Top 5 Mistakes in Claims Management – And How to Avoid Them
Claims management accuracy and efficiency are crucial for hospital billing, accounting and finance professionals. However, common missteps can cause...
By Greg Lanier, Chief Growth Officer, FinThrive
Last week, key customer executives from FinThrive gathered for two days in Sarasota, Florida. The discussion was electric, innovative, engaging, and transformative. Seema Verma, former CMS Administrator, and Donald Rucker MD, former National Coordinator for Health Information Technology were keynote speakers at this special event. Insights across various healthcare stakeholders were shared from children’s hospitals in California to large, national multistate healthcare systems. Discussions hinged on challenges facing our industry, such as profitability, labor, regulations, supply costs, siloed technology, and others. As the group engaged in solution-focused discussions, many ideas were shared on how to accelerate excellence in revenue management.
Hemant Goel, CEO of FinThrive, kicked off the event with his personal experience following his father’s heart attack in India. He shared a heartwarming story that expanded on the complications of delivering healthcare in a country with more than 1.4B people (almost 5x the US). He shared challenges in coverage, payment, charge inconsistencies, overcrowding and others that would have a direct impact on his father’s recovery, had he not been there to manage the situation personally. As he shared this story, he acknowledged that the US healthcare system has certainly had its own challenges. But when compared to India - technologically, equitably, and economically - it operates at a much more acceptable level. He praised the US healthcare system and the opportunities. Specifically, he talked about how we in the unique position to transform healthcare – to actually fix it.
A fireside chat occurred with Seema Verma, discussing her former role at CMS. She talked about running the largest payer in the world and all its responsibilities. By 2030, healthcare will represent the largest spend of the Federal budget - and is not delivering on outcomes. She spoke about opportunities in payer-provider collaboration, and the inefficiencies that are created in a third-party payment system. “20-30% of healthcare costs are attributed to administrative expense”, she shared. “Interoperability and data sharing between provider and payer can help us all focus on innovation.” She talked about what we might expect from healthcare in the next decade and said we “must be all in on technology – there is a tremendous automation opportunity to make it easier for healthcare workers to do their job”. She also pointed out the importance to continue with efforts towards Value-Based Care, as we have more control on outcomes when we all have shared risk.
We transitioned into a session with John Yount, chief innovation officer, and Evan Goad, our chief strategy and M&A Officer, to discuss the FinThrive vision and innovation journey designed to help customers achieve revenue management excellence. They shared that FinThrive touches 60% of hospitals today, and it is best positioned to transform the RCM industry with its holistic platform capabilities. On the tenets of rethinking revenue management, providing a frictionless experience, and the promise of an integrated revenue management platform, they pointed out that a consolidation effort is underway to help deliver healthcare revenue management more efficiently at a lower total cost of ownership.
Mark Janiszewski, chief solution officer, shared strategies on FinThrive’s integrated revenue management platform approach, including the application of artificial intelligence and automation. Mark shared the investment and strategy FinThrive has adopted to ensure its platform can deliver on its promises. The group ranked denial management, prior authorization, and payer reimbursement as their top challenges for 2023. Benchmarking to peers was also shared by provider participants as a key indicator to understand performance in revenue management.
The group broke into themed tables for lunch on payer relations, health equity, and children’s hospital operations. Innovative ideas were shared and opportunities to innovate workflows were discussed enthusiastically as the groups got to know each other a bit better.
The afternoon opened with Brad Rennick, our chief customer officer, outlining FinThrive’s customer engagement methodology and measurements of success. The group shared feedback and agreed with Brad’s philosophy of avoiding a limited “go live” or “implementation” approach to onboarding. Instead, FinThrive was presented as a trusted ally to the customers, where they partner through every step to both capture, and position customers to achieve, their top goals and outcomes.
Jonathan Wiik, vice president of health insights, closed the day on the topic of Medicaid redeterminations and the Public Health Emergency. The group engaged in a spirited conversation surrounding best practice, bad debt reporting, and the importance of updating contact information. All of these, in combination with running eligibility and coverage discovery, will ensure that the bad debt portfolio remains insulated through this disruption.
The group participated in a charity event for the YMCA Boys and Girls club of Florida, where bicycles were assembled to be given to children in underprivileged areas. The event was a good way for all of us to reflect on why we are in healthcare and afforded the opportunity to further solidify relationships in our organizations.
On day two, the morning kicked off with a fireside session with Donald Rucker, former ONC chair. Don provided his thoughts on the 21st Century Cures Act, as well innovations in interoperability. Dr. Rucker shared a vision of getting healthcare onto our smart phones, to provide a safer, more efficient, and less costly delivery. He expanded on the future of AI, and how these large language models will fundamentally change how we detect and treat chronic disease. He highlighted that policy makers have given up on payers allocating care and are bringing more regulation front and center in the form of transparency, prior auth, and surprise billing. He described prior auth as a “complicated land mine” and also like “squeezing a balloon” in that payers can be very sophisticated in rule and risk shifting to providers.
Jonathan led two additional best practice discussions on price transparency and accelerating cash flow. The group shared pitfalls and successes in navigating these difficult areas. Many ideas were exchanged amongst the group to help one another get better through technology and battle-tested workflows. Jeffery Becker, Vice President of Portfolio Marketing walked the group through a revenue management adoption model. This model will help providers understand their position of revenue management maturity and assess their performance. The group was very excited and engaged to see this new model and were hopeful on its application in the revenue management market.
It was inspiring to see what can be possible when brilliant minds and companies are brought together for a common purpose. As I reflect on the past week, I am energized by the power of people and the opportunities that await in rethinking revenue management for our industry.
About the Author
Greg Lanier
Chief Growth Officer, FinThrive
Greg Lanier is responsible for leading FinThrive's growth initiatives and sales team. Greg has more than 25 years' experience developing and implementing strategic initiatives to increase and accelerate growth across organizations. Greg is a proven high performance team builder and leader where he had success leading commercial teams at Oracle, SAP, Workday and other prominent companies.
