Timing of Rollout

Hi Matt,

I thought I would just share an update on my Middle Way transition. I had a hybrid clinic – private treatments and a pseudo-community option. After we talked last fall, I decided to roll out my new pricing structure for January 1^st because I liked the “clean” feeling of starting the new year fresh. I reduced my private treatment rates, eliminated the pseudo-community option, and started billing insurance for patients (though I am currently out-of-network for all plans right now). My private patients of course have been thrilled with the new pricing. The ones who were paying the reduced community price, I have extended their price until July, so they have an extra six months for us to work through their current treatment plan before they have a small increase in fee. And for me, I can see a difference in my confidence behind my prices – I no longer feel apologetic about them when talking to prospects (I myself couldn’t afford my previous rates, and I know that affected how I talked about it).

BUT, my only downside so far, which is why I wanted to share this in case others are making the switch, is that rolling this out in January coincided with my normally slowest month of the year – slow month + lower rates put me in a bit of pickle financially. I feel confident about the change overall, but some days I’ve had to dig deep for some extra faith that this will work out better in the end, both for my patients and for me. Would love some encouragement!  Thank you Matt!

Thanks so much for sharing your update. I hope more will start to do the same as the more that is shared the better we will all be able to help each other. Yes – January can be a slow month as people tend to run-up bills during the Winter Holidays and are hesitant to spend money at that time. Also those using their insurance start with new deductibles. I do have suggestions that should be of help. Try to use your new rates as a way to promote your practice. You should especially ask those who are now at a lower rate to please refer others to you as making this change is making you go through a financial stress. Be honest with your patients and some will feel for you and go the extra mile to come more often themselves and to refer. You don’t want to act desperate of course but many of your patients should be able to appreciate that it is tough to make a go at a practice in these times. If they like your services then it is a win-win for them to help their friends and help you at the same time. Find the right tone and it should not be awkward at all to ask for them to help you through this time.

For those who were seeing you under the community type rates, it was a good idea to phase that out for them but also try to encourage them to take advantage of their current rates. Any time you change a policy in your practice you should always think of how you can use this change to market yourself.

You mentioned being out of network for the insurance plans. Could you give me some more information about that? What kind of plans and what are the policies for the type of insurance patients you are seeing? I might be able to give you some advice. Once you build-up your insurance patient base, you can use that to keep your income more consistent. In 2012, we had our most profitable month of that year because of all the insurance billing we did in December did not come-in until then. Your new pricing structure should be better in the long-run. Do all you can to use that change as a marketing angle and once you get through this transition you should be fine. Hang in there!   

Matthew Bauer

Hi Matt,

I just went to the AAC seminar this past weekend!  Thank you, for that suggestion!  AAC had not had a seminar in Texas in over 2 years!  I am glad I was able to attend because it was very informative. I am glad to hear that people are doing well implementing the Middle Way model. 

I wanted to ask more about how you keep track of insurance billing.  Is it all via Office Ally?  How do you keep track of how much is owed by patient and/or insurance company?  How do you keep records for the insurance billing in an efficient manner?  

Adrianne Ortega

Hi Adrianne. Good to hear you made the seminar.  My wife is in charge of all our insurance billing. The way we keep track of things is really antiquated (unlike my wife). We don’t use Office Ally although I know many do and like it a lot. We use a ledger card system where we mark the date the patient was treated, the charge, any payment received (co-pay for insurance patients) and balance due. We mark all of our insurance files with a red sticker and keep those separate from our cash patient files. Once a month or so, we pull those insurance files, go over the ledgers and then do the billing with software that gives you a HICFA 1500 form to fill out. We then print-off a copy of this completed form and put it in the patient’s file. When we get the payment, we enter this onto the ledger card with the date and amount. We can then see if there is any balance due. We bill our American Specialty Health patients using their online system but print-off a form at the end of that process that gives all the details and place that in their file. Some day we will go to all-electronic files and billing. My wife informs me I will make that change without her – that she will quit if she has to learn a whole new system. I am not sure how I am supposed to feel about that.  

Matthew Bauer

Thanks Matt for your encouragement!

For Adrianne – just to give some more ideas about insurance billing, this is how I’ve set mine up – though I’m only a few months in to billing so certainly not experienced and I’m sure there are ways to make it more efficient.  In the patient’s paper chart I have a payment ledger (a printed Word table) where I record treatments, payments, balances due, and date submitted to insurance. (I also use Matt’s wife’s idea of putting all insurance forms/letters/etc behind a colored sheet of paper in the chart so it’s easy to find; as well as a colored dot on the chart by the patient name but I don’t keep the files separate from cash patients)

Then I use the Customer tab in Quickbooks to record the treatments and payments per patient because I do all my accounting through QB (I can quickly see at a glance who has outstanding balances).  I then submit the insurance form through OfficeAlly on the same date of service.  They recommended this in the AAC seminar especially for those who don’t have the cash flow to wait and bill a whole bunch at once.  After the first time submitting for a patient, I use the Managed Stored Info to pull up their basic info and then enter the new date of service, etc and it literally only takes a minute or two. 

Would love to hear how other people have their procedures set up as well for more ideas! 

Matthew Bauer

Stephanie