In this episode, Ryan Ellison, Director of Out-of-Network Claims, discusses how the No Surprises Act is changing the landscape, and what technologies are available to providers to fight for higher reimbursements on their out-of-network claims!
Labor shortages continue to plague the healthcare industry. While we are all probably familiar
with the shortages on the clinical side, there are equally as many or more concerns when it
comes to the shortfall in resources within the business office setting. In this short interview
with Wakefield’s Chief Revenue Officer, Mark Schanck, we’ll answer how some companies in
this space have seemed to crack the code when it comes to attracting, hiring, training, and retaining RCM talent. For a script of the full interview, read below!
Schanck says first and foremost, “Culture always beats strategy.”
He continues, “This is not to say that strategy is not important, it certainly is.
However, if you do not have an underlying culture that recognizes the importance of how well people work together, then your strategy to build and grow a successful business that drives results for its customers is going to fall short every time.”
Moderator: “That’s interesting…tell me more about what you mean by that.”
Schanck: In the RCM services industry, (which Wakefield is a part of), the key word here is “service”. Being a service organization also makes a statement of who we are NOT. We are NOT a software program that our client can install and then call us later for support. We are a service that is driven by people, and we all know that people can have good days and bad days. We all have some baggage to carry that we must deal with in one way or another. A corporate culture that recognizes this, can set up certain systems if you will, that help its people understand that not only are they valued, but they can feel like they are part of something meaningful and not just a commodity to be spent (which so many tight-margined service organizations can do).
Moderator: “What are some of these ‘systems’ you’re speaking of and why are they
important as it relates to our opening premise around staff shortages?”
It’s our job as an organization to provide our employees with the proper tools to succeed. In short, this boils down to tangible objectives like proper training and better technology. However, we also focus on the “EQ” side of the equation where employees feel they are part of an environment where “none of us are as smart as all of us” which helps them feel they can make a meaningful contribution. They also feel a sense of ownership, knowing that if they can see a problem, they can also become part of helping to solve that problem.
Moderator: “How have your clients benefited from this?”
Because of the resource challenges we’ve already discussed, our clients look to us in some cases to “fill the gap” by helping with aged AR, Legacy system conversions, early-out self-pay and customer service; and in other cases, they look to us to not only fill the gap but take over the entire process from billing through collections.
Certainly, compensation and benefits are important, and Wakefield has provided meaningful employment for its 1,000+ employees located across 15 operating centers in the U.S. However, when you can provide differentiation by creating a strong working environment and culture, that benefit of differentiation is a big reason why our client satisfaction rates are high. Our ability to meet and exceed Service Level Agreements and KPI’s with our clients is due in large part to the quality of the individual required to deliver on those metrics. When these individuals are inside a healthy environment as opposed to a toxic one, they communicate more effectively, they solve problems more effectively and they relate more effectively to the
individuals that they serve (whether that’s a hospital executive or a patient on the other end of the phone call) that they are trying to help.
Moderator: The following are questions that dive into the more specific qualities of
Wakefield and the services and technologies it offers.
1. Can you provide an overview of Wakefield as a revenue cycle management company and explain its key services and solutions?
Schanck: Wakefield is a Healthcare Revenue Cycle Management Organization that has enjoyed serving the healthcare market for over 70 years. While we provide end-to-end receivables management for healthcare organizations and providers, we also specialize in specific service lines around billing, Denial Management, AR clean-up, System conversions, Complex Claims (MVA, WC and VA), Out of Network
negotiations and appeals and even Bad Debt collections.
2. What specific problems do health systems commonly face in today’s healthcare landscape, especially related to revenue cycle management?
Schanck: While there are several concerns and challenges to point out, it seems
apparent that claim denials consistently hit the top of the list. Additionally, we are finding that while providers have some level of satisfaction that their claims were paid, they’re at the same time uneasy in knowing whether they received the full reimbursement they should have. Many dollars are left on the table and providers are uneasy left wondering if they received 100% (or close to 100%) of what they were actually owed. We also see concerns around the patient pay population, with more consumer driven initiatives that require the provider to have the proper technical and human resources to respond to effectively.
3. What sets Wakefield apart from other revenue cycle management companies in terms of the solutions/(technology?)
Schanck: First of all, our longevity in the market has given us the opportunity to develop some perspective around what works and what doesn’t. We’ve seen the evolution of technology (and utilize it) from operational workflow, business intelligence reporting and even Artificial Intelligence. But the one thing you will not see Wakefield do is discount the importance of the human element in all of this.
We feel we offer the best balance when it comes to combining our technology with the real-life experience of our subject matter experts. We’ve seen companies rely too heavily on their technology (mostly for the sake of margin improvement on their end) to the detriment of the provider who needs someone with real-life experience that can provide meaningful feedback and root-cause analysis.
4. Why do healthcare systems and providers partner with Wakefield?
Schanck: The number one reason providers choose Wakefield is for peace of mind.
They understand that the programs we develop on their behalf not only find and
recover their lost dollars, but also incorporate processes on the front end of the
revenue cycle that prevent those dollars from being lost in the first place.
For example, our payer negotiation team can work on our partners’ behalf to ensure
they receive every dollar possible, and when payers short-pay (or underpay, as we all
know they do) we can help on that side of the equation as well with our appeals team.
In addition to all of this, Wakefield also has a legal SWOT team that can be deployed todo the heavy lifting when it comes to complex claims (i.e. MVA, WC, VA, and OOSM). Often, providers do not have the technical resources or a bench of attorneys at their disposal to intervene on their behalf when it comes to the often long-pay cycle on these
types of complex claims.
Join us for an insightful webinar where we delve into the intricacies of managing complex and problematic legal claims. This session is meticulously designed to equip professionals with advanced strategies and a comprehensive understanding of challenging legal concepts in claims management. Our expert speakers will guide you through innovative approaches and proven techniques to effectively navigate and resolve intricate claims scenarios. Enhance your expertise and stay ahead in the dynamic world of claims management.
In this webinar, we’ll explore the recent changes in surprise billing regulations and how they impact out-of-network healthcare providers.
Our expert speaker, Ryan Ellison, will provide guidance on compliance, dispute resolution, and communication with patients and payers. Whether you’re a physician, billing specialist, or administrator, this webinar is your essential guide to successfully navigating the complexities of surprise billing changes and ensuring the financial health of your practice or healthcare facility.
Gain a clear understanding of the evolving healthcare landscape
Learn about the latest legislation
Implement practical strategies for handling surprise billing situations
Don’t miss this opportunity to stay ahead of the curve and make informed decisions in the ever-changing world of healthcare billing. Register now to secure your spot and get ready to master the new frontier of out-of-network billing.
Jim Peake interviews Ryan Ellison, VP Sales of Wakefield, to discuss out-of network billing collections in the addiction treatment industry. The advantage is that Wakefield will not charge upfront fees to generate additional income from past underpayments from previously billed patients. If your addiction treatment center does a lot of out of network billing with some of the big players like United Healthcare, CIGNA and Aetna then it might be worth a phone call to discuss ways to collect on past billings that are basically found profits and revenues. Wakefield takes a commission fee for their services.
The intricacies of the revenue cycle can feel overwhelming without the right team by your side. A partner can help your organization identify and address complex issues and realize long-term financial success, which is more important than ever as hospitals face rising costs and slim margins.
Unfortunately, without the right guidance, it’s all too easy to make the costly mistake of choosing the wrong partner.
Join our upcoming webinar as our industry experts reveal their insights, share best practices and provide actionable strategies to help you navigate the intricate journey of selecting the right partner in revenue cycle management. Our aim is to ensure that your hospital not only survives, but thrives.