#110 - Why Your Medical Practice Culture Determines Your Success

In this episode of the Nat Rev MD Podcast, Dr. Heather Signorelli chats with Marissa Vasquez, office manager at Emerald Coast, about the realities of running a medical practice. From building a positive culture and managing staff challenges to streamlining eligibility and financial processes, Marissa shares practical lessons every practice can use to thrive. 

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Transcript

Dr. Heather Signorelli: 0:04

Welcome to NatRevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency, so you can have the business of your dreams. I'm your host, dr Heather Signorelli, founder of NatRevMD. Let's get started, all right? Hi guys, welcome to the NatRevMD podcast, where we help private practices increase revenue, streamline operations and then also just create a place where people like to be a part of. I'm Dr Heather Signorelli, physician and founder of NatRevMD. Today, I am joined by someone who I truly admire, who is working hard in a very thriving practice, marissa, who is the office manager at Emerald Coast at Emerald Coast, and have her here just to share about the challenges you see in practices, the wins you've had, maybe some stories about things that make your skin kind of crawl or make you stay up at night just to talk real about the challenges you see in running a large practice. So thank you, marissa, for coming and being on.

Marissa (Office Manager): 1:05

Yeah, absolutely. Thank you for asking.

Dr. Heather Signorelli: 1:07

Well, okay, so give me the scoop how did you end up and get into your role that you have now? What's your background?

Marissa (Office Manager): 1:15

So I started in 2008. I started in medical records. I was just looking for a job, so I started an orthopedic practice locally in Pensacola. I did some steady increases. I did four and a half years there. So one year, the first year, I was a medical records technician, then I moved on to scheduling and then the last two and a half years that I was there, I was the administrative assistant to the administrator. At that time they were being bought out by one of our local hospitals. I had the opportunity to move on to operations support, which is the EMR side of things the training of the MDs coming in, the employees, things like that. So when I made that transition then I was there for about a year and a half they did a big budget cuts to our department. We lost our entire support team and so this.

Marissa (Office Manager): 2:13

So then that actually led me into a primary care office position. I mean at that point I had already had one of my children position. I mean at that point I had already had one of my children actually two of my kids and it was just a front desk receptionist position. I was there for about four years. That was primary care and then after that he ended up the physician. He was just one single doctor. He ended up having a medical issue that forced him to close his practice.

Marissa (Office Manager): 2:44

So then I was once again trying to find another job Still no managerial experience at this point and so I ended up at Hing Hall Dermatology. I was there for four and a half years and about six months into starting there I was just doing scheduling, front desk reception. They asked me if I wanted to be the office manager for their general dermatology department, and I had no experience in managing anybody, let alone a group of 10 to 12 employees. But it wasn't a clinical, it was non-clinical, it was, you know, medical reception, things like that. And so I took on that role and I had on the job training, and so for three of those years I did management. I was moved over to different locations, back and forth from Pensacola to Gulf Breeze, and that's actually how I got to know Dr Gibson, who works here now, because she shared when she worked for Baptist. She worked there as well, got it. We shared an office, so. But it came a point where the dermatology office he actually sold to a corporation and that corporation.

Marissa (Office Manager): 4:01

Actually I thought the corporation brought more order, that corporation actually I thought the corporation brought more order, brought better opportunities for our employees, but the management that was in place that happened to also be my management directly did not feel that they needed to kind of follow the rules, jump on board. There was a lot of resistance, a lot of resistance to change, and I really felt like at that point, you know, this is not healthy environment for me any longer. And so I reached out and I really really continued my journey trying to find a management position, and then it took me a while, like it really took me a long time, and I'll tell you why it took me a long time.

Marissa (Office Manager): 4:41

Regardless, I did not have a bachelor's degree in management. I didn't have a bachelor's degree at all. So that always kind of stopped me from being able to obtain just on experience alone, just because I didn't have that physical piece of paper.

