#184 You Are the Most Expensive Person Doing $15 Tasks in Your Practice

Independent practices rarely lose money because the medicine is wrong. They lose it because the highest-paid person is buried in clerical work and the front desk is too deep in daily chaos to chase eligibility, fill cancelled slots, or collect patient balances. We sat down with Tim Boyle of Reva Global Medical to talk about medically trained virtual assistants, and where the recovered revenue actually comes from. 

The front-end gap 

Scheduling, eligibility, verification, and prior authorization are the number-one denial categories. A front-desk team in the middle of ringing phones and walk-ins cannot also run the strategic prep that prevents those denials. A dedicated VA can, and that is usually the first seat to delegate. 

The no-show math 

A practice can run 20% open availability from no-shows. Without someone working a waitlist to fill those slots, that is overhead the practice simply eats. A VA reaching out the day before, and pulling from a call list when a slot opens, both lifts the patient experience and recovers revenue. 

The back-end gap 

Statements go out, but nobody works them. A trained VA handles patient-balance collections and the AR backlog, using HIPAA-certified propensity-to-pay tools to make a genuinely hard conversation go as well as it can for the patient. 

Who not how 

Heather and Tim land on the same idea the most successful owners share: protect your zone of genius and delegate the rest. The framing comes from Who Not How by Dan Sullivan and Dr. Benjamin Hardy. Clerical work is the low-hanging fruit, and the first thing to hand off. 

How the right VA is hired 

Reva accepts roughly 5% of applicants. The practice interviews finalists one-on-one with Reva’s camera off, so the owner chooses who joins the team. SOPs are set up first, a client services manager reports daily or weekly, and the practice does not pay until the VA is trained and working. 

THREE ACTIONS THIS WEEK 

• Download the 30-Day Revenue Recovery Plan and start working it from day one this week. 
• Pull your no-show rate for last month and multiply it by your average visit value. That is your waitlist opportunity. 
• List the three clerical tasks eating your day that do not require a clinician. That is your first delegation. 

EPISODE BREAKDOWN 

• Tim’s path from pro hockey to healthcare sales 
• Why revenue leaks at the front desk 
• Letting go of control as a practice owner 
• The hiring and training process (the 5% filter) 
• Who Not How and your zone of genius 
• Back-end collections and the tough patient conversation 
• What it costs and what comes back 

RESOURCES

• 30-Day Revenue Recovery Plan — eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 
• Book a Call with Heather — calendly.com/heather-natrevmd 
• Payment Posting Audit Checklist — eligibility.natrevmd.com/payment-posting-checklist 
• Practice Revenue Leak Scorecard — eligibility.natrevmd.com/nrm-revenue-scorecard-v3 
• RECOVER Diagnostic Quiz — natrevmd.com/quiz 
• Reva Global Medical — revaglobalmedical.com  |  Tim Boyle — Tim@revaglobalmedical.com 
• Book referenced: Who Not How by Dan Sullivan and Dr. Benjamin Hardy 

Transcript

SPEAKER_02 0:05

Figuring out what staff you should hire, what you need to delegate, especially as you scale, is one of the hardest things practices can do. And it's hard to find really good partners who can make sure that you have the right team and that they are doing the job that you specifically need in your own practice. So excited to have today's guest on with us today. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started.

SPEAKER_00 0:39

Thanks for having me on. I'm excited to be here.

SPEAKER_02 0:41

So tell me how you went from pro hockey to the business and tell me a little bit about just your journey.

