Shirley is a proud wife and the mother of two boys. She enjoys traveling and photography. Shirley is also a veteran of the US Army Reserves. In February 2010 Shirley founded CPR after serving as Provider Relations Manager for QualChoice of Arkansas and working one-on-one with the providers’ offices and healthcare facilities around the state. She found that many offices were understaffed or were having issues finding qualified employees to make them effective on the billing/reimbursement portion of their businesses.
Starting out with a few small practices, performing credentialing and billing services, Shirley put her experience to work and Team CPR was born. Over time many new services have been added to the skill set allowing our practices to perform at top effectiveness.
Transcript of the Conversation
RJ: Welcome to the iProv Made Podcast where we help you build a profitable healthcare practice. Beside me is my good friend Jordan Smith.
Jordan Smith: Hey everybody.
RJ: Tell us a little bit about Shirley Walker and CPR, which is our featured guest of the day.
Jordan Smith: Well, I’m going to say three things. First is 15 to 25% more revenue. The next thing I’m going to say…
RJ: Wait, you’re speaking their language now.
Jordan Smith: Yep. The next thing I’m going to say is a 98% first time claims pass rate. The third thing is a woman owned, minority owned, veteran owned organization that can help you achieve those first two things I talked about. If you’re not going to listen to it after this, then I don’t know what else to tell you, because I’ve never heard anything like that before.
RJ: We say we want to talk to people that want to build a more profitable practice and sometimes we get great leadership guests. Sometimes we get great inspiring guests. This hits it right on the nose. She talks about how to build a more profitable practice. So I’m ready to jump in. You?
Jordan Smith: Yeah. And one other thing, a more profitable practice without having to see any more patients. That’s the thing that struck me the most.
Jordan Smith: Yeah.
RJ: Well, let’s get into it. [inaudible 00:01:23], Shirley Walker. Welcome to the podcast. Shirley, we are so excited to be here in your brand new office space. Beside me is Jordan. Jordan, how are you?
Jordan Smith: I’m good.
RJ: We got a cool tour of… And the first thing it makes me want to do is burn down our place and find new office space. So congratulations. I know that’s a big thing.
Shirley Walker: Thank you. We’re very proud. We’re about to enter our 10th year. We turned 10 February 1st so it was kind of a good timing thing to be able to do all that.
RJ: A birthday present.
Shirley Walker: Yes. Yes, there you go, birthday present.
Jordan Smith: So by the time this comes out, CPR will officially be 10 years old.
Shirley Walker: Yes.
Jordan Smith: Nice.
RJ: Well, I always like to start in telling you our quick really six step process for how we think about building a business, and it starts with identifying symptoms. That’s usually how we start businesses, we see a problem. Number two is taking extreme accountability for that problem, and that’s us saying, “Hey, we’re going to fix that problem for you.” And not only we, it’s not like there’s a bunch of people… No, it is, I’ll fix that problem for you. The third thing is building a vision for what the future looks like, so your team and people that work for you can buy into. The fourth is building a strategy on how you’re going to grow and building tactics to make sure you do that over and over.
RJ: After building a strategy and tactics, the next is getting alignment with your team, and alignment takes a cadence. It’s your weekly staff meeting, it’s annual planning. You’ve got a room dedicated just for alignment, which I am so jealous of. And then last and only, after you figured it all out in your head is getting your team involved, so engaging that team. So we kind of like to start just by saying as an elevator pitch, when people first meet you, how do you go about telling people what you do here at CPR?
Shirley Walker: Sure. First, let me say thank you very much for having me. I’m very excited to be doing this with you guys and to get to tell a little bit about the company. CPR is a healthcare services firm. We were founded in February of 2010 with the single vision of helping clients succeed in their practices. What we were finding is a lot of practice managers either had the time but not the knowledge base or the knowledge base, but not the time. Practices were not being as successful as they may be could be and we wanted to be able to help provide that back office support, whether that be billing, credentialing, contracting, whatever support they need. Our average client sees between a 15 to 25% increase in revenue over the first year they are in business with us. We’re very proud of that and a lot of that speaks directly to the type of diligence that we have in our processes and how we follow up on things for them.
Shirley Walker: We’ve tried to listen to the clients as much as we can throughout the processes and we have picked up additional services to help support those as we’ve gone along. For instance, we’ve added IT services along the way because that’s something our clients were telling us they really needed. We do that at probably a little more cut rate than most IT companies in Little Rock, but it’s a support service for our clinics and it just helps them to succeed. It’s not necessarily meant as a call center for us, so we try to listen as they come up with little things that they wish they had and try to build those things in for them.
RJ: Wow. So it sounds like what you do at your core, if I understand it correctly, is kind of the billing procedural stuff, but you also listen to everything they need and kind of build in just support ways. Before they work with you and after they work with you, they see an increase of 15 to 20% top line revenue.
Shirley Walker: Mm-hmm (affirmative).
Shirley Walker: Yes, and we have a flexible approach. So different clinics do things different ways. You have some that they’d got the process down pretty tight. They just need someone to kind of hone it for them and help them follow up and get things accomplished. Other clinics, it’s literally the doctor and some poor receptionist who stuck out there with a CPT book in her hands. So then we take that entire process and handle it for them. We appreciate the flexibility of being able to come in and out of the process where they need us to.
RJ: Wow. So I like to ask the question, why do clients… What do you see where they usually don’t choose you?
Shirley Walker: Well, it’s funny, a lot of what we hear when we talk to people is, “Gosh, I wish I’d have known about you six months ago.” But a lot of it is that they have just entered into an agreement with another entity. Someone got to them before us basically, or they have entered into something with their software vendor who maybe already provides the same types of services and they’re trying that out. We are finding, especially as we grow and things are moving down the road, we are finding that several of those do come back around and say, “Okay, three years ago we tried something different. That isn’t working. Now we’re back.” So it lets us know that our message is getting through. We are residing with people, but a lot of times it’s just that they’ve found another solution before we got to them.
Jordan Smith: Gotcha. So the flip side of that, who are kind of the most successful clients, or said another way, who is your ideal demographic? And for the listeners out there, if they’re listening to this and saying, “Well 15 to 25% increase in revenue, cool, sign me up.” What does that…
Shirley Walker: What makes that happen?
Jordan Smith: Yeah, what makes that happen. But before even that, what does that practice or business actually look like when you say, you know what, these guys are a good fit for us?
