The Blueprint for Growing a Successful Rehab Practice with Heather and Katie

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Hey there, rock stars. Welcome back to another episode. Today we have Heather and Katie from in the Black Billing. They are a medical billing company that hyper specializes in the physical therapy space. But we're going to talk about today is understanding the state of the union of all things healthcare insurance. We're going to talk about the recent murder of the CEO of UnitedHealthcare. We're going to talk about the changes that are occurring with AI. We're going to talk about in House versus Outsourced Solutions. We're going to talk about the commoditization of physical therapy as well as the medical billing industry. It's going to be a phenomenal episode. So for any of you who are looking future of your company and want to understand better the medical billing space, this episode is absolutely for you. Enjoy the show. Heather and Katie, let's go through like a state of the union on how insurances are operating now in 2025. How are things going from what you see as medical billing experts? What's going on now that's different.

I would say that in my 20 years of working in billing, I've noticed that it has gotten way more regulated. Way more plans are requiring auth. They're not authorization. They're not approving the authorization. They're making more hoops to jump through while also paying less. So.

So they're paying less. They're making it super hard to make money. Heather, is that your experience as well?

Yeah, they're. They're making it hard to. Yeah. Get the claims paid so that they don't have to, you know, they have to pay them.

Yeah, that's. So that feels super unethical to me.

Yeah, right.

Why is that happening? I mean, it sounds like a stupid question, but I feel like I kind of have to ask it as you guys are the professionals. Like, is there a need for it or why are they doing that?

They, to me, they really just don't want to pay claims. And they've always like trained their people to not pay claims, to deny the claims, and they've just come up with more and more ways of not paying. And I mean, there's even a rumor going around they're using AI to deny claims. So it's just not even training people to do it anymore. It's just us automatically denying and hoping that people aren't going to come along, find that they denied it in error and fix it.

That makes me super upset. Like, that just seems like it's so intentionally wrong to deny people their money just because it makes Them more money. How does this negatively impact the patients?

I mean, they don't get the care that they need, they're going to end up needing surgery, they're going to end up immobile. Like, it impacts them severely. Like just their quality of life.

Yeah, that is really hard. Heather, thoughts on that?

Yeah, I'm just pondering on it. Yeah, I feel like it, it makes it. Yeah, it makes it hard for them to get the treatment that they need, for sure. You know, I feel like too, like with, with everything that they're denying and the AI and everything, I feel like it's just.

I, I can't. I, I can't come up with the words, but trying to think of.

Yeah, well, keep thinking on it. I think for me, it's. When I hear this, I get really upset. It really irritates me that this is what's happening because, you know, having been a PT practice owner all those years, I knew it was wrong, you know, But I also felt, I feel, I feel like that what they do is they put a lot of blame on the providers. I always felt guilty because I never felt like I could meet all the standards. I met someone by the name of Helene Fearon once, who's this physical therapy guru and an amazing woman. And she once told me, she goes, hey, Will, no one can be 100% Medicare compliant. And what really got me about that was that my training in PT school was if I'm not Medicare compliant, then I'm committing federal fraud. I am going, I am breaking like all. Not just like my ethics, I'm also becoming.

Prison worthy. Like, I'm just. It makes me a felon. It makes me so mad because I. For years I would lose sleep like crap. Did I bill that correctly? Did I? And what it. What ended up happening was I was under billing because I wasn't gonna. I wasn't willing to sacrifice my ethics. And then later, as a PT owner, I would find that I would bring people in to work with me and they were chronically under billing. And when I learned how to bill correctly, they thought I was being unethical. So. Yeah, from you guys being in the billing perspective, you guys really have a different kind of passion to, I don't want to say stick it to the insurance companies, but like, to really fight these things. Katie, where did that come from for you?

It came from my first job in the billing industry. So I was appalled. I had never done anything having to do with insurance. I'd never even had my own insurance at the time. I was in my early 20s and I was appalled when I started working in the physical therapy billing space at how little the insurance is paid and how much they fought it.

Yeah.

And I was like, these patients need the care. And I very soon saw that physical therapists, they have a bleeding heart. Like they're in the industry to help the patient. And so even if they know the insurance isn't going to pay, they're going to treat the patient because they care. Seeing that they're putting their all into it and the insurance is just denying, just to deny. I mean, it really fought against my sense of justice. And I was like, I can't let this continue to happen.

So I love that sense of justice that you have too. It's something that, when I met you, it was something that was very evident. But I didn't learn about the roots of that until later because you have a long standing passion for the underdog, overcoming the suppressive forces out there. Tell us a little bit about where that came from.

Well, I would say it just came from the way I was brought up. And, and just my parents are two of the most honest, integrous people you'll ever meet. To the point where my mom would over pump on the gas station for 5 cents and bring it into the gas station and they would be like, what are you doing? So they were just so honest. And so there was just always this sense of justice and. Right. And to see people literally being robbed. I mean, I just, I can't just sit back and watch it.

Yeah, for sure. And you have this incredible passion for American history. Your family has the most passion for American history that I've ever seen. You guys have celebrate 4th of July probably better than Christmas, right?

Oh, yeah. We have a very big 4th of July party every year to where my nieces and nephews are excited in the way they're excited for Christmas. Like, can you believe it's the 4th of July tomorrow? So we have a big celebration. We even have a citizenship quiz that we administer at our parties just to.

