Leaders in Medical Billing

In this episode of Leaders in Medical Billing, Ankit Jain, co-founder and CEO of Infinitus Systems, discusses how AI voice agents are changing the healthcare industry. With a background in AI venture capital investment and experience launching two successful tech startups (including a Google acquisition), Ankit shares how Infinitus is eliminating inefficiencies in billing workflows by automating phone calls for tasks such as benefit verifications, prior authorization checks, and claim status updates.  He explains the role of AI co-pilots and AI agents alongside humans, how they improve billing team productivity, and why security and compliance are critical when implementing AI in healthcare. Ankit also provides insights into the future of AI in medical billing, the challenges of scaling AI technology, and how automation can reduce healthcare worker burnout while improving the patient experience.  With over five million AI-powered calls handled, Infinitus is already working with some of the largest healthcare organizations to streamline administrative tasks and enhance operational efficiency. Ankit shares insights into the future of AI, including risks and how it can improve our entire healthcare system.  Tune in to learn how AI-driven automation is reshaping the medical billing industry and why billing companies should consider adopting a comprehensive voice AI platform.  Learn more about Infinitus on their website: https://www.infinitus.ai/  Sponsored by 4D Global, empowering medical billing companies through offshore staffing, automation, AI and technology.   

3/17/25 • 28:17

Chanie Gluck is joined by John Gwin, founder and CEO of The Auctus Group, a consulting firm specializing in financial and operational services for plastic surgeons and dermatologists. In this episode, John shares his passion for technology, leadership, and Revenue Cycle Management (RCM). John is also the Vice Chair of the HBMA Innovations Committee and the president of a nonprofit called BRAVE Coalition Foundation.  We delved into the unique structure of The Auctus Group, which employs over 100 team members across eight countries working remotely. John explained his innovative pod model, which fosters collaboration and empowers teams to make decisions collectively, rather than following a traditional hierarchical structure. This approach not only enhances organizational  communication but also promotes a strong company culture.  John then discussed the significant role that technology and AI plays in RCM. He shares insights into the technology tools that have transformed his operations, including DocVocate, Raxia, SuperDial, and more. He highlights the effectiveness of AI tools in improving patient payment rates and streamlining workflows. He also touches on the emerging trend of custom-built tech solutions that can be developed collaboratively, making advanced technology more accessible to smaller billing companies.  This episode is packed with valuable insights for anyone in the healthcare billing space, especially those looking to leverage technology to enhance their offshore operations.   You can learn more about Auctus Group here: https://auctusgroupconsulting.com/    Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

3/2/25 • 29:30

In this episode of Leaders in Medical Billing, host Chanie Gluck speaks with Sasha King, co-founder of Anatomy Financial. Anatomy is a healthcare tech start-up focused on automating financial workflows in the medical billing industry. Sasha shares her journey from serving as the Chief Commercial Officer at CareDX to founding Anatomy with her husband.  She explains how the challenges she encountered with financial clarity and the inefficiencies of traditional billing processes led to the creation of Anatomy, which operates as a healthcare lockbox designed to streamline the handling of billing-related mail. Using high-speed scanners and AI technology, Anatomy converts explanation of benefits (EOBs) into electronic remittances, significantly improving workflow efficiency for billing teams.  During their conversation, Sasha highlights the importance of building a strong team and a behind-the-scenes look into securing venture capital funds to launch a healthcare tech company. She emphasizes the need for education in the market, particularly for billing services that may not have previously considered lockbox solutions. Additionally, she offers insights into balancing her role as a working mother while leading a growing tech company.  As the discussion wraps up, Sasha expresses excitement for the future of Anatomy and the potential for continued innovation in healthcare billing. Her passion and dedication to solving real industry pain points are inspiring. For those interested in learning more about Anatomy Financial, additional information can be found at Anatomy.com. This episode provides valuable insights into the evolving landscape of technology for medical billing—tune in for an engaging and informative conversation!    Sponsored by 4D Global, empowering medical billing companies through offshore staffing.     

2/17/25 • 25:44

In this episode of Leaders in Medical Billing, host Chanie Gluck welcomes Jonathan LaChapelle, Director of Revenue Cycle Management at Adonis, a cutting-edge revenue intelligence and automation platform designed for healthcare. Jonathan shares insights from his extensive experience in the RCM space and discusses the revolutionary technology-driven capabilities of Adonis that address operational challenges in medical billing. Tune in to discover the innovative solutions that Adonis offers and how they can benefit medical billing companies.    Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

1/31/25 • 24:42

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Melanie McGivney, Director of Operations at Impact Healthcare Solutions. With over 20 years of experience in revenue cycle management (RCM), Melanie shares insights on operational efficiency, building strong offshore relationships, and overcoming challenges in multi-state hospital billing. From onboarding best practices to the exciting future of AI, this conversation is packed with actionable takeaways for billing professionals aiming to improve processes and client relationships.  Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

1/20/25 • 18:42

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Sunil Konda, Chief Product Officer at SYNERGEN Health. With over 16 years of experience in healthcare technology, Sunil discusses how automation, AI, and cloud-based solutions are transforming the revenue cycle management (RCM) landscape. They delve into reducing inefficiencies, managing denials, enhancing patient engagement, and navigating challenges in technology adoption. This conversation is packed with actionable advice for RCM professionals looking to modernize and innovate their processes.      Sponsored by 4D Global, empowering medical billing companies through offshore staffing.     

