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Ken Bulow - Getting Your Claim Paid After the Bill Goes Out
131 Plays2 years ago
Collecting payment from patients can be tedious and challenging, especially after their surgery is complete. We’re joined today by Ken Bulow, EVP of Operations at Surgical Notes, to chat about how you can implement workflows and proven processes to get your claims paid after the bill goes out.
In our news recap, we'll cover CMS’ 2023 final payment rule, new innovation around tattoos and medical alert bracelets, the average consumers medical debts, and a nurse who helped care for a man after he collapsed during a Broadway show.
Articles Mentioned:
2023 Final Medicare Payment Rule Released; Results Are Mixed for Surgery Centers
Could Tattoos Replace Medical Alert Bracelets?
Nearly half of consumers are in debt due to medical bills, survey finds
Nurse of the Week: Florida Nurse Helps Man After Collapsing During Funny Girl Performance
Brought to you by HST Pathways.
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Transcript
Introduction to the Podcast and ASC Industry Overview
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Revenue Cycle Insights with Ken Bulow
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode. We are talking with Ken Bulow, who is the Executive Vice President of Operations at Surgical Notes. Now, there are a lot of different parts to the revenue cycle process.
00:00:40
Speaker
But today we are focusing on getting your claims paid after the bill goes out and some workflow tips for making this simpler and more effective and eliminating work. We'll close the episode with a few news stories. We'll start with CMS's 2023 Final Payment Rule for ASCs, talk about a new innovation around tattoos and medical alert bracelets,
00:01:01
Speaker
Look at the average consumer's medical debt and how that impacts ASCs. And of course, end the new segment with a positive story about a nurse who helped care for a man after he collapsed during a Broadway show. Hope everyone enjoys the episode and here's what's going on this week in surgery centers. All right. How's it going guys? Welcome back to another fantastic episode here at this week in surgery centers.
00:01:28
Speaker
I'm your host, Rafael Akinsvi, and we have a fantastic episode. I'm super pumped about this one. This week we have Ken Bulow. He is the executive vice president of operations at surgical nodes. Fantastic leader. And we're really excited to have him on cause we're going to be talking about something that I know a lot of our listeners have asked about and want to hear. And you know, today we're going to be covering
00:01:52
Speaker
getting your claim paid faster after the bill goes out. And this is just one that I know impacts a ton of different surgery centers. And this is an area that we really want to dive into. Before I run through all the questions I have for you today, Ken, I want to first just kind of jump in and give you a chance to talk a little bit about yourself. For anyone who doesn't know you, go ahead and kind of tell the people about you and kind of what you do at Surgical Notes.
Role and Experience of Ken Bulow at Surgical Notes
00:02:17
Speaker
Great. Yeah. Thanks for having me on. I'm thrilled to be here today.
00:02:20
Speaker
I'm happy to share a little bit of my knowledge with your audience. I have been working in healthcare provider revenue cycle for about 25 years now. It's kind of all I've ever done. And then specifically working here with surgery centers since 2008. So I have been in leadership roles for revenue cycle firms or surgery center management companies working specifically with surgery centers since 2008. Awesome, awesome.
00:02:50
Speaker
Today at Surgical Notes, one of my primary duties is leading our revenue cycle team for our customers who've given us the privilege of handling their billing.
00:03:01
Speaker
That's fantastic. Hearing how long you've been in the space is one of the reasons why we really wanted to have you on the podcast. I think that time that you spent there and that wealth of knowledge gives so many great points there in terms of ways that you'll be able to give some guidance. We're excited to dive in. We'll jump
Strategies for Insurance Verification and Patient Payments
00:03:19
Speaker
right in. When it comes to revenue cycle management and the revenue cycle process,
00:03:24
Speaker
There are tons of different steps in that process for any surgery center. But, you know, we really want to kind of focus today on kind of that last piece there, almost the last piece in terms of following up with patients on those unpaid claims. And for people who aren't necessarily as familiar here, can you kind of give us a sense of, you know, what percentage of patients typically leave with an outstanding balance? Like how common is that?
