Podcasts about Revenue cycle management

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

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!

In this episode of Business Ninjas, host Andrew Lippman chats with Matt Seefeld, EVP at MedEvolve. Matt shares his journey from consulting to healthcare entrepreneurship and how MedEvolve helps medical providers survive and thrive in today's margin-crushing environment. From skyrocketing costs and declining reimbursements to the complexity of revenue cycle management, Matt breaks down the realities of running a healthcare practice in 2025—and why automation alone won't save the industry.

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.

Access Healthcare, now part of Smarter Technologies, makes revenue cycle management (RCM) more accurate and cheaper by breaking the process into modules and automating each one using AI.  To learn more about how they're doing it and the new organization that brings together Access Healthcare, SmarterDx, and Thoughtful.ai into one company, we sat down with Shaji Ravi, CEO at Access Healthcare.We start off by talking with Ravi about why getting paid and operating efficiently has been such a long standing challenge in healthcare.  He described how in many ways this is getting even more challenging as the cost of leveraging human resources continues to increase even outside the US.  That's why an AI-driven platform approach like the one Smarter Technologies has put together is going to be so important for healthcare organizations.Learn more about Access Healthcare: https://www.accesshealthcare.com/Learn more about Smarter Technologies: https://www.smarter-technologies.com/Healthcare IT Community: https://www.healthcareittoday.com/

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/  

Sam Schwager, Co-founder & CEO and David Khaydtov, Enterprise Account Executive of SuperDial sit down with GDN in New York City to discuss dental RCM and the future of AI. The SuperDial team share their thoughts on: The founding & development of SuperDial Merging AI with human expertise in RCM The future of dental RCM  Much more To schedule a demo or to learn more about SuperDial's dental RCM AI solution visit https://www.superdial.com/ You can also reach out to David Khaydatov via email at David@superdial.ai or on Linkedin at https://www.linkedin.com/in/david-khaydatov-857387b8/   

The Human Edge In An Automated Revenue Cycle Automation has reshaped the revenue cycle—but it hasn't replaced the need for expertise. In this episode of Office Hours, we welcome Evan Martin, VP of Revenue Cycle Management at ZoomCare and host of the Wilshire IT RevCast, to discuss how organizations can strike the right balance between technology and human insight. 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 of Leaders in Medical Billing, host Chanie Gluck sits down with Ramesh Gogineni, CEO of Med-Strategies, who shares his entrepreneurial journey from India to the U.S., and how he built a hybrid offshore/onshore medical billing model along the way.  Formally an engineer with plenty of operations and tech experience, Ramesh's healthcare career started when he married a physician and decided to set up a company that set up Electronic Health Records (EHRs) and then a billing company. He highlights the challenges of early offshoring, why blending automation with human expertise is critical for success, and the optimal staffing mix for RCM operations today.  He also offers practical insights on using RPA, AI, and smart vetting processes to drive efficiency while maintaining quality in Revenue Cycle Management. Listen to this episode to hear first-hand experience from someone who has spent decades experimenting with offshoring medical billing. Plus, Ramesh shares what he's looking forward to in the future of medical billing: improving relationships between payors and providers.  You can find out more about Med-Strategies here: https://med-strategies.com/  Sponsored by 4D Global, empowering medical billing companies through offshore staffing, automation, AI and technology.   

In this episode, Dr. Vishal P. Rekhala, an interventional pain management specialist, joins us to explore a game-changing approach to launching private medical practices through Independent Practice Partners (IPP). We unpack how IPP helps physicians go from concept to fully operational practice in as little as six months — without the usual red tape and overwhelm. Dr. Rekhala shares how a visionary group of ophthalmologists founded IPP to challenge the status quo and empower doctors to reclaim control of their careers. We discuss how this model is giving new life to private practice, especially at a time when many physicians feel trapped by hospital systems and insurance giants. As consolidation tightens its grip on healthcare, this conversation reveals how IPP offers a path to autonomy, financial growth, and better work-life balance — something many young doctors crave but struggle to achieve. We also spotlight the critical role of medical sales reps in this journey, acting as trusted guides who help physicians navigate the complex terrain of starting and scaling their own practices. From revenue cycle management and regulatory hurdles to the rise of boutique cash-pay practices, this episode is packed with real-world insights for physicians and sales professionals alike. Whether you're a doctor dreaming of independence or a rep looking to expand your impact, this conversation is your roadmap to thriving in today's evolving medical landscape. Connect with Dr. Rekhala: LinkedIn Connect with Me: LinkedIn Love the show? Subscribe, rate, review, and share! Here's How » Want to connect with past guests and access exclusive Q&As? Join our EYS Skool Community today!

In this special segment recorded live at the recent HLTH conference, we explore how combining AI and human expertise is driving measurable ROI across the revenue cycle. John Lynn of Healthcare IT Today sits down with Navaneeth Nair and Lora Pada from Infinx to discuss real-world strategies that balance automation with human oversight.

