WEBVTT
00:00:00.000 --> 00:00:02.980
Well, if you have two chronic illnesses, that's
00:00:02.980 --> 00:00:05.459
automatically a moderate level for the visit.
00:00:05.559 --> 00:00:09.119
That's automatically a 99214. That concerns me.
00:00:09.960 --> 00:00:12.800
So that can be a bit of a red flag. It also concerns
00:00:12.800 --> 00:00:16.019
me when people are doing evaluation and management
00:00:16.019 --> 00:00:19.899
visits plus psychotherapy and doing 20 -minute
00:00:19.899 --> 00:00:23.219
visits. I see a lot of fraud. I really do. I
00:00:23.219 --> 00:00:26.059
see a lot of fraud occurring all the time. There
00:00:26.059 --> 00:00:28.300
was a lot of issues with billers like everybody
00:00:28.300 --> 00:00:32.890
else. dollars. Claims weren't being done correctly.
00:00:33.770 --> 00:00:38.630
So, you know, there's a lot of money loss. I
00:00:38.630 --> 00:00:42.149
was like, I'm done. Done. Fired the biller. And
00:00:42.149 --> 00:00:49.789
figured it out yourself, basically. This week
00:00:49.789 --> 00:00:51.929
on No Prior Roth, I'm sitting down with Crystal
00:00:51.929 --> 00:00:54.130
Stone, and this is an episode I've wanted to
00:00:54.130 --> 00:00:56.670
make since we started the show. Crystal is a
00:00:56.670 --> 00:00:58.670
double board certified family and psychiatric
00:00:58.670 --> 00:01:01.289
nurse practitioner, an Air Force veteran, and
00:01:01.289 --> 00:01:03.810
the founder of three businesses in Southern Illinois.
00:01:03.969 --> 00:01:06.650
An integrated primary care and behavioral health
00:01:06.650 --> 00:01:09.150
practice, a psychiatric rounding service for
00:01:09.150 --> 00:01:12.129
nursing facilities, and a billing, coding, and
00:01:12.129 --> 00:01:14.569
auditing company with a motto I need you to hear.
00:01:15.109 --> 00:01:18.409
Professional, on paper, savage in appeals. She's
00:01:18.409 --> 00:01:21.129
also a certified professional coder, biller,
00:01:21.150 --> 00:01:24.700
and medical auditor, which makes... her just
00:01:24.700 --> 00:01:26.920
about the only person who has sat on every side
00:01:26.920 --> 00:01:29.099
of your insurance claim. Today, we're asking
00:01:29.099 --> 00:01:31.799
her the question, are you coding your psych visits
00:01:31.799 --> 00:01:34.959
wrong? We get into the visit codes you use every
00:01:34.959 --> 00:01:37.280
day, medical decision -making versus time, what
00:01:37.280 --> 00:01:40.060
actually triggers audits, the myths and the money
00:01:40.060 --> 00:01:43.140
new practice owners leave on the table. One quick
00:01:43.140 --> 00:01:45.760
note, this episode is education, not billing
00:01:45.760 --> 00:01:48.920
or legal advice. Payer rules vary, so verify
00:01:48.920 --> 00:01:51.819
everything for your own practice. Okay, grab
00:01:51.819 --> 00:01:54.769
a notepad. Let's get into it. Thanks for coming
00:01:54.769 --> 00:01:58.849
on, Crystal. Oh, my pleasure. I'm very much looking
00:01:58.849 --> 00:02:01.290
forward to this. So hopefully, you know, we can
00:02:01.290 --> 00:02:05.790
help somebody. Exactly. Yeah, I'm eager to talk
00:02:05.790 --> 00:02:08.750
with you today because your background is just
00:02:08.750 --> 00:02:12.430
very interesting and it's an interesting climate
00:02:12.430 --> 00:02:17.530
right now. So I want to hear a little bit from
00:02:17.530 --> 00:02:21.330
you. Like, how did you end up where you are today?
00:02:21.550 --> 00:02:23.050
Like, just tell us a little bit about your story.
00:02:23.520 --> 00:02:28.050
So like most people, you know, you graduate high
00:02:28.050 --> 00:02:31.229
school, they go to college. Well, for me, I was
00:02:31.229 --> 00:02:33.530
like, the college wasn't going to be my thing.
00:02:33.770 --> 00:02:38.150
I didn't do very well in school. I just did what
00:02:38.150 --> 00:02:44.629
I needed to do to get by and graduate. So I chose
00:02:44.629 --> 00:02:48.789
the military and, you know, found, hey, that's
00:02:48.789 --> 00:02:51.530
where I met my husband. You know, he was, you
00:02:51.530 --> 00:02:54.430
know, active duty military as well. Then, you
00:02:54.430 --> 00:02:56.229
know, you get married, you start having kids.
00:02:56.469 --> 00:02:59.949
I chose to get out because he deployed all the
00:02:59.949 --> 00:03:05.590
time. So he stayed in, I got out. And then it
00:03:05.590 --> 00:03:09.449
was attempting to go back to school. I still
00:03:09.449 --> 00:03:12.590
struggled. And I'm like, there's definitely something
00:03:12.590 --> 00:03:16.819
wrong. So as I entered into nursing school at
00:03:16.819 --> 00:03:21.020
that point, I was pregnant with the second child
00:03:21.020 --> 00:03:24.259
and had to take some semesters off because, you
00:03:24.259 --> 00:03:26.060
know, good old morning sickness, which never
00:03:26.060 --> 00:03:31.430
stays to be the morning. And, you know, struggled
00:03:31.430 --> 00:03:34.870
significantly with the first couple semesters.
00:03:35.090 --> 00:03:40.689
Then I had my son and then my husband was still,
00:03:40.729 --> 00:03:43.250
you know, he missed. he missed that. He was deployed.
00:03:43.409 --> 00:03:47.030
So he came back and, you know, I kept, you know,
00:03:47.030 --> 00:03:49.110
saying like, there's something wrong, you know,
00:03:49.110 --> 00:03:51.569
there's just something wrong. So that's when
00:03:51.569 --> 00:03:57.509
I definitely sought out a psychologist to say,
00:03:57.689 --> 00:03:59.909
Hey, you know, what is, you know, what is wrong
00:03:59.909 --> 00:04:01.889
with me? There there's, there's gotta be something
00:04:01.889 --> 00:04:05.430
wrong. So I went through all the testing and,
00:04:05.430 --> 00:04:08.030
you know, he came back and he was just, you know,
00:04:08.030 --> 00:04:11.479
told me that I had, you know, ADHD. Combined
00:04:11.479 --> 00:04:15.800
really bad. Yeah, that kind of makes sense. And
00:04:15.800 --> 00:04:19.480
then, you know, see my primary got put on medicine,
00:04:19.579 --> 00:04:22.339
which was definitely very, very life changing.
00:04:22.500 --> 00:04:25.160
So I went from being this like, you know, C almost
00:04:25.160 --> 00:04:29.019
D student to a straight A student. And then the
00:04:29.019 --> 00:04:33.480
love for education happened. I'm like, I love
00:04:33.480 --> 00:04:37.620
school versus hate it. So, you know, graduate.
00:04:38.920 --> 00:04:43.660
to continue education and then decide, you know,
00:04:43.680 --> 00:04:47.819
I got my MSN with a specialization in informatics.
00:04:48.579 --> 00:04:50.220
Then I was like, well, I don't want to do this
00:04:50.220 --> 00:04:52.439
job because it's pretty much living out of a
00:04:52.439 --> 00:04:54.360
suitcase and that's not what I wanted to do.
00:04:54.579 --> 00:04:58.800
So then I chose to go back and do the family
00:04:58.800 --> 00:05:02.529
nurse practitioner program. So I did that. And
00:05:02.529 --> 00:05:08.240
that was probably, I would say maybe. Six months
00:05:08.240 --> 00:05:13.240
to a year out of that, I decided that there was
00:05:13.240 --> 00:05:17.139
such a need for people in their homes, like seeing
00:05:17.139 --> 00:05:18.560
people in their homes because I had done home
00:05:18.560 --> 00:05:22.319
health. And in my area, there was nothing. There
00:05:22.319 --> 00:05:26.720
was no house calls. You know, we had a very huge,
00:05:26.959 --> 00:05:30.800
low socioeconomic population that couldn't get
00:05:30.800 --> 00:05:33.920
out of the home. So I chose to open my own practice.
00:05:34.259 --> 00:05:37.910
My collaborative was awesome. He loved what I
00:05:37.910 --> 00:05:40.970
did, you know, was doing because he was big on
00:05:40.970 --> 00:05:44.170
servicing that population, which I love what
00:05:44.170 --> 00:05:48.319
I did. And, you know, from the get go, I'm like,
00:05:48.399 --> 00:05:50.180
well, there's a lot of mental health, you know,
00:05:50.180 --> 00:05:56.100
issues here, too. And that's when I got the first
00:05:56.100 --> 00:06:00.420
taste of insurance, because it was, you know,
00:06:00.439 --> 00:06:05.850
it was a it was a nightmare from day one. you
00:06:05.850 --> 00:06:07.490
know you learn as you go it's kind of like a
00:06:07.490 --> 00:06:10.810
you know crash course and I had billers yeah
00:06:10.810 --> 00:06:14.029
to help uh along the way and then finally it
00:06:14.029 --> 00:06:20.009
was like you know I'm done and then ultimately
00:06:20.009 --> 00:06:24.740
I was like okay time to do it myself because
00:06:24.740 --> 00:06:27.360
I didn't think that you know it was there was
00:06:27.360 --> 00:06:29.819
a lot of issues with billers like everybody else
00:06:29.819 --> 00:06:32.680
I mean I lost thousands of dollars claims weren't
00:06:32.680 --> 00:06:37.870
being done correctly um Just, you know, lots
00:06:37.870 --> 00:06:41.310
of money on the table or, you know, they weren't,
00:06:41.310 --> 00:06:43.550
you know, they weren't processing the denials,
00:06:43.550 --> 00:06:45.550
the rejections or fighting with the insurance
00:06:45.550 --> 00:06:50.759
company. So, you know, there's a lot of money
00:06:50.759 --> 00:06:55.259
loss. And then that's when I was like, I'm done.
00:06:55.300 --> 00:07:00.540
I'm done. And when I pulled one of my reports,
00:07:00.800 --> 00:07:03.959
like the, you know, aging report, and I'm sitting
00:07:03.959 --> 00:07:09.509
here looking at... The 120 -day bucket, and we're
00:07:09.509 --> 00:07:12.170
talking tens of thousands of dollars is in that
00:07:12.170 --> 00:07:16.300
bucket. I was like, I'm done. Done. Fired the
00:07:16.300 --> 00:07:19.720
biller. And figured it out yourself, basically.
00:07:20.079 --> 00:07:23.759
In that time frame, I had been educating myself.
00:07:23.980 --> 00:07:26.360
I was like, well, you know, here we go. Let's
00:07:26.360 --> 00:07:28.860
pull the string and kind of see what's going
00:07:28.860 --> 00:07:31.259
to happen. I don't regret it. I don't regret
00:07:31.259 --> 00:07:36.009
it by any means. here we are. It taught me such
00:07:36.009 --> 00:07:38.550
a valuable lesson. I don't regret any of it,
00:07:38.569 --> 00:07:43.089
but then, you know, here comes me doing, you
00:07:43.089 --> 00:07:45.250
know, like here comes me, you know, getting my,
00:07:45.370 --> 00:07:48.970
you know, certification and, you know, behavioral
00:07:48.970 --> 00:07:53.029
health and becoming, you know, a psych MP. And
00:07:53.029 --> 00:07:59.069
it shaped how I created that practice hugely
00:08:00.000 --> 00:08:03.699
because I'd already dealt with the things on.
00:08:04.250 --> 00:08:06.189
the primary side, I'm like, yeah, we're going
00:08:06.189 --> 00:08:07.829
to do, we're going to do something different
00:08:07.829 --> 00:08:12.689
here. And you learn, I mean, I learned, you know,
00:08:12.750 --> 00:08:14.850
um, I guess you want to say like the crash and
00:08:14.850 --> 00:08:17.430
burn method, you know, what the primary, so we're
00:08:17.430 --> 00:08:19.189
not going to make the same, you know, we're not,
00:08:19.189 --> 00:08:22.290
we're not going to make the same mistakes. Then,
00:08:22.529 --> 00:08:26.579
you know, as I learned, because being in the
00:08:26.579 --> 00:08:28.699
military, everything's regulation based policy
00:08:28.699 --> 00:08:31.000
regulations, there's like a regulation for everything.
00:08:31.569 --> 00:08:33.710
Well, when, you know, when you're dealing with
00:08:33.710 --> 00:08:37.450
a lot of these policies, you know, with the insurance
00:08:37.450 --> 00:08:41.590
company, stuff's going to fall somewhere. All
00:08:41.590 --> 00:08:44.330
insurance companies are going to fall under some
00:08:44.330 --> 00:08:49.330
regulation. So deep dive, you know, often running.
00:08:49.669 --> 00:08:54.850
And that's where, you know, I feel that, yeah,
00:08:54.870 --> 00:08:56.610
better because I'm like, oh, this makes much
00:08:56.610 --> 00:09:02.059
more sense. And then. There was still some pieces
00:09:02.059 --> 00:09:05.379
I was missing. And I actually attended a billing
00:09:05.379 --> 00:09:09.659
conference that was hosted by who's my mentor,
00:09:09.759 --> 00:09:15.029
like my mentor, Carlene Dittrich. And we just
00:09:15.029 --> 00:09:18.350
connected from there. And is she a psych MP?
00:09:18.450 --> 00:09:21.750
No, she's actually straight up like, you know,
00:09:21.750 --> 00:09:26.370
biller, coder, auditor. She is, I think, one
00:09:26.370 --> 00:09:30.070
of three in the United States who is ERISA certified.
00:09:31.429 --> 00:09:36.879
And so what I was missing, it was great because,
00:09:37.000 --> 00:09:40.679
you know, kind of filled in those holes. And
00:09:40.679 --> 00:09:44.440
we've been kind of thick of Steve since. And
00:09:44.440 --> 00:09:48.019
so I ultimately a lot of times, you know, we'll,
00:09:48.019 --> 00:09:50.799
I would say probably quarterly, whatever, we'll
00:09:50.799 --> 00:09:53.240
teach classes. We've traveled, you know, throughout
00:09:53.240 --> 00:09:55.360
the United States presenting to other billing
00:09:55.360 --> 00:09:59.620
organizations. over a lot of the federal laws
00:09:59.620 --> 00:10:05.279
the state laws even tricare um so you know billing
00:10:05.279 --> 00:10:07.500
is i should say you know like the the billing
00:10:07.500 --> 00:10:12.559
aspect of it it affects all walks of life for
00:10:12.559 --> 00:10:18.000
sure yeah wow that's that's a cool story um what's
00:10:18.000 --> 00:10:20.860
your day -to -day look like i'm very curious
00:10:20.860 --> 00:10:24.440
like yeah tell us about it like a day or a week
00:10:24.440 --> 00:10:27.210
in the life of crystal stone like how you spend
00:10:27.210 --> 00:10:28.710
your time? Um, it, you know, that's the kind
00:10:28.710 --> 00:10:31.009
of, it is, I, I think I kind of laugh at that
00:10:31.009 --> 00:10:32.789
one because a lot of people think that I, you
00:10:32.789 --> 00:10:34.649
know, I see patients, you know, full time and
00:10:34.649 --> 00:10:35.950
that, you know, they're like, Oh, how do you
00:10:35.950 --> 00:10:38.450
do this? I don't see patients full time. I see,
00:10:38.490 --> 00:10:41.289
you know, I see patients pretty much, you know,
00:10:41.289 --> 00:10:43.750
Mondays, Tuesdays and Wednesdays, like every
00:10:43.750 --> 00:10:46.649
other Wednesday I round in the, in the skilled
00:10:46.649 --> 00:10:49.070
nursing facilities to see the, you know, for
00:10:49.070 --> 00:10:51.570
psych, but you know, Mondays and Tuesdays is
00:10:51.570 --> 00:10:54.129
predominantly when I see, you know, patients.
