Don't Be Surprised by the "No Surprises Act"

WEBVTT 1 00:00:00.920 --> 00:00:04.759 Hello, folks, and happy Tuesday to you. My name is Lawrence peppler 2 00:00:04.799 --> 00:00:08.160 and I'm the senior client success manager over here at Karac touge, practice management 3 00:00:08.160 --> 00:00:14.039 software and integrated practice illutions, and we are just overjoyed to bring you a 4 00:00:14.080 --> 00:00:19.120 really interesting and informative topic. Today we're going to be talking about billion coding 5 00:00:19.160 --> 00:00:24.679 and hints and tips. This issue of their series is going to focus on 6 00:00:24.760 --> 00:00:30.359 the no surprises act, in effect, this month. Are you in compliance? 7 00:00:30.600 --> 00:00:34.479 Once again, we're fortunate enough to be partnering with Cathy Widner, who 8 00:00:34.960 --> 00:00:42.719 is the de facto, absolute most astute professional when it comes to coding and 9 00:00:42.759 --> 00:00:47.679 compliance in our industry. Here, the superlatives that I could throw towards Cathy 10 00:00:47.679 --> 00:00:50.799 are never ending. Cathy, how are you doing this morning? Well, 11 00:00:50.840 --> 00:00:56.200 I am Jim Dandy and I'm always embarrassed by all of those superlatives love. 12 00:00:56.359 --> 00:00:59.799 Thank you for loving me. I appreciate that. So, Hey, folks, 13 00:01:00.200 --> 00:01:03.239 if you're not using the services over at KMC University, you ought to 14 00:01:03.280 --> 00:01:07.040 be, because there is no better service to help you with your billing and 15 00:01:07.120 --> 00:01:11.359 coding needs, and especially when it comes to getting in the weeds on coding 16 00:01:11.359 --> 00:01:15.439 and things of that nature. And and new changes that are coming. Cathy 17 00:01:15.480 --> 00:01:19.680 helps us keep abreast of what's on the forefront, what's coming down the pipe, 18 00:01:19.719 --> 00:01:23.000 things that we need to be aware of before they even happen. So 19 00:01:23.040 --> 00:01:26.640 what are we going to cover today? Well, this overview is going to 20 00:01:26.640 --> 00:01:33.040 cover these important aspects of this re wired law that affects providers. How the 21 00:01:33.040 --> 00:01:38.120 transparency peace applies to all providers, making them responsible for clearly communicating the cost 22 00:01:38.200 --> 00:01:45.239 of care to both ensured and uninsured patients, and this includes chiropractors. What's 23 00:01:45.280 --> 00:01:49.359 the definition of good faith estimate and how some are expected to be no more 24 00:01:49.400 --> 00:01:53.159 than four hundred dollars off when estimating the cost of care? And then we're 25 00:01:53.200 --> 00:01:57.760 going to talk about some tips for building a process to provide this information in 26 00:01:57.760 --> 00:02:02.640 the most streamlined way, with templates offered for your use. So, with 27 00:02:02.680 --> 00:02:06.959 that being said, Cathy's going to take just a little time get your mind 28 00:02:07.079 --> 00:02:10.840 going, get you thinking about this topic and present some really good information to 29 00:02:10.879 --> 00:02:14.199 you. So I'm going to pass it over to you now, Cathy. 30 00:02:14.800 --> 00:02:20.039 Awesome, and I want to be clear. The government has certainly provided templates, 31 00:02:20.080 --> 00:02:28.159 which we are happy to share as files that can be posted where Lawrence 32 00:02:28.319 --> 00:02:31.719 and the team will post this recording. So we're happy to provide those. 