Podcasts about Revenue cycle management

Revenue cycle management (RCM) sounds like the least sexy phrase in healthcare — a back-office spreadsheet problem. It isn't. Andrew Tsang, an independent healthcare analyst and writer of the Substack Health Is Other People, with 15+ years across providers, payers, consulting, and policy, joins Stacey Richter to unpack how RCM has grown into a $200-plus-billion industry that eats roughly a third of every healthcare dollar spent — not on care, but on the fight over who pays for it. Together they trace RCM's front end, middle, and back end, and the "hot potato" that lands on whoever has the least leverage to fight back. WHAT YOU'LL LEARN ✅ How revenue cycle management (RCM) grew into a $200-plus-billion industry — Andrew Tsang puts RCM-related market cap at roughly $217 billion, and estimates roughly a third of every healthcare dollar goes to the fight over payment, not to care ✅ The three phases of RCM (front-end eligibility and prior authorization, middle clinical coding, and back-end claims adjudication and appeals) and why the "hot potato" of financial responsibility lands on whoever has the least administrative leverage — patients, independent practices, or self-funded employers ✅ Why a routine screening colonoscopy can flip to a diagnostic procedure — and an unexpected bill — the moment a polyp is found, even though the ACA mandates the screening itself be free ✅ How the prior authorization burden (physicians average roughly 39 prior auths a week) forces independent practices to compete on administrative capacity rather than clinical outcomes, accelerating consolidation into larger health systems ✅ Why self-funded employers face their own version of the hot potato through stop-loss "lasering," where a stop-loss carrier can exclude a specific high-cost employee from coverage after a catastrophic claim ✅ Why direct contracting — agreeing on price upfront — is Andrew Tsang's proposed way to opt out of the RCM hot potato game entirely WHY THIS MATTERS Revenue cycle management isn't a niche back-office function — it's a $200-plus-billion economy built on claim-by-claim fights over who pays. As Stacey Richter puts it, this isn't a story about villains; it's a story about an industry built around claim-by-claim fistfights. Whoever has the least administrative leverage in any given moment — patient, independent practice, or self-funded employer — is the one who winds up eating the cost. MENTIONED IN THIS EPISODE Andrew Tsang's Revenue Cycle Market Landscape interactive chart and his Substack. EP497 with Zack Kanter: Apple Podcasts | Spotify | Other Apps EP363 with David Scheinker, PhD: Apple Podcasts | Spotify | Other Apps LinkedIn Post by Sheri Mancini, MD, FACS EP494 with Sarah Emond: Apple Podcasts | Spotify | Other Apps === LINKS ===

Hosts Colin Hung and John Lynn discuss Revenue Cycle Management. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

For the 196th episode of the Healthcare IT Today Podcast, we are talking about revenue cycle management! We kick this episode off by sharing what we have been hearing at the recent conferences we’ve both been attending in the RCM space. Next, we talk about what technology actually helps the coding personnel shortage we are currently facing. Then, we discuss what we think the reality and the promise of AI is in RCM. Lastly, we debate whether we are heading towards having totally autonomous coding/RCM one day. Here's a preview of the topics and questions we discuss in this episode: We've both been to conferences recently in the RCM space; what are you hearing? We are facing a coding personnel shortage. What technology actually helps? What is the reality and promise of AI in RCM? Are we heading for a day when we have totally autonomous coding/RCM? Now, without further ado, we’re excited to share with you the next episode of the Healthcare IT Today podcast. We publish a new Healthcare IT Today podcast every ~2 weeks. Thanks to our friends at Healthcare Now Radio, you’ll be able to listen to the latest episodes of Healthcare IT Today on their radio station for the first two weeks. Then, we’ll be publishing each episode as a podcast and YouTube video here after it finishes on the radio. You can also subscribe to the Healthcare IT Today podcast on any of the following platforms: Apple Podcasts Google Podcasts Stitcher Podcast Radio TuneIn Spotify iHeartRadio Pandora Thanks for listening to Healthcare IT Today and if you enjoy the content we’re sharing, please rate the podcast on your favorite podcasting platform. Along with the popular podcasting platforms above, you can Subscribe to Healthcare IT Today on YouTube. Plus, all of the audio and video versions will be made available to stream on HealthcareITToday.com. If you work in Healthcare IT, we’d love to hear where you agree and/or disagree with the perspectives we shared. Feel free to share your thoughts and perspectives in the comments of this post, in the YouTube comments, with @Colin_Hung or @techguy on Twitter, or privately on our Contact Us page. Let us know what you think of the podcast and if you have any ideas for future episodes. Thanks so much for listening! Listen to Our Latest Episodes:

Andrew Archibald, CEO of MEDMIN, breaks down why the UK's private healthcare sector has been stuck in operational chaos — and what he's doing to fix it. Built on a model where NHS consultants moonlight as private practitioners with zero business infrastructure, the system has forced brilliant surgeons to spend Sunday mornings writing their own invoices. MEDMIN steps in as a total practice management partner, handling admin, billing, marketing, and patient relations so doctors can focus on medicine. The results speak for themselves: new-to-practice consultants see 300% income growth within three years. Andrew also makes the case for embracing AI tools as a non-negotiable business move, and shares how MEDMIN is scaling toward a UK-wide brand that serves both doctors and patients. Key Takeaways: 3:34 — Curiosity is a professional strategy: Andrew attributes his entire career trajectory to a compulsion to understand how systems work and why they break, which drives him toward roles others avoid. 6:08 — COVID exposed a healthcare system already running on empty: the UK's waiting lists doubled during the pandemic and have never fully recovered because the NHS was underfunded through the 2010s before the crisis hit. 15:17 — The problem is personal: top-tier surgeons are spending Sunday mornings reconciling invoices instead of recovering, and that hidden administrative tax is the core inefficiency MEDMIN was built to eliminate. 24:42 — The ROI of removing friction is measurable: consultants who join MEDMIN as new-to-practice doctors grow their earnings by 300% between year one and year three. Quote of the Show (19:21):"People have just learnt to put up with inadequate systems. The healthcare system in the UK is very poor at investing in technology, in the administrative things that make the whole thing get better. And it's about time to say: stop accepting it." — Andrew Archibald Join our Anti-PR newsletter where we’re keeping a watchful and clever eye on PR trends, PR fails, and interesting news in tech so you don't have to. You're welcome. Want PR that actually matters? Get 30 minutes of expert advice in a fast-paced, zero-nonsense session from Karla Jo Helms, a veteran Crisis PR and Anti-PR Strategist who knows how to tell your story in the best possible light and get the exposure you need to disrupt your industry. Click here to book your call: https://info.jotopr.com/free-anti-pr-eval Ways to connect with Andrew Archibald:LinkedIn: http://www.linkedin.com/in/andrew-archibald-363050aCompany Website: https://medmin.co.uk How to get more Disruption/Interruption: Amazon Music - https://music.amazon.com/podcasts/eccda84d-4d5b-4c52-ba54-7fd8af3cbe87/disruption-interruption Apple Podcast - https://podcasts.apple.com/us/podcast/disruption-interruption/id1581985755 Spotify - https://open.spotify.com/show/6yGSwcSp8J354awJkCmJlD YouTube: https://www.youtube.com/results?search_query=disruption+%2F+interuuptionSee omnystudio.com/listener for privacy information.

