Billing: The 20% you need to know to manage the 80% With Will Humphreys

Yeah, we're, we're, you know, we're working into that to make it more and more valuable. We're looking to create specific trainings, but you understand how that goes. These, these entrepreneurial things are progressive. Right. Like, they're. They're a little bit of like. Okay, let's try that next time and keep going. So. Yes.

100.

I like your back. The wooden curtain thingy. That's cool. Yeah.

I usually try to hide more of my stuff behind, but now it's just sitting there.

Hey, guys. I haven't seen some of you for a while. Hi, Kristen. You're so far away from me.

Kristen's actually about 45 minutes away from me in Minnesota, so I'm closer right now. I'm in Warren. Oh, okay. I'm only like 30 minutes now.

Stop by the Q clothing shop when you're there. Oh, is there a cute one there? Used to be. I don't know if it's still there or not. I. I have a client at 9.

So I'll have to jump off a little early.

Hey, guys. Hey, Amanda.

Everyone. And you should.

Unmute and pop on and say hi. Yeah.

Hi.

So. I'm so sorry. Ang is our.

Virtual assistant that actually is with Will's company that started with us last week, Thursday, so.

Hello, Angela.

I don't know what's wrong with my camera right now. You're just fine.

My goodness, what a wonderful.

Wonderful group of people. Angelique, great to. Great to hear your voice again. Two days in a row. It's like Christmas.

Oh, my God.

For the rest of you that are on here, if you guys want to at least put in the comment section, you know, where you're from, your business type. So Will, I love that idea of who he's talking to and make sure you guys ask questions and all of that as we go through this as well.

Yeah. Thank you for that, Kara. Because I'm really looking for as much interactive information as you guys would like. I'm going to go through some. Some really cool stuff quickly so that we can get some Q and A because I've learned that's where the most value is. But I am going to set the stage with some. With some information there. So, yeah, really excited to get to see you guys and meet many of you. I've had a privilege of being here a few times. This is my second time, so just really honored to be back.

Make sure you have screen sharing and everything and.

You can go whenever you're ready.

All right, well, guys, who doesn't want to start their day talking about medical billing. I mean, come on, could there be a more exciting topic? You know, it's so funny. I'm going to start with a quick story. I want you to really imagine this. So I've been a PT practice owner since 2003. I sold my business in 2018 and I've been doing things to help the industry ever since. But the day I want you to know about is the day I'll never forget. So this was, this was December.

19, 20, 2012, and it was right before Christmas. Have you guys. As I know many of you are new in your practices, but it's a special time when you're a practice owner. It's super busy. Like, it's almost like the craziest time of the year. You've got all this work stuff going on as an entrepreneur and then you have the home stuff. I have four boys, all of which were under 10 years old at the time. And I was, the clinic was just hopping, just hopping. I had, you know, a team of four therapists. There was wall to wall patients. Christmas music was playing. It was just unreal. And it was one of those times as an owner where things are just going great, right? And then John, my part time, fractional CFO type guy, basically like a glorified bookkeeper, he walks onto the floor of the clinic and I can see in his face that already something's going on that I don't know about. And I'm just like, okay, you know. And John goes, hey, well, I need to talk to you off the floor. And so I'm in the middle of like, you know, two, three patients. I'm like, okay, well, let me get that settled. And so I walk off the floor. We have this office kind of off the main, the main gym, and so it's private. And he just looks like he just got hit by a truck. Like, he just looks really like, like he's struggling. And I go, john, what's going on, man? Are you okay? He's like, sit down. He goes, I really don't know how to tell you this. He goes, you have $5,000 left in your bank account and you have $20,000 in bills and payrolls next week. Which bills are you going to pay? How do you want to handle this? And all the energy left my sales immediately. That weight just hit me and I was just devastated. I remember just kind of figuring out like, what happened? How did I run out of all this money? And so John and I go through our, our financials and there were some indicators I had been ignoring for a while, like decreasing cash in my account. But I had this biller, let's, let's call her Amanda because her name was Amanda. And Amanda was very like.

You know, she was an in house biller. She was one that I know she was so good about, like no will. But the money's coming, I know where it is. This is going to be okay. This is. Because that's normal. I remember so many times having my bait. You know, over my years I had three in house solutions and two outsourced solutions and this was normal. There'd be huge dips in my cash flow. And that was what I was taught was normal after years of owning a practice and, and so turned out she was fraudulent. She was, she was sending me reports that were completely inaccurate because she was afraid of getting fired and she just was like banking on herself that she'd figure it out and she didn't. And so we got on the phone, I released her immediately. And now I need to find a biller. Like I don't even know what's out there. I don't know. It's retrievable. I have no idea. Payroll's coming up and to make things worse, we're leaving the next day to go to Idaho, where my wife is from, to go spend Christmas. And I don't have like any money and I don't have any gifts for my kids. And I'm in the car driving home at night because I left at night and I came home at night and it's, I just, I have a 45 minute drive through the Arizona desert and I could just hear the sound of the, the, the car alarm.

And this was common for me back when there were paper charts. I was driving home and I could hear the beep, beep, beep of my seatbelt alarm going off because there were so many charts next to me in the car. They were buckled in and my car thought there was a human being sitting next to me. That's how many charts there were.