00:03:52
Speaker
So I would say in the perfect world, you're doing a full and complete insurance verification prior to the day of surgery. You are figuring out what the patient's benefits are. You're figuring out what procedure is going to be performed, comparing that with your contract. So, you know, you take a knee arthroscopy
00:04:16
Speaker
You compare that with your Cigna contract and you figure out, okay, this is exactly how much I'm going to have as an allowed amount for my Cigna contract. Apply the patient benefits, and ideally, you know, a week or so prior to surgery exactly what that patient's going to owe. And so in the perfect world, we call the patient ahead of time. We tell them, hey,
00:04:36
Speaker
You're coming in on Tuesday. This is how much you owe. We'll take a credit card over the phone today. And in the perfect world, they pay you, or you use one of the modern tools out there to send them a text message saying, hey, here's how much you owe. Just click this link and pay us. So in the world, that's how it happens. In reality, I'm hesitant to give percentages because it really varies based on how that center is run, based on the technologies that they choose to take advantage of.
00:05:04
Speaker
But for those patients who don't pay up front, then you have another opportunity when they're standing right in front of you to say, hey, you owe me prior to service. And so again, taking advantage of that second opportunity to collect from them, they should have already known because you should have already contacted them ahead of time.
00:05:20
Speaker
So industry-wide, if I had to say at that point, by the time the patient has come in, somewhere north of 60% of what we see have collected something. It's not always the entire, some patients can't put it all down at once, but somewhere north of 60% have taken something. I've had a conversation, everybody's had a conversation with the patient, but 60% have had a conversation with that patient, either all or some portion of that.
00:05:49
Speaker
Okay, that that's helpful to know there. And I want to dive in a little bit deeper on that. And we won't hold you to an exact percentage on this, you know, maybe we'll get someone on the production team, they'll go look up a stat or something. But that is helpful for us to get get some sense of and in kind of thinking about that based on what you've said there. So that 60% is there's a certain amount that's been collected. But
00:06:13
Speaker
not necessarily all of the amount that a patient owes, and especially thereafter once they've left the surgery center. Correct. So you have some patients who have paid everything, some patients who've paid nothing, and some who've paid abortion.
00:06:28
Speaker
Okay. And there are genuinely some cases where you're just not sure of exactly what that charge is going to be. And so that estimate could result later on with either yelling them a little bit back or the patient or you a little bit more after the claim is adjudicated through the insurance company. That makes sense. That makes sense. Well, diving in there a bit, I want to kind of follow on to that same note. So what do you think are probably the three biggest things ASCs get wrong
00:06:53
Speaker
after a patient walks out the door and they still owe them some money for that case.
Communication and Automation in Payment Collection
00:07:02
Speaker
I think the thing that folks get wrong or may not understand is every day that goes by where you're unable to collect those dollars, your chance of collecting that dollar goes down. Yeah.
00:07:18
Speaker
So if you wait 30 days, if you wait 60 days, if you wait 90 days, every day that goes by, statistically you have a lower and lower chance of collecting that. So what we like to do is make sure that we're communicating with patients all along the way. Sometimes we are legitimately waiting for a claim to process before we know exactly what the patient knows. The great news is
00:07:39
Speaker
For most third party payers, the patient's getting an explanation of benefits and ELB from their third party at the same time. So they know it's coming. So they're helping, right? So Blue Cross Signing United Rivers helping keep in touch with that patient to say, hey, we're paying your claim to your provider and you do owe something and you should expect to hear from them. It's really important to just have all that done timely. I don't think that was three, but that's the
00:08:02
Speaker
That's kind of what I would say is most important. No, that makes sense. Sometimes you don't have to have a full checklist of different things. Sometimes you hit the nail on the head there, and I think that's something that's true and resonates really well for a lot of ASCs. You think about it, and it goes beyond just the ASC industry, I think, in general. Once you get service or a product of any kind,
00:08:25
Speaker
the further out you are from that time of service, just the less incentivized you are to make that payment at all, or at least in some kind of timely matter. So it makes a lot of logical sense there. Especially if you've had a good experience, right? You just, you've walked out of that place of service, whatever it is, but in our example, it's a surgery center. You've walked out of that surgery center, they've fixed whatever problem or they've, you know, have you on the path to recovery. You're feeling really good about them. The more time that goes by,
00:08:54
Speaker
The less inclined you are to remember that nurse or that doctor or that front desk person who you had a positive experience with and want to write a check. Yeah, that makes a ton of sense. If I was someone, let's just say, getting a car wash after my car is washed a couple weeks later, I'm probably not thinking about how great a job they did on my car anymore.
