Gordon Brewer:
Well. Hello everyone and welcome again to the practice of therapy podcast. And I'm so happy to have with me again, I'm somebody that's not new to podcasting, are new to this podcast and that's Jeremy Zug from practice solutions. Welcome, Jeremy are, you know,
Jeremy Zug:
Hey Gordon, thanks for having me back on. It's good to see again.
Gordon Brewer:
Yeah. So Jeremy is my go to person around all things insurance billing and he has his company practice solutions is one of those companies that absolutely love or who I use in my practice and we couldn't do what we do without them. But I wanted to have Jeremy back on, you know, just giving you, given the time and the season we're in on, hopefully by the time this episode comes out, we're hopefully feeling kind of the tail end tail end of the effects of coven 19. But I think it's going to linger with us through the summer, unfortunately. But anyway, wanted a Jeremy here. So Jeremy, as I start with everyone, tell folks a little bit more about you and practice solutions and for those that might not know about you and your whole journey.
Jeremy Zug:
Yeah. Well thanks. Thanks for that Gordon. And a little bit about me. So I, my wife and I started practice solutions to meet a market need of billing and credentialing as a source of relief to help providers focus on patient time or our time with patients anyway. And so we had, I'm from community mental health, I've been working in community mental health since I was 14, worked with patients 18, have a bachelor's in counseling and then my trajectory changed when we started practice solutions. But yeah, we, we exist fundamentally to help providers focus on patient care by removing one of the most Byzantine parts of private practice. And that's dealing with billing and credentialing.
Gordon Brewer:
Right? Right. And it's a, I know that they have been just just maybe in belief little over dramatic by saying this, but a lifesaver towards, of my practice in terms of just helping us navigate all the crazy things that can come up with insurance billing. But Jerry and Jeremy and I were talking about the forge. We started recording just some of the trends he's been saying, which is billing and particularly for those of us that are in private practice and we were on insurance panels and we really kind of depend on that for our, for our livelihood in terms of being paid and also just helping patients. I think there's lots of reasons for people to be on insurance panels. But Jeremy tell folks just kind of what you're noticing with, with all of this.
Jeremy Zug:
Yeah. So there are a couple of trends. I think the first trend that we need to talk about is the wide sweeping statements that insurance companies have made about patient responsibility as, as it relates to tele-health claims, right? Cause almost all of the practices we work with when fully remote, right? They did the tele-health thing and a lot of them were, were counting on and made statements to their patients that copays and deducts will be waived, right? All patient responsibility and cost share would be waived per the insurance companies. Right? And what we are starting to see is that insurance companies are in, they're not, and this is probably one of the hardest things, right? Because patients and how they perceive your practice and how the billing functions within that is really critical. And so to have sort of a what appears to be a bait and switch, it's not a bait and switch, but it feels that way is not super comfortable.
Jeremy Zug:
So the, you know, the first thing that we want to talk about here today is how to determine whether your patient's cost share will be waived, right? Whether they owe you a copay or deductible before you submit a claim. And you know, fundamentally there are some good resources, but the best way to do that right now is to call the insurance companies. And you're going to want to repeat the script, right? You're going to want to say is tele mental health covered on an outpatient basis for this patient. Right. And then give them the insurance information, the date of birth because that will lead the provider rep to tell you what they have. What we're seeing as a trend is if the patient had tele-health benefits baked into their benefits before coven, that's covered at a hundred percent. If they didn't, the patients still have copays and deductibles applying through this time. And that's, again, that's confusing for a lot of people, but as providers and as for us as a support structure, we can do the best job we can by being as clear as possible. Right. It's Chris Hogan that says to be unclear as to be unkind. Right? So we want to be as clear as possible with that.
Gordon Brewer:
Right, right. Yeah. So yeah. Are, are you seeing a trend of just claims being rejected even, you know, there were trying to make an attempt to put the right modifiers and all that kind of stuff with, with that. And, and for those that don't know, maybe might be good to kind of mention maybe just a few basics about coding in terms of a modifier and what that is and all that sort of thing.