1/6/25 • 32:51

In this episode of Leaders in Medical Billing, host Chanie Gluck continues the conversation with Sean McSweeney about how medical billing companies can differentiate themselves in a competitive RCM market. Sean emphasizes the importance of focusing on specialized services, leveraging technology, and aligning marketing strategies with client needs. Together, they discuss how to stand out without competing solely on price, the value of clear dashboards, and building trust through high-touch communication. From understanding the power of niche specialization to better client communication, this episode offers actionable strategies for medical billing professionals looking to stand out in 2025 and beyond.  To learn more about Sean and Voyant Health: https://voyanthealth.io/ Sponsored by 4D Global, empowering medical billing companies through offshore staffing. 

12/23/24 • 29:21

In this episode of Leaders in Medical Billing, Chanie Gluck speaks with Nio Queiro, the founder of Queiro Group and the Chief Strategy Officer for Nashville General Hospital. Nio shared her incredible journey in the healthcare industry, which spans over 30 years and includes roles such as the SVP of Revenue Cycle at Tufts Medicine and consulting positions with major organizations like Deloitte.  Nio's story is one of resilience and transformation. She recounted a life-changing health crisis in 2021 that led her to reevaluate her purpose and ultimately start her own consulting firm. Her firm focuses on organizational transformation, AI management, and leadership development, all aimed at creating empathy-led patient experiences.   One of the highlights of our conversation was Nio's book, "Joy Notes," which emphasizes the importance of finding joy even in difficult times. She explained how music and neuroscience can help shift our emotional states, offering practical advice for listeners to incorporate joy into their daily lives.  Nio also discussed her work at Nashville General Hospital, where she is dedicated to ensuring access to care for all residents in Middle Tennessee. She emphasized the importance of seeing patients as whole individuals and tailoring care to their cultural and personal needs.  We also touched on the critical issue of workforce development in the revenue cycle industry. Nio is actively involved in educating the next generation of professionals through online courses, internships, and fellowships, aiming to bridge the workforce gap and bring fresh talent into the field.  Lastly, Nio announced her upcoming podcast, "Joy and Gratitude," which will launch in January. The podcast will focus on real-life issues and how to navigate them with joy and gratitude.  For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

12/10/24 • 27:11

In this deeply personal and inspiring episode of Leaders in Medical Billing, host Chanie Gluck sits down with Greg Wehrman, a nationally recognized expert in behavioral health billing and founder of Wehrman Healthcare Management Solutions. Gregory shares his journey from a college student stepping into the billing world to becoming a leader in the revenue cycle management (RCM) industry. Alongside professional triumphs, Gregory opens up about his battle with cancer and how it transformed his perspective on business, delegation, and life. Listeners will gain valuable insights into building a sustainable business, leveraging delegation, and embracing new technology like AI and automation. Gregory’s heartfelt story is a reminder to prioritize health, family, and long-term planning while navigating the challenges of running a medical billing business.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

11/25/24 • 32:20

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Sean McSweeney, CEO of Voyant Health and a leader in healthcare revenue cycle management, analytics, AI, and automation. Sean shares insights from his impressive background in RCM and his current consulting work with billing companies and private equity firms. This episode explores common reasons why billing companies face growth hurdles, often due to misaligned sales and marketing efforts. Sean emphasizes the value of targeted marketing, relationship building, and in-person meetings for higher client conversions. He also provides practical advice for sales and marketing success, centralizing data, and preparing for a future powered by analytical AI. With hands-on tips and forward-looking strategies, this episode is a must-listen for medical billing professionals focused on growth.    Learn more about Voyant Health: https://voyanthealth.io/   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

11/7/24 • 35:34

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Carri Garbus, the owner of Vital Profits and an experienced medical billing professional. Carri shares her journey from working at her husband's podiatry practice to launching her own billing business, focusing on podiatry. She discusses the importance of specializing in a niche, the challenges of managing claims, and how she effectively uses social media to market her services. Carri also touches on balancing business growth and helping others by coaching them on starting their own billing companies. The episode provides actionable insights for anyone looking to build or expand their medical billing business.     Timestamps: 00:20 – Introduction and welcome to Carri Garbus 02:10 – Carri’s early career and transition into medical billing 07:12 – Opening her own medical billing business after her husband’s injury 09:45 – Specializing in podiatry billing and why she chose to focus on it 15:20 – Carri’s social media marketing strategy and its effectiveness 20:10 – How Carri balances business growth and client management 26:40 – Carri reflects on her business journey and personal fulfillment 28:30 – Final thoughts and where to find Carri online

10/17/24 • 26:10

In this episode of Leaders in Medical Billing, host Chanie Gluck interviews Tara Thomas, the CEO and founder of T&T Medical Billing. Tara shares her 26-year journey in the medical billing industry, starting from a receptionist at a hospital to building her own successful billing company specializing in mental health services. Together, they discuss the challenges of building a business, including finding the right help, managing remote teams, and maintaining work-life balance. Tara offers insights into her marketing strategies, how she built trust with her clients, and the joys and struggles of managing claims. The episode provides valuable lessons for medical billing professionals looking to grow their businesses and improve their operations.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