That tells you something. You're administering citizenship quizzes at your fourth of July family parties. I love that. Yeah.

Cause it's just to me, the privilege of being an American, born an American was so huge to me. And I got to this point where I realized that people in America tend to take it for granted. And I thought, could I pass a citizenship quiz? And that's kind of where that came from. And so we study, we learn, and it's like, oh, are you ready for the test? So I don't know.

Well, it's about taking that membership of our country so seriously and not taking it for granted. I think the biggest way people can learn about how grateful they should be to be able Americans is to travel. I've been to almost 40 countries and some of them are like, even Switzerland. Not just poor countries like Mozambique, but like Switzerland, where they have. Everything is like streets of gold and clean and beautiful mountains. There are. When you're in it, you're like, this still isn't America. And I can go through those reasons. But do you feel like there's a connection between your passion for, you know, the American Revolution and this thing called fighting insurances?

For sure. And it all boils down to our purpose, which is to help our customers create life, liberty and happiness. Yeah, that's in the Declaration of Independence. It's what America is about. Like, we have the liberty, the freedom to create life and liberty and happiness in any way we see fit. And a lot of people do not have that. Everyone calls it the American dream. And we can decide what we want to do, where we want to do it. And so when I see this life, liberty and happiness being taken away from not only the PT owners, but the patients, it just, it's. It goes against the American way.

It really does. And so it's funny because I always make the joke that in today's world, politically, you can't say anything without offending a certain group of people. Like, we've gotten to that point as a country, we've always had a difference of opinion. It's part of what's made us great with different points of view. But we've gotten so tribal and there's so many, like, classifications now of political. But it really is like two sides. It's kind of how it feels. So if you say one thing, you're going to offend somebody, but you can say insurance companies are evil, like something really heavy. And people go, yeah, that's about right. And so I want. I don't want to vilify the individuals within these companies. I think we're talking about the system. Right. But would you say that the insurance company systems are broken? Seems too light, evil. Seems too religious. Like, how would you classify the insurance systems that we have in the United States? How would you describe them in terms of, like, their effectiveness or ineffectiveness?

I would have to say they are very ineffective in the purpose of them. The purpose of insurance is that when you have a problem, a physical ailment, you can get the help that you need and you're paying your premiums every month. And then when you go to get the help and actually use that, you don't have it available to you. You can't get the help that you need. So to me, it's. It's for sure completely broken in my mind. And just to me, every single time we fight a claim and get it paid, we're fighting back against that. And when I was working for various companies.

I was like, I think my reach needs to be bigger because I could help this individual company. But there were so many PT practice owners who went to school to treat patients. That's their passion. And they were getting bogged down by billing, almost going out of business. Whether it's a biller that didn't know how to fight the insurance companies or one who was just kind of dishonest and not really doing it right. And so that's my way of fighting back, because it is. It's a broken system, and people aren't able to get the care they need, even though they're paying super high premiums in order to have that protection.

Yeah. You know, it feels almost like this David and Goliath kind of fight, right? Like, where you just have these. These big insurance companies with all their money and their insurance. Why do you like fighting it, Heather? What do you get out of that?

It's just. It's satisfying to be able to see, hey, you know what? Like, they deny for these crazy reasons. You turn around, you get it paid, and you're fighting for that bottom dollar for that provider. You know, like they're. They're putting their heart and soul into their passion of helping these, you know, these.

These patients and getting better and everything. And it's like, you don't want them to have to worry about their. Their money, you know, and they're. And getting paid for what they're doing. You know, you want them to worry about the care of the patient, and you want to be able to fight for that. And so whenever insurance companies are sitting there denying everything, it's like, you know, you want someone who can actually fight back for you. You know, while. While you're doing your passion, you know, you're. You're taking care of those patients. So, I don't know, it's. It's a passion for me because it's like, I want to be able to help those PT because they deserve it. Those PTs, you know, they put their heart and their soul into treating those patients and getting them better, you know, their quality of life. And they shouldn't have to worry about, you know, these insurance companies and not getting what, you know, what they deserve in return.

Yeah, I love that. And so, Rockstars, as you're listening to this, the thing I want you to really listen to is the, the influence that the insurance companies have, the system. Again, I want to be really careful not to vilify people because when you do that, you start having these things happen. Like when the CEO of UnitedHealthcare gets murdered. Like, I think that is such a misplaced. There was all, I mean, the stuff online on that was, was shocking to me how people were supportive of that. And you know, it was kind of like this attitude, like, well, of course it's bad, but at the same time, you know, this is what they get or something. Or they said it's like, no, no, that is a. That's wrong for wrong. That is wrong for wrong.

On that note, I have worked places where the billing manager was like, wanting people to rip into the insurance reps and encouraging them to just rip into them because they're.

Oh, treat them badly.

Yeah, treat them bad to the point where people that work there were getting in trouble if they weren't. But to my mind, they aren't the problem. And these are just human beings trying.

To get a bill. Yeah.

Like one of our other, one of our cultural values is kindness matters. And that is 100% true. Even when dealing with the insurance companies, you can fight back in a kind way and get the claims paid. And so, yeah, that United Healthcare thing just really got me because, I mean, we're out there fighting every day. We know what the battle's about. But to have it driven that far and so many people agreeing with that, I just, I couldn't.