SPEAKER_00 0:47

For sure. So an unfortunate situation brought me to where I am today, but it was the best thing that could have ever happened to me. So I put it a four and a half, so almost five years of professional hockey. And in my last year, it was cut short because I renated L3 to L5, cracked S1 and a half. So I was in a tough shape for that winter into summer. And I figured that I had to make a jump. I had to go do something different. I didn't know what I was going to do just because I knew hockey wasn't going to work for me. And in my during my recovery process, I was wearing these foot, these sandals, this footwear called UFOs, which anyway it emulates rolling your feet out on the top of tennis balls. So it just made the recovery process for my back, it just made it so much quicker than it would have been if I didn't have them on. So I thought I'm my dad was a sales guy. I didn't, I knew sales was the way I was going to go. So I figured what better place to start than the place that fixed me up. And I I reached out to Ufos and I started my sales career at Ufos. And once I started helping people and realizing how much that makes a difference in day-to-day life, I realized that healthcare was the space. And if I wanted to grow, then I would have to go to a technology slash either equipment or technology route for myself, I should say. So I started in a SaaS space with reimbursement software. And how seeing how that helped practices just gather money that they didn't have before and previously had to write off was very, very exciting. But I was a fully remote worker. So being fully remote was difficult for me. And I decided I wanted to be more face-to-face. So then I made the jump. And when I made the jump, I th I figured, why not try the equipment side while I'm making a transition, anyways? So I went to Perkin Elmer and sold laboratory instruments. Yeah. And the parts to laboratory instruments. So from that process, I learned the face-to-face with doctors and really dealing with more so the patient care side than the reimbursement side and the gathering revenue. So combining those two together, just coincidentally, I was having a conversation with an another former professional hockey player who started a real estate company, VAs for real estate companies and for uh people just buying either commercial or residential real estate throughout the country and a VA just as an executive assistant to help them out. And he saw through personal connections that it could be a real obviously you're gonna have to get different VAs for the medical space than you're gonna have for the real estate space because they need to be medically trained and all of that. But he figured it would be a big help for these different practices and it and when he was searching around, it's just we don't have a lot of competitors and it's not really something that a lot of people know about. And it's hard to hire at at full price if you're if you try to hire locally because of minimum wage and how high it is right now. So he asked me to come over. Uh I took on the director of sales and business development roll over here, and and the rest is kind of history.

SPEAKER_02 3:41

That's awesome. Well, that's good. I mean, you've kind of been in our space with the revenue side. I'm a physician, as you know by background, and I think I've seen my own friends who've struggled with really understanding, you know, how they can really have their practice be successful, whether that's the revenue side or the support side, which was what we're talking about today. It's not easy. I mean, we're not taught this in medical school. You spend, you know, 10 plus years getting your medical education, you don't have a lot of the business education, and it's kind of file trial by error, I guess. Um, I mean, you're just trying to figure it out. So, you know, we see a lot of our practices who use virtual assistance, especially for that front-end piece of the revenue. So for us, you know, we're RCM firm, but we don't do, we don't typically do the front-end piece. We're not typically doing eligibility or prior offs because I do, I do believe, and maybe you have an opinion on this, like the people who are answering the phone to schedule the appointments, I believe that those were really helpful to have those same people connected with the eligibility team. Do your virtual assistants connect those dots, or do you see it maybe both ways where they're not scheduling the patients and just doing eligibility? Tell me a little bit about, you know, kind of what you see different practices doing with those virtual assistants on that front end side.

SPEAKER_00 4:58

Both. It depends on volume, of course. So if you have more patients coming in, then you're gonna have to have multiple uh virtual assistants. But it's it's honestly it's preference for the practice uh operator, the doctor at the practice. So if you want that uh that virtual assistant that's on your front end dealing with those eligibility checks, dealing with that patient communication to be attacked to be working with your eligibility team and you have a high volume, you can just hire multiple virtual assistants to do both of those roles. Because, like I said earlier in the call, they they are medically trained. A lot of them have been priorly in working with reimbursement, either for a reimbursement company like your like your own or working in a hospital alongside. So it it really depends on what the practice owner wants and how they want to operate it, but they can do either. I do find it to be very, very beneficial if you have them connected with your eligibility team because then everything just flows a little bit easier. If there are any questions that come up, everybody's involved and they and they can kind of be more efficient with their workflow.

SPEAKER_02 6:02

Yeah, I I think that it's hard sometimes because you like I love to control things. It's just, you know, I think maybe it's part of the doctor mentality. I know it's not just to doctors. I think there's plenty of us on the planet, but it's hard letting go of those positions not being in the office. But at the same time, the practices that I see being most successful are the ones that have been able to let that go and be able to say, okay, these are the things I'm going to outsource to have somebody remote doing it. Just get you get the economies of scale. I think as long as you have the training and the accountability loops, you can have a very successful offshore or you know, outsourced partnership with the virtual assistants. How have you seen practices really engage those individuals so they're part of the team, but also relinquish some of that control so that they can, you know, do those jobs and and take that off the practice hand? Because I think it's just too much for a front desk.