Jeremy Zug:
Yeah. The billing and coding errors are not from our perspective, our vantage point at scale not being rejected and denied. What we are seeing is, is inconsistency in the claims processing. One of the errors that we are seeing on the billing and coding side. And I know that providers who billing and coding and it's almost like I switched from English to speaking Greek. I mean it's almost that it's a language unto itself, but there are two codes that are important, right. You know, critically. So even if you're going to do telehealth beyond COBIT which is what I think is going to happen, Gordon, I think we're going to see one of the consequences is long range tele-health sessions, right? But two codes are important and it's your place of service code, which if you're using an electronic health record, the practice settings feature of your electronic health record will help with that.
Jeremy Zug:
But that code needs to be zero two, normally it's 11, which says that I'm conducting therapy in an office right now. We're all conducting therapy, you know, telehealth remotely. And so what that code does zero to communicates to the insurance company. Our, this was a telehealth session. You'll still bill with your office address but you'll need that zero to code to delineate a telehealth session. The other code that's important is called a modifier. And if you Google modifiers in general, what you're going to find is a variety of answers because modifiers in medical billing and coding can delineate par. You know, which side of the body left or right up or down. So there are directional code, but in mountain mental health and in telehealth sessions, a modifier delineates two things. Tell health whether it was done via phone or a right zoom or some other like doc see me. Right. So where there's video and video and audio or whether it's just a phone. So the modifiers there that are important to note are either GT or 95 and depending on the insurance company that your network with, they've told you which ones you use. Sorry about the dogs, I'm at home, but your insurance company will say, you know, use GT or 95 as the modifier.
Gordon Brewer:
Yeah, yeah, yeah. And I think that's you know, I think one of the things that's nice about using like an electronic health record system, you know, like I know that you guys are familiar with therapy notes, which is what you guys primarily used for the one that you recommend. But I know it's just a matter of just simply changing it from office session to online session, just within the appointment itself. So it makes it pretty simple.
Jeremy Zug:
Yeah, that's right. That's exactly right. And even in therapy notes, you need to add the telehealth as a session or as a place of service, but within the session, the schedule, you're right, it's, it's very simple.
Gordon Brewer:
Right, right. So, yeah, hopefully that's not too difficult for people. So, yeah. So one of the things that I know too, we had talked about is, and I know this has been kind of a TA kind of a topic for a lot of folks just in our mental health space. Is, is tele-health going to become more of the norm now, you know, in terms of meeting with folks?
Jeremy Zug:
Yeah, that's a great question. And I know, you know, as a country and even as Michigan, we're in Michigan, so as a state we've gone through a couple of big legislative shifts as far as what's covered Gordon. I really hope so. Right. And I think that's something that, that providers can do a good job as far as lobbying and advocating with their government officials on cause like, one, I think it's effective. I mean, I think the outcome data is there to support that. And, and you can reach more people. Right? And I know that insurance companies oftentimes get a bad rep, but the predominant narrative of blue cross, for example, or Cigna or Aetna or any of the really big ones has been access to care. Right? That's been a very large agenda item for them for a very long time. And that's something that this could really enable in the future. So I really hope so. And, and providers can, you know, send a letter to your governor, your Senator and congressmen and push for it.
Gordon Brewer:
Right, right. Well, one of the things about it that I, that I've thought about is that I know for a lot of my clients and you know, it's that it's finding that balance between the time as a practitioner, you know, what are the hours that I want to work? And most everybody knows that if I, if I only saw clients from five o'clock till nine o'clock at night and on the weekends I could fill my practice, you know, just in the stamp of a finger because those are the premium times for most people wanting to come to see a counselor is, you know, evenings and weekends because they don't want to take time off the war, off work to come, come to an appointment. So, you know, I think the opportunity is for those of us that are seeing folks that are working, you know, they can, they can see us via this platform, this online thing, and they're not having to do the travel time to get to your office. They can take, take time off, you know, hopefully if they have a private place to meet, they can just meet with you in their office at work or whatever. And so I think it's going to be pretty appealing to people. And I think in terms of marketing your practice, again, like you said, insurance companies are pushing access to care. This makes us much more accessible.
