5 Minutes with... Don Self

BC Advantage (BCA): Can you tell us a little bit about yourself and how you started your career in the healthcare industry?
Don Self (DS):
In the early 80s, after getting out of the US military, I sold pegboard superbill systems to physicians and saw a need for physicians to be educated not only on the correct codes for services but also to be educated on reimbursement issues.  I then spent years studying this before opening my own consulting firm January 1st, 1988.

BCA: Being a reimbursement consultant, how do you help your clients become more profitable and understand how to get their practice compliant with new billing and coding regulations?
Most managers and physicians have their hands full with their full time job and they cannot afford the extra time to be spent studying all of the changes in the industry.  Too many physicians are getting bad information (yeah-bad as in ... bad) from associations and managers telling them to stop taking Medicare or telling them what they cannot do.  I specialize in pointing out what the physicians can do that Medicare and other carriers want them to do to achieve the best medical outcomes while increasing their profitability.

BCA: During your 1 hour consultation, what is the single most important information you can give the practice?
Hope.  I give them hope. I point out that if they give good patient care (the kind they want their mother or spouse to get), that good money will follow.  I also point out that seeing more patients is not the answer.  I also give caution.  I caution them that just because someone has a lot of letters after their name, that does not mean they know what they are doing or that they will give the best advice.  I advise them that just because someone may work for a large medical, osteopathic, or management organization, that doesn't mean that they are going to give the best advice to the client as most have their own agenda they are trying to achieve.

BCA: You have written many publications; where do you start and source your research from so that you can give the most accurate information? How long does it take to write a book? 
I have a lot of respect for websites like Snopes or TruthOrFiction or the TV show Mythbusters.  I've been busting myths in this business long before those websites or the TV show came on.  I go back to the source to find out what the truth is.  Just because something is said by an attorney or in a magazine does not mean it's accurate or true.  For instance, I wrote a couple books on ERISA, even though less than 4% of people working in medical offices (or attorneys) know anything about it.  I went back to the actual law and read it.  You would be surprised at how many attorneys, allegedly (that's a term attorneys like) knowledgeable about parts of ERISA, know nothing about how it can make a carrier pay a claim or even make a carrier stop recoupments on claims.  Yet, the data is in the law.  I recommend more people read (and I'm talking about more than the 144 characters in a Tweet).

BCA: What does a typical work day normally entail for you? 
Since we spend 7-8 months a year traveling the country in an RV, the first thing I usually do is look out the window to see where we are that day.  Then, I start reading my emails (I get between 50 and 120 per day on average), decide which ones to answer, and work on either another book or another webinar for my website.

BCA: What made you want to start your own business? How hard/easy was this to accomplish?  
At the time, it wasn't easy, but few things really worth accomplishing are.  I think there were less than a dozen private consultants in the country back in the mid 80s doing anything on medical reimbursement, but I knew that Terry McVey had a successful company, so I asked for his advice.  I then flew to California and spent a couple of weekends with a couple of national speakers and picked their brains.  I made friends at the Texas Medicare carrier and took them to lunch so I could learn from them.  I went to HCFA (before the entertainer changed their name to CMS) and asked questions.  I threw a paper route at 4:45am, passed out business cards to doctors during the day, painted house numbers on curbs on weekends, taught medical office management courses at the Junior College (yes-I had to write my own textbook), took 12 hours of college (to get $518 a month VA benefit), and spent one weekend a month doing USN Reserve duty (for the $107 a month reserve pay).  That lasted a couple of years until my consulting business took off, as our only income was what I brought in as my wife was the full time mother to 3 boys.

BCA: What strategies seem to work best for you when you are helping a practice accomplish better profit? 
Put patient care first.  If they do that, then good money will follow-if they do it the smart way.   My policy with clients is simple.  I'll spend an hour with them on the phone, and at the end of the hour, I'll ask if they believe I just increased their annual income by at least $20K.  If they say yes, then they pay me for that hour; and if they say no, they don't owe me.  With primary care practices, it's been years since anyone said no, as most see upwards of $50K a year based on that hour.  With some specialties, I refer them to others who can do a better job for them.

BCA: When helping a practice with billing issues, what is the number one issue you see that they are not billing properly for? How hard/easy is this to help fix?  
Most physicians have no clue as to what they're missing.  It's like the old adage "You don't know what you don't know."  That is very true.  Too many people do things today the way "it's always been done," without knowing why they do it that way.  For instance, the woman who cuts the end off the ham when she cooks it doesn't know that the reason her mom taught her that way to cook was because her grandmother's pan was too short.  Yet, they keep doing it.  Too many offices under-value the physician's time or they allow the computer software to pick the CPT code level to bill.  Many do not realize that the clearinghouse that contributed to the software algorithm to determine the code is owned by a major insurance carrier that benefits when the code is under-coded.  Most physicians rely on their office manager to tell them what they can and cannot bill and the manager was taught by another manager-so they keep doing things the old way…

BCA: To you, what has been your greatest achievement so far in your career?
Great question.  I know there are some patients alive today because I taught a physician the importance of detecting ANS problems (when I taught the doctor about the benefits and profitability of doing specific testing).  I know that some patients have avoided a needless amputation because a physician listened to me.  I know that some patients were helped by a physician that listened when I said "Why not?"  Yes, I've helped a lot of practices make millions in the past 30 years.  I've helped a lot of practices avoid bankruptcy in the same period-but it's not the money.  I've made a difference in patients' lives because physicians listened to me when I gave them advice.  What more could I ask for in an achievement in my career?

BCA: Is there anything else you would like to add for our readers?
If someone ever says you can't bill for this, make them prove it.  If a carrier says you must refund to them on a patient's claim, learn ERISA and stop them immediately.  If your family practice association tells you to stop seeing Medicare patients, quit that association-as they're hurting you.  The most profitable patient any primary care physician can see is a Medicare patient, and I can easily prove it-I don't care where you are.  No matter where you are in this country, your patients are no different than they are anywhere else.  They all want one thing.  They all want someone that is going to listen to them and give them the kind of care they want their own family members to receive.  If you give that kind of care, you will be successful-if you're smart.