And so I'm driving home and that's when I had this revelation that this was the opposite reason why I became an entrepreneur, right? Like the reason I became a PT entrepreneur in my case was to increase my income and my impact, but my freedom most of all. Not money's not my main driver, but freedom is. And this was the opposite. This was, this was completely like being incarcerated, but worse because it was my own creation. So I get home and this is where the story goes from bad to worse. I get home, it's super late. I'm just floored. I've got nothing left. And I walk in the door. My oldest son, who at the time was. Was, gosh, how old was he now? So he was 8. And I walk in, and he runs up. He was used to. He was playing with Skylander toys at the time. And he runs up, he's like, dad, dad, dad, look at this new Skylander I got. He's like, do you want to play with me? I said, oh, buddy, I'm so sorry. I can't. I'm. I'm not feeling very well. I'm going to go lay down. And as I was walking away, he said these words, and I'll never forget it. That's okay, dad. I'm sorry you're not feeling good again. Again.

Like, this wasn't the first time I've had this type of experience. And so I go lay down there, and I just start having this come to myself, realization around what it was that I wanted to do differently with my life and what it is that I wanted to become. So I want to set the stage from a place of, like, really understanding medical billing and, like, the impact of it and, like, how heavy it can be. Before I continue, I want to just briefly acknowledge Kara for giving me this platform to share this story with you guys. Kara has quickly become one of my favorite people in our industry. She has.

Our team over at Virtual Rockstar call her the quintessential entrepreneur. We literally had a conversation about her yesterday with all of our Filipinos. We've got, like, 40, and she's. We're talking about Kara, and she's like, she just gets back to you. She's got, like, 18 things going on, and she still is caring and responsive. So thank you so much, Kara, for. For letting me talk about this, because what we're really talking about here is a part of the business that none of us ever really wanted to sign up for medical billing. It's something that in my journey of eventually owning five locations, I mean, I really. I went from that stage with lots of coaching, and at the time, I had two locations. When this story occurred, I had two locations. And so I went. I reached out to him. There's. It's a very long story of how I recovered, but I want you to know that through the help of my network, I recovered. And through the. Through the help of great men and women who were. Some are paid, some were coaches, some were. But some were just wonderful human beings. I not only survived that episode, and it's actually kind of an interesting story how I did, but I overcame that, and that became one of my foundational tools that led me to finding someone by the name of Katie Archibald. Katie Archibald was my sixth solution. Katie came in and just saw the world differently. She saw it through the entrepreneur's eyes, which is I've come to learn one of the most valuable things that I look for in people I work with. And she just. Not only did she fix my billing and, like, save me, she did more than that. She empowered me. She said, will, this is a completely different business. Medical billing isn't something that you should even try to figure out all of it and stop feeling shameful that you don't know it all. Like, she's like, just stop. And then I learned from another mentor that we should outsource every single thing that we do that's not directly tied to our revenue. However, at this case, I'd already learned how to build that business with Katie because she came in and organized it. But the thing she did more than anything else, guys, is she taught me the 20% that I have to know as an entrepreneur to run my billing. I don't have to know 100% of it, but there's 20% of it that is key. And I'm going to teach that to you guys in 20 minutes today. So I really hope. First, I just want to thank all of you as well. Secondly, I want to thank all of you guys for being here, taking time out of your crazy schedules, trying to balance, like, 18 different things. But this isn't going to be just like a simple masterclass on, like, some. A couple of good tidbits, and you're doing 18 things at the same time. If you pay close attention to this, guys, this will revolutionize your business. And I'm not looking to sell you anything, like, at all, at all.

Katie and I, just for reference, we did start a medical billing company, but we're not taking clients. We've had a backlog. We have a year backlog. I wouldn't be able to. If anyone wanted to work with us, we wouldn't be able to take anyone. So Katie and I just. Quick story. I sold the business. Katie comes back. We start in the black. In the black is because I. I wanted to create an outsourced solution that would help people start, scale, and sell their businesses. And Katie just wants to work with. She's been in it for 30 years. She's not married, doesn't have kids. This is her baby. So we started in the black. And it's just been expanding so quickly that we stopped picking clients a year ago because we have a backlog of people that we're trying to work with, and we want to do it just one specific way. And so we're gratefully not nearly the biggest, but the best. And. And this is what led me to hiring virtual assistants overseas, which is what some of you know me for in that case. But at the end of the day, like, I'm just really passionate about helping people figure their businesses out because of how people serve me when I was back in that position all those years ago. So, please, thank you for, for introducing yourselves. Great to. To see all of you people from Texas. Peds Practices Mobile by design. Oh, I love that name. Jen. That is amazing.