00:10:55.120 --> 00:10:57.779
And I still work on the building Mondays, Tuesdays,
00:10:57.779 --> 00:11:01.700
Wednesdays, Thursdays, Fridays. I try to make
00:11:01.700 --> 00:11:05.330
it a point for work -life balance not to do any
00:11:05.330 --> 00:11:09.070
work on the weekends. I've been somewhat successful
00:11:09.070 --> 00:11:12.490
with that because I like to spend my time working
00:11:12.490 --> 00:11:17.649
on my 66 Ford Mustang that is my dream car. And
00:11:17.649 --> 00:11:20.250
that's what I like to spend my time doing, whether
00:11:20.250 --> 00:11:24.169
it's the car shows or, you know, Under, you know,
00:11:24.169 --> 00:11:26.730
underneath the car working on it or in the engine.
00:11:26.909 --> 00:11:29.789
So that's, you know, where I like to spend my
00:11:29.789 --> 00:11:33.029
time and I try very hard to keep that work -life
00:11:33.029 --> 00:11:37.570
balance. Yeah, that makes sense. So the patient
00:11:37.570 --> 00:11:42.350
care that you're doing, that's all like psych
00:11:42.350 --> 00:11:45.350
NP related? Not all of it. I, because I still
00:11:45.350 --> 00:11:47.389
see, you know, throughout those Mondays, Tuesdays
00:11:47.389 --> 00:11:49.950
and Wednesdays, it's a mixture. It's a mixture
00:11:49.950 --> 00:11:52.830
of, you know, primary care, but I did scale back
00:11:52.830 --> 00:11:55.470
my primary care because there was such a higher
00:11:55.470 --> 00:11:59.769
need for behavioral health, you know, and I like
00:11:59.769 --> 00:12:03.110
primary care, but honestly, my passion is more
00:12:03.110 --> 00:12:06.929
with psych. Yeah. Okay. And these are your businesses.
00:12:07.450 --> 00:12:10.190
Have you always been entrepreneurial? Like that's
00:12:10.190 --> 00:12:12.070
one of the things our listeners are very intrigued
00:12:12.070 --> 00:12:14.289
by kind of how people got into their businesses,
00:12:14.330 --> 00:12:16.889
you know, how much did they spend getting them
00:12:16.889 --> 00:12:19.860
off the ground? Is it worth it kind of thing?
00:12:20.000 --> 00:12:24.820
No, I haven't always been entrepreneurial. After
00:12:24.820 --> 00:12:31.440
being in the military and then, you know, it's
00:12:31.440 --> 00:12:34.220
kind of like, what now when you get out? Like,
00:12:34.220 --> 00:12:39.740
what now? And working for other people, it became
00:12:39.740 --> 00:12:43.639
a point of I'm done. I'm done. I am not corporate
00:12:43.639 --> 00:12:49.379
material. That's when, you know, opting to work
00:12:49.379 --> 00:12:55.259
for oneself because some of the rules for me
00:12:55.259 --> 00:12:58.740
did not set very well, like ethically, morally.
00:12:58.940 --> 00:13:03.379
And I'm not, you know, I know. So I opted to
00:13:03.379 --> 00:13:06.659
work for myself and I started the primary care
00:13:06.659 --> 00:13:09.879
practice and then it just expanded from there.
00:13:10.100 --> 00:13:15.320
OK, gotcha, gotcha. Can you educate us a little
00:13:15.320 --> 00:13:20.159
bit on the differences between in -network billing
00:13:20.159 --> 00:13:23.960
versus out -of -network billing? Because this
00:13:23.960 --> 00:13:26.340
just came up with my little sister yesterday,
00:13:26.659 --> 00:13:30.179
actually, where she was kind of telling me about...
00:13:30.570 --> 00:13:33.029
about what's happened with her insurance and
00:13:33.029 --> 00:13:35.490
just kind of billing an out -of -network provider.
00:13:35.610 --> 00:13:37.210
And I'm just curious, kind of your perspective
00:13:37.210 --> 00:13:41.169
on it. I also remember talking to an IOP practice
00:13:41.169 --> 00:13:42.950
that was like, yeah, we didn't make any money
00:13:42.950 --> 00:13:44.529
when we were in network, but now that we bill
00:13:44.529 --> 00:13:47.909
out of network. So can you just like educate
00:13:47.909 --> 00:13:51.289
us on that and on a level that's like basic?
00:13:51.370 --> 00:13:53.509
Because a lot of our listeners just need like
00:13:53.509 --> 00:13:56.220
foundational. So when we look at in -network,
00:13:56.320 --> 00:13:59.919
that means that you've essentially signed a contract
00:13:59.919 --> 00:14:04.080
with the insurance company to accept the reimbursement
00:14:04.080 --> 00:14:09.320
for the code that you are billing out for. So
00:14:09.320 --> 00:14:13.960
it's a pre -designed amount and each insurance
00:14:13.960 --> 00:14:15.820
is going to be different. So it's going to depend
00:14:15.820 --> 00:14:19.620
on the payer. You know, the state like state
00:14:19.620 --> 00:14:21.980
Medicaid is, you know, you. That's a matter of
00:14:21.980 --> 00:14:24.399
public information. Each state is different.
00:14:24.600 --> 00:14:26.860
You can look that up. Same thing with Medicare.
00:14:27.120 --> 00:14:30.700
Medicare is published. So is TRICARE. Then you
00:14:30.700 --> 00:14:34.220
know what you're getting paid. It's always been
00:14:34.220 --> 00:14:36.220
one of those things that it doesn't necessarily
00:14:36.220 --> 00:14:40.159
happen. No, but commercial is technically supposed
00:14:40.159 --> 00:14:42.779
to reimburse more than Medicare. I won't say
00:14:42.779 --> 00:14:45.419
that it necessarily happens. But in -network
00:14:45.419 --> 00:14:49.059
means, hey, you've contracted with the payer.
00:14:49.799 --> 00:14:54.759
So if you are, and that doesn't mean every plan.
00:14:54.899 --> 00:14:58.700
So it's important to know within your contract
00:14:58.700 --> 00:15:02.600
what plans you are credentialed with to be in
00:15:02.600 --> 00:15:06.820
that work. And so that means when you see those
00:15:06.820 --> 00:15:11.230
members, depending on how their plan is, is how
00:15:11.230 --> 00:15:13.370
things go, whether they have a copay deductible
00:15:13.370 --> 00:15:17.409
or coinsurance. So ultimately what happens is
00:15:18.000 --> 00:15:22.620
Let's say that a 99214 for the insurance, the
00:15:22.620 --> 00:15:26.820
maximum allowable is $100. So that is the most
00:15:26.820 --> 00:15:29.240
that you are going to get for that particular
00:15:29.240 --> 00:15:32.990
visit. Just for that visit alone, that doesn't
00:15:32.990 --> 00:15:35.230
include any add -ons or anything else. That just
00:15:35.230 --> 00:15:39.649
includes, you know, the $100 maximum for that
00:15:39.649 --> 00:15:43.929
visit. That means, you know, if the insurance
00:15:43.929 --> 00:15:47.480
is essentially going to pay 80 % because The
00:15:47.480 --> 00:15:51.460
patient has a $20 copay. So that means $100,
00:15:51.559 --> 00:15:54.460
80 from the insurance, 100 from the patient's
00:15:54.460 --> 00:15:58.159
responsibility. So that you can't balance bill.
00:15:58.360 --> 00:16:01.200
You, you know, what you see is what you get.
00:16:01.220 --> 00:16:04.940
What balance billing? So, so for instance, if
00:16:04.940 --> 00:16:09.049
somebody's, I'll say more from, you know, if
00:16:09.049 --> 00:16:10.889
you're like that, you'll see a lot of balance
00:16:10.889 --> 00:16:14.470
billing on a network, but in network means that
00:16:14.470 --> 00:16:17.610
what you get, that's it. You know, you can't.
00:16:17.610 --> 00:16:20.389
So like, let's say you charge. Let's say your
00:16:20.389 --> 00:16:26.049
charge sheet is $250 for a 99214. That's your
00:16:26.049 --> 00:16:28.149
fee schedule. That's what you're commanding.
00:16:28.539 --> 00:16:32.320
But with the insurance, the contract, you know,
00:16:32.340 --> 00:16:34.120
the contract states that you're going to get
00:16:34.120 --> 00:16:38.500
$100. You cannot balance bill that patient for
00:16:38.500 --> 00:16:42.080
that remaining amount from what you charge and
00:16:42.080 --> 00:16:45.899
what the insurance pays you. Does that make sense?
00:16:46.779 --> 00:16:50.919
It does. Now, out of network, it's fair game.
00:16:52.049 --> 00:16:55.730
But when people create their fee schedules without
00:16:55.730 --> 00:16:59.250
a network, it can't be something extremely ridiculously
00:16:59.250 --> 00:17:03.190
exorbitant. Like there's a site, Fair Health
00:17:03.190 --> 00:17:07.190
Consumer, that will essentially kind of tell
00:17:07.190 --> 00:17:12.809
you for your area what you can expect for being
00:17:13.130 --> 00:17:16.710
self -pay. It'll give you like, hey, this is
00:17:16.710 --> 00:17:18.809
kind of like what insurance is reimbursing in
00:17:18.809 --> 00:17:22.329
network. And this is essentially what is being,
00:17:22.490 --> 00:17:27.450
you know, paid for out of network. So depending
00:17:27.450 --> 00:17:30.369
on how people scale their practice, yeah, out
00:17:30.369 --> 00:17:33.009
of network can be very lucrative. And if you
00:17:33.009 --> 00:17:35.789
have the area to do it, but without a network,
00:17:35.950 --> 00:17:39.230
you know, some people choose to, you know, build
00:17:39.230 --> 00:17:42.630
the insurance and fight with them. And some will
00:17:42.630 --> 00:17:46.069
just. Hey, you pay me. Here's your super bill.
00:17:46.190 --> 00:17:50.369
You go fight with your insurance. I see. Can
00:17:50.369 --> 00:17:54.089
I ask how you do it in your practice? So because
00:17:54.089 --> 00:17:58.049
of my area, I do wish I could be self -pay. But
00:17:58.049 --> 00:18:03.650
my area, there's not a lot of self -pay. Majority
00:18:03.650 --> 00:18:07.130
of it is insurance -based. Now, if I was to go
00:18:07.130 --> 00:18:09.049
into certain areas of St. Louis, because I'm
00:18:09.049 --> 00:18:12.809
20 minutes outside of St. Louis, I... open a
00:18:12.809 --> 00:18:18.069
practice and did self -pay, I could essentially
00:18:18.069 --> 00:18:21.589
survive. But why would I want to go to Missouri
00:18:21.589 --> 00:18:24.329
since it's the most restrictive state for practice?
00:18:25.490 --> 00:18:28.769
Mm -hmm. Gotcha. So you're in network. Mm -hmm.
00:18:30.660 --> 00:18:36.019
Very much so. Yep. Okay. Gotcha, gotcha. What
00:18:36.019 --> 00:18:40.740
advice are psych NPs getting right now that concerns
00:18:40.740 --> 00:18:44.509
you the most in this space, would you say? billing
00:18:44.509 --> 00:18:47.890
on facebook you know all the social media platforms
00:18:47.890 --> 00:18:51.390
you know the things that people say they'll say
00:18:51.390 --> 00:18:55.349
you know um for instance i'll just use this as
00:18:55.349 --> 00:19:02.059
a example the they'll say well if you have two
00:19:02.059 --> 00:19:06.039
chronic illnesses that's automatically a moderate
00:19:06.039 --> 00:19:09.869
level for the visit that's automatically a 99214
00:19:09.869 --> 00:19:14.640
that concerns me it also concerns me when people
00:19:14.640 --> 00:19:18.450
are doing evaluation and management visits plus
00:19:18.450 --> 00:19:24.190
psychotherapy and doing 20 minute visits. When
00:19:24.190 --> 00:19:26.990
we already know that if you are doing a 90833,
00:19:27.269 --> 00:19:32.839
you need at least 16 minutes of psychotherapy.
00:19:33.339 --> 00:19:36.759
I see a lot of fraud. I see a lot of fraud. I
00:19:36.759 --> 00:19:39.440
really do. I see a lot of fraud occurring all
00:19:39.440 --> 00:19:43.940
the time. Yeah. Yeah. That's, it's concerning.
00:19:45.039 --> 00:19:47.400
Okay. To switch gears a little bit, this is one,
00:19:47.420 --> 00:19:51.240
this is a hot topic right now. Okay. And I'm
00:19:51.240 --> 00:19:54.099
going to go at it from the perspective of, and
00:19:54.099 --> 00:19:56.279
I'm not associated with any of these VC companies,
00:19:56.539 --> 00:20:00.000
Headway, Alma. It's just so relevant right now.
00:20:00.099 --> 00:20:03.480
I literally talked to one of my psych NP mentees
00:20:03.480 --> 00:20:06.980
this morning and she's a new grad and she's.
00:20:07.809 --> 00:20:09.849
nervous about, she's had a hard time finding
00:20:09.849 --> 00:20:13.049
a job. And so she's like, should I take this
00:20:13.049 --> 00:20:16.349
position making $90 an hour for this practice
00:20:16.349 --> 00:20:21.599
that my mentor has through Headway essentially?
00:20:23.259 --> 00:20:27.319
And I don't know if you've listened to any of
00:20:27.319 --> 00:20:29.180
the other podcast episodes, but there have been
00:20:29.180 --> 00:20:32.700
several people on my podcast who are like, I
00:20:32.700 --> 00:20:34.339
wouldn't have a group practice without Headway.
00:20:37.589 --> 00:20:41.869
love them. I love that I get paid, like no complaints.
00:20:42.309 --> 00:20:45.349
And so I understand why people would want to
00:20:45.349 --> 00:20:48.230
leverage this. And also it's just such a different
00:20:48.230 --> 00:20:50.809
climate as far as people having a hard time finding
00:20:50.809 --> 00:20:54.490
jobs and jobs with mentorship that a lot of times
00:20:54.490 --> 00:20:57.430
it is like they're just out there seeking out
00:20:57.430 --> 00:21:01.210
their own mentorship. And so I guess I'm just
00:21:01.210 --> 00:21:05.160
curious. from you? Like, I know you're not a
00:21:05.160 --> 00:21:08.099
fan of those platforms. Is there any situation
00:21:08.099 --> 00:21:11.680
where you would be like, Oh, I could see that
00:21:11.680 --> 00:21:15.980
it makes sense for, for this person. And if not,
00:21:16.079 --> 00:21:19.099
like, why? I mean, me personally, no. And the
00:21:19.099 --> 00:21:23.460
reason why I'm sure everybody's seen when Alma
00:21:23.460 --> 00:21:29.680
had, you know, published about the 90837, you
00:21:29.680 --> 00:21:32.470
know, Aetna. was saying, hey, they weren't going
00:21:32.470 --> 00:21:34.069
to pay for it anymore. They weren't going to
00:21:34.069 --> 00:21:37.670
reimburse for the 90837. Pretty much, you know,
00:21:37.670 --> 00:21:40.430
the highest that you're going to get is the 90834.
00:21:41.109 --> 00:21:44.369
So they pretty much didn't matter the backlash
00:21:44.369 --> 00:21:49.289
that transpired. They still did it. And also
00:21:49.289 --> 00:21:55.609
these VC backed platforms, which if you do the
00:21:55.609 --> 00:21:59.589
research, you will see that the insurance companies
00:22:00.450 --> 00:22:03.690
have a huge financial backing in these organizations.
00:22:04.529 --> 00:22:07.730
Why else would you be able to be credentialed
00:22:07.730 --> 00:22:12.549
in four to eight weeks when you're credentialing
00:22:12.549 --> 00:22:15.289
through your own private practice? It's taking
00:22:15.289 --> 00:22:21.730
three to six plus months to get that done. So
00:22:21.730 --> 00:22:28.789
when it comes to the VC platforms, they are pushing.
