Three Ways You Can Get Hosed By Your Biller With Ben Meyer, PTA Of Billing Done Better

Physical Therapy Owners typically have a hard time determining if their billing and collections are going well, leaving it up to the biller or company to stay efficient rather than being able to assess the data on their own. In this episode,  Benjamin Meyer , PTA of  Billing Done Better , shares the three ways PT owners can assess if their billing and collections are doing well without relying on the billers to inform them. It’s a necessary ability that owners need to master if they’re going to collect the most for their services and make a greater profit.

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Joining me is Ben Meyer out of sunny Florida. It’s cold and wintery in Alaska, and I’ve got Ben shoving it in my face here on the show that he’s nice and warm. Ben, thanks for joining me on the show. I appreciate it.

It’s nice to be here, Nathan. We don’t have snow here. We do have hurricanes, so still recovering from the hurricane.

A little give and take there. Ben is the Co-owner of Billing Done Better , a billing company for physical therapists. He reached out to me, having listened to the show before. Why don’t you share some of their experience? He’s a Co-owner with his wife, so they have the Billing Done Better company and wanted to reach out to talk about billing. We hit this every so often.

I think it’s a good refresher to talk about billing because owners typically don’t come from a place of knowing how to look at their billing, their collections, and how to hold billers accountable, whether that’s in-house or outsourced. Ben, let’s talk more about you. Where are you coming from? What brought you to the point of starting the Billing Done Better company?

I started my physical therapy journey as a tech for a small outpatient clinic. I’ve done a lot of jobs with a lot of different hats in those small clinics, from visiting doctors, Facebook marketing, Google SEO stuff. When I saw billing, maybe even more so than some of those other areas, I saw how we are as a physical therapy profession, everyone’s mad about how little we’re being reimbursed from insurance companies. This is a way we can fight back against that. We can collect more from these insurance companies. It’s a simple thing to do by being a little bit more aware of our billing and the way we collect. We can get more money from these companies.

You’re not still a technician, right?

No, I’m a PTA now. I’m a therapist branching into billing too.

Has your wife been working in the billing space for some?

She was working in the same clinic that I was in. She was working in the billing department while I was a therapist there, but since then, she’s left. She works at a different office but still with the billing and collecting department.

You folks come at it with some experience both on the clinical side and also the billing side. What are some of the things you’re noticing while working with PT owners? Especially the ones that your wife is working with, you would say, “This is what physical therapists are missing out on, or what they need to consider?”

I would say that if you’re not on top of your billing and by that, I mean if you’re not aware of how much you are not collecting versus what you should be collecting. You’re probably missing out on tens of thousands of dollars. That’s for what I would call a regular clinic. You’ve got one location, maybe 4 to 6 therapists. You’re probably sitting on $30,000 to $40,000 of claims that are sitting out there that if your builder isn’t getting this money, it’s going to be going back to the insurance companies.

What are the billers doing to not collect that amount of money? That might be surprising to some people. It’s going to be especially surprising to those people who aren’t having regular meetings, reviewing the reports and the KPIs related to billing. They might be saying, “Where is that tens of thousands of dollars that you’re talking about, Ben?”

When we spoke earlier, Nathan, you were talking to me and you said, “How can billers screw me over as an owner? What areas can they hide money from me that they owe me?” We spoke about three different ways here that a biller and collector can screw over you as the owner and what to do about it. The number one way is not trying to collect as hard as they say they are trying to collect.

How do you measure that? You’d say they’re not collecting everything that should be expected. That should be an ongoing expectation that you’re collecting everything possible. How do you assess for that? Where can you look for those things to get some objective data instead of relying on them saying, “I’m doing everything I can?”

There are a few different things that you can do. I know you had Will Humphrey on your show as well, and he gave some great statistics about what you can look for to gauge yourself and where you’re at with that. I have these here of what he said. He mentioned over 120 days. It should be less than 10%.

Of your AR aging.

That’s right. From 90 to 120 days, less than 5%. From 60 to 90, less than 5%, and from 0 to 60 days greater than 80%.

That 85/5/10 is a pretty standard expectation to say, “Things are going pretty well.” The one thing I’ve thought about with those numbers there are ways that billers can write things off so that they don’t show up on that report and they can massage that report to make it look better somehow. Is there any way they can manipulate those?