10/8/24 • 20:11

In this inspiring episode of Leaders in Medical Billing, Chanie Gluck sits down with Josh Fertel, owner of J3RCM, to discuss his remarkable journey into the medical billing industry. Pivoting from 30-years in the car business to founding his own medical billing company at the age of 57, Josh shares how personal challenges and a passion for learning led him to his career change. This episode explores the importance of networking, the role of communication in business success, and the entrepreneurial mindset that drives Josh's success. Tune in to hear his story and gain valuable insights for your business!     Timestamps 00:00:00 - Introduction and Host's Background 00:00:32 - Guest Introduction: Josh Fertel 00:00:47 - Josh's Career Transition to Medical Billing 00:01:42 - Overcoming Health Challenges 00:02:23 - Learning Medical Billing During Recovery 00:03:02 - Starting J3RCM and Early Success 00:03:32 - Challenges and Unique Perspective in Medical Billing 00:04:20 - Networking and Client Acquisition 00:05:16 - Building a Knowledgeable Team 00:05:49 - First Major Project: Chronic Care Management 00:06:46 - Launching the Angry Biller Podcast 00:07:01 - Frustrations with Physicians' Business Knowledge 00:08:48 - Enjoyment and Purpose of Podcasting 00:09:47 - Communication as a Key Business Focus 00:11:09 - Managing a Remote Team 00:12:45 - Networking and Learning from Industry Leaders 00:13:05 - Host's Business Journey and Offshoring 00:16:01 - Growth and Networking Strategies 00:17:05 - Client Referrals and Specialties 00:18:22 - Software Preferences and Challenges 00:19:13 - Future Goals and Success Metrics 00:20:04 - Planning for the Future 00:20:20 - Contact Information and Closing Remarks   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

9/17/24 • 21:18

In this episode of Leaders in Medical Billing, Chanie Gluck interviews Ashish Mandavia, a trained physician and now CEO and co-founder of Sohar Health. Ashish shares his journey from practicing psychiatry to becoming a healthcare tech entrepreneur, discussing the motivations behind his career shift and the challenges he faced in the process. He explores systemic issues in healthcare that motivated him to innovate, particularly focusing on revenue cycle management (RCM) and the need for better technology in this space. The conversation also delves into differences in healthcare systems between the U.S. and Europe, the impact of AI on healthcare, and the future of preventative care. Timestamps: 00:00 - 02:00 - Introduction by Chanie Gluck, overview of the podcast. 02:01 - 05:00 - Introduction of guest Ashish Mandavia and his background. 05:01 - 10:00 - Ashish’s journey from practicing psychiatry to entering healthcare tech. 10:01 - 15:00 - Challenges in the U.S. healthcare system and Ashish's motivation to innovate. 15:01 - 20:00 - Discussion on revenue cycle management (RCM) and why physicians avoid taking insurance patients. 20:01 - 25:00 - Overview of Sohar Health’s solutions for automating RCM processes. 25:01 - 30:00 - Importance of accuracy in RCM and the role of AI in improving healthcare processes. 30:01 - 35:00 - Future of Sohar Health and broader healthcare industry trends. 35:01 - 40:00 - Ashish’s perspective on AI and preventative care in healthcare. 40:01 - 45:00 - Closing thoughts, upcoming conferences, and where to find Sohar Health. For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

8/27/24 • 28:57

In this episode of "Leaders in Medical Billing," the discussion focuses on the transformative impact of AI and automation within the medical billing industry. Key topics include: AI and Automation Trends in Revenue Cycle Management (RCM): Exploration of current trends in AI and automation. The importance of incorporating automation to stay competitive in the industry. Risks and Liabilities Associated with AI: Analysis of the potential risks and legal liabilities of adopting AI technologies. Guidance on performing due diligence when partnering with technology vendors. Benefits of Automation in Medical Billing: Practical examples of how automation can improve efficiency and revenue collection. Insights into how automation can handle tasks like patient statements and follow-ups, resulting in higher collection rates. Future of AI in RCM: Discussion on the evolving role of AI, including its limitations and potential. Predictions on how AI technologies will shape the future of medical billing and revenue cycle management. Implementation Strategies: Strategies for medical billing companies to integrate AI and automation into their existing workflows. The importance of training staff to work alongside AI technologies to enhance operational efficiency. Legal and Ethical Considerations: Considerations for navigating the legal landscape as AI technologies continue to develop. The importance of maintaining ethical standards while leveraging AI for business growth. This episode provides valuable insights for medical billing companies looking to leverage AI and automation to improve their processes, enhance efficiency, and stay competitive in an evolving industry. For more in-depth discussions and specific takeaways, be sure to listen to the full episode.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

7/16/24 • 20:22

In this episode of "Leaders in Medical Billing," I had the pleasure of speaking with Jeff Robertson, the CEO of Nexsys Billing and Practice Management. Jeff brings a wealth of experience with 27 years in the industry, starting from owning a DME company to transitioning into revenue cycle management (RCM). Jeff shared his journey, which began with selling EMR software and evolved into providing comprehensive RCM services. His company initially focused on primary care and expanded to various specialties, with significant operations in New York and California. Jeff's passion for problem-solving and helping physicians optimize their workflows was evident throughout our conversation. We delved into the exciting advancements in healthcare technology, particularly in automation and AI. Jeff highlighted a standout tool, Raxia, which uses AI to optimize patient statement delivery, significantly improving payment collection rates. He also discussed the challenges of integrating new technologies and the importance of future-proofing businesses in the ever-evolving medical billing landscape. One of the critical challenges Jeff mentioned is the high turnover and low skill level at the front desk of medical practices, which often leads to billing errors. To address this, Nexsys Billing is proactively verifying patient information before appointments to reduce claim denials. Looking ahead, Jeff remains committed to staying at the forefront of technology and continuing to provide exceptional service to his clients. He emphasized the importance of maintaining a balanced life while navigating the dynamic healthcare industry. For more insights and takeaways, visit leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at 4DGlobalInc.com.   [00:02:32] Evolution from EMR to RCM. [00:05:17] Workflow challenges in clinics. [00:08:55] Sales team evolution. [00:13:08] Patient statements using AI. [00:15:36] Future of healthcare trends. [00:20:26] Automation in healthcare billing. [00:23:48] Front desk denials and training. [00:26:13] Elevating the RCM profession.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