00:22:29.769 --> 00:22:32.529
providers more and more to use everything that
00:22:32.529 --> 00:22:36.500
they have to offer. The biggest issue that I
00:22:36.500 --> 00:22:41.640
have with them is the patient's protected health
00:22:41.640 --> 00:22:45.079
information because they will go into those systems
00:22:45.079 --> 00:22:49.059
and take that information and they could disperse
00:22:49.059 --> 00:22:53.849
it to whomever they want. And there's nothing
00:22:53.849 --> 00:22:59.529
that you really could do. And when you for instance,
00:22:59.650 --> 00:23:02.230
receive medical records requests from third parties,
00:23:02.490 --> 00:23:05.089
you have to really look at those to determine,
00:23:05.190 --> 00:23:09.490
is it legit? Well, these VC companies, you know,
00:23:09.509 --> 00:23:13.670
again, are backed by these insurance companies,
00:23:13.730 --> 00:23:18.700
have full access to protected health information,
00:23:18.940 --> 00:23:21.660
and they can do whatever they want with that
00:23:21.660 --> 00:23:25.539
information, and you're none the wiser. I've
00:23:25.539 --> 00:23:29.500
also been told by other providers where, you
00:23:29.500 --> 00:23:31.819
know, they've come back in and their notes are
00:23:31.819 --> 00:23:37.000
unlocked and just a multitude of things. Where's,
00:23:37.000 --> 00:23:40.359
you know, where's the, you know, where's the
00:23:40.359 --> 00:23:43.740
safety and the security with that? That just
00:23:43.740 --> 00:23:48.359
reminded me of something. I was at a practice
00:23:48.359 --> 00:23:52.000
once upon a time where, like, I just noticed
00:23:52.000 --> 00:23:53.640
that, like, all the provider's notes weren't
00:23:53.640 --> 00:23:58.549
locked. And I was like. Why would your notes
00:23:58.549 --> 00:24:01.069
not be locked? And I never really got a straight
00:24:01.069 --> 00:24:04.089
answer, but I'm just curious from your standpoint,
00:24:04.190 --> 00:24:07.630
can we talk about that? Ultimately, notes should
00:24:07.630 --> 00:24:09.910
always be locked when you're done and they're
00:24:09.910 --> 00:24:14.269
finalized. You should not be, you know, billing
00:24:14.269 --> 00:24:17.829
out notes if the claim, you know, if it's not
00:24:17.829 --> 00:24:21.569
finalized. So that's, you know, you're setting
00:24:21.569 --> 00:24:24.769
yourself up for a huge amount of. compliance
00:24:24.769 --> 00:24:28.849
issues with that. That also, I'm not saying it
00:24:28.849 --> 00:24:32.309
happened. Okay. But there could definitely be
00:24:32.309 --> 00:24:36.819
allegations of some very fraudulent behavior
00:24:36.819 --> 00:24:41.779
that could be transpiring. Yeah. That was, you
00:24:41.779 --> 00:24:47.059
know, the concern that, you know, so I was just
00:24:47.059 --> 00:24:49.720
like, I just hadn't seen that before, you know,
00:24:49.720 --> 00:24:53.200
and it was someone with a vested interest who
00:24:53.200 --> 00:24:57.579
owns the practice. So, you know just was like
00:24:57.579 --> 00:25:03.400
hmm um okay so back to the headways and the almas
00:25:03.400 --> 00:25:06.920
and everything like that i mean it's hard for
00:25:06.920 --> 00:25:09.579
these new grads to know where to get experience
00:25:09.579 --> 00:25:14.289
because they're getting rejected and so what
00:25:14.380 --> 00:25:18.369
do you recommend as far as like how do these
00:25:18.369 --> 00:25:22.950
psych nps get experience um i mean let's you
00:25:22.950 --> 00:25:25.940
know And I understand it's like, hey, let me
00:25:25.940 --> 00:25:28.920
go join the VC because it's easy. I can get a
00:25:28.920 --> 00:25:32.660
job. But I don't think people realize what's
00:25:32.660 --> 00:25:37.079
also happening. So let's just say that you go
00:25:37.079 --> 00:25:40.640
and get credentialed with another practice first.
00:25:40.819 --> 00:25:42.900
You know, you find somebody, you get credentialed.
00:25:43.180 --> 00:25:45.220
Then if you go in credential with Headway, you're
00:25:45.220 --> 00:25:47.579
not so much going to have a problem. What we're
00:25:47.579 --> 00:25:52.059
seeing is those who have went to credential with
00:25:52.059 --> 00:25:55.420
Headway, Alma, Grow, any of those. And when they
00:25:55.420 --> 00:25:58.259
go to, they're like, hey, I get to leave this.
00:25:58.359 --> 00:26:00.259
I go, you know, they either open their own, you
00:26:00.259 --> 00:26:02.160
know, their own practice where they don't want
00:26:02.160 --> 00:26:05.400
to deal with these VCs anymore or they're working
00:26:05.400 --> 00:26:08.700
for somebody else. When they try to credential,
00:26:09.500 --> 00:26:13.980
it is roadblock after roadblock after roadblock
00:26:13.980 --> 00:26:17.440
and nothing but problems. And some of the insurances
00:26:17.440 --> 00:26:20.839
will be like, nope, nope, you're credentialed
00:26:20.839 --> 00:26:25.339
with Headway. And then you have to, some of them
00:26:25.339 --> 00:26:26.960
have to go back to Headway and be like, hey,
00:26:26.960 --> 00:26:31.700
I need you to fix this, release me or something.
00:26:31.819 --> 00:26:35.180
But I have seen it. We have dealt with that because
00:26:35.180 --> 00:26:39.900
my office manager, we were dipping our feet into
00:26:39.900 --> 00:26:43.440
credentialing. And then she's, because of all
00:26:43.440 --> 00:26:45.519
these issues, she's like, no more for right now.
00:26:45.789 --> 00:26:49.269
You know, there's just a huge amount of issues
00:26:49.269 --> 00:26:53.809
with credentialing. And so we're not credentialing,
00:26:53.849 --> 00:26:56.230
you know, we're not taking on anybody new because
00:26:56.230 --> 00:26:58.670
of just the issues that we're experiencing. But
00:26:58.670 --> 00:27:01.849
I don't think people also realize with these
00:27:01.849 --> 00:27:08.230
VC backed entities, they can change your reimbursement
00:27:08.230 --> 00:27:13.130
any time that they want and you have no say in
00:27:13.130 --> 00:27:21.549
it. Yeah. What happens if there's a clawback
00:27:21.549 --> 00:27:28.509
and you have left Headway and Alma or whatever
00:27:28.509 --> 00:27:32.210
platform that you were working with? How's that
00:27:32.210 --> 00:27:34.869
handled? That's something that psych NPs I've
00:27:34.869 --> 00:27:37.490
heard ask and be concerned about. Should I keep
00:27:37.490 --> 00:27:41.910
separate notes? Should I keep my own EHR if I
00:27:41.910 --> 00:27:44.359
am going to do this? I mean, I think if you're
00:27:44.359 --> 00:27:51.839
going to join these VC backed entities, I can't
00:27:51.839 --> 00:27:53.819
tell somebody what to do, but I sure wouldn't
00:27:53.819 --> 00:27:56.019
be using their software. I would have my own.
00:27:56.119 --> 00:27:59.920
So you, you know, you have your notes, but when
00:27:59.920 --> 00:28:02.759
it comes to a clawback, I think it's, I think
00:28:02.759 --> 00:28:05.880
it's going to depend on what your contract with
00:28:05.880 --> 00:28:10.559
that organization states. But, you know, clawbacks
00:28:10.559 --> 00:28:17.630
outside of those. you have room to fight it by
00:28:17.630 --> 00:28:21.769
the laws. Well, I hate to say this, but I did
00:28:21.769 --> 00:28:25.809
meet with Hedway. It's been a long time ago.
00:28:25.950 --> 00:28:32.900
And I grilled that marketing person like nobody's
00:28:32.900 --> 00:28:35.140
business because I wanted to know. He couldn't
00:28:35.140 --> 00:28:37.000
answer anything. Well, you could call billing.
00:28:37.079 --> 00:28:39.769
That doesn't answer my question. what happens
00:28:39.769 --> 00:28:41.690
if you know it's this this and this and i know
00:28:41.690 --> 00:28:43.529
how to fight it are you guys gonna do anything
00:28:43.529 --> 00:28:45.690
about it well you're still gonna get paid that
00:28:45.690 --> 00:28:48.289
still doesn't answer my question they were unable
00:28:48.289 --> 00:28:51.869
to answer my questions and what i think that
00:28:51.869 --> 00:28:55.410
people fail to realize is at the end of the day
00:28:55.410 --> 00:28:58.369
doesn't matter who you build through your npi
00:28:58.369 --> 00:29:00.829
is on there as the rendering provider so if anything
00:29:00.829 --> 00:29:05.109
anything happens you ultimately are the one that's
00:29:05.109 --> 00:29:10.420
responsible yeah Yeah, that's a good point for
00:29:10.420 --> 00:29:15.380
sure. If a psych MP is wanting to start educating
00:29:15.380 --> 00:29:18.279
themselves a little bit more in this area, what
00:29:18.279 --> 00:29:24.660
resources should they turn to? Yeah, what resources
00:29:24.660 --> 00:29:28.519
do you recommend? I think it's, you know, making
00:29:28.519 --> 00:29:31.980
sure that you, you know, research where the information
00:29:31.980 --> 00:29:37.490
is coming from. Figure out who are legit. resources
00:29:37.490 --> 00:29:42.089
to turn to and align yourself with those resources
00:29:42.089 --> 00:29:46.809
and saying, hey, are you able to provide me this
00:29:46.809 --> 00:29:50.049
type of information? Oh, no. Okay. Who could
00:29:50.049 --> 00:29:53.589
be somebody trustworthy that I can ask these
00:29:53.589 --> 00:29:57.250
questions to? Whether that be another PMHMP,
00:29:57.630 --> 00:30:02.549
I mean, aligning yourself to looking at who are
00:30:02.549 --> 00:30:06.289
good individuals as resources in the billing
00:30:06.289 --> 00:30:10.569
communities. Not everybody, you know, not everybody
00:30:10.569 --> 00:30:12.930
on Facebook is good. Not everybody on TikTok
00:30:12.930 --> 00:30:17.450
is good. So it's, it's important to really watch
00:30:17.509 --> 00:30:23.440
who are the, the educated individuals to align
00:30:23.440 --> 00:30:30.569
yourself with. Yeah. How do they know who, who,
00:30:30.710 --> 00:30:35.549
you know, is that, are those people? I think
00:30:35.549 --> 00:30:39.210
it, you know, I think it just truly depends.
00:30:39.349 --> 00:30:41.490
And you really have to watch what educational
00:30:41.490 --> 00:30:45.910
things that the person says. Because, you know,
00:30:45.910 --> 00:30:47.970
more, like I said, you know, going back to the,
00:30:48.130 --> 00:30:51.250
you know, people posting on Facebook, well, if
00:30:51.250 --> 00:30:54.809
you have two, you know, chronic diagnoses, that's
00:30:54.809 --> 00:30:56.670
automatically a moderate. No, it's not. But,
00:30:56.690 --> 00:31:01.829
you know, you really need to know. Who's the
00:31:01.829 --> 00:31:03.990
edge, you know, who's the one that you can trust
00:31:03.990 --> 00:31:09.190
to get the information from? And, you know, whether
00:31:09.190 --> 00:31:12.650
that's, you know, sometimes, I mean, I know it
00:31:12.650 --> 00:31:15.109
sounds funny, but Google, you know, can at least
00:31:15.109 --> 00:31:19.190
help, you know, get a start. But there are so
00:31:19.190 --> 00:31:22.950
many people on Facebook that's like, hey, you
00:31:22.950 --> 00:31:27.289
know, come join, come join this, you know. We've
00:31:27.289 --> 00:31:29.890
got the information. I have seen even groups
00:31:29.890 --> 00:31:34.829
that will advertise their services. And I cringe
00:31:34.829 --> 00:31:40.369
because they're not giving the individuals good
00:31:40.369 --> 00:31:43.269
information. So I think it truly depends on,
00:31:43.269 --> 00:31:48.650
you know, who's going to be giving that. I think
00:31:48.650 --> 00:31:50.750
conferences are a good way to get information,
00:31:50.990 --> 00:31:54.509
looking at the, you know, people that are a part
00:31:54.509 --> 00:31:57.900
of that. And, you know, possibly reaching out.
00:31:58.079 --> 00:32:03.079
And it is, it's a point of, yes, it becomes a
00:32:03.079 --> 00:32:05.539
detective work trying to figure out who's giving
00:32:05.539 --> 00:32:09.799
you the right information. But even still, you
00:32:09.799 --> 00:32:11.460
know, if somebody is giving you information,
00:32:11.799 --> 00:32:13.960
it's still your responsibility. You can trust,
00:32:14.000 --> 00:32:17.200
but you still need to verify it. Right. Yeah.
00:32:18.079 --> 00:32:22.279
Yeah. I know Elizabeth hired you for her private
00:32:22.279 --> 00:32:24.859
practice and she's coming to actually speak in
00:32:24.859 --> 00:32:29.230
the fellowship. soon to talk about documentation
00:32:29.230 --> 00:32:34.430
because she's like, wow, I learned a lot from
00:32:34.430 --> 00:32:37.609
Crystal. My notes apparently sucked, which coming
00:32:37.609 --> 00:32:41.390
from her, I mean, she's an overachiever. But
00:32:41.390 --> 00:32:45.150
she's like, yeah, I have gotten so much feedback.
00:32:45.829 --> 00:32:49.829
And so I'm like, the clinicians are very excited
00:32:49.829 --> 00:32:53.369
to hear from her, you know, post. working with
00:32:53.369 --> 00:32:55.890
you on some of that, like practical feedback.
00:32:56.430 --> 00:32:59.789
Um, are there vetted resources that you would
00:32:59.789 --> 00:33:03.289
recommend that are trustworthy? Like E &M university
00:33:03.289 --> 00:33:07.349
or like some of your courses, like, um, or somebody
00:33:07.349 --> 00:33:09.410
in my group the other day was like, is there
00:33:09.410 --> 00:33:11.490
an area, this is in my coaching program with
00:33:11.490 --> 00:33:14.650
specific billing codes. Like if I did X, Y, Z,
00:33:14.730 --> 00:33:17.589
what could I bill for like a cheat sheet or something?
00:33:17.730 --> 00:33:22.980
So Melanie. I'm sure I'm going to butcher her
00:33:22.980 --> 00:33:29.019
name. That's okay. I'm really bad at that. Grambling?
00:33:29.220 --> 00:33:34.609
Grabbling? Is it Anchor, Bloom, and Wellman?
00:33:35.529 --> 00:33:42.670
Okay. That's familiar to me. Yeah. Okay. So she,
00:33:42.910 --> 00:33:44.690
like, and I'm going to be honest, she approached
00:33:44.690 --> 00:33:48.869
me because she was creating a book. She was creating,
00:33:48.930 --> 00:33:53.500
like, a billing book. Okay. And she'll tell you
00:33:53.500 --> 00:34:00.480
that she approached me about editing it and like
00:34:00.480 --> 00:34:03.359
taking a look in and, you know, what did I think?
00:34:03.500 --> 00:34:11.840
Yeah. It was no holds barred. I was very blunt.
00:34:12.059 --> 00:34:18.300
I did not hold back. And pretty much the first
00:34:18.300 --> 00:34:21.059
round, I mean, I tore that book to shreds because
00:34:21.059 --> 00:34:22.920
I'm like, nope, nope, nope, nope, nope. This
00:34:22.920 --> 00:34:26.309
is no, nope. Nope. And I think we went through
00:34:26.309 --> 00:34:30.050
like four, five, six, maybe, maybe the most six
00:34:30.050 --> 00:34:33.289
different edits at different times because, you
00:34:33.289 --> 00:34:35.869
know, I'm like, no, nope, nope, nope, nope. I'm
00:34:35.869 --> 00:34:37.429
like, if we're going to, if you're going to do
00:34:37.429 --> 00:34:39.769
this, we're going to do it right. And, and everything
00:34:39.769 --> 00:34:43.590
that is in, in that book, you know, ultimately
00:34:43.590 --> 00:34:48.909
you can pull from the AMAs like CPT when it comes
00:34:48.909 --> 00:34:52.090
to, you know, the guidelines. I mean, this is,
00:34:52.150 --> 00:34:57.389
you know, truly evidenced based, you know, information.
00:34:57.550 --> 00:35:01.090
So, you know, and that's also, you know, coming
00:35:01.090 --> 00:35:03.989
from, you know, the auditing aspect of it. So
00:35:03.989 --> 00:35:08.750
it is a very comprehensive, you know, book. So
00:35:08.750 --> 00:35:13.150
yeah, she approached me and I said, sure. And,
00:35:13.170 --> 00:35:18.090
you know, yes, she, you know, yes, I was compensated
00:35:18.090 --> 00:35:21.639
for my time. But yeah, I went through that. I
00:35:21.639 --> 00:35:23.679
think I shocked her the first time because I
00:35:23.679 --> 00:35:25.320
think she, you know, was like, oh, my God, this
00:35:25.320 --> 00:35:27.659
is brutal. Well, I mean, if we're going to do
00:35:27.659 --> 00:35:29.679
it, let's do it right. We're not going to we're
00:35:29.679 --> 00:35:31.440
not we're going to make sure that people are
00:35:31.440 --> 00:35:34.800
provided the correct information to do the right
00:35:34.800 --> 00:35:38.260
thing. Right. Right. OK, that's good to know.
