Latest / Becker’s Healthcare Podcast / Why Managing Denials Isn’t Enough — It’s Time to Eliminate Them

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Why Managing Denials Isn’t Enough — It’s Time to Eliminate Them · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:03
  the Becker's Healthcare podcast series. It's great to
• 0:06
  have you. An exciting topic today, wide ranging
• 0:09
  certainly, why managing denials isn't enough. It's really
• 0:12
  time to eliminate them, and I'm so excited
• 0:15
  to talk about this with Patrick D'Angelo, president
• 0:18
  of CoroHealth. Patrick,
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  so excited to have you. Thanks for being
• 0:21
  here.
• 0:22
  Happy to be here, Lucas.
• 0:24
  Great to, be a part of this.
• 0:26
  Yes. There's a lot to talk about, and
• 0:29
  I I'm I'm going to aid you here.
• 0:31
  I apologize.
• 0:33
  You have more than twenty years of experience
• 0:35
  in this space. Again That's being kind, actually.
• 0:39
  There you go. You're you're again, that that
• 0:41
  positioning is so important because you're not just
• 0:44
  with one specific health system. Right? You have
• 0:47
  this view
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  of what's going on across the country,
• 0:51
  across dozens of health systems. Right? I'd love
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  to start off with just sort of the
• 0:56
  patterns that you're seeing
• 0:58
  from where you're sitting that health system leaders
• 1:01
  right now might not be able to see
• 1:03
  from where they're at.
• 1:05
  Yeah.
• 1:06
  You know, I think that's a great place
• 1:08
  to start because being on,
• 1:11
  you know, more of the service and the
• 1:14
  service provider,
• 1:15
  you're able to look across the spectrum
• 1:18
  of
• 1:19
  all health care institution,
• 1:21
  be it a large health system, be it
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  a small
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  private
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  physician practice, be it even payers and and
• 1:28
  and what they're dealing with. So seeing that
• 1:30
  spectrum kinda gives you a different light of
• 1:33
  exactly,
• 1:33
  you know, or somewhat of what what's going
• 1:36
  on,
• 1:37
  in in the in the health care space.
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  You know? And I think when you you
• 1:42
  represent providers, which is what I represent at,
• 1:45
  at Coral Health and and support them,
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  you know, you just see this constant trend,
• 1:50
  and it's it's almost it's turning into, like,
• 1:52
  a broken record of, you know, denials, managing
• 1:55
  denials.
• 1:56
  How do I get the right people? The
• 1:59
  shift in the workforce,
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  you know, today is way different than it
• 2:03
  was, you know, pre, pandemic. Right?
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  You have, you know, employees that, you know,
• 2:07
  pretty much, you know, work from home. We've
• 2:09
  never had that in our space before. Right?
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  So being able to, you know, manage that
• 2:14
  shift of employees knowing that,
• 2:17
  you know, your your lifeline is
• 2:20
  is always been reliant on your resources or
• 2:23
  your vendors.
• 2:25
  And now you have the,
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  you know, the the parallel track of AI
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  and and how that can support,
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  you know, each each individual and improve overall
• 2:37
  results and so forth. So, you know, it
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  is an it's a true interesting time, but
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  I will say the themes are are pretty
• 2:43
  common
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  across, you know, health systems, across practices,
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  physician practices,
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  you know, across the board and and and
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  where they struggle. And it's, you know, it's
• 2:53
  having
• 2:54
  the the right people, the right amount of
• 2:56
  people, having the right,
• 2:58
  partner or vendor, if you will, to support
• 3:00
  them in different areas.
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  You know? Do you,
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  do you outsource everything? Do you compliment?
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  Do you use staff aug? You know? How
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  do you how do you, you know, how
• 3:10
  do you work this? And it's it's different
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  depending on, you know, the health system and
• 3:15
  and how they wanna approach things.
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  And then, you know, like I mentioned, you
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  got AI, and and what are the decisions
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  there? Where do I start? Do I start
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  big? Do I start small? Do I trust
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  it?
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  Do I have to have a a an
• 3:27
  overlay to to keep a a close eye
• 3:30
  on it? And, you know, I think there
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  there are just a lot of questions that
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  the organizations
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  are truly
• 3:36
  trying to work through and understand and so
• 3:38
  forth.
• 3:40
  I wanna touch on something that you just
• 3:41
  briefly mentioned, which again is the importance of
• 3:43
  technology. We'll talk about AI here in a
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  little bit, but in a recent conversation that
• 3:46
  we've had in in a webinar that I
• 3:48
  hosted with Coral Health that you should definitely
• 3:51
  also check out if you haven't done so.
