WP201 | 4 Ways Insurance-based Practices Quietly Lose Time and Money with Justin Ith
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If you accept insurance in your private practice, you probably already know that it comes with a lot of moving parts.
Credentialing. Eligibility. Claims. Denials. Follow-ups. Documentation. Payer rules.
And somewhere in the middle of all of that, you’re also supposed to actually run your practice and take care of your clients.
In this episode of the Wise Practice Podcast, I sat down with Justin Ith, co-founder and CEO of Aria, a practice automation platform for growing group practices. Justin has spent years working in healthcare technology and revenue cycle management, but what really drew me to his work is why he chose to focus on therapists.
After going through his own experience with depression and finding a therapist who made a significant impact on his life, Justin decided that therapists were the people he wanted to help. When he began talking with clinicians about their biggest challenges, one thing kept coming up: the overwhelming amount of administrative work involved in running a practice.
So we talked about something I know is on the minds of a lot of practice owners:
Where are insurance-based practices quietly losing money?
Justin broke it down into four main areas.
1. Credentialing Mistakes Can Cost You Months of Revenue
Credentialing is one of those things that sounds straightforward until something goes wrong.
You submit an application, expect the process to take 60 or 90 days, and then find out that something doesn’t match. Maybe information in CAQH doesn’t line up with the payer application. Maybe something was entered incorrectly. Suddenly, what should have taken a few months takes much longer.
Meanwhile, you might have a licensed therapist sitting there ready to see clients and a waiting list of people who need services, but you can’t bill insurance for them yet.
That’s not just frustrating.
That’s lost revenue.
It’s also a good reminder that sometimes outsourcing something isn’t simply about saving yourself time. Hiring someone who really understands the process can help prevent mistakes that cost your practice far more than the service itself.
2. Eligibility Isn’t Something You Check Once
The second place practices lose money is through eligibility verification.
This can become especially complicated when working with Medicaid because a client’s eligibility can change from one month to the next.
A client may be verified and eligible in February, and then something changes in March. If your team isn’t checking proactively, you could provide services and later discover that you aren’t going to be reimbursed for them.
This is where the administrative side of accepting insurance can become incredibly time-consuming.
It’s not enough to verify benefits when someone first becomes a client. Practices need systems for continuing to check eligibility and communicating quickly when something changes.
3. Small Claim Errors Can Create Big Revenue Leaks
Next, we talked about the claim submission process.
Modern EHRs have made submitting claims easier, but there are still details that often require human intervention.
For example, practices may need to adjust a rendering provider or modifier depending on the clinician and payer. When those changes are being made manually, there is always an opportunity for human error.
I shared a story about a practice that completed an audit and realized they could correctly change a modifier they were using. Once they fixed it, they started bringing in significantly more revenue.
They weren’t trying to overbill.
They simply didn’t realize they had been underbilling.
Justin sees situations like this regularly. Practices may not even know that there are details they should be looking for, which means money can quietly be left on the table month after month.
This is another reason I’m such a fan of having good systems and good experts around you.
You don’t know what you don’t know.
4. Denials Often Start Long Before the Claim Is Denied
This may have been my biggest takeaway from the entire conversation.
Justin shared something one of his co-founders taught him after more than 25 years working in revenue cycle management:
The heart of most denials is in the front end and the mid-cycle.
In other words, practices often focus their attention on fixing denied claims after the denial has already happened.
But what if we spent more energy preventing those denials in the first place?
The front end includes things like intake and eligibility. The mid-cycle includes documentation and charting. When those systems are strong, many denial problems can be prevented before the claim ever reaches the payer.
I loved this because it reminded me of my own experience working in intake at a psychiatric hospital.
I always felt like if we got something wrong during intake, that mistake followed the client throughout their entire experience.
The same thing can happen with insurance billing.
Sometimes the problem showing up at the end actually began much earlier.
How Much Money Are Practices Leaving Uncollected?
During our conversation, I mentioned that I’ve heard estimates that the average group practice may lose $30,000 to $40,000 per year in uncollected insurance payments.
Justin said that number wouldn’t surprise him.
And then there’s another cost we don’t always think about: all of the staff time required to manage these administrative tasks.
As your group practice grows and you add clinicians, your administrative workload grows too. Eventually, practice owners can find themselves continuously adding staff just to keep up with insurance-related tasks.
That can quickly start eating into your margins.
Where Automation Can Help
This is where Justin and his team at Aria come in.
Aria looks for routine administrative tasks that can be automated instead of requiring someone on your team to complete them manually.