It goes by the age of the report. How long has the claim been active? If your report shows all your claims, there shouldn’t be a way for them to hide it. You should be able to see why that claim has been there for so long.

Can they write it off? I don’t know the intricacies of billing. Could they say, “Here’s a $500 account balance. The insurance isn’t paying on it or the patient isn’t paying on it. Can they just write it off?” If they made such an action, could I see that somewhere else?

In your report, it should be able to tell you what claims are out and how old they are. They should not be able to hide it if you’re getting an accurate report from your system.

Is there a write-off report typically in most EMRs or billing software where you can bring up a monthly, “This is what’s been written off in the past month as well,” just to see that data?

You should be able to do that with most systems as well.

You can get an AR aging report along with a write-off report for the last month and compare. That’s something that I personally would probably go through line item by line item to say, “Why was this written off?” They need to have comments for each one. I’m assuming if you had those two together, then you can believe that the AR aging report is true.

That’s right and you want to listen to their reasoning too about why was this written off and that there are some legitimate reasons why that could be and they weren’t able to collect. Maybe the person’s insurance wasn’t verified correctly and that’s something that you’re not going to get back.

Authorization wasn’t received.

Depending on the reason, there could be legitimate ones, but it’s up to you as the owner to listen to your biller or collector and seem “Are these legitimate reasons? Are these excuses? Why it’s not being done?”

One of the biggest headaches that I’ve seen in my clinics and other clinics throughout the years is the relationship between the biller and the front desk. You smirk because you might know what I’m talking about. It sucks if the biller has to go after the $20 copay that wasn’t collected five or six times. Now there’s a $100 balance on this patient’s account that they have to go after simply because the front desk didn’t collect it at the time of service. That can be hard. When you say not collecting all the money that’s necessary, it goes beyond billing and collecting people and also to the front desk. Everyone has to be on the same page and believe that we need to collect as much as we possibly can because that’s how much we value our services.

That’s right. Mistakes at the front desk from the very beginning can lead to issues with the billing department later. A lot of times, you can fix denials before they happen by making sure that those things are right at the front desk.

A mistake at the front desk at the very beginning can lead to issues with the billing department later.
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Is there a tendency from yours or your wife’s experience for billers to come up against denials and they accept that first phase denial as, “I have to write it off.” How many times will you go through the appeals process before you write it off?

Yes, you’re right. Some billers will see that this is right written off or this claim got denied and say, “I’ve done what I can do and that’s it.” They won’t try for more or what they’ll see is when they’ll go into their system, they’ll see a claim is pending and accept that it’s pending. What you want from your biller is for them to go in and say, “Why haven’t we gotten paid for this yet? Even though it hasn’t yet been denied, can we figure out why it’s spending and correct this issue before it becomes timely filing?”

What’s that timeframe? If you did the visit now and filed the claim now. It says pending 30 days from now. Do you let it sit in pending for another 30 days or when do you start making those calls to follow up?

You should be getting your eye on it at 30 days. You should be thinking, “Something’s up with this,” by 30 days. By 60, you should definitely be on the phone and saying, “Why haven’t I gotten my money with this yet?”

That seems like it could be a relatively easy system if you have that in place where, say, January 1st, you’re reviewing all the claims that went out on December 1st. Number one, making sure that all the patients were told or the insurances were billed for that day and all the claims are in process and see where they each are. That might be the effort of the day. Who knows? I’m just making up stuff but it could be a relatively simple process.

It can be. One of the issues that we find with that though, especially if you have your biller in-house because your biller is also your front desk person and they’re also answering phones, while it’s nice that, yes, those things should be done early, a biller that is in the clinic is also dealing with these other things. Those billing tasks get pushed to the side.

At what point would you recommend someone, say they have a full-time biller? Do you have a feel for when that full-time biller needs help? Is there a tipping point in terms of gross revenues, potentially or some other metric where you’d say, “This biller has probably met their max capacity? They need to bring on some additional, possibly part-time help?”

I don’t have any KPIs for you for that, but I would say that once the clinic is ready to expand and grow, they need to consider those options. If your billing is based on one person that you have, it’s not a scalable model. You need to consider bringing on additional help if you’re trying to grow as well whether that’s a billing company or maybe hiring somebody else as well.