Wow. So we've got Amanda, Melissa together. They live in Massachusetts. Thank you for being here. Yeah. And just so great to have everyone here. So let's, let's. I want you to be thinking about questions you have in your medical billing. Anything at all we can help with, because Katie taught me. I am actually not the medical billing expert, but from your perspective, I'm going to seem that way because I owned a practice. I had five locations, and then I went on to run, help run 26 locations. I did all of the recruiting. That was. That's my superpower. More so is recruiting. And honestly, this is. Before I transition to these billing things, I just want you to remember this one really big lesson in business, which is that all of our problems are solved by who, not how. So if you start right now, start programming yourself to think, okay, what problems do I have? And who are the. You know, stop thinking, how am I going to solve those? Go. Who's going to solve those for me? Or who can help me figure that out? You will grow exponentially with a fraction of the stress that I experienced. And so in the first. That's the second lesson. The first lesson. And I say this every time I go anywhere. Your network is your net worth. And you've probably heard some similarity of that. Guys, listen, I have four companies right now. I. I went from that guy who once went bankrupt to figuring out business at a level that I can operate however I want. And it's. Those are the two key principles I live and die off of. My oldest son asked me, he's like, dad, how do I be successful? I said, your network is your net worth. I mean, if you can get it tattooed on your back, that's how badly I want you to remember this. So when you spend time in these meetings, guys. And when you go to events and you talk to people, that is literally how you're going to overcome all pain. And you don't even. The crazy thing is you don't even know. Like, you don't have to go there with this mindset of like, well, I'm going there to get something. No, you go to give. Go to give. And then. And then the right people will literally show up right when you need them. Which sounds a little ethereal, but it's true. And any successful person I've ever worked with, I mean, I have friends who have companies that are worth over a billion dollars. No kidding. And they will live and die by this. So let's share screen and let's. Let's rock and roll with some medical billing fun and excitement, which I really believe it is, believe it or not. So let's go right into this slideshow. Karen, do you see this is. Okay.

Looks good.

Okay. The three fatal flaws in managing billing and collecting. What I used to be the CEO of In the Black. I am no longer. All right. Law number one. Feeling comfortable about billing. Billing. So this was what got me in trouble with Amanda, was that I was comfortable. I really. She. I believed her. I trusted her. I'm a very trusting individual, guys, and that has served me and not served me. I can trust people now as much as I want, as long as the data backs it up. So don't worry if you're looking at data and you know your billing's okay. Don't worry about this first step. But it's when we. We are blind about it, and you just go, well, I guess they're doing it, and I think it's good. That's when we can be in trouble. So are you 100% confident you're collecting every dollar you've earned? I can teach you how to do that. Inspect what you expect. So one of the biggest problems people have in our space is they just don't know how to inspect their billing. Right. Like, how do you even know we're going to talk about that today.

And lastly, know the 20% that helps you understand the 100% of your billing. So, yeah, that's what Katie did. She taught me how to. She basically taught me how to manage her so that if she got hit by a bus, I could. I could thrive. Not just survive. I would thrive. And that made her invaluable to me. Now we're business partners for four years. Like, crazy, right? Just unbelievable. Like, when people really care, the right leader and the Right Leader understands that they can do many things. So here's how you know if your medical biller is cutting some corners. There's a little article here I've put in there about this Mesa woman who went to jail. I'm from Phoenix, Arizona, and there's a local lady here who went to jail for stealing insurance company checks from her PT owner. And like the PTO owners had no idea because he wasn't inspecting anything. So what we want to look at is we always want to reconcile deposits against payments that are posted. And if you don't know what any of those words mean, don't worry, you should. A lot of what I'm going to show you, and I'm happy to send this pd, this presentation out, Kara, if you want. But like, you can present this to your, your medical biller and be like, yeah, can you reconcile the deposit against the payments posted? All we're basically saying here is what the bank shows versus what your biller's telling. You need to add up. It's a really simple process. They should do that. Any builder who can't do that is either stealing from you or shouldn't be in your position.

I laugh because of the pain from yesteryear. All right, number two, worst working denials. Watch for the write off. Worst case. So what billers do who stink is they, they will do the lowest. This is true. If you in house or outsource your billing.

They will, they won't do their job. And then when, when the money doesn't get collected, like the money that requires work, they just write it off. Which is, which is like. So for those of you who are like really new, the idea that like writing it off means it just goes away forever. So they didn't do anything to go get it. And then they tell you, oh, yeah, Will, you can't get this money, you have to write it off. And here's why most of us will believe that is because there are things in your billing that you have to write off. That's a common thing. But there is such a difference between writing off what you should be collecting versus writing off, which is uncollectible again. So this is something that I'll teach you kind of how to look for a little bit.

Saying everything is right on track. Look, medical billing is complicated. It is so complicated.

