Funding Sources in Private Practice: Medical Billing & Creative Solutions

This is a transcript from our podcast episode published October 31st, 2022. The podcast episode is offered for .1 ASHA CEU (intermediate level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.

A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.

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S4 Brandon Seigel

[00:00:00] Kate Grandbois: Welcome to SLP nerd cast, the number one professional resource for evidence based practice in speech, language pathology. I'm Kate Grandbois 

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[00:01:43] Kate Grandbois: Hello, everyone. Welcome to today's episode. We are really excited to welcome Brandon Siegel onto the show. Brandon, thank you so much for being here. 

[00:01:53] Brandon Seigel: Thank you, Kate. I am so excited to be part of all our S L P nerds [00:02:00] and beyond it. It's really exciting for me. 

[00:02:02] Kate Grandbois: You know, you, can't not mention the name I've had so many people be like, oh, interesting name.

It's you're in the right place. I feel like you're, you're a business nerd. You're a medical billing nerd and, and here we are.

[00:02:12] Brandon Seigel: Absolutely. I I've got, literally when we, we started this, you saw my little Doppler twin of me, which is basically a nerdy kid with glasses. Um, the only thing that was missing was the beard, which, uh, came later in life.

[00:02:27] Kate Grandbois: That's. That's wonderful. That's great. Well, we're really glad to have you here. I know you and I have touched base multiple times before we hit the record button. Then you've taught me a lot and I'm really excited to share your knowledge with our entire listener base. You are here to discuss funding options in private practice.

So selfishly I'm in private practice. I'm very excited to learn from you today, but before we start, why don't you tell us a little bit about yourself? What, what brings you to the world of funding in private practice?

[00:02:54] Brandon Seigel: Well, couple things first and foremost, everyone should know that my wife, my mother-in-law, my [00:03:00] brother-in-law are all therapists and, um, I've always been a business person, even though if you talked to me as a child, I would tell you I'm not a business person. My parents kept telling me until one day I had that awakening. And so when I had that awakening, it just, it's a natural muscle for me. And I really have found that, although I was bad at math as a child, later in life, I really became just great at, uh, communicating numbers.

And I say, it's one thing to understand numbers. It's another to communicate. And so, as I started recognizing the importance of a business algorithm in a private practice, I recognize that I could help solve problems. And so it started with my mother-in-law's practice that had more money than I want to share outstanding, um, with major insurance headaches, and basically she was working for free.

And, um, it turned into me saying I have to solve this problem. And so throughout that process, I not [00:04:00] only learned how to medical, to bill all the insurance, but I really navigated the funding sources from all different ways of funding, more than you can imagine. And I kind of came up with this business algorithm of helping private practices, diversify their funding and solve their funding issues in creative ways.

[00:04:21] Kate Grandbois: I'm so excited to learn more about it because as many of our listeners probably know, funding is a huge headache. We don't go to school for this. I won't share the abomination of my personal math skills. I live in Google sheets and Excel, um, and we're clinicians by training and it's really our passion.

Most of us, to focus on our clinical work. But as many listeners know, if you work in private practice or have a private client on the side, you can't work on your clinical work, focus on your clinical work if you're not getting paid. So unfortunately these business aspects are a critical piece of what we do for a living and.

We're [00:05:00] really grateful for people like you to show us the ways, show us the money, so to speak.

So you told us a little bit about your background, but you also have, uh, a podcast. You're a fellow podcaster, as people who are watching on YouTube can see with your fancy mic.

[00:05:14] Brandon Seigel: I am a fellow podcaster, so I have a love- hate relationship, but I love it because people love it. And it's called the private practice survival guide podcast.

It's on everything streaming, apple podcasts, Freaker, you name it, uh, iTunes or I apple the whole bit. So the private practice survival guide podcast with Brandon. 

[00:05:38] Kate Grandbois: That's awesome. Um, and I know that you are going to get into some pretty heavy duty stuff with us today. For those of you who are listening, if you are not at all familiar with private practice, this episode is likely not for you.

I think the content that we're gonna talk about today is intermediate. We're gonna be talking about billing codes. We're gonna be talking about EMR [00:06:00] systems, insurance liability. So if you're already in private practice and either thinking about dipping your toe into the insurance world, or you're already there and wanting to scale your business, then this is the episode for you stay tuned.

Um, I also wanna say that we're gonna cover a lot of ground today and you have a conference coming up where our listeners can learn even more. Do you wanna tell us quickly about that?

[00:06:21] Brandon Seigel: Absolutely. So we've got a conference called the growth code conference growth code conference.com. Um, it's designed for occupational physical speech, language pathologists.

We have, uh, private practice owners, private practice managers, office managers from coming all over the country to join us February 23rd through February 26th, we've got, uh, tons of content, lots of speakers, general sessions, we're covering marketing. We're covering HR, we're covering medical billing the whole bit.

We've got a lot of fun stuff, uh, coming, coming to everyone's way. So it's gonna be in sunny, Florida, February 23rd to 26th. 

[00:07:00] Kate Grandbois: So, everything [00:07:00] that we talk about today is going, is just a little bit of a tip of the iceberg. There is more out there, um, medical billing and in private practice management is a whole career's worth of information.

And there's absolutely no way we are going to squeeze it all in. Um, but we'll list everything in the show notes for anybody who's listening, jogging, folding  your laundry. Um, if you are after, after this episode, if you wanna go out and learn some more.

Before we get into it, I wanna take a minute to read through our learning objectives and disclosures. I'll get through them as quickly as possible. Learning objective, number one, describe the difference between private pay and insurance models of funding and private practice.

 Learning objective number two, describe at least one creative funding solution in private practice and learning objective number three, list two strategies to minimize administrative burden when billing and private practice. Disclosures Brandon Siegel's financial disclosures brandon is the owner and founder of wellness works [00:08:00] management partners, which provides services related to medical billing, marketing, HR services, business, coaching, and consulting, wellness works management partners is the producer of, and has direct financial relationships with the growth code conference, which will be mentioned during this episode, Brandon Siegel's non-financial disclosures.

Brandon has no non-financial relationships to disclose. Kate, that's me, my financial disclosures. I am the owner and founder of Grandbois therapy and consulting LLC, and co-founder of SLP nerd cast. My non-financial disclosures. I'm a member of ASHA, sig 12, and serve on the AAC advisory group for Massachusetts advocates for children.