Send us Fan MailSchedule an Rx AssessmentFresh off the NHIA (National Home Infusion Association) Conference, we're talking Revenue Cycle Management for infusion centers and home infusion pharmacies!In this episode as part of our Infusion Revolution Series on the Bottom Line Pharmacy Podcast, we sit down with Chris Hilger, CEO of SolisRx to break down:The three core areas of revenue leakageData fundamentals through the data mountain blueprint How infusion providers can use their own data to intercept denials before they happenWhy chasing Gen AI before you've built the fundamentals is a costly mistakeAnd more!More About Our Guest:Chris Hilger is the CEO of SolisRx and a leading voice on analytics in the infusion industry. He is a contributor to NICA on data analytics and AI adoption in infusion operations.Chris's experience comes from driving data strategy and implementation across a dozen infusion clients. He speaks and consults on analytics, revenue cycle visibility, and operational intelligence for stakeholders across the industry and has a decade of experience across healthtech, including a Master's in Health Data Science from Harvard.Stay connected with Chris and SolisRx: Chris' LinkedInSolisRx WebsiteSolisRx LinkedInStay connected with us: FacebookTwitterLinkedInScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterBonnie Bond – CPA LinkedInBonnie Bond – CPA TwitterMore resources on this topic: Podcast - Driving Independent Pharmacy Profitability in 2026Podcast – Opening an Infusion PharmacyPodcast – KPIs for the Rapid Growth Pharmacy

Brian Robertson, Founder and CEO of VisiQuate, describes the relationship between payers and providers, noting that payers have the advantage due to unified data and lower complexity than providers face. He emphasizes that providers could level the playing field by unifying their data and leveraging AI to predict and prevent claim denials and solve systemic problems. The ultimate goal of using data and AI in the revenue cycle should be patient-centered, ensuring that the technology leads to more accurate billing and better outcomes for patients, providers, and payers. Brian explains, "I would say in general, and I think a lot of us in the industry know this, the payer or the health plan has the edge, partly because they have fewer jobs to be done every day. They manage a financial risk engine for the most part. And if you consider that the other side of that is the provider who has to have all the upfront labor, all of the upfront dollars, they have to think about every permutation of care and patient satisfaction and physician satisfaction. So good care benefits for patients. So there are a thousand jobs to be done on the provider side, and I'll just say fewer jobs to be done on the health plan side. And the health plan side controls the money."   "I think in today's world of AI, he who has the more unified data has the edge. And I think there's little debate that the payer right now has the edge because they have a unified dataset and are a financial risk engine. So, I think the opportunity is for providers to use the power of data now to begin to bring a little bit more balance to that question. And they've got a hard job ahead of them, for sure."  "So our core value proposition is really centered on data unification. We're getting into many case accounts, transactions, charges, claim files, remittance files, and third-party data sets from providers who sometimes are on one system of record. Often, they're on many systems of record. So we have to get all of that fragmented data, normalize, cleanse, unify, and curate that data for action."  #VisiQuate #HealthcareFinance #RevenueCycleManagement #AIinHealthcare #DataUnification #DeniedClaims #HealthIT #PayerProvider #PatientExperience VisiQuate.com Download the transcript here

Brian Robertson, Founder and CEO of VisiQuate, describes the relationship between payers and providers, noting that payers have the advantage due to unified data and lower complexity than providers face. He emphasizes that providers could level the playing field by unifying their data and leveraging AI to predict and prevent claim denials and solve systemic problems. The ultimate goal of using data and AI in the revenue cycle should be patient-centered, ensuring that the technology leads to more accurate billing and better outcomes for patients, providers, and payers. Brian explains, "I would say in general, and I think a lot of us in the industry know this, the payer or the health plan has the edge, partly because they have fewer jobs to be done every day. They manage a financial risk engine for the most part. And if you consider that the other side of that is the provider who has to have all the upfront labor, all of the upfront dollars, they have to think about every permutation of care and patient satisfaction and physician satisfaction. So good care benefits for patients. So there are a thousand jobs to be done on the provider side, and I'll just say fewer jobs to be done on the health plan side. And the health plan side controls the money."   "I think in today's world of AI, he who has the more unified data has the edge. And I think there's little debate that the payer right now has the edge because they have a unified dataset and are a financial risk engine. So, I think the opportunity is for providers to use the power of data now to begin to bring a little bit more balance to that question. And they've got a hard job ahead of them, for sure."  "So our core value proposition is really centered on data unification. We're getting into many case accounts, transactions, charges, claim files, remittance files, and third-party data sets from providers who sometimes are on one system of record. Often, they're on many systems of record. So we have to get all of that fragmented data, normalize, cleanse, unify, and curate that data for action."  #VisiQuate #HealthcareFinance #RevenueCycleManagement #AIinHealthcare #DataUnification #DeniedClaims #HealthIT #PayerProvider #PatientExperience VisiQuate.com Listen to the podcast here

FQHC revenue cycle management sits at the center of community health sustainability in 2026. This episode breaks down how the eight-stage cycle works, where revenue leaks, and how Visualutions helps health centers recover it with FQHC-specific billing and credentialing expertise. Visualutions, Inc. City: Spring Address: 7440 Mintwood Lane Website: https://www.visualutions.com/

Health systems are no longer asking whether to deploy ambient AI. They are asking how to scale it across roles, connect it to revenue cycle, and avoid building another layer of fragmented tools. Kenneth Harper, General Manager of Dragon at Microsoft, joins Megan Antonelli to unpack what separates the organizations actually moving the needle from those stuck in pilot mode, what ambient AI's expansion from physicians to nurses and radiologists has revealed about clinical workflow design, and how CIOs should think about building a coherent clinical AI architecture in 2026. Kenneth Harper, GM, Dragon Product, Microsoft Megan Antonelli, Chief Executive Officer, HealthIMPACT Live

In this episode, Tracy Peffley, System Vice President of Revenue Cycle Management at Cleveland Clinic, joins the podcast to discuss strengthening financial performance while improving the patient financial journey. She shares insights on the organization's physician advisory program and explores how AI is expected to shape the future of revenue cycle operations and patient engagement.

In this episode, Lynn Ansley, Vice President of Revenue Cycle Management at Moffitt Cancer Center, joins the podcast to discuss how her team is leveraging automation, process optimization, and Epic implementation to transform revenue cycle operations.Learn more about relentlessly raising RCM yield here: https://med-metrix.com/?utm_source=beckers&utm_medium=podcast&utm_campaign=brand

Message us!In this episode of Whitley Penn Talks, host Kendall Neukomm is joined by Jolee Patnaude, Revenue Cycle Management Advisory Director at Whitley Penn, and Casey Gage, Finance Specialist at Eunice Health Clinic. They explore the impact of documentation gaps on patient care and reimbursement, common audit findings, including undercoding, how AI and ambient listening tools are transforming clinical documentation, and more. Whether you're a healthcare provider, administrator, or finance leader, this episode offers actionable strategies to improve documentation gaps, operational performance, and your patients' experience.Fill out this form to have new episodes sent right to your inbox! Follow Whitley Penn on LinkedIn, Instagram, Facebook, and X for more industry insights and thought leadership!

What if the biggest revenue leak in your practice isn't a denial or a payer contract problem - it's the person processing your payments? In this episode, Dr. Heather Signorelli breaks down the four-step payment posting audit we run on every practice we onboard - and why practices doing $300K+ a month are routinely losing $8,000 to $25,000 of it to undetected posting errors. You'll learn: • How to catch unapplied patient payments before they generate angry calls • The ERA spot check that exposes systemic contractual adjustment errors • How to find payer underpayments before your billing team writes them off • The write-off audit that protects your revenue from unauthorized adjustments This is the final episode in our four-part payment posting series. If you've been following along, you now have more visibility into your revenue cycle than most practice owners ever get.