00:35:38.300 --> 00:35:39.480
That's good to know. What's the name of that
00:35:39.480 --> 00:35:44.389
book? I cannot remember the name. Like, I'd have
00:35:44.389 --> 00:35:46.829
to ask her because I know she kind of had changed,
00:35:46.889 --> 00:35:52.260
you know, changed some some things on it. But
00:35:52.260 --> 00:35:55.260
ultimately, yeah, she's got the book. Okay, cool.
00:35:55.440 --> 00:35:59.280
What resources do you offer if Psych and Peace
00:35:59.280 --> 00:36:01.880
are interested in learning from you more? I mean,
00:36:01.960 --> 00:36:07.840
like I do a monthly billing and coding series
00:36:08.159 --> 00:36:12.219
with Psychiatry Circle, and we do different topics
00:36:12.219 --> 00:36:16.389
once a month. Last month, let's see, we did...
00:36:17.360 --> 00:36:21.239
The element one of the MDM. So this month we
00:36:21.239 --> 00:36:25.320
will do element two and then October will be
00:36:25.320 --> 00:36:32.280
element three. Okay. Okay. Awesome. Um, any like
00:36:32.280 --> 00:36:36.750
digital products or anything like that? No, I
00:36:36.750 --> 00:36:41.250
haven't done any digital products yet. I guess
00:36:41.250 --> 00:36:47.400
I need to, but I haven't. Why not? So. Time -wise,
00:36:47.519 --> 00:36:53.539
because for me, I'm like, okay, my biggest thing
00:36:53.539 --> 00:36:56.280
is, of course, seeing my patients, but also taking
00:36:56.280 --> 00:37:00.699
care of my clients to make sure that they're
00:37:00.699 --> 00:37:04.019
ready to rock and roll and that ultimately they're
00:37:04.019 --> 00:37:07.340
getting paid for the services rendered. And I'm
00:37:07.340 --> 00:37:11.079
sure everybody's heard about what's transpired
00:37:11.079 --> 00:37:14.860
since July 1st with the downcoding. So that's
00:37:14.860 --> 00:37:20.139
been real fun. with that. And, you know, I've
00:37:20.139 --> 00:37:24.340
done, wrote multiple letters to our attorney
00:37:24.340 --> 00:37:27.039
general, our department of, you know, insurance,
00:37:27.139 --> 00:37:31.719
and now I'm escalating it to the federal level.
00:37:31.980 --> 00:37:38.260
Oh, wow. Okay. Gotcha. Yep. So you're a big advocate.
00:37:39.670 --> 00:37:43.190
Absolutely. That's awesome. Would you recommend
00:37:43.190 --> 00:37:48.050
that psych NPs do more in -depth training like
00:37:48.050 --> 00:37:52.989
you did on like auditing and billing and coding?
00:37:53.369 --> 00:37:56.429
I think, so I'm going to say this. And when it
00:37:56.429 --> 00:37:58.650
comes to, when you look at what do I need in
00:37:58.650 --> 00:38:03.349
my practice and, you know, is it a biller? Is
00:38:03.349 --> 00:38:06.070
it a coder? I'll be honest. So if you're, if
00:38:06.070 --> 00:38:09.250
you're a psych MP and you are doing a lot of
00:38:09.250 --> 00:38:15.489
evaluation management, I would recommend, you
00:38:15.489 --> 00:38:20.480
know, employing a coder, whether it's on an as
00:38:20.480 --> 00:38:25.679
-needed basis, that way you can learn from it.
00:38:26.699 --> 00:38:30.300
Yeah. I think one of the most important things
00:38:30.300 --> 00:38:36.059
is, you know, having a coder. And my clients
00:38:36.059 --> 00:38:40.739
that I do coding services for, oh yeah, they'll
00:38:40.739 --> 00:38:42.730
straight up tell you. The first two to three
00:38:42.730 --> 00:38:45.369
months they said was rough with me because I'm
00:38:45.369 --> 00:38:47.630
like, I kicked their notes back. And I'm like,
00:38:47.670 --> 00:38:50.550
absolutely not. Nope. This ain't going to fly.
00:38:50.949 --> 00:38:55.230
And it was a lot of, you know, training and working.
00:38:55.329 --> 00:39:00.050
And I had my clients tell me that I was brutal
00:39:00.050 --> 00:39:07.030
and mean. But so it's not that I'm, yes, I'm
00:39:07.030 --> 00:39:12.099
very blunt. I need you to learn. I don't feel
00:39:12.099 --> 00:39:14.659
that orange and silver are colors that people
00:39:14.659 --> 00:39:19.860
want. And I do not want, you know, if the, if
00:39:19.860 --> 00:39:22.820
somebody comes in to audit you, I don't want
00:39:22.820 --> 00:39:25.179
you to feel like you have to lose sleep at night
00:39:25.179 --> 00:39:27.800
because then you can be like, I know my stuff
00:39:27.800 --> 00:39:31.579
is good. You know, that is the biggest thing
00:39:31.579 --> 00:39:37.670
I want for people is not to fear. doing their
00:39:37.670 --> 00:39:40.090
job. If you're going to do it, let's do it right
00:39:40.090 --> 00:39:42.190
the first time. Because when are you honestly
00:39:42.190 --> 00:39:45.960
going to have time to redo it? Yeah. What are
00:39:45.960 --> 00:39:49.590
some of the mistakes that you see frequently?
00:39:51.219 --> 00:39:57.039
Well, I mean, as far as mistakes, I see a lot
00:39:57.039 --> 00:40:05.170
of the psychotherapy notes. So when we look at
00:40:05.170 --> 00:40:08.469
the psychotherapy, so Let me give you like a
00:40:08.469 --> 00:40:11.489
little formula. The biggest thing is, you know,
00:40:11.550 --> 00:40:17.960
target, intervention, response, like progress,
00:40:18.139 --> 00:40:24.800
plan, and your time. So you want the chart to
00:40:24.800 --> 00:40:27.920
establish the psychotherapy service itself, not
00:40:27.920 --> 00:40:31.000
merely saying, hey, supportive therapy was provided.
00:40:32.550 --> 00:40:37.360
That is the biggest thing that... you know, the
00:40:37.360 --> 00:40:42.179
important things are not in that note. And also
00:40:42.179 --> 00:40:45.739
identifying that they are separate services.
00:40:45.960 --> 00:40:49.699
They are two very distinct services if you're
00:40:49.699 --> 00:40:54.440
doing E &M and psychotherapy. So it's important
00:40:54.440 --> 00:40:59.579
that that connection is made because you have
00:40:59.579 --> 00:41:01.940
to make that distinction because psychotherapy
00:41:01.940 --> 00:41:06.599
time cannot, cannot. simply be double counted
00:41:06.599 --> 00:41:10.639
to manufacture an evaluation management time
00:41:10.639 --> 00:41:13.659
level. Yeah. Okay. Gotcha. Yeah. I just talked
00:41:13.659 --> 00:41:16.920
to somebody else yesterday who said her boss
00:41:16.920 --> 00:41:21.039
was, um, is wanting her to do sometimes just
00:41:21.039 --> 00:41:24.079
psychotherapy with some of the patients. Um,
00:41:24.260 --> 00:41:26.880
yeah. What do you think about that from a billing
00:41:26.880 --> 00:41:30.889
standpoint? She's a psych NP. I mean, here's
00:41:30.889 --> 00:41:33.349
the thing, first and foremost, you know, everybody
00:41:33.349 --> 00:41:35.610
wants something. But that doesn't necessarily
00:41:35.610 --> 00:41:39.070
mean that you feel confident or comfortable in
00:41:39.070 --> 00:41:41.630
doing it. And if you don't, you don't do it,
00:41:41.670 --> 00:41:45.449
bottom line. But if you feel comfortable in,
00:41:45.510 --> 00:41:48.809
you know, providing the therapy services to the
00:41:48.809 --> 00:41:52.510
patient, absolutely. But when you document for
00:41:52.510 --> 00:41:55.449
psychotherapy, it's going to be extremely different
00:41:55.449 --> 00:41:59.159
than... documenting for, you know, an E &M and
00:41:59.159 --> 00:42:03.739
a psychotherapy. So you have to make sure that
00:42:03.739 --> 00:42:08.039
you are appropriately, you know, documenting.
00:42:08.440 --> 00:42:11.800
And I went over this, you know, I had a local
00:42:11.800 --> 00:42:15.280
therapy group reach out to me and ask to come
00:42:15.280 --> 00:42:18.920
speak to their group on how to audit proof their
00:42:18.920 --> 00:42:22.440
notes. And I did it. And a lot of them were shocked
00:42:22.440 --> 00:42:27.690
over a lot of stuff. And I, and, um, and like
00:42:27.690 --> 00:42:29.849
I told them, I was, you know, I said, these are
00:42:29.849 --> 00:42:33.309
things that you need. And so what was interesting
00:42:33.309 --> 00:42:35.570
is they had a different take on certain things
00:42:35.570 --> 00:42:39.389
because an attorney told them, well, you know,
00:42:39.389 --> 00:42:41.489
don't put too much in there because, you know,
00:42:41.489 --> 00:42:47.730
of lawsuits. Well, here's my thing. If you don't
00:42:47.730 --> 00:42:52.170
do what you are expected to and what is demanded,
00:42:52.230 --> 00:42:56.550
you know, to bill out your note. And to support
00:42:56.550 --> 00:43:00.449
your note, do you think you're going to get in
00:43:00.449 --> 00:43:04.250
trouble if the potential that court happens?
00:43:04.329 --> 00:43:07.590
Or are you going to get in more trouble with
00:43:07.590 --> 00:43:12.929
these entities if they audit your notes? Right.
00:43:13.429 --> 00:43:17.309
Yeah. That makes sense. That makes sense. I know
00:43:17.309 --> 00:43:18.829
we're coming up on time. There's so much I want
00:43:18.829 --> 00:43:20.130
to ask you. I'm going to have to have you back
00:43:20.130 --> 00:43:23.949
for a part two, three. I don't know. AI scribes.
00:43:24.510 --> 00:43:28.320
Any thoughts on those? I think that, you know,
00:43:28.320 --> 00:43:31.320
I know Allison, you know, has a good one, the
00:43:31.320 --> 00:43:36.920
PMHMP Scribe. I've tried all of them. I have.
00:43:36.960 --> 00:43:40.300
I've tried all of them. And there hasn't been
00:43:40.300 --> 00:43:43.199
any one more that I like than the others. I just
00:43:43.199 --> 00:43:47.179
find that, you know, I will, you know, use maybe,
00:43:47.320 --> 00:43:50.679
I think it's Bastion because it's HIPAA compliant.
00:43:51.659 --> 00:43:54.400
And throw stuff in there to fix, you know, like
00:43:54.400 --> 00:43:57.840
to fix my note the way that I want it. If, you
00:43:57.840 --> 00:44:01.369
know, like I use Freed if it doesn't give me
00:44:01.369 --> 00:44:05.690
what I want or Freed goes off the rails. Yeah.
00:44:06.650 --> 00:44:09.429
Hallucinates sometimes. Oh, yeah. I've been an
00:44:09.429 --> 00:44:11.369
OBGYN and I didn't even know that. I was like,
00:44:11.409 --> 00:44:16.429
that's interesting. Yeah. What do you what do
00:44:16.429 --> 00:44:19.539
you do for fun? Work on my car. Nice. Go to car
00:44:19.539 --> 00:44:22.579
shows. Yeah, that's, you know, that's my biggest
00:44:22.579 --> 00:44:25.559
thing. My husband, you know, bought my dream,
00:44:25.619 --> 00:44:27.840
you know, bought me my dream car. And that is,
00:44:27.860 --> 00:44:30.440
you know, but, you know, my kids enjoy. Well,
00:44:30.599 --> 00:44:33.619
I should say one of the kids enjoys it. And,
00:44:33.619 --> 00:44:37.460
you know, but, you know, that's my that's my,
00:44:37.619 --> 00:44:41.480
you know, form of fun and, you know, spending
00:44:41.480 --> 00:44:44.440
time with family. Yeah, I love that. I love that.
00:44:44.639 --> 00:44:47.179
Yeah. People are definitely interested in this
00:44:47.179 --> 00:44:49.840
topic. And I think a lot of people are, a lot
00:44:49.840 --> 00:44:52.199
of psych NPs specifically are, are very fearful
00:44:52.199 --> 00:44:55.159
right now post, you know, the Lindsay Clancy
00:44:55.159 --> 00:44:58.239
trial. And so I think it's really important.
00:44:58.679 --> 00:45:05.230
Um, and it's, it's really hard to find resources
00:45:05.230 --> 00:45:10.150
that you can trust. So, so I think the biggest
00:45:10.150 --> 00:45:14.610
thing is, is, you know, The person's note doesn't
00:45:14.610 --> 00:45:16.889
have to be enormous. It doesn't have to be a
00:45:16.889 --> 00:45:20.269
dissertation. It has to be clinically accurate,
00:45:20.570 --> 00:45:24.730
internally consistent and capable of showing,
00:45:24.730 --> 00:45:28.050
you know, like why you made the decisions you
00:45:28.050 --> 00:45:32.349
did. And for me, the biggest thing about being,
00:45:32.389 --> 00:45:35.269
you know, from the coder and the auditor side
00:45:35.269 --> 00:45:39.389
and, you know, what it has taught me was that
00:45:39.389 --> 00:45:43.380
that coding isn't. about just getting the highest
00:45:43.380 --> 00:45:47.170
code. It's about getting the right code. And,
00:45:47.230 --> 00:45:50.829
you know, and I'm big on compliance and, you
00:45:50.829 --> 00:45:53.210
know, being compliant doesn't mean that you have
00:45:53.210 --> 00:45:56.369
to leave money on the table. Compliance just
00:45:56.369 --> 00:45:59.389
means that you're accurately reporting the work
00:45:59.389 --> 00:46:03.869
you actually performed. Right. Yeah. That makes
00:46:03.869 --> 00:46:07.230
a lot of sense. And I mean, you know, what do
00:46:07.230 --> 00:46:09.110
you, you know, like, and I ask this to people
00:46:09.110 --> 00:46:13.500
all the time. Where do you think that an audit
00:46:13.500 --> 00:46:18.750
risk comes from? The audit risk comes from inconsistency,
00:46:18.750 --> 00:46:22.650
not the fact that you build a higher code. It
00:46:22.650 --> 00:46:26.949
comes from inconsistency. Yeah, that's a really
00:46:26.949 --> 00:46:30.590
great point. Okay, I ask everybody who comes
00:46:30.590 --> 00:46:34.380
on the show, because I named this podcast No
00:46:34.380 --> 00:46:36.780
Prior Auth. What does the term No Prior Auth
00:46:36.780 --> 00:46:40.119
mean to you, Crystal? Well, I mean, I think it
00:46:40.119 --> 00:46:42.119
just depends on what you're looking at. You know,
00:46:42.239 --> 00:46:46.940
when we look, when we think of, you know, no
00:46:46.940 --> 00:46:49.239
prior auth, I mean, that could come from, you
00:46:49.239 --> 00:46:54.480
know, requiring such for, you know, insurance
00:46:54.480 --> 00:46:58.480
services or, you know, medications. I think it
00:46:58.480 --> 00:47:01.260
deals with, you know, the prior, you know, the
00:47:01.260 --> 00:47:05.119
prior auths that unfortunately make our jobs
00:47:05.119 --> 00:47:08.429
a lot harder. It prevents our patients from getting
00:47:08.429 --> 00:47:13.449
the care and the services that they need. Yeah,
00:47:13.550 --> 00:47:17.329
yeah, 100%. Well, thank you so much for all this
00:47:17.329 --> 00:47:20.409
incredible information. We'll put links below.
00:47:20.809 --> 00:47:24.710
And yeah, I'll be... eager to have you back for
00:47:24.710 --> 00:47:27.349
a part two because I have more questions, but
00:47:27.349 --> 00:47:29.849
I have gotten feedback that people tend to like
00:47:29.849 --> 00:47:32.050
the shorter episodes. I've heard from a few people.
00:47:32.070 --> 00:47:34.630
They like the longer ones though. So let me know
00:47:34.630 --> 00:47:37.429
guys. Um, but yeah, thank you so much, Crystal.
00:47:37.530 --> 00:47:38.530
Thank you for having me.