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  You said something that really stuck with me
• 3:55
  in that conversation, which is that things have
• 3:57
  changed to where we're it used to be
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  people process technology, so that three pronged piece
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  that a lot of folks still mention today,
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  and it changed to technology
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  people.
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  What's driving that shift right now, if you
• 4:11
  wanna talk just a little bit about what
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  you mean by that? And and, again, for
• 4:14
  leaders that are still early in that journey,
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  what is that first move to get there?
• 4:19
  Yeah. Yeah. Well, I I I think it's
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  really in the
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  the age now of AI. Right?
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  You know, technology was always a critical part,
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  but it wasn't the first part. It was
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  always driven mainly by people.
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  And now as you look at the shift,
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  you know, technology
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  is really the process. Right? You're gonna load
• 4:43
  technology.
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  It's gonna tell you everything you wanted to
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  do. Right? I mean, it's even, you know,
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  your your epic work lists are are really
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  built around how do you want your process
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  set up. I think
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  fundamentally, every workflow
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  is driven by
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  technology of some sort. And that technology then
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  has some
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  pretty intelligent
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  work listings
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  or intelligent
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  areas that
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  can
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  drive the workload
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  based
• 5:15
  off demand, based off skill, based off need,
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  you know, it that ultimately help reduce
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  what you're trying
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  to do or what you've done in the
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  past manually.
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  So, you know, I I think on our
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  call last week, Lucas, you know,
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  the ladies that we had on, you know,
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  said, yeah. We still use people and the
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  the technology. Right? They were really people focused.
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  And I I don't disagree with that at
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  all. I think that's actually the the right
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  approach for sure. But you gotta meet have
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  that technology, I think, today,
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  drive where people are,
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  or drive where you want your people to
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  be and and be able to focus on
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  areas or what I would call, you know,
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  pits within
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  your
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  AR process or within your entire revenue cycle
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  flow, it'd be at front end, mid cycle,
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  and back end, have that technology
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  drive,
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  you know, where you need to focus on
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  and be able to report upon it. Because
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  I do think
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  you're not gonna eliminate
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  the people aspect.
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  Right? But when the technology identifies
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  routine
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  denials,
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  routine areas, routine fail points,
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  you're gonna have to go up and reengineer
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  or tinker the technology
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  to improve that feedback. Now,
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  unfortunately, I think
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  it's gonna be a cat and mouse game
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  with payers and providers that you're constantly tweaking.
• 6:45
  They'll make their change on their end and
• 6:47
  so forth. But the goal ultimately
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  is if you have
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  poor registration on the front end and you're
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  not fixing it through
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  resources or technology,
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  you're you're gonna be in a you're gonna
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  it's gonna continue to snowball, if you will.
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  So
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  having technology be that first one and the
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  people that really drive the feedback to improve
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  the technology,
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  that's where we've evolved. And that's that's where
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  we are today.
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  Speaking of these processes, I do wanna get
• 7:15
  a little bit more granular and maybe also
• 7:17
  use this as an example to illustrate what
• 7:19
  we just touched on. Right?
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  You talk often about the distinction between self
• 7:24
  pay after insurance and pure self pay, right,
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  when it comes to AI, specifically in in
• 7:28
  patient financial conversations. It's very, very crucial. It's
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  a very important topic for patients, obviously, for
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  providers as well. Again, that's, however, also a
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  nuance that a lot of folks don't necessarily
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  talk about.
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  Can you walk through that distinction a little
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  bit more and what it means for health
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  systems
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  that where they should be
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  deploying that AI on the patient facing side?
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  Yeah. And we we talked about this a
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  little bit last week as well.
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  You know, in in where I look at
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  it from a self pay perspective,
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  we you carve out your pure self pay
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  versus your, self pay after insurance. And, you
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  know, in most cases,
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  other than, you know, mostly Medicare, but your
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  self pay after insurance,
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  these are more of your
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  working class, if you will. Nothing against the
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  self pay or the non working class or
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  people who are are are are working there,
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  but they're more tech savvy.
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  Right? They are more likely to
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  pay their bills. They're more likely to use,
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  your your online pay, your things like that.
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  And sometimes they just need that little nudge
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  or that little reminder. And utilizing AI to
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  make that call
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  or send that message, that email, that text
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  is is what gets it done. And and
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  me personally, just because I'm in the space,
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  I'm the one that waits to see
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  if I get a balance after. I actually
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  wait to see the technology. I wanna learn.