I'm also a member of the Berkshire association for behavior analysis and therapy, mass ABA, the association for behavior analysis international and the corresponding speech pathology and applied behavior analysis, special interest group. Okay. Let's move on to the fun stuff. I'm almost out of breath from reading that, which is horribly embarrassing, but let's, let's get into the first question.

So why don't you tell us a little bit about the different types of funding sources in [00:09:00] private practice? 

[00:09:01] Brandon Seigel: Absolutely. So it's so funny because we, we get into this field and all we think is usually three different funding sources. We think of, uh, obviously insurance, which is our medical model. And then we also think of schools because a lot of us will subcontract or work for the schools.

Um, and then usually we think of this thing called private pay cash, but a lot of us don't think it exists in our field when it does, but there are so many different funding options beyond that, just to unlock some unique perspectives. Real quick. One is government contracts. A lot of us don't know there's government contracts that will pay for services, um, related to speech therapy.

And you might not even know it. And sometimes it's county based, regional based. Sometimes it is, you know, government funding, like early start DBS, D B all that stuff. So, um, the other thing that we're seeing a huge, huge growth in right now [00:10:00] is, uh, what's called self-funded employer contracts, where companies are now investing to say, I want a special SLP benefit for my employee's children.

And I want an AAC benefit and all of these things where employers are doing self-funded healthcare coverage, but they're adding in direct contracts with local providers to be on site or in the area to support their employees. So there's a huge, um, market right now in what I call self-funded employer gain, uh, other creative things.

Obviously there's nonprofit funding there's, um, you know, different ways in terms of, uh, different types of school contracts. And so we're, we're definitely seeing also subcontracts related to skilled nursing and things that are just not tied to the, the you accepting insurance. So sometimes we think of either accept insurance or [00:11:00] accept private plan.

There's nothing else there are different. Um, even just aging and place contracts. Um, there are grants, there are, um, again, I'm thinking on the cusp, but I, I would say that there's at least 25 different funding sources and we only think of three. Um, and so sometimes it's understanding what our role is in the community and aligning with who has budget connected to that.

Um, because there are groups that will just pay for your services. Um, and sometimes as a speech language pathologist you'll even get paid cash as an organization from another organization, like an ABA company. Um, there's a lot of creative ways to kind of connect your services so that you're not just stuck in one funding source um, as your solution. .

[00:11:47] Kate Grandbois: So right out of the gate, my mind is blown. I've been in private practice for 12 years. No longer than that. I see. I don't do math. That's fine. It, it, and I, I think up until now, I [00:12:00] probably, I knew about private pay and I knew about insurance and maybe one or two other things like I've done school contracts, for example, but I love the perspective of thinking about connecting your services with budgets who have money for you to pay your services, because it's, it sounds like there are such a wider variety of options to choose from.

[00:12:23] Brandon Seigel: Absolutely. And I had picked on the employer benefit because that is the biggest thing right now that's changing. Um, you know, in terms of employers right now are seeing they're expecting like 50, 60, 70% increases to premiums in the coming year because of COVID. Oh, so they're looking at alternative healthcare services. So what if I could change? And I, I'm going to get Kate's company catastrophic coverage for all her employees. I'm gonna get them a telehealth subscription. And I'm also gonna get a subscription to a local speech provider for their kids, because I know that our families really [00:13:00] value therapy.

So we're gonna create a monthly subscription where we do what's called a capitated contract with them versus a fee for service contract. So there's all different ways to kind of think outside the box to help each other out. 

[00:13:13] Kate Grandbois: Okay. So if you're a clinician listening to this episode, you're and your mind is blown like me and you're thinking, okay, well I have a small roster of clients or I'm look, I have a small practice and I wanna grow my practice.

I think, would you, is it fair to say that insurance is still a primary or large avenue of, of funding or something that's at least worthy of our attention to get credentialed and set up 

[00:13:41] Brandon Seigel: a hundred percent. So. The medical model is a model, especially as we, as we head to a recession, people are going to lean more on what coverage they have than selective private pay.

Now it doesn't mean we can't get creative with private pay as we'll talk about later in the episode, but especially with speech, I [00:14:00] think it's a cornerstone and I think speech therapy right now, um, in almost every state, I can say you can be sustainable through insurance as we'll just say, 50% of your funding model.

I'm not telling you to be a hundred percent funding model, but I think that there's a, a place for 50%, but the other thing we have to look at Kate, when we look at your business algorithm, like when I talk about your business algorithm, what I'm talking about is your employees, your overhead, all the pieces, what comes in and what goes out in expenses.

There's a big difference if I'm talking to Kate and Kate has 50 therapists versus Gina who has two therapists. When Gina only has two therapists, there is a supply and demand thing here where we, we have more control. We might not need insurance because there's less of us to go around. But when we've got 30 therapists that want full-time work, we're gonna need to play in the insurance game.

It's not a matter of if it's when, unless we're really [00:15:00] a school contracting company, insurance is gonna play a big part. So what I wanna say is that when we have a lot of therapists, we're gonna lean on government contracts, school contracts, insurance contracts, that's our primary cash flow of our practice.

And we're gonna utilize private pay and creative funding sources for some of our unique outliers and identifiers of what separates us as an organization. 

[00:15:25] Kate Grandbois: So to say that back to you, it sounds like it's fair to say if you're operating in a business model where volume is a part of your revenue stream. So you're not seeing 10 clients a week, you're seeing, I don't know, you've got 17 people working for you and each of them has a caseload of 20 that's when you really start to lean on insurance as a, as a backbone of your practice from a funding standpoint.

[00:15:48] Brandon Seigel: uh, I would say the combination of insurance and what I'm calling government contracts.

And I consider school kind of under government because of the government.

Kate Grandbois: Yeah. That makes sense. 

Brandon Seigel: Funded [00:16:00] mm-hmm so I would say those two entities are more of transactional funding. I do it. I get paid. I do it. I get paid. There's a reliability, there's a consistency. I go to the pool, I stick my straw on it and I drink some, some revenue, so to speak.

Um, 

Kate Grandbois:sounds lovely

Brandon Seigel: So , so those two factors play a part when I've got overhead to support, that's greater than just. A couple couple of us playing, playing in the pool. 

[00:16:25] Kate Grandbois: Okay. This is a wonderful analogy. I feel relaxed, like I'm sipping on a cocktail, sitting on a pool on a pool side somewhere instead of, you know, buried under the horrible paperwork that is insurance funding.

So, so let's talk about that a little bit. If we're really thinking about the kinds of funding sources that are available. Um, I, I know so many private practice owners who deliberate for a very long time as to whether or not to start accepting insurance because of the administrative burden that comes along with that.