6/13/24 • 27:23

In this insightful episode of "Leaders in Medical Billing," I had the pleasure of hosting Landon Tooke, the COO and Chief Compliance Officer at Impact Healthcare Solutions. Landon shared his unconventional journey from working in healthcare since 2001 to founding a rural health medical billing and consulting firm, and eventually pursuing a law degree to deepen his expertise in healthcare compliance and law. Landon discussed the evolution of his career, highlighting his transition from clinical roles to founding Impact Healthcare Solutions in 2009. His firm specializes in rural hospital billing, and over the years, they have increasingly focused on compliance-related issues, prompting Landon to gain further qualifications in healthcare law. A significant portion of our conversation delved into the pressing issues of cybersecurity and the legal implications of using artificial intelligence (AI) and automation in the medical billing industry. Landon emphasized the high value of medical records, making healthcare providers and RCM companies prime targets for cyberattacks. He stressed the importance of continuous education, robust cybersecurity measures, and the need for a proactive approach to protect sensitive data. Furthermore, Landon provided a critical analysis of the current landscape of AI and automation in RCM, distinguishing between true AI and more common automation processes used today. He cautioned RCM companies about the potential legal liabilities when deploying these technologies, especially as they become more sophisticated and autonomous. Listeners can find more about Landon and Impact Healthcare Solutions at their website or connect with him on LinkedIn for more updates on healthcare compliance and cybersecurity. This episode is brought to you by 4D Global, which specializes in empowering medical billing companies to expand through offshore staffing solutions. For more episodes and insights, visit our podcast website at leadersinmedicalbilling.com.   Timestamped Chapters  00:00:00 - Introduction and Background Chanie introduces the podcast and her guest, Landon Tooke, discussing their backgrounds and the focus of the episode. 00:01:04 - Landon's Journey into Medical Billing and Law Landon shares his unconventional journey from healthcare to founding Impact Healthcare Solutions and eventually pursuing law. 00:04:00 - Legal Education and Compliance Expertise Landon discusses his legal education and how it complements his role in medical billing and compliance. 00:05:45 - Cybersecurity in Medical Billing The conversation shifts to the importance of cybersecurity in the medical billing industry, highlighting the threats and necessary precautions. 00:10:09 - Practical Cybersecurity Measures Landon provides practical advice on enhancing cybersecurity within medical billing companies. 00:15:45 - AI and Automation in Medical Billing Discussion on the role of AI and automation in medical billing, distinguishing between AI and other technologies like RPA. 00:22:16 - Legal Implications of AI in Healthcare Landon talks about the potential legal challenges and liabilities associated with deploying AI technologies in healthcare. 00:27:17 - Comparisons and Future of AI The conversation explores the future implications of AI in healthcare, comparing it to other industries like autonomous vehicles. 00:30:45 - Impact Healthcare Solutions Services Landon details the services offered by Impact Healthcare Solutions, emphasizing their consulting and compliance capabilities. 00:32:26 - Closing Remarks and Contact Information The episode wraps up with thanks to Landon and information on how to connect with him and Impact Healthcare Solutions.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

5/22/24 • 32:55

In this insightful episode of the Leaders in Medical Billing podcast, host Chanie Gluck talks with Matt Riter, Principal at Capitol Associates, about key changes in healthcare legislation affecting the revenue cycle management (RCM) industry. They delve into critical provisions of the No Surprises Act and the challenges arising from recent cyberattacks affecting healthcare providers.   Key Topics Covered:   Change Healthcare Cyberattack (02:15): Matt provides an overview of the Change Healthcare cyberattack, its impact on UnitedHealthcare services, and the challenges faced by providers in accessing payment and data. No Surprises Act Updates (18:45): Discusses the Advanced Explanation of Benefits (AEOB) and Good Faith Estimate (GFE) provisions, emphasizing the importance of preventing surprise medical bills and promoting transparency. Medicare Reimbursement Challenges (32:20): Insights into the complexities of Medicare reimbursement, upcoming payment cuts, and how providers are affected by shifting policies. Legislation & Advocacy (45:30): Matt discusses pending bills in Congress addressing payment issues, virtual credit card fees, and EFT charges to support healthcare providers. FTC Antitrust Investigation (58:10): An analysis of the Federal Trade Commission’s investigation into UnitedHealthcare’s market dominance and the implications for the healthcare sector.   Below you will find the bills referenced in the episode H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which permanently ties annual Medicare reimbursement updates to MEI.   H.R. 6371, the Provider Reimbursement Stability Act of 2023, which reforms how CMS budget neutrality adjustments are calculated.   H.R.6487/S.3805, the No Fees for EFTs Act, which closes the loophole that payment vendors exploit to charge EFT transaction fees.     For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