Zach Shultz, Senior Director of Product Policy and Solutions at EnableComp, describes the challenges of revenue cycle management in healthcare with a focus on the strategic importance of full-time equivalent (FTE) allocation.  Hospitals could improve their bottom line by outsourcing complex, low-reimbursement claims, such as those from the VA so that in-house staff can focus on higher-value commercial claims. Despite the emergence of AI as a significant factor in automating the review process, human intervention is irreplaceable for quality assurance, managing escalations, and resolving complex claims. Zach explains, "I think that, especially serving the post- COVID landscape that we exist in today, staffing has become a kind of delicate thing. If you think about the rate posts or during the post-pandemic period, it was really hard to staff revenue cycle offices or staff business in general. Now, you kind of fast-forward to 2026, and maybe it's not as difficult as it was, but I think hospitals and businesses want to make sure they're very precise and strategic in how they utilize resources."   "Obviously, keeping overhead at a manageable level is really important to growth and success. So I think it's an invariable value that should always be discussed, particularly when it gets into the complex claims space, as we do. The work comps, the VAs, and claim types like that may take or require a little bit more manual intervention. It's super important to determine whether it's worth taking on these things myself or if outsourcing them is justified so I can focus on things that maybe have a slightly higher yield."  #EnableComp #RevenueCycleManagement #RCM #HealthTech #FTEEfficiency #ComplexClaims #RCMTechnology #HealthcareRCM #RevenueCycle #HealthcareFinance #StaffingStrategy #HealthcareOperations #AIinHealthcare #WorkforceOptimization #HealthcareLeadership #PatientFinancialServices enablecomp.com Download the transcript here

Zach Shultz, Senior Director of Product Policy and Solutions at EnableComp, describes the challenges of revenue cycle management in healthcare with a focus on the strategic importance of full-time equivalent (FTE) allocation.  Hospitals could improve their bottom line by outsourcing complex, low-reimbursement claims, such as those from the VA so that in-house staff can focus on higher-value commercial claims. Despite the emergence of AI as a significant factor in automating the review process, human intervention is irreplaceable for quality assurance, managing escalations, and resolving complex claims. Zach explains, "I think that, especially serving the post- COVID landscape that we exist in today, staffing has become a kind of delicate thing. If you think about the rate posts or during the post-pandemic period, it was really hard to staff revenue cycle offices or staff business in general. Now, you kind of fast-forward to 2026, and maybe it's not as difficult as it was, but I think hospitals and businesses want to make sure they're very precise and strategic in how they utilize resources."   "Obviously, keeping overhead at a manageable level is really important to growth and success. So I think it's an invariable value that should always be discussed, particularly when it gets into the complex claims space, as we do. The work comps, the VAs, and claim types like that may take or require a little bit more manual intervention. It's super important to determine whether it's worth taking on these things myself or if outsourcing them is justified so I can focus on things that maybe have a slightly higher yield."  #EnableComp #RevenueCycleManagement #RCM #HealthTech #FTEEfficiency #ComplexClaims #RCMTechnology #HealthcareRCM #RevenueCycle #HealthcareFinance #StaffingStrategy #HealthcareOperations #AIinHealthcare #WorkforceOptimization #HealthcareLeadership #PatientFinancialServices enablecomp.com Listen to the podcast here

There's a number in your practice that looks precise but lies to you every single month: your AR report. We routinely audit multi-provider practices showing $400K, $600K, even $1M in AR — and 20–40% of that “asset” is already dead. Not collectible. Just trash left behind by bad payment posting. In this episode — the first in a 4-part series on payment posting — Heather walks through what payment posting actually is, why getting it wrong silently inflates your AR, and the seven specific things that change in your practice when posting is done right. Inside the episode: Why your AR report is a mirror of your team's posting accuracy, not what you're actually owed How a $400K/month practice dropped their AR by 30% in two weeks — without collecting a dollar more The 7 reasons clean payment posting transforms your revenue cycle The audit moment we found 200+ accounts a week being reworked that were already paid in full What's coming in Episode 176: the most common insurance-side posting mistake we see in almost every audit If you're a practice owner, billing lead, or operations director who has ever made a financial decision off an AR report — this is the foundation. Resources mentioned (Buzzsprout episode resources block) 

Patty Hayward, General Manager of healthcare and life sciences at Talkdesk, describes how a hybrid model of humans and AI is reshaping healthcare contact centers. Patient access and revenue cycle management are the primary, interconnected challenges for these centers, and modern large-language AI is being used to handle complex scheduling logic. Data analytics helps identify patterns in patient inquiries, predict demand peaks, and move care from reactive to proactive. The expectation is that AI agents will guide patients, becoming a normal and accepted part of healthcare. Patty explains, "I think that the challenge has always been in healthcare that it's difficult to automate things in comparison to other industries. If you call retail, it's very hard to get a human. You're constantly dealing with bots or being deflected to digital front doors versus in healthcare, as much as organizations have tried to push people to the digital apps and MyCharts and different things like that, it's been difficult. And there are good reasons, and there are bad reasons for that."   "When you think about scheduling, scheduling really drives your revenue cycle because if people don't come to your organization, you can't bill them for things, you can't bill their insurance. And so your organization has problems with the revenue cycles. That's why I say they're inextricably linked, and it's very important to solve the access problem in order to solve the revenue cycle problem."  "So, making sure that you match that patient with the right provider, making sure that you have the right requirements around insurance authorization and things like that. And then, of course, letting the patient understand what their burden will be as far as the charges go for that appointment is all part of the dance, so to speak. And that really requires a large language model that can consume and understand that information. You're right, the decision trees weren't going to work as far as an AI piece goes." #Talkdesk #AgenticAI #AIAgents #ArtificialIntelligence #AI  #Automation #CustomerServiceAutomation #ValuebasedCare #VBC #PatientExperience #MemberExperience #CustomerExperience #Providers #Payers #HealthcareAI #PatientExperience #HealthTech #ContactCenters #AIInHealthcare #DigitalTransformation #HealthcareInnovation #PatientAccess #RevenueOptimization #HealthcareLeadership talkdesk.com Download the transcript here

Patty Hayward, General Manager of healthcare and life sciences at Talkdesk, describes how a hybrid model of humans and AI is reshaping healthcare contact centers. Patient access and revenue cycle management are the primary, interconnected challenges for these centers, and modern large-language AI is being used to handle complex scheduling logic. Data analytics helps identify patterns in patient inquiries, predict demand peaks, and move care from reactive to proactive. The expectation is that AI agents will guide patients, becoming a normal and accepted part of healthcare. Patty explains, "I think that the challenge has always been in healthcare that it's difficult to automate things in comparison to other industries. If you call retail, it's very hard to get a human. You're constantly dealing with bots or being deflected to digital front doors versus in healthcare, as much as organizations have tried to push people to the digital apps and MyCharts and different things like that, it's been difficult. And there are good reasons, and there are bad reasons for that."   "When you think about scheduling, scheduling really drives your revenue cycle because if people don't come to your organization, you can't bill them for things, you can't bill their insurance. And so your organization has problems with the revenue cycles. That's why I say they're inextricably linked, and it's very important to solve the access problem in order to solve the revenue cycle problem."  "So, making sure that you match that patient with the right provider, making sure that you have the right requirements around insurance authorization and things like that. And then, of course, letting the patient understand what their burden will be as far as the charges go for that appointment is all part of the dance, so to speak. And that really requires a large language model that can consume and understand that information. You're right, the decision trees weren't going to work as far as an AI piece goes." #Talkdesk #AgenticAI #AIAgents #ArtificialIntelligence #AI  #Automation #CustomerServiceAutomation #ValuebasedCare #VBC #PatientExperience #MemberExperience #CustomerExperience #Providers #Payers #HealthcareAI #PatientExperience #HealthTech #ContactCenters #AIInHealthcare #DigitalTransformation #HealthcareInnovation #PatientAccess #RevenueOptimization #HealthcareLeadership talkdesk.com  Listen to the podcast here