00:09:15
Speaker
If I hadn't already paid for it, they're probably not going to get a payment until I get that car washed again. So that makes sense. Well, let's say I am the surgery center that I'm trying to collect that payment. That process, I imagine, is probably not easy. It's probably pretty tedious and time-consuming trying to go through the process of collecting that payment.
00:09:38
Speaker
What are some of the workflow tips for making that process simpler and maybe eliminating some of the work so they can actually collect that payment? Again, we'll talk about insurance a little bit, but from a patient standpoint, ensuring that as soon as you know there is some patient liability, you've allocated that to a patient responsibility bucket using whatever technology you use.
00:10:07
Speaker
and then get those statements out. So we tend to work with vendors who automate the statement process for us. So there's a statement file that goes out every day and every patient that's ready for a statement will get that statement.
00:10:19
Speaker
Um, and so as much as you can kind of automate it, put it on a plan that says every X number of days. And, um, uh, typically we're looking at a little bit less than a month. We're dropping a statement to a patient every month and making sure that there's messaging that's escalating to say, Hey, look, you, you owe us this money. Let's pay us. And, and by the time you get to the third one, if they haven't paid you voluntarily, they're probably not going to. So at that point, it's probably worth picking up the phone and saying, hello.
00:10:44
Speaker
You know, you should have seen three statements from us. Have you received those? Is there a reason you haven't paid us? Was it a service issue? Was it a process issue? Or do you not have the money? Let's talk about some ways we can help you get there. And then fundamentally, I mean, there will be times when you have to take advantage of third party agencies out there that basically will represent themselves as a collection agency and take over from that point.
00:11:08
Speaker
The idea is to prevent that. Yeah, that makes a lot of sense. And I think for many surgery centers, you want to be able to get out ahead of it well before you have to go with a third party collections agency to be able to make that happen. And I think the point you mentioned there, I want to dive in on those first two points a little bit in terms of kind of communicating that to the patient well in advance and then also taking advantage of that additional step of kind of
00:11:34
Speaker
Calling and letting them know that hey, you might have received a few different statements, you know How effective do you think that's been for a lot of surgery centers? And do you think that drives a lot of success for them in terms of collecting those payments? Absolutely, I mean, I don't know about you but you know I get mail and sometimes it piles up on my desk and then I'll get a day and I'll sit down and I'll get to work on all of it and
00:11:58
Speaker
Sometimes you just need that little nudge from somebody to say, Hey, remember this, you know, this is dude, you got to take care of this. And, uh, and so it prompts them to do it. That makes sense. And, and is that something that, you know, in terms of kind of building some workflows around, do you think that's something where surgery centers can kind of templatize that process for their team? So it's maybe more efficient for them.
00:12:20
Speaker
Yeah. So, you know, you can use those statements as triggers. So if you set up a workflow that says, let's just say, for example, every 25 days I want to send out a statement, you can then create a workflow that says after statement one, I'm probably not going to do anything. I don't know if they pay.
00:12:36
Speaker
After that second statement, here's what I want to do. I want to put it on a call list. I want to have somebody call them. After the third statement, I want to do the same thing just so that it becomes a process. By the time you get to that third statement, you can say, I know this has happened because my process is I send a statement, I send a second one, I make a phone call, I send a third one, I make another phone call. If it is a process and it's all documented, you can be sure that that's done and that you've done your part to try to collect
00:13:05
Speaker
Yep, that makes sense. I'm a huge fan of anything I can put into a workflow or process. It makes my life simpler and it's easier to manage. And I imagine for a lot of our listeners, it's probably the same.