Marissa (Office Manager): 4:59

And so when I saw that the position was being hired for, here, of course, I met with Jennifer and Dr Gotthelf at the time was the owner, and so I got the job and I actually just graduated in May with my BA, so now I have the paper. But I will say that working in specialty offices really has helped me understand the importance of the core, which is primary care. Just knowing how those offices work has really really helped lead and guide and help the employees think. Like you know, we are the center for this patient care. It's very important that we have everything that we need for that. So, yeah, that's just kind of a little bit where everything that we need for that. So, yeah, that's just kind of a little bit where how I ended up here. And then, of course, I guess Dr Health liked me and didn't want to get rid of me.

Dr. Heather Signorelli: 5:55

So I'm still here. Well, and you know we've known Jennifer and Jim James for I guess, four years now, or ish, three and a half good people, and it just seems like your practice exudes good culture, like whenever we have an issue and you know, issues are always going to happen and I talk about this in a lot of podcasts right, like issues in an office or any place of work or any business are going to come up, and so I think it comes down to how do you communicate those things, how do you retrain people, how do you deal with turnover and then retraining those people, and so obviously you've set a really good culture, a really good place. So talk to me a little bit about you know kind of your staff today in the office and maybe a little bit about what are some of the strategies you use to set that culture. Is it team huddles, is it a regular one-on-ones or is it something completely different?

Marissa (Office Manager): 6:46

So you know, before I started there, I thrive on structure, I thrive on being held accountable. I know some people aren't like that. You know the culture we have here and we're lucky that we have such a short I say a short connection, but it doesn't take us long, like we don't have to travel to go and meet one on one with our employees. If I need to speak with them, they are there. You know, every day I could just pull them, you know, pull them aside, or we can come in the office quick chat. I think it's important for, in order for your work culture, your environment in your clinic, they have to feel like they are making a difference and that their presence is noticed. To feel like they are making a difference and that their presence is noticed. You know, I can't. I try to think back places. When I walked in to my work, people didn't even know I was there. Sometimes, you know, it's just even if you, you know the highs and the buys, and how are you today?

Dr. Heather Signorelli: 7:38

Yeah.

Marissa (Office Manager): 7:39

Not just listening to answer, but really listening to what's going on. I mean, they are the point of contact. They are the first you know if there's an issue with protocol or procedure or how we're doing something. It's important that a manager knows exactly what's going on, not to fix it, but to hear from those employees like I'm telling you. This is a concern, this is a problem I think a lot of managers these days are just worried about well, let's just get the job done. No, let's get it done right, Learn from it, move on and apply it, Because if you don't stop and do all of those steps and really make your employees feel like they are contributing value to a patient, to their coworkers, to even the providers that are here, they're not going to want to perform for you.

Marissa (Office Manager): 8:31

They have to be passionate and sometimes you have to bring out that passion. You have to remind them why they chose medicine, Totally, Totally. And that's just something from a management perspective. You know you don't have the ability to be like, you know, oh, it's just another day at work. No, you need to be intentional with what you do, because they are looking for leadership, and so here we try to make it a culture, about family. You know we don't want to impose on their personal matters, but we really want them to know that when they walk through that door, they're not just a body, they're not just a robot, they're not just doing a job for a paycheck, that their main focus is making a difference and whoever's, whoever they touch with their hands or whoever you know, whatever issue they're talking to about a patient on the phone and we all know primary care is it's the core, but it's also our patients.

Marissa (Office Manager): 9:27

A lot of work, yeah, and sometimes they honestly are alone and they just want to talk to you about what they ate for lunch or what soap opera they watched yesterday, because they don't have anybody.

Marissa (Office Manager): 9:41

And you know we try really, really hard I try to put that into the clinical staff as well as the front desk that you always want to think about how you would feel in their shoes. Yeah, I think if you come from that mindset, it really can change how you react to the situation, how the care is that you're giving. You know how the patient is receiving that care and and I really think that that's really what holds us together I mean we like to have fun too. I mean we don't take ourselves too seriously. I really like for the ladies to be able to feel like, like I always tell them like make your space, that you're sitting at your home, If you want to put some pictures and you want to, you know, make it your own, just so that you feel comfortable working. Yeah, but yeah, really really proud of our culture here, I will say this I think it's very important that you can control what you can. Don't dwell on too much of what you can't control.

Dr. Heather Signorelli: 10:34

That's important, yeah, and I mean in any service-based business, right Like you can help those who want to be helped, do your best, but at the end of the day, there are going to be some things and some people that are just a challenge and you can't take it personally.