Shirley Walker: Usually for us, we’re looking for someone that is willing to listen, is willing to do what we’re recommending for them to do. We are very staunch believers in following the rules and participating in the guidelines that are set forth by the various agencies that dictate what we do. We don’t believe in filing things just to make money. We don’t believe in trying to skirt the system just to make money, so we try to really do things the right way. If we find clients that their interests are aligned with that, those generally make the best ones. A lot of our clients are hungry for information. They want us to take them by the hand and teach them how to do something better, how to get on top of a system, how to control something, how to work with the carriers better, whatever their particular issue is. So our best clients are the ones that are open to hearing that information.
Jordan Smith: And coachable.
Shirley Walker: Coachable, that’s a great word.
Jordan Smith: Let her hiring you guys for a reason, knowing that they’re not the experts in what you do.
Shirley Walker: Yes, and it’s an ever evolving process. That’s something that we tell even our own employees. You think you know what you’re doing and yes, today you do, but next year half those carriers are going to change the rules and the code that worked two years ago doesn’t work anymore and now you’ve got to do this new something and there’s a new policy that comes out, and we help navigate all of that. Do we know all the answers? Absolutely not, but we go pursue them, we figure it out and we help them work through it.
Jordan Smith: Very cool. So all that being said, step us through kind of some success stories, some of your most successful clients.
Shirley Walker: Probably our biggest success story was several years ago we picked up an urgent care clinic that was really struggling with their revenue each month. They couldn’t really figure out why they weren’t making money. They were seeing plenty of patients. It should have all been working, and we were able to go through a lot of their billing processes. There were things that they weren’t billing for that they could be billing for. I’ll give you a great example. Someone comes in with a sinus infection, maybe they were only treating for the actual medication they administered, not the code to administer the medication, which you get to bill for both. So there were little things that we were able to go through and immediately start looking at, well, you’re billing this code. Why aren’t you billing that code? Things that we could help home, what they were doing.
Shirley Walker: We have a coder who goes through and reviews their documentation and she could tell them your coding is not strong enough. I need you to be saying these things. We could do little classes with them and help them understand. One of the things that a lot of practices get wound up in is bundling and unbundling of codes, knowing what you can bill together and why and how to do different things at different times. So helping them know how to navigate that appropriately. Again, not just with the effort to make money, but when it’s appropriate.
Jordan Smith: You know, I’ll reveal a little secret, which is this is not the first time we’ve had a conversation. You and I have talked a lot and I know that one thing that you always hit on, it’s a term that’s kind of always stuck in my head is this repeatable billing process.
Shirley Walker: Yes.
Jordan Smith: Right? Which is what you’re talking about.
Shirley Walker: Yes. Having something that you can put in place and you can follow it, it’s teachable. It’s easy to understand. And like I said earlier, the carriers are going to change things from year to year. Your software vendors are going to change things from year to year. It’s being able to have your process in place and tight enough that you can adapt to those changes and move forward.
Jordan Smith: And adjusting those standards as things change, but making sure that you know those things are in place moving forward.
Shirley Walker: Yes.
RJ: You talked about the urgent care clinic and making sure that we’ve hit on this, but their life before and after working with you, can you dive into that a little bit? Did they give you any key phrases that gave you insight of how it used to be versus how it is now?
Shirley Walker: Well, of course, you always hear, and I’m sure you guys hear this all the time, “Well, that’s how we’ve always done it. That’s how Dr so-and-so set it up that way 72 years ago and that’s how we’ve always done it.” Well, you imagine what has changed just in technology in the last five years, let alone 10, 15, 20 years. There are a lot of things that are in place now that make your life technologically simpler.
Shirley Walker: We laugh about technologically, sometimes it’s more complicated, but it’s supposed to be simpler. Things go through electronically. We’re able to get you paid faster, more effectively, more productively. We’re amazed at the number of clinics that still aren’t set up on EFT, or they’ve gone on EFT with the two or three carriers who have made them do it, but they’re not doing that all the way across the board. And we’re like, “Golly, you’ve got these checks showing up in your office, which means someone… First off, it’s an opportunity for fraud. Secondly, you’ve got someone who’s having to actually sit down and take that check and stamp it and go to the bank and do all that stuff where I can make that money go right into your account.”
Shirley Walker: So that’s one example of things that really can… The technology behind it can make your life a lot easier. For that particular clinic. A lot of it was just being stuck in one methodology of doing things. We see some clinics where maybe it’s a relative of the doctor who’s the wife, the niece and nephew, the cousin or whatever, who’s doing the billing, they’ve never been taught properly how to do it. They’re stumbling their way through it. They’re doing the absolute best they can. They don’t know some of those things are out there and that can make their lives a little easier. So those are a lot of the things that we’re able to kind of help streamline and loop around and get in control for them.
Jordan Smith: For sure, which goes back to that bottom line. I mean, not only figuring out ways where they can make more money, but cutting down on those inefficiencies that they might not even know exists, right?
Shirley Walker: Yes, and one of the things that we hear a lot of clinics when we start talking, trying to talk to them, is you start talking to the office manager, she’s afraid you’re going to take her job. It’s not our objective to put anybody out of work. There is plenty of stuff to do in a clinic. If you’ve ever sat in a clinic and watched it work, there are plenty of jobs to do. What we want to do is make it efficient for that person to be able to do something else that supports the practice and helps overall.
RJ: Yeah, probably more important stuff, I hate to say, than what you’re doing for them. Stuff that only they can do because they’re kind of boots on the ground, but we see that often whenever we’re talking to people about technology. I think as physicians, as owners, we’ve always heard about technology and we’ve thought about the future and we’ve always thought technology is supposed to make our lives so much easier. It was sold to us that technology was going to allow us to do what used to take eight hours a mere seconds, and it hasn’t done that. For the large part, it’s made it busier for everybody so the second we come in with the conversation of we’ve got technologies and tools to make your life better, they almost roll their eyes at it.
RJ: But I would encourage listeners to know that a lot of times it’s not the technology, it’s our inability to understand how that works. And so seeing someone who’s using the technology properly, we’ve all been there before, we’ve seen it and it’s an eye opener. So having an expert like CPR come in and say, “Look, this is how you utilize a check scanning system and not make it be harder, but actually make it more efficient.” That’s how you implement technology the right way.