00:00:00.000 --> 00:00:02.980
Well, if you have two chronic illnesses, that's
00:00:02.980 --> 00:00:05.459
automatically a moderate level for the visit.
00:00:05.559 --> 00:00:09.119
That's automatically a 99214. That concerns me.
00:00:09.960 --> 00:00:12.800
So that can be a bit of a red flag. It also concerns
00:00:12.800 --> 00:00:16.019
me when people are doing evaluation and management
00:00:16.019 --> 00:00:19.899
visits plus psychotherapy and doing 20 -minute
00:00:19.899 --> 00:00:23.219
visits. I see a lot of fraud. I really do. I
00:00:23.219 --> 00:00:26.059
see a lot of fraud occurring all the time. There
00:00:26.059 --> 00:00:28.300
was a lot of issues with billers like everybody
00:00:28.300 --> 00:00:32.890
else. dollars. Claims weren't being done correctly.
00:00:33.770 --> 00:00:38.630
So, you know, there's a lot of money loss. I
00:00:38.630 --> 00:00:42.149
was like, I'm done. Done. Fired the biller. And
00:00:42.149 --> 00:00:49.789
figured it out yourself, basically. This week
00:00:49.789 --> 00:00:51.929
on No Prior Roth, I'm sitting down with Crystal
00:00:51.929 --> 00:00:54.130
Stone, and this is an episode I've wanted to
00:00:54.130 --> 00:00:56.670
make since we started the show. Crystal is a
00:00:56.670 --> 00:00:58.670
double board certified family and psychiatric
00:00:58.670 --> 00:01:01.289
nurse practitioner, an Air Force veteran, and
00:01:01.289 --> 00:01:03.810
the founder of three businesses in Southern Illinois.
00:01:03.969 --> 00:01:06.650
An integrated primary care and behavioral health
00:01:06.650 --> 00:01:09.150
practice, a psychiatric rounding service for
00:01:09.150 --> 00:01:12.129
nursing facilities, and a billing, coding, and
00:01:12.129 --> 00:01:14.569
auditing company with a motto I need you to hear.
00:01:15.109 --> 00:01:18.409
Professional, on paper, savage in appeals. She's
00:01:18.409 --> 00:01:21.129
also a certified professional coder, biller,
00:01:21.150 --> 00:01:24.700
and medical auditor, which makes... her just
00:01:24.700 --> 00:01:26.920
about the only person who has sat on every side
00:01:26.920 --> 00:01:29.099
of your insurance claim. Today, we're asking
00:01:29.099 --> 00:01:31.799
her the question, are you coding your psych visits
00:01:31.799 --> 00:01:34.959
wrong? We get into the visit codes you use every
00:01:34.959 --> 00:01:37.280
day, medical decision -making versus time, what
00:01:37.280 --> 00:01:40.060
actually triggers audits, the myths and the money
00:01:40.060 --> 00:01:43.140
new practice owners leave on the table. One quick
00:01:43.140 --> 00:01:45.760
note, this episode is education, not billing
00:01:45.760 --> 00:01:48.920
or legal advice. Payer rules vary, so verify
00:01:48.920 --> 00:01:51.819
everything for your own practice. Okay, grab
00:01:51.819 --> 00:01:54.769
a notepad. Let's get into it. Thanks for coming
00:01:54.769 --> 00:01:58.849
on, Crystal. Oh, my pleasure. I'm very much looking
00:01:58.849 --> 00:02:01.290
forward to this. So hopefully, you know, we can
00:02:01.290 --> 00:02:05.790
help somebody. Exactly. Yeah, I'm eager to talk
00:02:05.790 --> 00:02:08.750
with you today because your background is just
00:02:08.750 --> 00:02:12.430
very interesting and it's an interesting climate
00:02:12.430 --> 00:02:17.530
right now. So I want to hear a little bit from
00:02:17.530 --> 00:02:21.330
you. Like, how did you end up where you are today?
00:02:21.550 --> 00:02:23.050
Like, just tell us a little bit about your story.
00:02:23.520 --> 00:02:28.050
So like most people, you know, you graduate high
00:02:28.050 --> 00:02:31.229
school, they go to college. Well, for me, I was
00:02:31.229 --> 00:02:33.530
like, the college wasn't going to be my thing.
00:02:33.770 --> 00:02:38.150
I didn't do very well in school. I just did what
00:02:38.150 --> 00:02:44.629
I needed to do to get by and graduate. So I chose
00:02:44.629 --> 00:02:48.789
the military and, you know, found, hey, that's
00:02:48.789 --> 00:02:51.530
where I met my husband. You know, he was, you
00:02:51.530 --> 00:02:54.430
know, active duty military as well. Then, you
00:02:54.430 --> 00:02:56.229
know, you get married, you start having kids.
00:02:56.469 --> 00:02:59.949
I chose to get out because he deployed all the
00:02:59.949 --> 00:03:05.590
time. So he stayed in, I got out. And then it
00:03:05.590 --> 00:03:09.449
was attempting to go back to school. I still
00:03:09.449 --> 00:03:12.590
struggled. And I'm like, there's definitely something
00:03:12.590 --> 00:03:16.819
wrong. So as I entered into nursing school at
00:03:16.819 --> 00:03:21.020
that point, I was pregnant with the second child
00:03:21.020 --> 00:03:24.259
and had to take some semesters off because, you
00:03:24.259 --> 00:03:26.060
know, good old morning sickness, which never
00:03:26.060 --> 00:03:31.430
stays to be the morning. And, you know, struggled
00:03:31.430 --> 00:03:34.870
significantly with the first couple semesters.
00:03:35.090 --> 00:03:40.689
Then I had my son and then my husband was still,
00:03:40.729 --> 00:03:43.250
you know, he missed. he missed that. He was deployed.
00:03:43.409 --> 00:03:47.030
So he came back and, you know, I kept, you know,
00:03:47.030 --> 00:03:49.110
saying like, there's something wrong, you know,
00:03:49.110 --> 00:03:51.569
there's just something wrong. So that's when
00:03:51.569 --> 00:03:57.509
I definitely sought out a psychologist to say,
00:03:57.689 --> 00:03:59.909
Hey, you know, what is, you know, what is wrong
00:03:59.909 --> 00:04:01.889
with me? There there's, there's gotta be something
00:04:01.889 --> 00:04:05.430
wrong. So I went through all the testing and,
00:04:05.430 --> 00:04:08.030
you know, he came back and he was just, you know,
00:04:08.030 --> 00:04:11.479
told me that I had, you know, ADHD. Combined
00:04:11.479 --> 00:04:15.800
really bad. Yeah, that kind of makes sense. And
00:04:15.800 --> 00:04:19.480
then, you know, see my primary got put on medicine,
00:04:19.579 --> 00:04:22.339
which was definitely very, very life changing.
00:04:22.500 --> 00:04:25.160
So I went from being this like, you know, C almost
00:04:25.160 --> 00:04:29.019
D student to a straight A student. And then the
00:04:29.019 --> 00:04:33.480
love for education happened. I'm like, I love
00:04:33.480 --> 00:04:37.620
school versus hate it. So, you know, graduate.
00:04:38.920 --> 00:04:43.660
to continue education and then decide, you know,
00:04:43.680 --> 00:04:47.819
I got my MSN with a specialization in informatics.
00:04:48.579 --> 00:04:50.220
Then I was like, well, I don't want to do this
00:04:50.220 --> 00:04:52.439
job because it's pretty much living out of a
00:04:52.439 --> 00:04:54.360
suitcase and that's not what I wanted to do.
00:04:54.579 --> 00:04:58.800
So then I chose to go back and do the family
00:04:58.800 --> 00:05:02.529
nurse practitioner program. So I did that. And
00:05:02.529 --> 00:05:08.240
that was probably, I would say maybe. Six months
00:05:08.240 --> 00:05:13.240
to a year out of that, I decided that there was
00:05:13.240 --> 00:05:17.139
such a need for people in their homes, like seeing
00:05:17.139 --> 00:05:18.560
people in their homes because I had done home
00:05:18.560 --> 00:05:22.319
health. And in my area, there was nothing. There
00:05:22.319 --> 00:05:26.720
was no house calls. You know, we had a very huge,
00:05:26.959 --> 00:05:30.800
low socioeconomic population that couldn't get
00:05:30.800 --> 00:05:33.920
out of the home. So I chose to open my own practice.
00:05:34.259 --> 00:05:37.910
My collaborative was awesome. He loved what I
00:05:37.910 --> 00:05:40.970
did, you know, was doing because he was big on
00:05:40.970 --> 00:05:44.170
servicing that population, which I love what
00:05:44.170 --> 00:05:48.319
I did. And, you know, from the get go, I'm like,
00:05:48.399 --> 00:05:50.180
well, there's a lot of mental health, you know,
00:05:50.180 --> 00:05:56.100
issues here, too. And that's when I got the first
00:05:56.100 --> 00:06:00.420
taste of insurance, because it was, you know,
00:06:00.439 --> 00:06:05.850
it was a it was a nightmare from day one. you
00:06:05.850 --> 00:06:07.490
know you learn as you go it's kind of like a
00:06:07.490 --> 00:06:10.810
you know crash course and I had billers yeah
00:06:10.810 --> 00:06:14.029
to help uh along the way and then finally it
00:06:14.029 --> 00:06:20.009
was like you know I'm done and then ultimately
00:06:20.009 --> 00:06:24.740
I was like okay time to do it myself because
00:06:24.740 --> 00:06:27.360
I didn't think that you know it was there was
00:06:27.360 --> 00:06:29.819
a lot of issues with billers like everybody else
00:06:29.819 --> 00:06:32.680
I mean I lost thousands of dollars claims weren't
00:06:32.680 --> 00:06:37.870
being done correctly um Just, you know, lots
00:06:37.870 --> 00:06:41.310
of money on the table or, you know, they weren't,
00:06:41.310 --> 00:06:43.550
you know, they weren't processing the denials,
00:06:43.550 --> 00:06:45.550
the rejections or fighting with the insurance
00:06:45.550 --> 00:06:50.759
company. So, you know, there's a lot of money
00:06:50.759 --> 00:06:55.259
loss. And then that's when I was like, I'm done.
00:06:55.300 --> 00:07:00.540
I'm done. And when I pulled one of my reports,
00:07:00.800 --> 00:07:03.959
like the, you know, aging report, and I'm sitting
00:07:03.959 --> 00:07:09.509
here looking at... The 120 -day bucket, and we're
00:07:09.509 --> 00:07:12.170
talking tens of thousands of dollars is in that
00:07:12.170 --> 00:07:16.300
bucket. I was like, I'm done. Done. Fired the
00:07:16.300 --> 00:07:19.720
biller. And figured it out yourself, basically.
00:07:20.079 --> 00:07:23.759
In that time frame, I had been educating myself.
00:07:23.980 --> 00:07:26.360
I was like, well, you know, here we go. Let's
00:07:26.360 --> 00:07:28.860
pull the string and kind of see what's going
00:07:28.860 --> 00:07:31.259
to happen. I don't regret it. I don't regret
00:07:31.259 --> 00:07:36.009
it by any means. here we are. It taught me such
00:07:36.009 --> 00:07:38.550
a valuable lesson. I don't regret any of it,
00:07:38.569 --> 00:07:43.089
but then, you know, here comes me doing, you
00:07:43.089 --> 00:07:45.250
know, like here comes me, you know, getting my,
00:07:45.370 --> 00:07:48.970
you know, certification and, you know, behavioral
00:07:48.970 --> 00:07:53.029
health and becoming, you know, a psych MP. And
00:07:53.029 --> 00:07:59.069
it shaped how I created that practice hugely
00:08:00.000 --> 00:08:03.699
because I'd already dealt with the things on.
00:08:04.250 --> 00:08:06.189
the primary side, I'm like, yeah, we're going
00:08:06.189 --> 00:08:07.829
to do, we're going to do something different
00:08:07.829 --> 00:08:12.689
here. And you learn, I mean, I learned, you know,
00:08:12.750 --> 00:08:14.850
um, I guess you want to say like the crash and
00:08:14.850 --> 00:08:17.430
burn method, you know, what the primary, so we're
00:08:17.430 --> 00:08:19.189
not going to make the same, you know, we're not,
00:08:19.189 --> 00:08:22.290
we're not going to make the same mistakes. Then,
00:08:22.529 --> 00:08:26.579
you know, as I learned, because being in the
00:08:26.579 --> 00:08:28.699
military, everything's regulation based policy
00:08:28.699 --> 00:08:31.000
regulations, there's like a regulation for everything.
00:08:31.569 --> 00:08:33.710
Well, when, you know, when you're dealing with
00:08:33.710 --> 00:08:37.450
a lot of these policies, you know, with the insurance
00:08:37.450 --> 00:08:41.590
company, stuff's going to fall somewhere. All
00:08:41.590 --> 00:08:44.330
insurance companies are going to fall under some
00:08:44.330 --> 00:08:49.330
regulation. So deep dive, you know, often running.
00:08:49.669 --> 00:08:54.850
And that's where, you know, I feel that, yeah,
00:08:54.870 --> 00:08:56.610
better because I'm like, oh, this makes much
00:08:56.610 --> 00:09:02.059
more sense. And then. There was still some pieces
00:09:02.059 --> 00:09:05.379
I was missing. And I actually attended a billing
00:09:05.379 --> 00:09:09.659
conference that was hosted by who's my mentor,
00:09:09.759 --> 00:09:15.029
like my mentor, Carlene Dittrich. And we just
00:09:15.029 --> 00:09:18.350
connected from there. And is she a psych MP?
00:09:18.450 --> 00:09:21.750
No, she's actually straight up like, you know,
00:09:21.750 --> 00:09:26.370
biller, coder, auditor. She is, I think, one
00:09:26.370 --> 00:09:30.070
of three in the United States who is ERISA certified.
00:09:31.429 --> 00:09:36.879
And so what I was missing, it was great because,
00:09:37.000 --> 00:09:40.679
you know, kind of filled in those holes. And
00:09:40.679 --> 00:09:44.440
we've been kind of thick of Steve since. And
00:09:44.440 --> 00:09:48.019
so I ultimately a lot of times, you know, we'll,
00:09:48.019 --> 00:09:50.799
I would say probably quarterly, whatever, we'll
00:09:50.799 --> 00:09:53.240
teach classes. We've traveled, you know, throughout
00:09:53.240 --> 00:09:55.360
the United States presenting to other billing
00:09:55.360 --> 00:09:59.620
organizations. over a lot of the federal laws
00:09:59.620 --> 00:10:05.279
the state laws even tricare um so you know billing
00:10:05.279 --> 00:10:07.500
is i should say you know like the the billing
00:10:07.500 --> 00:10:12.559
aspect of it it affects all walks of life for
00:10:12.559 --> 00:10:18.000
sure yeah wow that's that's a cool story um what's
00:10:18.000 --> 00:10:20.860
your day -to -day look like i'm very curious
00:10:20.860 --> 00:10:24.440
like yeah tell us about it like a day or a week
00:10:24.440 --> 00:10:27.210
in the life of crystal stone like how you spend
00:10:27.210 --> 00:10:28.710
your time? Um, it, you know, that's the kind
00:10:28.710 --> 00:10:31.009
of, it is, I, I think I kind of laugh at that
00:10:31.009 --> 00:10:32.789
one because a lot of people think that I, you
00:10:32.789 --> 00:10:34.649
know, I see patients, you know, full time and
00:10:34.649 --> 00:10:35.950
that, you know, they're like, Oh, how do you
00:10:35.950 --> 00:10:38.450
do this? I don't see patients full time. I see,
00:10:38.490 --> 00:10:41.289
you know, I see patients pretty much, you know,
00:10:41.289 --> 00:10:43.750
Mondays, Tuesdays and Wednesdays, like every
00:10:43.750 --> 00:10:46.649
other Wednesday I round in the, in the skilled
00:10:46.649 --> 00:10:49.070
nursing facilities to see the, you know, for
00:10:49.070 --> 00:10:51.570
psych, but you know, Mondays and Tuesdays is
00:10:51.570 --> 00:10:54.129
predominantly when I see, you know, patients.