Grant funding for FQHCs is declining. This episode breaks down how community health centers are using revenue cycle management to protect financial stability. Visualutions, Inc. City: Spring Address: 7440 Mintwood Lane Website: https://www.visualutions.com/ Phone: +1 281 297 2257

Send us Fan MailToday we're going to talk about something that seems really practical on the surface… but has massive implications for your income, your stress level, and the long-term health of your practice.And that is this:Why going cheap on your revenue cycle is almost always a mistake.Now, I want to start by saying—this is not about criticizing any specific vendor or company. This is about understanding how these systems actually work…so you can make better decisions.Because revenue cycle is one of those areas in your business where…what looks like savings on paper… often turns into lost income in reality.Please Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: https://share.hsforms.com/1FMup6xLPSpeA8hB77caYQwd32sx?hsCtaAttrib=171926995377 Want more formal learning? Check out Jill's newly released course: Physician's Edge: Mastering Business & Finance in Your Medical Practice. 32.5 hours of online, on-demand CME-accredited training tailored just for busy physicians. Promo pricing available now: https://education.healtheps.com/offers/Ry3zfLYp/checkout?coupon_code=PHYSEDGE3000  Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/    

On February 16, 2026, Nursing Economic$ Editorial Board member Therese Fitzpatrick, PhD, MS, RN, FAAN, talked with Ms. Cedrial Moore, the Senior Vice President of Kaufman Hall & Associates, LLC. They discussed the three distinct functions of the revenue cycle, key steps in revenue cycle management, the responsibility of executive leaders and chief nurse officers in revenue cycle management, and the concept of a write-off and its implications for hospital operations.Therese Fitzpatrick, PhD, MS, RN, FAAN, is the Managing Director at Kaufman Hall & Associates, LLC, in Chicago, Illinois, and a member of the Nursing Economic$ Editorial Board  Cedrial Moore, BS, is Senior Vice President at Kaufman Hall & Associates, LLC , in Chicago, Illinois.© Jannetti Publications, Inc.All rights reserved. No portion of this podcast may be used without written permission.To learn more about Nursing Economic$, visit http://www.nursingeconomics.net Visit our new JPI journal platform at www.jannettipublications.comMusical selections by Scott Holmes.http://www.scottholmesmusic.com

In this episode, Amir Syed, President of BRSi, shares insights on revenue cycle management, the impact of AI in healthcare, and strategies for healthcare leaders to stay ahead in the evolving landscape. Discover practical tips on process improvement, predictive analytics, and how to leverage technology effectively.AI is accelerating claim denials and revenue cycle challenges. Healthcare providers must focus on process optimization before investing in AI. Predictive analytics can prevent denials by identifying problem areas early.Resources: - ⁠BRSi Website ⁠- ⁠Aamir Syed LinkedIn⁠

Jaideep Tandon, CEO of Infinx, shares a sensible, leadership-driven perspective on the evolving role of AI in RCM. Rather than focusing on technology for technology's sake, the conversation centers on outcomes: improving efficiency, reducing revenue leakage, and supporting better financial decision-making across increasingly complex healthcare environments. Jaideep addresses how revenue cycle leaders can play a more active role in shaping AI success with a clearer understanding of how to evaluate AI initiatives, set realistic expectations, and lead AI adoption as an ongoing journey.

In this episode, Jaideep Tandon, CEO of Infinx, shares a sensible, leadership-driven perspective on the evolving role of AI in RCM. Rather than focusing on technology for technology's sake, the conversation centers on outcomes: improving efficiency, reducing revenue leakage, and supporting better financial decision-making across increasingly complex healthcare environments. Jaideep addresses how revenue cycle leaders can play a more active role in shaping AI success with a clearer understanding of how to evaluate AI initiatives, set realistic expectations, and lead AI adoption as an ongoing journey.Brought to you by www.infinx.com

Nina Lewis, Vice President of RCM at Zimworks & SupportDDS joins the show to discuss: RCM & its impact on cash flow Leveraging tech & human capital KPIs to measure for healthy RCM To learn more, email Nina here - nina@supportdds.com or book a discovery call here - https://supportdds.com/book-discovery-call/

In this episode, Navaneeth Nair, Chief Product Officer at Infinx, explains what it really takes to make AI work in revenue cycle management, from decomposing workflows into task-level agents to maintaining human-in-the-loop oversight. The conversation explores why effective RCM automation depends on orchestration, agent lifecycle management, and tech-enabled workflows designed for real operational complexity.

In Episode 498, host Stacey Richter converses with Mark Noel of ClaimInsight about the critical aspects of payment integrity within self-insured employers and plan sponsors, focusing on the arms race with revenue cycle management (RCM).  The discussion reveals three main insights: the substantial impact of small claim errors, the inherent flaws and conflicts within prepayment analysis by TPAs, and the problematic financial incentives influencing claim processing. Noel emphasizes the importance of prepayment integrity for both plan savings and protecting members, underscoring the need for meticulous oversight and proactive management in payment processes. === LINKS ===

“Revenue cycle is really about solving two problems: generating an accurate receipt and then jumping through the fifty hoops to get paid.” says Dr. Michael Gao, CEO of Smarter Technologies. In this episode of Vanguards of Health Care, Gao joins Bloomberg Intelligence analyst Jonathan Palmer to explain how AI is transforming hospital revenue cycle management (RCM). He walks through Smarter’s approach to clinical intelligence and automation, why AI works best as a first pass with human supervision, and how smarter workflows can lift margins for hospitals operating on razor-thin economics. The conversation also explores Smarter’s formation with New Mountain Capital and Gao’s mission to reduce the trillion-dollar burden of health care administration.See omnystudio.com/listener for privacy information.

Best of Office Hours 2025 - In this episode, Infinx CEO Jaideep Tandon breaks down why automation alone can't keep up with today's revenue cycle complexity—and why AI must move beyond task execution to contextual thinking, prediction, and adaptation. From denial prevention and prior authorization to AR prioritization, this conversation explores how AI, automation, and human expertise must work together to future-proof revenue cycle operations.

What if the money problem in your practice isn't production, but what's happening after the patient leaves the chair? Many dental practices are busy and producing well, yet cash flow still feels tighter than it should. In this episode, Nina Lewis, VP of Revenue Cycle Management at SupportDDS, shares what she sees every day working with dental practices that believe they are collecting properly, only to discover hidden gaps behind the scenes. We talk about why AR totals can be misleading, why over-90 claims reveal where systems are failing, and a real story where internal EFT changes created major payment delays for a dental practice. It's a conversation that helps owners see where revenue can get stuck, and why noticing it sooner can make a meaningful difference. SupportDDS provides dental RCM-certified virtual team members who support billing, insurance verification, AR follow-up, and workflow optimization. Their team helps practices uncover gaps, reduce delays, and strengthen collections with consistency and clarity. If you are a current DEO member and a client of SupportDDS, you are eligible for a FREE Revenue Cycle Management Assessment valued at $1,800.

