Episode 108: Understanding The Story That Your Billing And Reimbursement Tells You w. Dr. Fisayo Ositelu

This week’s conversation is with CEO and co-founder of Gentem, Dr. Fisayo Ositelu. Gentem is a company that takes a tech forward approach to giving private practice physicians visibility, to reimbursement and billing challenges that they may have.

Justin (01:22):
Hello, and welcome to episode 108 of APM success. I’m very pleased to be joined today by Dr. Dr. Fisayo Ositelu, who is the CEO and co-founder of gen 10, and I’ve invited him here today because I think what he and his colleagues are building is exciting, innovative. And I also think that the heartbeat behind this company is very similar to what we have here at APM wealth, which is wanting to, to support and enable and equip private practitioners, especially as much as possible, because I think they’re uniquely in the cross hairs of the macro trends of healthcare at large. So Dr. Fisayo, thanks for joining us today on APM success.

Dr. Fisayo Ositelu (01:58):
Thank you, Justin, for having me. So

Justin (02:00):
For our listeners out there, why don’t you share a little bit about what is it that Jen, Tim does?

Dr. Fisayo Ositelu (02:06):
Absolutely. As a gentleman is focused on really simplifying the reimbursement for healthcare providers across the board. And really our vision is a world where, you know, private medical practices, independent practitioners can stay independent and thrive, right? As you, as you alluded to earlier, there’s a lot of forces, a lot of macro trends working against the independent doctor. And so our goal is to really give them the wherewithal to be able to thrive, whether it’s through, you know, taking on the administrative burdens, things such as billing and revenue cycle management, to offering them access to financial products that essentially enable them to, you know, build and thrive and, and, and do what they to do. So that’s what we do in a nutshell

Justin (03:01):
Before this call, we were sharing a little bit about some of our experiences with the challenges that private practitioners face. Tell me a little bit about the experiences for you that have informed the way that you sort of see this unfolding for private practice. And why is it that this is part of your company’s mission statement is to equip private practitioners in particular?

Dr. Fisayo Ositelu (03:21):
Yeah, definitely. Personally I am a physician myself. I trained at Stanford school of medicine. That’s where I got my MD. I decided not to practice medicine in large part because of a lot of the administrative issues and the burdens that a lot of your audience is probably very, very familiar with. So I, I, so I went a slightly different route. I decided to get an MBA more so because really seen some of the issues out there and really wanting to have a bigger impact in the space in my community. So that’s really the impetus for, for not practicing medicine, but you know, that exposure gave me the, the knowledge, if you will, and the credibility to really tackle this space, right? Oftentimes you have folks, you know, trying to help physicians, trying to help doctors, but not really having a a good, a nuanced understanding of the types of problems. Right. And so based on that I, I, I’d worked at a little bit in the startup world and a FinTech company called NerdWallet. Some of you might be familiar with the company especially, I’m sure there’s a lot of good financial advice there.

Justin (04:41):
I am familiar with NerdWallet.

Dr. Fisayo Ositelu (04:43):
And so I was an early employee at about that’s where I got my professional career started a few years ago now, while it’s probably been eight years ago since I started out, when I started there first after that I worked in, in private equity where I ran revenue cycle management you know, businesses and we work with large healthcare systems. So think some of the, some of the biggest healthcare systems in the country, and that gave me really the, the macro view of, of really the issues that doctors are facing. I mean, it’s, as you can imagine, it’s a real, you know, a real, you know, a lot of complexity, right? There’s just a lot of stuff happening that a lot of things that you need to do to get reimbursement into the hands of doctors were working so hard. Lots of documentation having to go through denials, having to go through the technology.

Dr. Fisayo Ositelu (05:43):
There’s just a lot of things and complexity in between, you know, providing value and getting paid. Right. And and so that’s, that’s really the background and being able to bridge my experience albeit short as a, as a, as a doctor, an MD, and then bridging that with my experience in FinTech and in traditional revenue cycle management, and then really asking the hard questions, like, how, why is it so bad? Why is it so hard to get paid? Why is there so much friction of this process? There’s gotta be a better way, right? Why, why, why, why are doctors? And a lot of my colleagues are still practicing or are they getting burnt out? Why they’re getting stressed out, why they make an, a lot of money, but or some of them earning a lot, but still cannot, you know, you know, it’s still hard for them to thrive and in many ways, right. So

Justin (06:46):
I’m curious with that time with the PE firm, or are there any experiences as you think back that kind of stick in your brain that either sort of epitomized those years, or epitomise perhaps the challenges faced by some of your current clients, the private practice doctors?