Jeremy Zug:
Yeah, I agree. And there are some companies out there that, you know, I think it's dot com therapy, maybe that's the really big 100 so providers that just raised some series a funding to really launch their stuff. And there are a couple others that are making some really good progress in the country as far as tele-health, but it's still for the most part, you know, under developed and you have the other market share that I would encourage people to think a little bit about is overseas, right? I mean you have, you have a lot of us people overseas doing a variety of things, right? Whether that be oil engineers in the middle East or you know, businessmen and women in China and India, right. That our difference makes a big deal. So if you want to feel evenings but you be, you know, in your daytime hours. But maybe for them it's the evening. That's also not a bad idea. Right? I mean you can say where are the X paths across the globe? And maybe for them it's nighttime so they're more willing to pay privately for that. You know what I mean? There's a lot of options there.
Gordon Brewer:
Right. And I think that's a, that's a, that's a niche that really hasn't been tapped into that much yet for a lot of people.
Jeremy Zug:
I would agree. And you know, I don't know a ton of organizations that you could connect with. I mean, maybe you have some more ideas, Gordon, but I, I'm thinking like, I know I have, we have a client that that's services provider, people, patients all over the country, but their thing is somehow they've gotten connected to the oil companies and so, you know, wouldn't that be in the middle East or Alaska or wherever, you know, they see ex-pats remotely. And so that's been a really nice niche for them.
Gordon Brewer:
Right, right. That's great. Yeah. So, yeah, one of the things too, I know we were kind of chatting about is finding that balance between being particularly during this season with the covert things. And like I said earlier, I hopefully, hopefully we're starting to get towards the back end of this whole pandemic, but who knows. But you know, being able to find that balance between being profitable. But at the same time not taking advantage of people, you know, people that are out of work, out of their jobs and that sort of thing. And I know you had some thoughts about that just from your perspective, Jeremy.
Jeremy Zug:
Yeah, so, so one of the, I would say I would say agenda items, but one of the things that's really important about taking insurance that we harp on a lot and I harp on a lot is collecting from patients. And I know that's a really uncomfortable topic because you know, you start to say, well, you know, w I do therapy and now I have to collect money. And that kind of blurs a line and then you add the covert layer, right? And so, so now it starts to look like I'm this profitable business that is just after money. But if you're a patient's claims or processing with a copay or deductible and you're in network with that insurance company, you're contractually obligated to collect that. And that can feel like you're against a wall. Right? Right. It can feel like, well, maybe this person's spouse is out of work or maybe they're out of work and the cash flow isn't there yet, but I still have to collect a copay and deductible.
Jeremy Zug:
And I want to offer a couple of strategies that can help with one the patient perception, but to actually collecting that money. And so, you know, as a business and as a business owner, one of the, one of the values that we have is treating people how we would want to be treated, right? So if I'm a, if I'm a patient and I have teletherapy cause I need it and I have a deductible that I owe, but I maybe I'm short on cash. Where I would want is for the provider to say, listen, you owe you over the service. And that's true. I do offer this service. Right? No doubt about it. I would either want an extension on my debt, right? So whether that's, you know, you know what, I'm going to push this out 30 days. I'm going to have a credit card on file, but I'm not going to run that for 30 days until we know how things are shaking out or let's set up a weekly payment plan, right?