Yeah, it's making it wrong. It's a wrong for wrong. And it's. There's a line that crosses a line that's not acceptable. It makes me think of like Jesus or Martin Luther King in terms of how they approach things. Martin Luther King's a fun one to look at because here he is leading a group of people that are being oppressed. And what does he do? There's, well, there's other people who are leading aggressive counter movements to like, make their voices heard. And by the way, I'm not judging that. What I'm saying is the most effective person was the person who peacefully marched up on Washington leveraging kindness with firmness, with equality of mind. And that's what made the change. And it's well started to make the change right, because we're still Making it. But it's one of those things where when it comes to insurance companies, I think we got to realize, number one, that it is wrong. Because PT owners, again, rock stars. As you're listening to this, I think we talk about how the physical therapy industry in particular really doesn't understand money. How we view money as like this evil thing. It's like, no, it's just money. It's actually just a tool, and it can be useful or not useful. And there's a system in place that's meant to prevent you from getting what's lawfully and ethically yours. But the way that the insurance company systems are intentionally created is to make it to where we as Practice owners, or PTs, feel guilty because we can't jump through all the hoops. And it's actually created to where, like Helene Fearon said, it's impossible to be 100% compliant. Now, does that mean we should be fraudulent? No. But the point is that instead of, like, pts, like seeing more patients and trying to figure out how to recruit better, we should be banding together with billing experts like you to fight the system through love and peace and kindness matters. Meekness isn't weakness. It's the lack of communication and effort that's causing a problem here. And I think that as we're talking about this, it just gets me really clear because it's. You guys are on the front lines. I think of billing people, whether it's an outsourced or in house company, as the frontline warriors against this broken system that is causing the majority of all of our problems in physical therapy. If we got paid what we were owed, we could recruit easier, we could scale better, we could save the system money because they're not getting opiates. So with all that being said, you guys are obviously very passionate. I think that was one of the things that surprised me when you started working together was this idea that, like, you guys would get together and go, I got reimbursed from Aetna. Heck yeah. Everyone's like, hooray. And I'm like, I never saw that side of it. On the PT side, I just saw this outsourced billing company that was like, I always wondered if they were doing their job right. So let's get into that. PT owners right now are fighting this fight. They have to make the decision, do they go in house? Do they go outsourced? You guys are an outsourced billing company. I will tell you very directly, I was raised in a network of PT owners that were like, dude, you Never want to outsource. Why do you guys think people say that?

Because they've probably seen people who've been burned and they feel like it's more out of their hands and they can't control it as well.

Yeah. So it's true.

I think that's the fear is they don't know who's working their billing. They don't have control over who's hired for it. So I think that just scares them.

Yeah.

But to my mind.

Yeah. Why do you think make a plea for why they should bring it out or why they should send it outsourced?

To my mind is you're gonna have all the tools that you need to fight those claims and to get every claim paid with less worry on your plate. You don't have to worry about hiring the billers, finding high quality billers, because if you don't know billing, how do you hire high quality billers? So just putting it in the hands of people who have been doing it for me 20 years, Heather, 16 years.

I just think it takes more off your plate and makes it so you can do what you're passionate about. And with in the Black, I'm just specifically because that's my company, we give the PT owners what they need to hold us accountable. And you don't always get that. Probably almost never in an in house solution. It's just kind of this vague, mysterious thing, am I collecting what I should be collecting? But we try to make it easier for them to hold us accountable.

So accountability is a big part of this journey. But I will tell you, it's cheaper, isn't it, to do it in house?

Heather's hesitating on the cheaper side because that's a big thing of it. People are going to pay anywhere between 4 and a half to 10% for their outsourcing of their gross collection. So I can bring it in house for two and a half percent. So when you're saying you're hesitating on them, what do you mean?

I think yes and no. Because if you hire someone who doesn't have that knowledge behind it, you may not be getting what you really could be getting, you know, so there you could be collecting more if you have someone who's got a lot of knowledge and like background in that versus hiring, hoping that that one person or that couple people that you have has that knowledge to fight all those clothes claims and you know. Yeah, that way.

So I love it. Let me ask you this. Is there situations where it does make sense to bring it in house?

I don't know.

I can't think of a situation why it would make more sense.

I mean, interesting. You know, it's. You know, transparently I'm going to do this in the introduction. I'm going to reveal that I'm one of the owners of in the Black, right? And the reason I'm being so aggressive on this is because it is my company. So I want the audience to get a really balanced shake on that. And so for what I tell people, for me, when I talk about, like, in house or outsourced is the number one thing that I was taught by a mentor was that we should outsource every single part of our business that's not core to what generates revenue, because anything else is a separate business. So there are men and women who have clinics that have gone through the effort to build that business, and they have it under. Under steady state. I think that's great. I actually think those are people who probably should never outsource because they've already done the heavy lifting and they have people who are managing it and seeing it. But most people, and I mean the vast majority of people that I come up against, especially new clinics, there is no world where I see it makes sense personally. And again, I'm sharing my bias with the audience because I don't want them to feel like I'm like, you know, playing the devil's advocate just for fun. I want to create a balanced piece there. But, like, starting out with a new practice, there's so much. So there's so much complexity around that, but there are a lot of companies that don't do great. To be honest, the reason we started in the Black, Katie, was because I didn't feel like there was a single company at the time that produced it. So, like, again, what do you think when we talk about being burned? Where do. Where do billing companies burn people? Like, what is the thing that gave that reputation what it is?