Shirley Walker: Well, we’ve all heard of the paperless office. We’re all going paperless, because you know, you totally see I’m paperless sitting here at my desk, right? And that was such a great thing when it came out. Oh, we’re going to be paperless. Won’t it be amazing. I don’t know anybody that’s paperless. There are very few offices that have been able to completely pull that off successfully. And even when you think you have, someone wants that paper somewhere. So just to try to make those things as efficient as possible and not necessarily, we’re not going to hit the moon with that one, but if we can just get close, get things moving in the right direction, it’s a big improvement for a lot of practices.
Jordan Smith: For sure. And I know that there’s probably a lot of folks out there that are listening that are saying, “Oh, this is great, but we’re busy.” Busy doesn’t necessarily mean profitable.
Shirley Walker: Right.
Jordan Smith: So how many times have you met practices that aren’t making money or ones that say, “Listen, we are busy.” And you’re looking at the numbers and saying, “That’s fine, but you’re not making any money.”
Shirley Walker: Yes. A lot, honestly. We see practices that are frankly overstaffed. The doctor maybe can’t say no and he’s hired every person who’s ever come in and asked for a job. Or the office manager’s hired five people that she knew needed jobs. And not that those people aren’t absolutely wonderful people and maybe fantastic employees, but just like any other business, you have to look at the bottom line and you have to look at whether you can afford to do that, and how those people are making their worth through the practice.
Shirley Walker: So one of the things we try to help demonstrate, when we’re talking to our practices, what we bring to the table. Yes you’re going to pay for our services, but that’s going to either free up people to do other work or take care of other things that are on your plate. We also help eliminate, well, gosh, Sally’s going on maternity leave and so now my billing’s not going to get done for six months. That doesn’t happen here because there’s always someone to back up. The most your stuff’s going to get stopped for is a day or two while we’re moving things around. But it helps alleviate a lot of the concern, I think, for the clinic because they’re not having to worry about those little, well, gosh, now five people called in this week with the flu. Well, your billing isn’t stopping. It’s still going.
Jordan Smith: Yeah. So all that being said, how involved are the providers or the most successful doctors in their own business? Are they actually the ones taking ownership of the problem? Does it usually start with the office administrators? Talk to that a little bit.
Shirley Walker: It usually starts with the office administrators. We’re dealing with a clinic right now where the physician is very, very involved. He’s got people who are supporting his office staff who want to help. They don’t necessarily know how to help, but in a typical situation, it’s kind of a partnership and usually the office staff takes more of a leadership role because we want to keep that practitioner seeing patients. That’s what’s making them money. That being said, it is the practitioner’s business. It’s the doctor or the nurse practitioner or a PA, whatever. It’s their business. So we want them to be involved. We don’t want them to have to into the minutia of, well, how is the file going to get from here to there? Or how is the thing going to happen when this happens or that happens? We try to handle all of that with the office staff as much as possible.
Shirley Walker: We also believe very much in, I love you where you are. So some practices are absolutely, probably where they need to be and they just need a little help getting the billing done. Others, you’ve got a guy who was never taught any of that in medical school. They’re doing a much better job now with the younger guys coming out of school and they take business classes and they teach them all that. But if you get an older school doctor, he was never taught that. He maybe was never taught finance or how to make any of that work. He just knows that there’s enough money in the checking account. He doesn’t know that there are things that are being written off that shouldn’t be written off or there are things that are not being filed which should be filed. He has no idea.
Shirley Walker: So we appreciate when we’re able to engage with the entire practice and we want the physician to have buy in and that whole thing because it’s his business. But the reality of it is for us, we’re typically dealing with the office administrator or the insurance manager, someone who is hopefully in a high enough leadership position that they can actually make decisions and make changes because sometimes it’s a process that they’re doing in the office that we need them to make modifications to. And when you’re dealing with someone who doesn’t have the ability to actually call the shots on that, you’re kind of stuck cause they’re waiting. You have to try to get buy in from the physician. Well, he’s busy and you can’t get his time. And so we try to get someone high enough in the clinic that they can, if we go to them and say, “This process isn’t working,” they have the ability to make changes to it.
Jordan Smith: I’ve heard you before say, let us breathe life into your practice.
Shirley Walker: Yes, that’s our tagline. Let us breathe new life into your practice.
Jordan Smith: Yeah. Very cool.
RJ: And I think you might’ve touched on this a little bit ago, but your ideal customer or the types of practices you’d like to work with…
Shirley Walker: What are those?
RJ: Yeah, what are those?
Shirley Walker: Really, we’re not… I get kind of tickled at billing companies that we only work with this or we only work with that. We have not developed that type of niche. We really believe that everyone deserves help. All practices need help on some level. We have a good variety of billing people with a wide array of knowledge base across different specialties, and things that we don’t know we learn. So billing is billing at the heart of it. There are nuances for each specialty. There are certain things that happen in one versus another, but the billing process itself is basically, it’s got its own ebb and flow to it. You’re always going to be filing the claim. You’re always going to be doing the followup. You’re always going to be billing the patient. Those pieces aren’t going to change whether you’re a cardiovascular surgeon, an urgent care clinic, a podiatrist or whatever. Now, there will be nuances in that, what you can bill, what you do, you have this other service, maybe you deal with different carriers differently. There are those things that happen, but-
Shirley Walker: Deal with different carriers differently. There are those things that happen, but we don’t… We’re not super picky about what provider types we will do billing for. We believe in trying to help everybody.
Jordan Smith: So, what I’m hearing is, if you want to increase revenue by 15 to 25% give Shirley a call, right?
RJ: Well I agree, and I think you’re speaking to business owners, and we’re all thinking the same thing. Yeah, anytime you can add 15 to 20% on the top line, I want to talk to them. But how can you determine if you can actually help someone?
Shirley Walker: Well, we usually do that by sitting down and having a conversation with them. “How are things going? What are you doing now? What system are you on? What’s working? What’s not working? Where do you think your problems are?” And then we’ll ask them if we can see some of their reporting metrics. Most systems, and I say most because we actually do bill out of a system that doesn’t do this very productively, most systems will create an AR report so we can see what… And the AR report is divided into buckets, so we can see how old the claims are and what’s sitting in what bucket.