And I know we're gonna get into that when we start talking about our [00:17:00] third learning objective, but let's talk a little bit more about the logistics and structure of insurance funding models. Um, what would you say are some of the key necessary pieces to bring that into your practice? If you don't already have that set up.

[00:17:21] Brandon Seigel: Well, the first thing I, I actually wanna just talk about is when we're dealing with insurance, we actually have two different buckets that we can pull from in network out of network.

[00:17:30] Kate Grandbois: Oh yes. Yes. It's like a decision tree. It's like private pay versus insurance and then insurance is broken up into two of them.

[00:17:38] Brandon Seigel: Or we could also say one is an RV and one is a plane. I don't know if you've heard that radio ad for RVing, but it makes me never wanna step on a plane. It's got kids screaming that you're on the runway and like, it's really awful. So there's what I call air travel. And today we'll call that insurance and then there's RVing, which is out of network.

We call that out of network. [00:18:00] Um, there's good and bad in both circumstances. 

[00:18:03] Kate Grandbois: Interesting. Okay. So, but one sounds a lot more like fast and one sounds a lot more luxurious is that, is that intended? 

[00:18:11] Brandon Seigel: Um, depends how you play it. So let's say it this way. We're gonna, we're gonna start with in network. So why do we accept in network?

Because we can get more clients. It's a marketing action. I just wanna be transparent when people are accepting insurance as an in-network provider, you have a bigger pool of people that want your services, and you might not have enough of a differentiator to pull outside of that bucket. So you sacrifice pay in order to tap into the pool of in network, uh, clients subscribers.

Now we're gonna put that to the side and we're gonna look at out of network out of network allows you to name your price. You have price control. [00:19:00] So a lot of people like out of network because you are not subject to the in network rates. Now within the out of network bucket, I wanna make sure everyone understands.

There are three different ways that we can play the out of network game. The first is we accept assignment of benefits and we submit to insurance. So it feels similar to in network because we're waiting to get paid by insurance. And we're submitting the claims on behalf of our client, our subscriber, but we get to name the prices.

So we're not subject to contracted rates. We have our fee schedule and whatever the out of network covers they cover and they will pay us and we will charge whatever the responsibility is of the patient. If they don't pay, we will charge the full rate that we charge the client, the, the insurance to our client.

And that is what I [00:20:00] call out of network accepting assignment of benefits,. 

[00:20:06] Kate Grandbois: AOB I know that acronym, a AOB, AOB assignment of benefits. So just to again, say this back to you so that people are following along, we've got insurance divided into two categories in, in network and out of network and out of network this is where you are billing insurance directly. And, but setting your own fee schedule and assign and accepting the AOB, the assignment of benefits. 

[00:20:30] Brandon Seigel: So that's one bucket. 

[00:20:33] Kate Grandbois: That's one of them, three options, three options for out of network 

[00:20:36] Brandon Seigel: three. So that's just one. 

[00:20:38] Kate Grandbois: I'm gonna guess that one of them is a super bill.

Yep. Why don't you tell us about that one next.

[00:20:42] Brandon Seigel: So the second one is, Hey Kate, here it is. I'm gonna take your money. $185. Boom. Give it to me. Here's your receipt, your super bill, your codes, my MPI, everything you do, what you want with it. You submit it to insurance and there's a good chance that you're gonna get reimbursement if [00:21:00] you take the effort to do it. And if you need anything more like copies of my notes or whatnot, let me know. So we've got 

Kate Grandbois easy peasy wash my hands of it. That sounds great to me,

Brandon Seigel: polarising energy. So one is, oh my gosh, I'm still responsible, but I'm getting my rates. The other is like, give me my money. Here you go, go have at it, whatever you get, you get and you're on your own.

Right? So then there's the middle bucket. 

Kate GrandboisOh, I didn't know that there was a middle bucket. 

Brandon Seigel: so the middle bucket is I'm gonna charge you Kate, $185. I'm gonna submit. I know. Everyone's like, why did you come up with that, that dollar amount?

[00:21:37] Kate Grandbois: I'm like, should we have a conversation about setting your rates?

Maybe that's another episode. Anyway, keep going, keep going. Don't we're in the middle bucket. 

[00:21:44] Brandon Seigel: So we're in the middle bucket. I charge $185. Kate pays me $185, but rather than me give her a super bill. I'm gonna submit the claim to her on her behalf, but I will not accept assignment of benefits. So the insurance will pay Kate, but [00:22:00] meanwhile, I've saved her a step by submitting the claim for her and I'll know right away if it gets rejected or processed or whatnot. So I am speeding up the process and I'm doing a little bit of work, but I'm not necessarily getting hit by the cash flow, waiting to get paid by the insurance company.

[00:22:17] Kate Grandbois: But you're also taking on some of the administrative responsibility as a courtesy to the family versus the super bill where you're just giving them a bill and walking away with your cash.

[00:22:28] Brandon Seigel: And here's the other kind of curve ball. Are you ready for one more curve? I wasn't prepared for a curve ball. So here's the curve ball. This is I'm giving a disclaimer, this not advice. It's just a perspective. You gotta deal with it and think with it and check with your accountant, lawyer, everything. So don't boy don't hold me to it, but there is a world when we are what I call a private pay practice that offers the opportunity of out of network where we don't accept assignment of benefits that we say, look.

Here's your super bill, but if you want us to submit, we have a [00:23:00] subscription price for us to submit on your behalf. So you charge Hey, $50 a month and we'll do all your submissions for you. 

[00:23:08] Kate Grandbois: Interesting. So it's like a, you're charging the family for an administrative service. 

[00:23:13] Brandon Seigel: for, for, to save a, save the energy. And we're not under contract with an insurance company.

So it's not looked at a surcharge or anything. It is an elective that, uh, you know, service that we are offering. Hey, you know, you want us just kind of like, Hey, you want us to offer you 30 minutes of childcare while you wait to come back for your child, we've got childcare as well. Um, interesting. It's just an alternative way to say.

We know that sometimes the burden of submitting is worth extra 50 bucks a month. And so for you to submit all the claims on our behalf, like it's worth it and it's month to month, you can cancel it anytime. 

[00:23:50] Kate Grandbois: Interesting. That definitely sounds like a, I wanna have a conversation with my accountant and attorney first kind of flavor, but it's really, that's a very, talk about creative [00:24:00] solutions.