It's not that things can't be on track. Right? But that's someone who's always telling you that it's always on track is a huge indicator that they're cutting corners or Lying to you. Amanda told me for months, everything's fine. You're going to be okay. It was kind of like when you. If you've ever seen those movies where people get kidnapped and like, they tell the, the person they're kidnapping, oh, I'm going to take you somewhere safe and secure. We want to take you to a secure location where you'll be safe. They keep indicating over and over your, your security right before they kill you. It's like, that's like that. Where they're like, hey, everything's on track. Don't you worry your money's coming if they can't show you? Or like, Mike, Katie was constantly telling me, well, Medicare's got denials going, and here's what we're doing about it. Like, insurance companies are constantly making things out of thin air to make it hard for you. Get your money. And here's what I want you to really hear, guys. It's not by accident ever. I always kind of knew that as a PT owner, as someone who is a medical billing company, I promise you, those medical billing companies are literally making up and lying dishonestly to get you your money. That sounds a little negative, but think about it. Like, in today's world, you can say anything politically and you'll find somebody, right? You can say insurance companies are evil. And everyone goes, yeah, that's about right. Like, we just accept. We just accept that our insurance systems are so broken. But many people think they're broken by mistake. They are absolutely not. And when you own a medical billing company, it honestly, it like, it broke my trusting nature because I always kind of hoped that maybe they were kind of just inefficient. And it's not their fault. It is a hundred percent their fault. They literally make things up. So that's why your billers should be constantly like, hey, this is. This is a new problem coming up that I'm dealing with. So the best case scenario that I've ever seen when I've done an analysis of a larger company is a $10,000 loss in profit. The worst case scenario is people who've got. I've seen people who are losing hundreds of thousands of dollars who don't know it's. So this is. I'm going to teach you really quick now, guys, like, two things. We're looking at two things to help you manage your billing. The first is this thing called forecasted collections. So we should be looking forward our medical billing. We want to create a formula so that you can start predicting what you should be Collecting. So forecasting creates unparalleled accountability. It shifts the discussion from being reactive. 99% of all medical billing. Hope this might be all of you. You're looking at your practices, you're looking at this. If you even get a report from someone who's doing your billing, if you've outsourced your billing, it's really important. By the way, I'm painting the picture that like, there's no great outsourced companies. There's a lot of great ones out there now. I'm really a big, I'm so excited about this. But even great ones may not be doing this. And, and this is a great thing for you to just kind of bring up because it just makes it easier for you to manage. I'm really like excited about how many great companies are coming up, as a matter of fact. So. But having a forecasted collection allows you to look forward and go, okay, so we're in May. What should I get for June? I'm going to teach you how to calculate that. And with that, you're always, you're always going to be, you're not going to be reviewing just what happened. You do want to review what's called your trailing metrics, like your, your postmortem, your. Anything that's happened before. But most of the time that's, that's the only thing that's reviewed and it's incomplete picture. We want to see where we've been financially and like, understand the story. And then we want to be able to look forward and project what's coming. As all of you are visionaries, you're all, you're all business owners or leaders, your job, number one, is to look forward. That's your job, is to know, is to predict as best you can what's coming. That's your number one job, is to be a visionary. So that's, you do it with financials, right? So if you don't do that, then you find yourself in a position where you lose profits. And this is what it looks like. And this is so easy, guys, this is so easy. If you see a graph and you kind of go brain dead, stay with me because I promise this is super, super easy, guys. I read like the smallest books I can find with pictures. That's how my brain operates. And so that's how I manage my billing. Katie helped me create this. All you do is you look at what you, what you, you take the total number of visits you've seen the previous month. Okay? All of you should know how much you Collect per visit on average. Okay. If you don't, don't feel bad. Just go get that from your biller, your in house or outsource solution. Go. Yeah, what's my average collection per visit? Hopefully you know that if you don't go ask it. Take your total for June on the last day of May. You take the total number of visits in May and you multiply it by what your average collections is and that becomes your June forecasted amount. Okay, so here we have a blue line. And your biller should be able to create this very easy in Excel. And if not, I'd be happy to show you guys how to do it. But you, your biller every week should be measuring what they collect. Okay, that's the red line. So red is going to be the actual collections. You'll see this on this graph. Blue is what you're projecting and you can see that it went up. This line goes up just because every month it's a little bit different. So there's an adjustment week and then it flattens out for the rest of the month. And that's how you can. You have him graph it and in one second I can look and see how I'm doing. Look how easy that is. So here's what this graph, it's going to dip up and down this blue line. At best. That's not billing for you. If you're doing a good job with your billing, if your billing company is doing a great job, that red line will stay above the blue line consistently. And then what you do is you want to raise the blue line because you don't want to be collecting 120 of collections all the time. That means your average collections actually is actually higher than, than what you're thinking it is. But when that, so what helps is that like when that red line dips dramatically down for more than a week, you know already, and this should be, you should look at this every week, every single week. You just take a look at this graph and your biller produces this every week. And you look at it and you go, oh, okay, oh, it dipped down a week. No big deal. But you're waiting to hear the biller to be proactive. That's one of our company values in the black is to be proactive and say, hey, this is what's going on. If they're not, you show them the graph and go, hey, what's going on?

But you want a billing solution that is going to predict it. Now what I will tell you, we're the only billing company I know that does this, but this is what got us in trouble, is that I understand. I understand why a lot of really good billing companies don't provide this data. Because billing is so complicated. There are times where it's more than two weeks, where our collections are below expected. Like, we've had six weeks below, and it freaked out some of our partners. Like, freaked them out, because they're like, wait a minute, you're not doing your job. And like, no, no, we've been coming to you, telling you about this. We're the ones showing this to you, so we're not hiding anything, you know, so I can. That's why I think a lot of billing companies literally don't want to forecast for you, is because it does open a bit of a Pandora's box for people who get emotional pretty quick. And that's understandable. So. So how can you tell? So what do you do? Well, again, if they're the ones coming to you saying, here's the problem and here's what we're doing to fix it, first of all, that's a really big positive indicator, right, that they're proactively letting you know about it. Number two, you should keep asking about it until it makes sense. Right? Like, it's okay to go. Okay, Help me understand that. Yeah, that's really complicated. There are some situations where we've had clients just go, you know what? We just trust you. Once you develop trust with the company and it's. They. They've proven that they can collect well for you, you can let go a little bit. You don't have to. So there's a lot of. A lot of OTs and PTs I've learned are type A personalities hiding in the skin of a type B personality. And I'm one of them. Like, I seem like I'm really easygoing and fun, but if you go to my closet, all my shirts are in color order.