33 00:02:32.080 --> 00:02:37.479 Obviously we've kind of dug into it more and we have some additional things and 34 00:02:37.520 --> 00:02:39.919 we'll talk a little bit more about how those are available. So I'm giving 35 00:02:39.960 --> 00:02:47.680 you a very targeted version of something that in our world is a five module 36 00:02:47.680 --> 00:02:53.039 course. It is so complicated. So don't expect that you're here to learn 37 00:02:53.120 --> 00:02:57.520 every detail of this. That is certainly not what we either intend or what 38 00:02:57.719 --> 00:03:01.199 is even reasonably possible. So I want to just share kind of right up 39 00:03:01.199 --> 00:03:06.159 front. I'm going to go quickly. So why did the government want to 40 00:03:06.199 --> 00:03:10.280 cramp our style like this? Well, the challenge is that this is about 41 00:03:10.319 --> 00:03:16.000 consumer protection and you don't have to go very far to find out about these 42 00:03:16.080 --> 00:03:23.639 challenges that have happened. Two big giant offenders have been ambulance services, particularly 43 00:03:23.639 --> 00:03:30.840 air ambulance services, and these kind of pop up emergency rooms that are all 44 00:03:30.919 --> 00:03:35.919 around. I can throw a rock either east or west from my home and 45 00:03:36.000 --> 00:03:39.719 hit two of them because they're simply everywhere. Sometimes they're in Ergent care, 46 00:03:39.840 --> 00:03:46.520 sometimes they're an emergency room and the problem is their facilities that perhaps out of 47 00:03:46.639 --> 00:03:50.360 network. Doctors work in but you don't know that when you're you've cut your 48 00:03:50.400 --> 00:03:53.960 hand and you need something quick, and then later you get a tenzero dollar 49 00:03:54.039 --> 00:03:59.080 bill, and I'm not exaggerating. So this is where all this came from. 50 00:03:59.199 --> 00:04:03.000 We, as providers, got caught up in the mix. I will 51 00:04:03.000 --> 00:04:08.400 tell you that even as of today, which is whatever the heck. Today 52 00:04:08.520 --> 00:04:15.680 is, January the twenty five, they're still unanswered questions. So nobody has 53 00:04:15.719 --> 00:04:18.120 the right answers and anyone that tells you they do as blow and smoke. 54 00:04:18.199 --> 00:04:20.680 So I'm going to tell you what we know. I'm going to tell you 55 00:04:20.680 --> 00:04:25.759 what you should do, what you can do and, as usual, our 56 00:04:25.839 --> 00:04:29.680 job is to be as practical as we can for you about what's going on. 57 00:04:30.040 --> 00:04:32.759 So we've had a really big kind of year, starting in two thousand 58 00:04:32.759 --> 00:04:36.839 and twenty one with the twenty one century cures act, with the new hippo, 59 00:04:36.959 --> 00:04:42.639 changes to information blocking, Hippo rite of access, changed the hip a 60 00:04:42.720 --> 00:04:46.680 privacy rule and the proposed changes happened, and then, boom, the no 61 00:04:46.759 --> 00:04:51.199 surprises act happened as well. So what we know? Their issues are are 62 00:04:51.319 --> 00:04:58.800 hidden charges, the excessive balance billing that's happening and the idea that the number 63 00:04:58.800 --> 00:05:01.920 one reason for bankruptcy in the United States is medical debt. Now, I 64 00:05:01.959 --> 00:05:08.600 don't think our little world of chiropractors particularly are the problem here, but, 65 00:05:08.639 --> 00:05:12.240 as I said, we've gotten kind of caught up in the process and there 66 00:05:12.240 --> 00:05:15.480 may be practices that you do in your office that are now going to be 67 00:05:15.639 --> 00:05:19.199 contrary to what they want you to do with this new law which, by 68 00:05:19.199 --> 00:05:24.040 the way, everything I'm telling you, went into effect at the beginning of 69 00:05:24.079 --> 00:05:27.920 this month. So if you've done nothing on it or are like nine out 70 00:05:27.920 --> 00:05:31.279 of ten doctors who we speak to who call in and say what it's what, 71 00:05:31.279 --> 00:05:34.759 what happened, it's not okay. Like you have to stay on top 72 00:05:34.839 --> 00:05:39.519 of things and I'm so grateful that Chire touch asked me to come and just 73 00:05:39.560 --> 00:05:45.079 share a little bit of information with you here. So surprised. Billing in 74 00:05:45.120 --> 00:05:50.240 and of itself is essentially I wasn't expecting this to happen. I had an 75 00:05:50.319 --> 00:05:58.040 interesting thing happened myself recently where I visited an eant and I was still meeting 76 00:05:58.079 --> 00:06:02.199 my large deductible and I noticed that I had a charge for four hundred and 77 00:06:02.240 --> 00:06:08.920 