Marissa (Office Manager): 10:49

Nope, and that's the other thing is I'm a very big stickler on. I do not like drama fueled environments, I don't have time for it. That's not why we're here. Luckily know the owners and the other physicians here that are very. We're here for one reason and one reason only, and so I really think that communicating that and really having those open lines of communication with the staff create that comfortable culture environment where they feel that they've got an issue. They could just come straight to me or any of the other managers here.

Dr. Heather Signorelli: 11:23

And that's not always common and I do think it comes from the personality of the leader and the leaders so down to Jennifer and the owners and the physicians and the whole team, and also to yourself. So what I'm hearing is obviously having some sort of personal connection, whatever that means for you and each individual staff member, making people feel like they're part of the team, reminding people like, at the core of this, we're seeing patients and we're trying to impact their patient lives or your patient lives, and then really just giving an open door policy type of environment where it both ways when you have an issue or when they have an issue, you can freely talk about those without anybody getting upset or feeling like it's personal, which I think right. There is like the core of really any team. I don't think that's different than in a, in a different type of business, maybe the patient part of the why piece, but I think people in general when they go to work in a doctor's office deep down, depending on the person, maybe really deep or somewhere higher up but that's why they chose to go work in patient care you know nowadays with Amazon and you know the pay or whatever you can get in tech I think you do have to really want to be in a patient-centered business and so making sure that that aligns with the employees, because you can go work at Amazon for whatever I don't even know what their pay starts are these days but you can go work somewhere else and maybe it's a different role but it may be not as stressful at times. So I think I truly believe people who seek out a job in a healthcare environment are doing it because it's a passion driven desire to work in healthcare.

Dr. Heather Signorelli: 13:05

All right. So I've got a question for you. I think what are some of the biggest challenges you face from a day-to-day perspective running a practice? Because I think for some of our practices they have rockstar managers and it's amazing. Some are small enough to where they just haven't been able to afford, or that's not where they're choosing to spend their money just because they're on the smaller side. And so talk to me a little bit about those big challenges that you face day to day. You know, is it staffing, scheduling, patient flows, like? What does that look like? And how do you keep the team grounded, not frustrated and kind of focused to solve those?

Marissa (Office Manager): 13:41

So I mean we went through recently, we've gone through some staffing changes. We were on a really good streak for a long time about a year and a half of a full staff, no one leaving Things happen, and so we just actually went through a staffing. We are back to hire, you know, full-time, full staff. But yeah, it is challenging because I don't have a pool of people to choose from. I don't have a PRN on the side group like a corporate office does. So, believe it or not, I've taken on roles. You're the PRN, I'm the PRN.

Marissa (Office Manager): 14:18

I've taken on roles that my front desk staff do and my clinical manager, my front desk supervisor. We have all added to our schedule loads just to make sure that the other front desk medical receptionists are not overloaded. You know you have to and honestly, I'm so thankful that my managers are like I'll do it. I'll do it. You know, give it to me. And because they know it's we're helping the patients, that's what's important. Those things can't fall all while still trying to find someone that really wants to work and it'd be a dedicated employee. So I think that that is really.

Dr. Heather Signorelli: 14:58

If you need to tell them to go away, you can. It's okay.

Marissa (Office Manager): 15:00

Yeah. So I mean it's really been a challenge for us really the staffing, and it's really hard to find good people. It's really really hard. You know, I always say I think COVID just ruined us, and you know I'm not saying that like working from home is bad or remote. What I'm saying is I think it has created a lazy generation that you know, even just resumes that I get. I'm like really, really. I mean, have a little bit more pride in what you're doing. Yeah.

Dr. Heather Signorelli: 15:33

Resumes. Actually, it still is that front door to a company.

Marissa (Office Manager): 15:36

I mean it's not organized well-written.

Dr. Heather Signorelli: 15:39

I'm the same way. I'm like, really a company I mean it's not organized well-written. I'm the same way. I'm like really, like I don't even, I can't even follow this, I mean. And nowadays with chat, gbt or whatever, I feel like you can take a resume, plop it into something and go improve this. And actually I am starting to see resumes that have that like chat GBT.