Why AI Needs to Think for the Future of Revenue Cycle Management Traditional automation in revenue cycle management is no longer enough—healthcare providers need AI that thinks, adapts, and problem-solves. Join Jaideep Tandon, CEO of Infinx, and host Stuart Newsome as they explore the shift from automation to intelligence, the latest industry trends, and how AI is driving denial prevention, smarter prior authorizations, and optimized A/R workflows. Don't miss this insightful discussion on the future of revenue cycle management. 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

Traditional automation isn't enough—AI is the future of revenue cycle management. Join Jaideep Tandon, CEO of Infinx, and Stuart Newsome for a discussion on how AI is transforming denial prevention, prior authorization, and A/R workflows.Brought to you by www.infinx.com

In this episode of Leaders in Medical Billing, Ankit Jain, co-founder and CEO of Infinitus Systems, discusses how AI voice agents are changing the healthcare industry. With a background in AI venture capital investment and experience launching two successful tech startups (including a Google acquisition), Ankit shares how Infinitus is eliminating inefficiencies in billing workflows by automating phone calls for tasks such as benefit verifications, prior authorization checks, and claim status updates.  He explains the role of AI co-pilots and AI agents alongside humans, how they improve billing team productivity, and why security and compliance are critical when implementing AI in healthcare. Ankit also provides insights into the future of AI in medical billing, the challenges of scaling AI technology, and how automation can reduce healthcare worker burnout while improving the patient experience.  With over five million AI-powered calls handled, Infinitus is already working with some of the largest healthcare organizations to streamline administrative tasks and enhance operational efficiency. Ankit shares insights into the future of AI, including risks and how it can improve our entire healthcare system.  Tune in to learn how AI-driven automation is reshaping the medical billing industry and why billing companies should consider adopting a comprehensive voice AI platform.  Learn more about Infinitus on their website: https://www.infinitus.ai/  Sponsored by 4D Global, empowering medical billing companies through offshore staffing, automation, AI and technology.   

In this episode, Scott Becker sits down with AKASA co-founders Malinka Walaliyadde and Benjamin Beadle-Ryby to discuss the transformative impact of AI on healthcare revenue cycle management. They explore how AKASA leverages generative AI to drive efficiency, improve financial outcomes, and support healthcare staff, while addressing concerns around trust, data integrity, and job displacement.

Send us a textIn this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice is joined by HST Pathways Chief Executive Officer David Thawley for an in-depth discussion about the company's recently released “State of the Industry Report: Best Practices & Industry Benchmarks for Optimizing ASC Operations.” Prentice and Thawley discuss several of the trends in ASC care and management in 2024, including specializations on the rise, operating room efficiencies, revenue cycle management and a host of best practices that emerged from examining the operational data and reporting of 590 ASCs across 47 states.To access a free copy of the report, visit the HST Pathways website.

AI Agents For Smarter Revenue Cycle Management (RCM) Discover how AI agents are transforming healthcare automation with Navaneeth Nair, exploring their role in improving efficiency, reducing denials, and optimizing revenue cycle management with Chief Product Officer Navaneeth Nair. 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

Discover how AI agents are transforming healthcare automation with Navaneeth Nair, Infinx Chief Product Officer, exploring their role in improving efficiency, reducing denials, and optimizing revenue cycle management. Brought to you by www.infinx.com

In this RCM Insights segment, Stuart Newsome introduces insights from Navaneeth Nair, Chief Product Officer at Infinx, on the critical distinction between automation agents and AI agents in revenue cycle management. Expanding on previous discussions about document automation, this episode explores how proprietary automation platforms drive efficiency, reduce manual workload, and seamlessly integrate with EHR systems, while AI agents play a more advanced role in decision-making and adaptability.

In this episode of Leaders in Medical Billing, host Chanie Gluck welcomes Jonathan LaChapelle, Director of Revenue Cycle Management at Adonis, a cutting-edge revenue intelligence and automation platform designed for healthcare. Jonathan shares insights from his extensive experience in the RCM space and discusses the revolutionary technology-driven capabilities of Adonis that address operational challenges in medical billing. Tune in to discover the innovative solutions that Adonis offers and how they can benefit medical billing companies.    Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

AI agents are reshaping healthcare revenue cycle management by automating tasks like eligibility verification, prior authorizations, and denial management. Learn how these tools enhance efficiency, reduce costs, and evolve into an essential part of our everyday lives.