I'm just. That's just how I'm wired. So, like. So you have to kind of let go. You do have to, like, let go. If your. Your company's done really well for you, you got to be really tight when it's new. And then once they've done really well for you, you monitor this. And if they're the ones coming to you saying, hey, this is the problem and we're fixing it, and they're giving you weekly updates, and then I'll teach you these other things what to do, then you just gotta, you know, obviously you gotta trust it to a point. But the biggest indicator is always your. Your cash flow in your bank account. When that bank account goes less than 15% of what your standard, like, level is. And then you want to just keep bringing it up every week until you get it resolved. And. And I'll teach you how to do that as well. But this is the easiest way to monitor your billing right here. Forecasted collections. It's a week. It's a monthly meeting. You want to have a monthly meeting with your billing company for about. It doesn't have to be 60 minutes that you want to meet. You want to zoom or see that person every month. You want to look at the previous month's performance. That's what they all typically do. So I'm not spending a lot of time on historical reporting. I'm more concerned about forecasting anyway. You want to look at the story that they tell. If all you're getting is a piece of paper that says, here's what you collected, you. You want to ask for a meeting, have them tell you the story of what it was like to collect that money. You'll know what that. We know what I mean when I say that a story is like a whole series of people saying, yeah, here were the challenges. Here's what we did to overcome it. And you want to give people feedback. When I managed Katie or anything else, the best leaders who work with my billing company are the ones who are like, wow, you guys crushed over 100 of your collections. Thank you so much for doing a great job. It. It means so much to the right biller to get feedback from you guys. It really does. If they don't seem to care about your feedback, then they don't really care about your account.

And so you want to create that target in that monthly meeting for the next month, and then you want to monitor it every week. I have a feeling a lot of you are gonna. A lot of people you're working with are gonna be frustrated because we're going to be like, why are we. Why are we having to report this? But just remember, this is super easy to create. This is an Excel spreadsheet. It's a. It's. They should be tracking something already weekly. So this should be very easy for them to do. So number three, the big flaw, Reviewing the wrong stats. All right, so here's how it typically works. Most people just report. Most billing companies or billers will just report a percentage of your collections. Just like, hey, you know, we build out X amount. We only collected X amount. We're at 48% or 40% of what we build, that's good. This number to me means nothing. I don't even review it anymore. It's all I did for years to manage my billing. I don't even review it because that number can be manipulated. Don't feel bad if that's. If that's the only number you're looking at. It does serve a purpose. It does. It's just that when you're doing these other things, it becomes obsolete. So, you know, but the fault, the flaw was. That's all I was looking at. I was looking at that number and my total collections. And so literally one of my outsourced solutions, I remember, would you send me a monthly report on paper? And it just said, okay, here's how much we build and here's how much we collected. And I had no idea if that was good or bad. Like. Like, okay, I guess that's good because I'm paying them and they should be. I'm trusting them to tell me what to do, right?

So that's where I got in trouble. And then your collection per visit.

This is a compounded by contracts and network determine regional averages. So, like every. I've learned, man, we've worked with, you know, hundreds of companies over the years. So like in the state of Arizona, the average collection per visit varies by zip code. Sometimes, like, it's very hard to know exactly what your collection per visit should be.

But I will tell you that is probably the most stable of these three stats being percentage of collection, total collections, and collection per visit. So it's really important. I'm a big believer in making friends with the people nearby that other PT clinics or OT clinics near me and just being like, what do you get per visit? And then honestly, that helps me get a baseline of what, at least regionally, what we're collecting. And then that helps me go to my biller to figure out if what they're doing is accurate. But when you're doing that, when you're networking, you'll get that information that will help you figure that out. All right, so let's get into the real meat of it, and then we're going to wrap up.

This is the second thing that I really focus on when I'm measuring my billing. The first thing is forecasted collections, because that tells me in, you know, week to week, in real time, how I'm collecting versus what I'm supposed to be collecting. Right. The second thing I look at is accounts receivable. So this is a report, your AR report or accounts receivable. Is the, is the summary, if you think, if you think of a summary of all your patient accounts. So an accounts receivable are the accounts. An account is, is a.

Is represents every client. So like if you know, John Smith would be an account, right? John's plan of care and what we build for John and what we collected, that's an account. So all of your accounts or all of your patients receivable is all the money we're receiving or getting off of the patients that you're, you're treating. I'd like to speak, I'd like to like clearly define these words as we go because we just kind of blow and go in this industry. So for those of you who are brand new, I'm speaking to you like that's what the accounts receivable report is. It's a report that tells us what we're collecting money wise from every patient. Every patient represents an account.

So it's divided into various, I've seen divided a few different ways. Don't worry if it doesn't match up to this perfectly. But in General, there's a zero to 60 day bucket, meaning here's how much money we've collected in the last 60 days from today, the day that you pull that report, 60 days behind us, here's how much we've collected from patients 60 to 90, 90 to 120 and then greater 120.

So we want, and then there's a total number at the end, so there's a total number at the very end of this, that's how much money in total that we still have to collect. These are monies that we haven't collected, but we have to collect. So this is, think of it as like the debt that patients owe us. So in the last 60 days we collected.

Excuse me, sorry. In the last 60 days, we want the majority of what's owed to us in this first bucket. And that makes sense, right? Because we want the majority of the money that people owe us to be recent. We want it to be money that is just like patients who have been recently seen in the last one or two months. So if, let's say, let's say it's $100,000 for easy number. There's $100,000 that's owed to us in our company that we should be receiving. We want 80% of that or $80,000 to be in the first 60 days of the day that we pull this report because that means that our billers are doing a good job because that means they've collected most of the. Most of the patient visits that we've seen that go beyond 60 days. And so those are those buckets. You want 5% of that amount to be in that 60 to 90. You want to be 5% or less of that total amount in that 90 to 120, and you want 10% or less in that 120 bucket. And so when I look at my billing for a company, I look at their forecasted, and then when I look backwards, I look at their accounts receivable, what they should be collecting, and I look at what percentages are here. When you have a bad biller, that greater than 120 is going to be much higher than 20%. That's how you know you've got someone who's missing a lot because.