5/7/24 • 49:55

Join Chanie Gluck as she navigates the complex aftermath of the Change Healthcare cyberattack alongside Landon Tooke, COO and Chief Compliance Officer at Impact Healthcare Solutions. In this insightful episode, they discuss the latest developments and strategies for strengthening cybersecurity in the healthcare sector. Show Notes:  Chanie sets the stage, discussing her experience and the focus of today’s episode—the Change Healthcare cyberattack.  Landon, a seasoned healthcare attorney, gives an update on the current situation regarding Change Healthcare, explaining the sequence of events that led to the recent data breaches and the implications for healthcare providers and revenue cycle management (RCM) companies. Detailed breakdown of the cyberattacks by Black Cat, subsequent responses by Change Healthcare, and the emergence of Ransom Hub, a new threat actor claiming possession of sensitive data.  Discussion on how the breach has sparked debates over healthcare data security, antitrust concerns, and the potential reevaluation of large healthcare mergers. [Cybersecurity Focus]: Emphasis on the importance of maintaining cybersecurity vigilance, investing in protective measures, and considering cybersecurity insurance as essential parts of healthcare operations. Conclusion: Chanie and Landon reflect on the broader implications of the cyberattack and stress the need for continuous improvement in cybersecurity strategies within the healthcare industry. --- We're thrilled to announce that "Leaders in Medical Billing" has been recognized by Feedspot as one of the Top 15 Medical Billing and Coding Podcasts on the web, currently ranking in 5th place! Learn more about this honor here https://podcasts.feedspot.com/medical_billing_and_coding_podcasts/     For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

4/18/24 • 14:39

In this enlightening episode, Benjamin Riegel, founder and host of the Revenue Cycle podcast "My Good Friends" and CEO of Tarpon Health, takes us through his journey from co-founding Health Rise Consulting Firm to establishing a unique community that fosters innovation and support among healthcare leaders. With a wealth of experience in enhancing healthcare systems and a deep dive into the complexities of healthcare changes, Benjamin shares his insights on the importance of community, the power of learning from failures, and the impact of technology in healthcare. Join us as we explore the evolution of healthcare through the lens of a seasoned expert who believes in the power of collaboration and innovation to drive positive change.     For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