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  I wanna I wanna see what they're doing.
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  So I'm the type of guy that doesn't
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  pay right away, and I wait till really
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  the end just to catch the dunning cycle.
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  What is the process? How long between calls?
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  Are they really doing it? So it help
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  gives me the actual feedback to either get
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  back to that client or to my customers
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  to say, hey. This seemed to work for
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  me or or I've seen it work a
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  little bit better. So I look at the
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  self pay after as being more
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  they'll adapt to
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  the change in trends of AI and just
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  trying to get the bill pay. On the
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  self pay side,
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  I I don't speak for all of them,
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  but most of them will use that AI
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  as a way, well, it didn't get through,
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  or I didn't hear it, or, yeah, my
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  check's in the mail. And it's a lot
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  easier to do that
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  with
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  a pure self pay
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  because
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  they're either gonna pay or not gonna pay.
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  And and based off their their current situation,
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  likely use that not to pay. It it
• 10:00
  you'll need more of a human touch to
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  hopefully keep them on the phone, get them
• 10:04
  the assistance they need, find out what charity
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  care is, can we offer a prompt pay
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  discount
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  altogether. But one of the things I did
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  talk about last week, which
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  goes over self pay and self pay after,
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  even with AI,
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  you have to be sensitive
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  to the
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  patient you're calling or guarantor you're calling
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  depending on the type of illness or why
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  they've had this bill.
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  Right? So if you have a family member
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  or yourself
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  that's going through a horrible health issue
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  and you're struggling with work, you're struggling with
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  making payments,
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  and you having a robot constantly call you,
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  it, I think, impacts
• 10:51
  the community
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  and the ethic of the hospital. Right? And
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  and I think having a human still call
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  in those situations,
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  for example, a children's,
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  a a children's hospital.
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  Right? You you're there there's so much sensitivity
• 11:06
  going there, and and you don't wanna lose
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  that. And I think a lot of children's
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  hospital promote themselves with being the forefront and
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  being the provider
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  for those families during these hard times. And
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  having an AI just constantly ping them, you
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  sort of lose somewhat of the sensitivity. And
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  I I just want, you know, everybody to
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  realize that that could be a hard barrier
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  that will take longer for
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  the community, the patients, the guarantors, the sufferers,
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  the ones who are struggling
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  to understand
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  having a human touch versus an an,
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  an AI robot, if you will.
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  And I wanna talk a little bit more
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  about that specific fact. We've we've touched on
• 11:46
  it in the beginning of our conversation. Again,
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  you you see this work in a lot
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  of cases. You see especially the AI agent
• 11:52
  piece make a difference for people, specifically when
• 11:54
  it comes to workload.
• 11:56
  Unfortunately, you're also part of the other side.
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  Right? You you see when it doesn't work.
• 11:59
  You have the experience to say, hey. This
• 12:01
  might not have worked. This this didn't work.
• 12:03
  This needed to be adjusted, etcetera. Right? I'd
• 12:06
  love to know what some of the warning
• 12:08
  signs are that you would like to point
• 12:11
  to with leaders when an AI implementation
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  doesn't work. What are some of the things
• 12:17
  that you are pointing to that leaders should
• 12:19
  be aware of today of, like, okay. We
• 12:22
  need to adjust this.
• 12:23
  Yeah. I I think there's probably multiple areas
• 12:26
  you can look at. I mean,
• 12:28
  you know, financial decline would be, like, the
• 12:30
  first one. If you start to see, you
• 12:32
  know, your metrics starting to slip, you know,
• 12:34
  be it cash,
• 12:35
  be it anything, you see your, you know,
• 12:37
  your AR shifting
• 12:39
  into higher age buckets,
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  you know something's wrong. Right? Now I'm not
• 12:44
  saying that would be a 100% AI. There
• 12:46
  could be other shifts in the business that
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  would drive that. But for the most part,
• 12:50
  it would be those AR metrics.
• 12:53
  Moving back to the self pay area, you
• 12:55
  know, if you're making a lot of, quote,
• 12:57
  unquote, contacts,
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  yet you're not seeing the shift, or the
• 13:03
  inflow
• 13:04
  of cash or resolution rates to those contacts,
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  I think that would be
• 13:09
  a a huge indicator
• 13:10
  of what you have to do and and
• 13:12
  maybe
• 13:13
  adjust or think. And that's where we go
• 13:16
  back to the technology and people.