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Melanie McGivney, Director of Operations at Impact Healthcare Solutions. With over 20 years of experience in revenue cycle management (RCM), Melanie shares insights on operational efficiency, building strong offshore relationships, and overcoming challenges in multi-state hospital billing. From onboarding best practices to the exciting future of AI, this conversation is packed with actionable takeaways for billing professionals aiming to improve processes and client relationships.  Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

Curious about how financial priorities can harmonize with a people-centric culture in healthcare? Join us for a compelling conversation with Ken Kaufman, a visionary leader in the dental support organization sector, as he reveals the delicate balance between fostering a thriving organizational culture and achieving financial goals. With his impressive journey from BYU to CFO, Ken offers invaluable insights into strategies for sustainable growth, emphasizing the importance of caring for employees and patients alike. Discover how Ken's passion for startups and the dental industry has shaped his approach to building a culture where financial and cultural priorities are not at odds but work in tandem to drive success.Unlock the secrets of maximizing healthcare revenue as Ken shares his expert advice on creating robust systems and automating processes within practice management. From merging Revenue Cycle Management systems to conducting annual fee schedule reviews, Ken provides actionable steps to optimize collections and streamline operations. Learn how transitioning to accrual accounting and implementing effective analytics can paint an accurate picture of business health while maintaining ethical practices. This episode promises a deep dive into the complexities of financial operations, offering practical guidance to navigate these challenges without losing sight of what truly matters—your organization's cultural core.As we explore the intricacies of compensating healthcare providers and the exciting realm of real estate partnerships, Ken sheds light on incentivizing growth and creating strategic collaborations. Gain insights into salary ranges, compensation structures, and the ever-evolving landscape of commercial real estate ventures. Whether you're a dental practice manager or a healthcare executive, Ken's experience and wisdom will equip you with the knowledge to make informed, strategic decisions that align financial success with a vibrant, people-focused organizational culture.If you need help finding the perfect location or your ready to invest in commercial real estate, email us at admin@leadersre.com Sign up for a FREE vulnerability analysis and lease renewal services View our library on apple podcasts or REUniversity.org. Connect on Facebook. Commercial Real Estate Secrets is ranked in the top 50 podcasts on real estate

Explore how automation can transform revenue cycle processes by eliminating manual inefficiencies, reducing costs, and improving cash flow. Discover targeted solutions that streamline tasks like prior authorization, eligibility verification, and claims management to optimize operational performance.

On today's episode, Mark continues his deep dive with dental billing and revenue cycle management expert Penny Reed, Chief Growth Officer at E-Assist Dental Solutions. Penny breaks down five powerful strategies to improve collections, streamline billing processes, and ensure dental practices get paid what they're owed. From understanding chair hour values and optimizing PPO contracts to collecting patient co-pays upfront and sending clean claims, Penny shares actionable insights for dentists navigating the complexities of insurance and revenue systems. Plus, she highlights the importance of accurate reporting, solid protocols, and leveraging AI tools to simplify communication and billing follow-ups. If you're tired of revenue leaks and denied claims, this episode offers the clarity and tools to transform your practice's financial health. EPISODE RESOURCES https://eassist-dental-billing.com https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

On today's episode, Mark welcomes back Penny Reed, Chief Growth Officer at E-Assist Dental Solutions and a leader in dental business coaching. Penny shares her wealth of experience in revenue cycle management (RCM) and explains why a broken billing system can wreak havoc on your cash flow and patient relationships. Together, they dive deep into the importance of accurate insurance verification, airtight financial policies, and clean claims submission to prevent the dreaded "garbage in, garbage out" scenario. Penny also discusses the growing role of AI in claims processing, outsourcing RCM for efficiency, and the critical need for team alignment and communication to ensure a successful partnership. If you've struggled with collections, operational gaps, or billing frustrations, this episode is packed with insights to streamline your revenue systems and boost profitability. EPISODE RESOURCES https://eassist-dental-billing.com https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

What the heck is Robotic Process Automation and how does it apply to Revenue Cycle Management? In other words, RPM for RCM. My guest today runs a very successful RCM company that's takes leading the way with new technology very seriously. He'll tell us what all of this means.Vinod (Vinny) brings over 15 years of experience in operations, financial analysis, strategy, growth, corporate development, strategic planning, and marketing. At Medical Billing Wholesalers, he is involved in applying his experience to optimize revenue cycle process flows to improve our clients' profitability and performance.In this episode Carl White and Vinny Sankaran discuss:What RPM is and what it is notGood uses of RPMQuestions to ask your RCM provider about RPMWant to be a guest on PracticeCare®?Have an experience with a business issue you think others will benefit from? Come on PracticeCare® and tell the world! Here's the link where you can get the process started.Connect with Vinny Sankaranhttps://www.linkedin.com/in/vinodsankaran/Connect with Carl WhiteWebsite: http://www.marketvisorygroup.comEmail:  whitec@marketvisorygroup.comFacebook:  https://www.facebook.com/marketvisorygroupYouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmigLinkedIn: http://www.linkedin.com/in/healthcaremktg

In this episode, David Dawson, senior vice president of Conifer Health Solutions, joins host Dan Karnuta to discuss the use of artificial intelligence in healthcare-related revenue cycle management. They discuss what RCM is, the issues that have caused inefficiencies in the RCM process and how AI is a promising solution for solving them. Karnuta is director of the Professional Program in Healthcare Management at The University of Texas at Dallas Naveen Jindal School of Management.