Shirley Walker: We can run various different reports in their system to see how quickly things are being worked, what their rejections look like, what their write-offs look like, if they’re having a lot of refunds. There are things like that, that will tell us what’s happening at the front desk, what’s happening on the filing side, whether things are being followed up appropriately, and usually within a couple of hours of a good conversation and looking at some of those reports, we have a pretty good idea if we can make an impact for them.
Shirley Walker: We look at what they’re currently paying for their staff who are involved in the billing, because obviously we want to try to stay roughly in line with that, and we have to make sure that what it’s going to cost them to hire us isn’t going to break the bank as it were. What most clinics find is that it’s absolutely a worthwhile investment. And again, they’re able to re-task those people for other positions throughout the company and put them wherever it is they need. At the end of the day though, we don’t believe in entering a relationship that isn’t mutually beneficial, and we have parted ways with clients where their goals were not aligned with ours for a variety of different reasons. So we’re not afraid to do that. We don’t like to walk away from something, but if it’s not a good fit for us and it’s not a good fit for you, there’s no point in continuing.
Jordan Smith: I’ve heard you say that before, where a lot of those first time engagements, a lot of them, it’s just the timing’s not right or it’s not a good fit. Often times you guys are the first ones to say, “Hey, here’s some things you can do, but I’m not sure that this engagement is right-”
Shirley Walker: And we try to warn them of, “Well, hey, you’ve started this new relationship, be on the lookout for this or that.” We are seeing a rash of… Which is very concerning in the medical billing community… We are seeing a rash of companies that are being outsourced to India, and that’s concerning on lots of levels. First off, they’re really cut rate on what they can offer. So they’re charging two or three or four percent for what most billing companies are having to charge more for. Secondly, your PHI is leaving the country, which is concerning on a whole other level. But from the doctor’s perspective, “Gosh, I can get this job done for a fifth of what you were going to charge me,” or whatever. We try to warn them to look for these warning signs, “Pay attention to this. Make sure this, make sure you ask these questions. Make sure you’re getting these reports.” Try to help guide them, even if we aren’t the company that they end up with.
RJ: Yeah, sometimes outsourcing makes a lot of sense for businesses, but if you’ve never outsourced before, I would really urge our listeners to try outsourcing something as simple as a brochure design, or try outsourcing something like a logo design first, and you’ll see how hard outsourcing is. And then that’s only coupled or compounded if you do something as difficult as billing.
Shirley Walker: And you mean outsourcing across the pond, across the water?
Jordan Smith: Yeah, just try something simple and realize how many steps… Your next pen order, try to get your logo plopped on those things.
Shirley Walker: Exactly. And frankly, if you talk to a lot of clinics, everyone can relate to, “Well I had to call United’s call center and that person couldn’t speak English,” or, “I had to call… ” We went through this whole hour and a half long ordeal the other afternoon talking to Humana’s call center in the Philippines. And you could tell that they were all sitting in the same room, but they couldn’t talk to each other. They couldn’t transfer you to each other, and you just chased your tail for an hour. So anytime you’ve had to do a little bit of that, it makes you appreciate that. I get, too, from the doctor’s perspective, it’s a less expensive way to get his billing done and he thinks it’s going to be okay, but there also is a lot of truth to that, “You get what you pay for.”
RJ: Well and I’ll chime in. A lot of times when you hear this 15 to 20% increase, you think, “Oh, I’d love to find it, and I’d love to have that.” We all want that. And it’s not like Shirley or other vendors are magically finding those gaps. Yes, sometimes we expose things, but almost always you’re sitting in your vehicle now, and you know if you have inefficiencies in your operations. It is just you thinking that… You just kind of shrug your shoulders and say, “There isn’t another option. It is my mother in law who’s doing it and she doesn’t know any different. There are no other options.” But it is interesting to think about how there are solution providers out there who can integrate nicely into your atmosphere and show those slight improvements. It’s not overnight success often, not because Shirley or other vendors can’t do it, but because there’s that operational way to properly integrate your solution into your workforce.
RJ: So Shirley, talk about how do you integrate with an existing practice now?
Shirley Walker: We really try to take a very flexible approach to that. So we set up an SFTP, a Secure FTP portal for them. We have certain things that we ask them to send us every day that we use as safety nets to make sure that we’re getting everything. They pretty much punt anything to us that they want. So if they get a weird letter from the insurance, excuse me, a weird letter from the insurance company or the patient has sent in some correspondence they don’t know what to do with, they can punt all of that to us in that folder. And we have someone who pulls that folder every morning, gets it off to the appropriate biller, and takes care of it.
RJ: Oh it’s exceptions. These are just things that they don’t know what to do with?
Shirley Walker: Yes.
RJ: Very cool.
Shirley Walker: So they punt all of that to us, as well as there are daily things that we have them send to us. And we try to-
RJ: That’s standard procedural stuff, but even things that’s like, “We don’t know what to do,” it kind of starts with you guys, too-
Shirley Walker: Yes, and we encourage them to do that, partly because we don’t want them wasting their time on it, and partly because… And this is going to sound way worse than I mean for it to, but it’s a lot easier and more productive for us to fix something in the system than too risk letting you maybe fix it incorrectly [crosstalk 00:28:20] and then we have to fix it again anyway. So it helps you go on and see your patients and do your thing and all you had to do was punt it to us.
Shirley Walker: There are a lot of things that we do that I know other billing companies don’t do. I’m hearing that a lot lately, like, “My last billing company made me do all these 47 things that you say you’re going to do.” We would rather take the extra few minutes and do it ourselves. It’s done correctly. We know it’s done right. It helps our first pass claims rate, which is sitting at a little over 98%. We’re able to get those through right the first time because we’ve made sure everything’s in the right field and it’s all working appropriately. Other than that, the clinics know that they can call the office anytime they want, so if the patient is standing at their window arguing with them, they can call our number and hand the receiver over, and the biller is going to talk to the patient.
Shirley Walker: Our telephone number goes on all the statements. We have electronic processes that support the statements, too, where they’re texted or emailed out, but ultimately all of the questions and all of the information comes back through to us, so that frees the office up again. And something that several of our clinics have told us is, it removes them from that financial conversation. You don’t want to be standing there looking down my throat talking about why I have strep throat, or sinus trouble, or whatever it is I have today, and, “Oh by the way, Mrs. Smith, you still owe us that $45 bill.” It completely removes you from that conversation.
RJ: Which patients like, too.
Shirley Walker: Yes.