That can include things like:
Verification of benefits
Coordination of benefits checks
Ongoing eligibility verification
Claim scrubbing
Modifier or rendering provider adjustments
Justin explained that advances in AI are making it possible to automate parts of healthcare administration that traditionally required much more human judgment.
The goal isn’t simply to replace people.
It’s to allow your team to spend their time on work that actually requires a person.
And as your practice grows, that becomes even more important.
Protect Your Revenue Before You Focus on Growing It
We talk a lot as practice owners about making more money.
How do I get more referrals?
How do I add another therapist?
Should I run Google Ads?
How do I grow my caseload?
Those are important questions.
But sometimes growth isn’t about bringing more money into your practice.
Sometimes it starts with making sure you’re actually collecting the money you’ve already earned.
Take a look at your insurance processes.
Where could money be leaking?
Where are you relying heavily on manual processes?
Where do errors keep happening?
And instead of simply fixing problems as they appear, ask yourself whether there’s something earlier in the process that could prevent them altogether.
Because the healthier your systems become, the easier it is to build a practice that can grow without creating more work, more stress, and more administrative chaos along the way.
Meet Justin Ith
Justin Ith is the co-founder and CEO of Aria, the practice automation platform for growing group practices. He has spent the past decade in health technology, with a focus on billing and revenue cycle, working with organizations of every size, from solo practices to large systems like Optum, Providence, and Seattle Children's. What he cares about most is the business side of running a practice: the owners who set out to help people and end up buried in back-office work they never trained for. That is the problem he started Aria to work on.
Justin’s Resources
Show Sponsor Wise Practice Summit
If you're enjoying today's episode, I want to personally invite you to one of my favorite events of the year—the Wise Practice Summit, happening October 8th through 10th in Nashville, Tennessee.
If you're a practice owner who wants practical strategies to grow your business, become a stronger leader, and connect with other faith-based practice owners who truly understand the unique challenges of this work, this event is for you.
Over three days, you'll hear from incredible speakers, gain actionable tools you can implement right away, and connect with trusted partners like GreenOak Accounting and other experts who are dedicated to helping private practice owners thrive. More importantly, you'll be surrounded by a community of people who share your heart for serving others while building healthy, sustainable businesses.
We're just a few weeks away, so if you've been thinking about joining us, now is the time to grab your ticket. I'd love to meet you in Nashville and spend those three days learning and growing together.
Learn More Here: https://www.wisepracticeconsulting.com/summit-2026-1
Links and Resources
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[00:00:00] Whitney Owens: If you've enjoyed this podcast, I wanna personally invite you to one of my favorite events of the year, the Wise Practice Summit, happening October 8th through the 10th in Nashville, Tennessee. If you're a practice owner who wants practical strategies to grow your business, become a stronger leader, connect with other faith-based practice owners, I truly believe you will benefit from this event.
[00:00:21] Over three days, you will hear incredible speakers, gain actionable tools to implement right away, and connect with our trusted sponsors, from accounting experts, to SEO experts, to virtual assistance experts, and more. Most importantly, you will be surrounded by a community of faith-based practice owners who share your heart for serving others, building healthy, sustainable practices.
[00:00:46] We are just a few weeks away, so if you've been thinking about joining us, now's the time to grab your ticket. I'd love to meet you in Nashville, spend three days learning together and having a good time. Visit the link in the show notes or head to wisepracticeconsulting.com to grab your ticket. I cannot wait to see you there.
[00:01:04] Building a thriving faith-based private practice isn't easy. It takes courage, wisdom, and commitment to lead your business without compromising your faith and values. I'm Whitney Owens, the owner of a seven-figure multi-location group practice and founder of Wise Practice Consulting. Every week on the podcast, I share real strategies, lessons, and conversations that come from actively leading my own practice, helping practice owners across the country do the same.
[00:01:29] Whether you're building a solo practice or growing a team, this podcast is here to equip you, empower you, and remind you, I believe in what God's called you to. You don't have to do it alone. Welcome to the Wise Practice Podcast. Let's get started. Hey, friends, welcome to the podcast. We have made it to September.
[00:01:48] I don't know if you're feeling the heat like I do, but I am down in Savannah, and even though it's still gonna be hot in September, at least I, like, know we're entering the month of September, and things will begin to improve. But I am thrilled. I love moving into the fall. There's so much excitement with your kids going back to school, the activities starting back up, the sports.
