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Co-hosted by Taya Moheiser, CMPE, CMOM & Kem Tolliver, CMPE, CPC, CMOM. #revenuecyclemanagement #medicalbilling #RCM
Taya Gordon (01:04.706)
All right, welcome Revdivers. We are gonna chat today with someone who is not only a friend of ours, but someone who we keep running into in the speaker circles because she is out here doing her own great big things and still in the revenue cycle area, which means obviously she needs to get to know our Revdivers. And on the call with us today is one Paola Turchi, who is the RCM Solutions Lead at Notable. Paola, welcome finally to the show.
Paola Turchi (01:31.33)
I know, hello everybody, hi Taya, hi Kim. Very excited to be here. I can't believe it took us this long to get together, but hey, we're here. So let's just take it all in.
Taya Gordon (01:39.451)
I know.
Taya Gordon (01:43.374)
We are so excited because there's so many avenues where we could pick your brain and let our listeners really get some super cool solutions. And so we spent some time trying to figure out where are the best areas to pick your brain because honestly, I think we could have you on several shows and still not get through everything. So we wanted to start with what I think brings everybody the most joy, which is prior authorization. I mean, people just get so excited when they hear that. They're so overjoyed, right? And...
Paola Turchi Turchi (02:11.787)
Oh, yeah.
Taya Gordon (02:12.822)
Yeah, it makes everybody happy. So no, seriously, like when we talk about prior authorization and the burdens, right, that it places on revenue collection, like what revenue burdens have prior authorization requirements had on revenue cycles that you manage? Like what burdens do you help manage in solution?
Paola Turchi (02:33.522)
So there are a few components and it's funny that you mentioned that brings so much joy to everybody when they hear authorizations because it's something that I have been tracking over the years when I'm presenting for MGM a or other organizations And when you look for metrics every year, there is some sort of survey that says power Authorizations is a burden to an organization every and every year is the same thing over and over for
Taya Gordon (02:38.546)
I know.
Paola Turchi (02:57.814)
Several years, it's not just the last two or the last three, it's been happening for a long time. And the things that organizations, at least the ones that I'm working with, struggle with, it starts with staffing availability, having enough people to do the job, one. Two, they also struggle with keeping up with the requirements from the payers, which appear to always be changing. Yes, you hear that UnitedHealthcare, that Cigna, that Edna are somewhat...
easing the requirements and removing codes from the list of procedures that need to be authorized. But there are still very comprehensive list of codes that need to be addressed, one that changes constantly. And it's not easy to find out. So transparency about what needs to be done is not easy to, hey, look at that, I went to the website and here is a very clean, beautiful list that I have to address. You have to look around to find out where this information is.
So those are the, I would say, perhaps the two big components that we have is transparency from a pair of perspective, easy to find, as well as always changing regulations and then having enough staff members at a practice to be able to support that process. So when I work with organizations, there is three things that I like to look at in every problem that we have. People, process, and technology. So when we're talking about the process is okay,
looking into what is it that you are doing? What generates your queue? Do you actually have a digital queue? Or are you working out of spreadsheets? Or are you working out of faxes that you are receiving? And
Taya Gordon (04:34.806)
Or are you working out of a sheet of paper on the side of your desk and several post-it notes?
Paola Turchi (04:41.863)
That is exactly right. And we laugh about it, but that's the reality for a lot of organizations is that the doctor just send them a piece of paper and now they're working out of this piece of paper. So when I see organizations like that, the first thing is, of course, we all want to implement the latest and greatest technology available to help them. And if that is an option, absolutely go for it. But when there is not, let's start on somehow.
keeping a centralized spreadsheet document somewhere that tracks the efforts of the users. Right? Okay, I have this particular piece of paper that I received. I am going to log it into my spreadsheet. I'm going to put a due date as to when this needs to be completed so I can prioritize my work. So I can then at the end of the day track how many did I complete? How many are left? Do I
If you are not tracking it, you cannot fix it. So that's the first thing. If you cannot implement the latest and greatest technology, then go through at least logging it somewhere centralized so it's visible to everybody. So that's my process perspective. From a people perspective, do we have enough resources that have the knowledge of that specialty to know that an authorization is on file, that authorization is needed?
A lot of this information, unfortunately, resides on people's heads. So I work with organizations to be able to document this information. So when that person leaves, then a new person starts, it's easier to transition that new individual on understanding what are the requirements for that particular insurance for that particular procedure. So documenting what is on people's heads really facilitates this process, streamlines the process.
