I cannot do this on my own. I cannot do this on my own. I don't even want to think about it and I think my desire there was not there. However, I know a lot of people who did billing themselves when they started as private practice owners and they were solo and that was a way they were able. They didn't have ton of claims and they were able to start implementing it, learning it and really understanding billing from the get go, which I think is really helpful.
Speaker 1:That's for another episode about the pros of doing your own billing, which I'm getting into now, but we're not going to. We won't chat on that. Well, that's for another episode. So. But what you can do is hire professional billing services to take that off your plate and if you are overwhelmed, I would highly, highly recommend to delegate which is also another episode delegation. Check that one out. But I would hire professional billing services if you're overwhelmed, because they can really help you. If you're outsourcing these complexities of the billing procedures to someone who knows what they're doing, these specialized companies have this expertise. They know how to navigate, they know how to do this. It's going to save you a ton of time, energy and headache.
Speaker 1:Just make sure you're you know who you're billing with and make sure they come reputable, make sure they come like, get referrals and make sure you know what they're doing and check in with them. Make sure you have open communication to understand what's happening, because it's an important pillar of your business, so you want to make sure it's in good hands and that you are not eyes closed to it as well. All right, the next thing is regular auditing and quality control. Like anything else, you want to make sure you're constantly auditing, assessing how things are going with coding and billing policies and procedures, identifying potential areas of improvement or potential errors, and implementing all these quality control measures to really verify the accuracy, completeness, decrease your energy, decrease the time and make sure it's all high quality and where you want it to be constantly improving that and kind of going hand in hand with that is when you're auditing. You want to make sure you're constantly like auditing and understanding and being aware of any kind of regulatory changes. So you want to really keep up to date with the changes with healthcare regulations, coding, guiding guidelines, payer policies and this helps you ensure that billing and coding practices are going to remain compliant with the current standards, because they are ever changing. So you want to be really aware of what's changing. And again, it can sound like a completely different language that you do not know at first, but then the more and more you understand the lingo and how to do it and all the intricacies of it. It's like anything else it's a skill you can build and understand and not it won't be too overwhelming for you.
Speaker 1:The next resolve is collaborate. Okay, take a collaborative approach to billing. Have regular communication and feedback loops so that everyone in their different areas of billing are aware of what their role is and what they need to be doing and how we bill right. So if you do internal billing and you take on the billing and none of your providers do the billing, you want them to understand what they do need to do when it comes to billing and why that might be entering the diagnosis For each client or each, each patient that you are going to be billing for. Right, that might be their role. And another role might be understanding Billing to a degree, or insurance and insurance coverage so that they can go over the intake paperwork that covers insurance and covers payment that that clients need to know right off the bat, right? So your dieticians or a therapist may need to be aware of that. So communication with that, communication with changes, with anything with billing, so they're aware and not out of the loop and it's not creating frustration or confusion, is really, really important. So with your dieticians, with your VA or your executive assistant who is helping you with the billing, they need to be aware. So communication, communication, communication, feedback, feedback, feedback can really help to identify and resolve any challenges that you face.
Speaker 1:Additionally, I'm going to add here a collaborative approach with mentors and with people in your field who do billing. That's so helpful because they may know something you don't know. That's going to help streamline, make things easier, tell you about something you may not have known about billing that you should not be doing or that you should be doing, or a change that's going to happen soon. Have a group that you check in with. There's Facebook groups that can help you with this as well. Get a mentor to walk you through who has more experience than you. So, again, you can prevent any like losses financially, energy, wise, in time as well. So, collaborative approach I would probably say that's my number two when it comes to the resolutions here, number one being learning, learning, learning, being open to education. And then number two is taking that collaborative approach and being in the know with a group of like minded individuals who are doing the same thing as you.
Speaker 1:Okay, and last one is just I won't go into the details of this is, but it's going to be regular feedback and improvement. Okay, so just constant, constantly trying to improve and learn more. Take courses, get mentorship, just look and audit, ask for feedback to improve your billing processes and the complexities of billing, because you can make it simple with more education. You can make it more and more and more simple, right? If we don't know what we're doing and we're not, we might have a system that can be improved by so much right. It can be. It can take a quarter of the time, it can be less emotionally taxing, but we don't know what we don't know. So we have to be looking into it, understanding it, educating ourselves to get to a place where it's like a piece of cake I got this Whereas and just improve it immensely. Okay, but you gotta, you gotta dive into that, alright.
