Latest / Becker’s Healthcare Podcast / Navigating Revenue Cycle Challenges and Growth Opportunities with Amanda de los Reyes

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Navigating Revenue Cycle Challenges and Growth Opportunities with Amanda de los Reyes · Becker’s Healthcare Podcast

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  - When it comes to today's RCM, we know
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  - the challenges,
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  - complexity of claims, talent shortages,
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  - low funding, and lagging tech.
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  - That's why we built MedMetrix.
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  - We have the expertise and advanced tech to
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  - give you that edge on your revenue cycle.
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  - We're a partner who will relentlessly raise your
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  - yield, a partner who's on your side because
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  - they've been operator side, who knows your battles
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  - and will make sure you win from start
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  - to finish, end to end. MedMetrix,
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  - be exceptional.
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  - This is Andrew Cash with the Becker's Healthcare
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  - Podcast. I'm thrilled to be joined today by
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  - Amanda De Los Reyes,
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  - vice president of revenue cycle at Renown Health.
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  - Amanda, it's a pleasure to have you on
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  - the podcast. Thank you for having me.
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  - Before we begin,
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  - can you tell us a little bit about
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  - your background?
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  - Absolutely. So I've been in health care for
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  - the past twenty four years. My career began
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  - at Legacy Health where I spent twenty one
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  - years.
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  - I started out in hospital operations and moved
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  - to finance and then finally revenue cycle.
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  - After that, I took a role at Valleywise
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  - in Phoenix, Arizona as the vice president of
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  - revenue cycle,
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  - and I just joined Renown as the vice
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  - president of revenue cycle in January of this
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  - year.
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  - Yeah. And so you're still fairly new to
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  - your role at Renown. And so how are
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  - the first few months of your job going?
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  - And as a leader, what do you think
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  - are the keys to settling into a new
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  - organization?
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  - Well, it's going fantastic.
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  - I've received a great warm welcome from everyone
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  - at Renown, so that's been great. Of course,
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  - it's been extremely busy starting to learn,
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  - to, you know, a new organization and that
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  - type of thing.
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  - So just kind of getting all of the
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  - knowledge has been,
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  - has been a little bit overwhelming, but has
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  - also been great.
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  - As far as kind of how to settle
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  - into a new role, my philosophy really is
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  - to kind of understand the organization and the
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  - team and how things are currently operating before
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  - just coming in and making, you know, massive
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  - changes or anything like that,
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  - and really gaining the team's perspective and buy
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  - in on any changes that will be made,
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  - but not just to come in and start
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  - making changes, of course, unless there's a compelling
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  - reason to do so, which that can happen
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  - from time to time.
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  - But really trying to build the credibility with
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  - the team and get to know them. And,
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  - of course, you know, revenue cycle are big
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  - on data and analytics and KPIs, so really
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  - understanding,
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  - the current kind of situation of where the
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  - KPIs are, what's working really well, and where
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  - there could be some potential opportunities.
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  - Yeah.
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  - And so what would you say are three
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  - of the top trends that you're following in
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  - health care today?
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  - Oh, okay. So I would say AI and
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  - automation. I think there's a lot of opportunity
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  - there.
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  - With, you know, with caution, of course.
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  - But there's some really exciting things that are
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  - already in place and on the horizon.
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  - One of the other issues is the increasing
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  - number of denials and really the tension between
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  - the payers and providers that seems like it's
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  - at an all time high. And, you know,
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  - as soon as we're able to work through
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  - certain denials, another one pops up and it's
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  - just like plain whack a mole. So that's
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  - definitely something,
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  - that I'm following.
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  - And then,
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  - HR one and how that will impact different
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  - health systems. You know, it has different,
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  - kind of outcomes based on the type of
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  - health system where you're located geographically,
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  - if you are, you know, in a Medicaid
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  - expansion state,
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  - the type of state directed payments that you
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  - have. And so that's something that I'm watching
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  - very closely over the next six months and
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  - really trying to make sure that my team's
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  - prepared for some of the things that will
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  - directly impact us, you know, right off the
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  - bat such as,
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  - the Medicaid redeterminations
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  - being every six months and some of the
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  - things that we can put into place to
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  - help with our patients, you know, to make
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  - sure that they can continue to have coverage
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  - so that they're not concerned about, you know,
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  - receiving a large bill and those types of
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  - things.
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  - Mhmm.
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  - And so what would you say is the
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  - biggest revenue cycle headwind you're facing right now
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  - and how are you, addressing that challenge?