RJ: The patient doesn’t want to hear it-
Shirley Walker: No, and they don’t want to be scared to go to the doctor.
Shirley Walker: I think there’s a real fear factor for a lot of people, “God, I’m really sick but I know I owe them some money.” And that being said, we also try to teach the clinic how to handle that appropriately at the front desk so that that’s being collected when the patient is there in the appropriate manner, without the patient having to be fearful about that bill.
Jordan Smith: I’m sure our physicians and our audience knows this, but you said something that I keyed in on, “98%-”
Shirley Walker: First pass?
Jordan Smith: “… first pass.” Which means that if I have a claim, 98% of the time I’m going to get paid on that the first time.
Shirley Walker: … the first time. Yeah, so what that means is that it made it successfully from us through the clearing house… And sometimes there are multiple clearing houses… To the carrier with no problem first time, 98% of the time. Now we still have things that reject, maybe your name was spelled wrong, maybe you got married and forgot to tell us, maybe you changed something. But we do checks on the front end to try to catch as many of those things as possible before the claim ever goes.
Shirley Walker: And we started doing that several years ago because so many of the carriers have a very short timely filing window, 90 days. So if we try to send something and wait on it to reject, and then come back and try to figure out how to fix it, we’ve lost half that time. And by the time we figure it out, your timing filing window’s closed and you’re going to eat that claim. So there are a lot of things we do to try to get those things through as quickly as possible the first time.
Jordan Smith: Well, I’ve heard you say, too, that one of the biggest things that you hear once you guys get a clinic onboarded, is how little they have to touch things, right?
Shirley Walker: Yes, yes. And that’s our goal. We want them to be able to do what they’re supposed to do and we take care of the rest. We find a lot of billing companies simply file the claims and they’re not doing anything else with it. And we don’t believe in that. There is a process that we follow when things come back in, payments are posted. Our staff is not allowed to just write things off. Of course there are things that nobody covers; That’s a little bit different, but they’re not allowed to just adjust the claim off and that’s the end of that. They usually get to come have a talk with me if they’re going to do that and most of them don’t like to do that.
Shirley Walker: So we really try to make sure that we’re maximizing all of that. A lot of times there’s a really good reason that something needs to be appealed, something wasn’t submitted correctly, you put the wrong code on something, we didn’t catch that you switched the diagnosis codes around. There will be reasons things like that don’t pay, and we try to exhaust all of those opportunities before things are written off. What we hear from a lot of our clients is other billing companies don’t do that. They just file something, whatever pays, pays, the rest of it gets adjusted off. And that’s the end of that.
Jordan Smith: Well that’s what I was going to ask you about, because I’m sure there’s a lot of listeners out there that are saying, “Well how are you guys able to do that?” Or, “What’s the difference between whatever I’m doing now and… What makes CPR better?”
Shirley Walker: Well I think a lot of it is just diligence. We believe very strongly in doing the job, doing it completely, doing it as accurately as possible. Is it 100% correct 100% of the time? Well, absolutely not, but we do try to put forth our very best effort and make sure that everything is going through in the best manner possible.
RJ: Well, and asked in a different way, obviously there’s listeners there that you’ll never have the opportunity to talk to, but they are looking at maybe working with a billing company similar. Are there best practices in the industry? Or are there questions that you’d say if you’re talking to someone in Alaska, say, “Hey, ask these kinds of questions to make sure that they’re following best practices.” Or a business like yours.
Shirley Walker: There’s not a lot of published data out there, as far as guidelines. Of course, you can find articles people have written, but there’s not, “Well, gosh, your claim ought to pay in this amount of time,” or, “This ought to work this way,” or, “This ought to work that way.” Which I think is part of what’s opened the door for us to do some of the things the way we do. We sit down as a leadership team, we decide what we think those things ought to be. We have very strong guidelines on what our AR needs to look like, what our targets need to be there, and we follow those things. When we talk to clinics, especially new clinics, we find that other billing companies, some of them have some of those in place, but maybe not all of them. Some of them have different ones than we have in place. Some of them don’t have any.
Shirley Walker: We have some clinics who tell us they’re lucky if they ever talk to their billing people. They don’t have a person that they can get on the phone when they have a question. Well, here they have an assigned person that is theirs. Now anyone can answer the phone, anyone can help them. If Sally’s on vacation this week, there’s a whole myriad of people here who can generally pick up the phone and answer a question. But we hear that is one of the things that people really like. But as far as things that are documented and help guide how your practice ought to work, there’s not a whole lot of best practice information out there. There are a lot of revenue cycle management companies, billing companies, people who live in that world, but there’s not any kind of a guideline necessarily. I think we’ve all just kind of designed our own.
RJ: Yeah, sure. Well, a couple things that stuck out to me is, this idea that you guys handle all the exceptions. Third parties often have very strict procedures and say, “Hey, do these 20 things, and here’s how you do the 20 things.” But this idea that you guys will look at the exceptions for me so that I don’t have to, that punt folder that you talked about. I think if I’m talking to our listeners, I’m saying, “Make sure that they’ll do that, because there’s so much value in those exceptions that nobody knows how to do. But you as the listener, as the owner, as the physician, you should not be doing that. Let somebody else do that.”
Shirley Walker: It’s not a good use of your time, and it’s not your area of expertise. I’m not out trying to practice cardiovascular surgery. That’s not what I was taught to do. That’s not where my area of expertise is. I would go to you. So, it’s the same kind of thing for us. We are experts at what we do, and when we don’t know something, we don’t know how to do something, or the carrier’s done something, which happens a lot, honestly. Carriers do weird stuff. We’ll get a remit, nobody can figure out why they did what they did. Well, it’s a lot better for you to punt that to us. And we spend the hour on the phone arguing with them and trying to get it fixed. And we’ve got the ability to go through and refile and do whatever we need to do in the system.
RJ: And those exceptions, as you read through those, can you talk about pricing models? Do you bill that hourly, and then you bill other stuff? You talked about percentages. Can you talk about pricing models in the industry?
Shirley Walker: You’ll see pricing vary wildly. I referenced a minute ago that people in India, and the Philippines, and places like that typically are charging two to three, sometimes four percent. Here, it depends wildly on your specialty, where you’re located, what you’re doing, how many claims you’re doing, how much work you’re doing. Typically, though a lot of billing you’re going to see done in the six to 10% range, so depending on, again, on what specialty you are and how complex your work is, and what all is involved. We try to… Part of that initial conversation is figure that stuff out. “How much work are you doing? How many patients are you seeing? What’s coming in in revenue each month?” And we do it based on total money collected. So the difference there is some billing companies will do it just on insurance. Some will do it on total money collected.