4/3/24 • 22:07

Benjamin Reigle, founder and host of the Revenue Cycle podcast "My Good Friends," shares his extensive experience in the healthcare industry, including co-founding Health Rise Consulting Firm and leading initiatives at companies like McKinsey & Company and Accredited Health (now R1). He is also the CEO of Tarpon Health, a community driving automation for healthcare providers. In this episode, Benjamin dives into the topic of healthcare change, emphasizing the importance of understanding industry shifts. Stay tuned to gain insights into the evolving landscape of healthcare. The Change Healthcare breach, as discussed in the podcast episode with Benjamin Reigle, has had a profound impact on the healthcare industry. The breach resulted in challenges with claim submission, cash flow, and data security, affecting not only the operations of Change Healthcare but also having a ripple effect on healthcare providers, payers, and patients. The breach led to issues with claim submission, as some payers who relied solely on Change as their intermediary were unable to process claims. This created a backlog of claims and disrupted the revenue cycle for many healthcare organizations. Some providers resorted to manual processes, such as printing and mailing claims, which added complexity and delays to the billing process. Cash flow was significantly impacted by the breach, especially for smaller healthcare entities like physician groups and community hospitals. With claims not being processed efficiently, these organizations faced financial strain due to delayed payments and uncertainty about when the situation would be resolved. The lack of cash flow threatened the financial stability of these smaller entities, highlighting the importance of having contingency plans and backup systems in place. Data security concerns arose as a result of the breach, with questions about the extent of the data compromised and the potential implications for patient privacy. The breach raised questions about the adequacy of security measures in place and the vulnerability of healthcare systems to cyber threats. The need for enhanced data security protocols and proactive measures to prevent future breaches became a pressing issue for healthcare organizations. Experian Health Client Communication February 23, 2024 Experian Health is aware of Change Healthcare’s (Optum’s) announcement on February 21 about a cybersecurity incident affecting its systems. Experian’s Cyber Incident Response team and Cyber Threat Intelligence teams have been engaged and are closely monitoring the situation. We have not seen evidence of a threat to Experian. Out of an abundance of caution and consistent with Experian’s security practices, Experian has temporarily severed connectivity to Change Healthcare. During the period of this severed connectivity, there will be an impact to batch and EDI authorizations, claims and remits, claim status, eligibility, and notice of care transactions that Experian Health sends to Change Healthcare. Experian will resume connectivity to Change when it receives assurances from Change Healthcare that it has adequately contained the threat. Payers work with a variety of clearinghouses to process data. In many cases, multiple payer connections are available although sometimes payer connectivity may be limited or even exclusive to a single clearinghouse. In the majority of cases, transactions from Experian Health route directly to the requestedpayer. When connectivity is limited or certain routes are unavailable, however, it is common to route traffic through another clearinghouse. Below is a list of potentially impacted payers. Our teams are actively evaluating and rerouting transactions when an alternative route is available and will provide an update to this list as soon as possible. BCBS-MA Blue Cross Blue Shield of Massachusetts Claims 13162 1199 National Benefit Fund 93044 A & I Benefit Plan Administrators 37283 AAG-American Administravie Group 72467 ACS Benefit Services Inc. © Experian Health, Inc. Experian Confidential Information Page 2 of 28 83077 Advantek Benefit Administrators CB159 Advisory Health Administrators 65093 Advocate Physician Partners CB637 Aegis Administrative Services 128CA Aetna Better Health of California 128FL Aetna Better Health of Florida 68024 Aetna Better Health of Illinois 128KS Aetna Better Health of Kansas 128KY Aetna Better Health of Kentucky 128LA Aetna Better Health of Louisiana 128MD Aetna Better Health of Maryland 128MI Aetna Better Health of Michigan 46320 Aetna Better Health of New Jersey 34734 Aetna Better Health of New York 50023 Aetna Better Health of Ohio 23228 Aetna Better Health of Pennsylvania 38692 Aetna Better Health of Texas (Medicaid & CHIP) 128VA Aetna Better Health of Virginia 128WV Aetna Better Health of West Virginia 26337 Aetna Better Health Premier Plan MMAI 45221 Aetna OhioRISE 13334 Affinity Health Plan 46594 AFFINITY MEDICAL GROUP 37280 AGA 20048 Agate Resources Inc. (LIPA) 64158 Agency Services Inc ARA01 AgeRight Advantage AWNY6 Agewell New York 95422 AIDS Healthcare Foundation 12K01 Alabama Medicaid 91136 Alaska Carpenters Trust 44423 Alexian Brothers Community Services of TN 13550 ALICARE AHCA1 Alignment Healthcare 26160 AllCare Advantage 58234 Alliant Health Plans of Georgia 50749 Allianz Global Assistance 37308 Allied Benefit Systems A0701 Alta Bates Medical Group RP016 Alterwood Advantage 13343 Amalgamated Life - PA / Alicare 75137 AmeriBen Solutions Inc. TH095 American Family Insurance 62030 American General © Experian Health, Inc. Experian Confidential Information Page 3 of 28 31135 American Health Advantage of Mississippi 31125 American Health Advantage of Oklahoma 31130 American Health Advantage of Tennessee 31155 American Health Advantage of Texas 1066 American Healthcare Alliance 74048 American National Ins. Co. (ANICO) 44444 American Postal Workers Union Health Plan 48055 American Progressive Life and Health Insurance Company 56195 American Trust Administrators Inc. 54763 AmeriHealth Administrators 77799 AmeriHealth Caritas Delaware 77003 AmeriHealth Caritas Florida 27357 Amerihealth Caritas Louisiana (LACare) 47073 AmeriHealth Caritas Next - A Product of AmeriHealth Caritas VIP Next, Inc. 45408 AmeriHealth Caritas Next A Product of AmeriHealth Caritas Florida, Inc. 83148 AmeriHealth Caritas Next North Carolina 81671 AmeriHealth Caritas North Carolina 84243 AmeriHealth Caritas Ohio 22248 AmeriHealth Caritas Pennsylvania 77062 AmeriHealth Caritas VIP Care 87406 AmeriHealth Caritas VIP Care - Delaware DSNP 77013 AmeriHealth Caritus VIP Care Plus (Michigan) 77002 Amerihealth District of Columbia 77001 AmeriHealth NorthEast 64090 AmFirst Insurance Company (payer only accepts Secondary claims) 24818 Amida Care 79966 Amida Care Medicare 37105 Amita Health Medical Care Group 34192 Antares Management Solutions 29370 Anthem Ohio Medicaid 34196 Apex Benefit Services 83112 Apex Health 11081 Arcadia Healthcare Solutions - IPG 36364 Arcadia Healthcare Solutions - NPA 39185 ARISE 61184 Arkansas Superior Select 6603 ASAGEHA AAMG1 Asian American Medical Group 46156 Aspire Health Plan 36483 Aspirus Medicare Advantage 75068 Assurant Health Self Funded 74240 Assured Benefits Administrators 84320 Astiva Health 87020 Atlantic Coast Life © Experian Health, Inc. 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Experian Confidential Information Page 28 of 28 TRANS-LIFE-INS Transamerica Life Insurance TRIPLE-S-ADV Triple-S Advantage TRIPLE-SALUD-BCBSPR Triple-S Salud (BCBS Puerto Rico) TRUSTMARK Trustmark Small Business Benefits UCARE-MINNESOTA-COMM UCare of Minnesota UCARE-MINNESOTA-MEDICAID UCare of Minnesota Medicaid UCARE-MINNESOTA-MEDICARE UCare of Minnesota Medicare UMR-WAUSAU-BATCH UMR Wausau UNION-PACIFIC Union Pacific Railroad Employees BETTER-HEALTH Unison Health Plan BETTER-HEALTH Unison Health Plan UNITE-HERE Unite HERE Health-LV UNITED-AMER-INS-CO United American Insurance Company UNITED-MINE-WORKERS-ASSOCIATION United Mine Workers Association UNITED-TEACHER-MCARESUPP United Teacher Associates Medicare Supplement UNIVERSITY-CARE-ADVANTAGE-AZ University Care Advantage Arizona UNIVERSITY-FAMILY University Family Care UNIVERSITY-PHYS-ADVANTAGE University Physicians Care Advantage US-FAM-HP US Family Health Plan USAA-LIFE USAA Life Insurance Company USAA-MCARE-SUPP USAA Medicare Supplement VA-FEE-BASIS VA Fee Basis Program VA-HAC VA Health Administration Center VANTAGE-HEALTH-COMMERCIAL Vantage Health VANTAGE-HEALTH-MEDICARE Vantage Health Medicare VILLAGE-FAMILY-PRACTICE Village Family Practice WEB-TPA WEB-TPA WPAS Welfare and Pension Administration Service (WPAS) WELLFLEET Wellfleet Group LLC WV-CHIP West Virginia CHIP WS-FINANCIAL-GRP Western and Southern Financial Group WESTERN-HEALTH-ADVANTAGE Western Health Advantage WHA-MCARE Western Health Advantage Medicare WESTERN-SKY Western Sky Community Care MEDICAID-WY Wyoming Medicaid Notice of Care BCBS-MA Blue Cross Blue Shield of Massachusetts   [00:01:15] Change in healthcare industry. [00:04:42] Cybersecurity breach at Change. [00:08:55] Cash flow challenges for healthcare groups. [00:13:37] Major issues in healthcare cybersecurity. [00:16:28] Hackers demanding ransom for data. [00:20:45] Cybersecurity threats in healthcare. [00:24:40] Healthcare system vulnerabilities. [00:29:53] Lack of transparency in communication.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com  