That'S somebody who's letting it, letting things go. Now, I will tell you, there are cases where I've had, even in my own company, clients above 20%, but there's very specific reasons, like, let's say a lean, a lawyer lien or workman's compensation. Workman's compensation and liens. I usually pull those out of this number completely because they are going to consistently be collected above 120 days. So I pull those numbers out and then I look at this number, these numbers just like this, to see how my accounts are. So in our billing company, we do red, yellow, green, red. We just. So when we report on this particular stat, we focus on the greater than 120. Red is anything above 22% or bigger than 22%, 23, 24. Anything bigger than 20, 22% is red. Yellow for us is 16 to 22, and green is anything less than 16, even though I see less than 10 here, because ultimately my average when I'm, you know, dealing with tens of millions of dollars every month, I want to make sure my team is staying within a very controllable amount. We're not losing anyone's money at less than 20%. And when we're less than 15%, they're getting it better than anyone else that they could build with. So that would be my second focus on your billing and collecting would be this right here. And so, yeah, let me see what else I have on the slides here.

Yeah, okay. I think that's all I want to present on right there. It's. I feel like I can definitely overwhelm as well. So I want to keep it really simple, guys, that you're, you're focusing billing. I want you to be forecasting your medical billing collections and Then retroactively, I want you to focus on your accounts receivable. And look at those buckets. Still look. You can go ahead and please still look at whatever they're. They're showing you, which is probably percentage of collections. You definitely want to know your average collection per visit, and you want to be looking at your bank totals and reconcile those against your. Your piece there. But it, it's. It's amazing because. Let me see here. So I've been doing a lot of talking. I was sharing the screen, so I didn't see if anyone has any questions.

Well, so a lot of people. Well, the. I'm looking. The majority of people in here are still doing their own billing. So when they, when they get started, we try to teach them to do their own billing so they know and understand everything before they transition.

Which is. Leads me to another thing. Like with your rockstar company, if you have virtual assistants that can assist in the billing process. So we have some people that utilize VAs to help with the billing process.

But we do have a couple people with billing companies or billing people that's not, you know, going the greatest as well. So. But I'd say the majority that are on currently are all still in the stage of doing it themselves.

Got it? Yeah. Thank you. Well, this is great because, you know, as you're doing it, I love that you guys do that, by the way. I've never heard of that. And it makes sense that you're at your size that you'd want to. To have your hands in it to a certain degree. So it seems like your. What your program does, Kara, is it helps them get their arms wrapped around in general, what their billing looks like.

Yeah, I love that.

We found that if therapists don't have a clue on what's going on and they offload it too quickly, then they get themselves in a little more trouble because they have no idea what's going on. So trying to get them to understand the basics.

Yeah, I love it. Well, I. So this was great. You guys have the basics in terms of the process of billing. What I showed you today is more about how to. How to overview your billing solution, whether it's in house or outsourced. And I see a ton of. Of questions here.

Let's look at. Can I explain it? I'm just kind of just pulled on the first one that caught my attention. Can you explain the difference between in house biller versus outsourcing difference? Benefits versus program pros, Cost difference. Okay, let's talk about in house versus outsourced cost benefits and that kind of thing. So there's.

When in doubt outsource. Outsourcing fees are going to be significantly higher. But that's the premium that you're if for the right company you it's okay to pay. What are typical premiums? Premiums range between 5% of what you call. So outsource would be, would mean a company that someone logs into your accounts and does all the A to Z billing for you. A to Z billing means everything from scrubbing the claim to reconciling the collections to fighting for denials to all that stuff. And so the, a typical fee for that will range between 5% of all your gross collections. And that's how it works. So again using a. If you made a hundred thousand dollars a year in collections, 5% of that would be five grand, right? So I've seen 5% all the way up to 10%.

The average falling right on 6%. Six and a half is typically what I see for that in the Black charge is 6%. I've seen companies charge. We used to charge 8% and we used to get that all day. But we just, it depends on what they're, what they're offering. But most companies are pretty standard. Doing A to Z billing. If you do it in house and you hire an American, you can bring it down to 4%. And if you hire someone overseas to do it for you, then you bring it down into that like 2% range. So it's, it's or less. And so the challenge here's, here's the benefits and the pros and the cons of in house versus outsourcing it. The benefit of outsourcing it, if done right, is that you completely don't have to think about it and you shouldn't. Right. Like they present, they're presenting the reporting to you. Like my clients, they don't worry about their billing. We show up once a, once a month. Usually they miss their, their calls because they don't care anymore. They've got other fires. But like they present the data to you, they're worried about it. The con is that it costs more. But honestly the other con is that there's there's more companies out there that aren't doing that then that say that they're doing that, that aren't and that's, that's hard. Although that's changing. I think things are getting better. The benefits of doing it in house is greater control of your billing but also less focus on, on your patient care. It's another Business, it's a. It's fine to do it in house, but you have to recognize it is a separate business.