I think it's just there's no transparency. They can't see what's going on with their billing. They don't get any communication from the billing team, and they just have this vague sense that they're losing money, but they don't really know for sure. And I think that's why they get so scared of it, is because they don't have as much control over it. And so when they just have a vague sense they're losing money or know for sure they're losing money because their bank account is draining.

Then they. They feel like they should keep it in House because they have more control.

Yeah. And I think there's elements of truth to that because transparently you and I met because you were my in house solution. I had gone through three outsourced solutions and it was always like I never felt like they were going for the low hanging fruit. And so we, you came in, kind of countered this whole argument and like became the in house solution. But you were my third in house solution. The two people I'd hired before you almost bankrupted me because when the outsourced at least provided some reliable degree of consistency, even though it sucked, the in house solutions I had more control over. Or so I thought. It was. So people dependent that one lady was, was, was lying to me and she applied later to our company in the Black. So it was funny just because like that wasn't funny at the time that created the single worst moment of my career was when we almost went bankrupt because she had been falsifying reports and our money was just disappearing. So when we went to create this company, that was the idea. But you and I always had a passion about wanting to help the small guy. That was always where we wanted to go. Where did that come from?

It came from my experience. I think I worked for four or five different physical therapy companies before working with you and starting in the Black. And each time that I went to a new place, I saw these people who were struggling and there was literally tens of thousands, sometimes hundreds of thousands of dollars just left sitting on the table. And I would see people who had tried to start this company and they were just struggling and struggling and they couldn't get ahead and they couldn't grow, they didn't have the money to grow. And so what I thought was, well, if we start a company then we can help these people that they went to school, they want to start a practice, but they're going to get stopped in starting that practice by not having a good billing solution. Just like you said, it's so complicated with the contracts in the beginning and you have to be right on those insurance companies watching those to make sure they're processing correctly, making sure everything in the system is set up properly to begin with. So helping someone get started on the right foot, they don't have to go through those pains of almost going out of business as they're trying to start their business and they can just focus on growth and their passion of doing what they love, which is treating the patients.

Yeah. And it's something, so there's almost something romantic about helping somebody get to that million Dollar mark. When a pt, it's not the age, but it's the stage of a business. When a PT gets, or any business owner gets to that million dollar mark, they're kind of at the beginning of really being a business owner because up until that point you're hustling and there's so much more complexity. It's like having a rowboat in the ocean. It doesn't take a lot of wave for it to rock. So from a billion collecting perspective, that's so romantic. The problem is that not a lot of medical billing companies will take smaller practices. Here's the journey that I've noticed in my coaching. And again, I'm really open to people using in house or outsourced solutions because I've seen people who've already gone through the effort and some people are just controlling in a way where it doesn't matter if it's more efficient, they just want to own it. And that's great, I think that's fine. But normally what happens is PTs start, they usually try to outsource because it's too crazy to begin. Then they realize that they're getting burned when they hit closer to that million dollar mark. So then they try to bring it in house and that becomes a whole new journey of nightmare, which I experience personally. But the ironic thing is sometimes companies figure it out, sometimes they keep it outsourced with a better company. But no matter what, when they get really, really big, they all outsource. I've noticed that. So I do have friends who have like 30, 40 clinics. They still have in house solutions. I'm talking bigger than that. Our company Empower, for example. You were the in house person that like merged 26 locations. Katie. But then eventually, over time they ended up outsourcing it because there's degrees of efficiency of just not having to focus on that, on your business. So at the end of the day, the small practices need it the most, but they don't usually qualify for billing companies. Heather, why is that? Why do a lot of billing companies not work with smaller PT practices?

I think maybe it's because of the profit that they would make off of it.

Maybe, you know, actually lose money on it.

Pretty much lose money. Yeah, exactly.

Yeah. Because it doesn't matter. Even if you're charging 10%. 10% of 200,000 a year is, you know, it's a very small margin between like 4 and a half to 10%. So with small guys, girls shouldn't even care about that. Yeah.

And because technically in the beginning it takes More work. It takes more work on the billing side to get a company up and going because there's so many complexities in working out the kinks of the contracts that they just created and working out the kinks in the system. So there's more work and not a lot of reimbursement. And yet that's always been my passion and what I've wanted to do. So it's kind of been like a hard thing.