3/21/24 • 33:30

In this insightful episode, we dive into the heart of medical billing and coding with Beth Schleeper, CEO and founder of TNT Consulting and Advanced Coding Services. Beth shares her inspiring journey from starting a billing service as a new mother to fulfilling her dream of opening a coding school. Along the way, Beth emphasizes the importance of community, trust, and continuous learning in the healthcare industry. She also touches on the challenges and triumphs of acquiring billing companies and the evolving landscape of healthcare technology. Through her story, Beth illustrates the power of determination, innovation, and giving back to the industry that has shaped her career.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

3/12/24 • 32:04

Catherine Keegan, a seasoned professional with 34 years in the RCM space, shares her journey in academic healthcare and community medicine at East Carolina University. As the Director of Revenue Integrity, she discusses the vital role her team plays in revamping the revenue cycle process, ensuring compliance, and driving positive change appreciated by the entire community. Keegan's responsibilities include overseeing the Charge Description Master, fee schedules, charge reconciliation, and clinical denial management, showcasing her passion for making a difference in healthcare.     [00:02:57] Rural healthcare challenges. [00:08:56] AI in healthcare billing. [00:10:20] AI in healthcare revenue management. [00:15:37] Be the unicorn. [00:21:14] Exploring revenue cycle insights.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

2/28/24 • 22:16

Drained by constant business travel, Heidi Ritton said enough was enough and formed her new business LLC on a layover in the Charlotte airport. Five years later Behavioral Health Billing Services is thriving. It wasn’t easy, but failure wasn’t an option with two small children and a husband who went back to school. In this episode, Heidi shares the tenacity it takes to be a successful entrepreneur and the tools and tricks she’s used to build her business.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

2/13/24 • 22:08

In this insightful episode, we had the pleasure of speaking with Ken Hogue, a seasoned professional in revenue cycle management. Ken shared his deep-rooted connection to healthcare, influenced by his family's background in the field, and his passion for being a mediator and executive in the space. Ken's journey began with a desire to improve the healthcare system without being directly involved in patient procedures. He has worked with notable organizations like Change Healthcare and Rochester Regional Health and is currently the Senior Director overseeing the entire revenue cycle for both hospital and physician sides. During our conversation, Ken recounted the challenges of implementing Epic EMR during the pandemic and the transition to virtual operations. He emphasized the importance of advancing the organization in growth and proficiency, grooming future leaders, and ensuring financial success. Ken manages a staggering $1.4 billion in revenue, five hospitals, hundreds of physician practices, and leads a team of 540 individuals. He discussed the evolving landscape of healthcare regulations and the need for effective communication and compliance to navigate these changes. We delved into the intricacies of the No Surprises Act and price transparency, exploring how Ken's organization is publishing information online and providing patient estimates to meet compliance and improve patient engagement. Ken also highlighted the role of business intelligence (BI), artificial intelligence (AI), and automation in healthcare. He shared success stories of increased efficiency and the importance of understanding workflows to ensure the effectiveness of automated processes.     [00:02:09] Implementing Epic during the pandemic. [00:04:24] Administrative burdens and communication. [00:08:35] Healthcare regulations and patient education. [00:15:30] BI, AI, automation. [00:18:39] Automation and workflow design. [00:20:17] Success through automation. [00:25:36] Implementing over 100 ideas. [00:29:00] Creating a career ladder. [00:32:30] Advancement and work-life balance. [00:35:37] Career paths and mentorship.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

1/23/24 • 36:31

In this solo episode of the Leaders in Medical Billing podcast, I reflect on the insights and lessons learned from the past two years of engaging with industry leaders. As we step into 2024, I aim to provide valuable takeaways for medical billing companies looking to strategize their growth in the coming years. Key Themes from Past Episodes Delegation: A recurring topic has been the challenge of delegation. I shared my personal experience with Dan Sullivan's unique ability exercise, which helps identify tasks to delegate, allowing business owners to focus on their strengths. Decreasing Reimbursements: Many guests discussed the use of offshore labor to manage payroll expenses and the balance between onshore and offshore teams. Innovative Pricing Models: Robert Kowalik's approach to variable pricing based on claim processing time was highlighted as a creative solution to decreasing margins. Employee Growth: The importance of providing growth paths for billing staff was emphasized by guests like Gary Siano and Emily Ostek. Impact of Private Equity: The influx of private equity in healthcare and its implications were discussed, along with strategies for sales growth and acquisitions. Compliance and Transparency: Mark Haskelson spoke on compliance, and the challenges of price transparency and the No Surprises Act were addressed. Government Engagement: Andrew Graham and Matt Tamez shared their experiences with lobbying and advocating for change at the state level. Front Desk Efficiency: Robin Goldberg's strategies for addressing billing issues at the front desk were explored. Technology and Automation: The role of AI, RPAs, and machine learning in the future of medical billing was a significant focus, with the emphasis on the need for clean data. Personal Advice and Future Plans Customer Engagement: I advise engaging with clients to understand their concerns, opportunities, and strengths. This understanding can lead to creating more value and avoiding commoditization. Education and Networking: Staying informed through industry conferences, publications, and other resources is crucial for success. Upcoming Guests: We look forward to featuring guests who are not only identifying problems but also offering solutions and success stories. This episode is sponsored by 4D Global. Visit them at 4dglobalinc.com.   [00:01:46] Delegation challenges and solutions. [00:05:08] Price transparency and education. [00:09:03] Understanding client's pain. [00:11:52] A prosperous and successful 2024.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