eighty five dollars that pass through because it was applied to deductible for this endoscopic 78 00:06:08.920 --> 00:06:13.879 bloody blah blah, which was an endoscopic but it was a literally a camera 79 00:06:14.000 --> 00:06:17.279 that they put up on each side of my nostrils. I remember this distinctly 80 00:06:17.560 --> 00:06:24.160 and if this doctor spent four seconds, that's an exaggeration. She put this 81 00:06:24.199 --> 00:06:27.199 thing on her head, she went bloop bloop in each side and I got 82 00:06:27.199 --> 00:06:30.680 a four hundred and eighty five dollar bill, which I freaked the frick out 83 00:06:30.720 --> 00:06:33.920 about, and I you don't want to. You know us as billards and 84 00:06:34.000 --> 00:06:38.680 coders right where the worst people to send a send a balance bill to, 85 00:06:38.839 --> 00:06:41.920 and I fought it all the way to the Ombudsman because it was it was 86 00:06:41.959 --> 00:06:46.319 not fair what she did. So a surprise bill is when you get something 87 00:06:46.360 --> 00:06:53.040 you're not expecting and it often comes down to a non participating provider or facility. 88 00:06:53.120 --> 00:06:56.800 And remember the facilities are what caused this problem in the first place. 89 00:06:57.000 --> 00:07:02.360 Now the difference is balance billing. Balance Billing is when you're supposed to be 90 00:07:02.399 --> 00:07:08.560 writing something off that the patient ends up getting charged for in general terminology. 91 00:07:08.639 --> 00:07:14.519 That's what it means. So you are absolutely okay with charging the patient for 92 00:07:14.600 --> 00:07:17.399 their portions, but again with no surprises. We do have to let them 93 00:07:17.439 --> 00:07:23.680 know what's what. So remember this is a consumer protection law, which means 94 00:07:23.720 --> 00:07:30.360 it affects your patients. So again, hidden charges, excessive balance billing and 95 00:07:30.439 --> 00:07:33.839 the medical debt issue. Now one of the first things that we're going to 96 00:07:33.839 --> 00:07:39.800 talk about is understanding who you are in your practice and how you deal with 97 00:07:39.839 --> 00:07:42.839 things. And I say this with all the love in my heart because we 98 00:07:42.879 --> 00:07:46.480 talked to so many doctors. There are some of you out there who don't 99 00:07:46.519 --> 00:07:49.920 know if you're in er out of network, with a plan, and if 100 00:07:49.920 --> 00:07:56.600 you're out of network, you're billing anyway and maybe mishandling what the patient should 101 00:07:56.639 --> 00:08:00.800 be paying. So all of that has to be first. You've got to 102 00:08:00.800 --> 00:08:03.680 bring yourself up to speed with what you should know. It's at Na, 103 00:08:03.839 --> 00:08:11.240 it's at Nahmo, I'm in network. Fine, it's blue cross PPO plan, 104 00:08:11.279 --> 00:08:15.839 I'm not in network, and you have to know what these things are 105 00:08:15.959 --> 00:08:20.759 because, depending on those levels of participation, even if you call yourself and 106 00:08:20.920 --> 00:08:26.480 all cash based practice, you have to know these things because if I walk 107 00:08:26.519 --> 00:08:31.919 into your practice and I have whatever insurance, and yes, you're a cash 108 00:08:31.960 --> 00:08:37.480 based practice, but I have blue cross Blue Shield that has out of network 109 00:08:37.519 --> 00:08:41.559 benefits, if I see you. You are affected by this act and you 110 00:08:41.600 --> 00:08:46.720 need to be aware of that. So there's two parts to this thing. 