Hey, Rockstars. Are you having a challenging time recruiting, retaining or training your people? Then, man, am I excited to tell you about the Rockstar Summit, guys. This is my personal event that we are launching on March 1st and 2nd. It is going to be two full days of nothing but workshops on how to solve recruiting, training and retaining problems. It's very heavy on the recruiting side. We're going to show you where to find candidates that no one else is accessing so that you can get a leg up in the industry and grow the business that you deserve. So again, that's March 1st and 2nd. Please go to www.rockstar-summit.com to learn all about the details. I will be there in person teaching some of the classes. But we have experts from across the country coming as well. You do not want to miss it. I hope to see you there. I think the problem is that in the medical billing space, they suffer very similar in the way that the physical therapy practices do. And it's both because they're insurances. They're based on medical insurance reimbursement. If the billing company is tied to the reimbursement of the PT practice and the PT practice doesn't have great margins, well, guess what? Billing companies don't have great margins. I don't know why I didn't research that before we started this company, but I was like. Because really what it was was, Katie, I knew you would do better than anything else that was out there. So that's why I wanted to build this with you. Because it was like, Katie's going to do it right, and you have. And it was a shocker when I realized, wow, these are thin margins. These are not high, profitable margins. And it makes sense because we're tied to them. So it's just interesting to me to think about how the billing companies as an industry have become what they are for the same reason the PT companies have become what they are. I think most PT billing companies or any medical billing company usually starts with a really good heart in place. I think they intend to do really well. But the margins are so poor that they end up doing the same thing that pts will tend to do, which is like just fit in more patients. Well, what do billers do? They'll tend to outsource their billing to maybe overseas, not people. I have no problem against outsourcing overseas to individuals, but other companies overseas where the owner and maybe the PT billing company owner doesn't even know who's working the account. Right. Where do you see industry wide. That was my opinion of where we've gone off as a PT billing company industry. Where do you think the pro. What other problems do you see in the industry with other companies?

Honestly, I think it's. And I know this is going to sound like me just wanting to make more money.

You promoting in the blackout?

No, like when people charge less. Like someone's charging four, four and a half percent. That's all well and good until the money's not coming in the door because they can't afford to pay quality people to do the work. So I think that's one of the ways where I see it go off. And I'm, I mean, I just. That's a literal truth because we've struggled with the recruiting and finding good people. And if you're starting a new company out a new PT practice and you're charging four, four and a half percent, how do you put in the quality work that needs to be done to get them up and going?

I couldn't agree more. Heather. Thoughts?

No, for sure. Quality. I feel like you lose that quality when you, you know, are lower in your percentage there. You know, I feel like you get what you pay for. I guess you can say, yeah, you.

Know, it's so true. But don't think that way because they're, why they're thinking, well, I've got this thin margin already. Why would I pay more for a billing company? And it's so true that there's a. In economics, we call this the race to zero, the race to the bottom. So it's, it's how to commoditize or marginalize any industry. Is that. How do you. How do we compete as a business? And this is true for PT practices, rock stars as well as medical billing practices. So pay attention on both levels because both of these matter to you. Is that for me to be successful, I've got to stand out. How do I stand out? There's only three competitive advantages that have ever been identified in the business world. I can do it cheaper, I can do it faster, I can do it better. So PT practices. Let's use that as an example. Then we'll bring it back to billing. What do PT practices say? Oh, we have quality care. Quality care. Quality care. You can't quantify that. I mean, you can try to with photo and other types of programs, but the public doesn't know about that, so it doesn't matter. So quality faster. Okay. Can you truly say that you can treat patients and get them better, faster in a way that you can communicate that to the public? Right. So what we end up doing is doing it cheaper. At the end of the day, we do it cheaper. And you have a company called an insurance company that's trying to. To not pay you already. So you have pts coming out of school wanting more. You have insurance companies paying you less. And so we end up filling in the gaps with just treating more patients because there is such a demand for it. Same with billing companies. They're all in it. Like, how do I stand out? Well, how can I show that I can do it cheaper? Or how can I do it faster or better? So it requires the billing company to educate their PT owners how they're doing it better, which is what I think you guys do. Honestly, I think the reason that we've been so successful all these years, we grew so fast, was because we were good at communicating that. But when everyone goes to cheaper, we all lose. When everyone starts cutting their fees. Cutting their fees. Well, they're not doing that by providing better quality billing. They're doing that at the expense of the results. And the PT owner doesn't care because they're getting 4.5% and they don't know enough about their billing to know that they're leaving chips on the table. So how do you guys educate the PT owners? Like, what do you do to help show them where their money is?

So what we do is we take and we create a calculation that shows how much we should collect in a month based on their productivity, based on their actual productivity. Because I've actually sat in on another billing company's billing call with the client where they said, hey, we collected 2,000 more than last month. But should they have collected 10,000 more than last month based on the productivity? There's nothing said about that.

Yeah.

And so what we do is it's a rough calculation because as everyone knows, you can't rely on insurance companies to follow certain patterns religiously.

Right.

But what we do is we take the productivity from the previous month, take your average collections per visit based on your payer mix to determine how much we should collect. The following month. It's not an exact science, but it gives us a baseline to hold ourselves accountable. Like if we collected 2,000 more, but we should have collected 10,000 more, then we'll have answers for trends we're seeing on stuff that was slower paying. But you'll be able to have that baseline number and we hold ourselves accountable to it. We'll go to the monthly meetings or send monthly reports where we say we didn't quite meet 100% this month. This is why these are the trends we're seeing. Or we're looking into it to find what the trends are. Because sometimes it's something that just now happened with a major insurance company where they decided not to pay claims for three weeks. But we're digging in, we're looking into it and we're, we're the ones telling them we didn't collect 100%. And it ebbs and flows. It's below 100%, above 100%. As long as it's near there and doesn't consistently stay under 100%, then, then we're where we need to be. We also hold ourselves accountable to the 120 plus AR we want claims to pay. 90% of claims should pay within 30 days. Yeah, we don't want, we want as little claims as possible to get to 120 days. The main ones that I see get to 120 days or ones that were treated without authorization or whatever. And we're appealing it, but we want to keep that 120 + ideally below 10%. So we'll report that on our monthly stats. Those are the two things that I say you can use to hold us the most accountable. Are we collecting what we should based on your productivity and are we collecting it in a timely manner? And if we have a lot of Money that's in 120 +, we'll answer for why like this had no off denials. We've appealed it. This is what we've done to fix it. Just so you know where your money is and you know how to hold us accountable.