Dr. Fisayo Ositelu (07:03):
Yeah, absolutely. So there, there are a number of of things. I think the whole premise suite, we ran a number of businesses, one of which was focused on underpayment recovery. So this whole, and there’s a whole industry focused on literally cross-checking and making sure that the payers are paying what they’re contractually obligated to pay. Right. And this is a massive industry And it was

Dr. Fisayo Ositelu (07:31):
So mind boggling. I’m like, wow, there’s so much complexity, sometimes shakiness. And sometimes it’s things that should not be that you literally have to hire a firm to check your contracts, crosscheck, what was paid. And then we would get maybe some, some percentage of whatever we were able to recover. Right. But coming, coming to that industry and just seeing just how much waste, how much doctors and healthcare providers were not getting paid appropriately, just really stimulated an interest in just diving deeper into this space.

Justin (08:16):
Were there any areas that you found to be the most the biggest offenders, either certain payers or certain types of payer or certain types of person without obviously like, I’m, I don’t want you to say anything that’s going to get sued, But anything that, well, I think, I think, I think there’s

Dr. Fisayo Ositelu (08:32):
Across the board. I think that’s, you know, there’s some payers than others, some commercial payers better than others. Medicare tends to be good, right. On the, for the most part, they tend to pay on time, you know, sometimes they, their reviews, but, you know, they tend to be, you know, good Medicaid tends to be some of the tougher ones, right. Whereby there challenges with payments, sometimes payment, timeliness, denials even the amount of payment. So Medicaid tends to be a little bit more challenging, but it’s, it’s really across the board. They’re, they’re different types of challenges, as you can imagine. So

Justin (09:24):
Into that environment, you decided to launch this company with your, your co-founder, who was a Facebook software engineer. Tell us about how, how you defined the problem that you were trying to solve, that you thought the solution didn’t currently exist in the marketplace, or wasn’t being found by practitioners.

Dr. Fisayo Ositelu (09:43):
Right? I think the fundamental thing, the first thing is that as doctors, we’re not taught finance, we’re not really taught enough of the business side of the house. So I would say going into this world, there’s a lot of things that were new to me coming out of medical school, medical training. Right. The fundamental question I kept on asking myself though, was why is it that doctors have to wait weeks, sometimes months to get paid? Like why, why can’t I as a doctor or healthcare, provide care when I deliver a service, you know, pay me there and then, or shortly afterwards, why is there this huge? Why is this whole process around it that could take months. Right? And so the, the, the original hypothesis is that what if we build a system and infrastructure whereby whenever you send in a claim, right, we can process that claim and pay you upfront.

Dr. Fisayo Ositelu (11:01):
We can pay you almost immediately whenever we get, whenever you processed that claim, right? What are the barriers that, why can’t this be the case? It will make life a lot easier for doctors. They’ll be able to get a better cashflow. There’ll be able to plan more efficiently. There’ll be able to invest in whatever projects they want to do, expanding their practice and things like that. So it was a fundamental question of why can’t doctors get paid as soon as they deliver value to the patient. Right. And so that got me and my co-founder who, as he said was, it was an engineer at Facebook, but even before then, he’d worked in healthcare. He’d worked at Aetna at Accenture consulting. And so he had a pretty, pretty decent understanding of the healthcare industry. And so we just asked ourselves, why can’t we bridge, you know, just the core revenue cycle management, which, which is essentially all of the steps that go into, you know, getting paid for delivering a service, what does eligibility and benefits of verifications to coding, to claim scrubbing and submission AR all that stuff.

Dr. Fisayo Ositelu (12:17):
Why can’t we bridge this core thing that seems that everyone does now billing and RCM with this very powerful concept in FinTech, whereby you can, you can actually it’s called factoring or purchasing receivables whereby you can you know, combine those two to provide a lot of value for the doctors. I think what makes us unique is the way in which we use the data, right? Our backgrounds are in, in tech, you know, we’re based in Silicon valley. And, you know, I’d worked in pretty solid FinTech companies like NerdWallet. And of course my co-founders coming from Facebook. And so th th the way they view data is very, very different, much more sophisticated. And so being able to look at the data that’s coming through the claims and the RCN, and being able to predict what what reimbursements are, what are the risks to reimbursements? Denial is a lot of very just using those data assets to really come up with a great process and ultimately accelerate revenue cash for, for these providers.