Dr. Heather Signorelli: 15:55

look, you know I'm okay with it, like at least they've taken the initiative to to clean it up. You know I'm okay with it, like at least they've taken the initiative to to clean it up, check your spelling, like in today's world, spelling should be the least of your worries and if you can reformat in the chat, gbt world or whatever AI tool you're using, I mean, and you can do that free.

Marissa (Office Manager): 16:15

Yeah, absolutely so. Yeah, I think it's just really trying to. You know, we found some really good ones. I will say they are the two that we have now. They're newer but they're amazing. They're doing such a great job. But yeah, I mean, really, for me personally, challenges are constant changes with insurances, making sure you have the most up-to-date information. I've just gone through credentialing hell, as I call it.

Marissa (Office Manager): 16:41

And I don't have a background in credentialing. It doesn't mean I try to defeat myself from getting all the knowledge that I can, but that's really challenging to try to keep up with changes for the insurances and also working our EMR making sure that we're coding and things like that. But no, I mean that to me is the biggest thing is just really getting someone in that's steady cares about their field and then to them they really want to be here. You have some that just don't even show up for an interview.

Dr. Heather Signorelli: 17:13

I know it's just crazy and I do agree with you. I think things have changed. I mean so I do think having people who are willing to work in an office every single day, you know there's just less of that. I feel like people are like, oh, I can just go on YouTube and be the whomever is the star and make money, and hey, there is a market for that. So I mean, good on you if that's you. Absolutely. It is hard to find really good mission driven people.

Dr. Heather Signorelli: 17:39

And again, I think one of the things that's so different about this space is in health care you're not getting a raise every year. I don't mean you personally, I mean the practice is not getting a raise every year, right, unless you're producing more volume. I mean, yes, you can renegotiate rates and there's some ability to do that, but it's not like you. It's not like in a regular non healthcare business where you say, okay, I'm going to raise prices 5% this year because because I mean we all get the emails of we're raising prices this year because of inflation we just don't have in a healthcare business have that option and even negotiation of contracts you'd be lucky to get one or 2%, let alone five. I mean you see some companies doing much more than that and so to stay competitive with wages makes it difficult. I mean you're either having to grow more essentially, produce more volume, or you can't stay competitive in the marketplace. You know, would you agree with that? Or how have you guys kind of stayed competitive, absolutely?

Marissa (Office Manager): 18:39

I mean, you know, like you said, you can only do so much with fee schedules.

Marissa (Office Manager): 18:43

You can only negotiate and even you know it takes forever to just negotiate. It's a back and forth, you know, and it's just a headache to really get paid even a little bit of what you're. You know these patients or you know the providers are doing the work and then you see what comes back and it's like this is ridiculous, but from an HR standpoint it is. It's very difficult I mean our insurance rates alone for healthcare to offer that to our employees 60% up and it's just crazy to us because we want to be able to offer great benefits. Private practice is a dying breed and I really think that that is why the private practices are not able to do it successfully. I mean, that's one reason why we have Jennifer and Jimmy, who are so great at knowing what this practice needs, what this practice can afford. That is really challenging too, even when we're talking about hiring somebody. The biggest thing for me is they can go down the street to a corporation, get maybe a higher pay rate, but they're going to lose that one-on-one connection. They're going to lose the ability to have a schedule that works for them. I always say I mean, I have three kids. I always say I traded my sanity when I left one job, my past job, and came to this one, it wasn't for higher pay, it was a straight lateral transfer. I didn't try to negotiate that because I wanted to be able to have my career and have my life. My family and I had lost that for so long.

Marissa (Office Manager): 20:24

So everything in private primary care is factored into when it comes to finances, every time we have it.

Marissa (Office Manager): 20:31

And if there's a day where we have patient rooms that aren't filled, that is a missed opportunity for revenue, but it's not just revenue. That is a missed opportunity for revenue, but it's not just revenue. It's a missed opportunity for us to be able to thrive successfully, provide bonuses for extra bonuses for staff lunches, staff awards, all those kinds of things, putting that money back in their pockets, putting that money back in a profit sharing for those employees. So it's very important that our clinics stay full, that we're always thinking about that, that factor of and really Jimmy has taught me that that when you put all the numbers out, if you have empty patient rooms, you have room to make revenue, you have more room to see more patients and really that is the main thing. That is the driver for us to be successful. You know, some practices cannot do it and that's why they just bend the knee and then they go to a corporation and their biggest complaint after doing that is you know I don't have a one on one.