SPEAKER_00 6:58

100%. Yeah. And it's it's very independent, like I said earlier, depending on where you are in the country, hiring locally is just so expensive. It's it's impossible. Yeah, big time. So and the revenue that you're missing out on that you'd have to write off, some people don't even know they're missing out on it. So because you have so many different things that you have to do, that you're not only losing revenue, but then the patient experience, because of how burnt out you are, becomes uh a little bit worse than what it would be if you're able to offs offshore, outsource that. But the thing is, like you said, it's very difficult to trust that process. And we completely understand that. So when we bring on a different practice, right? It's a private practice or a hospital, it doesn't matter. What we do is we conduct an interview process. So we only hire 5% of the people that we of the people that apply to our company just because of all the boxes that you need to check, right? So when we when we vent out that down to five. So if there was a hundred people that applied, we hi we now have five people that we can choose from that we'd be able to present to a practice. And when we present that candidate to the practice, we turn our cameras off and we let you interview that person one-on-one. So you know exactly who's coming into your practice, how well they speak, if they're able to fit in your space, because someone in California might work differently than someone in New York. So that process, and we got to gain your trust as Reva Global Medical. We need to gain your practices trust. So we'll take the training process on in in-house. So we'll pay for all that. And we'll just, yeah. So we'll make sure that you know who you're gonna get and you know that they're gonna be fully trained. And once they hit the ground running, you don't have to start paying them until they are working in your practice, ready to go, knowing what they're doing.

SPEAKER_02 8:39

Oh, is it policies and procedures as well?

SPEAKER_00 8:42

Of course.

SPEAKER_02 8:43

Okay, that's awesome. That's awesome.

SPEAKER_00 8:44

Yeah, so we have SOPs in place before. So you know exactly what the expectation of this virtual assistant is, and we'll also provide you a client services manager so that client services manager can report to you, either daily or weekly, depending on your schedule, on how that person is doing, what the goals for that virtual assistant was, if they hit that goal, if they exceeded it, how many calls they answered, what percent of revenue that was missed before is now getting brought back into the practice. And then just patient communication and patient experience. So obviously, as you know, it's tough day before you'd like to reach out to somebody, hey, you have an appointment tomorrow, because they might have forgot about the appointment. And then if you reach out to that patient, that experience is going to be much better because then they can obviously reschedule that appointment, but also for your practice, you can find someone else to place in that spot and reach out to your client list to people that don't have necessarily have an appointment, but you can call them and say, hey, listen, a spot opened up tomorrow. Do you have any availability? Are you able to make it? And we just have found for practices that doesn't only make the patient experience better, but it also brings in a lot more revenue that was once lost too.

SPEAKER_02 9:54

And I think that that's a big, uh a big thing to to recognize. Like when I see our practices, they have someone in the front desk, right? They're obviously checking in patients, they're handling things that are coming across their desk. But that more strategic, I need to make sure that we are prepared for the next day, that piece of stuff often gets put back to the back burner, right? Because you've got somebody complaining, you've got the phones ringing off, you've got faxes coming in, you've got doctors asking questions. And so to have somebody dedicated who's not sitting in the chaos of a front desk, which if anybody's been in a practice, it's the chaos of a front desk. Yeah. Like they can really think through, okay, I need to do eligibility. I need to do, you know, prior authorizations and I need to, you know, figure out the failure points of certain verifications. And for the listeners, like these are the number one denials that we get is really eligibility, verification, prior authors, depending on the type of practice that you're in, obviously. So that if you can really make sure that those tasks are managed, like great, then it's more revenue. But then the other piece that you just mentioned is this idea behind and you know, appointments, uh, appointment reminders, which, you know, maybe that's automated through your software, but then open slots. I have no shows. How do I get a wait list to fill those no-shows so that I have no wasted, you know, uh appointment slots for for your because it's you know, you'd be a surprise. I mean, you end up, I mean, I'm sure you know you can have 20% open availability. And if you don't have somebody fill in those spots, then you know, that's overhead you're not covering.

SPEAKER_00 11:25

So exactly. And that's kind of where we came into play, right? We noticed all of these different spaces where there were gaps, and and it's just adding someone, it's the clerical versus the clinical work, right? Like you should do the doctors go to school for so long just to do that clinical work, to have that patient care, where that clerical work is was driving the patient experience down, and it's driving a lot of doctors to burnout because you're just wearing so many different hats that you shouldn't have to be wearing. And whether it be, I think that in every spot of your workflow that you should be using something. Obviously, you can't pay for it always, but like a reimbursement software should be in your CR or it should be in your system that you're using right now because you don't know, like I said before, like sometimes you don't know where you're missing out on that revenue, but you're missing a percentage of it for whatever the denied claim is. And and then we add that human value to it in case the reimbursement software doesn't work, then you call out to the insurance company, but that process becomes a lot quicker and you're able to do a lot more in middle time. So just making your workflow more efficient as wherever you can.