But for many people, they like it. It's just. And I will say most, most private practitioners I work with maintain it in house when they find the right biller. Now that's the problem. That's the con. Is that your people dependent, not system dependent. Again, so if that person gets hit by a bus. I hate that analogy, but it's true. Like if that person goes away for any reason, then you're left to find a new person in your entire building. Collecting is at stake. So it just, it's. It's a. It's a hard thing to navigate. But that's why I'm a big believer in creating. If you do an in house solution to create some redundancies, and that's why maybe some virtual assistants might make sense, is that you could have a couple of people doing billing and one person who's also doing other things so that if one person's sick or hurt as you grow, you can do that.

Does hello Note do the correct reports? I'm sure they do.

I will. By the way, I had the privilege of meeting with the CEO of hello Note and he blew me away, that guy. Like, if they don't have some of this reporting, he'll bake it in. But I'm sure they're great. Do you know anyone that will just help with going back and checking to see all the money that I have missed out on? Oh, I've been there. I know for a fact that many mistakes have been made and it is too overwhelming when I go back and try to figure it out. Yeah, man, have I been there, Latasha. I've been there for sure. If you want to reach out to me directly, I'll see if one of my billers in their own time, she'll. They'll be expensive per hour. But I have people that might be able to help you. Honestly, they're so busy with what they have, they may not. But if. If that's the case, I would probably just ask. That's more of. You know what, Latasha, just reach out to me. Let's. Let's get on an email chain on that. Because if I don't have a builder that can help you right away, there are definitely people I know that, that can reach out and help you.

Han. Hey, Han. I love Han.

Can we get paid extra for the virtual assistant to get trained through your biller consultant? Yeah, well, I have somebody who can Paint. You can train your. If you hire a virtual rock star to do your billing, my billing team will train them.

And we're working out. It is for an extra fee and I'm still working that out. Han. But it's, it's. There'll be a one time fee and then they'll be fully trained. I feel bad like I've missed people's questions. You guys have been so good about interacting. I just talked at you for this long. Thank you so much for all these wonderful questions. You guys are what a great community.

For small businesses. Would you recommend having an in house bill or outsourced? I think you could do. I think either way works. I will tell you that like if you're really small outsourcing it is really hard for to find someone because I know most, a lot of medical billing companies, they don't take certain companies that are small. It takes just as much work to onboard you as it does a five location company. And that five location company makes them tens of thousands of dollars a month. So it's really. If you can find a company that wants to take you on, great. And just make sure they don't deprioritize you because you're small. So my, you know what I'm working on with the virtual assistant space is I, I don't have it figured out yet. So don't. Hey, will I want that yet? Because I'm really big on being integris but I'm working with Kara on figuring out the perfect like combination of virtual assistant to help you guys. Because I, I think if I could create a, my dream would be for, for a new business owner to hire one virtual assistant who does all of their billing answers, all their phones, does all the insurance verification and authorization and even some marketing for you. And then my dream is that that person becomes the boss of other virtual assistants that do those things independently as you grow. Because scaling was so hard for me, I'm working hard with Kara to figure out like what's a, what's an easy way to get like to start a practice and then go to your second location like if you want. Like just to that point where we have. Because when you do virtual assistants you save so much money of course. And I'm working hard on my end to create the training so that I'm training them for you. That would be magic for me if I could create a system where we're training them for you. We can't train them 100% for you because you know you've got to you've got to help them in your specific region with things that I don't know. But like I can train a biller. I've hired hundreds of billers over the years overseas, like directly, not through another company, through me, myself. And so I'm very excited about being able to provide that at some point if you guys are interested in doing that. We do have clients who do use virtual assistants for billers and I'm happy to do that with you. We just don't have that like one person who does all those things. Oh, Han had a really good comment earlier about 20 minutes ago. Sorry, Han. I only see Medicare and bill out of network for Med Advantage. Everyone else gets a super bill if they want to submit. Okay, cool. I build myself. My questions about billing are number one. When a claim comes back as duplicate but you didn't get paid for that claim, what do you do? When I bill it again? It says duplicate again. So this is a very specific billing question on. I'm going to put you in touch. If you'll email me these. I'll put you in touch with my biller. I don't want to. When it comes to the actual processes of billing. Like I said, I'm not the billing expert. That would be my partner. What is the process to fight a claim? I can tell you in general that I'm going to send that to Katie as well. Is it possible to get rid of the patient to come every day? Is it impossible to get the patient to come every day to see PT not has separate days. Sometimes we are supposed to put on a 59 modifier and you have a system to audit to follow up with unpaid claims. We do. So send those questions over to me, Han, and I'll make sure Katie answers those.

All right. You guys are clearly doing a lot of your own billing. I think it's great that you're. You're starting with it because obviously your. Your understanding of the billing process is super advanced compared to even owners I know that have 10 locations sometimes.

Well, can you create a billing company just for the therapy Business Builder program? I. That's what I'm doing with the virtual assistants. Like I want to create it to where it's not a company, but like an if I can hire and train your biller for you, that's like the ideal scene. So the reason I'm not super promoting the billing thing is because if I open the door, I know I'm going to get 30 people wanting a. Which is great business, by the way, but like they want. I'm going to get 30 plus people saying, hey, I want a biller tomorrow and I'm not built to do the training for that yet. So you can hire a biller from me immediately and I'll find someone who's got great experience. If you guys are like, hey, I want a virtual assistant to do my billing, let me know, I will go find you a great medical biller and I'll provide some support in that. I can't do all of their training for that massive amount. So like Han saying, hey, let me know. I'd be great. I can work in building in that training system but I can't do it all for you guys yet. So if you're decent at billing and you go, if you want to start with a virtual assistant, let me know. And especially if you're already doing your own billing, that's an easier transition because you're not like taking your hands off completely. You'll transition that biller in. That might be a great fit.

