Leveraging technology to streamline the healthcare revenue cycle

In this episode of the MGMA Insights Business Solutions podcast, MedEvolve executive vice president Matt Seefeld discusses leveraging technology to streamline the healthcare revenue cycle.

Who is MedEvolve and what do you do there?

I came on board about seven years ago to evaluate this privately owned company out of Arkansas. It was a practice management company, and it did not have electronic medical record software. MedEvolve also had a small RCM business primarily focused on insurance A/R. It’s not necessarily a growth story in what we would consider a commoditized space nowadays. So the first thing I started looking at was where the gaps were in the practice management system that allows our RCM company as well as our PM clients to truly understand in real time the production and the outcome of their RCM staff – effective intelligence to bring you actionable intel on your employees.

When we started to build this out, we saw the gaps in a lot of other PM systems. I’ve seen this throughout my career. I’ve been in healthcare revenue cycle consulting, technology, and software development for 24 years, and I don’t blame the PM/EMR companies. There’s a lot of competition there and they must focus on physician experience and the consumer experience now. Who gets left behind ironically is the people that manage the revenue cycle, which is how providers get paid for what is now very expensive to deliver. So, the focus is on how to give empowerment back to our clients that say, “these individuals are doing a great job and need to be promoted.” The idea is to recognize, reward, and retain. The other ones must have an opportunity to improve or show they want to, and if not, you’ve created capacity within your team and created an opportunity to reduce some of your labor costs. I think everybody would enjoy a little bit more margin today.

What is your focus right now?

I oversee a lot of departments including sales and marketing. I also oversee the implementation of our effective intelligence suite, which is this workflow automation system we can add to any practice management system in the market. I also developed all the strategy and the ideation behind this. This has been “my baby” since 2003, when I realized that there was an opportunity to build something that could bolt on to any PM system. Back then, I was working with large health systems and academic medical centers and helped them bring margin back to the organization by recognizing and rewarding employees that were going above and beyond.

In addition, I’m working closely with our VP of Product Strategy looking at other ways to bring in AI automation – specifically AI coding. We just did a partnership with a fantastic company in that space. What we’re trying to do is be the company that helps our clients understand the total touches it takes to get the outcome in the revenue cycle process, and this is one thing that continues to be missed in my opinion.

What does “Recognize, Reward, Retain” mean?

I had a surgery recently. Prior to me going under though, I was joking around with him. I said, “Hey, I noticed my allowable is like 1500 bucks. That’s pretty good. Blue Cross Arkansas is going to pay you well for this 20-minute procedure.” And he kind of chuckled. I said, “Do you have a Medicare patient after me paying you half?” He said yes, but I went further, and I said, “You have a lot of costs by just performing this surgery, don’t you? Do you know how much it costs and how many people and touches it takes to get my claim paid for you?” He said no, so I said, “Do you think that that would be something important for a business owner?” He agreed.

I like to compare what we are doing with Effective Intelligence to what Henry Ford did a hundred years ago. He realized he could have one person make an entire car, or he could figure out the order in which things need to be assembled to be able to produce more at a higher margin to get better costs on raw materials. How can we in American healthcare still not answer that question? Today, everyone’s talking about AI and automation, but humans are not going to ever be taken away from the revenue cycle. For instance, commercial managed care payers are always going to create chaos. They’re looking for people to make mistakes.

Then, how do I motivate people? How do I get people on my revenue cycle teams to become more focused on self-actualization – do more today, do better today? You must recognize that effort and reward it. Our software pairs with any PM system and allows you to track every touch and by whom those touches are occurring to get you paid. From the studies that we’ve done, including our own RCM team, there was 357,000 touches over a couple of years’ worth of services. For our team, it’s about $5.25 a touch to a claim. Everything we do for our RCM company is still onshore, so it’s more expensive.

If I could reduce 50% of that cost, what is that going to do to the margin of a privately held company like us? It’s going to be huge. We have to start thinking about touches as waste. The quote that I always use is that once you start touching claims, post service and post coding, your margin starts to go down. Your wallet share is shrinking. And if we look at the macroeconomic factors today, then compared to even three or four years ago, what do we have – inflationary prices, more money spent on supplies and people. We also have tight staff turnover. Every one of our clients is suffering with clinical staff moving elsewhere to get better jobs for more money. So, you have this chaos going on in the clinical machine and then you’ve got the RCM administrative staff, which you’re also now paying 10-20% more.

You have insurance companies that don’t want to pay you more. Medicare will continue to look at ways to narrow what they pay. So it’s not a pretty picture for anybody that runs a revenue cycle. We want to empower our clients with tools that allow them to claw back some of that lost margin. That’s the position that our business is in now. So yes, we still have a rock-solid PM system, but we do integrate with any EMR out there. Yes, we still have an RCM services business both on the self-pay side as well as the insurance side, but it’s the Effective Intelligence suite that comprises most of the conversations that we’re having now, and that’s where we want to be as a company. We want to continue to push the frontier on what we’re doing.

MGMA put out a great article yesterday, and it was so great to see that everything we’re doing is aligned with what MGMA is hearing in terms of strategies for 2024 almost to the T. And the quandary now though is how do you get providers to actually acknowledge that and act on it? Because selling in healthcare is very hard. It’s always been hard. What we saw this last year is that people did not want to spend money when they were losing so much money. So the question is, what is it going to take for a provider to realize that they have to make investments in technology to be able to claw back some of that margin? And I don’t have an answer to that yet. Not on that side.

How can executives leverage AI and use automation the right way in the revenue cycle?