SPEAKER_02 12:29

Yeah, it's it's the book. Oh, I'm blanking on his name, the Who Not How book by I think it's Dan Miller. Um, I may be getting that wrong, but the who not how is this premise around delegation. And I think for independent practices, um, really of whatever size, we practices that are, you know, single physicians, we practices that have, you know, 20, 30, 40 physicians. And so the who not how approach, when I see the most successful physicians, it's okay, what is my zone of genius? What am I gonna say? These are the things that I have, me personally, has to do. And then these are the things that I'm gonna start to delegate. And that happens over time. And but I I see these roles as sort of that low-hanging fruit, one of the first things you start to delegate. And especially even if you have a front desk staff, as your patient volume increases, those individuals can't handle everything. And so having this individual who can help triage, you know, some of those things that we just mentioned, I think is key.

SPEAKER_00 13:20

Yeah, absolutely. And that's honestly for our business for Reba Global Medical, like that's where we'll we look at ourselves as consultants, right? So we look front end and back end. That's the front first two places. You can use this anywhere along our workflow, but the most important places that we've seen from practice to practice, because it doesn't matter how big you are. If you're an IVF practice and you're only seeing so many patients, those tests are still very expensive. So it can it can matter what you're doing as well as the volume of patients coming in. So no matter who we're talking to, we always look at that front end and then at that back end.

SPEAKER_02 13:53

That's where we I'm gonna ask some questions that you know I can I can already hear my practices that we work with thinking about. Okay, so if they're like, I have no idea what I need, I don't know what day it is. I've just trying to keep my head above water. Can I come to you and say, okay, here are the problems I'm having? Help me craft the role and the job, you know, description to help this work.

SPEAKER_00 14:14

Yes. So that's that's what my initial call with the practice will be is I'll just take a step back and I'll look at the pain points. How many calls are you receiving each day? How many missed calls are you getting? Do you have a voicemail inbox that's through the roof? Because that's obviously what's leading to missed appointments and lost revenue. And then I'll ask how many claims, how many denied claims are you dealing with? Do you have a reimbursement software in place? How many, so do you have an AR backlog that you're currently dealing with? And how long, like so just certain questions, certain, I hate to call them pain point questions, but you need to know what's going on. You need to know what's wrong. And then we will find, and then when we're doing our, when we're higher, our hiring process for the candidate, we have all of those ideas in mind. So we know exactly who we're looking for for this one practice. That's a little bit of the reason why it it takes us so long to hire the right person, because not so long, but it takes so many candidates to get the right one, is because we're looking for a specific problem to fix in a specific practice, and we're finding that right person, like the exact right person to do it. So it's very important though.

SPEAKER_02 15:19

And I I think of the front end eligibility prior auth. I also think uh we have many of our practices struggling with the back end, meaning we send the patient statements, but nobody's really paying the patient statements.

SPEAKER_01 15:30

Yeah.

SPEAKER_02 15:30

And so calling patients and having a script together to say, okay, hey, we've got to start collecting these balances. Is that a service that you guys provide? Yeah.

SPEAKER_00 15:38

And that's a tough conversation to have, right? So training those VAs to make that conversation as comfortable and as easy as possible for both the patient and obviously the VA. And that's that's a big part of the training because the patient communication back and forth, like you never want to send a patient a bill, but if you have to, at the end of the day, that's that's how it goes. So that conversation is gonna be one of the toughest ones you're gonna have to have with that patient. And you want to make sure it goes as well for the patient as possible so that we have extensive training along those conversations that they have to have. And then we can also use programs that can show you the patient's propensity to pay. Um, it's uh through different uh they're all HIPAA certified, but through different softwares, just so they can guide that they have guidelines on how to have that conversation and and where they're at with their with their life.

SPEAKER_02 16:26

So uh the other thing that we often hear is okay, so how what's the process look like for working with you? Are you are they hired on to your payroll and the practice is paying you, or are they hired onto the practice and and or how what does that arrangement look like?

SPEAKER_00 16:41

Are they your they're your worker? They're only working for your practice, they're dedicated to you, but the the first way you just said it, so we'll hire them on and then the the practice will pay us.

SPEAKER_02 16:52

Got it. Okay. And then do you do part-time or primarily only full-time roles?