00:10:55.120 --> 00:10:57.779
And I still work on the building Mondays, Tuesdays,
00:10:57.779 --> 00:11:01.700
Wednesdays, Thursdays, Fridays. I try to make
00:11:01.700 --> 00:11:05.330
it a point for work -life balance not to do any
00:11:05.330 --> 00:11:09.070
work on the weekends. I've been somewhat successful
00:11:09.070 --> 00:11:12.490
with that because I like to spend my time working
00:11:12.490 --> 00:11:17.649
on my 66 Ford Mustang that is my dream car. And
00:11:17.649 --> 00:11:20.250
that's what I like to spend my time doing, whether
00:11:20.250 --> 00:11:24.169
it's the car shows or, you know, Under, you know,
00:11:24.169 --> 00:11:26.730
underneath the car working on it or in the engine.
00:11:26.909 --> 00:11:29.789
So that's, you know, where I like to spend my
00:11:29.789 --> 00:11:33.029
time and I try very hard to keep that work -life
00:11:33.029 --> 00:11:37.570
balance. Yeah, that makes sense. So the patient
00:11:37.570 --> 00:11:42.350
care that you're doing, that's all like psych
00:11:42.350 --> 00:11:45.350
NP related? Not all of it. I, because I still
00:11:45.350 --> 00:11:47.389
see, you know, throughout those Mondays, Tuesdays
00:11:47.389 --> 00:11:49.950
and Wednesdays, it's a mixture. It's a mixture
00:11:49.950 --> 00:11:52.830
of, you know, primary care, but I did scale back
00:11:52.830 --> 00:11:55.470
my primary care because there was such a higher
00:11:55.470 --> 00:11:59.769
need for behavioral health, you know, and I like
00:11:59.769 --> 00:12:03.110
primary care, but honestly, my passion is more
00:12:03.110 --> 00:12:06.929
with psych. Yeah. Okay. And these are your businesses.
00:12:07.450 --> 00:12:10.190
Have you always been entrepreneurial? Like that's
00:12:10.190 --> 00:12:12.070
one of the things our listeners are very intrigued
00:12:12.070 --> 00:12:14.289
by kind of how people got into their businesses,
00:12:14.330 --> 00:12:16.889
you know, how much did they spend getting them
00:12:16.889 --> 00:12:19.860
off the ground? Is it worth it kind of thing?
00:12:20.000 --> 00:12:24.820
No, I haven't always been entrepreneurial. After
00:12:24.820 --> 00:12:31.440
being in the military and then, you know, it's
00:12:31.440 --> 00:12:34.220
kind of like, what now when you get out? Like,
00:12:34.220 --> 00:12:39.740
what now? And working for other people, it became
00:12:39.740 --> 00:12:43.639
a point of I'm done. I'm done. I am not corporate
00:12:43.639 --> 00:12:49.379
material. That's when, you know, opting to work
00:12:49.379 --> 00:12:55.259
for oneself because some of the rules for me
00:12:55.259 --> 00:12:58.740
did not set very well, like ethically, morally.
00:12:58.940 --> 00:13:03.379
And I'm not, you know, I know. So I opted to
00:13:03.379 --> 00:13:06.659
work for myself and I started the primary care
00:13:06.659 --> 00:13:09.879
practice and then it just expanded from there.
00:13:10.100 --> 00:13:15.320
OK, gotcha, gotcha. Can you educate us a little
00:13:15.320 --> 00:13:20.159
bit on the differences between in -network billing
00:13:20.159 --> 00:13:23.960
versus out -of -network billing? Because this
00:13:23.960 --> 00:13:26.340
just came up with my little sister yesterday,
00:13:26.659 --> 00:13:30.179
actually, where she was kind of telling me about...
00:13:30.570 --> 00:13:33.029
about what's happened with her insurance and
00:13:33.029 --> 00:13:35.490
just kind of billing an out -of -network provider.
00:13:35.610 --> 00:13:37.210
And I'm just curious, kind of your perspective
00:13:37.210 --> 00:13:41.169
on it. I also remember talking to an IOP practice
00:13:41.169 --> 00:13:42.950
that was like, yeah, we didn't make any money
00:13:42.950 --> 00:13:44.529
when we were in network, but now that we bill
00:13:44.529 --> 00:13:47.909
out of network. So can you just like educate
00:13:47.909 --> 00:13:51.289
us on that and on a level that's like basic?
00:13:51.370 --> 00:13:53.509
Because a lot of our listeners just need like
00:13:53.509 --> 00:13:56.220
foundational. So when we look at in -network,
00:13:56.320 --> 00:13:59.919
that means that you've essentially signed a contract
00:13:59.919 --> 00:14:04.080
with the insurance company to accept the reimbursement
00:14:04.080 --> 00:14:09.320
for the code that you are billing out for. So
00:14:09.320 --> 00:14:13.960
it's a pre -designed amount and each insurance
00:14:13.960 --> 00:14:15.820
is going to be different. So it's going to depend
00:14:15.820 --> 00:14:19.620
on the payer. You know, the state like state
00:14:19.620 --> 00:14:21.980
Medicaid is, you know, you. That's a matter of
00:14:21.980 --> 00:14:24.399
public information. Each state is different.
00:14:24.600 --> 00:14:26.860
You can look that up. Same thing with Medicare.
00:14:27.120 --> 00:14:30.700
Medicare is published. So is TRICARE. Then you
00:14:30.700 --> 00:14:34.220
know what you're getting paid. It's always been
00:14:34.220 --> 00:14:36.220
one of those things that it doesn't necessarily
00:14:36.220 --> 00:14:40.159
happen. No, but commercial is technically supposed
00:14:40.159 --> 00:14:42.779
to reimburse more than Medicare. I won't say
00:14:42.779 --> 00:14:45.419
that it necessarily happens. But in -network
00:14:45.419 --> 00:14:49.059
means, hey, you've contracted with the payer.
00:14:49.799 --> 00:14:54.759
So if you are, and that doesn't mean every plan.
00:14:54.899 --> 00:14:58.700
So it's important to know within your contract
00:14:58.700 --> 00:15:02.600
what plans you are credentialed with to be in
00:15:02.600 --> 00:15:06.820
that work. And so that means when you see those
00:15:06.820 --> 00:15:11.230
members, depending on how their plan is, is how
00:15:11.230 --> 00:15:13.370
things go, whether they have a copay deductible
00:15:13.370 --> 00:15:17.409
or coinsurance. So ultimately what happens is
00:15:18.000 --> 00:15:22.620
Let's say that a 99214 for the insurance, the
00:15:22.620 --> 00:15:26.820
maximum allowable is $100. So that is the most
00:15:26.820 --> 00:15:29.240
that you are going to get for that particular
00:15:29.240 --> 00:15:32.990
visit. Just for that visit alone, that doesn't
00:15:32.990 --> 00:15:35.230
include any add -ons or anything else. That just
00:15:35.230 --> 00:15:39.649
includes, you know, the $100 maximum for that
00:15:39.649 --> 00:15:43.929
visit. That means, you know, if the insurance
00:15:43.929 --> 00:15:47.480
is essentially going to pay 80 % because The
00:15:47.480 --> 00:15:51.460
patient has a $20 copay. So that means $100,
00:15:51.559 --> 00:15:54.460
80 from the insurance, 100 from the patient's
00:15:54.460 --> 00:15:58.159
responsibility. So that you can't balance bill.
00:15:58.360 --> 00:16:01.200
You, you know, what you see is what you get.
00:16:01.220 --> 00:16:04.940
What balance billing? So, so for instance, if
00:16:04.940 --> 00:16:09.049
somebody's, I'll say more from, you know, if
00:16:09.049 --> 00:16:10.889
you're like that, you'll see a lot of balance
00:16:10.889 --> 00:16:14.470
billing on a network, but in network means that
00:16:14.470 --> 00:16:17.610
what you get, that's it. You know, you can't.
00:16:17.610 --> 00:16:20.389
So like, let's say you charge. Let's say your
00:16:20.389 --> 00:16:26.049
charge sheet is $250 for a 99214. That's your
00:16:26.049 --> 00:16:28.149
fee schedule. That's what you're commanding.
00:16:28.539 --> 00:16:32.320
But with the insurance, the contract, you know,
00:16:32.340 --> 00:16:34.120
the contract states that you're going to get
00:16:34.120 --> 00:16:38.500
$100. You cannot balance bill that patient for
00:16:38.500 --> 00:16:42.080
that remaining amount from what you charge and
00:16:42.080 --> 00:16:45.899
what the insurance pays you. Does that make sense?
00:16:46.779 --> 00:16:50.919
It does. Now, out of network, it's fair game.
00:16:52.049 --> 00:16:55.730
But when people create their fee schedules without
00:16:55.730 --> 00:16:59.250
a network, it can't be something extremely ridiculously
00:16:59.250 --> 00:17:03.190
exorbitant. Like there's a site, Fair Health
00:17:03.190 --> 00:17:07.190
Consumer, that will essentially kind of tell
00:17:07.190 --> 00:17:12.809
you for your area what you can expect for being
00:17:13.130 --> 00:17:16.710
self -pay. It'll give you like, hey, this is
00:17:16.710 --> 00:17:18.809
kind of like what insurance is reimbursing in
00:17:18.809 --> 00:17:22.329
network. And this is essentially what is being,
00:17:22.490 --> 00:17:27.450
you know, paid for out of network. So depending
00:17:27.450 --> 00:17:30.369
on how people scale their practice, yeah, out
00:17:30.369 --> 00:17:33.009
of network can be very lucrative. And if you
00:17:33.009 --> 00:17:35.789
have the area to do it, but without a network,
00:17:35.950 --> 00:17:39.230
you know, some people choose to, you know, build
00:17:39.230 --> 00:17:42.630
the insurance and fight with them. And some will
00:17:42.630 --> 00:17:46.069
just. Hey, you pay me. Here's your super bill.
00:17:46.190 --> 00:17:50.369
You go fight with your insurance. I see. Can
00:17:50.369 --> 00:17:54.089
I ask how you do it in your practice? So because
00:17:54.089 --> 00:17:58.049
of my area, I do wish I could be self -pay. But
00:17:58.049 --> 00:18:03.650
my area, there's not a lot of self -pay. Majority
00:18:03.650 --> 00:18:07.130
of it is insurance -based. Now, if I was to go
00:18:07.130 --> 00:18:09.049
into certain areas of St. Louis, because I'm
00:18:09.049 --> 00:18:12.809
20 minutes outside of St. Louis, I... open a
00:18:12.809 --> 00:18:18.069
practice and did self -pay, I could essentially
00:18:18.069 --> 00:18:21.589
survive. But why would I want to go to Missouri
00:18:21.589 --> 00:18:24.329
since it's the most restrictive state for practice?
00:18:25.490 --> 00:18:28.769
Mm -hmm. Gotcha. So you're in network. Mm -hmm.
00:18:30.660 --> 00:18:36.019
Very much so. Yep. Okay. Gotcha, gotcha. What
00:18:36.019 --> 00:18:40.740
advice are psych NPs getting right now that concerns
00:18:40.740 --> 00:18:44.509
you the most in this space, would you say? billing
00:18:44.509 --> 00:18:47.890
on facebook you know all the social media platforms
00:18:47.890 --> 00:18:51.390
you know the things that people say they'll say
00:18:51.390 --> 00:18:55.349
you know um for instance i'll just use this as
00:18:55.349 --> 00:19:02.059
a example the they'll say well if you have two
00:19:02.059 --> 00:19:06.039
chronic illnesses that's automatically a moderate
00:19:06.039 --> 00:19:09.869
level for the visit that's automatically a 99214
00:19:09.869 --> 00:19:14.640
that concerns me it also concerns me when people
00:19:14.640 --> 00:19:18.450
are doing evaluation and management visits plus
00:19:18.450 --> 00:19:24.190
psychotherapy and doing 20 minute visits. When
00:19:24.190 --> 00:19:26.990
we already know that if you are doing a 90833,
00:19:27.269 --> 00:19:32.839
you need at least 16 minutes of psychotherapy.
00:19:33.339 --> 00:19:36.759
I see a lot of fraud. I see a lot of fraud. I
00:19:36.759 --> 00:19:39.440
really do. I see a lot of fraud occurring all
00:19:39.440 --> 00:19:43.940
the time. Yeah. Yeah. That's, it's concerning.
00:19:45.039 --> 00:19:47.400
Okay. To switch gears a little bit, this is one,
00:19:47.420 --> 00:19:51.240
this is a hot topic right now. Okay. And I'm
00:19:51.240 --> 00:19:54.099
going to go at it from the perspective of, and
00:19:54.099 --> 00:19:56.279
I'm not associated with any of these VC companies,
00:19:56.539 --> 00:20:00.000
Headway, Alma. It's just so relevant right now.
00:20:00.099 --> 00:20:03.480
I literally talked to one of my psych NP mentees
00:20:03.480 --> 00:20:06.980
this morning and she's a new grad and she's.
00:20:07.809 --> 00:20:09.849
nervous about, she's had a hard time finding
00:20:09.849 --> 00:20:13.049
a job. And so she's like, should I take this
00:20:13.049 --> 00:20:16.349
position making $90 an hour for this practice
00:20:16.349 --> 00:20:21.599
that my mentor has through Headway essentially?
00:20:23.259 --> 00:20:27.319
And I don't know if you've listened to any of
00:20:27.319 --> 00:20:29.180
the other podcast episodes, but there have been
00:20:29.180 --> 00:20:32.700
several people on my podcast who are like, I
00:20:32.700 --> 00:20:34.339
wouldn't have a group practice without Headway.
00:20:37.589 --> 00:20:41.869
love them. I love that I get paid, like no complaints.
00:20:42.309 --> 00:20:45.349
And so I understand why people would want to
00:20:45.349 --> 00:20:48.230
leverage this. And also it's just such a different
00:20:48.230 --> 00:20:50.809
climate as far as people having a hard time finding
00:20:50.809 --> 00:20:54.490
jobs and jobs with mentorship that a lot of times
00:20:54.490 --> 00:20:57.430
it is like they're just out there seeking out
00:20:57.430 --> 00:21:01.210
their own mentorship. And so I guess I'm just
00:21:01.210 --> 00:21:05.160
curious. from you? Like, I know you're not a
00:21:05.160 --> 00:21:08.099
fan of those platforms. Is there any situation
00:21:08.099 --> 00:21:11.680
where you would be like, Oh, I could see that
00:21:11.680 --> 00:21:15.980
it makes sense for, for this person. And if not,
00:21:16.079 --> 00:21:19.099
like, why? I mean, me personally, no. And the
00:21:19.099 --> 00:21:23.460
reason why I'm sure everybody's seen when Alma
00:21:23.460 --> 00:21:29.680
had, you know, published about the 90837, you
00:21:29.680 --> 00:21:32.470
know, Aetna. was saying, hey, they weren't going
00:21:32.470 --> 00:21:34.069
to pay for it anymore. They weren't going to
00:21:34.069 --> 00:21:37.670
reimburse for the 90837. Pretty much, you know,
00:21:37.670 --> 00:21:40.430
the highest that you're going to get is the 90834.
00:21:41.109 --> 00:21:44.369
So they pretty much didn't matter the backlash
00:21:44.369 --> 00:21:49.289
that transpired. They still did it. And also
00:21:49.289 --> 00:21:55.609
these VC backed platforms, which if you do the
00:21:55.609 --> 00:21:59.589
research, you will see that the insurance companies
00:22:00.450 --> 00:22:03.690
have a huge financial backing in these organizations.
00:22:04.529 --> 00:22:07.730
Why else would you be able to be credentialed
00:22:07.730 --> 00:22:12.549
in four to eight weeks when you're credentialing
00:22:12.549 --> 00:22:15.289
through your own private practice? It's taking
00:22:15.289 --> 00:22:21.730
three to six plus months to get that done. So
00:22:21.730 --> 00:22:28.789
when it comes to the VC platforms, they are pushing.