There was always this metric and I’m still not clear that I’m convinced of it. I was told, “If there are $1 million in revenue, that is sufficient for a full-time biller, essentially.” Not $1 million in claims sent out or anything like that but simply $1 million in revenue. That’s a good rule of thumb and I’m not sure if that’s too much or might be leaning more towards that metric being more toward $800,000 to $900,000 but give or take a few hundred thousand. $1 million might be a tipping point for a full-time biller before they need some additional help. Does that feel about right to you?

I would say that’s about right. The thing is that circumstances vary so much. It’s difficult to put a direct price tag on that. You can compare that to the fill rate of your therapists. You can ask yourself, “When do I hire another therapist?” You might say, “When it gets to 90% fill rate, then you want to look at it.” That’s just one factor. As you said, there’s one factor to look at, but there are many others as well.

Circumstances vary so much. It's difficult to put a direct price tag on that.
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I’m glad you mentioned that because it does depend on what you’re asking that biller to do. If you’re expecting them to do insurance verifications and authorizations, that number is significantly lower than $1 million in revenue. Probably cutting half, if not more. What are some other things that you might recommend to owners to determine whether or not they get “screwed?”

The first one, if you have your builder, they’re screwing you over by not trying to collect as hard as they say they are. The next one is they’re saying your billing is doing great and it’s not.

How do you assess that?

First of all, you have to say, “Are they basing that on your standard of doing great or is that their standard of doing great?”

It’s easy to objectify that. In our situation, we saw a hundred visits in the month prior. Say we had an average reimbursement rate of $100 per visit. We expected the biller to collect $10,000 next month or in the month we’re talking about. If she didn’t meet that, then we had to have a discussion as to why.

She got good enough where fifteen days into the month, she says, “I’m on Target,” or fifteen days into the month, she’s like, “We’re behind, so I need to hammer the phones and see what’s happening so we can hit our target at the end of the month.” A simple metric to go by is simply projected collections in the given month based on the number of visits in the previous month times your average reimbursement rate. That’s an easy metric to go by and if you do that, then you can objectively say whether things are going well or not. That is right.

Having those metrics in place gives your biller and collector objectives to shoot for. What do you say is a good job? For instance, we could have a PT in our clinic and maybe they have a 60% productivity rate. Who’s to say if that’s good or bad? As an owner, you should know that’s not where it should be. Who sets that standard? It’s not the PT. It should be the owner. It’s the same exact thing with the billing too. We need to be setting that standard for the biller and not the other way around.

I think that’s where physical therapists, not to fault them necessarily and for not holding that standard, but most of them don’t know. At least, that was my case. I don’t know how to hold my biller accountable. I don’t know what a standard should be. Physical therapists are much the same way. A lot of them might hear you say 60% productivity is not acceptable. If they’re not measuring that statistic and seeing how it affects their business, then they don’t know if 60% product is appropriate or not and just so everyone knows, it’s not.

I hope your therapists aren’t doing that now.

How many appointments in a given week are filled? That’s what the productivity rate look. Are there any other metrics like that to determine objectively if things are “going well?”

To keep it simple, I like the one that you mentioned about the percentage of collection and knowing where you should be. I encourage to get a broader perspective of one, your market, so that could mean reaching out to other PT owners in your area and say, “What are you guys doing with billing? Am I significantly less? How is that working?” When you have that broader perspective, you determine, “I need to expect this from my billers.”

Owners need to get a broader perspective of their markets.
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I think that projected collection statistic is an easy one to go off of. The AR aging report stats that you shared, the 85/5/10 is another one to easily go off of. In our situation, the 10% of 120 days and over typically didn’t include auto liens that might be going into court or worker’s comp. Do you make that adjustment?

No, I haven’t made that adjustment for that.

We usually set those aside because we would take lean cases and we knew they were going to court. This could take a year or two years. Give me an update.

You could if you wanted to. If you’re feeling that’s affecting your numbers and not showing what you feel it should be showing, then you could.

I can’t hold my bill accountable to a lawyer that’s dragging something through court as long as they’re in communication with the law firm every month or so. What’s the third thing?

Third thing, not communicating how you’re billing and collecting can improve.

Tell me what you think.