Shirley Walker: Well, I still have to do the same amount of work essentially. We want you to use our system as your repository for your financial information. We want those patient accounts to be correct. We want all of that done. We’re entering it all for you. We’re taking care of it all for you. So we charge a percentage based on the total collected. So if you go in, it’s January, it’s deductible month, your $5,000 deductible needs to be met, then today’s charge is going to end up going to deductible. Well I still have to put that in, and file a claim, and send it to the carrier, and fight with them and do whatever I have to do to get that posted. And you’re eventually going to end up paying that charge that gets included. That kind of helps us cover the cost for the things that aren’t insurance-based, but they’re still the same amount of work. It’s still the same kind of effort that goes into it.
Jordan Smith: I know that you also spend a lot of time… You mentioned earlier letting organizations be an expert in what they’re an expert in. I know that you practice this as well, as far as the affiliate program that you have, right?
Shirley Walker: We do. We have an affiliate program called Thrive. We actually named it… I guess it’s been about three years ago now. What happened when we first started the company is we found that our clients were coming to us to ask for advice on things. “Hey, my shredding vendor, I’m not happy with them,” or, “We just lost our medical waste vendor,” or, “We need an X or Y, whatever.” Some of those we were able to recommend the people we work with, and others we found that, “Oh, okay, well we can help you find somebody. We’ve not really thought about that before.” But we would sit down as a team and, “Okay, is this something we can do? And if it’s not something we can do, how can we find them someone who can do it?” We called it our affiliates program for forever, and we finally decided that it deserved its own recognition, its own title, so it’s Thrive, and you just have to be a client or be associated with us.
Shirley Walker: You don’t have to continue being a client, even past clients can use it. But we have accumulated people who are… We have a cybersecurity expert, we have a shredding vendor, we have accounting people, we have a placement agency, all kinds of different people, marketing firms, different people that are engaged in that, so that when our clients need something, they’ve got a place that they can go look and at least have a starting point. It doesn’t cost them anything to use. It doesn’t cost the vendors anything to be a member of. It’s just really one of those things we kind of landed in. We believe in it. We believe in trying to help our clients, and it kind of helps give them a place where they can at least have a jumping off point.
Jordan Smith: Which is huge… The fact that you guys were having that number of conversations with clients.
Shirley Walker: Yes.
Jordan Smith: And that they not only trusted you with what they entrusted you to do, but they also saw you as an advisor of sorts, too, to be able to come to-
Shirley Walker: It was really funny how that came about, because that was not really anything we imagined would ever develop into something. We started with a folder. Kind of like you do the menus, the, “Hey, we’re going to call in for lunch today. Who’s got the menu folder?” Well, it was, “Hey, so-and-so is calling for a security expert. Who’s got the folder?” So we decided to formalize that a little bit. And the vendors really like it, because it gives them an opportunity to shine a little bit and put their information out there.
Shirley Walker: And a lot of our clients have a lot of the same needs. So they’re needing the same type of cybersecurity, or the same type of physical security, the same shredding vendors, the same… It really helps them to have a place to go to.
Jordan Smith: Very cool. Well, tracking progress and outcomes is really a big part of our framework. Is there a methodology… Or how do practices track progress and outcomes in your part of the business?
Shirley Walker: Well, we have some who track everything, and we have some who really don’t get engaged in that part at all. They just want the work done, and as long as everything’s being taken care of and handled, they don’t really get-
Shirley Walker: It’s being taken care of and handled. They don’t really get engaged. Now whether they do or not, I do. We’re monitoring our AR every week. We have steps in place where we monitor the provider’s reimbursement. And what I mean by that is fee schedules change every year. So let’s say you’re charging $50 for something and your fee schedules with three of the carriers now went up to $55. Well, once we see that that claim starts paying at a 100%, we know that you’ve sort of outpaced that fee schedule and we help adjust that because you’re leaving money on the table. We recommend that clinics review that reimbursement every couple of years anyway, but if something like that happens, one off, we help fix it. We monitor things that the carriers are telling us are new initiatives they’re putting out, new things that they’re going to stop covering or start covering, new pre-auth requirements, things like that. We’re monitoring those things for the clinics.
Shirley Walker: Now, some of them, again, are ultra engaged and they want to read all of it and they want to understand it. Some of them are like that doesn’t pertain to me, I’m not going to worry about it, you guys have got it, whatever.
RJ: Very good. Well, I mean I think that’s our, what we all stand in the shower thinking is nobody else is looking at these things that matter in the business except for me. And it’s great finding partners who say, no, I’ll worry about that stuff for you so you don’t have to worry about, and I can’t even start to put a dollar value on that. But those are the kinds of people I need in my life because a lot of times I’m thinking about all parts of the business, and then finally I have partners, Jordan who says, Hey, I’ll worry about this stuff so you don’t even have to worry. And so I literally, the value of me getting that worry off of my mind where I’m not charging rent in my brain space, I can just say, Oh yeah, Jordan’s worried about that. That’s huge. That’s very valuable.
Shirley Walker: Well, and as we talked before we started recording today, as small business owners, which must of us are, you do have a lot of worries. You have a lot of worries that no one can really even comprehend. How’s the rent going to get paid? Oh gosh, this and that didn’t happen this month and I’ve got payroll next week. All these things that really absorb your emotional energy. So to be able to push things off and know that they’re handled and they’re taken care of and you don’t have to, and your life’s going to end up being better for it in the end.
RJ: Well, if you talk to physician groups who have sold to large hospital systems, that’s usually the thing that pushes them over is thinking, I don’t have to worry about this kind of stuff anymore. I can just be a provider. I can just do what I went to school for, what I’m an expert in. So it’s very good that you’ve got vendors like you, but not only just like you, but a whole group in your thrive network that can provide that same similar service. So none of these providers usually, it’s usually not just the provider usually. They’ve usually already got a team. What team members on their side are critical for you to be successful?