I love that. And when we created that concept, Heather, I'll tell you this. When Katie and I created that concept. Cause that's what she did for me in house. She did it so differently where it was like, hey, let me teach you the 20% you have to know to manage 80% of me. So it made it really easy. Cause like if she ever got hit by a bus, I kind of knew at that point how to oversee it. And I believe that's what you guys have done so well with the clients over the years is educate them. But here was the shocker for me is that it didn't end patient or PT owner concerns. I thought by being that transparent it would squash them. It really didn't. I would say that we probably have more discussions because we're so transparent where I've seen you guys. And so that was what was interesting to me. And really probably the hardest thing about being in this business is that most companies don't show. I've never met a company that says transparent as what in the black does. They send a report. They base most of their knowledge like, hey, here's our percentage of collections is like the key stat, which is not the key stat. And so people look at that. I used to do that for years. Oh, I got 40% of what I build out. I guess that's good. And didn't know what I didn't know to ask. Whereas we're teaching people, here's what you should ask. And here's where we. Here's what you should expect next month. And we didn't hit it. And all people hear sometimes is they didn't hit it. And it freaks them out.

Yeah. So people tend to go into a panic. And what we have to do is just really emphasize the fact that we are giving a baseline, but it's never going to be exactly 100% sure. It's ebbing and flowing. But as long as we're given the benefit of the doubt, we are on the back end. We're watching the collections weekly. We have battle plans that we create where we're looking at the weekly collections. Like, are we on pace to collect 100% this month? And then we come up with. We have the formula where each team member that works that account is looking at it like, why are we not on pace? What trends are happening? We bypass normal habits and routines. Yeah, bypass normal routines if it looks like it's going to be in danger so that we can start working stuff sooner than we normally would like, within normal processing times to see if there is some big thing that happened with an insurance company and to try to get ahead of that as much as possible. And I think what you're explaining is sometimes we're not given the benefit of the doubt. They just see that it's below 100% and instantly freak out, which is understandable. They've been burned before.

Right. It's kind of like a previous prior problem that they've experienced and they're. We're talking by the Way we're only talking about newer clients. This is after people have had time with us. Oh yeah, there's a trust that we'll talk about.

But yeah, yeah. So once we get. Once they understand that we're watching it weekly and that we see right away if it's below expected collections and we're working on it, we're digging in, we're finding why, we're like hitting it as hard as we can. So if we can be given the benefit of the doubt that there are ebbs and flows, but we're looking into why. And we, I mean we care as much as they do. Like it kills us when we're below 100% even like especially for a protracted period. But we are ultimately at the mercy of the insurance. But they are hearing from us and they will hear from us until they pay the claims.

Yeah. And it's almost like those early stages when people. Because at the beginning, again, the transparency is nice. There are people who never care. Like you start them as clients, they're oblivious to it or they're just immediately trusting to a fault, which in this case it serves them because it's a good place to put the trust. But for people who know something about their billing or they've been burned before, they tend to go super concerned initially until they gain the trust. But once the trust is there, then it's a different relationship. And Heather, I don't want to mention the client in particular, but there was a particular client that I remember you earned that trust with over time. What was that like for you, going from that place of earning that trust to having that trust? Like what, what did you feel like you did for that client that helped them eventually just be like, ah, Heather's got it.

Just always communicated with them. I was just super open, transparent, honest, you know, letting, letting her know like everything that was going on and just communication is key until that, you know, especially even after the trust. But communication, 100%.

Yeah. I think that's what was so powerful about it. And then I think all this being said and Rockstar's reason this is so important is because whether you have an in house or outsourced solution, do you guys have predict. Are they predicting your income? Is there whoever's working for you? And this is something that was really big for me from one of my financial coaches and I'm so grateful you and I saw this eye to eye. Was like any financial institution should be predicting income if they're in charge of collecting it. So why isn't anyone who's listening to this? Whoever who's doing your billing, Are they telling you in January, what February collections are as they get towards the end of the month? Because they should. And again, it opens up this can of worms for people who've been burned or don't know much about it. But at the same time, that's what the insurance company industry has created. It's not the billing companies, that's that insurance company, but the billing company. Sure as heck, if they're going to be. Whether it's in house or outsourced, they are responsible and accountable for what they say they're going to do. So what, what do they say? What is that person or company saying that they're going to do? Are they going to go collect it? And if so, to the penny. What does that look like? All this paints a picture that in the Black has been perfect all these years. In the Black has made mistakes, right? Absolutely. So what do you guys offer to help counter? Anything that might occur in that area.

So we have a guarantee on our work where if there's anything that we've done or our team has done. Yeah, our teams aren't always perfect, but we're working on it. Our team is perfect now.