In this episode, Navaneeth Nair, Chief Product Officer at Infinx unpacks insights from a real conversation with a healthcare organization exploring AI for revenue cycle operations. While the discussion starts in accounts receivable, it quickly reveals why only fully autonomous AI agents, not assistive automation, can deliver meaningful impact across the entire revenue cycle.

The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL. --- SYNPOSIS The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs. --- TIMESTAMPS 00:00 - Introduction 01:08 - The Importance of Revenue Cycle Management09:29 - The No Surprises Act and Data Transparency12:03 - Professional Societies and Continuing Education17:50 - Credentialing and Taxonomy Codes40:28 - Impact of Insurance Credentialing on Patient Care42:08 - Revenue Cycle Management Walkthrough48:18 - Challenges with Medicare Advantage and Coordination of Benefits54:20 - Covered vs. Non-Covered Services59:03 - Medical Necessity and Insurance Policies01:01:04 - Prior Authorization and Payment Issues01:13:11 - Payment Plans and Compliance01:23:10 - Practice Management Software01:31:10 - AI in Healthcare and Compliance01:38:57 - Final Thoughts --- RESOURCES Medical Group Management Administration (MGMA)https://www.mgma.com/

What if your practice is profitable on paper—but bleeding money behind the scenes? In this final episode of 2025, Dr. Len Tau welcomes Dana Moss, founder of PPO Dental Consulting, for a deep dive into the realities of dental insurance and PPO strategy. Dana breaks down how dental practices can increase profitability without sacrificing patient-centered care by negotiating smarter, streamlining fee schedules, and knowing when—and how—to strategically exit low-paying plans. Drawing from years of hands-on experience as a front office coordinator, insurance specialist, and practice administrator, Dana shares what most practices get wrong about insurance and how to fix it. You'll learn why billing office fees correctly is non-negotiable, how getting to the 80th percentile can dramatically change your negotiating power, and when outsourcing insurance coordination makes more sense than handling it in-house. Dana also explains umbrella plans, negotiation timelines, and why organization is the single biggest factor in PPO success. This episode is packed with actionable insights for startups, mid-career dentists, and practice owners preparing for growth—or an eventual sale.   What You'll Learn The two non-negotiables practices must fix before negotiating PPO fees Why billing office fees changes your profitability picture How the 80th percentile impacts insurance negotiations When to renegotiate—and when not to The pros and cons of DIY vs outsourced PPO negotiation How smarter insurance systems lead to stronger cash flow   Key Takeaways 00:44 Welcome, Sponsors & Final Episode of 2025 02:07 Meet Dana Moss & Her Background in Dental Insurance 03:40 Who Dana Helps Most: Startups, Growing Practices & Sellers 08:01 Preparing to Negotiate PPO Fees the Right Way 10:30 The Two Non-Negotiables: Billing Office Fees & Fee Balancing 14:30 PPO vs Fee-for-Service Philosophies Explained 15:29 How Often You Can Renegotiate Insurance Fees 16:20 DIY PPO Negotiation vs Outsourcing: Pros & Cons 18:07 Using Your Top Procedure Codes Strategically 20:40 Dropping Low-Paying Plans & Understanding Umbrella Networks 26:39 Training Insurance Coordinators for Clean Claims & Strong AR 29:13 AI, Remote Teams & the Future of Revenue Cycle Management 31:00 Life on the Road: Dana's Full-Time RV Lifestyle 33:20 Lightning Round Q&A with Dana 36:50 How to Work With Dana + DIY Negotiation Kit Offer 37:40 Closing Thoughts, Sponsors & Event Reminder   Connect with Dana Dana Moss Founder, PPO Dental Consulting

William Blair's group head of healthcare technology and services analyst, Ryan Daniels, explores how artificial intelligence is revolutionizing healthcare revenue cycle management by automating financial workflows, reducing costs, and reshaping the industry's future for providers and vendors.

Todd Doze, CEO of Janus Health, specializes in bringing AI to hospitals to connect the hospital revenue cycle management with the overall patient experience. Automating some manual RCM tasks, such as prior authorizations and referrals,  has led to significant reductions in claim denials, faster processing times, fewer errors, and better compliance with recent legislation. Challenges remain to ensure the AI model's accuracy and to demonstrate clear ROI and a direct impact on the hospital's revenue. Todd explains, "Today at Janus, we focus on helping providers improve their operational and financial efficiency. We work with about 250 acute care hospitals across the country, servicing some of the largest health systems in the nation by providing automations and AI-driven operational intelligence. This gives management insight into what their revenue cycle folks are doing to ensure they're taking the optimal paths to adjudicate claims and also automating as much of the laborious, tedious work that goes into treating patients in the most optimal manner." "There are a lot of very manual pain points within the rev cycle experience. For example, many of us have been referred by our primary care physician to a specialty provider. A very common example is referring to an imaging center for an MRI or X-ray. And many times, to access an appointment with that specialty provider, the provider may need to submit a prior authorization request to the patient's insurance. And then there's also the communication loop process focused on the referral. And so there are many areas for error, and there are a lot of ways the patient experience can go south very quickly."  #JanusHealth #AIinHealthcare #HealthcareAI #HealthTech #HealthcareOperations #RCM janus-ai.com Download the transcript here

Todd Doze, CEO of Janus Health, specializes in bringing AI to hospitals to connect the hospital revenue cycle management with the overall patient experience. Automating some manual RCM tasks, such as prior authorizations and referrals,  has led to significant reductions in claim denials, faster processing times, fewer errors, and better compliance with recent legislation. Challenges remain to ensure the AI model's accuracy and to demonstrate clear ROI and a direct impact on the hospital's revenue. Todd explains, "Today at Janus, we focus on helping providers improve their operational and financial efficiency. We work with about 250 acute care hospitals across the country, servicing some of the largest health systems in the nation by providing automations and AI-driven operational intelligence. This gives management insight into what their revenue cycle folks are doing to ensure they're taking the optimal paths to adjudicate claims and also automating as much of the laborious, tedious work that goes into treating patients in the most optimal manner." "There are a lot of very manual pain points within the rev cycle experience. For example, many of us have been referred by our primary care physician to a specialty provider. A very common example is referring to an imaging center for an MRI or X-ray. And many times, to access an appointment with that specialty provider, the provider may need to submit a prior authorization request to the patient's insurance. And then there's also the communication loop process focused on the referral. And so there are many areas for error, and there are a lot of ways the patient experience can go south very quickly."  #JanusHealth #AIinHealthcare #HealthcareAI #HealthTech #HealthcareOperations #RCM janus-ai.com Listen to the podcast here

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the complexities of compliance in healthcare, particularly as the year comes to a close. They explore the importance of understanding revenue cycle management, the disconnect between clinical and payer policies, and the necessity of reading contracts thoroughly. The conversation emphasizes the need for common sense in clinical practices and the critical role of compliance programs in healthcare settings.TakeawaysThe importance of understanding revenue cycle management as the year ends.There is often a disconnect between clinical policies and payer policies.Providers must read and understand their contracts before signing.Medicare sets the standard for many insurance companies' policies.Insurance companies prioritize profit over patient care.Common sense is crucial in clinical practices and billing.Services should only be billed once completed, not prematurely.A written compliance plan is essential for healthcare practices.Compliance programs should be dynamic and regularly updated.Payer policies must align with clinical practices for effective compliance.