Marissa (Office Manager): 21:32

I don't have one on one with my patients anymore. Like I feel like this is like all about numbers. Now, this is all about money. You know, I can't really practice how I want to practice, and so we don't want to get ever to that point, and so that's really why we've created the environment that we have and the drive to just keep on doing what we're doing and is everybody you know kind of to that filling the patient rooms?

Dr. Heather Signorelli: 21:54

is everybody, front desk yourself, involved in filling those patient rooms calling patients?

Marissa (Office Manager): 22:06

saying that you've got appointments that we haven't seen you in a year. It's time. How do you manage that piece? So most of our patients they're seen every three, six yearly. We're also a part of Allidade, which is an ACO. We have work lists that we work to identify those patients uncontrolled blood pressure. Our Medicare wellness is really important for our Medicare patients to get in every year. Most of them have chronic issues so we already see them more than once.

Marissa (Office Manager): 22:30

But yeah, I mean if we have a patient that calls and cancels an appointment, we don't just cancel it off, we're sending a message and we're doing follow up because even if we have to leave a voicemail, we also have had to, unfortunately, because patients these days just no show, no call, and we can have four to five in a day. You multiply that by five days in clinic, that's 20 patients. So you know that's 20 people that we could have seen. And so we have had to enact a no-show policy, no-show fee. We go one step further. If they've got that no-show fee on that chart, they have to pay that before they can make another appointment.

Marissa (Office Manager): 23:09

We really do use and I have personally used the going out to dinner or the groceries analogy, you can't go to the store and pile up your cart and just walk out like I can't pay. It's the same thing with healthcare and really to educating our patients about their deductibles, their balances, their co-pays, why their insurance is denying it. A lot of patients have no idea what entails, what their insurance entails, and do you?

Dr. Heather Signorelli: 23:38

give them a script or a pamphlet. I know, we did pamphlets a few years ago, but what are you doing today?

Marissa (Office Manager): 23:44

So typically, if they're at a stopping point with the front desk, we'll communicate that back to Michelle or I'll talk to them and kind of walk them through their bill. No, but we have signage. Copays are due at the time of service.

Dr. Heather Signorelli: 24:01

If you have a deductible, be ready to get a bill for it and do you do a deposit for deductibles. We've got some practices starting to do like just a small flat fee for deposits, we don't, not for the insurance plans.

Marissa (Office Manager): 24:14

I would like to look into something like that for the future. Like I said, we just got our front desk back, so I'm hoping that maybe we can start doing that collection we do for our self-pay patients.

Dr. Heather Signorelli: 24:27

And self-pay, you know, pay full in time. What we're seeing with some practices that they're doing and we're seeing this even from primary care to like subspecialty, you know surgeries or whatever, like we're seeing the whole gamut where they're they're actually doing a. If they have a deductible right, they will do a. You know a deposit, essentially $50, 75, depending on kind of what's going on with the practice and what kind of visit you're doing. But they'll say, okay, it's a $50, you know $75 deposit and they'll collect that deposit. It sits on posted. Now, the only risk around this is we have some practices who are really good with refunds and some practices that are really not good with refunds and so obviously, if every you know by the time a claim is submitted and if other claims have been submitted, that deductible may be zero at that time and you may owe a patient a refund, if you like.

Dr. Heather Signorelli: 25:20

One of our new softwares that I love is ModMed, Modernizing Medicine. It is a beautiful software and they have a refund button. You just push it and it's like refund and it refunds the patient back to the credit card that they put it on, sends them an email. I did a webinar for the EMR because I love the feature so much. I know it's silly, but it just because. How much time do you spend on refunds? Like, I mean not you know.

Marissa (Office Manager): 25:50

Yeah, oh yeah, yes, yes, I mean we we do try to identify the refunds for the patients. I will say that our out of network policy has really really helped. So enacting those payment plans, the recurring payment plans, has really really helped. Yep, it's really actually, and we've had people default on them. We've had people you know and unfortunately they get educated and then they're like oh, I better not do that.