Yeah, we're going to talk about that. I want this episode to be super transparent because we hit a growth stage. We were growing. We got so popular. It just started flooding in and we hit a stage where literally we had so many employees that layers of leadership became complicated and billing got sideways and there were some mistakes that we made.

Yeah, we also have very high standards for our team members and who we want on our team as far as work ethic and honesty. And when you get to a certain size, it's really hard to find that many people that are living up to our standards.

Yeah, we definitely struggled in being able to do all that, plus manage the accountability lines. So tell about the guarantee again.

Yeah, so our guarantee is if we do something that causes the company, the PT company, to lose money, we guarantee our work. If it's a timely filing denial because we didn't follow up on the claim in time, we're gonna reimburse the full allowed amount back to the client.

That is something that has never happened. And when I talk to potential customers, that's why people that even. And these are very few and far between issues, by the way. But the times that there has been an issue that we created that lost the client's money, writing a check and sending that over keeps us in integrity, which going back to You, Katie and Heather, the idea of, like, that's what matters most. So when we're in integrity, that's great. But I found that, like, we've even had, truthfully, I would say that the lowest churn of any billing company in the, in the, in the country. But we have had a couple of companies leave us. And I mean, it might be a couple, like after five, six years, it's. And when that happens, there's no hard feelings because they're made whole in those cases. Right. And it's so powerful that exists. So what has changed in your income? You said that there was a change, so we grew really fast, but you said that's not an issue anymore. So what's changed?

What's changed is last year we created a partnership with a company called Athelis that has harnessed AI to be able to.

Bill. So they use the technology that the insurances are using to deny claims, to fight back.

And they're crazy good at it.

They're really good at it. Like, I've been blown away just looking at their systems and their processes, talking to their clients that have been working with them for a while. So we were lucky enough to partner with Athelis. And what we've created now is what's called the accelerator program, where we've pared down, like, how many clients we have, and we're working with just smaller clients that are sub 1 million to build them up to a million so they can qualify to work with Athelis.

And so, yeah, so in the Black focuses, as the initial dream was about, on smaller practices, even though they're not very profitable, but they get access to. To the best of the best. The best of the in the Black team members.

Yeah. So we were able to create this program that we've always wanted to create at intheblack to do that. We want to help companies that are just starting or have started like a year before, six months before, help them to get to a million dollars. So we're taking on 10 new clients this year. And I'm just really excited because like I said, that's always been my dream. It's. It's been our dream to be able to help people, but it's just. It wasn't feasible with our structure before.

No, because we had to take larger companies and we love those companies, but it was great. And by the way, when we say partnership, Athelis doesn't own in the black, Atheles is its own company, but they were able to structure an agreement to where we could focus on smaller companies and then graduate them to Athelas. Not that they have to go, but it's like we were worried about AI when we were a standalone company for five years. We knew it was coming. And then I'll never forget the day that a good friend of mine, Angie McGilvery, sent me a text and said, you guys got to check this out. I think that they're the AI solution for billing. And it was. I flew to Silicon Valley. I got to spend time with 20 to 30 of their clients. And they're like, yeah, man, they're just like any company. When they started out, they were rough, but we're getting claims turned around in weeks, not months. We have the best cash flow we've ever had. It's. It's taking. I mean, they reduced 80% of the human pop. The human part of billing, which to me is so exciting as a PT owner and scary as a guy who owned a billing company, was like, AI is coming. They're going to wipe all of us out. And it's like, no, we were so smart. You and I'm complimenting ourselves on camera. This idea to reach out to them. And what was cool is they were reaching out to us at the same time because they've been asking around who's one of the best billing companies in the industry. And it was in the. The biggest complaint was that we weren't accepting clients because once we got too big, we stopped taking clients because we were starting to recognize we were starting to screw up. And I love that we were. I love that we're talking about it now that like, hey, it wasn't perfect at that point. So we readjusted and now it's like this 8. There's 18 total companies we can work with. We only have 10 more slots left. And you. So this isn't. For most of you. This is why it's not a sales pitch for in the black. Because 99% of you, this won't even apply. Apply for is just the idea of understanding in today's episode where we are in the industry, what's coming technologically and what the benefits are of in house and outsourced solutions. But for people who are starting out or have less than 800,000 or million dollars in revenue, you guys are taking 10 clients. And I think that's phenomenal because they will work with the very best people and we guarantee everything in that regard as well. So I think it's at a very exciting time for in the Black. Very exciting time for new potential pts to be building in our journey, we helped a handful of people start out and grow. What was that like for you guys?

It was exciting. It was exciting to, you know, be a part of their success too, you know, and. Yeah. See where they could take it, you know, Just exciting to be a part of that.

Yeah, that growth was powerful.

We had a company that we started billing for them, their very first telehealth patient. They didn't even have a brick and mortar business yet, and now they have three clinics in 13 and a half.

They're opening another one as well. They're opening another one.

And just to see that that's what I always wanted to do and to know that we're going to be able to do that more now, it's exciting to me.