Justin (13:38):
So one of the first things I, I sorta got on what I’ll call the anesthesia and pain management conference circuit maybe three years ago. Now, if you’re going to have, and one of the things I remember thinking is how are there? So, first of all, what is revenue cycle management? This is the new Justin thinking this, and why are there like 74 different booths at this conference that all do revenue cycle management? So it’s, it’s not there’s a lot of competition, I guess, in this space for people who are doing G I’ll, I’ll put an air quotes, just RCM. So talk a little bit about the challenge or the problem with those other 73 companies or, or the way that this has been handled in the past, and what is your twist or your take, or the way that you’re augmenting through improving the way that you’re interpreting this data. How are you distinguishing yourself from this very crowded field?

Dr. Fisayo Ositelu (14:31):
Yeah, it’s absolutely. You’re absolutely right. It’s absolutely crowded. And you know, but it, the devil is in the details as they say. So what, what you see is there’s this, there’s this quite a bit of, of folks doing billing and some do it to better or worse degrees. The way we like to it is that fundamentally we have more skin in the game. And what does that mean? Because we were deploying capital because we’re paying upfront when we process these claims, right? We have a way different risk profile than somebody who’s just submitting claims and taken up a center page and just not doing the hard stuff. And, you know, the incentives are, may not be as aligned. You know, you come, you go into situations where it’s mainly folks submitting easy claims, not really stressing about the hard stuff, all the denials and being diligent about working those, the AR we see a lot of our customers coming from those kinds of situations.

Dr. Fisayo Ositelu (15:46):
The difference in Genten just very simply as we have more skin in the game, why, because we are actually deploying capital, right. Secondly, because we are, we’re deploying capital, we have to be more diligent. We have to really figure out a way to, you know, to use a technical term underwrite more effectively, right? So we’re looking at the data, we’re understanding the payer trends, looking at peer behavior, overseeing that Humana has a certain type of, of denial rate for certain kinds of claims. We’re up-to-date with the policies we’re using data to really inform a lot of our work internally, right? How we sort of prioritizing certain things. We’re certainly using automation as best as we can to just make things more efficient on the, on the, just in house for us. So it’s, it’s a combination of the more skin in the game and just the data-driven approach that we’re using to not only make ourselves more efficient, but also discover avenues to increase reimbursement and optimize process.

Justin (17:08):
I am such a huge believer in understanding alignment of incentive. And I love to explore this and all its different permutations and all the places that we can possibly find it. One of which is how does your financial advisor get paid and what do they get incentivized to do more or less of? How does a physician who is looking at an employment? What are they, what is your employer paying you to do more of, or to do less of, or what are they indifferent about whether or not, you know, if you’re on salary, that means something very different than if you have RVU targets. And I think I love this idea of understanding the incentive of your billing company and, or your revenue cycle manager, or however you want to describe them. And is the incentive, what, well, what are the, what are we incentivizing them to do?

Justin (17:49):
You know, the classic example of, well, if they make 5% of collections, then they’re going to take the, the lowest hanging fruit, or at least this is the challenge, the problem they take the lowest hanging fruit, they take, you know, they’re 5% of the, the stuff that they can get most easily, and then let the rest of it go. Because at some point they hit diminishing returns with their staff’s time. Right. I think what you’re describing, which is you’re you’re and maybe just describe the transaction. So I’m properly understanding, but it’s like an upfront payment.

Dr. Fisayo Ositelu (18:19):
Yeah, exactly. So to, to just piggy back on your point, the reason why the other shops have to focus on the easy stuff is because they tend to be more labor driven type things, right. You know, there’s the athlete factor in the cost of labor. And at a certain point, there’s a, there’s a diminishing returns that come into play for us because we’re a tech where we’re tech. We have great people don’t get me wrong. We’re still is to have people, but because of all the tech we put on the backend to make ourselves more efficient, automated, then we’re actually able to chase even the smaller dollar claims because we’ve just prioritized that on our accused. And, you know, we want to do the best for our folks. The other thing that I would say makes us unique, and we get a lot of doctors, we hear a lot of doctors complaining about this is the fact that they don’t have transparency into the process, right.