1/10/24 • 12:16

In this episode of Leaders in Medical Billing, our guest Robert Kowalik shares his unique journey from being a physical therapist to transitioning into the billing side. With experience in running a private practice and managing a billing team, Robert saw an opportunity to help other physical therapy practices with their billing needs. He started by focusing on accounts receivable conversion and gradually evolved his approach to a specialty-focused, parallel process billing system. Tune in to learn more about Robert's insights and experiences in the medical billing industry.   Time stamps [00:00:13] Transition from physical therapy [00:07:26] The biggest time inflator. [00:09:41] Variable rate structure for billing. [00:16:38] The black hole concept. [00:17:14] Turning billing into business intelligence. [ 00:23:44] The focus needs to be on the other side of the scale. [00:26:03] Converting billing team to BI team.     For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com  

12/19/23 • 26:08

In this episode of Leaders in Medical Billing, our guest Christopher Turner shares his journey with implementing the Entrepreneurial Operating System (EOS) in his company. Christopher explains how he transitioned from being a founder to a CEO and the role that EOS played in transforming his business. He discusses his experiences with Vistage, a peer advisory group, and how he learned to manage and run a business. Christopher also shares his initial confusion when asked about his company's operating system and how he discovered the benefits of EOS through another member's success story. Tune in to learn more about the impact of EOS on company culture and Christopher's journey as a leader in the medical billing space.   Timestamps [00:00:25] Implementing EOS and transforming companies. [00:04:34] Replicating and scaling a business. [00:09:31] Culture and company success. [00:12:28] Investing in meaningful benefits. [00:19:30] Billing issues in healthcare. [00:21:19] Pervasive issues in medical billing. [00:26:39] Confusion with medical billing. [00:29:43] Future of humanity.   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

12/5/23 • 29:55

In this podcast, Denise Corbisiero, the COO of Integrity Billing, shares her personal journey into the mental health and substance abuse treatment industry. Denise started her career running a call center before transitioning into treatment, which fueled her passion for helping facilities and substance abuse facilities succeed financially. She has been in healthcare since the mid-nineties and has observed several changes and challenges in the field, including changes in healthcare providers' practices and an increase in insurance companies' control over treatment procedures. Denise also highlights how technology, such as AI, is enhancing the industry by easing employee workload and has hopes to further automate processes like the appeals procedure. Beyond automation, Denise stresses the importance of personal relationships with customers as a critical factor in success in the industry. She touched on the success of their SaaS product that verifies benefits in seconds, proving to be quite popular with clients.   #MentalHealthAdvocacy #SubstanceAbuseRecovery #HealthcareInnovation   Timestamps [00:00:02] Introducing Denise Corbisiero, COO of Integrity Billing [00:00:20] Choosing Mental Health Industry: Challenges & Struggles [00:08:10] Tough Recovery & Insurances Hurdles [00:11:34] Embracing Change: AI’s Role in Reducing Workload [00:13:38] Underlining Customer Relationships: Turnover and Internalization [00:16:00] Accelerating Benefit Verification: Leveraging SaaS [00:19:21] Future of Automation: Streamlining the Appeals Process [00:21:54] Preferred Systems for Behavioral Health [00:23:21] Defining Success and Making Connections   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com

11/21/23 • 23:57

In this insightful podcast episode, we speak to Ryan O'Hara, an experienced healthcare professional currently working at Acclara, an RCM company. Ryan outlines his stress over the U.S. healthcare system, particularly the 22% GDP spending on healthcare despite having some of the worst outcomes. He acknowledges the need for a unique approach to address these inefficiencies, especially in the RCM space.   Ryan details the adversarial relationship between revenue cycle professionals and insurance companies, emphasizing the potential for improved cooperation through data-driven dialogue. He suggests that showing insurance companies potential benefits can encourage them to be proactive in providing remedies. Discussing administrative inefficiencies, Ryan underlines the significance of talent identification and nurturing within the healthcare sector. Interestingly, he boils talent down to four characteristics: happiness, hard work, empathy, and being a team player.   Discussing the subject of insurance and healthcare providers, Royal emphasizes the need for creating financial incentives for health capital, thus shifting the focus from making people better when they're sick to keeping them healthy. Ryan concurs, expressing his aspiration to act as a peacemaker between insurance companies and health systems.   Lastly, Ryan proposes a revised approach to measuring KPI's in the healthcare sector. Rather than the common practice of tracking numerous metrics, Ryan advises focusing on five things: cash versus a goal, AR measurement, agings by the payer, cost tracking and managing vendors to optimize spending.   Website: https://www.acclara.com/ LinkedIn: https://www.linkedin.com/in/ryan-o-hara-920b3623b/   For more insights and takeaways, visit www.leadersinmedicalbilling.com. This episode is sponsored by 4D Global, empowering medical billing companies to grow through offshore staffing. Visit them at www.4DGlobalInc.com   Timestamps [00:00:03] Introduction to Ryan O'Hara and Acclara [00:00:27] Discussing Healthcare Costs and Outcomes [00:02:04] Tackling Adversarial Relations in Revenue Cycle [00:05:06] Power of Data in Healthcare Conversations [00:08:07] Identifying Talents to Improve Healthcare Practices [00:14:15] Essential Traits for Leadership in Healthcare Sector [00:16:40] Advocating for Better Patient Centric Healthcare [00:24:00] Ryan's Vision for Bridging the Gap between Insurance and Health Systems [00:30:37] Key Performance Indicators in Healthcare, A New Perspective [00:32:30] Critique on AR Days and Measuring Absolute Revenue Returns [00:33:47] Importance of Measuring Aging by Payer [00:35:25] Monitoring Costs in Healthcare Sector and Vendor Management.

11/7/23 • 36:18