Marissa (Office Manager): 26:19

You know, or you know, and the thing I love about our offices, we I am more than happy to work with a patient that has a balance. I am, if you're working with us and you are aware of it and you are doing everything as a patient, I you know that you can do to make right your balance. I'm going to meet you with that same energy. I am not going to we're not going to deny anybody care, but in healthcare there has to come a point because we lose money. Every medical facility loses money when they provide free care and essentially that is what it is, and it's not just a runny nose, it's somebody who has really serious chronic issues, and so that's really something that we have tried very, very hard on the front end to make sure that we are collecting those balances. I will say the staff here any other office I've ever worked at I rarely, rarely have to be like why wasn't that balance collected? They are very, very good. They've got their screen, as I call it, their start over here and end over there. They go from left to right to make sure that we are not missing anything and they're also not afraid to say you know what? I don't know why you have a balance. Let me go ask my office manager. She's going to explain it better.

Marissa (Office Manager): 27:37

But yeah, I mean it's a, and I know the economy is bad, I'm well aware of that. You know you have to remain diligent, you have to remain strong on your front end, that you have to collect those co-pays, you have to pay those. That is your agreement with your insurance. That is not your agreement with our office. I had a patient actually tell me yesterday well, why did your office charge me a deductible? And I said, well, we didn't charge you a deductible. You haven't met your deductible and you're going to need to call your insurance about that, because you have a contract with them that says you're going to pay this amount and then they're going to kick it in.

Dr. Heather Signorelli: 28:17

And he's like I didn it's it is, and, but I think so what I think your office has done well and I've got one more eligibility question, cause it's like the hot topic of everything. But I think what your office has done well is, even in the face of turnover, even in the face of staffing changes, you train them. Like it's not magical that the front desk people show up and know how to collect balances. You've trained them how to do that. You've told them what to do. Do you write scripts or anything for them, or do you just kind of do that as you go to training?

Marissa (Office Manager): 28:52

They do have some scripts. I was told a very, very long time ago, probably years ago, that if you're trying to collect money from a patient you don't say would you like to take care of your balance. Today you say you have a $20 balance. We take cash, check or credit card. You don't ever ask them.

Marissa (Office Manager): 29:14

One already know, everyone knows, unless your house burned down and your address is wiped from the earth, you get a statement. You know if you have a balance. So I think really the sternness and really being aware of that patient's account that's in front of you, you have a balance. So I think really the sternness and really being aware of that patient's account that's in front of you, you have a balance, it's due today. How would you like to pay? Is the only question that you should ask. So I think getting them to and we not only do that with our, not just with our financial verbiage, it also is put into appointments and hospital follow-ups Can't capture those TCMs if we're saying to the patient do you need to follow up with that? No, miss Jennifer got a minute notification. You went to the ER. She wants you to follow up in office. We can get you in today, tomorrow, those kinds of things.

Dr. Heather Signorelli: 30:04

Yeah, it's a question, it's, it's a. This is what is needed for the practice, for your health, for your X Y Z, and this is what's happening.

Marissa (Office Manager): 30:13

When they can say no, you know I'm good or I'm going to follow up with specialty. But I really think it's the tonage, the verbiage, the way you present it to the patient, that this is what we're doing, this is what we need from you and not really giving them any kind of wiggle room for that?

Dr. Heather Signorelli: 30:31

Yeah, this is not optional, all right. So one thing you know, we've been billing for your practice for three and a half years I think now something like that 2022. And eligibility is always the fun topic and I just feel I want to feel bad for practices. I feel bad for front office staff because I feel like in this ever-changing rule between COB coordination of benefits through eligibility checks and an easy way to do that, which there isn't a great way to do this.

Dr. Heather Signorelli: 30:57

It's a pain in the rear end, no matter what you do Like. How do you you know? How do you work with your staff on those eligibility expectations?

Dr. Heather Signorelli: 31:06

Because, I know you hate when we ping you about eligibility and we hate having to do it, and so it's like how do you manage that? Because your office in general like of all of our offices, you guys do a great job with this. We've had some hiccups as you had new staff and then you've worked through those, but, like, how do you handle that? Because it's a pain.