Shirley Walker: Usually the office manager or the administrator, again, I kind of referenced this earlier, but someone with enough clout to make things happen. So if we realize that there’s a process that’s not working, something needs to be changed, someone’s not doing something correctly. We need that person who can say, Oh, I can go fix this. Instead of the person who says, Oh well I’ll have to talk about that with the doctor. Not that that isn’t helpful too, but that takes a lot longer and sometimes you’re not getting the buy in of the doctor. He doesn’t really understand the way the office manager that you’re talking to does. So usually that’s the best point person for us, the office manager, the insurance manager or the administrator, someone with enough clout that they can understand whatever issue we’re having and help us actually deal with it.
Shirley Walker: Other than that, we really like it when we can have a relationship with the physician. But most of our really successful practices, that’s not much more than a, Hey, glad you’re here kind of thing. Because that physician likely already has people that he really trusts, that are really good at their job, that are handling things for him. Like you just referenced having Jordan, you’ve got that person that I don’t have to sweat this. That’s over there. They’re taking care of it. I’m just here to wave and go on into the room and see the next patient.
Jordan Smith: Very cool.
RJ: Well, I’ve always been excited about learning more and this has been fascinating and eye-opening for me. For every business owner, for practice owners specifically, they’re trying to build a systematic, predictable, repeatable business. A business owner along with his or her business can produce the same result for customers just time and time again. Think about your practice running like clockwork. That’s what we all want. So I do this thing called the final round.
Jordan Smith: I know we need a drop or like a music, something cool.
RJ: We can do that. We’ve got the guys in the office.
Jordan Smith: Oh yeah.
Shirley Walker: A gong.
Jordan Smith: Yeah. If, if you guys are out there and you’re listening to this, we did not find a way to do it. If you haven’t, then you don’t know this was recorded anyway. Let’s jump into the final round.
RJ: All right. Listen, if there was a magic reset button as it relates to starting your business, what systems would you go back and put into place sooner rather than later, and why?
Shirley Walker: Wow. Well, that’s quite a question. We’ve been in business nearly 10 years now and when we first began our big areas were credentialing and billing. They work very differently. The people out there who have done credentialing know that that’s a thankless task and it’s certainly not much fun. It’s not one of those things that you sit there as a child and go, Oh, can I please, please, please do credentialing. But there are also things that exist now, which didn’t exist back then that some things have made that a lot easier and some things have made it a lot more complicated. Ultimately though, I think I would say that I would probably start looking for stronger solutions and question the capabilities of our vendors much sooner than I did. I learned a lot of really harsh lessons early on, getting into relationships with vendors and then a year down the road realizing that wasn’t meeting our need because I thought I was pretty clear about what we needed to do but doesn’t really do that. And yeah, you can do that, but you’ve got to sidestep it 14 different ways to get back to here.
Shirley Walker: So I learned a lot about holding those people accountable and when we can’t solve those problems, having mechanisms to mediate, come back around and try to fix them. We started out working with the software in each clinic. We didn’t have a lot of money to buy our own software and engage in our own agreements, and we really kind of thought that that would be the best way to do it. The clinic was already used to that software or that would work really well. And we do still do a little bit of that. But what I have learned, is that we are much better experts at two or three software platforms and getting you to use those. We’re more efficient. I have a lot more redundancy built in. When someone’s on vacation, it’s a lot easier to get someone else to cover then to try to find the one weird random person in the office that might know how to use getmyclaimpaid.com, then the three or four systems that we’re accustomed to using.
Shirley Walker: We will work on the legacy system for our clinic, but a lot of those situations are not as prevalent as they used to be in the past. A lot of people are kind of coming along. And sometimes we find a clinic who’s like, God, I hate this system, just put me on something else. We actually just did one of those two weeks ago. Anything, just get us off the system. So anyway, that’s probably one of the biggest ones.
Shirley Walker: We do an annual leadership retreat. We started doing that about three years ago. We use that to visit literally every aspect of the company. We talk about a little bit about finances and where we are and what our goals are, but mostly we go through every process in the company. How is this working? We could probably do better at this. This is the thing that’s given us a lot of heartburn this year. How can we fix that? Is it a new software platform? Oh, this software platform would replace those two software platforms. How can we do that? How can we integrate that? And then we set goals for the year to implement those particular things. I probably would’ve started doing that one about year two.
RJ: Yeah, I agree and every year it rolls around. You think in your head, we don’t need to do this year, it’s expensive, it’s time consuming, and we talked about almost everything last year. And then lo and behold, you do it just because one person the office says no, we probably should do it. And you get done and you think, God, I’m glad we did that. I’m so happy we didn’t skip over that. So listeners out there who think they want to implement it but don’t even know what to talk about, I would say just do it.
Jordan Smith: Yeah, and so getting into some more tactical stuff like that, what’s kind of one thing that you would tell these business owners and doctors and office managers, if there’s one thing that they could apply every single day to move the needle, what would you kind of suggest to them?
Jordan Smith: And what would kind of compound into big wins if they applied those things?
Shirley Walker: Probably the most important thing, and this is something that I need to hear regularly too because as much as we all know it, we don’t all do it, but do things consistently and completely. For example, in a clinic, one of the biggest problems we see is they’re not collecting money at the front desk. So that alone makes the clinic a ton of money. Not to mention teaches your patients what they need to expect. You’re laying groundwork for a lot of things you don’t even really realize you’re doing because that person knows I’m going to need to show up, I’m going to have to have this. The clinic is a bigger success for us internally. It’s making sure that we are following our own processes and making sure that something’s done. Someone’s out sick, someone’s on vacation. Making sure that those things get covered.
Shirley Walker: For a physician, one of the biggest things we see is not charting completely, not finishing that chart, not signing off on it, soap notes, not complete, just half done. And for the clinics that are really struggling with that, we recommend you hire a scribe. It’s a little bit of money, it is, but it’ll pay off big for you in the end because everything’s done completely. We help a couple of the insurance carriers do audits each year on their records. We pull the records and actually code and audit those for them for a variety of different Medicare required things that they have to do. And probably the single biggest thing we see is poorly charted records that don’t support what they say they did. So yeah, it is huge. It is huge. And having someone who knows how to do that, again, younger doctors are taught how to do that a little bit better because the technology’s been here the entire time they’ve been in medical school.
Shirley Walker: It’s not always the older doctors though. The older doctors might hand chart everything and it all gets in there. There’s kind of this middle ground where people want to adopt the technology and they want it to speed things up for them and so they skip a bunch of steps. And so, I would encourage people to go back and make sure that you actually collect that.