And then the last thing really is from a technology perspective, we're talking about what are those tasks that are repeatable, that are copy, clicking and pasting, that can actually be automated, checking the status of an authorization. So we sent an authorization to Blue Cross, they take 14 days to authorize the service. And a process or a policy of the organization is to check the status every day. So if it takes 14 days, they're checking the status for 14 days.
Paola Turchi (07:01.826)
times is the insurance decides to take 14 days to provide the authorization. So automating, finding those very repeatable tasks to be able to automate the process. So guess what? Those resources are freed up so they can actually work on things that really require their skill set. They're working at the top of license is really what we're trying to accomplish. So we're looking at training, documenting what they have in their head so that can be shared.
across multiple people or do multiple departments. Also, if they don't have any tooling place documented or at least on a spreadsheet. Now, I imagine that you experienced this as well. There is very powerful EHR and practice management systems out there. And they have always done a spreadsheet, but they don't know or have not leveraged the fact that they have a technology that could support the digitalization of that spreadsheet.
So that's another way of that. I work with clients like, okay, what system do you have? I know they have a queue. Let's set it up to be able to digitalize this process versus working with the piece of paper that was given to the provider that then was put in a spreadsheet. That is kind of.
Paola Turchi (08:18.174)
What are you guys there? I don't know, but I also heard.
Taya Gordon (08:19.377)
What was that noise?
kem tolliver (08:20.855)
That was weird.
kem tolliver (08:33.371)
Oh really? Oh wow. Okay.
Taya Gordon (08:36.398)
let the dog out of my office while we're pausing recording. That was super weird.
kem tolliver (08:39.991)
That's weird. Okay, well that gives, that will just allow me to segue into the next question, the next Q&A. All right, so when Taya sits, when Taya gets back, hi. Okay, so I'm gonna pick up from right there. Okay. Three, two, one. Wow.
Paola Turchi (08:49.026)
Okay.
Paola Turchi (09:00.28)
Perfect.
kem tolliver (09:07.679)
I have to tell you, so Paola Turchi, you just gave a super comprehensive response to that. And prior authorizations has certainly been a challenge in the industry, especially with all the regulatory changes that are coming down the pike with it. I want to take a step back and really give our rev divers an insight into your background, because everything that you just said is so insightful.
Can you tell us a little bit about your career and what you have contributed to the healthcare industry as I prepare to ask you about another challenge that we're seeing, which is patient collections. I'd love to just kind of introduce our listeners to your background.
Paola Turchi (10:00.354)
Thank you, Cam. So, yes, I have been crazy enough to have had my entire career in revenue cycle. Started from doing registration and scheduling, moving on to doing collections, then becoming a certified coder. And with that, then managing revenue cycle team that did collections for multiple specialties. After that, going into leadership.
positions that manage offshore resources, also resources that we had here in the States, all of that from a back end of the revenue cycle. And the fact that I actually had done the job really allowed me to understand what the resources were going through to help facilitate the streamline of processes and to feel their pain, right? I have felt their pain. I speak their...
kem tolliver (10:55.679)
Yeah, and I think that's where it's really great that you've had that experience, right? That hands-on experience, because as revenue cycle leaders, it's one thing to lead teams, it's another thing to have kind of been in their shoes and understand their challenges so that you have now authority to implement solutions, right? One of the...
the challenges that I think we're plagued with in healthcare is reactive patient collections. And the thought that, oh, we'll get the money from the patient after the time of service, right? That really becomes an obstacle, especially in an environment of virtual care delivery, right? Because we don't have the patient in front of us. And we wanted to hear from your perspective, right? How has...
this reactive patient collections methodology affected the revenue within organizations that you've worked with. And more importantly, can you talk about and share some solutions that you've implemented to kind of address reactive patient collections?
Paola Turchi (12:11.289)
Yeah, absolutely. And Cam, back then it was okay to wait until the patient was seen and tried to collect later on because we were talking about $10 copays, $5 copays.
Now we're talking about the majority of the practices have somewhat of 30% of more patients being the payer, the ones that are paying for their care. So we can not just wait until the end and hope that we get paid for the 10-dollar co-pay. And if we don't, then we get, what is it? It was called professional courtesy adjustment. So those times are over. We need to be more proactive on collecting patient collections.
One of the things that we have implemented with organizations is moving the resources from the back end to the front end, like reactivating the patient collection process before the patient shows up for the appointment versus waiting. To do that is instead of having the collection process or the team three, four, five resources that you might have, sending statements, send the collection letters, calling the patients.
Moving a subset, so we have moved a subset of those resources up front to identify, these patients are coming, at least top 10 services that you might be providing that are high, high costs, right? The patients are coming, how much are they possibly going to owe about the service? Letting them know how much they are going to offer the service and then trying to set up some sort of a payment plan or some sort of a collection process prior to them getting the service.