00:13:17
Speaker
So jumping forward a bit there, one of the things I heard you say before that I think is a stroke of genius is things go wrong in patterns. And I think that that makes a ton of sense. In terms of running a surgery center, if you were running a surgery center today, how would you identify the patterns and learn from them so that you can avoid some of these gaps and problems around collections in the future?
Identifying and Fixing Systemic Claim Issues
00:13:47
Speaker
I think I may have been referring to more to insurance follow up at that point, where we see things go wrong in patterns. So the way that I think about insurance carriers here today in 2022 is they want to pay us. And this is a little bit controversial in the provider community. I think for the folks who have been in the provider space as long as I have, we've always had this view of they're the enemy. The payer is the enemy. They don't want to pay us. They want to hold on to those dollars and earn interest on them.
00:14:17
Speaker
And I fundamentally believe today that is not the case. I believe that they set up their claim shops and they want to pay us because they have to pay an agent on the other side as well if they don't pay us. And in order to do that, they set up rules.
00:14:35
Speaker
And they publish those rules on their websites, and there's a provider manual that tells you how things work. And so typically what we find today is that when your claims aren't getting paid by a third party, it's because you didn't follow some rule. We can debate for hours about whether those rules make any sense, whether we agree with those rules,
00:14:55
Speaker
But the fact is there are some fundamental boundaries guardrails that they've set up and it's our job to follow them. So yeah, we do see when things go wrong. It tends to be in patterns. It could be that there's a new modifier requirement for a certain payer. It could be that a code that used to be payable is no longer payable. It could be.
00:15:13
Speaker
there's a contract rate change that we weren't aware of that we should have been aware of, but whatever it is, it's the job of the surgery center or whoever's working the revenue cycle for that surgery center to try and understand what is it that went wrong here? How do I fix this thing, this individual claim that's in front of me? And then what other claims or what other process do I need to put in place to make sure this thing never happens again? And the more you do that,
00:15:43
Speaker
Over time, the cleaner you see your revenue cycle get until something changes on the payer side. That makes sense. I think you called out a couple really great points there. One, in terms of that perception of the relationship with payers. I think that's just a common misconception. I think that makes a ton of sense there in terms of rethinking or maybe realigning our thinking around how we see the relationship with payers.
00:16:10
Speaker
I think one of the parts I want to dive into a bit more there is talking about those steps of actually going through what I would say is almost a root cause analysis on why we're seeing some of those, why you have some of those errors or things don't get paid. In terms of diving in there a bit more, what are some of the ways that maybe surgery centers can do some of that root cause analysis more consistently when they have moments where things aren't getting paid and they're not sure what code
00:16:37
Speaker
might have changed. What are some of the things you think that can be more effective for them there? I think that it's a little bit of a culture shift of how we approach collections. And so again historically collections is I'm calling and saying pay my bill pay my bill third party pay my bill and it's really fundamentally you know getting curious and so it's training folks or hiring differently around people who
00:17:05
Speaker
we like to use the phrase are intellectually curious, right? People who like puzzles, people who want to say, okay, I have this thing in front of me, and I didn't get the expected outcome. Where and he used that he's causing houses, where, where did we go wrong and owning it, right? And saying it's on me, where did we go wrong that we didn't get the outcome desired. And so it's where you find that could be in many places, it could be encoding, it could be in registration, it could be that,
00:17:31
Speaker
You know, something went haywire with the claim submission, but you really have to have that intellectual curiosity to kind of dig and uncover and try to figure out where do we go.
00:17:41
Speaker
That makes sense. And I think you kind of nailed a couple of good points there in terms of that intellectual curiosity and then being honest with yourself on kind of, you know, where did we go wrong to be able to get to that point? Because I think it's easy to want to point a finger elsewhere, but sometimes it's a lot harder to say, OK, maybe we didn't do everything up to par. So that makes a ton of sense.