Jeremy Zug:
Where you're going to pay $10 a week, you know, for the foreseeable future. So that I have some assurance as the clinician and as the practice owner that you're good for it, but also that you can bake that into your budget a little bit so that you can continue to collect. And so the patient can get used to knowing that that's, Hey, that's there. I need to take care of it. That maybe the clinician's not charging me my thousand dollar deductible, which is a huge measure of grace. But I know it's there and I'm going to, I'm going to take care of that in the future. So, you know, providers, and this is even for good times, good advice, but you can set up payment plans for deductibles and copays or you can push it. As long as you're making a good faith effort to collect that balance, then you can extend that. Right. And, and we've, we've done that with, with clients of ours that are saying, you know, listen, it's, it's, this is tight-knit. It's like I get it now. I totally, and so, you know, we're willing to be flexible cause we want people to feel cared for and we do want to take care of them. But you know, you still have to run a business and you have to run a practice view taking a stance or how have you handled that conversation so far?
Gordon Brewer:
Yeah, that's a, you know, one of the things that you know is, is nice. And just using your services that you are, a big part of it is you send out the statements for us and that's, that's a huge thing and something that we don't have to, I don't have to have that on my radar. And I think one of the things that you're right is that with, I think with, and I've had clients in the past where they've had like a high deductible and they, Oh, Oh that and they, they want to pay it. But I think just being able to set up a, you know, like a payment plan with them and say, okay, we're gonna, we're gonna let me know what day of the month you want us to charge your credit card and we'll, we'll set that up and do it that way.
Gordon Brewer:
And I think a lot of people are just very very much appreciative of that. And it's a good faith kind of thing. And the, you know, I'll say this is that I think, I know one thing that a lot of us in private practice just counselors in general, therapists in general, because we're giving people and we want to help people. I think a lot of it has to do with our own money mindset and that I think we somehow or another feel bad for collecting from people or getting, getting paid for what we do. But if you think about it, you think about the years you spent in graduate school, the amount of money that you spent on graduate school and getting your credentials and all of that sort of thing, what you provide is a value. And I think that people genuinely want to pay us for that. Yeah,
Jeremy Zug:
That's so true. I mean, people know that when they go to a doctor's office, they're going to owe something. Right? And it's no different in therapy, right? If I want to go to a counselor, I know that I owe them something. And it's not just cause I'm in billing, right? That's the only reason why I would know that. But as a consumer of a service, I know I owe you something and I expect to pay it because it's valuable. I recognize the value of it and, and it makes a lot of sense, you know, that way. And I think the big lesson there, not only on the money mindset side, but as business owners and leaders in your community, you have to manage tension, right? That's part of the stick with, and you know this from managing people for a long time, is that you just have to manage that tension as a business owner.
Jeremy Zug:
And that's a really important reality that you have to make your peace with that at some point you're going to have to have, you're going to make these decisions and they may be the hard ones, but they're also going to be the good ones. Right? There's a really good book written by Paul bloom called against empathy, which that title is sort of insights a, a thing. Right? but his whole point is that if you make business decisions or white sweeping policy measures around maybe an isolated incident, it's, it's actually bad longterm and it's a good thesis. I think it's worth reading.
Gordon Brewer:
Right, right. Yeah, I like that. Yeah. So one of the, to switch gears just a little bit Jeremy, I know that one of the hot debates, regardless of this covert thing or whatever, is a lot of practice owners really kind of trying to figure out whether or not they want to accept insurance or be credentialed or beyond insurance panels. And so I think it might be good to hear from you just kind of the case for accepting insurance and why somebody might want to decide to do that. Because you know, I tell people up front and you usually would too, is that it's much easier logistically to not take insurance and not do all
Jeremy Zug:
Of that. But what, what would be the case for doing it? Yeah. Well maybe I'll do you one better, maybe a couple of points for in a couple of points against, right? So a couple of points for clinically you can meet, some of you can work with populations that you're passionate about, right? So whether that be military personnel, active duty, retired, and you want to take on Tri-Care patients. You know, that's a, that's a huge demographic in one with a lot of need. And you know, my mom who actually helped push us into the practice and staff when she had her private practice works for the VA and it's something she's really passionate about. So if you want to work with a client population, that can be a really good thing, right? Medicare, Medicaid trickier, you know, if that's your clinical area of expertise, do that, right?