[00:02:08] I love watching my kids play different sports, and I also really love growing my practice, and so we get to serve more people. People are reaching out for therapy. Things start to move faster. So I'm really looking forward to the fall and moving into that season. The other thing I look forward to is the summit.
[00:02:26] It's like the highlight of the year. So you've been listening to the show. You've heard me talk about it. You're thinking, "I thought about it. I'm not really sure. That would be really weird for me to show up by myself." It's totally fine. We're really friendly people. I can think of so many... I'm thinking about one practice owner right now.
[00:02:44] He showed up, knew nobody. In fact, he was still in grad school when he showed up two years ago. And at that conference, he joined the community. A few months later, he started his private practice. Now he's completely full, doing speaking engagements, and he's our keynote at the Wise Practice Summit this year, Derek Vaugher, so I'm really looking forward to that.
[00:03:07] All that to say is, you just never know where something's gonna take you. Showing up to an event, a relationship you make, and at the event, you can get education. You get CEs for learning how to grow your faith-based practice, connect with other faith-based practice owners, sponsors who are sitting at their tables and ready to tell you how to grow your practice.
[00:03:29] They'll tell you about website design, SEO services, bookkeeping services. There's lots. The assistant services. I could keep going on and on. In fact, today I have one of those sponsors on the show from Aria. It's Justin Ith. He is excellent. So we're gonna talk about the four proven ways to streamline and to not lose money when you're billing with insurance.
[00:03:55] But to finish telling you about the summit, please join me, Nashville, October 8th through the 10th. You can buy your tickets on the website. Again, it's not too late. Do something fun and exciting. Buy your ticket. Join me. You'll get lots of emails with all the details afterwards. If you got questions, you're not really sure, you can email me directly, whitney@wisepracticeconsulting.com.
[00:04:20] You're also welcome to shoot me an email or to fill out the contact form on the website. So I'm excited for episode one-- episode two oh one. It's time for another cup of coffee. The four ways that insurance-based practices quietly lose time and money with Justin Ith
[00:04:41] Welcome to the Wise Practice podcast, and today I have Justin If coming on the show. He is the co-founder and CEO of Aria, the practice automation platform for growing group practices. He has spent the past decade in health technology with a focus on billing and revenue cycles, working with organizations of every size, from solo practices to large practices like Optum, Providence, Seattle Children's.
[00:05:04] What he cares about most is the business side of running a practice, the owners who have set out to help others and end up burned out by the back office work that they never were trained for. I feel it in my heart just reading your bio. That's the problem. And that is why he started Aria. So I'm so glad you're here, Justin.
[00:05:23] Justin Ith: Thanks, Winnie. I'm super excited to be here. I appreciate the time.
[00:05:27] Whitney Owens: Yeah, yeah. So when I first met you- My heartstrings were pulled by your story of starting Aria and who you are. So Justin, I would love to hear more about your story, kind of the origin story of Aria.
[00:05:41] Justin Ith: Yeah, no, I'm super excited to, to share that.
[00:05:43] Um, you know, I like to start actually first with my family. Um, I come from a family of physicians, uh, and pharmacists, and, uh, I was a black sheep who was actually really into building and art. Um, and so I, um, kinda started more as a, a builder, and I kinda took my first coding class and realized, like, wow, I'm actually pretty good at, at producing software.
[00:06:06] And software is really just a tool, um, to help people solve problems. And I came to a point in my career where I realized, you know, I could use this tool for anything, um, well, who do I wanna help? And when I looked around and kinda my family and the origins of the place that I grew up, I really was drawn to working in healthcare, and specifically supporting clinicians, um, and really kinda helping the helper.
[00:06:31] Uh, within that, I had the opportunity to work with providers from, in hospitals and, um, specialty practices, um, and particularly actually on more on the backend kinda admin side. Um, and it wasn't until kinda my first encounter with a, uh, therapist or a mental health therapist that I really understood better the behavioral health side.
[00:06:53] Um, I think like many, Whitney, you probably saw a lot of folks who were going through it during the pandemic era. Um, and I, um, kinda went through a bad depression myself, and I had a chance to go meet and work with a therapist, and it took a little bit of time to find the right one. But once I did, you know, she really changed my life, and I really put a lot of gratitude towards the work that her and I did together and, and where I am today.
[00:07:19] And I know my story's not alone. I know the work that you do and your listeners do to help people like me and my friends and family, um, can transform lives. So I was at a point where I realized these are the people I wanna help. You know, this is the group of people that inspires me to, um, you know, help the world.