That's a really, really interesting, interesting perspective. Okay. So we've got our under our insurance umbrella, we've got in network out of network. You've walked us through these three options for operating out of network. I only knew of the super bill. Um, so that's really helpful. But when we start talking about going in network, I feel like that's where a lot of clinicians start to get like hives.

Like I, they reimburse sets such lower rates than private pay. You take on all of this additional administrative burden. You become a covered entity, et cetera, et cetera, et cetera. So where do you even, I'm, I'm curious to hear where you're even gonna start going down this road. with, so with the in-network piece.

[00:24:43] Brandon Seigel: So the first step is I think you have to have a vision of what you're trying to do. When you're going in network, usually there's two things that impact that decision. One is what I call scale, the size of what you wanna produce. And the other is accessibility that you wanna make your [00:25:00] services more accessible to those who might not be able to access it.

So that's the first, that's the why, let's define the why. The next thing is we have to reach out and find out what fee schedules are current. You would be amazed by how many people go in network and don't know what the rates are. And I literally just had a meeting last week. I think it was yeah. Last week with, uh, a client that they reached out and they're like, look, we wanna know how to bill OT PT speech.

And they're like, can we find out? And it was one of my 30 minute free strategy sessions. So they went, they credentialed, they contracted, they did everything. I said, do you know how much you're gonna get paid? They said, no. So why would you contract, like, would you sign up for a dinner without knowing how much the dinner's gonna cost you?

[00:25:49] Kate Grandbois: but how do you find out?

I always, and maybe this is wrong, but we're gonna be vulnerable here and having have a learning moment for the entire audience to understand something better. How do [00:26:00] you even find out? I was always under the impression that contracts between insurance payers and providers were under lock and key. Once you had that contract, you, you, weren't supposed to talk about insurance, not to mention talking about money makes people uncomfortable to begin with.

[00:26:13] Brandon Seigel: So technically speaking, yeah, and in network providers should not be sharing their rates with you and what they get paid might not be what you get paid. So what you need to do is part of your utilization management process, which is where you're connecting with that, is you need. So I always say, um, the more power that you have, the easier it is to get what you want. 

Kate Grandbois: Touche.

Brandon Seigel So if a client comes to you and says, I love for you to work, my insurance. I have the client call their insurance and say, I have a provider that I want, I can't find anyone in the area. Can utilization management help me connect you with this client? And that might sound weird, but like, literally I start in that way, cuz I've got the power.

Now it could be that the, what they do is they come [00:27:00] to me and they say, Hey, the, we need you as an in-network provider. My first thing is I need your fee schedule. Show me your fee schedule. Sorry that fee schedule won't work. Well, then they may do a letter of memorandum or a memorandum of understanding, which is like a single use contract in which you can name your price for that client.

And then upon, depending on how many people they end up meeting you, they may grandfather you in to that in network contract at the rate that you want. That's the first thing to understand that sometimes when you hold the power, you actually can negotiate. And so sometimes a patient saying, I don't have a provider of the quality I need within your network.

I found someone, can you work with them to either create a letter of understanding or whatever you wanna call it, a single use contract with this provider. Um, and sometimes they'll also just bring you [00:28:00] into their end network. So that's one thing. The second thing is you can contact the insurance and I get, you were like, I never get a call back.

I never got an email. It might take you 60 emails and calls. You've gotta be persistent. You doing it once, twice, three times. Do I seem like someone that lets you drop the ball? No, I'm like, I'm gonna chase you down.

[00:28:20] Kate Grandbois: Your little avatar was very intense. I will, I will give you that 

[00:28:23] Brandon Seigel: very intense. And I'm currently, so I'm currently contracting with someone right now that I said.

Literally like every other day, I'm like, Hey, I haven't heard back. Where are we at? What's your timeline? Who do I need to talk to, et cetera, because we know staffing is hard, but I also throw my patient minions on the insurance to say, I need you to contract with Brandon. I need you to contract with Brandon.

I need you to contract with Brandon. It works. Um, but, 

[00:28:49] Kate Grandbois: but you have to create that leverage because we don't have that leverage, 

[00:28:53] Brandon Seigel: create the leverage. If you don't have that leverage, then you have to be a squeaky wheel where you call and you say, I [00:29:00] understand you sent me a contract. I need to know the rates do not sign a contract.

Is it based on CMS? What is that? If they say to you, well, you need to sign that contract before we'll share the rates with you. Don't do it. Don't do it. 

[00:29:19] Kate Grandbois: That's really great advice. And I think that many of us feel beholden to whatever the insurance company dictates. We don't see ourselves in positions of power, or we don't see ourselves as, as being individuals who could create leverage or create more of that position of power. So that's, that's tremendous advice. I'm wondering. 

[00:29:40] Brandon Seigel: just so that everyone understands, because I work with insurance throughout many, many states, Medicaid only works in very few states and I just wanna be very transparent.

And this was the mistake that the, this other group did is they contracted with Medicaid, not realizing it's $32 and 50 cents [00:30:00] for a visit. Okay. 

[00:30:02] Kate Grandbois: That is, That is not clinical staff rates. So that is not clinician rates that's horrifying.

[00:30:06] Brandon Seigel: But then I can go to Texas and get 86, 50 or 88, 50 or whatnot for 9 2, 5 0 7. So each state is different. But what I want you to understand is the majority of states Medicaid. There's a reason why people don't accept it. So if you're like, no one takes Medicaid, so I'm gonna go take it. There's a reason why, well, Brandon, there's this underserved.

Then they need it. I go, you're gonna lose money. You're gonna lose money. Well, how do the hospitals do it? How do the healthcare systems do it? Totally different contract. It's not the same contract. 

Kate Grandbois: Wow. 

Brandon Seigel:So first and foremost, it's very hard. If you're not in Texas or a couple other states, it's very hard to work with Medicaid, California, New Jersey, Florida.

Good luck, uh, Florida, you can do it, California, New Jersey. I have yet to find a private practice who's not a nonprofit who does not have grant money or other things to offset it. [00:31:00] Who can do Medicaid now by and far, I'm gonna throw this out there. A 9 2, 5 0 7 reimburses for commercial insurance or, um, some HMOs, usually between $55 to $98 is the average for that 9 2 5 0 7, just so we know that language code. Now, what wear speech is able to optimize is a lot of speech are getting into feeding and they're pairing a 9 2 5 2 6 feeding code for myofunctional. And myofascial all that with a 9 2 5 0 7. Well, now all of a sudden they're doing that untimed code.