Speaker 1:The next common challenge that in network, in network, providers face is inadequate reimbursement rates. Now, this is different than delayed reimbursement rates or untimely reimbursement rates. We're talking about the actual amount you get reimbursed inadequate reimbursement rates. So we often grapple with this challenge of low rates from insurance companies, and these rates dictate the amount that providers are going to be paid for these different services rendered to clients and patients who are covered by these insurance plans, and low reimbursement rates can have significant impact on the practices revenue, the longevity, the sustainability of the profitability Just significant, significant challenges. So you really want to be aware Of what the reimbursement rates are for specific insurance companies for the specific service you provide, for the specific area. You are in the specific state, right, because contracts are different from provider to provider in different states providing different services. You want to be really aware Because if you get in these contracts and start taking certain insurances that pay you a quarter of what what your maybe private pay rate does, that's going to significantly change your business, right.
Speaker 1:So I'm gonna pause there and I want to ask you some questions. So if you're thinking of moving to insurance, you really want to consider where you are and how that would impact your business. So let's say you're new and you're just starting out and you don't even have clients yet. You're maybe a solo practice owner and you're considering taking insurance. Okay, great. Well, you're in the beginning. You're in the beginning stages, so you're just learning everything and nothing has been implemented. You probably are very low in your expenses, so you have nothing to cover.
Speaker 1:So you can decide if you want an insurance-based company or insurance-based practice. That are going to bring lots of different challenges and things and also wonderful things as well but you can kind of weigh the pros and cons of what that would look like and start to get familiar with the different. Get together with some providers, ask them if they would share more information Sometimes the insurance company would tell you or start trying to get those contracts and don't sign them until you find out what that payment is and try and look at your numbers and see what your expenses are and where you want to be and what you can keep up with, which also means you need to look into the future of your business and where you want to be as well, because that's going to impact your decision. You can always change it, but it's going to impact your decision. Now, if you are a let's say, you're a 10-dietition outpatient practice and you take private pay and you're thinking about taking insurance, well, you have to think about what your expenses are, where your profit is, how sustainable things are right now, and look at everything. Because if you had changed to insurance space and your, let's say, the reimbursement rate is a lot lower and all your clients are going to switch over to that insurance, you have to understand your numbers and where that's going to take you.
Speaker 1:I don't want to spend any more time on this, but this is very, very important to understand and double check and project the numbers out and actually see what's going to happen. You don't want to say you know what. It might be good to take this insurance and not think about, well, how many of my clients are going to switch from self-pay to private, to insurance, and what's that going to do? Is that going to cut my income and my revenue in half? Is that going to impact my ability to pay my dietitians? Is that going to make profit zero? Is that going to put a strain or is it going to be around the same thing? Am I going to have an external biller who I'm going to now have to have an expense for? How much of my time is this going to take up? Do I have that time? So really, really, really think about all of that. I just feel the need to say that because it's really important to know your numbers and project those numbers out. Okay, let's go back to the challenge of inadequate reimbursement rates and talk about the resolutions Now to address the challenge of low reimbursement rates from insurance companies and really mitigate the impact on the revenue and make things easier.
Speaker 1:There's a lot of things you can do. The first is regular review and negotiate those reimbursement rates. Now I would say right, when you get those contracts is the best time to negotiate and either accept or decline or negotiate for different reimbursement, because once you have those contracts, I have seen that you can get an increase, but it's very slight and if they decide to increase that at all, but you can review and negotiate, that is something that can help and that you can be successful with. So you want to have thorough analysis and really review and analyze those reimbursement rates from all the insurance providers and have a system in place where every year you are asking for a higher reimbursement and to renegotiate those rates and ask for that raise every year and understand how those rates compare to those costs of delivering your services. So really, a thorough analysis and then negotiation. Engage in those negotiations with insurance companies, Don't be afraid to do that and try and secure a higher reimbursement rate. The worst thing they're going to do is say no. So you want to present the data and the case studies that demonstrate the value of the service, the quality of the patient care, the need for your specific service, especially if you're niche and there's not a lot of providers in the area that provide that. And when it comes to those contract renewables, you want to take that opportunity to negotiate and improve those terms, and there's. So just look through your contract, chat with someone who knows what they're doing and negotiate higher rates is definitely something you can do.