[00:07:38] And I actually went out, I, I remember telling you this, Whitney, like, I actually didn't start Aria with a very specific idea in mind. I started Aria by just simply talking to clinicians. Uh, I went to community health base, uh, organizations, group practices, private practice owners, and I asked them, mainly the main question was, you know, what's the biggest issue you face?
[00:07:59] And two things kept coming up. You know, one of them was some patients in particular were really emotionally taxing and hard to work with. And the second one that kept coming up was the amount of admin work that they were, like, unexpectedly brought in to do when they went into this line of business and this way of kind of being in the world, uh, was just way more than they expected, and it was really draining, and it was causing burnout.
[00:08:24] And I didn't really have a good solution for the first problem, but that second one, you know, I think, um, I was like, "Great, let me see how I can help there." And what Aria has evolved into today has been basically a sequence of talking to a clinician, asking what the biggest issue is on the admin side, solving that, and asking what's next, and then what's next.
[00:08:43] And that's kinda how we got to where we are today
[00:08:46] Whitney Owens: Hmm. Thank you for sharing that. And I mean, for you that you can see me, and anyone watching on YouTube, but like, it just, like, warms my heart when you talk about the difference we make because that's what therapists are here to do. Yes. And so it's, it's this...
[00:09:00] I love this, like, reciprocal relationship, and even, you know, our partnership, it's, it's therapists have helped you- Yep ... and now you're giving back to that very work, and I think that's so beautiful. And you have the skill set with software, which most therapists are not tech-savvy, so we need you.
[00:09:18] Justin Ith: It's a great tool for certain problems, and then, you know, obviously we need you.
[00:09:22] And, um, it's funny, um, just to be super transparent and blunt, right? Like, the therapy market isn't this... Like, there's a lot of different ways where software can go make money, and this is not, like, the most high optimal way to do that, and that's not my reason of being or what I'm doing here. Mm. Um, it's about, you know, when I eventually die and I look back on the time I spent and what I worked on, am I proud of that?
[00:09:46] And I couldn't be prouder of spending my time and my kind of limited resources to help this community of people, and that's what, uh, we would start at Argia to do. That's beautiful.
[00:09:56] Whitney Owens: Yeah. Well, I always say as therapists and we didn't go into this for the money either, you know?
[00:10:01] Justin Ith: Yep.
[00:10:02] Whitney Owens: Yeah. There were a lot of things I could have gone to school the same amount of time and made a lot more money, so, um-
[00:10:06] Justin Ith: Tell
[00:10:06] Whitney Owens: me
[00:10:07] Justin Ith: about
[00:10:07] Whitney Owens: it
[00:10:07] great. Okay. Well, so the topic we wanna do today is ways that practice owners are losing money, or the costs really, I guess, of using insurance in your practice.
[00:10:18] Justin Ith: Yeah. No, totally. Um, there's a lot there, um, when we, when we think about practices that right now that are kind of taking on insurance and, and how can we make that better for them.
[00:10:28] Um, you know, is there a specific area within that, that we wanna dive into first?
[00:10:33] Whitney Owens: Yeah. So I would love to just go one by one, like how are the ways that therapists are losing money off of insurance?
[00:10:41] Justin Ith: Sure. So, you know, when you take on insurance, the, the pro is that you're now opening up the population to people who your fa- your, your, uh, practice can serve.
[00:10:52] And, um, that's great, but obviously that comes with a lot more administrative and kind of bureaucratic headache that can come with that. Um, first off is, is, you know, is credentialing, and then we can get into that. There's those pitfalls there. There's the eligibility and intake side that's shifted now that you're doing insurance.
[00:11:10] And then there's kind of the claim submission and then d- denial piece. I think those are kind of the four buckets. And, you know, as I think about, and I, I work with dozens of, uh, group practices around the country, and I start seeing patterns of kinda what are the ones who are doing it best and what are the ones who, you know, can get more improved on, and there's areas within all four of these where folks can get better at.
[00:11:32] So- Hmm You know, let's, let's talk maybe first about credentialing. Um, picking the right credentialing partner or deciding to do it yourself is a big decision. The cost of doing credentialing yourself or picking the wrong one is you submitted the application. First off, reading that correctly can be a pain, but then once you submit it, um, did you get everything correct?
[00:11:55] And if you didn't, um, what is the appeal process or revision process you need to run through? All of a sudden, something that was supposed to be maybe a 60, 90-day thing is now taking you many months to do. And so we would end up going into group practices with Aria where we work with them. We're like, "My gosh, my last credentialer, um, really messed up how we did credentialing.
