Chiropractic Billing Expert Interview – Dr Brian Capra

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Dr. Brian Capra, a graduate of Life University, has been a practicing chiropractor and office automation expert. He routinely visits chiropractic offices around the nation while receiving raving feedback from his clients. In his blog on Chiropractic Office Billing Software Profitability, Dr. Brian offers practical solutions for building a profitable and completely paperless office. The following two-part interview with Dr. Brian provides a behind-the-scenes look at his work.

When did you become interested in chiropractic? Dr. Brian : I became interested in Chiropractic just before graduating with a bachelors in biology. I have always enjoyed studying complex systems. I loved learning about how life is formed and how amazingly efficient is the human body. Most business systems are crude approximations of the amazingly efficient systems in the human body. Chiropractic maximizes that innate intelligence to do what it understands infinitely better than any human mind. To think that we can outsmart this intelligence with a pill, potion, or lotion is naive. Removing interference and maximizing the potential of life, relationship, or business is what has intrigued me most about Chiropractic.
What attracted you to office automation? Dr. Brian: The human body uses automation to manage millions of processes every second. The autonomic nervous system is a good example. Imagine having to memory-manage every heart beat and breath throughout your day. That job alone would keep you so preoccupied you would forget to go get food and water for you survival. On the business side, the insurance companies continuously add things to manage to the practice. If these new things are memory-managed, the efficiency of the practice suffers. Ultimately, patient care, practice capacity, and profitability shrink. I’m concerned about where chiropractic profession is going in terms of profitability. I feel like most practice owners are indifferent and apathetic, while the ship is being steered by people who do not have our best interests at heart — out-of-control payers and incompetent billers, to name two. We are at an absolutely crucial and unprecedented point in our history where technology enables the insurance companies to underpay us, profile us, audit, and take back the little money was paid … But many billing companies do not have the processes, the technology infrastructure, or the talent required to face the challenges posed daily by the insurance companies. And the practice suffers substandard reimbursement, overworked practitioners, burnout. I can’t tell you how many times I have heard a doctor say “how can I keep up with notes, billing, etc.” The answer is simple: use your chiropractic training, use the principles that keep your own body functioning.

Question: Why did you decide to start Billing Precision? Dr. Brian : The simple reason: I needed a billing solution for my own practice, I experienced second rate service first hand for too long, and I knew of no solution that would be good enough for rapid development of my practice and that I could trust to change as the insurance industry changed. I knew that lots of people feel the same way but I could not wait anymore for somebody else to do it for me. When I graduated, I went to learn from some of the most influential doctors, including Dr. Lerner, Dr. Loman, and Dr. Nalda. In addition to outstanding clinical training I also learned from them how to approach building and managing my own practice. I learned the importance of discipline and the potential of adequate infrastructure. I also saw how frustrated they were with the lack of integrated solutions: everything about running the office seemed to require memory-management, from scheduling the patient, to tracking care plan compliance, to managing outstanding balance. I feel that most practice management solutions are built backwards or incomplete (see my 4-part blog Is your Chiropractic Practice Management System Built Backwards???). They just keep reinventing the wheel. Another Scheduler, Custom notes, Automated check in. My feeling on this is SO WHAT??? Is the system checking you for compliance? Is it making sure everyone is billed? Are your notes really going to protect you against an audit? A good system must also manage patient education and community outreach. Part of our mission is to bring an industrial strength billing service and a practice management system, including a patient relationship management system, and help build the overall patient capacity of the practice.

How did your own viewpoints evolve from the time you started Billing Precision? Dr. Brian : My viewpoints evolved in step with the growing scope of our service. As the number and size of the practices we support grew, I realized that my initial conjecture about the importance of integrated office workflow is paramount to success. For instance, besides a solid billing process, perfect SOAP notes are critical for better care, for lower audit risk, and for full reimbursement.Two other critical points are practice owner’s business focus and teamwork. An unfocused practice owner will always confuse profit, revenue, and costs. And insurance companies will always exploit the lack of teamwork between billing and front office personnel.
Today I realize that focus and teamwork can be turned around from being points of vulnerability to the strongest weapon for improving practice profitability and making the insurance companies pay everything they owe you. You can lock them down. You can research your options, fight back, and help others to fight back too.

When talking to practice owners who invite you to their office, what are the comments that stick out most in your mind?Dr. Brian: In many ways, working with practice owners reminds me of working with the patient: a practice is a very complex system, where the flow of information must be uninhibited in order to have the practice growing at a healthy pace. Patients must make progress and vital functions of the office too must perform optimally to grow and to avoid risks.Patients are notorious for saying “well, I just get these headaches about once a day.” When they realize that a headache is a problem with blood to the brain and most chiropractic do not have headaches, they see a whole new reality they never knew is possible. When patients begin to understand the principles of how things happen, they understand that chiropractic is not just a treatment for headaches. They begin to appreciate their true potential.
A systemic “subluxation” may not be immediately observable to a naked and untrained eye, yet it may cause major setbacks for the practice owner. Just like patients who lack education about their own body and their nervous system, practice owners are often ignorant about the reasons for their underpayment or for the lack of practice growth. Many are complacent, they think where they are is as good as it gets.

Doctors and practice managers are no different with realizing the potential for the health and wellness of their own office. Their own resistance to change and education, not the payers or the lack of adequate technology, is their biggest enemy. Few practice owners are open immediately to the changes in attitude and self-discipline required for measurable improvement in collections and reduction of audit exposure. Some seem stuck on “I don’t need this,” “we have it under control,” “we tried it and it did not work,” “we can do it better” or “if it is so great how come nobody else is doing it?” Others have tasted previously awful experiences with outsourcing to billing services that neglected denials and underpayments and collected commission fees only on claims that were paid anyway.

What would you advise to the chiropractor who is about to start a new practice?Dr. Brian: Keep the principles in mind. An office is in a lot of ways a living thing. Just as it is impossible to for the liver to do the job of the kidneys it is impossible for the chiropractor to do the job of the biller of front desk. Luckily, God made a centralized system to control and coordinate the intercommunication and function of every cell in the body. Obviously the system is the CNS and all organs and systems are accountable to it. A new doctor should see that he/she should leverage a technology and use it as the CNS of his/her practice. In that way they can act at times like the brain, sending messages and giving orders to the rest of the body through the technology, and at other times allow that system to sustain the life of the practice. The doctor can then pick and choose where his/her time is most effectively spent: IE, Marketer, Adjuster, or Manager.Steps to success:
1. Get a system of practice
2. Get a technology that will help measure that system and one that will help manage it
3. Run the system
4. Find inefficiencies
5. Build in automation, leveraging technology and other people’s time, to prevent the inefficiency from reoccurring
6. Measure the changes and adjust accordingly