Marissa (Office Manager): 31:26

So it is a load you can't you know. We see each of our providers sees about 20 patients a day. We, tops, have four providers in office. So every day, that's every day. So you can't do them a week in advance. They have to be done daily, one to two days and they have to be worked every day.

Marissa (Office Manager): 31:48

What Kristen has really really done that has helped the front. So there is a sheet that they have every day of assigning who is in charge of what. So from, for example, my front desk person from 8 to 11, she's working only on new patients. My other person during that time she's on verifications, but in the afternoon that verification load goes to my other person. So they have specific duties so that we can ensure that every item that has to be done by them is being worked on, not by the same person, but every day, so that they can't get off task. They know if they're doing verifications and the phone rings and they pick it up and they answer it. They help the patient, they put it down, they go right back to verifications.

Dr. Heather Signorelli: 32:42

So they're focused.

Marissa (Office Manager): 32:44

Yeah, and verifications doesn't give you a green check mark that says patient's active. You have to look at what type of plan. Do we even accept that plan? You have to see what network are they in PPO, HMO, what is their copay for our office? Do they have a deductible? Have they met their deductible? Then you have to go all the way down to the bottom and find out if their Medicare ID number is different or if they have another X in front of their Blue Cross and Blue Shield number. So they know every single and all of these steps are taught to them so that it's ingrained in their brain to just boom, boom, boom, boom, boom and they know what to do.

Marissa (Office Manager): 33:27

Now we do have some payers that we don't have the ability to verify them electronically. So those take a little bit of time. But I will say for our office, doing all of the electronic ones first, that we can verify very quickly. That's the bulk of our payers, that's the bulk of our schedule. That's the bulk of our payers. That's the bulk of our schedule. The off the wall, Maritain health and ABS, things like that that we can't, those take a little bit more time. But once again, even the information that we can't do electronically, we're transferring in manually and I really, really think that before I got here and before we started doing verifications, we have dramatically seen a less amount of issues insurance-wise. I don't have a lot of reaching out saying, hey, this is you know.

Dr. Heather Signorelli: 34:18

No.

Marissa (Office Manager): 34:19

But I really think it starts with educating the front desk. For example, if we get a new insurance card that starts populating beginning of the year, or we know of a new plan, the minute we get that card we're making copies, we're blacking out patient names. If it's one we can't take, we're like nope, put this on your no-fly zone.

Dr. Heather Signorelli: 34:42

Oh, that's a good idea.

Marissa (Office Manager): 34:44

So that they can physically see, because you can sit there all day and tell them the name of an insurance that just populated. They're not going to know that. So but also how to enter in a TRICARE. I mean, I know TRICARE IDs have gone back and forth One day it's the DOD number, one day it's the social, one day, I mean, they go back and forth Even knowing how to load a Medicare patient's plan, that red, white and blue card, what items come secondary to that, not replacement plans.

Marissa (Office Manager): 35:13

That's a big kicker to know that. You know we have a lot of patients who will hand us everything. They hand their red, white and blue, but they've got Florida blue Medicare which takes the place of it. So really, educating staff and having those pictures to show them, no, if a patient hands you this, it goes this way, this is the way you put it in and so really that's helped them to understand, you know, but it changes all the time so you really can just give them and I think for us, for the verifications, we've also started calling our patients that have inactive insurance when we are verifying it Prior to them coming in. We're not waiting for them to show up at the front desk. We are calling them, reaching out, saying you have an appointment tomorrow. I need your insurance card, pictures of it. You can email it to me. We have a texting feature, but we have to have that before you step in office because if we can't verify it, we won't be able to see you that day, and that's really that's huge.

Dr. Heather Signorelli: 36:15

This whole process is huge because it is in-depth, it is it's a game changer and it is, from a denial perspective, right. You guys have some of the lowest denials, I think, of any of our. I mean just less than 1%. I mean it's crazy low. Now, primary care in general, if there's denials, it's typically either a major coding issue or eligibility. Eligibility nine times out of 10 is the main issue we have with any of our practices and yours. Just I mean again, in the grand scheme of things, you guys have an extremely well-oiled machine when it comes to eligibility.