[00:12:16] And now, you know, we've had this backlog of clinicians who are licensed and want us to take insurance, and they can't yet because of the way that you're filling out the paperwork and the way that you're really have that attention to detail." So I think that's a huge piece in making sure that you kind of pick the right ones there
[00:12:33] Whitney Owens: Gosh, and I'm just sitting here thinking about the stories I've heard from practice owners when they're waiting- Yeah
[00:12:37] on credentialing for a therapist. They have a wait list of clients. So these clients need services, and they can't get them because of this. And so having someone- Yes ... who can do it and do it well and do it faster and follow up a lot, like, big deal.
[00:12:51] Justin Ith: Yeah.
[00:12:51] Whitney Owens: Mm-hmm.
[00:12:52] Justin Ith: And, and not even just the following up piece.
[00:12:54] I think, you know, one of the biggest things that some folks... And I'll be more specific, right? And these are things I'll say that Aria does help with, but you can do this yourself. So, um, making sure when you're in your CQH profiles for your clinicians, and you have your different licensure, um, and, um, pay basically all the different, uh, credentialing pieces there, does all of that match up line for line with the application that you end up submitting?
[00:13:20] You, what you end up seeing a lot of times is actually the mismatch between what's in CQH and then what's... and goes out on the application right there. Mm-hmm. And so it's really, like, fine-tooth comb on that aspect. Um, and- Mm-hmm ... yeah, to your point, it can cause a huge delay.
[00:13:34] Whitney Owens: Yeah, and just the, the idea of a practice owner spending their time doing that, like-
[00:13:38] they got clients and other things they need to take care of besides, besides that, and hiring someone that really knows how to do it and do it well.
[00:13:45] Justin Ith: Yeah, absolutely. Um, and look, there's a lot of different credentialing folks out there. Um, our, our, our big thing within Aria specifically is we take a automation approach first, and what that means is we actually work a lot with CQH and the different payer portals where you do the applications.
[00:14:03] Um, and we've mapped that out. And so a lot of the human error that can happen, uh, we've eliminated by or greatly reduced by having basically an automated approach to it. It also, um, is... comes at a, at a different price point, um, which we think is really favorable. So- That's
[00:14:20] Whitney Owens: great ...
[00:14:20] Justin Ith: um, that's, that's how we kind of approach that.
[00:14:23] Whitney Owens: Yeah, and it makes it so much easier once you're established, then each person comes on, and you just get them through.
[00:14:28] Justin Ith: Abso- ab- absolutely. Yeah. Um, the other bucket is kind of on the eligibility side. Mm-hmm. So we can kind of speak to that. You know, a, a big piece of it there is, um, for folks who are maybe taking on, um, a me- a Medicaid heavy practice, for example.
[00:14:43] That's, that's ones that we work with, and I know your audience is very mission-based and wants to give and help. And so the Medicaid population, uh, in particular, um, there's a lot of value to give, but it also comes a lot of complications, I think, of working with Medicaid- Mm-hmm ... um, particularly on the admin side.
[00:14:59] And so a huge piece of that is, uh, we- where we see kind of revenue leak is around not doing continuous checking of the verification of their eligibility. Um-
[00:15:10] Whitney Owens: Yes ...
[00:15:11] Justin Ith: things can change month to month, yeah.
[00:15:14] Whitney Owens: Mm-hmm. I especially see that with Medicaid.
[00:15:16] Justin Ith: Yeah, absolutely. Winnie, do you take- do, does your practice work in Medicaid,
[00:15:19] Whitney Owens: or?
[00:15:20] No, but-
[00:15:21] Justin Ith: Yeah ...
[00:15:21] Whitney Owens: my daughter actually is on Medicaid. She-
[00:15:24] Justin Ith: Okay. Yeah ...
[00:15:25] Whitney Owens: yeah, in the state of Georgia, there's a special waiver for autistic children, or really children that need wraparound services. Yeah. Um, so it's secondary for us, but oh my gosh, I have to fill out forms constantly, and I have a master's degree, and it's complicated to stay paneled with them as a, you know, as someone who's on the, on using it, you know, for your own child.
[00:15:45] So I can't imagine, like, being in a group practice, you know, people from all over the place. I have the background to understand it, and I still struggle.
[00:15:52] Justin Ith: Right? I know. It's- Mm-hmm ... it's remarkable. And so, you know, when you think about serving this population who does need this help, you know, there's a lot in the back end that they have to deal with to make sure that they continue to see you.