Speaker 1:The second resolution is to have a variety of insurances that pay well or pay okay. That can help, that can create a sustainable practice, but also diversify those revenue sources by having self-pay patients as well, which is, of course, always an option. And so if you choose to take two of the top five insurance carriers in your area, well, those others can always be self-pay and that's going to help with the offset of maybe lower insurance reimbursements, okay, so you can offer, of course, self-pay, which is an easy thing to do. You can also diversify revenue sources by having additional services or kind of a concierge medicine type of practice where you're offering direct primary care that involves, like, some kind of subscription fee. That provides more of a steady and predictable source of income, or you can have a combination of all of them, but diversify those revenue sources even so, like you can have a you can be in contract with or you can be in network with an insurance carrier that is like, okay, and they did, it's good, it's good. It's not great, but it's good. But then maybe you have another insurance that you are in network with that you that pays well, and then you also have private pay right. Those are going to offset the cost of the lower insurance and you want to weigh the pros and cons of having accessible care and having more clients so that you can be bringing in more to the practice. And again, which is going to offset if you have a larger practice, bringing in less versus? It just depends on what kind of business model you have and I feel like I'm going in taking a tangent, so we're going to stop there, all right.
Speaker 1:The next resolution to reducing the barriers and reducing the challenge of low reimbursement rate would be to try and reduce your cost to offset a lower reimbursement rate by operational efficiency and reducing admin burden. So streamline your practice as operations to really reduce those overhead costs. Look at the different costs and understand and have awareness of where you might be spending too much, where you can cut, how you can be more efficient and effective so you can optimize and evaluate that productivity, optimize workflows, adopt cost effective technologies. That's going to really help because if you can reduce costs, you may be able to take that insurance and bring more clients in and then maybe increase your bottom line. All right, this next resolution is going to be patient education. This is important because when you are educating your clients about their insurance plans and understanding their insurance plans and the costs and the reimbursement processes, the more educated they can be, the less frustrated they're going to be and this is going to help you to manage their expectations of you and also of what they're going to experience and improve payment collections, which is very important, right? Because if you have to send 15,000, I just picked a random number to collections every year, that is going to, of course, impact your financial health and so you want to. The more you can educate your clients and patients, the more they're going to understand and accept and help and not be frustrated and cause maybe them to kind of ghost you and where you can work with them and they're really well educated and communicated with and they will follow through with that payment if their insurance denies.
Speaker 1:And the last resolution to help with the low reimbursement rates is Data-driven decision-making. This is a great one to end on, use the data analytics that you have to gain insights into your practice's financial performance, your patient demographics and all of your numbers, because you really want to understand what's happening in your practice and project, what can happen when you take insurances, and know those numbers. This data can inform really strategic decisions regarding what you do and also prevent you from getting into a situation where you are going to be struggling might not be sustainable and you're going to have a lot of hard work and stress that impacts you. And number four, another common insurance challenge administrative overhead. This is absolutely a challenge, something you can absolutely overcome and resolve, but taking insurance does add a lot of time, energy and finances.
Speaker 1:Dealing with insurance claims, verification, billing, other related services like communicating with patients, answering their questions, communicating with insurance, the time it takes to understand insurance all of this really consumes a significant amount of time and resources, and this administrative burden not only can distract from, maybe patient care or other goals, but can also again lead to errors, denials and just delays and reimbursement, so that administrative overhead is a very real thing. So you want to make sure that you have the resources, the willingness, the capability and the understanding of the administrative overhead so you can conquer it and successfully bill without the overwhelm and know you have the means to do so and the resources to do so. So how can you make sure that you resolve this administrative overhead to conquer this common insurance challenge, to effectively address this challenge of managing all these administrative tasks and streamlining these processes, you can do a lot of things like investing in practice management software, delegating tasks to qualified staff members, outsourcing certain functions, centralizing documentation, regular process evaluation, patient education and compliance and regulation. So let's talk about some of these. Number one investing in practice management software. So there's a lot of overhead, but if you are able to streamline your workflow by having a good practice management software, which I keep mentioning in this episode, and having an EHR that is reliable, that you like, that saves you time, that really does all those things that you want to make sure your EHR is able to do to reduce the energy for your specific practices with billing, that's going to be so helpful because these tools can really streamline the workflows and automate this. So, for example, if your EHR is able to maybe save certain settings and batch out claims and it's organized and you're able to run reports easily, then that's going to be. You know that might be the EHR. You want to pick over another one that has some other pros, but they're not specifically what you're looking for that are going to save you time, so you want to shop around.
