“As every practitioner has figured out, it is nearly impossible to understand what these insurance companies require, what they will cover, and yet at the same time, they have almost complete control over our livelihoods, over our confidence in the care we provide, and even over our mental health!”
- Where we started
- The struggle is real
- Carrying a legacy
- What we can do for you
Our Origin Story
By Jenifer Ausiello, DNP, APRN, AGNP-C, ACHPN, CPC, CPMA
A few years back, my wife and I decided to open our own primary care practice. I am a nurse practitioner and my wife is in school to be a nurse practitioner. We both specialize in adult and elderly patients. We felt strongly that the disabled/elderly population were disadvantaged, especially those who did not have the mobility or assistance to go to a traditional medical office. We thought to ourselves, as many often do upon starting a new adventure…This is going to be great! We found our niche and decided to specialize in doing home visits for the homebound patient population.
Let’s be honest, no one wants to work for someone else. Our dream was to be entrepreneurs and be our own boss. Our goal was to build the practice to a point that we could make the jump from our other jobs and support our family on our own. Eventually, we wanted to be able to hire other providers and support staff and have the business be a consistent source of passive income and expand our services to more people.
At this point in time, I was struggling with the realities of how time consuming it was to provide quality care to my patients. We were working 18+ hour days to make sure our patients had everything they needed. We received most of our patients from Home Health Care Agency referrals. We were buried in paperwork. The phrase “caught up” was laughable. But we couldn’t afford to slow down. Our patients and referring agencies wanted for nothing, but we were miserable. All time together was working time, and all conversations revolved around patient care. There was no balance between work and home life. It was ruining our marriage and our general happiness. That made me feel like a failure, not just in my relationship but in my ability to provide for my family and to run a successful business. But what else were we going to do? All businesses go through this right? Just keep working. So, we kept plugging along.
Then one night, as I was charting on the visits from the previous day, signing orders, checking emails, etc. I stopped to open the mail. I was always excited to see the payor envelopes because it is more money! “I like checks!” is kind of my motto. But this night, I opened the envelope expecting that check, ready to do my mental math and figure out how much profit we had made to date, when I saw it. The bold font title of the letter, “Request for Repayment”. The panic that ensued lasted days, even weeks. I read every line of the letter and just could not understand how this could happen. I was physically unable to do anything for days. I could only seek out information about what I was going through. The panic and anxiety overtook me, and I spent every waking moment worrying and searching for information about how this could happen and what it means. Things got worse when I realized this could lead to a full-blown audit! I knew, or thought I knew, that we worked ourselves to the bone making sure our patients were well cared for in every way. Yet, none of it mattered to the insurance company. As every practitioner has figured out, it is nearly impossible to understand what these insurance companies require, what they will cover, and yet at the same time, they have almost complete control over our livelihoods as practitioners, over our confidence in the care we provide, and even over our mental health!
Along with the panic I was already feeling regarding audits, fear regarding future denials, and other possible repayments set in, the self-doubt followed, and I felt like giving up entirely. Like I was going to have to resign myself to keeping my “real job”, give up entrepreneurship, and be doomed to work for someone else for the REST OF MY LIFE.
I should mention that my wife is constantly telling me that everything happens for a reason. Because this next part is where it gets interesting. My wife received a phone call regarding her father’s health, and everything changed. My father-in-law and my wife had been estranged for many years. So, when I met him for the first time, it was in his hospital room. One of the first things he said to me was “I think you’d be perfect to take over the company”. I had no idea at the time what he was talking about, but he had been running his own compliance consulting business for 30+ years and had planned for my wife to take it over when he retired. He helped numerous medical practices and their attorneys with lawsuits and compliance issues. He conducted internal audits for practices and provided education on everything from patient intake to proper coding and billing of visits. His expertise and leadership was essential to the startup and continued success of his clients. So, we talked it over and decided the legacy should live on through us as he had always wanted. There wasn’t much time to get this accomplished, so the next several months consisted of “crash course” on the job training mixed with intense studies. We learned as much as we could from him but also poured over regulations and insurance company provider handbooks, contracts, and policies day and night. We sought out intensive training programs from the industry leaders. After an immense amount of work and training, my wife and I were certified as professional coders and professional medical auditors.
During this process, my father in law deteriorated quickly. We spent copious amounts of time with him daily for months, which eventually led to him living in our home for the final week of his life. In the end, he and my wife were closer than they had ever been, we learned invaluable knowledge, and he passed feeling confident that his legacy was in good hands.
Here is where my wife gets to hear that she is right. Things played out the way they did for a reason. This journey has allowed me to understand exactly why I got that Notice of Repayment letter and how I could not only avoid future repayments but also, how to avoid denials and welcome audits. This meant we could also use this knowledge to help other providers avoid these anxiety invoking moments too… BEFORE they happen. In the end, the information we learned and the tools we have now allow us to bill for the time we spend caring for our patients and get paid without the worry of denials, audits, or repayment letters.
A new passion was also born. So many of our fellow healthcare practitioners are going through the same things that we have encountered, but without the knowledge that we now have. I think you will agree that the majority of us got into this line of work to help people. But healthcare is a business with very tight purse strings. With all of the different mechanisms of recoupment activity, all the types of audits and companies working on behalf of insurance companies to take money back from providers, it’s just a matter of time before you will become the target.
Our Company MediCorp Compliance Solutions allows us to help other practitioners avoid the sleepless nights and bill with confidence for the excellent care they provide. And in the end, this has allowed us to be right where we want to be, getting paid what we are worth and with more time to spend with our growing family and allows us to help others do the same.