The cool thing about AI today is all of the structured data that’s being generated between the EMR and the practice management system. Then MedEvolve solutions add another layer of structured data around the actions that are being taken and the outcomes the staff are getting in the revenue cycle. I always say he who has access to the most data wins in AI, because now you can use generative AI rather than reactive AI, like Chat GPT. What it does is look at all the structured data and independently come up with patterns. Why is revenue down? I can go into our analytics stack, and I can click some buttons and figure it out in a reasonable timeframe. However, not only is the machine going to figure it out much quicker, but it’s going to start learning and evolving. It starts to offer recommendation sets. Imagine a provider being able to come in every morning and just read their insights. The engine just told you where your problems are and it went further and told you what to do about it. Tt even told you the economic benefit if you act on it. This is why I’m so bullish on capturing more structured data around what’s happening with claims and revenue cycle. The PMs can’t do this because you must have that next step of data.

Just telling me that a claim is in this status isn’t enough. What was the outcome of the action I performed? Did it yield anything? We’re not using pivot tables in Excel anymore. I was talking with a partner of ours yesterday. I said, “Having been around analytics and dashboards for 20+ years, isn’t it funny how I finally accepted the fact that this industry still exports monthly reports to Excel.” No matter how cool the dashboards are, they’re not going to leverage it in the way that it needs to be leveraged. This is why we’re focused so much on insights and adaptive AI.

I’m not even going to ask you to go figure it out. I’m just going to tell you what to do. I think that’s where we are, and I’m totally okay with it because it’s going to surpass our ability to do analytics quickly. A consultant can bill you $300 an hour, sit in an office somewhere, and then give you a nice PowerPoint. We used to do that back in the day. AI is just going to tell you these things. It’s a virtual consultant on the fly. It’s always there. It’s always watching. I always say it’s like your eyes and ears to where that extra penny is. I’m still amazed that when we enter the sales process, we always try to ask for some basic information to establish the health of the revenue cycle. 95% of the time, I can’t even get that. These are basic questions like, “How many claims do you have on your A/R today?” “What’s your net collection rate?” They don’t have it available. They say, “Well, I think I can get it.” This is a battle right now. We don’t have time to go get it. It’s got to be right there in front of us. So, I think there’s going to be a leap. The other principle that we’ve introduced is this concept of zero touch rate, but what it really means in a colloquial sense is no human had to get involved after you delivered the service rate, which is very different than clean claim pass. That’s just one component. Now, our clients are now able to look at how many claims go out the door and get paid without human intervention.

But the inverse of that is where humans are having to get involved. This is important, because I think there’s a lot of investment potentially going into the wrong areas of revenue cycle. People I see at shows see cool AI bots and want to automate. What if that’s actually not your problem? Do you know where your humans are getting involved? If your problem is refiling, first pass denial or tasking, you’ve got to be able to understand that because that’s where your $20 per hour employees are spending their time. Then based on where the humans are getting involved, that’s when we start to look at where to fill the gaps.

It’s the reason we like the AI coding machine that we’re putting in now – because it fills that gap. It’s expensive to code charts. If you could code 30-50% with the AI engine and you can reduce first pass denials for coding, that’s a huge win for anybody. Prior authorization automation is the same thing. If a bot can go out and tell you yes or no, it’s going to help clean up the front end of the revenue cycle just a little bit more. So, there are certainly applications for total automation. MedEvolve’s approach to coding is more on a partnership now. We built a lot of revenue cycle technology on our own, but we don’t buy companies. We’re looking at partners that fit this ecosystem that drives automation and at the end of the day drives fewer touches or, ideally, no touches. That’s the whole goal.

How does a healthcare organization evaluate where and when to use AI and automation in the revenue cycle?

I think now is the time to it. Healthcare organizations need to act this year very aggressively on automation, specifically workforce automation. We need to accept that the PM systems were not designed to do that. It’s not even on the roadmap. I’ve had conversations with many PM/EMR companies – we’re partnering with some of them. So, now is the time to make investments in technology that’s going to bring transparency to where all the humans are getting involved – from the point of the service being rendered to the zero balance.

Then, find technology that allows you to reduce that waste – reduce those touches. However, you need to start with understanding where humans are getting involved – not just the A/R team, but everyone involved in revenue cycle. All internal “chatter” and individual actions from front office to back office need to be captured and tracked for that visit so we understand the true cost. Henry Ford would not be okay right now with saying, I’m going to go do a surgery, but I don’t really know what the administrative cost is going to be.” You need to know if you are making or losing money on it.

We’re all consumers of healthcare, so when margins degrade and healthcare organizations are forced to close their doors, that’s hurting communities. There are certain groups in my community that have flat out told me that they don’t take Medicaid or Medicare anymore.

Where are people going to get healthcare? So that’s not the answer. The answer is we have to regain margin and we have to be efficient with our RCM staff to get paid. The only way in my consulting brain to do that is to understand first where all the work is occurring, and then we get forensic on how we fix it. Is it a personnel issue? Maybe. Is it a process issue? Possibly. Is it a technology gap? Possibly. Maybe it’s a combination of all three. It’s not a one size fits all. Those are the investments that healthcare executives need to evaluate if they’re going to achieve growth, create capacity in their teams, especially groups that are trying to buy more practices.

About Matt Seefeld

Matt Seefeld, Executive Vice President at MedEvolve, brings over 24 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence solution and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014. Matt ran global sales for NantHealth and provided consulting services for healthcare technology and service businesses nationwide, prior to joining MedEvolve full-time.

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