On Today's episode of Transforming Healthcare with Dr. Wael Barsoum, we're excited to be filming for the first time and that too with an incredible leader in the payor industry, Tony Helton. Tony Helton is the President and Chief Executive Officer for Medical Mutual of Ohio. Prior to being appointed to his current role in November 2024, he was the organization's EVP and CFO. Earlier in his career, Helton spent nearly two decades at the Cleveland Clinic in several roles, including Interim CFO and Executive Director of Revenue Cycle Management and Continuous Improvement. Helton earned a bachelor's degree in accounting and an MBA from John Carroll University. Join us as we delve into what a mutual is, the differences between mutuals and insurances, and Tony's mission for his community and his incredible journey in this industry.    

Linda Schatz, Director of AKASA, explains the role of Clinical Documentation Integrity (CDI) specialists in ensuring accurate coding and bridging the gap between clinical documentation and specific, accurate codes to ensure proper reimbursement. The complexity of medical coding often leads to errors, which can be nearly eliminated by using AI to review 100% of patient encounters to identify inconsistencies and help CDI and coding professionals process more accurate claims quickly. Accurate documentation is important for hospital revenue, patient care quality, and perception of the hospital's performance. Linda explains, "Well, the old adage, if it isn't documented, it wasn't done. If the doctor uses incorrect or perfectly acceptable medical terminology, it doesn't translate into an appropriate code. You've heard the term UIs, this is years ago, right? Grandma had UTIs and died. In the coding world, that used to code for a simple UTI. So the hospitals are getting paid for a patient that took care of a UTI, when in reality that patient was septic. To the outside world, it looks like Grandma came to the hospital, something that could have been treated outpatient, and she died. So the public perception of quality is less. So not only is it revenue, it's quality, but ultimately it's delivering patient care."   "I'm an old nurse. I've been in this field for over 40 years. I've worked across the NICU, PICU, and adult ICU. I've worked in access hospitals to large academics and all the way through hospice. That's pretty unique as a nurse to have that big of a background. Then I became a CDS, or clinical documentation specialist, or integrity specialist, and learned the documentation and coding aspect." "Then I moved into the consulting role and worked with organizations and physicians all across this nation, helping them learn how to do this. And so you've got the clinical background, the coding background, and now I understand how generative AI works. And so while you're a new nurse, you're a horse, right? When we hear a heartbeat, we think of a horse, and after years, you earn your stripes and you become a zebra, and then you add all of these multiple areas of expertise, you become uniquely valuable as a pink zebra."  #AKASA #GenAI #CDI #RevenueCycleManagement akasa.com Download the transcript here

Linda Schatz, Director of AKASA, explains the role of Clinical Documentation Integrity (CDI) specialists in ensuring accurate coding and bridging the gap between clinical documentation and specific, accurate codes to ensure proper reimbursement. The complexity of medical coding often leads to errors, which can be nearly eliminated by using AI to review 100% of patient encounters to identify inconsistencies and help CDI and coding professionals process more accurate claims quickly. Accurate documentation is important for hospital revenue, patient care quality, and perception of the hospital's performance. Linda explains, "Well, the old adage, if it isn't documented, it wasn't done. If the doctor uses incorrect or perfectly acceptable medical terminology, it doesn't translate into an appropriate code. You've heard the term UIs, this is years ago, right? Grandma had UTIs and died. In the coding world, that used to code for a simple UTI. So the hospitals are getting paid for a patient that took care of a UTI, when in reality that patient was septic. To the outside world, it looks like Grandma came to the hospital, something that could have been treated outpatient, and she died. So the public perception of quality is less. So not only is it revenue, it's quality, but ultimately it's delivering patient care."   "I'm an old nurse. I've been in this field for over 40 years. I've worked across the NICU, PICU, and adult ICU. I've worked in access hospitals to large academics and all the way through hospice. That's pretty unique as a nurse to have that big of a background. Then I became a CDS, or clinical documentation specialist, or integrity specialist, and learned the documentation and coding aspect." "Then I moved into the consulting role and worked with organizations and physicians all across this nation, helping them learn how to do this. And so you've got the clinical background, the coding background, and now I understand how generative AI works. And so while you're a new nurse, you're a horse, right? When we hear a heartbeat, we think of a horse, and after years, you earn your stripes and you become a zebra, and then you add all of these multiple areas of expertise, you become uniquely valuable as a pink zebra."  #AKASA #GenAI #CDI #RevenueCycleManagement akasa.com Listen to the podcast here

This episode, recorded live at the 10th Annual Health IT + Digital Health + RCM Annual Meeting, features John Talaga, EVP Healthcare at Flywire, Rob McDaniel, Senior Director of Revenue Cycle Management, and Keith Givelekian, Executive Director of Digital Business at Cleveland Clinic. The discussion explores how Cleveland Clinic and Flywire are partnering to modernize the patient financial experience through personalization, unified strategy, and innovation that prioritizes patient needs and caregiver efficiency.This episode is sponsored by Flywire.

In this episode, Kanar Kokoy, Founder and CEO of Chirok Health, shares insights on responsible AI adoption in healthcare, emphasizing governance, human oversight, and cultural change as key to driving sustainable impact in revenue cycle management.This episode is sponsored by Chirok Health.

Senior Revenue Cycle Manager Christina Harkins shares how Infinx personalizes every RCM engagement—from onboarding through optimization and even exit planning. Learn how structured discovery, tailored timelines, transparent communication, and U.S.-based audits drive long-term revenue success for practices of all sizes.