Speaker 1:Second, how can you reduce administrative overhead? You can delegate tasks, delegate, delegate, delegate billing seems very overwhelming if you already have a full day and you have, you need to be elsewhere in your practice and if this and if this is the case, then assess your resources. If you and your ability to delegate this into hire on a bill or to train a current team member like a virtual assistant or executive assistant. So training, investing in training of that those staff members of a medical bill or encoder, ensuring that they're really well versed in insurance related tasks is going to really save time and energy. When you're delegating tasks to those qualified staff members, whoever you may choose to do billing whether it's your external medical bill or an internal medical bill or a current VA, whatever it might be you also want to establish really clear roles and clear responsibilities within that team, ensuring that every person knows the specific tasks that they are responsible for and knows the systems and the SOPs in the insurance process and you want to make sure you have regular communication and regular updates so everyone's informed and stays on the same page. Additionally I will just touch on this very quickly because we talked about this but you can outsource certain functions. So you can take on some of the billing, but maybe outsource credentialing services or third party verifications or maybe, if you wanted to have someone call and denied claims and get a little bit of help with that and save a few hours a week, you can outsource certain functions or outsource billing all together. And then the last three resolutions are similar to resolutions with the other barriers we already chatted about. So just I'm going to quickly say those which is really regularly processing, going through your process and evaluating, assessing how it's going to improve it, making sure patients are educated and making sure you're keeping up with compliance and regulation.
Speaker 1:All right, the next common barrier, number five, is changing regulations. This challenge is can be tough because there are frequent changes in insurance regulations and policies and you really want to be informed. It can create confusion and it can create problems and mistakes when you are not fully updated on the ever-changing regulations of insurance. So you can very easily resolve this by making sure you're staying updated. They do send out emails and letters. Make sure you're reading that. Don't skip out on reading that. Attend workshops that they provide. Engage in your community to see where mentorship might be, or camaraderie, where you can learn more from folks who are doing the same thing. Engage with those industry resources. Consult legal and compliance experts when you need. So just stay updated. Don't put that off your radar and say everything's going well. Let's just keep it going the way we are and not look at this. You want to make sure you're consistently looking at any kind of changes and maybe not avoiding that.
Speaker 1:All right, and number six and number seven, which I put together, which should be a larger percentage of this. In my mind, it should have two numbers, because I think it's. You know, there's a reason I'm ending on this one is because this is probably the one that has emotionally impacted me the most and the one that I was not as ready for, and this is the barrier or, I'm sorry, the challenge of patient confusion and patient frustration. I'm gonna take a breath with that one, because it's very tough, especially if you, if you take those things to heart and, yeah, it's difficult because oftentimes clients are really confused with insurance and they can be frustrated with you when it's not a you problem and there's nothing you could have done about it, even if you're having very clear and consistent and open communication. So clients frequently encounter challenges when attempting to comprehend their insurance coverage and they often get incorrect information from insurance and it often results in billing disputes over all the satisfaction with the experience, negative reviews and it's really really tough because the complexity of insurance policies and medical billing processes.
Speaker 1:It is frustrating to clients and because insurance is frustrating and especially when they, you know, may receive bills they didn't anticipate, they may not have looked over their plan, they may be new to using their insurance if they're someone who just got off of guardians insurance, and so, yes, it is frustrating and I very much understand clients frustration. As you know, I am a user of medical insurance as well and it can be extremely frustrating and some of this is just unavoidable and it's something we just have to take care of ourselves around. But this is something I was surprised at. You know, we work really hard as providers to take insurance and to create accessible care and we take on that headache of taking insurance, and so we do all we can for our clients we care so deeply about, and so when they're confused and frustrated and they're frustrated that their plan isn't covering and they say you know it's they feel like it's our fault, rather than understanding, maybe, insurance fully and understanding that actually it's insurance Do your plan that's saying no to coverage of this, or who's causing this confusion? Because they're telling you conflicting information or leading you to believe something that's not true about coverage, and so this is really really difficult and there is a lot you can do that you do have control over this that we did speak about, which will go over again, and then there is a matter of just taking care of yourself as well. So the resolution here is going to be education, transparency and clear communication.