111 00:08:46.879 --> 00:08:50.159 The whole idea of when part one started, which was in July of last 112 00:08:50.240 --> 00:08:58.559 year, was to try to increase stakeholders transparency, to create competition, to 113 00:08:58.720 --> 00:09:03.320 have doctors, half a hospitals particularly have to list their fee schedules and things 114 00:09:03.399 --> 00:09:07.600 of that nature, because it would give us consumer pricing information allow them to 115 00:09:07.600 --> 00:09:11.879 sort of shop a little bit. And what the ultimate goal was to increase 116 00:09:11.960 --> 00:09:16.519 competition. Now part two, where the final rule came out in September, 117 00:09:16.639 --> 00:09:20.879 is the one that we have to pay the closest attention to. Number One, 118 00:09:22.000 --> 00:09:24.720 they established a resolution process. That was their big deal. If a 119 00:09:26.240 --> 00:09:30.960 person doesn't like what they got for a bill, there's a formal federal process 120 00:09:31.000 --> 00:09:33.720 they can go through. You know what the problem is? They first hired 121 00:09:33.799 --> 00:09:39.120 the person in December to go create the process. That was supposed to be 122 00:09:39.200 --> 00:09:43.080 an effect January first. So Gospel according to Cathy. I'm going to be 123 00:09:43.080 --> 00:09:48.200 aware of it, but I'm not worried about that right now. Second thing, 124 00:09:48.240 --> 00:09:50.799 which you're going to talk about a lot today, is the good faith 125 00:09:50.919 --> 00:09:56.120 estimate. This one hundred percent applies to us. The third thing is what's 126 00:09:56.159 --> 00:10:01.799 called an advanced eob that has to come from the payer, because this rule 127 00:10:01.879 --> 00:10:05.679 not only affected doctors, that affected payers. Payers have to be in a 128 00:10:05.759 --> 00:10:09.159 position to be able to say, in a way, think about verification, 129 00:10:09.240 --> 00:10:13.279 here's what we expect the out of pocket cost on this to be. Now 130 00:10:13.360 --> 00:10:18.399 I will tell you my own health plan. I belong to Kaiser Permanente here 131 00:10:18.440 --> 00:10:22.799 in Colorado, and they are ready do this because everything that they've been doing 132 00:10:22.799 --> 00:10:26.960 it for a few years, everything that I would have done if I chose 133 00:10:28.039 --> 00:10:31.919 to. I could request and as deiment and they would say, based on 134 00:10:31.000 --> 00:10:35.039 what we believe the coverage to be on the diagnosis and the process that's going 135 00:10:35.080 --> 00:10:39.759 to happen, we expect your portion to be x. now, this is 136 00:10:39.759 --> 00:10:43.159 impossible right now. Can't be done for everybody, so we don't even worry 137 00:10:43.159 --> 00:10:48.799 about this today. Patient Provider Dispute Resolution. That's kind of this thing. 138 00:10:48.879 --> 00:10:54.039 It's possible, but unlikely. And then, obviously there's an expansion of the 139 00:10:54.159 --> 00:10:58.000 rights to external review. This is the piece, along with what we're going 140 00:10:58.039 --> 00:11:03.679 to call billing protections, that we're going to focus on today because in my 141 00:11:03.879 --> 00:11:07.519 estimation, to not blow your minds. I'm going to focus in on the 142 00:11:07.559 --> 00:11:11.399 things you need to know about those two pieces. Number one, the world 143 00:11:11.440 --> 00:11:18.159 requires providers to furnish a good faith estimate of expected charges upon request or scheduling. 144 00:11:18.159 --> 00:11:22.840 Now we'll get into what that means. And providers are expected to inquire 145 00:11:22.879 --> 00:11:28.519 about insurance status at the time of scheduling the appointment. Now you may already 146 00:11:28.600 --> 00:11:31.039 do this. If you don't, you're going to have to get it added 147 00:11:31.039 --> 00:11:37.759 into your process because, particularly those of you who maybe don't take well, 148 00:11:37.759 --> 00:11:39.159 you're enough to do it either way, because you could have people with no 149 00:11:39.240 --> 00:11:43.799 insurance or they have like Hmo that you're not a part of, etc. 150 00:11:43.879 --> 00:11:52.399 Healthcare providers and healthcare facilities are required under this to furnish a notification of good 151 00:11:52.399 --> 00:11:56.759 faith estimate of expected charges to anyone who is going to pay cash. Now, 152 00:11:56.759 --> 00:12:03.840 who are these people? Anybody with insurance but you're out of network with 153 00:12:03.919 --> 00:12:11.840 their insurance, anybody who is exercising their hippo omnibus