Yeah, there's. And for. What's funny is for me, as you guys know, I love business. My favorite part is the launch. I love the concept, organization, and launch of it. And then it gets to a size where it becomes really nightmarish for me, and that's when I need someone brilliant to run it. And, and truly, I think that's what's so great about it, is that what we get to do together is just help these, these future entrepreneurs. Because my belief is our whole industry lives or dies by private practice. Our whole country lives or dies by business, small business. And so what we care about, whether it's on the billing side with you two or on just the. The business side of it in general on my end, is that we're really making the biggest impact in the industry because we believe that physical therapy is the solution. Solution. Like if we can get PT again to be the first line of thought for medical, for the public, for in terms of musculoskeletal issues, we are going to reduce billions, billions, like hundreds of billions of dollars of wasted health care costs. So if we can just get the insurance to help, not hurt, think about how much more we could impact. But in the short term, at least we're getting in our small way a 10 or 15 companies every year up and going. Right.

Yeah.

So very good. All right, so final thoughts, guys. What would you want the audience to know? You've got many men and women who own practices listening to this, and they're thinking about their billing and they're just like, maybe they're struggling with it. What just kind of general advice would you give them in terms of, like, helping them navigate the future of medical billing?

My general advice would be to work with whoever you have doing your billing, whether it's in house or outsourced or you want to outsource.

If you want to outsource, you're smaller. Yeah.

Just to get the tools that you need to hold them accountable with as little headache to you as possible.

I love that. Heather.

Yeah, I would say get with. Get with someone, whether it's outsourcing or your current billing. I would say just have someone knowledgeable in the insurance, you know, and. And in the billing part of it. And you want it to be as transparent as possible. That person, you know, you want them to be so that you can kind of see like, okay, what are you collecting? What aren't you collecting? What should you be collecting? I think just having that. Yeah, I think that would be my best.

I love that because both. What you said is parallels. What I would like to just leave as a final thought as well to the rock stars is that it all comes down to trust. And trust isn't an ethereal feeling. It is a factual experience. Trust by getting results. Results what matter most if we aren't seeing results, if we're not clear, if we're not, like, fully complete in our understanding of what's happening. To get with smart men and women, that can help you get there, because that's the only way I got there. I feel like I am an expert in medical billing because I know Katie. I am not nearly the expert she is, but I feel like I can advise practices from a place of authority in a way that I never could have dreamed of all those years ago. So as. So just because I know you guys are willing to help the industry even if you have, Even if they're too. They don't qualify for in the black. Or if they're just, like, wanting some support from people they can trust because you guys get results how they get ahold of you?

They can email me at Katie@intheblackbilling.com K A T I E@intheblackbilling.Com and my phone number is 480-613-4017.

I was kidding about the phone number.

No, that's my work.

Oh, that's your work number. Okay. Heather, how do they get a hold of you?

Well, they can email me heatherntheblackbilling.com and.

With three E's, Heather. With three E's. I'm just kidding. It's regular spelled Heather. Yeah.

Do we need that? 480-741-8549.

Yeah, you're good. Well, guys, just add that. Thank you guys so much for Being on the show, we're gonna have you back to check in on how this accelerator program is doing and advancing. And as always, it's great to be with you ladies.

Thank you. It's good to be here.

Also, there's something that I wanted to add into our little thing.

Let's add that into this little thing.

I don't know where you'd add it, but it's something that I've been wanting to say is so. In my experience, you know, I've worked for an in house before, you guys, you know.

Yeah.

But I've never, I've never worked for. And I might get. I don't know if I'll get emotional, but I've never worked for not only an owner or a manager, but someone that is so passionate and so committed and so dedicated and just it's, it's inspiring to work for someone like that. So it's fun.

Katie's is so special.

Yes, Katie.

The.

What Katie has brought to the table has open my eyes and see many different areas with billing. Like it's.

Which is interesting because you were a master biller when you showed up. So what does that mean?

That's actually something so, so like the, the reporting she's done, the, the way she looks at things, the way like the projected collections, like that's something I would have never thought of being a biller. You know, I'm just being. I mean I was a regular biller, like you know, just doing claims, food posting, then I was a manager, you know, and, and then I did it all by myself for a clinic. And I would have never thought about the things that she's brought to the table. So I just think that it's so inspiring and just. Yeah.

Because the pace of the leader pays the pack. It's such an important piece. And I'll add to that I have had numerous partnerships over the years and Katie's at the top of my favorite partnerships and partnerships. They say the only ship that sinks is a partnership. And that's just not been our experience. It's been, it's been six years of just extremely positive experiences. And we've, you know, like any high level experience, there's. There's moments where you have to work things out, but it's never been anything but a joy for me. Like, and I think that's what, I think that's what makes it so different for people. So I'm glad that you say that because we'll definitely make sure it enters the show at a point because at the end of the day, like, do people feel that way about their billing? Like, do they. Do people at their companies feel that way about their leader? Well, if they don't, that's probably where the problem starts to go sideways pace. The leader pays the pack. Yeah. So thanks for saying that, Heather.

Thank you.

All right, well, guys, thanks for. Thanks for being here. This was so phenomenal. Yeah. Wasn't it?

Yeah.

Guys, thank you for taking time to listen to today's episode. If you found today's information to be useful, could you take a minute and help me? I would love it if you could leave a podcast review in your app so that other people who are looking for this information can find it. Plus, my dream is to have the largest network of medical entrepreneurs and leaders in the world so that together, we can change health care to make it better for all. So, in addition, if you can think of anyone that you could send this to, not only would that mean a lot to me personally, but it would build this network so that we can make healthcare the way that we want it.