• 13:19
  In the past, you had to retrain the
• 13:20
  people, redo that, and, you know, it was
• 13:23
  a it was a longer shift to improvement.
• 13:26
  Now, you tinker with the technology
• 13:29
  and you've changed the process and you have
• 13:31
  a a a you can have a quicker
• 13:33
  impact to improvement.
• 13:35
  And you you have the ability to say,
• 13:37
  okay. Hey. Like, this didn't work that well.
• 13:39
  Let's shift it this way. Or based off
• 13:42
  the metrics, let's shift it that way. But,
• 13:44
  you know, again, I think you're gonna have
• 13:47
  to have
• 13:48
  if you're using that technology
• 13:51
  to drive a process or person,
• 13:54
  you're gonna need to make sure you have
• 13:56
  the right tools or the people
• 13:58
  to watch those shifts in metrics to make
• 14:01
  sure you're on top of it so it
• 14:03
  doesn't just keep snowballing into something bigger.
• 14:06
  I think, again, you've mentioned something very important
• 14:10
  here again, the fact that this is
• 14:12
  it's this that snowball effect. And and I
• 14:15
  like to link this to to the fact
• 14:17
  that everything is changing all the time. Right?
• 14:19
  This is a fast fast moving space. Organizations
• 14:22
  have to be aware of that. One of
• 14:24
  the things that we talk about quite a
• 14:26
  lot is the fact that payers are also
• 14:28
  adapting. Right? Health systems are adapting. Payers are
• 14:32
  adapting. Health systems a health system do something,
• 14:35
  then the payer does something. Right? It's sort
• 14:37
  of this cat and mouse. Folks are adjusting
• 14:40
  because this is a constantly moving space as
• 14:42
  we just highlighted.
• 14:44
  What does this race
• 14:45
  look like from your perspective? And as we
• 14:48
  close our conversation here today, right, how should
• 14:51
  revenue cycle leaders think about this space with
• 14:54
  that in mind?
• 14:56
  Yeah. I mean, if I had an answer
• 14:57
  to this, Lucas, my goodness, what we could
• 14:59
  do.
• 15:00
  It's you know, it's one of those things
• 15:02
  because each payer is is different. Right? And
• 15:05
  and they get categorized different. And that's what
• 15:08
  I think that's a lot of the complexity.
• 15:10
  Right? Is it's not, you know, one size
• 15:12
  fits all with payers and and providers and
• 15:15
  and how they work.
• 15:17
  But,
• 15:18
  you know, I I do say it's
• 15:21
  it's
• 15:22
  capturing
• 15:23
  what you know is failing.
• 15:25
  Regardless if payers right or aren't capturing it,
• 15:29
  categorizing it as how do I fix this
• 15:32
  solution bundled. Right?
• 15:34
  Fix this solution for multiple
• 15:36
  and try to stay on top of it.
• 15:38
  Right?
• 15:39
  It's hard to pinpoint where the fixed point
• 15:41
  would be, right, the chicken and the egg
• 15:43
  here for the most part. But being able
• 15:46
  to
• 15:47
  just categorize
• 15:49
  where your biggest pain points are
• 15:51
  and basic blocking and tackling. And that's with
• 15:54
  technology.
• 15:55
  That's with humans. That's being able to stay
• 15:58
  on top.
• 15:59
  And, you know, I you always like to
• 16:02
  say you can work with your payer. Right?
• 16:04
  You always like to say that you're big
• 16:05
  payers. You can sit down and and figure
• 16:08
  out how to work it. But if you
• 16:09
  you can't really do that
• 16:11
  unless you have the data points and the
• 16:14
  proof points
• 16:15
  on where you feel
• 16:17
  they're failing you. Right? And I do think
• 16:20
  sometimes we just categorize payers as they're just
• 16:23
  horrible. They're just gonna do it because they're
• 16:25
  gonna maybe they do. I'm not gonna go
• 16:27
  go there with this conversation. But I would
• 16:30
  say that if you don't have the data
• 16:33
  and the factual points,
• 16:35
  you're not gonna improve anything. One with technology,
• 16:39
  one with your people, and most importantly, the
• 16:41
  payer relation.
• 16:42
  Patrick, thanks so much again. It's great to
• 16:45
  have you. Same here, Lucas. Appreciate it.
• 16:47
  We also want to thank our podcast sponsor,
• 16:49
  Coral Health. You can tune in to more
• 16:50
  podcasts from Becker's Healthcare by visiting our podcast
• 16:53
  page at beckershospitalreview.com.