Jeremy Zug:
Because you don't want to sacrifice that stuff. That's why he went to school. At the same time. Right? So, so working on with clinical populations that you wanna work with is important. The thing you're going to sacrifice is profitability, hands down, right? If you're a cash based practice, right? That charges one 25 for a hundred dollars and you take Medicare or Medicaid or Tri-Care almost for sure you're going to take a hit on the money side. So, so weighing your values as far as and your needs to, right? Do I want to work with these clinical populations and do I want to hit this particular revenue number? You're going to have to weigh that a little bit. And like I said, you're going to have to manage the tension between those two. Another, another case, 4.4 is there is something to be said about access to care and that growing a practice, right?
Jeremy Zug:
So if you take blue cross and a predominantly blue cross insured community and make sense that you're going to grow your practice a little bit more or a little faster and somebody who may not. And for the most part the cross and Cigna and Aetna are generally easy to work with so it doesn't add that much burden to your plate to think about and it's going to grow. So there's like speed and deployment and your time horizon, your time horizon around deployment of mental health care matters depending on your situation. But again, you're going to have to manage paperwork and a contract and the fee schedule and denials and reject rejections and some fuzzy bureaucracy. So that would be the thing you give up there. But on some of those insurance companies, for sure, that commercial side pays pretty well and pretty consistently.
Jeremy Zug:
So that's, that's another reason for, and I guess against just dealing with ambiguity. I would say another reason for is again, access to care, right? We have a big mental health problem in the country. There's an article by CNN published last year, end of last year. That said the life expectancy in the U S had actually gone down because of suicide and drug related accidental death. That shouldn't be the case. I mean, that's for the richest country in the world. I have a hard time believing that that should be there. And so I think that just the idea that we can provide access to a multitude of people makes a lot of sense. So couple of reasons for it I guess.
Gordon Brewer:
Right, right. Yeah. And I think the other other thing you have to weigh is, like you said, is providing access to people. And I think you have to look at the demographics of your community. No. I live in an area that compared to other parts of the country where a lower, sexier socioeconomic kind of area, I mean we're right here in the heart of Appalachia and we're surrounded to the North of us here, the, the coal fields of Southwest Virginia, Kentucky. And so that's a hard head area economically for a lot of people. And so their access to care is dependent on them being able to use their insurance to be able to pay for it. And so think you have to weigh those kinds of maybe kind of ethical issues out there as well. When you think about that. And the other, the other thing too is, at least what I've noticed is, is that if you do go onto the insurance panels, particularly if you pick those panels that are the predominant ones in your area you're pretty much guaranteed, you know, acquire client base. I mean, you're going to get the clients and so it's, it's, it's kind of an easy way to get clients to some degree by doing that. So
Jeremy Zug:
Yeah, I agree. And it takes a little bit of a forensic and academic approach to right. Cause one, one mistake, one pitfall that I see a lot of new practice owners fall into, and we got some people about this all the time, is they'll contact us and say, I want to get a network. I want to hire you guys to get us some network with 20 insurance panels. And our sales team will say, well, I call a flag on that play. It's like, no, I don't think you do. Right? Because that's shotgun approach of let's just see what sticks, right. We'll actually have the opposite effect of what you want it to have, right? Because now you have to manage all of the complexity of billing and credentialing with those panels. And you haven't even seen a patient yet. So what we tell people all the time is, you know, do your research, talk to some toxin to some colleagues, talk to the big companies in your area, find out where you want to be, and then make a decision on your end objective and then pursue that. Don't, don't take this like spaghetti on the wall thing because it'll have the opposite effect of what you want it to.