00:18:04
Speaker
We're now moving into the life lessons phase of the ASE podcast. Yeah, that's the next phase. That's the thing we gotta get. We gotta get you back on the pod just so we can do a whole thing that's, you know, just the life lessons from Ken Buello, things to live by.
00:18:19
Speaker
Well, I think we're hitting a lot of really good points here. And we've covered a ton of really great nuggets for our listeners. And as we kind of think about some of the next steps going forward here, one of the things that I want to just jump back on before we end, you had some really great points there in terms of that relationship with payers. Are there any things that you would say are just maybe some key tips for building that relationship with payers so that surgery centers can just be more effective and successful there?
00:18:50
Speaker
Yeah, I think there's a couple things. In terms of building relationships, helping them understand what your goals as a business are and how your goals can align with the payers. So at Surgery Center, it's pretty easy. Historically, we've always just said, hey, we're the lower cost of care.
00:19:11
Speaker
Let's move cases out of the hospital. I think that is still today a fantastic argument, but it requires a bit more nuance to organize that thinking around here's our business plan. Here's how if we get X, Y, or Z in terms of rate we're looking for, we'll be able to recruit a couple more docs. And if we recruit a couple more docs, here's what it means to you. So that's kind of on the upfront kind of relationship piece.
00:19:34
Speaker
And then internally, I think it's really important to know those contracts. Know what's in those so that, again, it's all part of how do I prevent problems before they become problems? Knowing what the requirements are within each contract. How do you have to build things? Bilateral is a good example when something is done on the left side and the right side. There are a couple different ways to build those and understanding for each pair what their requirements are. Because again, if you do that, you can prevent problems up front.
00:20:02
Speaker
And every problem prevented up front is just less work that you need to do later on. That makes sense. That makes a ton of sense. Well, before I let you get out of here today, Ken, you know, one of the things that we do every single week with every single one of our guests is we ask them one of the questions that we can kind of send all of our listeners off
Adopting Modern Technology in Surgery Centers
00:20:21
Speaker
with. So what is one thing our listeners can do this week to improve their surgery centers? And it can be related to anything. It doesn't just have to be on the payment side.
00:20:31
Speaker
That's a really good question. And obviously, as a fan of the pod, I know that that's how we end these segments. So I think I would say it's 2022. Let's embrace technology. There are a lot of surgery centers out there.
00:20:46
Speaker
who i see scheduling on spreadsheets i see not taking advantage of you know we use our phones for everything today and there are so many opportunities to introduce technology again think about revenue cycle that can help us be more efficient so whether it's adopting a way to text the patient
00:21:07
Speaker
either clinical information or financial information, adopting a method for them to communicate with you electronically, including paying their bills electronically. I would look for those. I would try to take advantage of those. It really exists everywhere else in our life. And I think from my experience in visiting surgery centers, it seems to
00:21:29
Speaker
to take advantage of what's out there. That's awesome. That's some great advice there. I think just to the point that you mentioned in 2022, we have a standard for technology everywhere else in our lives. So why don't we expect that in our workplace and in our surgery centers?
00:21:44
Speaker
That's fantastic. Ken, this has been a fantastic episode. I really appreciated having you on. I feel like there's so many great clips we'll be able to take from this and be able to share this out with all of our listeners. So thank you for coming on the pod and we look forward to having you back. And we might have to take you up on that offer of an entire episode of just life lessons with Ken. Life lessons. Life lessons, yes. I appreciate it. Thank you for inviting me. It's been great to participate in it and I'm happy to
00:22:13
Speaker
I'm happy to come back and share life lessons from Ken, although there's probably a lot of people who wouldn't want to listen to that. Thank you. I appreciate the time and we'll talk soon. Awesome. Talk to you soon.