Dr. Fisayo Ositelu (19:23):
They don’t know where the data is. They get a very basic report at the end of the month. They’re noticing their AR is aging and aging and aging. And all they get is excuses. So for us in our platform, there’s full transparency. We have skin in the game. And you know, we’re aligned not to your question about how it works is whenever we submit a claim, we, we typically, as far as our onboarding process have access to, we get access to the contracts and fee schedules. So what that means is that we’re, we typically know what the insurance is contractually obligated to pay. And based on that, we’ll calculate the expected reimbursement, which is as, you know, always different from what you charge or bill out. And then, excuse me, we would now take a percentage. We would pay off a percentage of that upfront, typically 85% on average upfront, right?

Dr. Fisayo Ositelu (20:29):
And then we, that, that payment goes to the, to the doctor. Now, when the, when we get the payments from the insurance company, however long, few weeks, you know, sometimes over a month when we get that payment, the gets through remaining 15%, right. Remember I said, I meant we advanced 85%. They get the remaining 15% minus our fees. Right. Which, which depends on how big the practices and, you know, a bunch of other things. So they’re getting a guaranteed 85% upfront. And then when the actual reimbursement comes through, they get the remainder minus our fee. So that’s how it works.

Justin (21:18):
Got it. And so one of the benefits for a physician is instead of waiting 30, 45, 60 days to get those 85 cents and getting it all on the backend, right. We’re accelerating that one to two months.

Dr. Fisayo Ositelu (21:33):
Exactly. And, and, and, you know, some physicians actually opt out of that. So to be clear, not every doctor wants that, you know, something like I’m cool. I just want a, I just want more accountability. I just want more transparency. I just want, you guess, I just want you guys to do it right. Cause my, my biller sucks to use that word. Right. and so what, because we were built ourselves and our tech with that mindset of, we have to get a ride because we have skin in the game, they end up benefiting from just everything, right. It’s just like, well, we have transparency, we have accountability. And we’re tracking everything. So some, some folks choose to use the advances and some choose not to, and either way works with us.

Justin (22:25):
So the billing service that you use is a very we’ll call it an intimate relationship with a practice because it’s how you get paid and it’s very painful to replace. And so there’s a lot of inertia there and it’s gotta be like really, really bad. Or you gotta feel like this is costing me a lot of money in order to make that change. So talk a little bit about, you know, how do you deal with that inertia for the physicians, with whom you work or how do you try to ease that process?

Dr. Fisayo Ositelu (22:55):
Yeah. So that’s a great question. And, you know, I can tell that you definitely are, are plugged into this world because that’s something that we do come across. And you know, I really think it really depends on the level of, of frustration. I think for us typically the folks that are more willing to join us tend to be the ones that are just really not getting the level of revenue or impact or satisfaction that they want from their current fillers. That’s not to say that we don’t work. We work with folks that even have in-house teams. Sometimes we just amplify those teams. So for instance there’s scenarios, there’s a bunch of old AR things just aging. And because a team may not have the right expertise or the bandwidth, you know, we can, would typically can go there and just help and get them paid.

Dr. Fisayo Ositelu (24:02):
Just it’s essentially money. That’s just sitting there. So sometimes folks in the us as an extension of their team in that regard, we do projects like that, where you have all this AR aging and it’s not getting worked clearly. Right. And so you bring us on board and would help you do that. And, and one last thing is we also have technologies where we don’t even have to do the service. You can use our, our platform to do your billing because it’s just more, it’s just more robust. You can use us, we have something called a real time eligibility, which essentially enables you to figure out, in addition to, you know, figuring out if a, a, a, a patient is covered for a procedure, you can actually also estimate what their out of pocket costs would be based on their benefits. Right. And so what that does is that it helps you accelerate cash flow. We know that patient payments, you know, high deductible health plans is becoming more and more of a thing. Especially when you think about a network as well. So all those things are becoming a bigger deal. So we have software solutions to really help our providers.

Justin (25:24):
At what point is a physician seeing that information? Is it when the patient checks in, at the front desk to show up for a procedure?