Marina Bigsby, Chief Customer Experience Officer at AccessOne, focuses on providing financial products and services to help make healthcare more affordable for patients and improve the physicians' revenue cycle management. The aim is to provide more transparency and payment options upfront to avoid situations where patients forgo needed care. Using AccessOne's technology and mobile payment solution, providers collect payments faster and proactively identify and address operational inefficiencies and staffing challenges.   Marina explains, "We're a technology company. We partner with our providers and look at their various situations. Their situation might be that they have a pocket of their population with high debt problems, or maybe there is a staff shortage or some other operational efficiency challenge. We're designing a product that works for them. Our platform is highly configurable, and we built something that works for them and helps them collect more so they can allocate funds to wherever they need. We have a proprietary funding option, so they can work with us to accelerate cash quickly into their RCM or manage risk differently. So that's really what we're doing. We're working with them to collect more so they can help more patients."   "It's a time savings so that they get cash faster, which is always good, but it's also a time savings from an operational savings. So responses are great -- we send out a text and our MobilePay product is a replacement, a complete replacement of a piece of paper. Awareness of the text helps people say that even if they don't want to pay through the text, they know there's a bill and know it earlier than they normally would have, so they can pay it however they'd like. Whether in a portal or through our text, that awareness is increased. There are lots of glowing reviews around that product." #AccessOne #RevenueCycleManagement #RCM #PatientExperience #PatientFinancing #PatientAccess accessonepay.com Download the transcript here

Marina Bigsby, Chief Customer Experience Officer at AccessOne, focuses on providing financial products and services to help make healthcare more affordable for patients and improve the physicians' revenue cycle management. The aim is to provide more transparency and payment options upfront to avoid situations where patients forgo needed care. Using AccessOne's technology and mobile payment solution, providers collect payments faster and proactively identify and address operational inefficiencies and staffing challenges.   Marina explains, "We're a technology company. We partner with our providers and look at their various situations. Their situation might be that they have a pocket of their population with high debt problems, or maybe there is a staff shortage or some other operational efficiency challenge. We're designing a product that works for them. Our platform is highly configurable, and we built something that works for them and helps them collect more so they can allocate funds to wherever they need. We have a proprietary funding option, so they can work with us to accelerate cash quickly into their RCM or manage risk differently. So that's really what we're doing. We're working with them to collect more so they can help more patients."   "It's a time savings so that they get cash faster, which is always good, but it's also a time savings from an operational savings. So responses are great -- we send out a text and our MobilePay product is a replacement, a complete replacement of a piece of paper. Awareness of the text helps people say that even if they don't want to pay through the text, they know there's a bill and know it earlier than they normally would have, so they can pay it however they'd like. Whether in a portal or through our text, that awareness is increased. There are lots of glowing reviews around that product." #AccessOne #RevenueCycleManagement #RCM #PatientExperience #PatientFinancing #PatientAccess accessonepay.com Listen to the podcast here

Explore how Artificial Intelligence acts as a symphony within Revenue Cycle Management, with automation, cognitive AI, and generative capabilities each playing a distinct role. Learn how Infinx provides the framework to harmonize these technologies, augmenting human workflows for a seamless and efficient revenue cycle. Brought to you by www.infinx.com