If you are listening to this prior to October 9, 2025, go to the 32BJ Changing the Playbook on Hospital Prices event, where Mark Cuban will be keynoting. Cora Opsahl will also be speaking, and I will be there listening. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, trust, simplicity, and a chicken. Yeah, this is where this whole conversation with Mark Cuban and Cora Opsahl winds up. And it is a barnstormer because you know what some really good advice is for anybody trying to do right by patients and taxpayers and plan sponsors? It will take trust. It will take making the complicated as simple as possible. And also if you could pay with a chicken, like in the good old days, that would be messy—I can say with confidence, having grown up in Pennsylvania Dutch country, where there are many, many chickens—but also being able to pay with a chicken could also indicate that healthcare prices are reasonably chicken proportionate and that the doctor-patient relationship is good enough to break bread (or have chicken). That last part is really important, and Cora Opsahl says this at one point in the episode that follows. It doesn't matter how wonderful the transparency or the financing. If the prices are insane and there's no more reasonably priced options in any given market, then yeah. Shane Cerone says in an upcoming show, he says, “We do not have a broken healthcare market. We do not have a healthcare market. There is no market.” Okay … so, you could call this conversation a continuation of the episode with Ann Kempski (EP444), entitled “Two State Healthcare Laws Often Don't Go as Planned.” But it's not just healthcare laws that often don't go as planned. It's some very foundational constructs that we have built the healthcare sector upon that may also not go as planned. The healthcare sector is like a game of pachinko. You chuck an input into the mix, and it will bounce all around into all the perverse incentives and human beings and the non-market that we have. And who the heck knows what is gonna pop out the other side? It's like game theory at its most unpredictable. So, in healthcare, there are many, many examples of when the solution to a problem arguably creates worse problems than the problems the solution was trying to solve for. But we—Mark Cuban, Cora Opsahl, and I—are gonna shake our fists at two such solutions today: high deductible health plans (or just high deductibles in general) and then self-insured employers trying to solve the complexity of the healthcare industry by hiring consultants and middlemen, middle people, and other vendors to navigate the pachinko parlor (that is, our $4.9 trillion healthcare sector) on their behalf. Now, I am not in any way saying the spirit of these two endeavors—high deductibles and hiring consultants and middlemen—weren't wholehearted. They seem just like many other well-intentioned solutions: very logical on their face. What I am saying is there are many ways in the real world for even the most, again, genuine endeavor to turn into a money grab for those so inclined. While at the same time I'm saying all this, I'm also very much saying that there are some amazing consultants and middle folks such as independent third-party administrators, otherwise known as TPAs, and PBMs (pharmacy benefit managers) who are transparent and hold themselves accountable to the fiduciary responsibilities that their clients are held to in real terms—not just in marketing speak with 40 pages of disclaimers following. There are great folks out there, many of whom listen to this podcast and are part of our tribe on the regular. And to you, I say thank you for being here, because it takes all the knowledge and more from every one of the guests featured in these past 487 Relentless Health Value episodes plus treating every day like a school day to make sure that we all are not getting shanked from behind by some innocent-looking contract term that turns out to be anything but. The conversation that follows starts out talking about high deductibles; naturally segues into how third-party intermediaries can actually exacerbate the issues here; then we get into transparency, financing, clinical organizations taking on risk, and the benefits and challenges of direct contracts; then Mark lays out a vision for the future. Okay … I wanna get to this conversation. If you are a new listener here—and you might be because … yeah, Mark Cuban—let me just inform you that this podcast is largely listened to by those who work in the healthcare industry. So, you are going to encounter acronyms. You will also encounter me referencing earlier episodes because surveys say listeners really appreciate these callbacks to go get additional information about any given topic. You can get what amounts to a personalized Master's of Healthcare Administration curriculum if you follow the episode threads long enough. And that was a direct quote from a listener. About the acronyms: They are holy terrors, and we in the healthcare industry are chock-full of them. See the list of acronyms that come up so that you can follow along at home if this is your first day at our rodeo. Also in the show notes is a transcript of this show, along with links to all of the mentioned episodes. Okay … here's my conversation with Mark Cuban, who is Mark Cuban and also CEO and founder of Mark Cuban Cost Plus Drugs. Also, we have Cora Opsahl, who is health fund director of the 32BJ Health Fund and an expert in many things healthcare. Also mentioned in this episode are Shane Cerone; Ann Kempski; Mark Cuban Cost Plus Drugs; 32BJ Health Fund; Preston Alexander; Stanley Schwartz, MD; Elizabeth Mitchell; Kimberly Carleson; Andreas Mang; Jonathan Baran; Claire Brockbank; Dave Chase; Cristin Dickerson, MD; Green Imaging; Kevin Lyons; and Vivian Ho, PhD.   You can learn more at markcubancompanies.com and costplusdrugs.com and follow Mark on LinkedIn, Bluesky, Threads, and X. You can follow Cora on LinkedIn.   Mark Cuban, a native of Pittsburgh, PA; a graduate of Indiana University; and now a Dallas, TX, resident, has always been an entrepreneur. From selling and trading baseball cards, selling garbage bags and magazines door-to-door, to starting a business buying and selling stamps at age 16, there have been few years in his life when he wasn't starting or running a business. He got a job at one of Dallas's first retail software stores, Your Business Software. He spent nine months doing everything from learning how to code, supporting and installing every type of business software, and of course, making sure the store opened on time. That went well until he made the executive decision to turn over the store opening duties to a peer so he could pick up a check for a sale. He was fired. Mark decided it was time to start on his own. The next day, MicroSolutions was founded. Over the next seven years, MicroSolutions became a national leader in Systems Integration and custom applications for local and wide area networks. Growing to 80 employees, never having a losing month of operations and nearly $36M in annualized sales, in 1990, MicroSolutions was sold to CompuServe. At that point Mark “retired” to investing in public and private companies. His knowledge of the networking industry led to success and brought returns of 80% and more each year. Mark purchased the Dallas Mavericks for $285M. The Mavs would have the second-best record in the NBA during his ownership tenure. Mark sold majority control of the Mavs in 2023 but continues to be actively involved with the team. He first appeared as a “Shark” on ABC's Emmy Award–winning hit business show Shark Tank in 2011 and quickly established himself as one of the most popular and tough Sharks, investing millions of dollars in hundreds of small businesses. He's been nominated nine times for an Emmy for Shark Tank. His last appearance on the program was during season 16 in May 2025. In 2019, Mark co-founded costplusdrugs.com. Its launch on January 19, 2022, with transparent pricing and a limited markup, has fundamentally changed the pricing of medications in the United States. Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of SEIU 32BJ have easy and sustained access to affordable, high-quality healthcare. Cora has prioritized a data-driven approach, focusing on reducing trend, solving the affordability challenge on behalf of union members, and, most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. In 2024, Cora conducted an innovative medical request for proposal, stipulating that all finalists have a signature-ready contract drafted by the 32BJ Health Fund prior to award. As a result, the Fund negotiated an agreement that brought unprecedented visibility and increased accountability to its benefit. In 2025, the Health Fund is focused on direct-contracting opportunities that allow it to carve out key benefits and ensure quality while managing spend. Cora is regarded as an expert in pharmacy benefit management and was recently appointed to the Board of Governors for the National Alliance for Healthcare Purchaser Coalitions and the Purchaser Advisory Council for the National Quality Forum and Joint Commission. She previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations, strategy, and acquisitions. Cora earned an MBA from Saint Louis University.   06:25 What was the original rationale behind high deductibles? 07:38 How high deductibles are creating a class of functionally uninsured people. 09:29 EP482 with Preston Alexander. 10:20 “We're using health insurance as a proxy for healthcare.” —Mark 12:30 How providers are now in the debt collecting business rather than the healthcare business. 12:55 EP486 with Stan Schwartz, MD. 15:16 “We have a fundamental reasonability problem.” —Cora 16:07 EP425 with Marshall Allen. 18:25 Direct contracting versus self-funded employers. 19:27 EP436 with Elizabeth Mitchell. 19:30 EP480 with Kimberly Carleson. 19:33 EP372 with Cora Opsahl. 23:53 Why the current system doesn't allow the accountability that is needed. 24:39 EP452 with Cora Opsahl. 26:34 How direct contracting gives strength back to independent practices that high deductible plans take away. 27:46 Who pays, what's the price, and where does the power lie? 31:24 EP419 with Andreas Mang. 34:45 How it comes down to power and leverage when controlling healthcare costs. 38:13 EP483 (Part 1 and Part 2) with Jonathan Baran. 38:35 Why putting together a network and just buying healthcare—not discounts—is not as difficult as it seems. 40:10 Why we need to stop talking about disruption and start talking about change. 40:56 EP453 with Claire Brockbank. 41:02 EP484 with Dave Chase. 43:07 EP485 with Cristin Dickerson, MD. 44:32 EP487 (Part 1) with Kevin Lyons. 46:34 EP466 with Vivian Ho, PhD. 47:40 Why it's the incentives that are different between American hospitals and hospitals in a single-payer program. 50:25 The main takeaways from the conversation. 51:08 Why you can't fix the problems in healthcare without transparency.   You can learn more at markcubancompanies.com and costplusdrugs.com and follow Mark on LinkedIn, Bluesky, Threads, and X. You can follow Cora on LinkedIn.   @mcuban of @costplusdrugs and Cora Opsahl discuss trust and simplicity in #healthcare on our #healthcarepodcast. #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Kevin Lyons (Part 2), Kevin Lyons (Part 1), Dr Stan Schwartz (EP486), Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander

Send us a textRevenue cycle management isn't just a back-office operation—it's a strategic tool for strengthening care delivery in Tribal communities. This episode, REDW National Tribal Practice Leader Wes Benally sits down with Melissa C. Goad, CRCR, CPA, MBA, a healthcare finance veteran with 30 years of experience spanning both payer and provider perspectives. Melissa shares her transformative journey as CFO of a 638 Tribal Healthcare Facility on the Navajo Reservation, where she led a comprehensive revenue cycle optimization initiative that delivered a tenfold return on investment.From fixing data flow challenges and reducing denials by up to a third, to implementing culturally sensitive front-end operations and embracing industry best practices, Melissa's insights offer a practical roadmap for Tribal healthcare organizations looking to maximize reimbursements and close gaps in care. Her approach? Take it layer by layer, build cross-functional teams, and remember that optimizing revenue cycles ultimately means securing the resources needed to serve the community better.Chapters·        00:00 - Introduction and Melissa's Healthcare Background·        02:05 - The Importance of Revenue Cycle Management·        04:45 - Assessing Opportunities in Tribal Healthcare Settings·        06:36 - Embracing Industry Best Practices·        12:24 - Denials Management and Registration Challenges·        17:37 - Data Flow and EHR Customization Issues·        20:13 - The Power of Cross-Functional Teams·        25:05 - Cultural Considerations in Tribal HealthcareTakeaways·        Revenue cycle optimization is about ensuring continuity of care and honoring commitments to the community, not just financial health.·        Tribal healthcare facilities face unique challenges including geographic isolation, staffing limitations, complex billing regulations like the All-Inclusive Rate (AIR), and often inadequate technology.·        Starting with a thorough assessment before implementing changes prevents costly assumptions and builds a strong foundation for improvement.·        Registration is one of the most critical points in the revenue cycle—if data starts wrong, it ends wrong.·        Cross-functional teams that include both clinical and revenue cycle staff are essential for identifying and fixing denial patterns.·        Cultural sensitivity in patient-facing operations, including language support and understanding Tribal-specific requirements like CBI collection, strengthens both patient experience and reimbursement accuracy.·        Organizations can expect to see returns within 6 months of implementing systematic fixes, with some facilities achieving tenfold ROI on revenue cycle investments.Ready to Strengthen Your Revenue Cycle?Whether you're considering a 638 transition or looking to improve existing operations, connect with REDW's Tribal healthcare advisors to explore how we can help strengthen your organization's financial health and expand care for your community. 

On this episode of the Raving Patients Podcast, I sit down with nationally recognized revenue cycle expert Cissy Mangrum of RevTech Partners and Maximize RCM Consulting. With nearly three decades of leadership experience in both healthcare and dental, Cissy has helped countless practices streamline their operations, reduce denials, and improve their bottom line. Revenue Cycle Management (RCM) isn't just about billing—it touches every part of your practice, from credentialing to front office workflows to clinical documentation. In this conversation, we break down why most problems occur long before a claim is denied, and how simple behavioral and operational shifts can radically improve your collections, cash flow, and even patient experience. If you've ever wondered why claims are getting stuck, why AR is piling up, or how to make RCM work for your growth goals, this episode is a must-listen. What You'll Learn from This Episode Why RCM starts at the very beginning of your processes, not just the back end The top five reasons claims get denied—and how to prevent them Key benchmarks to know if your practice has an RCM problem (like days in AR and net collections %) How technology and AI are changing verification of benefits and claims submission The connection between RCM, cash flow, and EBITDA—especially if you're preparing to sell your practice The impact of RCM on patient experience, and how transparent communication and financing options build trust and loyalty — Key Takeaways 02:50 Introduction to Revenue Cycle Management 04:40 Understanding Revenue Cycle Management 12:55 Challenges in Revenue Cycle Management 17:48 Common Issues in Claims Submission 20:08 Identifying RCM Issues 25:59 Impact of RCM on Cash Flow and EBITDA 27:54 RCM and Patient Experience 32:15 Technological Innovations in RCM 34:33 Lightning Round Q&A — Connect with Cissy Want to learn more from today's guest? You can reach Cissy at: Email (RevTech Partners): cissy.mangrum@revtechpartners.com Email (Maximize RCM Consulting): cissy.mangrum@maximizeRCM.com Websites: revtechpartners.com | maximizercmconsulting.com  LinkedIn: Connect with her directly on LinkedIn—she'd love to hear from you. — Learn proven dental marketing strategies and online reputation management techniques at DrLenTau.com. This podcast is sponsored by Dental Intelligence. Learn more here. This podcast is sponsored by CallRail, call tracking & lead conversion software for dentists. Find out more here. Raving Patients Podcast is your go-to place for the latest and best dental marketing strategies that will help you skyrocket your practice. Follow us for more!

From Prior Authorization Chaos to Clear AI Orchestration Prior authorization isn't just broken — it's unsynchronized. On this episode, Evan Martin, VP of Revenue Cycle Management at ZoomCare Inc as well as Host and Producer of The Wilshire's IT RevCast, shares what happens when real-time care delivery meets a fragmented, rule-heavy prior auth system that can't keep up. With just one authorization specialist covering 50 clinics, Evan paints a clear picture: today's healthcare moves fast, but prior auth is still stumbling through a maze of plan-specific rules, outdated workflows, and underperforming automation tools. We explore how even routine imaging, meds, and mental health services become tangled in conflicting payer policies and benefit silos. Evan breaks down the bottlenecks, the firefighting, and the policy blind spots — plus why simply layering automation on top won't fix it. The real opportunity? An orchestrated model powered by agentic AI triages, retrieves, and routes the right information to the right place — so human teams can actually focus on patient care. This isn't theory. It's the lived complexity of treating patients while waiting for permission — and what the future could look like if we finally got the process in tune. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

In this episode, Dr. Bo Gu, CEO of Youlify and former cardiothoracic surgeon, shares how his experience in emergency medicine led him to create an AI-augmented revenue cycle management platform designed to support physicians. He discusses key trends in healthcare billing, the importance of transparency, and his mission to help practices improve financial performance and stay open.

S4:E181 David brings the weekly update on venture and then Paul follows with an interview with Rob Rodrigues, CEO of MP Cloud, a software startup focused on Revenue Cycle Management for EMS providers. The EMS industry is being acutely compressed by the Medicaid Cuts but MP Cloud expects to gain market share by offering better tools to improve cash flow, streamline operations, and reduce errors in providers' everyday work. (interview recorded 6.13.25)Follow David and Paul: https://x.com/DGRollingSouth https://x.com/PalmettoAngel Connect On LinkedIn: https://www.linkedin.com/in/davidgrisell/ https://www.linkedin.com/in/paulclarkprivateequity/ We invite your feedback and suggestions at www.ventureinthesouth.com or email david@ventureinthesouth.com. Learn more about RollingSouth at rollingsouth.vc or email david@rollingsouth.vc.

Donna Ramadan, VP of Revenue Cycle Management at Great Lakes Dental Partners & Ryan Merriman, Senior Enterprise Account Manager at Rectangle Health discuss: The impact of technology on patient collections & payer interactions Reducing AR from $8 million to $2 million The importance of compliance in healthcare Much More To learn more about Rectangle Health you can visit https://www.rectanglehealth.com/ or visit the DSO Resource Guide - https://dso.pub/Rectangle To learn more about Great Lakes Dental Partners visit - https://www.greatlakesdentalpartners.com/