All right, cool. Yeah, hon. Let's work together. Michelle, is there a clear standard? Michelle says, is there a clear standard expectation of projected payments for 20% after Medicare pays? Yeah, I know that seems random, right? But it is fairly common. It is, it is actually very clear and expected. Like when Medicare, Medicare, it's in like what their contracts, it's like they pay 80. They paid 80% and that's why we have all these other insurances as supplement of.

Very good questions, you guys. Honestly, I mean this, you guys are advanced in the billing space because of what care has done with you guys. You guys doing your own billing and stuff. Your questions, I guess I talked to, I talked to groups of owners who have. I have this one client who has over 50 locations and he knows these types of questions really well, but he's like the only other person I get these questions from.

Most definitely. I'm going to put my email address in for everybody who wants to reach out. I have some people reaching out individual, individually. So here's my email. I'm going to give you guys my, my. I have different companies and different emails. I'm going to give you. This is my central email.

Michelle, I'd love to work with you as well. For sure. Just reach out to me, please reach out.

This has been so fun, you guys. Who would have thought? Medical billing, woohoo. I think what's fun about it is that it's incredibly complicated. It is. But we, if we can empower with knowledge, we can get power to like navigate the Waters. And so I want to tell you guys the end of my story. It's kind of cool because it's almost the end of the hour. I never told you the end of my story about that guy who's driving with the charts and the seat next to him and the kid and all these things. So Katie comes in, she fixes my billing, right? She takes me to a new, different level. We go to five locations. I decided to sell my practice because, honestly, guys, I was bored. I was legitimately like, okay, I work 10 hours a week, and all I do is recruiting. I want to serve the industry. It was. It was a combination of being super driven to help the industry, but also feeling like my other. When you have five locations, the next choice is to go to 10. And that just didn't seem fun to me at all. And fun is one of my main filters. And so I thought, you know, I'd rather do things to help the industry. And so I went to go. I sold in a totally different way. This is why it's so cool that you guys are all together. Like, in 10 years, you guys could do this. But I called my friends in Arizona, and I was like, hey, what if we sold together? Like, instead of being bought, what if you. What if we all came together and said, hey, we've got 26 locations? And we went to sell. So we did. And we were shocked because it worked. I called four of my buddies. We had 26 locations. We went to market. We didn't merge anything before we sold. We just told them, if you buy us, we'll merge. And by the way, that almost bankrupted us. So I fixed that problem too, elsewhere. But, um, we. We ended up getting purchased. And so my company was evaluated against my friends companies. My company was the third biggest. It was smaller by patient visits and locations compared to two of my other friends, okay? But I got paid more than anyone else when I got bought out. And do you know why? Because of my net profits. I was making more. I was collecting more than all my friends. And there were some other things involved. It wasn't just Katie, but my medical billing was a big part of it. And so it was kind of cool, right? Like, I went from just like, not having any control to, like, coaching my kids teams and like, having that balance. And I think that's the point of the story, guys, is that with. With this kind of knowledge, you get power and control. And that's fun because you only have to learn it once, right? And then once you learn it, you know it. And it might be a headache from time to time, but you. You have control of it. What you can control, you can start using to predict where you want to go, and so then you can kind of determine where you want to go from here. So I love that.

All right, guys. Well.

I'm really grateful for all of you. It's been such a treat to. To have this time with you. This is honestly rapidly becoming the most fun I have when I speak because of just the. The general intelligence level looking at all of these people. So do something really. I have. I have a special request actually, before I leave. I hope that's okay. This is a. This is actual favor I want from you guys. So my birthday is this Saturday, and that's. It's not about me, like, when I. But I do this, I do this with my teams, and I would actually like to invite you guys to do this as well. You have my email on. My birthday is June 1st. I think that you guys. And I'm getting, like, a little emotional I'm even thinking about this, but you guys do so much for other people, and you. You rarely take care of yourselves. Like, you guys hardly ever do anything for yourselves. So I'm asking you on a Saturday to do something just for you. Whether that's like buying yourself something or doing something to take care of yourself. Like, if you. If you're, like, getting your nails done or. Or. And that's not a sexist comment, by the way, me and my wife get pedicures. It's like one of our favorite date nights. Like, whatever it is that you do that represents something that. That you do for you. And then if you would share that with me, that's like the coolest gift I could ever get. If you have my email there, if you want to. You don't have to, by the way, but if you do share it with me, that would mean a lot to me because what you guys do every day makes such a difference. And you guys oftentimes don't know it because you're running so ragged. So just. Last comment. Thank you. Thank you. From someone who's been there, who can see in the rearview mirror what kind of difference you're making in the lives of your patients and in your family and just never give up. Never give up, guys. That's it. The only way to lose. The only way to lose in this game of business is to give up. So just never give up. It gets better so much. So many great things are coming as long as you keep networking. So, Kara, thank you I appreciate your time today.

Thank you. Appreciate it. We'll see you guys all at four for our next training today, if you're around. So thanks.

Have a wonderful day, guys. We'll see you.