CMS 2023 Payment Rule and Industry Reactions
00:22:29
Speaker
As always, it has been a busy week in healthcare, so let's jump right in. Our first story this week comes from ASCA and CMS. As you likely heard by now, on November 1, CMS released its 2023 Final Payment Rule for ASCs and HOPDs. Now, the document they released is 1,764 pages, so we are working on a bigger, more detailed story on the final rule for next week, but I wanted to quickly share
00:22:59
Speaker
that CMS has only added four new procedures to the ASC covered procedures list for 2023.
00:23:09
Speaker
And ASCA had actually proposed 47 procedures. So to see only four make it through is pretty disappointing. The final rule has a few other takeaways for ASCs though, some that are really positive. So we'll put a few links in the episode notes so you can learn more. And again, we'll take a deeper dive on next week's episode.
Innovations in Medical Alert Alternatives
00:23:32
Speaker
Our second story comes from outpatient surgery and they are looking into tattoos replacing medical alert bracelets. Researchers at the Georgia Institute of Technology have developed low cost painless tattoos that could potentially be used in healthcare. The tattoos themselves are skin patches that contain microscopic needles,
00:23:54
Speaker
And researchers suggest that they could be used to cover up scars or guide cancer radiation treatments, but they could also serve as an alternative to medical alert bracelets that are often used for diabetes, epilepsy, or allergies. So one example of how it could work is the provider could actually design a tattoo for a patient
00:24:17
Speaker
and it can include letters, numbers, images, or symbols, then the mold is filled with permanent or temporary ink and then applied to the patient.
00:24:26
Speaker
And the difference is that there's no blood, no pain, and it can be applied within minutes. So it could also include black light ink, excuse me, so it won't be visible all the time if the patient prefers. And I love that this could be an option for patients and can give them some control over their body back. And for patients who aren't comfortable with traditional medical tattoos, whether for religious reasons or personal preference,
00:24:54
Speaker
This offers them an alternative that might not feel so intense. So really cool stuff coming out of the Georgia Institute of Technology.
Impact of Medical Debt on Americans
00:25:04
Speaker
Our third story today in an article published by Healthcare Dive, over 45% of Americans say healthcare bills have put them into debt. In addition to this alarming statistic, they also highlight how many Americans are financially unprepared to deal with a health emergency.
00:25:23
Speaker
60% said they do not maintain a dedicated savings fund for health emergencies, and 56% said they are struggling to pay for any health maintenance costs.
00:25:37
Speaker
So these numbers are jarring for many reasons. Obviously, numbers like this will prevent or delay care for many who desperately need it, but it also highlights how important it is for ASCs to begin financial discussions with patients as soon as possible. And we really have to do it in a way that is fully transparent, really compassionate, and easy for patients to understand.
00:26:03
Speaker
And as difficult as it can be, we have to meet patients where they are at. So offering customizable payment plans will be key and also providing them with educational resources in their native languages as well so that they can understand where the cost comes from and just make them feel more comfortable going through the process and also committing to making such a financial commitment. And ultimately will also help ASCs get paid as well.
00:26:32
Speaker
Looking at kind of inflation and where everybody or culturally where we are at with health care, medical bills, super important that we kind of lean in and realize this is where we're at and we just need to make price transparency a priority.
Positive Stories of Healthcare Professionals
00:26:50
Speaker
And to end our new segment on a positive note, Nicole Horachowski, who is a registered nurse from Florida, she was at a Broadway musical for Funny Girl featuring Leah Michelle, when she noticed a man stand up and collapse during the performance.
00:27:05
Speaker
After giving it a few seconds, she went over and introduced herself as a nurse and was able to care for the man until they were able to safely get him into an ambulance. Maintaining the man's safety and dignity was of utmost importance to Nicole and she was quoted afterward saying, that's what happens when you take your nurse pledge and you get pinned and you are always a nurse.
00:27:29
Speaker
On the clock, off the clock, Christmas day, or any other random day of the year, you are always a nurse. And I'm sure many of you can relate to that sentiment and also have very similar stories you could share as well. So amazing job, Nicole.
00:27:44
Speaker
And that news story officially wraps up this week's podcast.
Podcast Conclusion and Future Episodes
00:27:48
Speaker
Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we'll see you again next week.