00:22:29.769 --> 00:22:32.529
providers more and more to use everything that
00:22:32.529 --> 00:22:36.500
they have to offer. The biggest issue that I
00:22:36.500 --> 00:22:41.640
have with them is the patient's protected health
00:22:41.640 --> 00:22:45.079
information because they will go into those systems
00:22:45.079 --> 00:22:49.059
and take that information and they could disperse
00:22:49.059 --> 00:22:53.849
it to whomever they want. And there's nothing
00:22:53.849 --> 00:22:59.529
that you really could do. And when you for instance,
00:22:59.650 --> 00:23:02.230
receive medical records requests from third parties,
00:23:02.490 --> 00:23:05.089
you have to really look at those to determine,
00:23:05.190 --> 00:23:09.490
is it legit? Well, these VC companies, you know,
00:23:09.509 --> 00:23:13.670
again, are backed by these insurance companies,
00:23:13.730 --> 00:23:18.700
have full access to protected health information,
00:23:18.940 --> 00:23:21.660
and they can do whatever they want with that
00:23:21.660 --> 00:23:25.539
information, and you're none the wiser. I've
00:23:25.539 --> 00:23:29.500
also been told by other providers where, you
00:23:29.500 --> 00:23:31.819
know, they've come back in and their notes are
00:23:31.819 --> 00:23:37.000
unlocked and just a multitude of things. Where's,
00:23:37.000 --> 00:23:40.359
you know, where's the, you know, where's the
00:23:40.359 --> 00:23:43.740
safety and the security with that? That just
00:23:43.740 --> 00:23:48.359
reminded me of something. I was at a practice
00:23:48.359 --> 00:23:52.000
once upon a time where, like, I just noticed
00:23:52.000 --> 00:23:53.640
that, like, all the provider's notes weren't
00:23:53.640 --> 00:23:58.549
locked. And I was like. Why would your notes
00:23:58.549 --> 00:24:01.069
not be locked? And I never really got a straight
00:24:01.069 --> 00:24:04.089
answer, but I'm just curious from your standpoint,
00:24:04.190 --> 00:24:07.630
can we talk about that? Ultimately, notes should
00:24:07.630 --> 00:24:09.910
always be locked when you're done and they're
00:24:09.910 --> 00:24:14.269
finalized. You should not be, you know, billing
00:24:14.269 --> 00:24:17.829
out notes if the claim, you know, if it's not
00:24:17.829 --> 00:24:21.569
finalized. So that's, you know, you're setting
00:24:21.569 --> 00:24:24.769
yourself up for a huge amount of. compliance
00:24:24.769 --> 00:24:28.849
issues with that. That also, I'm not saying it
00:24:28.849 --> 00:24:32.309
happened. Okay. But there could definitely be
00:24:32.309 --> 00:24:36.819
allegations of some very fraudulent behavior
00:24:36.819 --> 00:24:41.779
that could be transpiring. Yeah. That was, you
00:24:41.779 --> 00:24:47.059
know, the concern that, you know, so I was just
00:24:47.059 --> 00:24:49.720
like, I just hadn't seen that before, you know,
00:24:49.720 --> 00:24:53.200
and it was someone with a vested interest who
00:24:53.200 --> 00:24:57.579
owns the practice. So, you know just was like
00:24:57.579 --> 00:25:03.400
hmm um okay so back to the headways and the almas
00:25:03.400 --> 00:25:06.920
and everything like that i mean it's hard for
00:25:06.920 --> 00:25:09.579
these new grads to know where to get experience
00:25:09.579 --> 00:25:14.289
because they're getting rejected and so what
00:25:14.380 --> 00:25:18.369
do you recommend as far as like how do these
00:25:18.369 --> 00:25:22.950
psych nps get experience um i mean let's you
00:25:22.950 --> 00:25:25.940
know And I understand it's like, hey, let me
00:25:25.940 --> 00:25:28.920
go join the VC because it's easy. I can get a
00:25:28.920 --> 00:25:32.660
job. But I don't think people realize what's
00:25:32.660 --> 00:25:37.079
also happening. So let's just say that you go
00:25:37.079 --> 00:25:40.640
and get credentialed with another practice first.
00:25:40.819 --> 00:25:42.900
You know, you find somebody, you get credentialed.
00:25:43.180 --> 00:25:45.220
Then if you go in credential with Headway, you're
00:25:45.220 --> 00:25:47.579
not so much going to have a problem. What we're
00:25:47.579 --> 00:25:52.059
seeing is those who have went to credential with
00:25:52.059 --> 00:25:55.420
Headway, Alma, Grow, any of those. And when they
00:25:55.420 --> 00:25:58.259
go to, they're like, hey, I get to leave this.
00:25:58.359 --> 00:26:00.259
I go, you know, they either open their own, you
00:26:00.259 --> 00:26:02.160
know, their own practice where they don't want
00:26:02.160 --> 00:26:05.400
to deal with these VCs anymore or they're working
00:26:05.400 --> 00:26:08.700
for somebody else. When they try to credential,
00:26:09.500 --> 00:26:13.980
it is roadblock after roadblock after roadblock
00:26:13.980 --> 00:26:17.440
and nothing but problems. And some of the insurances
00:26:17.440 --> 00:26:20.839
will be like, nope, nope, you're credentialed
00:26:20.839 --> 00:26:25.339
with Headway. And then you have to, some of them
00:26:25.339 --> 00:26:26.960
have to go back to Headway and be like, hey,
00:26:26.960 --> 00:26:31.700
I need you to fix this, release me or something.
00:26:31.819 --> 00:26:35.180
But I have seen it. We have dealt with that because
00:26:35.180 --> 00:26:39.900
my office manager, we were dipping our feet into
00:26:39.900 --> 00:26:43.440
credentialing. And then she's, because of all
00:26:43.440 --> 00:26:45.519
these issues, she's like, no more for right now.
00:26:45.789 --> 00:26:49.269
You know, there's just a huge amount of issues
00:26:49.269 --> 00:26:53.809
with credentialing. And so we're not credentialing,
00:26:53.849 --> 00:26:56.230
you know, we're not taking on anybody new because
00:26:56.230 --> 00:26:58.670
of just the issues that we're experiencing. But
00:26:58.670 --> 00:27:01.849
I don't think people also realize with these
00:27:01.849 --> 00:27:08.230
VC backed entities, they can change your reimbursement
00:27:08.230 --> 00:27:13.130
any time that they want and you have no say in
00:27:13.130 --> 00:27:21.549
it. Yeah. What happens if there's a clawback
00:27:21.549 --> 00:27:28.509
and you have left Headway and Alma or whatever
00:27:28.509 --> 00:27:32.210
platform that you were working with? How's that
00:27:32.210 --> 00:27:34.869
handled? That's something that psych NPs I've
00:27:34.869 --> 00:27:37.490
heard ask and be concerned about. Should I keep
00:27:37.490 --> 00:27:41.910
separate notes? Should I keep my own EHR if I
00:27:41.910 --> 00:27:44.359
am going to do this? I mean, I think if you're
00:27:44.359 --> 00:27:51.839
going to join these VC backed entities, I can't
00:27:51.839 --> 00:27:53.819
tell somebody what to do, but I sure wouldn't
00:27:53.819 --> 00:27:56.019
be using their software. I would have my own.
00:27:56.119 --> 00:27:59.920
So you, you know, you have your notes, but when
00:27:59.920 --> 00:28:02.759
it comes to a clawback, I think it's, I think
00:28:02.759 --> 00:28:05.880
it's going to depend on what your contract with
00:28:05.880 --> 00:28:10.559
that organization states. But, you know, clawbacks
00:28:10.559 --> 00:28:17.630
outside of those. you have room to fight it by
00:28:17.630 --> 00:28:21.769
the laws. Well, I hate to say this, but I did
00:28:21.769 --> 00:28:25.809
meet with Hedway. It's been a long time ago.
00:28:25.950 --> 00:28:32.900
And I grilled that marketing person like nobody's
00:28:32.900 --> 00:28:35.140
business because I wanted to know. He couldn't
00:28:35.140 --> 00:28:37.000
answer anything. Well, you could call billing.
00:28:37.079 --> 00:28:39.769
That doesn't answer my question. what happens
00:28:39.769 --> 00:28:41.690
if you know it's this this and this and i know
00:28:41.690 --> 00:28:43.529
how to fight it are you guys gonna do anything
00:28:43.529 --> 00:28:45.690
about it well you're still gonna get paid that
00:28:45.690 --> 00:28:48.289
still doesn't answer my question they were unable
00:28:48.289 --> 00:28:51.869
to answer my questions and what i think that
00:28:51.869 --> 00:28:55.410
people fail to realize is at the end of the day
00:28:55.410 --> 00:28:58.369
doesn't matter who you build through your npi
00:28:58.369 --> 00:29:00.829
is on there as the rendering provider so if anything
00:29:00.829 --> 00:29:05.109
anything happens you ultimately are the one that's
00:29:05.109 --> 00:29:10.420
responsible yeah Yeah, that's a good point for
00:29:10.420 --> 00:29:15.380
sure. If a psych MP is wanting to start educating
00:29:15.380 --> 00:29:18.279
themselves a little bit more in this area, what
00:29:18.279 --> 00:29:24.660
resources should they turn to? Yeah, what resources
00:29:24.660 --> 00:29:28.519
do you recommend? I think it's, you know, making
00:29:28.519 --> 00:29:31.980
sure that you, you know, research where the information
00:29:31.980 --> 00:29:37.490
is coming from. Figure out who are legit. resources
00:29:37.490 --> 00:29:42.089
to turn to and align yourself with those resources
00:29:42.089 --> 00:29:46.809
and saying, hey, are you able to provide me this
00:29:46.809 --> 00:29:50.049
type of information? Oh, no. Okay. Who could
00:29:50.049 --> 00:29:53.589
be somebody trustworthy that I can ask these
00:29:53.589 --> 00:29:57.250
questions to? Whether that be another PMHMP,
00:29:57.630 --> 00:30:02.549
I mean, aligning yourself to looking at who are
00:30:02.549 --> 00:30:06.289
good individuals as resources in the billing
00:30:06.289 --> 00:30:10.569
communities. Not everybody, you know, not everybody
00:30:10.569 --> 00:30:12.930
on Facebook is good. Not everybody on TikTok
00:30:12.930 --> 00:30:17.450
is good. So it's, it's important to really watch
00:30:17.509 --> 00:30:23.440
who are the, the educated individuals to align
00:30:23.440 --> 00:30:30.569
yourself with. Yeah. How do they know who, who,
00:30:30.710 --> 00:30:35.549
you know, is that, are those people? I think
00:30:35.549 --> 00:30:39.210
it, you know, I think it just truly depends.
00:30:39.349 --> 00:30:41.490
And you really have to watch what educational
00:30:41.490 --> 00:30:45.910
things that the person says. Because, you know,
00:30:45.910 --> 00:30:47.970
more, like I said, you know, going back to the,
00:30:48.130 --> 00:30:51.250
you know, people posting on Facebook, well, if
00:30:51.250 --> 00:30:54.809
you have two, you know, chronic diagnoses, that's
00:30:54.809 --> 00:30:56.670
automatically a moderate. No, it's not. But,
00:30:56.690 --> 00:31:01.829
you know, you really need to know. Who's the
00:31:01.829 --> 00:31:03.990
edge, you know, who's the one that you can trust
00:31:03.990 --> 00:31:09.190
to get the information from? And, you know, whether
00:31:09.190 --> 00:31:12.650
that's, you know, sometimes, I mean, I know it
00:31:12.650 --> 00:31:15.109
sounds funny, but Google, you know, can at least
00:31:15.109 --> 00:31:19.190
help, you know, get a start. But there are so
00:31:19.190 --> 00:31:22.950
many people on Facebook that's like, hey, you
00:31:22.950 --> 00:31:27.289
know, come join, come join this, you know. We've
00:31:27.289 --> 00:31:29.890
got the information. I have seen even groups
00:31:29.890 --> 00:31:34.829
that will advertise their services. And I cringe
00:31:34.829 --> 00:31:40.369
because they're not giving the individuals good
00:31:40.369 --> 00:31:43.269
information. So I think it truly depends on,
00:31:43.269 --> 00:31:48.650
you know, who's going to be giving that. I think
00:31:48.650 --> 00:31:50.750
conferences are a good way to get information,
00:31:50.990 --> 00:31:54.509
looking at the, you know, people that are a part
00:31:54.509 --> 00:31:57.900
of that. And, you know, possibly reaching out.
00:31:58.079 --> 00:32:03.079
And it is, it's a point of, yes, it becomes a
00:32:03.079 --> 00:32:05.539
detective work trying to figure out who's giving
00:32:05.539 --> 00:32:09.799
you the right information. But even still, you
00:32:09.799 --> 00:32:11.460
know, if somebody is giving you information,
00:32:11.799 --> 00:32:13.960
it's still your responsibility. You can trust,
00:32:14.000 --> 00:32:17.200
but you still need to verify it. Right. Yeah.
00:32:18.079 --> 00:32:22.279
Yeah. I know Elizabeth hired you for her private
00:32:22.279 --> 00:32:24.859
practice and she's coming to actually speak in
00:32:24.859 --> 00:32:29.230
the fellowship. soon to talk about documentation
00:32:29.230 --> 00:32:34.430
because she's like, wow, I learned a lot from
00:32:34.430 --> 00:32:37.609
Crystal. My notes apparently sucked, which coming
00:32:37.609 --> 00:32:41.390
from her, I mean, she's an overachiever. But
00:32:41.390 --> 00:32:45.150
she's like, yeah, I have gotten so much feedback.
00:32:45.829 --> 00:32:49.829
And so I'm like, the clinicians are very excited
00:32:49.829 --> 00:32:53.369
to hear from her, you know, post. working with
00:32:53.369 --> 00:32:55.890
you on some of that, like practical feedback.
00:32:56.430 --> 00:32:59.789
Um, are there vetted resources that you would
00:32:59.789 --> 00:33:03.289
recommend that are trustworthy? Like E &M university
00:33:03.289 --> 00:33:07.349
or like some of your courses, like, um, or somebody
00:33:07.349 --> 00:33:09.410
in my group the other day was like, is there
00:33:09.410 --> 00:33:11.490
an area, this is in my coaching program with
00:33:11.490 --> 00:33:14.650
specific billing codes. Like if I did X, Y, Z,
00:33:14.730 --> 00:33:17.589
what could I bill for like a cheat sheet or something?
00:33:17.730 --> 00:33:22.980
So Melanie. I'm sure I'm going to butcher her
00:33:22.980 --> 00:33:29.019
name. That's okay. I'm really bad at that. Grambling?
00:33:29.220 --> 00:33:34.609
Grabbling? Is it Anchor, Bloom, and Wellman?
00:33:35.529 --> 00:33:42.670
Okay. That's familiar to me. Yeah. Okay. So she,
00:33:42.910 --> 00:33:44.690
like, and I'm going to be honest, she approached
00:33:44.690 --> 00:33:48.869
me because she was creating a book. She was creating,
00:33:48.930 --> 00:33:53.500
like, a billing book. Okay. And she'll tell you
00:33:53.500 --> 00:34:00.480
that she approached me about editing it and like
00:34:00.480 --> 00:34:03.359
taking a look in and, you know, what did I think?
00:34:03.500 --> 00:34:11.840
Yeah. It was no holds barred. I was very blunt.
00:34:12.059 --> 00:34:18.300
I did not hold back. And pretty much the first
00:34:18.300 --> 00:34:21.059
round, I mean, I tore that book to shreds because
00:34:21.059 --> 00:34:22.920
I'm like, nope, nope, nope, nope, nope. This
00:34:22.920 --> 00:34:26.309
is no, nope. Nope. And I think we went through
00:34:26.309 --> 00:34:30.050
like four, five, six, maybe, maybe the most six
00:34:30.050 --> 00:34:33.289
different edits at different times because, you
00:34:33.289 --> 00:34:35.869
know, I'm like, no, nope, nope, nope, nope. I'm
00:34:35.869 --> 00:34:37.429
like, if we're going to, if you're going to do
00:34:37.429 --> 00:34:39.769
this, we're going to do it right. And, and everything
00:34:39.769 --> 00:34:43.590
that is in, in that book, you know, ultimately
00:34:43.590 --> 00:34:48.909
you can pull from the AMAs like CPT when it comes
00:34:48.909 --> 00:34:52.090
to, you know, the guidelines. I mean, this is,
00:34:52.150 --> 00:34:57.389
you know, truly evidenced based, you know, information.
00:34:57.550 --> 00:35:01.090
So, you know, and that's also, you know, coming
00:35:01.090 --> 00:35:03.989
from, you know, the auditing aspect of it. So
00:35:03.989 --> 00:35:08.750
it is a very comprehensive, you know, book. So
00:35:08.750 --> 00:35:13.150
yeah, she approached me and I said, sure. And,
00:35:13.170 --> 00:35:18.090
you know, yes, she, you know, yes, I was compensated
00:35:18.090 --> 00:35:21.639
for my time. But yeah, I went through that. I
00:35:21.639 --> 00:35:23.679
think I shocked her the first time because I
00:35:23.679 --> 00:35:25.320
think she, you know, was like, oh, my God, this
00:35:25.320 --> 00:35:27.659
is brutal. Well, I mean, if we're going to do
00:35:27.659 --> 00:35:29.679
it, let's do it right. We're not going to we're
00:35:29.679 --> 00:35:31.440
not we're going to make sure that people are
00:35:31.440 --> 00:35:34.800
provided the correct information to do the right
00:35:34.800 --> 00:35:38.260
thing. Right. Right. OK, that's good to know.