From a patient perspective, I tell you, I love the fact that I know, or knowing, how much I'm gonna offer that visit before the visit is taken. Waiting after the fact is just, to me, it's nuts. It's the only industry that does that. Usually, before you get a dentist appointed to anything done in dentistry, they come with somebody and tells you exactly everything that you're gonna owe before the service is provided. We are a little behind in that end. We're trying to get there, but that's one component. Moving a couple of resources to the front.
Paola Turchi (14:16.846)
to really proactively reach out to patients to let them know how much they are going to owe. What options do you offer? So one of the things is meeting the patients where they are. So some patients might use an online portal to pay. Some patients might still like to send you a check. So patients might come to the office to pay for the service. So providing a variety of payment solutions or payment options has proven to be very helpful.
to collect from these patients. Also training, I've provided scripts to the check-in person to have that conversation. It's very uncomfortable for them to collect from patients. And I think COVID took us back a few years because during COVID, we didn't wanna have this exchange of money because we were gonna get infected. So we stopped collecting money. And now they're uncomfortable going back collecting money. So putting scripts in place that helps them have that
difficult conversation with patients to collect these monies up front is also very helpful that has been proven to be helpful to the organizations I work with. The other thing is, if possible, we have removed the front desk from the picture on asking for these monies and instead implemented technology that does that for them. So depending what system you have, let's say an EHR system.
your EHR system might be able to provide that, but if not, there are tools out there that are able to provide this information to the patient prior to showing up. There is not a human in the loop anymore. The information has been extracted from the EHR, and then the patient receives that pre-registration check-in, right? And then they can tell, okay, I'm coming in for my appointment, it's in two days, I'm gonna owe $50, and here they want us to pay $10. That is like...
kind of like the magical solution in the sense that now you're not dependent upon a user to have this uncomfortable discussion with a patient, technology is doing it for them. So I think, Kam and Taya, the transparency to the patient to be able to understand what they are going to owe for that particular visit, moving that to the front versus waiting until the statement is out, has been proven to be very, very helpful to collect dollars upfront.
Paola Turchi (16:40.778)
or before the service versus waiting for statements and collection letters. But at that point, the likelihood of collection is just drops. You collect much more.
Taya Gordon (16:51.682)
Absolutely. And I think just to like piggyback on something you mentioned, you mentioned meeting the patients where they are and offering different payment methodology. And we spoke about this in the fall. You know, there's so many opportunities that you have to implement additional payment systems. In between sessions, I got a text message from my daughter's pediatrician that said, hey, you have a new balance due. This is the amount. Would you like to pay it by Venmo?
Paola Turchi (17:09.611)
Mm-hmm.
Taya Gordon (17:20.162)
was like, I can pay you by Venmo, done, right? Like the easier we can make it, why are we not doing that? And I think that that's just a salient point. And I know that if you know, the rev divers we have right now are probably scrambling to take all the notes from this episode, because there's so much really great information, which is why we wanted to have you on the show. And so there's, I know, I don't know if Kem has more, but I know I have at least one more thought. And something else I really wanted to pick your brain on.
And something that you know, Kim and I speak about frequently because we are passionate about that, and that is denial prevention. And to your point that you said earlier, we're the only industry that does this, the way that we do this, right? We're the only ones that hope that the money that we got paid was right. We're the only ones that say, we'll take care of you now, you pay us later. And if you don't pay us later, we're just kind of like, whatever, we'll take care of you again, you know?
Paola Turchi (18:13.505)
Yep. Mm-hmm.
Taya Gordon (18:14.714)
So when we're looking at doing things like that, we really need to look at what else can we do to optimize our revenue cycle. And for me and Kem, one of those things is preventing denials, right? And it's so critically important. And part of the problem with denial prevention, at least in my opinion, is that people don't always understand the payer policies. They don't always understand those technical payer policies.
and either they don't follow them or they misunderstand them and it ends up leading to denials. Do you see that in your day to day working with your clients as well?
Paola Turchi (18:49.221)
Absolutely, Taya. And I think there are two components to it. One is, which I think a lot of organizations struggle to begin with, is even understanding why their claims are being denied.
Sometimes they don't even have the tools in place to know that 50% of their claims are being denied because they didn't add a modifier, because they didn't check eligibility, because they didn't do coordination of benefits, and are things that are preventable. So you're spot-on in the sense that understanding the requirements from the payers and having that documented is going to be crucial for organizations to be able to avoid these denials moving forward.