Morgan Stanley Research and Investment Management analysts discuss how AI can keep costs down for the industry and give patients a more personalized experience.----- Transcript -----Craig Hettenbach: Welcome to Thoughts on the Market. I'm Craig Hettenbach, Morgan Stanley's U.S. Healthcare Technology and Providers analyst. Today I'm here with my colleague Steve Rodgers from Morgan Stanley Capital Partners to talk about a growing and underappreciated segment of healthcare – the behind-the-scenes technology that is transforming the sector to keep costs down and improve patient care. It's Monday, December 9th at 9am in New York. In 2022, the size of the U.S. healthcare sector was [$]4.5 trillion and is projected to grow to [$]6.8 trillion in 2030, accounting for 20 per cent of overall U.S. GDP. We know that the U.S. population is aging, and we expect to see 71 million U.S. citizens age 65 and over by 2030. That puts ever growing demand on health care systems. So, Steve, you and your colleagues in investment management have been looking lately at key macro trends driving change in the healthcare sector.What are these drivers and how do they work together?Steve Rodgers: When we look at the health care landscape, we really think about four major macro trends. The first is cost containment. And this is just this simple idea that costs are escalating at an unsustainable rate. The second is demographics; we also know that things like obesity is increasing the prevalence of chronic conditions and increasing the overall utilization of the healthcare system. And so, we're looking at ways to invest behind that macro trend. We've also identified something called consumerism. And consumerism stems from the reality that today, patients are taking more of a financial responsibility in their healthcare. And with that comes more decision making. So, the old days – where the patient received healthcare services, but the payer paid, and there was really no link between the two – have moved on.We call it the retailization of health care. Waiting in the office for your appointment for 30 minutes used to be a standard. Today, that's unacceptable because these patients will move to the next provider who's providing them a better retail experience. The final macro driver we call enabling technology. Health care has lagged many other industry segments in the use of technology as a source of efficiency. I like to give the example of chemotherapy treatments, right? Technology would produce a new chemotherapy treatment, and while that's great for patient care and outcomes. It actually could lead to increased costs to the system because it was an added route that people would go down.Now there's technology which allows a provider to say, “Start with this one because of your genetic makeup.” And not only will you have a better outcome more quickly, but it will be less cost to the system. We're also seeing that kind of efficiency happen on the administrative side of healthcare as well. The way we think about these macro trends and how they work together is really thinking about demand versus supply. So, we see demand drivers coming from demographics and consumerism. We see supply drivers coming from cost containment and really enabling technology has impacts on both demand and supply.Craig Hettenbach: Let's focus more specifically on just how digitization and cost containment dovetail. When people talk about the impact of AI and ML on healthcare, typically the focus is on things like big pharma, medical equipment, and hospitals. But there's actually a whole intricate infrastructure that helps healthcare run.Can you talk about these behind-the-scenes businesses and why investment managers are so interested in the opportunities they offer? Steve Rodgers: Yeah, it's really important. We focus on investments that are using technology to enable their businesses. And so that's automation. That's machine learning. It's AI. But all of these technologies are being used behind the scenes to make care more efficient and they're a better use of our dollars. For example the personalization of communications from health plans. So historically a health plan would send the same communication, you know, to – the same form to every patient.Well now, technology allows the health plan, at the point of generating that communication, to know that information about the person that's getting it. And having the ability to personalize it in ways that might help them be more likely to interact with it. Maybe they're trying to get them to do something about their health. Well, they can take an administrative communication, you know, called an explanation of benefit, which really just explains how much you owe versus how much the health plan owes. And you can also add important information to that that might help you utilize your benefits better.Another example that we see is on the hospital side. As people I think have heard, hospitals have been very inefficient, right? They pay bills the wrong bills, they're duplicative invoices, and there haven't been really good ways to figure that out. Well, we now have technology that can identify those duplicative invoices, that can actually identify that there are multiple contracts that they have with a vendor and direct them to use the cheapest one.Last one that I would highlight is around the procurement of pharmaceuticals. So, again, if you imagine a hospital system that has 50 different hospitals and one person at each hospital might be buying the pharmaceuticals that fit to the needs they have in that facility. Well, now there's technology that's really helping consolidate those purchases, get the benefits of scale. Also tracking what is a very dynamic pricing market and figuring out today this channels is less costly than that one, so buy it from here; tomorrow it might be different.We're seeing behind-the-scenes uses of technology in all of those types of areas, which are leading to efficiencies. Craig Hettenbach: That's really interesting and I agree. Sometimes investors can overlook healthcare infrastructure as an area offering a lot of hidden growth. Let's take a subsector like Revenue Cycle Management or RCM. What is it exactly and what opportunities does it offer when it comes to technology and cost containment?Steve Rodgers: What it is, it really is the whole process from start to finish of a healthcare episode. So, starting with something as simple as eligibility, or is this patient eligible for this procedure?Then once that procedure happens, it has to be documented and coded and billed. And then once that bill goes out that needs to be collected and paid on. So, this whole process is really how healthcare works and it's one of the most important business processes for healthcare companies .And what we've seen with revenue cycle is it's been a very, historically, a very manual process that involved a lot of human effort. So early on, some of the most basic functions of revenue cycle were automated. So, the example I can give there would be the front-end entry of a claim.So that used to be sent over by fax and a person would have to look at that and type it into a computer and start the processing that way. Well that, for a long time, that's now been automated with either what's called OCR, which is a scanning technology. But even, you know, now, a lot of that's coming in digitally. But a lot of the rest of the process is still manual. And the reason is because the tasks are so complex. So, to resolve a claim, you often need to pull data from multiple sources. There'd be some subjective determinations about what's allowed or not allowed.You would then need to apply [it] against a multiple complex rules and benefits. And sometimes the sheer dollars involved would make it too risky to just pay that claim without someone actually looking at it. Really we're entering an automation cycle where some of these new technologies are making it possible to reliably automate these more complex functions.And so it's a combination of machine learning and AI but it's really driving efficiencies that are really exciting from an investment perspective to us right now.Craig Hettenbach: Got it. In addition to revenue cycle management, are there any other subsectors that look interesting to you right now?Steve Rodgers: We also, we call it cost cycle management. This is the idea of applying the same principles that we're seeing in revenue cycle to the purchasing of providers. So that can be supply costs, inventory management. Another area that we think is interesting is self insured employer outsourcing. One of the main frustrations that we hear time and time again from self insured employers is that their employees are not utilizing the benefits that they have. With technology, companies that are finding ways to get broader and better adoption; then in turn allowing these employers to see better utilization, which is going to lead to a healthier workforce and hopefully do so also, with some cost containment.So Craig, it's clear that there's an overlap between what we look at from the investment management side and what you and your colleagues focus on in research. How do you think about analyzing how AI and machine learning are impacting healthcare?Craig Hettenbach: Yeah, so for research across the department, we came up with a framework to look at and that's the NEXT framework. So number one, new business opportunities to evaluate. Number two, efficiencies. Number three, external productivity. And number four, content creation. So those are four things to help kind of frame what the opportunity set looks like, when leveraging AI and technology.Steve Rodgers: And how does this framework apply to your space, healthcare services and technology specifically?Craig Hettenbach: The second point of that next framework, the E for efficiencies, is something that we're already starting to see the tangible benefits. And so, just to give you some context here, the CEO of a leading hospital, at a conference recently said that 25 to 30 per cent of overall healthcare costs are tied to administrative.So there is a lot of low hanging fruit there. There's other areas within whether you think about things like prior authorizations that are still done manually, either via fax, phone, email. Those are things that some health plans and technology partners are looking to automate. So, I think the efficiencies – we're still early on, but you're starting to see at least the business case in terms of investments there.And then there's the longer term look on the clinical side. And I think the understanding there is that's going to take longer. An executive at a recent industry conference I was at, I thought he said it best when he said, ‘You know, AI is going to save time before it saves lives.' Steve Rodgers: How is this technology changing how physicians or providers do their jobs?Craig Hettenbach: When we look at what's happened with physicians and nurses and still not too far removed from COVID and just burnout, it's palpable. And I think it's something that technology can certainly be used as an enhancer.So ambient listening is a new technology. When we think about electronic health records; yes, it's great to get that information into that record, but it's also timely and consuming. And so, I think things like that – that can listen to and populate notes – is going to be a real time saver for both doctors and patients.And on the patient side as well, when we think about just our experience, right? Healthcare just has a long ways to go in terms of response time. And that's something that I think more automation and technology, whether it's things like scheduling or check-ins and things like that, I think ultimately you'll see more technology deployed.Okay, Steve, are there any other potentially overlooked near term or longer-term pockets of opportunity within health care that you think investors should focus on?Steve Rodgers: Yeah, I think a general rule for investors or, you know, a heuristic that they should think about is, really trying to invest behind the things that are providing – really trying to stay on the right side of healthcare. And so, when we look at things like cost containment, you know, we see companies out there where they might be benefiting from inefficiency in the system. Those are things that I'd stay away from. I'd focus on companies that are providing better quality care at a lower cost and staying on the right side of healthcare. Because I do believe that a lot of these investments – the AI, the technology – are going to drive efficiency and really eradicate some of these business models that are really taking advantage of the inefficiencies in the healthcare system.Craig Hettenbach: Great, Steve, well that's very helpful and thanks for taking the time to talk today.Steve Rodgers: Great speaking with you, Craig.Craig Hettenbach: And thanks for listening. If you enjoy Thoughts on the Market, please leave us a review wherever you listen and share the podcast with a friend or colleagues today.