[00:16:04] So you know, they may be eligible and verified with Medicaid in February, but come March, now it's a, it's, it's a different situation. And so being making sure that you are proactively checking before sessions come up, uh, and then also when you do see issues, how do you have that communication, right? Like, like how do you still balance between, you know, serving this population while also flagging that, you know, you're not gonna be reimbursed.
[00:16:33] And so that's a whole piece to, to really be looking out for as well. Mm-hmm. Yeah.
[00:16:37] Whitney Owens: Yeah. Yeah. Well, thank you for that. Um, all right, so we have credentialing, and we have eligibility.
[00:16:44] Justin Ith: Yeah, yeah. And
[00:16:44] Whitney Owens: f- following up with that, and I'm sure that's a constant for practice owners. Um, okay, and what was the next bucket?
[00:16:52] Justin Ith: Yeah, the other bucket was, you know, I think on the claim submission side. So back in the day, maybe like five years ago, there was a lot more of actually writing what's gonna be in the claim before it's submitted out. But you know, good EHRs, like Simple Practice or TherapyNotes do a pretty good job of making that pretty simple.
[00:17:09] I think the big thing there that we see practices losing revenue on is, um- Oftentimes, depending on maybe you have associates or you have interns you have in your practice and you're billing for, you'll need to change maybe what the rendering provider is or what the modifier codes are, and that's an often manual process.
[00:17:28] And so, and it also becomes prone to human error at times.
[00:17:32] Whitney Owens: Mm-hmm.
[00:17:32] Justin Ith: And so, um, a way to make sure that folks are really looking out there is do you have a standard operating procedure for how you're doing those claim adjustments before they're submitted to the payer? And, um, a big piece of that is making sure you really write it down and make sure your team adheres to that.
[00:17:51] Um, on the Aria side, we automate that for you, so you don't have to do those adjustments yourself, and you can let your team go work on other kind of higher value work than having to do those adjustments. But that's a piece where we just see cracks falling through or we, we, we get a denial and we're like, "Oh, shoot, I forgot to, you know, make that modifier change or change that rendering provider."
[00:18:13] Whitney Owens: Yeah. Gosh, I heard about a practice recently that did an audit and they changed their modifier and started making so much money.
[00:18:20] Justin Ith: Yeah.
[00:18:21] Whitney Owens: Yeah. But it's like- To do it
[00:18:22] Justin Ith: correctly ...
[00:18:22] Whitney Owens: it's like they don't even, um... It's like the practice didn't even know, oh, I could do this to allow for this. And it wasn't an unethical thing, it was something that was helpful.
[00:18:31] And so having someone else be able to, like, point that out and see it made a big difference for that group practice.
[00:18:38] Justin Ith: Yeah. Yeah. And, you know, knowing right to what modifiers are is not, to your point, that- that's something we're all trained in, um, uh, you know, or for clinicians to be trained in. And so this is where working with the right folks who know, be- whether it be us or others, can really be helpful to make sure you're getting the most, um, out of the revenue you're collecting.
[00:18:58] Whitney Owens: Yeah. Goodness. All right, so the denials?
[00:19:02] Justin Ith: Yeah. The denial side is always a tricky one, you know. Um, I, one of my co-founders, her name's Michelle, uh, she's been in revenue cycle now for 25 years. She's incredible hearts, um, mom of two. And, um- She taught me years ago that the heart of all denials comes from the front end and the mid-cycle.
[00:19:27] So if you can solve the front end, which is the intake piece and the eligibility side, and the mid-cycle, which is kind of noting, charting, then your denials should be gone. And a lot of people put resources and money to hire billers to go really tackle the claims and denials that come up. And the big thing that we always try to work with pri- group practice owners on, and the most successful ones I work with, put a lot of their resources much more on the front and mid-cycle.
[00:19:54] Mm. And when you do that, that's really what's gonna adjust whether or not you get those denials at all. And so that's a big piece of that, is making sure that, like, you look at your denial reasons. Is it because the, you know, you, you, you had the wrong demographic information, obviously eligibility issues that come up, secondary issues, secondary coordination benefit issues come up.
[00:20:15] Um, and being able to really look at that and say, "Okay, what do we need to adjust on the front and mid-cycle so that we stop getting these denials here?" And making sure that, like, the right hand and left hand are really talking to each other to make those adjustments.
[00:20:29] Whitney Owens: Mm.
[00:20:30] Justin Ith: Yeah.
[00:20:30] Whitney Owens: I mean, I feel like that was our biggest nugget right there.