Marissa (Office Manager): 36:50

Well, we've really taken it serious from the things that you guys have pointed out. I mean, I want to know if my staff's doing something wrong. That's the only way you learn. If you're doing it wrong and you're not being told it's wrong. You got to tell somebody because we're just going to keep doing it wrong. No-transcript.

Dr. Heather Signorelli: 37:21

You did, we did too.

Marissa (Office Manager): 37:22

We were on that journey.

Dr. Heather Signorelli: 37:23

We were on that journey together. Yes, we were.

Marissa (Office Manager): 37:25

I will say I have learned so much more than I. If I wouldn't have gone through that billing nightmare, I probably wouldn't have learned as much as I have and I would not be able to do any of the things that I do and be able to educate staff about this. And the main thing for me is I've really tried to drill into the front desk is what happens in the front affects the back. It affects every single part of it. It affects if that patient can get that medication. It affects their prescription benefits. When it comes to the providers, it affects the way they have to code something. And it's not just the insurance part, it's how you schedule something. You can't schedule a preventative annual for a 69 year old male. That's a Medicare wellness visit because it's going to deny. It's really about if you get it right on the front end, you have a less headache on the back end.

Marissa (Office Manager): 38:21

And I always tell them what happens in the front affects the back, but what happens in the back also affects the front. You know, we we used to have a culture where just grab the back, but what happens in the back also affects the front. You know we used to have a culture where just grab the patient, just go ahead and pull them back and I'm like no, ma'am, we have these little buttons and they're in progress. So while the front desk is doing what they need to do they're in progress the back staff can see that when they are done, they change to, in which means you can come grab that patient and so you know, nobody wants to leave their desk to run back and get an insurance card when we've already taken a blood pressure and done vitals.

Dr. Heather Signorelli: 38:57

No, especially when that and that and then that defeats the whole purpose of okay. So now, if you do need to collect a copay and have that conversation and they're sitting there with a blood pressure cuff or in a gown, and you know, then it's, then you're in this whole awkward situation and then you miss your opportunity. Because if there is a balance or if there is an issue and then you're already seeing the patient, what are you going to do? You know? Not see them at that point. No, you know that's.

Marissa (Office Manager): 39:22

And and once those patients are in that situation, they're looking for every exit door to not walk by your front desk. It happens when I've even gone as far, too, as trying to educate our medical assistants. This is how you can tell if the patient has a balance. If you get in there and that patient starts talking about all this kind of stuff, kind of take a minute and look back and be like, oh okay, well, this is why you were told this.

Marissa (Office Manager): 39:47

but let me, let you talk to somebody I don't want you to let them leave here because they're not going to answer that phone when I call or when our front desk is calling. We want to get resolution, but we also want to make sure that our patients are educated that this is what our practice expects. And some people are on board. Patients love it. They're like, wow, you tell me more than my insurance companies told me, but even but that's building a trust factor. They're they're understanding that they're not just a number to us, that we really do value them, but just trying to get them keep that well-oiled machine. If you think it's going to all happen without any kind of issue, then then you don't need to work. Then you don't need to work in health care.

Dr. Heather Signorelli: 40:30

You know, I do think it's having that expertise, it's setting the right culture, it's training, it's communication, which we've all touched on today and that makes your office a joy to work with and those billing moments we had in the past when we first took on the account so glad that those are no longer there and that we're in a better spot. You know those first few months there were difficult. Just you know, the vendor and everything like that was not fun, but we got through it and now I feel like you guys are rocking and rolling and it's just been great to work with you guys. You know your entire office is easy to work with, organized. When we've got an issue and when you've got an issue like, it's just like okay, come to the table, let's fix this. Yeah, absolutely, it's been great to work with you guys.

Dr. Heather Signorelli: 41:12

Well, thank you for your time today sharing kind of. All of these little nuggets I think are really important for other offices who may not have this all down yet. I think it's inspirational to hear from other offices that it can be done and it is possible. I love it. Well, thank you very much for being on today and I hope you have a good rest of your week. Yeah, thank you so much. I appreciate it. Thanks for asking me, okay, and then for the listeners, of course. If you liked this episode, please share it with another practice or physicians in your life who are maybe struggling with some of these issues. So thanks so much for being on and we'll talk to you next week.