James Grover, President of Vyne Dental, addresses the friction and inefficiencies in the dental healthcare system to facilitate payments and improve patient outcomes. The dental care environment is fragmented and lacks coordination between patients, dentists, and payers. Vyne Dental works with dental practices to streamline the revenue cycle management process, improve patient communication, and ensure timely and accurate payments.   James explains, "We sit at the commerce crossroads between patients, practices, and payers, basically helping patients to pay, helping payers to pay, and helping practices to get paid for the services that they're rendering." "Then in the payer space, they're trying to avoid fraud. They also have certain places where there are plans that approve certain things but don't allow for others, and they need to do their work. Unfortunately, there's a tremendous amount of waste between all three constituents. That waste results in higher prices for patients and less business success for both practices and payers." "So you have a patient who gets services and the practice is pretty much programmed to get that payment when the patient comes back in the next time. Why? Because they want their insurance to pay for it. For practices to get paid, that patient has to come back in. Well, there's a huge problem. The ADA says that only about 41% of new patient visits result in the patient returning. And so, about six in ten new patients don't return to the practice, and there is only about 85% retention of existing patients." #VyneDental #AccelerateRev #DentalBilling #RCM vynedental.com Listen to the podcast here

James Grover, President of Vyne Dental, addresses the friction and inefficiencies in the dental healthcare system to facilitate payments and improve patient outcomes. The dental care environment is fragmented and lacks coordination between patients, dentists, and payers. Vyne Dental works with dental practices to streamline the revenue cycle management process, improve patient communication, and ensure timely and accurate payments.   James explains, "We sit at the commerce crossroads between patients, practices, and payers, basically helping patients to pay, helping payers to pay, and helping practices to get paid for the services that they're rendering." "Then in the payer space, they're trying to avoid fraud. They also have certain places where there are plans that approve certain things but don't allow for others, and they need to do their work. Unfortunately, there's a tremendous amount of waste between all three constituents. That waste results in higher prices for patients and less business success for both practices and payers." "So you have a patient who gets services and the practice is pretty much programmed to get that payment when the patient comes back in the next time. Why? Because they want their insurance to pay for it. For practices to get paid, that patient has to come back in. Well, there's a huge problem. The ADA says that only about 41% of new patient visits result in the patient returning. And so, about six in ten new patients don't return to the practice, and there is only about 85% retention of existing patients." #VyneDental #AccelerateRev #DentalBilling #RCM vynedental.com Download the transcript here