Speaker 1:Really, to address this struggle, you want to make sure you are being very proactive with the education and proactively giving information Right when you give those initial paperwork and when you are chatting with them on the phone, you want to provide them with written materials, access to online resources. Maybe put it on your website. Make sure you have those things in place so it is everywhere and it has been delivered to them quite a few times, okay, in different formats. You also want regular communication and open communication about things going on so that they're not communicated with late or there's not a lack of communication and what might be happening. You really want to over communicate and notify clients in advance of any kind of changes to their insurance that we might be seeing on our end or things we might be seeing happening with their claims Just really everything we're seeing. Keep them very in the know.
Speaker 1:Next, in that intake paperwork and when you're chatting with them, you want to have really clear expectations and clear explanations so that they understand why and they understand what to expect, because understanding what to expect to get the heads up, plus the why and explanation behind it, are going to help clients to feel in the know and feel cared about and feel like you are taking the time to explain and give them the heads up and then make sure you hold your boundaries with that as well. So, with those clear explanations and clear expectations, use language that they will understand. Create visual aids, have detailed documentation. Make sure you let them know what you are able to do as the network provider and what is the insurance responsibility, making sure you are letting them know when it's when it's something they need to talk about insurance about and something when it's time to chat with you about something. So making sure you're saying that right off the bat so they know who to go to as well. So very, very clear and consistent communication.
Speaker 1:You want to have billing transparency, so cost estimation, detailed billing statements, different payment options if that's something that's feasible to you, and you want to empower and advocate, encourage questions, create an environment where a client feels comfortable asking questions about their insurance coverage and bills. If it's something you're able to answer and if it isn't, make sure you have those clear, respectful boundaries around what you're able to do and what you're not able to do. And then let them know we are there advocates. We want to advocate for our clients. We want to help them by doing everything we can to resolve any kind of billing disputes that we are able to. That you know is within our power to do. Let them know we're doing all we can and do all you can. Ask if you can advocate and advocate for them and empower them to advocate for themselves in navigating all these complex complexities of insurance, so that one's really important. And lastly, staff training you really want to make sure everyone on the team is very clear around insurance, their role, who to go to when there's questions, where to point their their clients to, and to help empower them to provide accurate information, to feel comfortable and confident and address every client's concerns very effectively, efficiently and in a timely fashion.
Speaker 1:So that wraps up the seven common barriers when it take, when it comes to taking insurance, and, additionally, all the resolves and all the resolutions and what you can do when it comes to these barriers. I don't want this episode to discourage you from moving forward with the taking insurance, but I do want it to encourage you to consider each and one, every one of these different barriers and see how does that feel for you, how would your practice do with that, with your, you know, in, with your individual practice. It's everyone has a different practice, with different systems, different, different needs, different abilities and different desires as well. So think about that, think of where you are, where you want to be projecting, where you may be, and think very carefully through all of these seven and see if you're willing and able and if the resolution is something you want to work through and is if you come out of these after you're assessing all seven of these and you think that, hey, I think I can get this and be successful. So just thoroughly go over those seven, write it out, chat it out with a mentor, take time with all of those, because taking insurance can absolutely, absolutely, really just skyrocket the success of your business as well and open up new opportunities, make it more sustainable, make it more accessible. There's so much it can do and it's a learning process if you have not done it.
Speaker 1:So just making make sure to really assess and project into the future to make sure you're covering all basis. You really know the ins and outs, what to expect if you can handle it and if you want to handle it. So with that, I'll leave you be. I also want to end by saying I am pro insurance If you can handle it. I'm definitely want you to have a sustainable and successful practice and be happy in it. But I do think insurance creates accessibility, creates. It helps our clients tremendously and it can also really help your practice to be more profitable as well, if everything lines up. So I will go ahead and leave it there. I hope you all have a great, wonderful rest of your day and until next time, keep growing and make sure to take care of yourself while you're at it.