Gordon Brewer:
Right? Right. Yeah. And it just, it's a, it gets complicated. The more panels you're on, it's just because each one is totally is different in the, they handle things. And so you've got to handle each panel equal. No, they're not. They're not. Yeah. So
Jeremy Zug:
Yeah, it's, it's pretty, it's pretty wild. How did you come to make those decisions in your practice?
Gordon Brewer:
Yeah, that's a appreciate you asking that, that, that was a, that was a tough decision for me because I was at a point at one time where I said, I just want to be done with this and just get off of all these insurance panels and, and I think really what the, you know, what really turned it around for me is what I said when I, when I started looking at the number of calls we were getting and so many people asking if we could accept their insurance and, and that sort of thing. I thought, okay, you know, what I'm going to have to really kind of resigned my business model to is being geared towards higher volume. In other words, seeing more, more people in order to get the, the there and then being able to also outsource that, that whole insurance billing part of it. Because it is so time consuming. And I think maybe when somebody first goes into private practice, I think it's, and they're going to be on insurance panels. It's a good idea to maybe do a little bit of it themselves just so they understand it and understand the workings of it. But once you reach a certain volume, and I don't know what that magic number is you definitely want to outsource that in some form or fashion because it will, it will just eat up your time.
Jeremy Zug:
Yeah. So we've seen a couple of couple of things around that, so I totally agree. I think providers should know how it works, which is why we have the model that we do, where providers can see exactly what we're doing in therapy notes so that they know how their business is running. I think that's critically important. There's not a business process that we have that, I don't know, rudimentary on a rudimentary level how it works and that's on purpose. But what we start to see is around like five to 10 patients is when clinicians start to say, well, the amount of time I learn or I'm spending learning about this or doing it actually becomes less valuable than just outsourcing it. Right. And the thing that we're trying to do, and we will continue to do in the future is, you know, we're, we're adding services, right?
Jeremy Zug:
So very soon and we've got 22 days until patient support comes out where we're going to start to collect money from patients and explain balances and you know, send those texts and emails and pick up the phone and call your patients. You know, that comes out in June and we, we want to be an active part of taking the time burden off so that providers can focus on patient care. But it's around five to 10 a week is when providers start to say, well, I'm spending five to 10 hours a week on billing, but I could replace those five to 10 hours with patients and make significantly than
Gordon Brewer:
The time. Right. Right. Yeah. Well, Jeremy, this is a no, we could probably talk all day, Sarah, this stuff and other things as well. But tell folks more about how they can get in touch with you and more about practice solutions and we're going to have all these links in the show notes and a show summary as well. Yeah, I would love for people to get in touch with us by going to the practice of therapy website and clicking on our logo cause that redirects you to to our website and the landing page where Gordon is featured and some of the work that we've done together there. So that's one way. The other way is just going on a website practice sol.com and there's our contact box there that you can fill out and we love to talk to you.
Gordon Brewer:
Any member of our team is more than happy to sit down and talk to you. Our whole goal is to be a champion for your practice and to be an active partner in your growth. And so if even this week we've said to people, you know, I think you'd be a good fit over here or this is a better process. And then some clients are like, we're a great natural fit, cause our whole, our whole thing is about helping practices focus on patient care and we want to help you in any way that we can. And sometimes that means saying that we're not a good fit and we do that all the time. Right, right. Yeah, no, we'll have those links in the, in the show summary and I know I'm going to go ahead and give you two links that I know will work.
Gordon Brewer:
One is just simply practice Saul practice saul.com/gordon and that'll get you to the, to the landing page for the practice of therapy. Or you can go to practice of therapy dot com slash practice solutions and that'll get you there as well. So we'll have both those links. It'll get you the same place and so be sure and check Jeremy's in practice solution. Now, I mean, they just they are absolutely provided. Excellent service and I can vouch for it, are the two we use in our practice. So. Well, Jeremy, thanks again for being on the podcast and I'm sure we'll have you back on to talk about other grand things. Thanks me. It's been a pleasure. It always is. All right. Take care. Yep.