In this episode, recorded live at the Becker's Healthcare 12th Annual CEO + CFO Roundtable, Michael Palmer, Vice President and Deputy Chief Information Security Officer at R1RCM, dives into the critical role of cybersecurity within healthcare revenue cycle management. Palmer discusses key challenges, from handling interconnected healthcare systems to safeguarding against ransomware and denial of service attacks, and emphasizes the importance of vendor security protocols and continuous monitoring to mitigate evolving cyber threats.

We are happy to welcome Colleen Huff to the Growth in Dentistry podcast! Colleen is a Revenue Cycle Management expert with 30 years of dental industry experience. Listen in to hear Colleen and Steve discuss:Revenue Cycle Management challenges in dentistry, particularly after the Change Healthcare breach and how AR days are up since the breachImportance of understanding clearinghouse operations and insurance claim processesTips for managing claims and time management strategies…and so much more!Check out Colleen's book, *A Mouthful of Insurance*, out now: https://www.amazon.com/Mouthful-Insurance-Proper-training-tomorrow/dp/B0D8WLNZ3T. See a demo of DI and get a $50 gift card: http://get.dentalintel.net/podcast.

November 1, 2024 Ray and Scott talk PRS MS Director of Operation, Marianne Desciose about Revenue Cycle Management (RCM) current and sometimes hidden issues.PRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a QuoteUrology Advanced Coding and Reimbursement Seminars - In-Person SeminarsRegister Now for the Urology Advanced Coding and Reimbursement SeminarClick Here for Information and RegistrationEvent DetailsLocation:Las Vegas: December 6-7, 2024, at HorseshoeNew Orleans: January 31-February 1, 2025, at Harrah'sTime: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pmIncludes: Breakfast and Lunch on both days, plus 14 AAPC CEUs   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Click Here to Start Your Free Trial of AUACodingToday.com

In this episode, Kathy LeBrew, Executive Vice President, Chief Transformation Officer, and Chief Revenue Officer at M Health Fairview, discusses the evolving healthcare landscape. Kathy shares insights on the impact of caregiver burnout, the rise of cybersecurity threats, and how M Health Fairview is navigating managed care and financial performance. She also reflects on leadership's role in healthcare's future, emphasizing people and innovation.

This episode of the Becker's Healthcare Podcast tackles the financial realities of dentistry with Cissy Mangrum and Marci Sweet. Cissy, Senior Vice President of Revenue Cycle Management at Specialty Dental Brands, and Marci, Vice President of Marketing at DentalXChange, discuss the challenges DSOs and practices face, and how automation in RCM is revolutionizing the financial landscape.This episode is sponsored by DentalXChange.

Gretchen Case, Managing Partner at The Wilshire Group a boutique healthcare revenue cycle consulting company that helps healthcare clients streamline workflows and processes. They work with hospitals, physician groups, and other providers to optimize their investment in technology and improve patient outcomes. Gretchen points out the various aspects of revenue cycle management, which include insurance benefit verification, explanation of costs, and identification of financial support. The middle revenue cycle includes the codification of clinical data and coordination with insurance companies and electronic health records. The third phase is the billing and payment.   Gretchen elaborates, "Some of the automation I've seen over the last several years has been designed to query the documentation and come up with suggested codes, called computer-assisted coding. And there is a lot of that in play. I think it expedites things and it makes things more efficient. I don't know of anybody who's just flipped that button and left it behind and not continued to monitor and manage it." "There's also movement right now around what we call a single path. That's just one way of saying it, but it's about coding the professional and the technical at the same time. What does that mean? The physician's procedure charge and the technical is what the hospital is going for that technical component of the services. And a lot of times, we share codes. So, if you're going to be coding the physicians and getting her bill out the door correctly, you might as well be coding the hospital one at the same time. So there are definitely developments there, but I haven't seen anything. Just completely automate it and step away." #TheWilshireGroup #RevenueCycleManagment #RCM #Hospitals thewilshiregroup.net Download the transcript here

Gretchen Case, Managing Partner at The Wilshire Group a boutique healthcare revenue cycle consulting company that helps healthcare clients streamline workflows and processes. They work with hospitals, physician groups, and other providers to optimize their investment in technology and improve patient outcomes. Gretchen points out the various aspects of revenue cycle management, which include insurance benefit verification, explanation of costs, and identification of financial support. The middle revenue cycle includes the codification of clinical data and coordination with insurance companies and electronic health records. The third phase is the billing and payment.   Gretchen elaborates, "Some of the automation I've seen over the last several years has been designed to query the documentation and come up with suggested codes, called computer-assisted coding. And there is a lot of that in play. I think it expedites things and it makes things more efficient. I don't know of anybody who's just flipped that button and left it behind and not continued to monitor and manage it." "There's also movement right now around what we call a single path. That's just one way of saying it, but it's about coding the professional and the technical at the same time. What does that mean? The physician's procedure charge and the technical is what the hospital is going for that technical component of the services. And a lot of times, we share codes. So, if you're going to be coding the physicians and getting her bill out the door correctly, you might as well be coding the hospital one at the same time. So there are definitely developments there, but I haven't seen anything. Just completely automate it and step away." #TheWilshireGroup #RevenueCycleManagment #RCM #Hospitals thewilshiregroup.net Listen to the podcast here