They're doing two units within whatever they decide is needed. 30 minutes, 40 minutes, 45 minutes, whatever they dictate. And now they took quote, unquote, let's just say $55 and $55. Now they're getting $110 for that visit. Right? That's how they're making in network work, just so we know, [00:32:00] 

[00:32:00] Kate Grandbois: right. Combining different codes.

And if you're listening and you haven't explored the different combinations of different CPT codes, uh, the American speech and hearing association website does have a good, I'd say gateway, uh, website into how the different codes can be used, what the different codes are for. Um, but that's, that's a really, really awesome suggestion.

And I, I think as I mentioned, so many of us feel beholden to what the insurance companies say we can do. It's a very intimidating, particularly if you're a small practice trying to grow, um, you know, you sign, sign away in blood on the dotted line and cross your fingers that you don't commit some sort of break some sort of rule or, or, you know, infringe upon some law.

Because once you sign that contract, you do become, uh, become what's called a covered entity, correct me if I'm wrong and you are beholden to additional laws and regulations. Can you tell us a little bit more about that? 

[00:32:57] Brandon Seigel: Yeah. And I'm gonna jump to that, but I wanna [00:33:00] just finish one thing on, on the code thing.

Um, just because there's codes does not mean you can use the codes, does not mean that just because you can use the codes does not mean you'll get paid for the code. Just because the codes are approved as a benefit does not mean that insurance has to pay for that code. So there's a lot to understand in terms of exclusions and evidence of coverage and all these factors, whether it's in network out of network and whether you can code things together.

A lot of times I'll see people reference ASHA and there's a lot of great info in ASHA, but there have been some management codes that were misquoted and are illegal to be used. So please check.

Kate Grandbois: Interesting. 

Brandon Seigel: Please check, because some of these management codes should not be used depending on insurance and location and all those things.

So a lot of the times what a coding professional will do is they will check their AAPC. Again. I'm gonna say it one more time. AAPC is a coding professional association, kind of like [00:34:00] you have your Association. It is, in my opinion, the elite of medical billers, they've got certifications that you take crazy tests for and et cetera, they have a product called codify.

And in that codify, you can check codes together as what's required, what the requirements are, et cetera, just in terms of coding regulations so that everyone 

[00:34:20] Kate Grandbois: I'm laughing because I was in there this morning. there you go there, you, I didn't know I was using an elite database or an elite service, but that's good to know.

Um, they have some info, they have a paid service, but they also have some good free information on their website as well. 

[00:34:37] Brandon Seigel: They have both. And I think that even everyone always asks me, like, where should I go to learn how to bill? And I say, there's not a direct, here's how to bill as a speech language pathologist.

There's not, but there are some good classes and courses and things that you put together. And sometimes it's about understanding Medicaid and Medicare. Which there are some great [00:35:00] resources out there for that. And sometimes it's going to ASHA and sometimes it's going to private practice specialists, and sometimes it's going just to the coding world, like AAPC and codify.

Um, so all of that is helpful, but let's get back to your question, which is kind of the liabilities of being in a network provider and kind of doing that. So we find out, you know what, Brandon, I'm going in network. I'm gonna make the pricing work. Um, so you need to make sure that you're paying your staff correctly.

You need to make sure that you have that business algorithm of how much should I pay for therapy. So I'm gonna give you one nugget real quick. I know this is kind of a, I just wanna give a lot of content for you all. 

[00:35:43] Kate Grandbois:I I'm, I'm here for it. Do it, 

[00:35:44] Brandon Seigel: your revenue that a therapist generates, they should never take more than 60% in total cost of the revenue they generate.

 So if you accept a rate in this case, that's [00:36:00] $55. Okay. And of that $55, you say, you know what, Brandon, I don't wanna do a 30 minute visit. They need an hour. Okay. So at the end of the day, if we were to say, what am I paying them? You're total cost taxes, benefits, everything cannot exceed $33 for that visit.

[00:36:18] Kate Grandbois: I think that's great advice. And I, um, I joked earlier with the, with the margins comment, but this is something that I learned sort of on the road. And when you do math by looking at the percentage of visit, it's a really, at least for me as a practitioner who is not a mathematician, uh, it's a really nice way to keep your profits and your revenue in check.

As you build things along to make sure you're not accidentally cutting into a budget too steep, or, you know, you, you have enough room for overhead. And I, I think that that's, that's very sound advice. 

[00:36:51] Brandon Seigel: Yeah. So we wanna know. So when people say what's my, what should I pay my therapist? What's my productivity.

It all comes down to the revenue they generate and I'm getting 60%. [00:37:00] And us just basically financially modeling what that looks like. Here's what 60% productivity looks like. Here's what 70% looks like. Here's what, 75% productivity. So sometimes we build a base payoff of 60% productivity and we bonus of both, there's all different ways to play the tricks.

But getting back to in network insurance, we accept the prices. Okay. I'm, I've, I've made a deal with the devil, so to speak and some of these insurances are the devil. So then we need to understand what does it take? We need to make sure we're credentialed. We need to make sure that we have software that allows us to submit electronically.

And ideally, we also set up electronic payment, the ERA electronic remittance. Um, and so these are all factors that we want to structure. The other thing we need to understand is how long it takes to get credentialed. And how does it work in terms of if someone's not credentialed, um, what are our rights and what is right and what is wrong?

[00:38:00] There's a lot of great areas. So like, one of the things is, can I, bill, can I have this, uh, therapist, bill under me because I'm credentialed with insurance, that's a gray hole that is an abyss. And it's like, well, I do that for my CF. So can I do that with someone? Depends. All I'm gonna say is it depends.

There are insurance companies that, that will tell you under no circumstances, can the rendering provider not be the credentialed provider. 

[00:38:31] Kate Grandbois: Interesting. So there's a, and it's really a case by case basis. You really have to know exactly what your contracts are, what your payers will and will not allow

[00:38:37] Brandon Seigel:. And you have to ask the right questions, not set them up for the answers that you wanna hear.

[00:38:47] Kate Grandbois:I love that. It's not manipulation. It's smart communication. Yep. Yep. It's wise. It's good question asking. Okay, so, so let's say, pretend you've, you've gone. You've made a deal with the devil, as you said, I [00:39:00] love that expression. And not only now, are you beholden to being credentialed and using an EMR, but there are other requirements as well. Can you tell us

[00:39:07] Brandon Seigel:, so we're credentialing, we've got the EMR system. We gotta verify eligibility. We gotta make sure we're getting authorizations. We need to make sure that we're disclosing. Um, obviously what the, the out of pocket max would be for them. Um, it's called a good faith estimate. Ironically side note, my mother-in-law called me and said that she was chasing down all her providers for one of my father-in-law's procedures, asking for a good faith estimate.