rights and they have insurance 154 00:12:11.840 --> 00:12:16.320 but they're telling you not to bill it, and anyone there to pay cash. 155 00:12:16.360 --> 00:12:20.919 These are all people that this applies to, and so what we're going 156 00:12:20.960 --> 00:12:26.519 to show you definitely applies to those people, here's the big challenge, and 157 00:12:26.720 --> 00:12:31.720 to an individual who has not yet scheduled but requests so anybody can request this. 158 00:12:33.039 --> 00:12:35.600 So what you need to do is have a process in place now. 159 00:12:37.279 --> 00:12:41.840 In fairness, I want you to know this has been such a moving target. 160 00:12:41.960 --> 00:12:46.759 Even for our own clients. We have about eighty five percent of the 161 00:12:46.799 --> 00:12:50.000 material that we would have available in the forms and all the things. We're 162 00:12:50.000 --> 00:12:54.440 eighty five percent of the way there because we have two questions that we want 163 00:12:54.480 --> 00:13:00.879 the final answer to out to both C ms and a set of healthcare attorneys 164 00:13:00.879 --> 00:13:05.679 before we finalize our material. We expect that this week our materials incomplete. 165 00:13:05.759 --> 00:13:11.480 Those you that are members, you'll find it in the library here by next 166 00:13:11.600 --> 00:13:13.320 week. Is Our goal, by the way, also the lunch of our 167 00:13:13.360 --> 00:13:18.360 brand new website next week. So I want you to know we don't even 168 00:13:18.360 --> 00:13:22.559 have all the final stuff now. Most of what the government provided is so 169 00:13:22.679 --> 00:13:28.240 heavily worded toward a facility that it sucks. It's not good stuff for us. 170 00:13:28.279 --> 00:13:31.919 There have been a few other consultants to put something together and frankly, 171 00:13:31.960 --> 00:13:35.120 they did nothing more than take the government one and slap it on their letter 172 00:13:35.159 --> 00:13:41.360 head. We have created something for chiropractors and the way chiropractors practice because, 173 00:13:41.519 --> 00:13:43.639 guess what, people calling you might get them in the same day as a 174 00:13:43.679 --> 00:13:48.320 new patient. Now what do you do? You have these rules to follow. 175 00:13:48.360 --> 00:13:50.799 So that's kind of where we're moving in that direction, but I'm trying 176 00:13:50.840 --> 00:13:54.480 to be as transparent as I can. We don't even have all the answers, 177 00:13:54.480 --> 00:13:58.240 but we will have by next week and that will be the final answer 178 00:13:58.320 --> 00:14:03.639 here, or at least the answers we need today. So this is the 179 00:14:03.639 --> 00:14:07.080 issue that's been a big issue for people like us, because you have to 180 00:14:07.120 --> 00:14:13.039 be, according to this rule, able to supply your good faith estimate three 181 00:14:13.080 --> 00:14:16.480 business days before the day the service is rendered. Now, is there a 182 00:14:16.519 --> 00:14:20.720 way around that? Yes, and I'm going to show you what that is. 183 00:14:20.840 --> 00:14:24.879 But you still have to make the patient aware. It's a little bit 184 00:14:24.919 --> 00:14:28.000 like the wink wink that could happen around in a BN. Well, if 185 00:14:28.039 --> 00:14:31.799 you want to get your papers at home and see all the stuff in the 186 00:14:31.799 --> 00:14:33.320 papers, in the papers, in the papers, you check option one and 187 00:14:33.320 --> 00:14:35.720 we'll go ahead and bill it. If you don't want any of that, 188 00:14:35.759 --> 00:14:41.799 you do number two. Same Story. We absolutely are required to be able 189 00:14:41.879 --> 00:14:48.240 to provide all of these estimates three days ahead. I'm more than happy to 190 00:14:48.240 --> 00:14:52.279 get you in today if you wish to waive that, or I can schedule 191 00:14:52.360 --> 00:14:56.080 you out far enough so that we could at least give you an estimate of 192 00:14:56.120 --> 00:15:00.279 these first days charges. So most people are going to go whatever. There 193 00:15:00.399 --> 00:15:03.120 