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  - Yeah. I it's kind of a little bit
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  - of a play on the things that I'm
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  - following, which I guess makes perfect sense.
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  - So revenue cycle specifically,
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  - the escalating friction and the more opaque denials
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  - driven by payer automation,
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  - you know, we'll we'll receive denial sometimes that
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  - are obvious that there is some type of
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  - automation because it's the wrong denial type.
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  - But, you know, it seems that the pay
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  - you know, most of the time, the payers
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  - have more money to invest and spend on
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  - some of the automation.
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  - And from my perspective, I think some of
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  - the operational folks don't really understand,
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  - that we work with directly at the payers.
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  - Some of the service reps don't understand even
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  - some of the automation that their plan is
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  - using, and so it can be really difficult.
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  - And it can be really difficult to be
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  - able to talk through those items
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  - and work through how to overcome those things,
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  - especially when they're not correct. And then sometimes
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  - it's hard to determine what even the reason
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  - is for the denial and the lack of
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  - information that the payers are providing about those
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  - denials.
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  - I think the second thing I've get again,
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  - and this is more global for hospitals in
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  - general is with HR one and, you know,
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  - kinda going back to the redeterminations
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  - and things like that. But there's a lot
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  - of other things that are on the horizon
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  - from a regulatory
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  - standpoint
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  - with looking at hospital outpatient departments and the
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  - potential sunsetting some of those programs. And so
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  - I think it's just really important to keep
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  - a a close pulse on those types of
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  - things right now.
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  - Yeah. And so what are you most excited
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  - about right now?
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  - Well,
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  - going back to automation, I think the shift
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  - in what automation can do. And I know,
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  - you know, sometimes automation can be scary for
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  - frontline staff because they may feel that their
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  - job's going away and really talking to them
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  - about, you know, what the automation can do
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  - for them and how they can enhance their
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  - skill set to be more specific and, you
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  - know, at a higher level than what it
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  - was currently because we can
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  - hopefully resolve a lot of the low hanging
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  - fruit with, some of the automation and have
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  - really more specificity and and detailed, kind of
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  - thinking around some of the more complex types
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  - of things. And so they can work at
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  - a higher level.
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  - I just think there's a lot of opportunity
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  - with automation, but you have to be,
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  - cautious with it because if you turn something
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  - on and it's wrong, it can be wrong
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  - 500 times where the person could have been
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  - wrong maybe 50 times. And so just making
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  - sure that you do have the checks and
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  - balances in place as you continue to kinda
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  - move forward down that path.
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  - Yeah. And would you say that overall,
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  - you're getting, good buy in with your team
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  - on,
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  - on starting to use some automation?
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  - I I know that there is obviously some
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  - hesitation with some staff as you've mentioned.
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  - Yeah. We're just kind of dipping our toe
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  - in at Renown right now, and I think
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  - the most important thing is just transparency.
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  - I think if people understand what the tool
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  - is and what it can do and how
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  - they fit into it,
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  - it's a lot easier to obtain their buy
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  - in. And it it usually goes much further
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  - than just saying, oh, we're gonna do this
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  - and not really a good explanation behind the
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  - why. So I think that's probably the most
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  - important thing with,
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  - is transparency
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  - in general, but especially
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  - as it you're introducing new technology.
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  - Mhmm.
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  - And, the last question I have for you
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  - today is how are you thinking about growth
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  - over the next twelve to twenty four months?
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  - Well, we actually have a lot of really
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  - exciting things happening at Renown.
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  - We have a really unique partnership,
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  - that we just joined with Kaiser Permanente,
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  - and that will allow a lot of additional
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  - access to care in Northern Nevada,
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  - as well as California. And so that's really
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  - exciting. And so we're continuing to move move
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  - forward with our current initiatives
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  - and scale,
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  - our new, you know, workflows to be able
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  - to grow,
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  - having a lot of growth at the system
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  - And just, again, providing additional access where folks
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  - didn't have access before, is really exciting. But
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  - we're growing in all of our specialty care,
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  - which is fantastic for the community because
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  - folks were having to, travel outside of the
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  - community to receive certain types of care, and
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  - so now they can be within their own
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  - community. So I'm excited for kind of the
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  - the partnership to take off here within the
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  - next twelve months and also the continued growth
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  - with our different specialties at Renown.
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  - Yeah. That's great. And,
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  - like I said, that's all the questions I
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  - had for you today. Thank you for joining
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  - us today, Amanda. It's been a pleasure speaking
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  - with you, and I look forward to talking
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  - with you again soon. Thank you very much.