I'm like, you shouldn't have to ask for it. They should already provide that to you. 

Kate Grandbois: Right. Right. 

Brandon Seigel: You know, things like that. The other thing I wanna make sure that everyone knows is that when you are in network with an insurance company. You are not most contracts. I'm gonna say it this way. Cause I don't like to talk in black and white.

Most contracts will not allow you to see a client unless it is through their funding source for a [00:40:00] medically covered service. So if Kate has blue cross and I accept blue cross and Kate says, Hey, Brandon, I just wanna come to you private pay. I don't wanna use my insurance. The minute you hear she's a blue cross subscriber.

It is blue cross or nothing, honey. Like they have no middle ground there. So you have to recognize that there is this component where I said, Kate, I'm an in-network provider. It is, you have disclosed that you are a blue cross provider. I must treat you through your insurance. I have, I I'm obligated by my contract.

Now, if something's not medically covered and it is not a medical necessity. Then you need to have a release form that helps 'em understand that they are signing up for elective services that are not part of their medical benefit, that they understand that their insurance will not be held liable in any form.

And that I like to say, this is recreational and elective solutions that you are choosing to sign up for [00:41:00] and that they sign it really clear because you do not want that receipt going to the insurance and the person saying, I thought, I'd see if they'd cover it. What do I have to lose? Right? No, you can cost me my contract.

So it's very important that you have that agreement so that you say NA NA NA NA nah, I had them sign this. They knew it was not medically necessary because insurance has two objectives. And I mean, no disrespect when I say this, but it may offend insurance companies who are listening. One is they wanna only cover what they have to cover.

Yep. And I'm gonna say that again. They only want to cover what they have to cover and what's the second thing? They do not wanna get sued. 

[00:41:44] Kate Grandbois: Yeah. Well, nobody wants to get sued, but I think, I think that the, I think the point you're making is such a wonderful one and really, really important because so many of us are so afraid of the, the big, scary [00:42:00] insurance fraud, right?

So like what's covered and what's not covered. And I am gonna take this moment to get on a little bit of a soapbox that almost all of our listeners have heard me get on. I wanna say every single episode, because we talk about it so often. Indirect service. There is such little coverage for indirect service, and I complain about it all the time because indirect service is a critical part of providing high quality evidence based interventions.

Right? So these are things like consulting with classroom teachers, consulting with parents, providing training, um, reviewing documentation, working on generalization while the client or the patient isn't isn't physically present. And it's my understanding that these indirect services are generally not covered by insurance funding 

[00:42:47] Brandon Seigel: hundred percent.

They're not part. So I'm gonna take everyone into a sandbox right now. We're sitting in this sandbox. Okay. And all these grains are all the sand [00:43:00] grains represent the needs of one person to reach their best selves. Okay. So. Have you ever seen those turtle sandboxes? I love them. Green launch. Oh yes. Sand in everything.

[00:43:12] Kate Grandbois: That was like a, that's a call back to my childhood right there. They were all so 

[00:43:15] Brandon Seigel: hot visually we're in this green turtle and all of the sand greens represent, represent the needs that we have to be successful in life. Functionally, healthwise, everything, all of those sand grains for the sake of this analogy could be benefited by speech therapy.

But guess what? Only one handful from that entire sandbox is considered medical ness, which is 

[00:43:44] Kate Grandbois: horrifying back to what did you say? Deal with the devil in thinking about our healthcare system and, and the red tape and the, and the funding issues. There are that many grains of sand that there are that many needs to only be [00:44:00] provided coverage and funding for these medically, this medically necessary handful of grains of sand.

Um, and I think, I wonder, go ahead. Do you know why? Because they're not medically necessary or because the insurance company doesn't wanna pay for it and doesn't wanna get sued 

[00:44:17] Brandon Seigel: but, well, that's true, but the reason why it's only one hand truly one hand versus two or three or a bucket fold is because the benefit that we operate in is a very specific bucket called a rehabilitation benefit.

And because it's a rehabilitation benefit, it provides such a narrow lens of need for the medical function of person, a child sector 

[00:44:46] Kate Grandbois: that just leaves so many grains of. 

[00:44:49] Brandon Seigel: Exactly. So many. So why, why isn't speech therapy also part of a, uh, behavioral benefit? Why is it only in the re the rehab benefit? I don't know [00:45:00] why you're the expert.

Tell me so some person or people came up with this idea of medical necessity and they've segmented, functionally what people need. So you tell me, you know, back in the day, when I say back in the day, 20 years ago, we could get someone weeks and weeks of rehab for a stroke rehabilitation. And now you're lucky if you get maybe two weeks, if you're lucky.

So, uh, the, the, the grains are changing based on utilization. And so this comes back to we've put our livelihood in the hands of an insurance company. Yep. And that's the mistake we as a society have done because. The insurance is a for profit. Yes. They will make profit before they make well on your policy.

They're betting on you being healthy. They're betting. So when we spend, let's just throw out a number, [00:46:00] uh,

we spend $9,000 on our premium. Let's say a year they're betting on you spending less than $9,000 on your healthcare company. That's what they're betting on. Claiming 

[00:46:14] Kate Grandbois: simple, making the point or reminding us that they're a for profit company is, is such a sickening lens. Really. I mean, it, it's, it's sort of bothersome, but I wonder if we could get back to this, all of these other grains of sand in the turtle sandbox, because it's sort of touching on our second learning objective, which is creative funding solutions.

So if you are a provider. You are, you know, looking at the one grain of the one handful of, of services that you're able to provide. 9 2 5 0 6 9 2 5 9 2 5 0 7 9 2 6 0 9. I'm just like rattling off the ones that I happen to use all the time. You know, that they're covered services. You have the family sign, a contract, knowing that if you provide any indirect [00:47:00] services, you have them sign an agreement that they understand it is not covered by their insurance, et cetera.

How do you go about getting funding for some of these indirect service that as a clinician, you know, is critical and necessary for their wellbeing, for their progress to make gains for good patient outcomes. But to your point before, it's a matter of accessibility, not all families are sitting, you know, they're not the Scrooge McDuck diving in their basement with gold coins.