SPEAKER_00 16:56

Just because of how many things that we like how extensive the veto process and how hard it is to find the candidates and how much they can do along a workflow, we only offer full-time because we find that when we do that consulting, when we take that step back, usually if someone's reaching out to us needing help, we'll be able to find a full-time role. And obviously it's gonna be a fraction of the price of hiring and hops.

SPEAKER_02 17:21

And, you know, I know we've kind of touched on this, but do you have numbers in terms of what folks are maybe losing in terms of revenue from lost eligibility? Like, say somebody doesn't have this role net, and right now they're having denials, which we see again is our top top denial. You know, I think if this is they can be losing, you know, close to six figures, especially on a seven-figure business from an annual basis. Would you agree with those numbers?

SPEAKER_00 17:46

It depends on the technologies that they have in place as well. If they're just doing eligible or if they're just going to do insurance verification and they're trying to go collect denied claims by having one person have a phone call and reach out to them and they do not have a virtual assistant in place, yeah, definitely at least six figures. But if they do have it can be, it can vary, of course, depending on what technologies you'd have in place. But the more efficient you're gonna be, the more revenue you're gonna bring in and the less burnout you're gonna have across your staff for sure. So I think uh I think six figures is definitely a safe place to put it on a seven-figure business.

SPEAKER_02 18:21

Yeah. And um, you know, again, hopefully folks listening know their denial numbers because that is the number one thing that has to come from your RC apart. So if you don't know those, make sure that they're getting those to you because that's really, really key. You know, denials are a big part of understanding how to fix revenue. So, okay, so if you've got a physician who's thinking, I just don't have the time for this right now, I this is you know, not something I can handle. You know, what would you say to them so that they realize the importance of this and and get this going?

SPEAKER_00 18:52

But besides asking those questions of like, of course, like I I'd have to put my sales hat on a little bit, of course, but I'd I'd have to ask them the questions on how many calls are you receiving because at the end of the day, this is putting time back on your calendar, not taking time off of it. So yeah, you can talk to me and you have to look at me, which is unfortunate for a couple minutes. But once you get that help in-house, you're gonna see how much how much time is put back on your schedule. You're not gonna have to go chase those claims, you're not gonna have to reach out to a patient to make sure they're coming. You don't even have to go worry about making sure that the patient's getting all the right medicine, the medications, because you're gonna have someone doing that for you on the back end. And it's it's really just gonna put time back on your day, and you will see it in the first month. All of our practices have come back to us after the first month saying, I'm it's usually a can we have another one? But it's always it's David, they've just been so helpful. We didn't know a lot of them say we didn't know that we were missing out in so many different areas. So I'm not saying that practices aren't as efficient as they should be. It's just there's always a way to be more efficient and bring in bringing revenue.

SPEAKER_02 19:59

Well, I again I it brings me back to that book, The Who Not How. I it's in stages, right? So there's always something to optimize, and that's within any business, anywhere.

SPEAKER_01 20:07

Of course.

SPEAKER_02 20:08

And so it's just about stages. What stage are you in and where what can you optimize today? Um and you know, as I tell my kids, get 1% better every day, and that's what you can expect, you know, what's gonna be perfect. All right. So folks who are listening, uh, where can they find you? And again, we'll put stuff in the show notes, but where can folks find you if they're interested in delegating some things?

SPEAKER_00 20:29

Yeah, absolutely. So I'm on, I and the company are on Instagram, LinkedIn, Facebook. So you can find us there, uh reva Global Medical.com. So we'll have everything you need to know on what we can do, how we do it, and how we operate on that website. And then uh just I also I if you just want to reach out to me personally, it's Tim at revaglomedical.com. I'd be happy to have a conversation with any and everybody just on ways that we can we can help.

SPEAKER_02 20:55

Great, I love it. And uh just for folks listening, we have personally, you know, used virtual assistance over the years and have found it to be extremely valuable as part of our business too. So look forward to you know chatting with you guys and and going from there. So um it was great to have you on the show today. I appreciate you know your help and support and educating just around this topic because again, I feel like it's one of those things where it's hard to delegate some of these things, but really critical from a revenue and efficiency standpoint.

SPEAKER_00 21:20

So trust is hard, but there's a way for sure.

SPEAKER_02 21:23

Okay. Well, uh, it was great to have you on. And uh again, uh we'll put the show notes in. And uh, if you guys like the episode, we'd love for you guys to share it with a colleague or a friend. And uh we'll talk to you on our next episode. Thanks so much.

SPEAKER_00 21:34

Thanks so much, Dr. Header.