Understanding the Claims Lifecycle: A Step-by-Step Guide
Grasping the details of the claims lifecycle in healthcare is crucial for getting timely reimbursements and maintaining financial well-being. As...
By Jonathan G. Wiik, Vice President, Health Insights, FinThrive
The 2023 HFMA Region 8 Mid-America Summer Institute (MASI) was a great educational conference. There were about 400 folks in attendance, ranging from large health systems and critical access to EMS and business partners. This conference lent itself to good networking opportunities at the Can Can Wonderland in downtown St. Paul, where we got to play video games from our childhood while discussing current healthcare opportunities and challenges with peers.
From an educational standpoint, there were some top-notch speakers. Tru Pettigrew, from the Minnesota Timberwolves, spoke on inclusive leadership and helped us all become better leaders. The new HFMA chair, Dennis Dahlen, shared his 2023-2024 theme of “It’s Time,” highlighting a call to action for our industry to improve margins and care delivery.
Day Egusquiza, from AR Systems, had two great sessions. She spoke on the ramifications of the Public Health Emergency (PHE) redetermination cliff, where potentially 15M+ Medicaid beneficiaries are at risk to lose coverage—primarily due to administrative paperwork requirements. In the general session, “Payers (Still) Going Wild – Are You Bored Yet?”, Egusquiza highlighted opportunities in the Medicare advantage rule for medical necessity criteria, as well as payment challenges from carriers on line-item audits.
I also presented a session on what healthcare leaders can expect in 2023 and beyond. Despite unprecedented declines in margins, patient volumes and payer relations, there is still hope. Successful organizations are leveraging people, process and technology to change the paradigm and focus on what matters most—the patient.
There were several engaging panel discussions, including one on the challenges with Medicaid redeterminations and the unwinding of the PHE. Representatives from Common Spirit, Liberty Hospital and HealthPartners highlighted how the changes in the Medicare Advantage rules might impact their organizations. All panelists shared their frustration with payers, specifically in the areas of payment and administrative burden. The group transitioned to a discussion on AI and said although the industry “needs” AI, it should not be called that in the truest sense, but rather more so as robotic process automation (RPA). Patient experience was also a focus of the conversation, as they mentioned their patients and the associated payer reimbursements are the keys to their financial recovery.
There was also a CFO panel discussion with representatives from Hays, Henry County, St. Luke’s and CHI, covering a range of topics, including workforce, automation/RPA, investments in RCM technology, transparency, cybersecurity and leadership.
HFMA MASI delivered again as a valuable regional conference. I encourage you all to get out there and educate yourselves, connect with your peers and make healthcare a better place.
See you at the next industry event!
About the Author
Jonathan G. Wiik, MSHA, MBA, CHFP
Vice President, Health Insights
Jonathan Wiik, VP of Health Insights at FinThrive, has over 25 years of healthcare experience in acute care, health IT and insurance settings. He started his career as a hospital transporter and served in clinical operations, patient access, billing, case management and many other roles at a large not-for-profit acute care hospital and prominent commercial payer before serving as Chief Revenue Officer. Wiik works closely with the market and hospitals on industry best practices for revenue management. He is considered an expert in the industry for healthcare finance, legislation, revenue management and strategic transformation.