If you don't get that reference, then you're not as old as I am. Yeah. But, um, I, you know, I wonder what other, what other, um, Funding solutions a clinician could employ or at least counsel their, their client about when they're in that position. 

[00:47:43] Brandon Seigel: Yeah. So I almost sang the ducktail song, just so you know but, um, I won't because you want a thing you can, you're allowed, I I'm close to it, but I will, I will digress.

So the first thing is, is you need to play the game to [00:48:00] understand that on this buffet table only the medical necessity is connected to insurance. We have to stop trying to fit a 16 meal buffet to one plate, and that's what we're doing. How do I get insurance to cover? How do I get insurance to cover? How do I get insurance to cover?

So if I'm trying to get 10,000 grains of sand into one funnel, it's not possible. So I have to play the game by saying, what is part of this rehab benefit? What can I cover under this rehab benefit? And how do I tap into other resources to support this person, this child, this family, whoever it may be, depending on your demographic.

So creative things, just so we can think out outside the box, first thing first, and you have to check with your lawyer, check with your CPA. Please don't take my word for this, but there is a world where you have two different companies, two different tax IDs, two different NPIs. One is [00:49:00] Brandon Siegel rehab, and I focus on the rehabilitation of yourself.

And I only focus on that medical necessity. I'm an in-network provider. Here we go. Boom. But then I have this neighboring company that's called BCS concierge, where we are out of network focused on wellbeing function and elevating the way that you walk through life. Okay. 

[00:49:24] Kate Grandbois: and that was a very smooth commercial to fly right off the top of your head.

[00:49:29] Brandon Seigel: See, you would never know that I was creative solution. My Brandon single before I went to business school, Brandon was in the performing arts. Oh, that's funny. Yeah. Um, so anyway, we could have a concierge care that works on things that are outside of the medical model we could work on. Um, and then we have the medical model.

That's one thing just sometimes we'll do in network and out of network. Also, there are some things that we see as in network [00:50:00] versus some things that are out of network. Again, I'm throwing some curve balls here. The next thing is just in terms of creative funding, we could participate in care. Credit care credit is a funding option, kind of like a credit card.

You can offer 0% and it might be that you say, Hey, we offer care credit to help offset some of these additional resources services that you need that are above and beyond medical necessity. And you get 18 months to pay that down as a monthly period. So that, that sometimes it's not free money. Sometimes it's leveraged money or time based money that, that you do so that K can get paid by care credit on day one.

But then the patient has 18 months to pay that off. And we're seeing that to be very helpful right now, even with those who are in network with insurance, when things are needed. Now, something I did not say that I think is really important that everyone understand if you bill insurance as an in network provider [00:51:00] and you make the mistake and it gets denied by insurance, you are not allowed to charge the patient for that.

So if you treat a patient without an authorization and it is denied with, cause you must eat it, you cannot charge the patient. And there are a lot of people out there that think you can charge a patient. Well, I, I held them to it. No. You didn't get authorization. You're in breach of that contract. You have to eat it, not the patient, not the insurance.

Just so we're on the same page. I mean, in 

[00:51:33] Kate Grandbois: some ways it's comforting to know that there are all these regulations that protect the patient, but in other ways, it's so disheartening to really take a step back and look at all the red tape and barriers that go in between a provider providing high quality care and giving the patient the treatment that they need 

[00:51:51] Brandon Seigel: playing with insurance reminds me of the board game risk.

If you ever played risk, you have to know how to dominate and put all your forces [00:52:00] together to, to win the land because it takes world domination to be at its best when you're working with insurance. So if you like the game of risk, then absolutely. You'll like the insurance game. It's tactical, it takes strategy, it takes mindset and it takes a team.

But when done correctly, you're making therapy accessible on a whole nother level. So getting back to creative funding options, another idea, we're seeing a lot of subscription based, um, options. Right now. We're seeing a lot of speech companies offer things as low as Hey, $99 a month. And you get a 15 minute this and a 30 minute this and all these different ways of both synchronous and asynchronous speech therapy to augment and support above and beyond the medical needs.

So again, you can combine forces if you do it right, and you stay true to your contracts. The other creative funding source that I'm a big fan of [00:53:00] is partnering with a nonprofit and coming up with sponsorships and saying, look, we wanna work with the same community as you. We're gonna help you fundraise.

We know that people need tax deductions. We don't wanna be a nonprofit, but what we'd like to do. It's come up with criteria where we have scholarships that fund therapy for children or families or parents or people. And this is what the scholarship looks like, and this is how we're gonna help fundraise for these scholarships.

And that allows us to, um, to really get to that next level. So I think scholarships are a great way, um, to, to get, uh, sponsorship. The other thing going onto it is we're seeing more and more. I had talked about it earlier, employer funded models. How do we contract with employers to fund services through a capitated contract?

What does a capitated contract mean? It means you get a certain amount of revenue per month to support their entire demographic. [00:54:00] And you basically are banking that not too many are gonna use it, but it allows you to have like a certain amount of, um, money flowing in for the accessibility of your services.

Um, Other things we've got early start D D D money. We've got, uh, grants. If we are a nonprofit, we have some grants that are not D D D are not nonprofit related. I just heard of someone that got $50,000 of funding for being a small business from their local SBA, for them to put into programming for the community.

Holy cow, that's a big check, $50,000. So have you connected with what, because what is the SBA? The SBA does not require you to be, uh, um, uh, a nonprofit they're trying to help small businesses thrive. So have you connected to your local SBA group? That's free money there? 

[00:54:55] Kate Grandbois: That's such a good suggestion. I also love the idea of, [00:55:00] I mean, I guess I'm looking at all of this through my clinical specialty, which is AAC, which as we know from the literature, AAC, interventions are really only as successful as the.

Uh, indirect service provision that accompany them, right? So you can have the best advice in the world, but if you're not getting trained on it, if you're not, you know, carrying it out into the community and, and using it in places and your communication partners, aren't being trained, it's not gonna be anywhere near as effective.

Um, and so the idea of embracing some of these creative funding solutions through care credit, or through a nonprofit through scholarship, it really is, is opening a very different perspective into how to really support those individuals. Mm-hmm , but I'm sure that's, that applies to all aspects of speech pathology.

I'm just selfishly looking at it through my own lens. 

[00:55:47] Brandon Seigel: well, and, and what we're also seeing is we're educating schools on how to better budget, where they spend their money. So I'm finding school districts that are specifically [00:56:00] budgeting tens of thousands of dollars on just education of teachers related to AAC.