you know. What do you mean? What's The ball park? The provider 194 00:15:03.200 --> 00:15:07.519 is responsible for the list of services. Theoretically, this is the piece that 195 00:15:07.559 --> 00:15:11.759 I talked about. is almost impossible now, but I want to let you 196 00:15:11.799 --> 00:15:16.919 know this is coming down the road. I don't know how far out. 197 00:15:16.000 --> 00:15:20.200 I hope it's way the heck far out, but you need to know. 198 00:15:20.360 --> 00:15:26.559 This is that connection between the provider and the payer. So our suggestion for 199 00:15:26.639 --> 00:15:31.279 you as a to do right now is make sure that you're enrolled in your 200 00:15:31.279 --> 00:15:37.159 pay or portals so that when this comes to fruition, you're already at least 201 00:15:37.159 --> 00:15:41.000 set up to be where you need to be. The practices that are smaller 202 00:15:41.039 --> 00:15:45.759 practices, maybe you're not so involved with insurance, it's going to be less 203 00:15:45.759 --> 00:15:48.440 onerous. But if you're involved with insurances and you're not a part of that, 204 00:15:48.480 --> 00:15:52.519 you want to get busy on that. Obviously it's not possible by January. 205 00:15:52.600 --> 00:15:58.799 It's also was not possible even today. So the good faith estimate, 206 00:15:58.840 --> 00:16:02.759 as I said, is for those people self paying, those who are ensured 207 00:16:02.879 --> 00:16:07.480 using their Omnibus Hippo Rites and those who are insured but don't have benefits for 208 00:16:07.519 --> 00:16:11.480 your coverage or item. We like to call that the election to self pay. 209 00:16:11.960 --> 00:16:17.399 So I want laser, but laser is experimental according to my insurance company. 210 00:16:17.559 --> 00:16:22.399 Even if you're in network with a payer and we think oh no, 211 00:16:22.480 --> 00:16:26.639 surprises, doesn't affect us here. It may be that if you're asking the 212 00:16:26.679 --> 00:16:30.159 patient to pay for their laser treatment, the good faith estimate has to come 213 00:16:30.159 --> 00:16:36.440 in place. Now, are most of you good doctors and offices doing something 214 00:16:36.440 --> 00:16:38.919 anyway like this? I'm going to bet that you are. If you're our 215 00:16:38.960 --> 00:16:44.559 member, of course you already know how to do the election for the excluded 216 00:16:44.639 --> 00:16:48.480 services formed that we have because we've been asking doctors to do this for years. 217 00:16:48.600 --> 00:16:52.960 Is it's just a good business practice to put something in writing and say 218 00:16:53.000 --> 00:16:56.159 hey, this is not going to be covered. If you want it, 219 00:16:56.240 --> 00:17:02.039 sign here, and it's quasi similar to, you know, an excluded services 220 00:17:02.080 --> 00:17:04.720 a bien or special notice for Medicare now you may be wondering why I haven't 221 00:17:04.720 --> 00:17:08.559 said Medicare in any of this. This does not apply so much to Medicare 222 00:17:08.599 --> 00:17:15.720 patients because billing protections are already built into the Medicare law. They're already there. 223 00:17:15.839 --> 00:17:21.200 So somebody who, even if you're non participating with Medicare, think about 224 00:17:21.240 --> 00:17:26.359 that. You don't have to tell them surprise billing because you already know you 225 00:17:26.400 --> 00:17:29.839 can't charge more than the limiting fee. Now, when they've become a cash 226 00:17:29.880 --> 00:17:34.519 paying patient for maintenance care, at that point maybe that's the time to do 227 00:17:34.599 --> 00:17:40.119 so. But if you're continuing to charge the Medicare allowed fee or limiting fee, 228 00:17:40.160 --> 00:17:42.920 you don't even have to worry about that. So here's what's required for 229 00:17:42.960 --> 00:17:47.559 good faith. Estimate our GFEE, as we're going to call it, when 230 00:17:47.559 --> 00:17:51.400 the person calls for their appointment. If you don't do it now, you've 231 00:17:51.440 --> 00:17:53.920 got to work on a process to get this done. For those of you 