Shirley Walker: Probably the biggest thing though in a clinic is put the right people on the front desk. Those are typically the poorest paid employees. They’re the start position. The, I’m going to get somebody here for 11 bucks an hour, and I can’t tell you having done what I’ve done in my life. I was a provider relations manager for a long time and I went around and visited practices, and I can’t tell you how many different places I’ve walked into and saying poor little Sally sitting at the front desk scared out of her boots holding a CPT book and saying, they just told me to do my best. Invest some time, and some effort, and some training.
Shirley Walker: We typically offer to help our clinics with that. We’ll come in and show that person on the front desk the steps that they need to go through and help them feel supported. Don’t make that your poorest paid person in the clinic because they’re responsible for collecting a lot of your money and you want them doing it well.
RJ: Sure. Well, I can see how that can make a boatload of difference at the end of the year, done daily. Okay, our last question on our final round. Imagine you’re standing in front of a room of new physicians, people just like you when you were starting out too. They’re battling their way through fears, worries, doubts and struggles to find their footing. What are two or three strategies you would recommend they focus on to ensure their success?
Shirley Walker: Find someone you know who knows what they’re doing and pick their brain. I’m very, very lucky. I have a mentor who has started, run, and successfully exited a couple of businesses. He guides me in 95% of what I do, and I know that he’s always there. So having someone that you can pick up the phone, they get it, they get where you’re coming from, they understand what you’re saying, and they can help. Sometimes they need to talk you off the ledge. Sometimes it’s just you’re going down the right path more than you think you are, you just need to keep moving. It’s that little bit of encouragement.
Shirley Walker: Have the right people in the right job. And that’s something that all of us small business people struggle with. And sometimes I have found that that changes over time. I have you in a position today and that’s working great, but a year and a half from now, you’re maybe not the right person for that job anymore. Maybe that job has evolved, or maybe you have evolved and now we need to move you on to something else, and that’s something I struggle with myself. It’s really tempting to cheap out your billing by having your cousin or your sister or your nephew or your whatever do it. I would encourage you not to do that. Really try to invest in having the right people, the right software, the right things, and the right places because what you’re going to save over here is going to cost you 10 fold over there.
Shirley Walker: And then kind of along that same line, using the right vendors, making sure that you’ve got the right support things in place, and that you’re not using 10% of every software program you have. That you find something that will suit most of what you need to do instead of paying. And sometimes that’s a painful process. We go through that every couple of years where we sit down and go, okay, well we’ve got this thing that we’re using for this and we’ve got this thing that we’re using for this. Well, there’s this new software out here that does both those things. Let’s integrate those and save ourselves some money. So constantly being on the hunt for those things. And I know we drive our clients crazy sometimes when we’re changing vendors, but we’re doing it to make ourselves more efficient, more productive, and make them ultimately more efficient, more productive.
Jordan Smith: Well absolutely. And I know that you are super humble as far as the success that you guys have had. So going back to something you just said, which is find people who are smarter than you and pick their brain. I know not only from talking to you, but hearing from other success stories from your current clients that that’s the role that you guys, and you personally are in too. So I would encourage anybody out there that’s listening, if you have any questions, whether you feel like they could help you or not, any questions at all, I would encourage you to pick up the phone, shoot an email, talk to CPR and you and your team. So all that being said, what’s the best way that if somebody is out there listening and they want to get in touch with you, what are some of the ways that they can do that?
Shirley Walker: Sure. You can call our main number. We’re located here in Little Rock, Arkansas. It’s (501) 223-2776. You can push zero and ask for me directly. If you’ll listen to the IVR, there actually is an option for you I want to know more. Anyone can help get you directed to me. You can email us at email@example.com. You can email me directly at shirley, S-H-I-R-L-E-Y, .firstname.lastname@example.org [email@example.com 00:58:39] and you can find us on Facebook at team CPR. We’re also on Instagram and Twitter and Snapchat, and our social media person has done a fantastic job at connecting all those things, but if you’ll start out on Facebook you’ll find pretty much everything else.
Jordan Smith: Very cool and we’ll include all those links in the show notes if you guys want to go there and click on those as well.
Shirley Walker: I guess our website. I completely skipped that, www.team-cpr.com. Was trying to run through all those things while we were back there, but yeah, thank you guys so much for having me today. I really appreciate this. This was a lot of fun and, and hopefully informative,
RJ: It was really informative and we can’t just tell you how much we appreciate you spending time and speaking on behalf of the audience. Very informational, and speaking to the audience, I can’t agree with Jordan more. Surely when we first met, I’d heard about her and what she had done for many of our clients, and I picked up the phone and called her and she was reachable, she was willing to talk. And I urge everyone listening to reach out and just ask her how, just tell her about your issues and I guarantee you she can connect you with the right people. Shirley, you so much. Jordan, thanks for your time and excited to keep on moving forward.
Jordan Smith: Very cool. Thanks everybody. Thanks Shirley.
Shirley Walker: Thank you.
RJ: That was Shirley Walker with CPR guys. I hope you enjoyed and learned as much about her businesses as I did. I was blown away, Jordan?
Jordan Smith: Dude, that was great. Again, the most prepared guests that we’ve ever had on the podcast. So if you guys want to get in touch with her, she mentioned a couple of different ways, team-cpr.com, team CPR on Facebook. And if you’ve got a question for her or her team, they’re always super helpful, firstname.lastname@example.org. I would encourage you even if you’re thinking, Hey, I’m not sure if these guys can help me out or not. She talked about that affiliate program. She talked about thrive. She talked about just trying to add as much value as possible. So I would reach out to her.
RJ: Yeah, I hope you guys will share the podcast with someone else that might enjoy hearing this, whether they’re a physician or just another business owner. Please do share this. We’re trying to do this for you guys. So if you have recommendations, please reach out to us and tell us that. We are trying to build the show that adds most value to your life.
Jordan Smith: Yeah, and if you have questions for us, please feel free to give us feedback. You love us, hate us. We don’t, I mean, I’ll probably care if you hate us. I don’t care. I want to know. We want to provide value to you. That’s why RJ and I are doing this. So let us know if you have any comments, suggestions, anything. We’re open to feedback. We love hearing from you guys.
RJ: You know how to get in touch with us, your favorite podcasting platform on all the social medias out there. We’ll talk to you soon and thanks for joining us.