Yeah. How are you tapping in to also. There are some schools that every three years they get to revise their budget. How are you creating partnerships in the community above and beyond just an IEP based need? Okay. So 

[00:56:20] Kate Grandbois: looking back at our learning objectives, I'm just sort of zooming back out. You've given us so much information and I'm thinking again about the clinician.

Who's listening to this and has a small practice where is trying to grow and scale and is maybe playing the insurance game, but they just have a ticket to the game. They're not in the stadium. You know, they're not embracing the components of mindset and strategy and risk as you, as you so eloquently described.

I'm wondering if you can give some advice to those clinicians listening on how to minimize that administrative burden, right? Because some of the, at least when you first get into the insurance game, it is [00:57:00] very overwhelming. I mean, you've got the claims you've got, you know, All million acronyms AOBs EFTs.

It's, there's a lot that you have to sift through. So what advice can you give clinicians on how to minimize some of that administrative burden at the outset, but also throughout the growth of your clinic? 

[00:57:23] Brandon Seigel: So, first off, I think you need to hire for skill sets that you don't have. And so whether you're bringing in someone with that expertise or you're outsourcing, I think when you are committing to the most important part of your business, I know you don't wanna know this, but it's fuel.

And I, I say it this way, we're a vehicle of change. Our purpose is not to make money. It really is not because if it is, you're gonna be unfulfilled, but we have a purpose that we're trying to achieve. Greatness, change in community, all this stuff. But in order for our vehicle of change to reach our optimal destination, we need fuel.

And the more fuel, the farther we can go, the more change, the more [00:58:00] purpose, et cetera. And so when we're investing in a fuel line, Don't just read a blog and think, you know how to medically bill hire consultants, hire people, hire, hire, uh, a billing agency, a credentialing agency, uh, someone who can set up the infrastructure.

Now what I want you to know, and I'm saying this, honestly, this is in no way a plug to me because I'll be honest. I'm very particular about the practices we take on because it's a huge investment when you invest in a company the right way. But what I am saying is 90% of billing agencies out there are garbage, the garbage.

So you wanna measure who has AAPC certified coders who are on site, on the ground in the United States. People that you can talk to people that will respond to your text, people that are co-creating with you, that you know, are gonna believe for you and recognize the smaller you are, the harder it is to find quality support.[00:59:00] 

So you may find a contractor if you're using the contractor elderly. Correct. But you may find a billing agency. You may go and look and go to a conference and meet people every time you hire a billing agency or a specialist. I want you to get five references. Five. I don't want five. That's a lot of references for billing.

Yes. Because, 

[00:59:24] Kate Grandbois: well, I guess if 90% of them are garbage, you're gonna need five. 

[00:59:28] Brandon Seigel: You want five and you want five industry specific. That's you said a high bar. I do, because this is our lifeline. This is no you're right. 

[00:59:39] Kate Grandbois: I think the analogy of the fuel line is 

[00:59:41] Brandon Seigel: fabulous. So what do I do for a living? I put out fires.

I'm trying to prevent you from needing a firefighter. And truly I say this, I, I see I'm working with a speech clinic right now that just had the worst billing experience possible with one of these agencies. They over promise they [01:00:00] underdeliver, they don't spend enough time really helping. And then they justify like, what do you expect?

We're just, you know, trying to get through and bill and blah, blah, blah, blah, blah, find high purpose, high, intentional people that have an emotional response to doing right by you. And that takes references. And that takes people. And that takes the right fit because there's a lot of, we'll say wolfs and sheeps clothing, so to speak.

And it's sad. And that's why I hate to say it Kate. But the number one thing, I go home and tell my wife is people stink. And it's because it's really hard to find that was very 

[01:00:34] Kate Grandbois: pagey version of I'm sure what becomes out of my 

[01:00:36] Brandon Seigel: mouth. yeah. And so find high intentional people that want to really support you.

That really care that are willing to put their reputation on the line to co-create with you. And that are willing to say, Hey, if this doesn't work, you have an easy out, you never want someone locking you into a contract ever, ever, ever, ever, ever. So, um, [01:01:00] so the first thing is you have to find people that can help you get to that next level.

The second is you need the right systems in place. You need solid EMR co uh, EMR system. You need the right policies and procedures that protect you. You need, um, artificial intelligence is so crucial today. Now there's new software and systems, and I don't have the name off the top of my head, but there are softwares out there that will do your eligibility and authorizations and tell you what you need to pay.

Really invest in measure twice. Cut. Once a lot of the times, we try to grow too quickly. And again, I saw another client recently that said to me, Brandon, I'm losing cash flow. I'm losing cash flow. I need help. I need help now. I'm I'm I don't know what I'm doing. And the problem was, was they said, I need more clients.

I said, you don't need no more clients. You need to find out where your lost leader is. You've done something wrong in the algorithm. Your fuel line is wrong. Marketing [01:02:00] allows us to find future destinations of how far we can go. But if the fuel line, you know, we could be running on empty for a long way.

And so just make sure that you really tap into understanding what you're doing. Start small, grow smart, don't try and out, create and get, oh my gosh, I wanna grow so fast. The people that are the most successful that I meet are the people who said, I never envisioned having 10 therapists. I just wanted one or two.

And then it organically happened. And it felt right versus the person that. I wanna be a million dollar private practice I wanna sell for the big money you're in it for the wrong reason. Then start with your purpose, grow smart, slow and steady wins the race. This is a triathlon, 

[01:02:50] Kate Grandbois: you know, we usually end our episodes with a, what are your parting words of wisdom, but I think you just nailed it.

I mean, that was, that was so inspiring and so [01:03:00] well done. And I'm, I'm so grateful. Thank you. 

[01:03:04] Brandon Seigel: I tried you, 

[01:03:06] Kate Grandbois: you succeeded. It was wonderful. Um, to everybody who was listening, um, all of the references that we mentioned throughout this episode are going to be listed in the show notes, um, as well as where you can find more information about the conference and about, um, Brandon's company.

So if you have any questions, please don't hesitate to write in Brandon we're so, so, so grateful, um, for having you with us today. Thank you for sharing 

[01:03:32] Brandon Seigel: so much. Thank you, Kate. It's been so much fun. Don't get discouraged. The opportunity is there. You just have to play the game, right. That's awesome. Thank 

[01:03:41] Kate Grandbois: you.

Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please [01:04:00] check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

The picture shows a brand block which indicates that SLP Nerdcast is an ASHA approved continuing education provider, the course is intermediate level and offered for .1 ASHA CEUs.