[00:20:33] I was like, "I've never heard of it like that." I love it.
[00:20:35] Justin Ith: Yeah.
[00:20:36] Whitney Owens: Yeah. I used to work at a psychiatric hospital in the intake department- Okay ... and we always, I always believed that a client was gonna have a good experience if I could get it right on the front end.
[00:20:46] Justin Ith: Yes.
[00:20:47] Whitney Owens: You know, if the intake process messed up, if one thing was written wrong or done, it trickled through the entire experience of that client.
[00:20:54] Yeah. So it's very similar for what you're talking about. Yeah.
[00:20:57] Justin Ith: No, absolutely. I mean, for you in that time, like wh- when you were, when you were doing intake, what was that process like?
[00:21:05] Whitney Owens: Well, we, we- with the insurance piece or just in general? With
[00:21:07] Justin Ith: the insurance piece, yeah.
[00:21:09] Whitney Owens: Yeah. Yeah. So I would have to call and get the pre-authorization before we admitted patients.
[00:21:14] Justin Ith: Mm-hmm,
[00:21:14] Whitney Owens: mm-hmm. Um, so that was, that was interesting. Um, sometimes they would deny. They would say, "Well, that person hasn't done this much outpatient or this much IOP," you know? And I'm like, "Well, they're suicidal in the next room." Yeah. Like, "Give me your license and I'll let them go," you know? Um, but I also actually at that same job, I did, um, appeals.
[00:21:34] Mm. So the insurance would stop paying for someone to be at the hospital. I would get the file. Back then they were paper files, and I'd read through the whole thing and write the letters. Yeah. So I- I learned a thing or two about some parts of the insurance world, but just i- as I'm sitting here listening to you, I'm just like, wow, so many details.
[00:21:52] Justin Ith: Yes.
[00:21:53] Whitney Owens: So many details. And, and Aria, from what I understand, has a process for, like, finding those details that a human would probably even miss, right?
[00:22:04] Justin Ith: You know, parts of it for sure. I think there are... It's funny, you know, when we started this, sometimes we would go and talk to group practice owners and ask them, like, "How are you approaching this one process?"
[00:22:16] And I was surprised at times how often I was like, "I don't know." Like, "I don't know the answer." I know. That, that I ha- haven't actually thought about that. And so part of our, you know, we've gotten to the point now where oftentimes when we're going to these conversations, we're oftentimes educating practices actually of like, "Hey, this is how you should be thinking about this, and these are the details that maybe you're missing."
[00:22:38] And for example, the modifier one's a great one. Um, like, "Hey, you can be actually not over-billing, but you're under-billing right now, and you should be billing at the correct levels where you're able to get the reimbursements you're, that you're entitled to." And so, um, it's a lot of details, and there's so much room for human error in this whole thing, um, that should really be eliminated.
[00:23:03] This is a tax that all of us pay as, you know, both patients and people in the American healthcare system that we should not have to be paying. Uh, it's ridiculous- I know ... actually. Yeah.
[00:23:14] Whitney Owens: Mm-hmm, yeah. I've actually heard the average group practice loses 30 to $40,000 a year in uncollected insurance payments.
[00:23:22] Justin Ith: Yeah. I wouldn't be surprised by that at all. Okay. Yeah.
[00:23:25] Whitney Owens: Yeah.
[00:23:25] Justin Ith: A- and, and then you look at the, frankly you look at the, the cost on the practice to, um, kind of meet all the admin needs. Um, and this, again, the big one is as we're, we're talking with group practices, as they're trying to scale and add more clinicians to serve a, a greater population, you know, they look as like, "Okay, well then the amount of admin work continues to just grow, grow, grow.
[00:23:47] You know, how's that eating to my margin? How's that eating into, you know, the, the business health there?" And, um, that's a big constraint that's happening.
[00:23:56] Whitney Owens: Yeah. Yeah. Well, can you tell us a little bit more, um, we've kind of talked a little bit about Aria, but like what does Aria do for insurance-based practices to help them with some of these challenges?
[00:24:08] Justin Ith: Yeah, for sure. So, you know, Aria's a practice automation platform. Uh, so what does, what does that mean? We work with group practices, um, and specifically in behavioral health and ABA. Um, and we look at what are the rote and routine parts of the admin process that their team is doing that we could take off their plate.
[00:24:31] And so for us, that's things like, as we kind of talked about earlier, verification of benefits, doing a deep coordination and benefit check. So instead of having someone manually do that per intake, that's fully automated. Instead of having to keep checking before every single session manually, that's fully automated.