Dr. Fisayo Ositelu (25:33):
Yeah. So typically the physicians don’t do it. They’re their office managers or billing staff would do that, but typically you’d have a schedule. A schedule is so the appointments and what we would do is that we have the ability to pull those appointments and run checks in an automated fashion before the patients come in. Right. Typically it’s before they come in. And sometimes it’s a week, sometimes a few days we’d get access to your schedule, just run those eligibility checks, get you the results in a batch format. And we have software that lets you know, based on what kind of visit it is what the patient’s responsibility is going to be. Obviously we’re looking at if they’ve hit the deductible and co-insurance all that, all that fun stuff.

Justin (26:31):
I’m really interested in that you said sort of segmenting AR and you said anybody or anything over like 120 days, for example, maybe if you have an in-house billing team, you just like, oh, you know what? This stuff is only, it’s probably not gonna get paid anyway, we might as well throw it to Jen Tam or something like that. That’s an, that’s something that you’re seeing practices do.

Dr. Fisayo Ositelu (26:46):
Oh, absolutely. And if you think about it, right, there’s a number of, there’s a number of things I mentioned Vander, but even just knowledge base, typically their policy policies are always changing. And so, you know, these practices may not be in a position to always train their staff, to keep, keep up with all the changing policies and rules and things like that. So you, you typically need a group to advise your support. Who does this for, I mean, this is literally what we do, right? That we invest in education. We have relationships with payers, you know, so that we can know really help folks. You know, you can focus on what you want. If you want to keep your in-house staff, that’s fine. We can just augment you and get you paid. So that’s how we do it. So

Justin (27:39):
Depending on the size of a practice and how many physicians and how many, you know advanced practice providers and other medical staff there may be, there may not be really an in-house billing solution. Maybe it’s just integrated into the EHR, or maybe there are a couple people in-house that are doing this and running down these delinquent accounts receivable. Do you have a, a practice profile that you have found for gen Tam is like, this is our, this is the spot where it really crush it, the sweet spot where this is a really good fit.

Dr. Fisayo Ositelu (28:11):
Yeah. That’s a great question, Justin. We work with a few kinds of specialties pain, pain being one of them, ortho, ortho and pain is actually one of our core specialties and adjacent to that as anesthesia. We also work with a lot of behavioral health, mental health groups. That’s a very fast growing segment. And then lastly, we do a decent amount of work with vascular vascular surgery and vein. So surgical subspecialties folks that are, you know, opening ambulatory centers. And I know that’s something that is quite quite popular and the paint, the paint community as well open the Dettori center is also popular in the no vascular surgery as well, ortho as well. So those are, that’s the cohort we really focused on. And I feel like last year, you know, mental health, the Fort for a lot of obvious reasons became a very fast growing segment. So we’ve also gotten quite a few customers in that space as well.

Justin (29:32):
So if there’s somebody out there listening and I’m sure there’s at least one who is thinking, you know, this sounds really intriguing. I’m kind of off at my billing solution and I’m I’m, I want to start shopping and I want to understand what kind of a job they’re doing and perhaps quantify it, quantify the billing efficiency in ways that we haven’t been able to in the past and start repenting other solutions. What does that process look like with time?

Dr. Fisayo Ositelu (29:56):
Yeah, so you would go to our website and request a demo and what, what that triggers is the you’d get a billing specialist to reach out to you, essentially triage and understand so what your issues are and then determine whether or not we can help. So part of that process is a billing analysis. We do offer a free billing analysis, where we look at your, your data, some of the usual suspects, the AR but we’re also looking at some less typical things, denial trends and, you know, things that because of our experience in pain, we, we look at and things that can increase your revenues and just making sure that all your T’s are crossed and I’s are dotted. So, and then we provide you a a billing analysis where we go through those things, right? And then there’s significant conversation about whether or not it makes sense if the savings or the revenue uplift would, would justify sort of switching to a new partner and things like that.