This stems down to the mindset that you’re billing and collector is at. It’s very different from the mindset of an owner. An owner’s going to go and look at a situation or a system in their business and try to think about ways that they can improve this system to make it better to bring in more revenue for the business. That’s not what a bill or a collector is typically going to do. They say, “I’m hired to do the billing and collect, so that’s what I’m going to do. I’m going to billing and collect.” They’re not looking for those same ways that the business as a whole can do better.

I like what you’re talking about because even in my meetings now, I mentioned this before we push recorded that I don’t think I take that next step in my biller to say, “What can we do better? Is there something missing?” Whether that’s a front desk procedure that we could do better at or maybe it’s an insurance verification procedure that can get a little bit quicker. You name it. What can we do to better improve our billing and collections process overall? What would make your job easier?

If you start asking those questions over and over again on a monthly basis and if you’re not meeting with your billing and collector on a monthly basis, then you need to do that and require that they do so to review the stuff that we’re talking about. Give them ownership over that department and say, “What can you do to do better? What can we do to help you do better? What can we do to make this cashflow faster?”

That’s right. Developing a better relationship with your biller and doing that monthly checkup or we as therapists do progress reports on our patients every so often. Monthly progress report with your biller to go over why are these things happening and are there any trends happening. Are there repeated mistakes that are happening over and over again that if we fix one small thing, now these fills won’t get denied over and over again?

Will, my partner, mentioned there’s one company in particular. I don’t think he named them in a previous episode but they know that the day after they send a claim out to a particular insurance company, they have to resubmit the exact same claim the next day because that company is going to deny the first claim that gets sent for whatever reason. The very next day, they know that’s part of the system.

It’s terrible the games these insurance companies put and it comes down to them not wanting to pay out. That’s what it is. They’re trying to collect as much money for themselves and not give it to the therapists that they are working with.

Where I think the biller and the collections company can be worth their weight in gold to an owner. Number one, like we said, being on top of the collections, getting as much money as possible, and getting their systems down. If they do all of that, they are great. They’re providing goal-level service if they want to provide platinum-level service.

Taking what you’re talking about to a step further to say, “What I’m seeing is this insurance company is either denying this singular code as long as you’re billing the other code with it or it pays better if you use this code in conjunction with the others than the other or because of MPPR, you might want to use four different codes instead of two codes with multiple units. When you start getting that feedback and direction from your billing and collections company, that is making them worth their weight in platinum versus gold honestly.

I believe that for sure. I’ll even take that one step further with diamond-level service if they can also say, “We’re going to do a training with your therapist or your front desk and get this problem fixed.”

That would be awesome. I know from my friend, Mark Moore, in Arizona. He and his biller, who is in-house, developed a cheat sheet. They have it laminated with the major insurance companies that they deal with in their community. It’s that. It’s when you bill this code or don’t bill this code with this insurance or you can only bill this many units with this insurance. That’s laminated and posted everywhere for the providers to utilize. Now you know that, number one, your biller is in tune and because of their efforts, they’re getting the rest of the team in tune to maximize collections. Anything else that you want to talk about in regards to billing and collections?

I think we covered it. I do. We did a great job.

It’s exciting because I think this is an area I love to educate owners on this because like I said, they don’t have a lot of this training. You can’t go into all the books that I recommend, Good to Great , The E-Myth Revisited and Traction , all these books. You’re not going to find out how to teach a PT owner how to hold their billing collections department accountable. I love having these episodes with experts like you and your wife and talking about it and help them maximize their collection. To quote my partner, Will Humphrey’s, “Profitability unlocks possibility.” If they can increase that average reimbursement, even $5 or $10 per visit makes huge potential.

Money just starts flowing in. You wouldn’t think about it too. A few dollars per patient over a week, over a month, over a year, you’re talking tens of thousands, hundreds of thousands of dollars even.

Ben, if people wanted to get ahold of you and/or your wife at Billing Done Better, how would they do that?

You have a few options. You can visit our website, BillingDoneBetter.com or you can find me on LinkedIn, just search for Benjamin Meyer.

If they wanted to contact you directly, do they go through the website or do you have an email address you want to share?

You can send it to BillingDoneBetter@Gmail.com.

Thanks for your time. I appreciate it.

It was an honor being here, Nathan. Thank you very much.

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