00:35:38.300 --> 00:35:39.480
That's good to know. What's the name of that
00:35:39.480 --> 00:35:44.389
book? I cannot remember the name. Like, I'd have
00:35:44.389 --> 00:35:46.829
to ask her because I know she kind of had changed,
00:35:46.889 --> 00:35:52.260
you know, changed some some things on it. But
00:35:52.260 --> 00:35:55.260
ultimately, yeah, she's got the book. Okay, cool.
00:35:55.440 --> 00:35:59.280
What resources do you offer if Psych and Peace
00:35:59.280 --> 00:36:01.880
are interested in learning from you more? I mean,
00:36:01.960 --> 00:36:07.840
like I do a monthly billing and coding series
00:36:08.159 --> 00:36:12.219
with Psychiatry Circle, and we do different topics
00:36:12.219 --> 00:36:16.389
once a month. Last month, let's see, we did...
00:36:17.360 --> 00:36:21.239
The element one of the MDM. So this month we
00:36:21.239 --> 00:36:25.320
will do element two and then October will be
00:36:25.320 --> 00:36:32.280
element three. Okay. Okay. Awesome. Um, any like
00:36:32.280 --> 00:36:36.750
digital products or anything like that? No, I
00:36:36.750 --> 00:36:41.250
haven't done any digital products yet. I guess
00:36:41.250 --> 00:36:47.400
I need to, but I haven't. Why not? So. Time -wise,
00:36:47.519 --> 00:36:53.539
because for me, I'm like, okay, my biggest thing
00:36:53.539 --> 00:36:56.280
is, of course, seeing my patients, but also taking
00:36:56.280 --> 00:37:00.699
care of my clients to make sure that they're
00:37:00.699 --> 00:37:04.019
ready to rock and roll and that ultimately they're
00:37:04.019 --> 00:37:07.340
getting paid for the services rendered. And I'm
00:37:07.340 --> 00:37:11.079
sure everybody's heard about what's transpired
00:37:11.079 --> 00:37:14.860
since July 1st with the downcoding. So that's
00:37:14.860 --> 00:37:20.139
been real fun. with that. And, you know, I've
00:37:20.139 --> 00:37:24.340
done, wrote multiple letters to our attorney
00:37:24.340 --> 00:37:27.039
general, our department of, you know, insurance,
00:37:27.139 --> 00:37:31.719
and now I'm escalating it to the federal level.
00:37:31.980 --> 00:37:38.260
Oh, wow. Okay. Gotcha. Yep. So you're a big advocate.
00:37:39.670 --> 00:37:43.190
Absolutely. That's awesome. Would you recommend
00:37:43.190 --> 00:37:48.050
that psych NPs do more in -depth training like
00:37:48.050 --> 00:37:52.989
you did on like auditing and billing and coding?
00:37:53.369 --> 00:37:56.429
I think, so I'm going to say this. And when it
00:37:56.429 --> 00:37:58.650
comes to, when you look at what do I need in
00:37:58.650 --> 00:38:03.349
my practice and, you know, is it a biller? Is
00:38:03.349 --> 00:38:06.070
it a coder? I'll be honest. So if you're, if
00:38:06.070 --> 00:38:09.250
you're a psych MP and you are doing a lot of
00:38:09.250 --> 00:38:15.489
evaluation management, I would recommend, you
00:38:15.489 --> 00:38:20.480
know, employing a coder, whether it's on an as
00:38:20.480 --> 00:38:25.679
-needed basis, that way you can learn from it.
00:38:26.699 --> 00:38:30.300
Yeah. I think one of the most important things
00:38:30.300 --> 00:38:36.059
is, you know, having a coder. And my clients
00:38:36.059 --> 00:38:40.739
that I do coding services for, oh yeah, they'll
00:38:40.739 --> 00:38:42.730
straight up tell you. The first two to three
00:38:42.730 --> 00:38:45.369
months they said was rough with me because I'm
00:38:45.369 --> 00:38:47.630
like, I kicked their notes back. And I'm like,
00:38:47.670 --> 00:38:50.550
absolutely not. Nope. This ain't going to fly.
00:38:50.949 --> 00:38:55.230
And it was a lot of, you know, training and working.
00:38:55.329 --> 00:39:00.050
And I had my clients tell me that I was brutal
00:39:00.050 --> 00:39:07.030
and mean. But so it's not that I'm, yes, I'm
00:39:07.030 --> 00:39:12.099
very blunt. I need you to learn. I don't feel
00:39:12.099 --> 00:39:14.659
that orange and silver are colors that people
00:39:14.659 --> 00:39:19.860
want. And I do not want, you know, if the, if
00:39:19.860 --> 00:39:22.820
somebody comes in to audit you, I don't want
00:39:22.820 --> 00:39:25.179
you to feel like you have to lose sleep at night
00:39:25.179 --> 00:39:27.800
because then you can be like, I know my stuff
00:39:27.800 --> 00:39:31.579
is good. You know, that is the biggest thing
00:39:31.579 --> 00:39:37.670
I want for people is not to fear. doing their
00:39:37.670 --> 00:39:40.090
job. If you're going to do it, let's do it right
00:39:40.090 --> 00:39:42.190
the first time. Because when are you honestly
00:39:42.190 --> 00:39:45.960
going to have time to redo it? Yeah. What are
00:39:45.960 --> 00:39:49.590
some of the mistakes that you see frequently?
00:39:51.219 --> 00:39:57.039
Well, I mean, as far as mistakes, I see a lot
00:39:57.039 --> 00:40:05.170
of the psychotherapy notes. So when we look at
00:40:05.170 --> 00:40:08.469
the psychotherapy, so Let me give you like a
00:40:08.469 --> 00:40:11.489
little formula. The biggest thing is, you know,
00:40:11.550 --> 00:40:17.960
target, intervention, response, like progress,
00:40:18.139 --> 00:40:24.800
plan, and your time. So you want the chart to
00:40:24.800 --> 00:40:27.920
establish the psychotherapy service itself, not
00:40:27.920 --> 00:40:31.000
merely saying, hey, supportive therapy was provided.
00:40:32.550 --> 00:40:37.360
That is the biggest thing that... you know, the
00:40:37.360 --> 00:40:42.179
important things are not in that note. And also
00:40:42.179 --> 00:40:45.739
identifying that they are separate services.
00:40:45.960 --> 00:40:49.699
They are two very distinct services if you're
00:40:49.699 --> 00:40:54.440
doing E &M and psychotherapy. So it's important
00:40:54.440 --> 00:40:59.579
that that connection is made because you have
00:40:59.579 --> 00:41:01.940
to make that distinction because psychotherapy
00:41:01.940 --> 00:41:06.599
time cannot, cannot. simply be double counted
00:41:06.599 --> 00:41:10.639
to manufacture an evaluation management time
00:41:10.639 --> 00:41:13.659
level. Yeah. Okay. Gotcha. Yeah. I just talked
00:41:13.659 --> 00:41:16.920
to somebody else yesterday who said her boss
00:41:16.920 --> 00:41:21.039
was, um, is wanting her to do sometimes just
00:41:21.039 --> 00:41:24.079
psychotherapy with some of the patients. Um,
00:41:24.260 --> 00:41:26.880
yeah. What do you think about that from a billing
00:41:26.880 --> 00:41:30.889
standpoint? She's a psych NP. I mean, here's
00:41:30.889 --> 00:41:33.349
the thing, first and foremost, you know, everybody
00:41:33.349 --> 00:41:35.610
wants something. But that doesn't necessarily
00:41:35.610 --> 00:41:39.070
mean that you feel confident or comfortable in
00:41:39.070 --> 00:41:41.630
doing it. And if you don't, you don't do it,
00:41:41.670 --> 00:41:45.449
bottom line. But if you feel comfortable in,
00:41:45.510 --> 00:41:48.809
you know, providing the therapy services to the
00:41:48.809 --> 00:41:52.510
patient, absolutely. But when you document for
00:41:52.510 --> 00:41:55.449
psychotherapy, it's going to be extremely different
00:41:55.449 --> 00:41:59.159
than... documenting for, you know, an E &M and
00:41:59.159 --> 00:42:03.739
a psychotherapy. So you have to make sure that
00:42:03.739 --> 00:42:08.039
you are appropriately, you know, documenting.
00:42:08.440 --> 00:42:11.800
And I went over this, you know, I had a local
00:42:11.800 --> 00:42:15.280
therapy group reach out to me and ask to come
00:42:15.280 --> 00:42:18.920
speak to their group on how to audit proof their
00:42:18.920 --> 00:42:22.440
notes. And I did it. And a lot of them were shocked
00:42:22.440 --> 00:42:27.690
over a lot of stuff. And I, and, um, and like
00:42:27.690 --> 00:42:29.849
I told them, I was, you know, I said, these are
00:42:29.849 --> 00:42:33.309
things that you need. And so what was interesting
00:42:33.309 --> 00:42:35.570
is they had a different take on certain things
00:42:35.570 --> 00:42:39.389
because an attorney told them, well, you know,
00:42:39.389 --> 00:42:41.489
don't put too much in there because, you know,
00:42:41.489 --> 00:42:47.730
of lawsuits. Well, here's my thing. If you don't
00:42:47.730 --> 00:42:52.170
do what you are expected to and what is demanded,
00:42:52.230 --> 00:42:56.550
you know, to bill out your note. And to support
00:42:56.550 --> 00:43:00.449
your note, do you think you're going to get in
00:43:00.449 --> 00:43:04.250
trouble if the potential that court happens?
00:43:04.329 --> 00:43:07.590
Or are you going to get in more trouble with
00:43:07.590 --> 00:43:12.929
these entities if they audit your notes? Right.
00:43:13.429 --> 00:43:17.309
Yeah. That makes sense. That makes sense. I know
00:43:17.309 --> 00:43:18.829
we're coming up on time. There's so much I want
00:43:18.829 --> 00:43:20.130
to ask you. I'm going to have to have you back
00:43:20.130 --> 00:43:23.949
for a part two, three. I don't know. AI scribes.
00:43:24.510 --> 00:43:28.320
Any thoughts on those? I think that, you know,
00:43:28.320 --> 00:43:31.320
I know Allison, you know, has a good one, the
00:43:31.320 --> 00:43:36.920
PMHMP Scribe. I've tried all of them. I have.
00:43:36.960 --> 00:43:40.300
I've tried all of them. And there hasn't been
00:43:40.300 --> 00:43:43.199
any one more that I like than the others. I just
00:43:43.199 --> 00:43:47.179
find that, you know, I will, you know, use maybe,
00:43:47.320 --> 00:43:50.679
I think it's Bastion because it's HIPAA compliant.
00:43:51.659 --> 00:43:54.400
And throw stuff in there to fix, you know, like
00:43:54.400 --> 00:43:57.840
to fix my note the way that I want it. If, you
00:43:57.840 --> 00:44:01.369
know, like I use Freed if it doesn't give me
00:44:01.369 --> 00:44:05.690
what I want or Freed goes off the rails. Yeah.
00:44:06.650 --> 00:44:09.429
Hallucinates sometimes. Oh, yeah. I've been an
00:44:09.429 --> 00:44:11.369
OBGYN and I didn't even know that. I was like,
00:44:11.409 --> 00:44:16.429
that's interesting. Yeah. What do you what do
00:44:16.429 --> 00:44:19.539
you do for fun? Work on my car. Nice. Go to car
00:44:19.539 --> 00:44:22.579
shows. Yeah, that's, you know, that's my biggest
00:44:22.579 --> 00:44:25.559
thing. My husband, you know, bought my dream,
00:44:25.619 --> 00:44:27.840
you know, bought me my dream car. And that is,
00:44:27.860 --> 00:44:30.440
you know, but, you know, my kids enjoy. Well,
00:44:30.599 --> 00:44:33.619
I should say one of the kids enjoys it. And,
00:44:33.619 --> 00:44:37.460
you know, but, you know, that's my that's my,
00:44:37.619 --> 00:44:41.480
you know, form of fun and, you know, spending
00:44:41.480 --> 00:44:44.440
time with family. Yeah, I love that. I love that.
00:44:44.639 --> 00:44:47.179
Yeah. People are definitely interested in this
00:44:47.179 --> 00:44:49.840
topic. And I think a lot of people are, a lot
00:44:49.840 --> 00:44:52.199
of psych NPs specifically are, are very fearful
00:44:52.199 --> 00:44:55.159
right now post, you know, the Lindsay Clancy
00:44:55.159 --> 00:44:58.239
trial. And so I think it's really important.
00:44:58.679 --> 00:45:05.230
Um, and it's, it's really hard to find resources
00:45:05.230 --> 00:45:10.150
that you can trust. So, so I think the biggest
00:45:10.150 --> 00:45:14.610
thing is, is, you know, The person's note doesn't
00:45:14.610 --> 00:45:16.889
have to be enormous. It doesn't have to be a
00:45:16.889 --> 00:45:20.269
dissertation. It has to be clinically accurate,
00:45:20.570 --> 00:45:24.730
internally consistent and capable of showing,
00:45:24.730 --> 00:45:28.050
you know, like why you made the decisions you
00:45:28.050 --> 00:45:32.349
did. And for me, the biggest thing about being,
00:45:32.389 --> 00:45:35.269
you know, from the coder and the auditor side
00:45:35.269 --> 00:45:39.389
and, you know, what it has taught me was that
00:45:39.389 --> 00:45:43.380
that coding isn't. about just getting the highest
00:45:43.380 --> 00:45:47.170
code. It's about getting the right code. And,
00:45:47.230 --> 00:45:50.829
you know, and I'm big on compliance and, you
00:45:50.829 --> 00:45:53.210
know, being compliant doesn't mean that you have
00:45:53.210 --> 00:45:56.369
to leave money on the table. Compliance just
00:45:56.369 --> 00:45:59.389
means that you're accurately reporting the work
00:45:59.389 --> 00:46:03.869
you actually performed. Right. Yeah. That makes
00:46:03.869 --> 00:46:07.230
a lot of sense. And I mean, you know, what do
00:46:07.230 --> 00:46:09.110
you, you know, like, and I ask this to people
00:46:09.110 --> 00:46:13.500
all the time. Where do you think that an audit
00:46:13.500 --> 00:46:18.750
risk comes from? The audit risk comes from inconsistency,
00:46:18.750 --> 00:46:22.650
not the fact that you build a higher code. It
00:46:22.650 --> 00:46:26.949
comes from inconsistency. Yeah, that's a really
00:46:26.949 --> 00:46:30.590
great point. Okay, I ask everybody who comes
00:46:30.590 --> 00:46:34.380
on the show, because I named this podcast No
00:46:34.380 --> 00:46:36.780
Prior Auth. What does the term No Prior Auth
00:46:36.780 --> 00:46:40.119
mean to you, Crystal? Well, I mean, I think it
00:46:40.119 --> 00:46:42.119
just depends on what you're looking at. You know,
00:46:42.239 --> 00:46:46.940
when we look, when we think of, you know, no
00:46:46.940 --> 00:46:49.239
prior auth, I mean, that could come from, you
00:46:49.239 --> 00:46:54.480
know, requiring such for, you know, insurance
00:46:54.480 --> 00:46:58.480
services or, you know, medications. I think it
00:46:58.480 --> 00:47:01.260
deals with, you know, the prior, you know, the
00:47:01.260 --> 00:47:05.119
prior auths that unfortunately make our jobs
00:47:05.119 --> 00:47:08.429
a lot harder. It prevents our patients from getting
00:47:08.429 --> 00:47:13.449
the care and the services that they need. Yeah,
00:47:13.550 --> 00:47:17.329
yeah, 100%. Well, thank you so much for all this
00:47:17.329 --> 00:47:20.409
incredible information. We'll put links below.
00:47:20.809 --> 00:47:24.710
And yeah, I'll be... eager to have you back for
00:47:24.710 --> 00:47:27.349
a part two because I have more questions, but
00:47:27.349 --> 00:47:29.849
I have gotten feedback that people tend to like
00:47:29.849 --> 00:47:32.050
the shorter episodes. I've heard from a few people.
00:47:32.070 --> 00:47:34.630
They like the longer ones though. So let me know
00:47:34.630 --> 00:47:37.429
guys. Um, but yeah, thank you so much, Crystal.
00:47:37.530 --> 00:47:38.530
Thank you for having me.