But most importantly to start, we need to track them. We need to identify why our claims are being denied. So your practice management system, if you have one that actually has been certified, will have some sort of report that you're able to identify that what is the reimbursement comment. So what I have worked with my clients is really identified, okay, how do we group these reimbursement comments? So that way you can identify who is the source of the problem.
Is it the front desk? Is it coding? Is it because we don't know the requirements? What is it that is causing this? So you could actually address that problem. So that's number one. Is what kind of reporting do I have available in the system to be able to group your reimbursement comments, to be able to identify trends that tells you where you should concentrate your efforts. Now, when we're talking about, if we look at the change healthcare denial management index that comes every year.
49% of these denials come from the front desk. And what they mean by that is not having an authorization in place, not checking the eligibility for the patient, not having the coordination of benefits that they need to have. Those are just like the common type of denials that you are getting, and that will feed your process to put something in place to avoid them. What do I mean by that? So for example,
Paola Turchi (20:57.378)
if the denials are because of eligibility? Well, I have seen scenarios in which the end user is just looking for a check mark. If it's green, we're done. I don't have to do anything else. No, you have to review their response because the response is telling you that the patient does not have traditional Medicare. They have a Medicare Advantage plan. So there is a training that needs to take place to be able to educate the users. So that's one of the things that we've doing is like, okay, what are the denials? Is it eligibility? Is it associated with a specific user?
What kind of eligibility details am I getting? Somebody else is responsible for the bill. I don't have the right ID number. What is it? So we can train the end users to be able to capture that information to begin with. The second part has to do with edits. Practice management systems have the capability of configuring edits to track those billing errors before they go out. Because we wanna capture them before they go out, right? So if we wanna make sure that if you have an office visit and you have a procedure.
maybe have someone review, make that fall into a queue to review it to identify whether or not a modifier is needed because that's perhaps something that was missed that needed to be in place to be able to send it out. If you're missing, you're billing for a medication and you don't have an NDC number, have an edit that actually drops that claim into the queue so you can attach the NDC number so the claim doesn't go out with those things. So...
So understanding why your claims are being denied. So look at your reports, you get your reimbursement comments, group them, identify the source, and then little by little start implementing, leveraging the technology that you have in place and implementing processes to train the individuals that capture the data, capturing the way that you need it, is what I have seen worked with other organizations.
kem tolliver (22:42.583)
And let me just say that, you know, denial prevention is definitely the way to go. And I think I could speak for all three of us when I say that denial management is reactive, right? And really focusing on ways to improve workflows, to optimize technology is where we get to denial prevention, which in turns increases our revenue. It also...
gives us better scores when it comes to our patient, provider, and workforce satisfaction. So all of those things play a part in what we're trying to accomplish. Paola, thank you so much. Your wisdom and your insight has been so valuable. Going back to your career, what we like to do is to impart some type of career advice.
Paola Turchi (23:34.448)
Okay.
kem tolliver (23:37.583)
leadership pathway knowledge to our audience. So if there's like a nugget of advice that you'd like to share with our Revdivers, we'd love to give you this opportunity to share with them.
Paola Turchi (23:54.358)
I will think of two. I know you asked for one, but I'm going to give you two. The first one is celebrating the journey, right? I think as leaders, we concentrate so much in the final outcome that we don't get to celebrate the process, the small wins that actually help us build the end result. So slowing down, celebrating the day, celebrating the journey, celebrating the team.
is something that builds stronger foundation to get to the outcome that you are trying to get to. So that's one. And then the second one, which is also very applicable for early careerists, is get involved. Volunteer with professional organizations. It's like put yourself out there. Whatever organization you align with, whether it's the MGM, HFMA, AAPC, whatever happens to be.
be involved, be engaged in the community, in community conversations, build your network, volunteer for these organizations because you get to meet so many people. Like the chance for me to even get to meet you at the MDMA conferences and learn from each other. You are not, you might feel like you're alone in your bubble of your practice, of your medical group, but that's not true. You have a whole network of resources that you could leverage if you put yourself out there to do it.
So that's kind of like the two very quick things that I perhaps will share with you.
kem tolliver (25:22.463)
Wow, thank you for sharing that, Paola. Thank you for your time today. And again, thank you for your contribution to the industry. Again, this podcast is really targeted to revenue cycle professionals and folks within healthcare who are impacted by the revenue cycle, which is pretty much everyone. But having your expertise shared with our audience has been a really important kind of...
end to the year because we're moving into a new year. We're gonna have new guests coming on that we're really excited about. Hopefully we'll have you back on the show again. So thanks so much for being with us. And Rev Divers, until we meet again, keep diving into those Rev cycles.
Paola Turchi (26:11.069)
Thank you, guys.