232 00:17:53.960 --> 00:17:56.640 who are members, this will all be part of the checklist that's in that 233 00:17:56.720 --> 00:18:00.839 course, but it's important to know you need to ask them a series of 234 00:18:00.920 --> 00:18:04.680 questions. Are they ensured? Do they plan to use their insurance, etc? 235 00:18:06.400 --> 00:18:11.400 Now it would be very simple. I assume for most of you are 236 00:18:11.480 --> 00:18:17.559 going to be doing a new patient evaluation and management service on visit one. 237 00:18:17.599 --> 00:18:21.440 Now, let's not even talk about our new conditions and returning patients. Let's 238 00:18:21.480 --> 00:18:25.559 just talk about new patients for now. It would not be hard for you, 239 00:18:25.640 --> 00:18:29.319 and this is certainly what we're advising our members to do, to go 240 00:18:29.680 --> 00:18:33.160 pull a two thousand and twenty one coding audit to be able to go. 241 00:18:33.200 --> 00:18:37.039 I want to see all of my em services for new patients, nine and 242 00:18:37.079 --> 00:18:41.960 nine two oh something, and I want to see what the ratio is of 243 00:18:41.000 --> 00:18:45.279 how many times I build each one. Right. That's just a straight up 244 00:18:45.319 --> 00:18:52.039 coding audit. And let's pretend for a minute that stupid numbers. Twenty five 245 00:18:52.079 --> 00:18:55.200 percent of the time it was a no to. Fifty percent of the time 246 00:18:55.240 --> 00:18:57.119 it was a nous three. Twenty five percent of the time it was a 247 00:18:57.200 --> 00:19:03.920 no for, and for demonstration's sake, only my nine two hundred two is 248 00:19:03.960 --> 00:19:07.680 a hundred dollars, my two hundred and three is a hundred and fifty and 249 00:19:07.759 --> 00:19:11.519 my o for is two hundred. It would be very, very simple for 250 00:19:11.599 --> 00:19:15.960 me, because all you know right now, I don't care what you think, 251 00:19:17.000 --> 00:19:19.920 you know all you know right now is that that person is going to 252 00:19:19.960 --> 00:19:25.400 get an em service, because that's really all you can guarantee. They come 253 00:19:25.400 --> 00:19:27.920 in, they have that evaluation. Do I take extrays or not? Do 254 00:19:27.960 --> 00:19:32.480 I treat or not? Those are decisions that happen after the patients there, 255 00:19:32.480 --> 00:19:36.039 even if you work off of a protocol. So if I know that between 256 00:19:36.039 --> 00:19:40.720 one hundred and two hundred dollars is what I can verbally estimate on the phone 257 00:19:40.759 --> 00:19:44.279 because that's what I know, and the majority of those people are one hundred 258 00:19:44.279 --> 00:19:48.599 and fifty, that's a very easy thing. You could say simply by doing 259 00:19:48.640 --> 00:19:52.480 a little audit review of your information. If the patient wants to get in 260 00:19:52.519 --> 00:19:56.799 the same day, you do need to tell them. I'm required to give 261 00:19:56.839 --> 00:20:00.720 you a written estimate of this. I can provide that when you get here 262 00:20:00.799 --> 00:20:06.160 later today, or I can send it to you if you're willing to schedule 263 00:20:06.160 --> 00:20:08.480 at least three days out. So that's a bunch of bollocks if you ask 264 00:20:08.559 --> 00:20:11.559 me, but it's just the rule of what you have to do. So 265 00:20:11.640 --> 00:20:17.759 start with, what's your Em Service? On visit one? Now they can 266 00:20:17.880 --> 00:20:22.160 ask and you have to send it. I'm going to show you kind of 267 00:20:22.160 --> 00:20:26.920 what the government has for a form for that, but if it's not yet 268 00:20:26.279 --> 00:20:30.200 scheduled, they can ask for that estimate in writing. And it's a pain 269 00:20:30.279 --> 00:20:33.039 in the fanny, but they can do it and you have to comply. 