Dr. Fisayo Ositelu (31:09):
But it’s typically a more consultative type approach because, you know, there needs to be mutual value. We’re also evaluating if it’s a good fit as well, because it’s not always the case. So so that’s really our approach. We like to provide value at the minimum. You get to build analysis. And even on our website, we have a, a lost revenue calculator. Jen go to gen ten.com and you can, I think you can find it on one of the tabs last redneck calculator, where you can, it’s just a tool where you can put in some numbers and see how much money. And then we’re, we’re also benchmarking with, you know, other practices. So you see where you stand. So you use the loss revenue calculator, you can reach us for a demo and so on, you know, talk to you. And so that’s how the process goes.

Justin (32:03):
Lost revenue calculator sounds like not a place to go when you’re feeling it like in an emotionally fragile state. And that sounds like it could be, could ruin your day

Speaker 3 (32:10):
Potentially, but you’re fine. It could

Dr. Fisayo Ositelu (32:13):
Like, you know, the, the truth is sometimes you just have to see it, right.

Speaker 3 (32:19):
Always better to know the truth itself might

Justin (32:22):
Ruin your day, but it’s still a good to know, obviously talk a little bit about pricing and, you know obviously if you’re like a one man show or one woman show you’re launching a practice and everything you’re, you know, low volume there’s a, I’m sure a scale based on volume for, for how your pricing is going to work as it relates to these different services. And sh if it’s too complicated, I mean, maybe you can send me something that we can upload into the show notes, but can you give us just a sense for how you compare?

Dr. Fisayo Ositelu (32:50):
Oh yeah, definitely. I think for us, we price very similar to your, in the, some, some of the, the folks that your audience might be used to it, we take a percentage of collections and it’s typically around, and we were from 2.9, 3% to as much as 6%. I think the median is right around a 5% based on the size of the bigger, the mother volume, the lower the the percentage. But I would say that what you get for that we will provide more value for that for, for very similar costs. Right. And, and because as I said, because the field is so, you know, it looks crowded and it is crowded too, you know, you have to do a lot more to stand out, you know, so we’re, we’re venture backed from, we, we have, you know, we’re backed by some great investors, right? You know, we’re tech first company, we’re bringing in perspectives from different kinds of industries. We’re not your traditional billing RCM company. So we have, we have the ability to combine a you know, a traditional RCM company feel you would have a dedicated manager to your account. And then on the backend, we have just really, really stellar technology. And, you know, we’re, we, we like to show our product because it tells us to tell us a story.

Justin (34:29):
Awesome. Any any other parting words of wisdom or anything else that you think would be helpful for listeners to know as they’re thinking about potentially making a switch with billing?

Dr. Fisayo Ositelu (34:40):
Yeah. Well, I would say that, you know, you just asked this really do do an assessment of your current situation and ask yourself, do I have the level of transparency that I need really try to understand the goals that you want for your, for your private practice, for your business. Are you looking to grow, are you in the right place? And you’re just thinking about the macro environment as well, whereby you know, all, a lot of these private practices are getting gobbled up by large hospitals and health systems and, you know, really ask yourself, am I resilient? Do I have the ability to thrive? Do I have a plan? How much cash do I have on hand? Right. If something happens again, black Swan event, like last year, I, I, am I just going to be swept, you know, in the wind, I might do.

Dr. Fisayo Ositelu (35:41):
I have a plan, right. And hope is not a strategy as, as people typically say, right. So I think if you look at things holistically that way, and, you know, the choice becomes not like, Hey, I’m changing one billing company from one billing company to the other. It’s like exploring having a partner that kid really provided a range of, of, of services and products and value that can help me thrive, stay independent weather all kinds of storms, you know, some someone predictable and, you know, just using technology really with a proper tech company in, in every sense of the word, a proper tech company, not, not a, not a body shop, not, not some, not, not this old school type thing, like a proper tech company. And so I think once you start looking at the choice, that way, when you’re in your, in, in your mind start framing that way, like, what are you saying? I’m actually curious. I want to learn more about what is out there, right? There’s gotta be something different. I think that’s where it makes sense to engage a company like us, like gentle because that’s who we are.

Justin (37:06):
Awesome. Well anybody who’s interested in learning more, you can go to the show notes, APM success.com/ 1 0 8, where we’ll put some additional materials for your reading pleasure, as well as links for today’s show Jen Tam contact information all that stuff. So Dr. [inaudible], thank you very much for joining us today on APM success. If you liked what you heard this week, head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you Want it to leave a review in iTunes, that also really appreciate it. Thanks for using some of your valuable time to join me today on APM success.