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We all have different sizes of audiology practices. Multi-location, multi-provider, all the way down to the part time, lifestyle practice that is only open a couple of days a week.

If we focus on the per-provider productivity; 1 Full time audiologist, in a single location can be used to multiply for all the larger and smaller sizes that fit in between.
For example- 1 Full time audiologist, when optimized, works 4.5 days a week, and 21 days per month, and should have a monthly profitability of around 30% of total revenue or about $300,000 a year.

Industry ‘experts’ will tell you that this is not possible. The same ‘experts’ don’t actually run a well respected audiology practice like we do.
We don’t take any Third Party Administrators, and we won’t compromise on quality of care. Both of these statements support each other- meaning that the TPA’s will not allow us, by contract to deliver optimal care to our patients.

The ’experts’ give you a bunch of reasons why it can’t be done, and why you should expect a 10% earnings statement or a 10% ROI.

But none of that 10% discussion passes the smell test. You know- that if something doesn’t smell right, there’s something just not right with it?
You’re going to put up one MILLION dollars in a year to get 10% back? That’s pretty risky, and a less than ideal return.

You’d be better off putting in $10,000 and getting 11% annualized index funds from the stock market.

We put up a MILLION dollars and get back $300,000 and we have the tax returns to show it! Let’s talk about how we can help you to do something similar by withdrawing from your TPA arrangements and replacing with high quality private pay patients, to whom you can give optimal care!

You’re doing it all wrong.

Really, it’s not your fault- no one told you how to do it. The insurance company is not giving seminars or training on how to best receive the allowable benefits for a patient- so how would you know what questions to ask?

We do know how to do it. Mostly it’s because we did it wrong too! We did it wrong long enough to figure it out. We even paid medical billing companies to do the verifications for us- and wow did they do it wrong!! That’s how we ended up taking it in-house- there’s no reason to have them do it poorly, AND pay them for the verification too!

Try to think of the verification as the foundation of your house. If it’s not done properly, there’s always going to be a problem down the line with any number of systems in the house(plumbing, carpentry, roofing, electrical). For billing, it’s the claims, the re-files, the payments and the write-offs that will all be really off, if the verification is not right.
When a verification is not done properly, contracted fees are not allocated properly and claims are delayed or denied. One of the more influential factors in 2023 and 2024 is the notification to a TPA(Third Party Administrator) that a prospective hearing aid patient has an unused ‘discount’ available to them. Note that this is not a funded benefit to the patient, but a ‘discount’. We put ‘discount’ in quotes because we know that this is not a true discount. It’s not the same services that you provide at a lesser fee- It’s really lesser services provided at a lesser fee. Hearing healthcare just doesn’t work that way.

Verifications are SO important that we include them at no additional charge with our claims and submission services. Verifications MUST be done correctly to ensure proper coding, claims submission and billing. It also has a huge effect on your staff and their use of time. Let them answer the phones, and take care of patients- NOT spend an hour on an insurance company’s phone tree!

The minute you complete your audiology service to a patient, there’s a countdown timer that starts. Did you know that? You get 259,200 seconds to get the claim done.
Submitting claims to any Third Party Payer needs to be accurate and timely.
The day to day of the practice gets in the way, and claims either are forgotten, pushed to the back of the stack- or just plain old procrastination sets in. We’ve been there!
Timeliness usually means no longer than 6 months old(that’s the 259,200 seconds btw)

The good news, is that we have been able to settle older claims (up to a year, in a lot of instances) to be paid on the original amount. The longer the time from the original date of service, the less likely it is that these claims will be processed or paid. A sense of urgency is needed.

If these claims are not processed or paid, it’s usually the practice that pays the bill. That’s right- YOU are then paying the bill (often through write off) for patients to come to your practice and receive their hearing health care.
One of our favorite sayings around our office is that every service/claim is paid: by the patient, by the insurance company, or by the practice , itself!!!

Get your older claims and refiled claims paid by patients or insurance companies so you aren’t paying them yourself!