Send us a Text Message.Both patients and providers are more than familiar with the headaches associated with collecting payments.But what solutions are there that support both patients and providers?In this episode of HealthBiz Briefs, Tom Furr, CEO of PatientPay reveals how things like the Affordable Care Act are driving out-of-pocket costs and what the solutions are for supporting providers in collections without damaging patient opinions in the process.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.

In this episode of Leaders in Medical Billing, Chanie Gluck interviews Ashish Mandavia, a trained physician and now CEO and co-founder of Sohar Health. Ashish shares his journey from practicing psychiatry to becoming a healthcare tech entrepreneur, discussing the motivations behind his career shift and the challenges he faced in the process. He explores systemic issues in healthcare that motivated him to innovate, particularly focusing on revenue cycle management (RCM) and the need for better technology in this space. The conversation also delves into differences in healthcare systems between the U.S. and Europe, the impact of AI on healthcare, and the future of preventative care. Timestamps: 00:00 - 02:00 - Introduction by Chanie Gluck, overview of the podcast. 02:01 - 05:00 - Introduction of guest Ashish Mandavia and his background. 05:01 - 10:00 - Ashish's journey from practicing psychiatry to entering healthcare tech. 10:01 - 15:00 - Challenges in the U.S. healthcare system and Ashish's motivation to innovate. 15:01 - 20:00 - Discussion on revenue cycle management (RCM) and why physicians avoid taking insurance patients. 20:01 - 25:00 - Overview of Sohar Health's solutions for automating RCM processes. 25:01 - 30:00 - Importance of accuracy in RCM and the role of AI in improving healthcare processes. 30:01 - 35:00 - Future of Sohar Health and broader healthcare industry trends. 35:01 - 40:00 - Ashish's perspective on AI and preventative care in healthcare. 40:01 - 45:00 - Closing thoughts, upcoming conferences, and where to find Sohar Health.

This episode of the Becker's Healthcare Podcast tackles the financial realities of dentistry with Cissy Mangrum and Marci Sweet. Cissy, Senior Vice President of Revenue Cycle Management at Specialty Dental Brands, and Marci, Vice President of Marketing at DentalXChange, discuss the challenges DSOs and practices face, and how automation in RCM is revolutionizing the financial landscape.This episode is sponsored by DentalXChange.

Learn how Rick Tully, Executive Director of Revenue Cycle Management, navigated the complexities of a cyberattack sharing valuable insights and strategies for enhancing cybersecurity. Discover strategies for enhancing cybersecurity, including the use of dual clearinghouses, and the balance between manual processes and automation to ensure operational continuity. Brought to you by www.infinx.com. 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/

Learn how Rick Tully, Infinx Executive Director of Revenue Cycle Management, navigated the complexities of a cyberattack and sharing valuable insights and strategies for enhancing cybersecurity. Discover strategies for enhancing cybersecurity, including the use of dual clearinghouses, and the balance between manual processes and automation to ensure operational continuity. Brought to you by www.infinx.com

Our special guest this week is Sarah Armstrong, CEO of Trend Health Partners and my good friend from over the years.  Sarah has always shown me kindness and postivity.  Being in the business of people is built into her and with this episode we found out some of the "why".  Sarah opened up to us and walked us through her incredible journey.  Like any journey it's full of amazing highs and really low lows.  Through it all Sarah persevered and even changed Ben's mind on payor relationships.  It's a must listen podcast for this season.  Remember to like and subscribe!   Chapters 03:01 Payment Integrity and Communication Challenges 07:14 Making Small Changes in Healthcare 10:39 The Attitude Towards Fixing Healthcare 23:28 Personal Loss and Suffering 31:19 The Power of Empathy and Support 36:10 Embracing the Good and the Bad in Life 43:22 Leadership through Individual Connections 46:05 Showing Up for Others 48:11 Embracing Work-Life Fluidity and Authenticity 50:08 The Constant Pursuit of Improvement as a CEO 55:24 Engaging in Conversations about Healthcare and Revenue Cycle Management  

In this episode we are joined by Laxmi Patel, Chief Strategy Officer at Savista, and Kaleigh Stetler, Head of RCM at Asante Health System, as they discuss how Asante has transformed its RCM approach. Learn how they selected an RCM partner, the impressive results they achieved, and valuable tips for healthcare leaders considering outsourcing RCM.This episode is sponsored by Savista.