[00:24:48] Now on the claims scrubbing side, before a claim's submitted, with those adjustments we talked about, right? When you need to, you know, change the modifier or rendering provider or, or any, any other time you feel like you're touching a claim before it needs to go out, that should be automated. And I've been working in the automation industry for a long time where there's really been an inflection point, Whitney, where traditionally the ways these things have been done have been kind of rules-based.
[00:25:13] Like a, you know, click here, click do this, and then it's done. Like, it's very streamlined, right? Yeah. And healthcare administration has always faced this kind of last mile problem where it ends up becoming a human judgment need because some payer rule changed or some part of that process is, is, is, um, not what was baked into the automation rule.
[00:25:34] And because of that, we've always had needed to kind of make sure we had a lot of people at the ready to make that judgment call. You know, for the first time ever now with what we're, we're seeing in AI, there are adjustments that that judgment can actually be given and to someone like Aria to be able to go make those changes, and that causes the ability for practices and practice owners particularly to get a lot of things that couldn't be automated before can be automated now.
[00:26:02] Mm-hmm. And all has to do with kind of the insurance side. Yeah.
[00:26:05] Whitney Owens: That's really great. And then our staff can spend their time doing other things that are important.
[00:26:10] Justin Ith: Our staff can spend their time doing other, other things that are important. And in particular, you know, uh, a big piece is, like I said earlier, is, is that growing.
[00:26:18] So if you're a group practice owner and you're really adding more and more clinicians and you need to expand the amount of administrative capacity to deal with all the patients that are coming in, that's I think where Aria does best, Whitney. Mm-hmm. Is it's about instead of having to hire yet another person to, on your intake team or what have you, you can- Yeah
[00:26:37] expand the capacity of your existing one. So all of a sudden the ratio between kind of one administrative folks to, you know, 15 clinicians can go one to 50, and that's really in particular where we are most helpful.
[00:26:49] Whitney Owens: Love it. Yeah. So you have got a really nice offer for the Wise Practice listeners with-
[00:26:55] Justin Ith: Yes
[00:26:55] Whitney Owens: a month of reporting. Am I hearing that correct?
[00:26:57] Justin Ith: That's correct. Yeah. Yeah. Okay. So, um, one of the things that we offer is, um, we have a practice reporting dashboard. So what it is is you're able to look at kind of the- operational, financial, and clinical performance of your practice, and we do this by connecting to your EHR and basically giving you is a really in-depth view of that, and we're really excited to offer that to your audience for a month for free.
[00:27:21] Completely easy. Just sign up, um, and give it a shot. See what insights you can get from that, and then if you wanna keep going with there, we'd love to chat with you then, but it's completely free for your audience.
[00:27:31] Whitney Owens: I love that. Yeah. So great. Well, uh, Justin, you are gonna be joining us in Nashville, correct?
[00:27:38] Justin Ith: I am. Super excited for that. Yeah. And the karaoke you
[00:27:41] Whitney Owens: said? Yeah, so, um, we are really excited about the Wise Practice Summit, so those of you that are already gonna be there, you're gonna meet Justin in person, and he can show you the software in person. Um, but then also if you're listening and you haven't bought your ticket yet, then you better because it's gonna be a really great event, and there'll be companies like Aria there to, like, really be with you and really talk through and have these conversations.
[00:28:04] I think so many great partnerships and conversations happen in person. Yes. Um, so I'm really excited about that. There'll be a lot of other great sponsors as well, a- and plus I hear Justin's great at karaoke, right?
[00:28:15] Justin Ith: I think we said my, my fiance's the singer. I'm the dancer, so I'll, I'll, I'll go. I'll boogie out there with you guys.
[00:28:22] Whitney Owens: Oh, well, I love it. Well, this has been a pleasure, and I can't wait to meet you in person, and I'm really excited about the work that Aria's doing to make life for therapists so much easier and to help clients more. So
[00:28:36] Justin Ith: thank you. Thank you. I appreciate the time, Whitney.
[00:28:38] Whitney Owens: The Wise Practice Podcast is part of the Site Craft Podcast Network, a collaboration of independent podcasters focused on helping people live more meaningful and productive lives.
[00:28:48] To learn more about the other amazing podcasts in the network, head on over to sitecraftnetwork.com. The Wise Practice Podcast represents the opinions of Whitney Owens and her guests. This podcast is for educational purposes only, and the content should not be taken as legal advice. If you have legal questions, please consult an attorney.