270 00:20:34.839 --> 00:20:41.039 So we encourage you to really build a solid intake process. Those that use 271 00:20:41.079 --> 00:20:47.319 our new patient telephone form. That's a great way to use that process because 272 00:20:47.359 --> 00:20:51.039 it lays out what the patient has or doesn't have in network out of network, 273 00:20:51.079 --> 00:20:53.200 and then it allows you to verify and to know where you're out with 274 00:20:53.240 --> 00:20:57.119 them. In Roll with your pay air porters for now. Get that done. 275 00:20:57.119 --> 00:21:02.119 Get Medical Review Policies and eimbursement guidelines. You hear me say this all 276 00:21:02.200 --> 00:21:04.400 the time from the payers that you deal with, so you know what is 277 00:21:04.440 --> 00:21:10.720 and isn't covered. Start a solid verification process that's in place before the patient 278 00:21:10.799 --> 00:21:15.920 comes in, if you can, and not just eligibility verification of what actually 279 00:21:15.039 --> 00:21:22.519 is or isn't covered, and then really build your compliant financial policy. figure 280 00:21:22.559 --> 00:21:26.640 out your coding averages, how many different you know of each one you did 281 00:21:26.680 --> 00:21:32.240 and maybe you can figure out what you want to provide as verbal estimates on 282 00:21:32.279 --> 00:21:37.319 the phone. Provide that written estimate at visit one. Something that you could 283 00:21:37.319 --> 00:21:41.519 put together. My guess is it would be very easy to have a standard 284 00:21:41.559 --> 00:21:45.359 template, have what you normally do and then fill in that information, then 285 00:21:45.359 --> 00:21:48.880 provide a more detailed one at your report of findings, are financial report of 286 00:21:48.960 --> 00:21:56.480 findings, and most certainly keep it in between that ballpark of four hundred dollars. 287 00:21:56.799 --> 00:22:02.519 So if you're already doing some type of a good faith estimate, awesome. 288 00:22:03.200 --> 00:22:07.279 The little gory details are going to still reveal themselves, I think over 289 00:22:07.319 --> 00:22:11.920 the next thirty, two, sixty days. Make sure that, if it's 290 00:22:11.920 --> 00:22:18.720 an out of network person that you deal with specifically that extra billing protections form 291 00:22:18.839 --> 00:22:23.359 that we talked about now. In my mind, and certainly the way we're 292 00:22:23.359 --> 00:22:27.799 advising our members, is I still think it's a good idea to use a 293 00:22:27.839 --> 00:22:34.079 patient election to sell pay form, to double indemnify, so to speak, 294 00:22:34.119 --> 00:22:37.400 the fact that the patient says no, no, I don't want to use 295 00:22:37.440 --> 00:22:41.960 my insurance. I want to do this. The other thing that you can 296 00:22:41.000 --> 00:22:45.200 do if you're worried about this initial visit situation, I know I've talked about 297 00:22:45.240 --> 00:22:49.519 it in these trainings before, and certainly we have this in our library as 298 00:22:49.599 --> 00:22:53.680 well, is what we call the pre acceptance interview, that the pace, 299 00:22:53.960 --> 00:23:00.279 the way you manage new patients is that the patient comes in, they have 300 00:23:00.599 --> 00:23:04.240 a discussion with the doctor, that anybody can have a conversation, because we 301 00:23:04.240 --> 00:23:07.519 don't want to call it a free consultation, but they can come meet the 302 00:23:07.559 --> 00:23:12.039 doctor, talk about their issue, determine whether they're a good fit and because 303 00:23:12.160 --> 00:23:18.680 they're in now, you could give that more specific estimate of how much that 304 00:23:18.720 --> 00:23:22.440 first visit would be. I love all of those ideas. I think at 305 00:23:22.480 --> 00:23:26.000 this point it's about process, you know, and even those that work with 306 00:23:26.079 --> 00:23:30.200 us one on one, every different coach is working differently with every single person 307 00:23:30.240 --> 00:23:33.440 because we don't want to upset your apple cart of your practice that much. 308 00:23:33.440 --> 00:23:37.079 We want to make it so you do what you need to do, but 309 00:23:37.200 --> 00:23:41.200 it's not overboard. Catherine, thank you so much for joining us today. 310 00:23:41.319 --> 00:23:45.759 We appreciate your folks. Have a great day.