Understanding Healthcare with Zack Kanter

Revenue recovery with Eliana Berger

Eliana Berger is co-founder and CEO of  @JoyfulHealthRCM [https://studio.youtube.com/channel/UCtBtYh1Yh_ZF1zUAPrczMdA]. In this episode, Eliana and Zack discuss revenue recovery – how healthcare practices lose revenue through unpaid insurance claims. Eliana explains denials management, why fixing denials requires more than just filing appeals, and how Joyful Health's AI platform recovers that revenue without requiring practices to change their existing systems. 00:00 Introduction 00:43 What is Joyful Health, and how did Eliana start it? 02:33 What does a healthcare practice's billing tech stack look like? 06:31 Why is healthcare revenue so hard to track? 13:43 What's the difference between a rejection, denial, and stale claim? 17:58 What happens when a claim is denied? 22:25 How does Joyful fit into the billing workflow? 28:53 How do you prioritize what to build? 30:58 What does a 90-95% recovery rate mean? 37:07 How does Joyful reduce the cost to collect? 41:00 What would you change about revenue cycle management? Learn more about Joyful Health: https://www.joyfulhealth.com/ Read about Joyful Health's Series A: https://www.joyfulhealth.com/post/joyful-health-raises-22m-to-build-denial-intelligence-recovery-infrastructure Connect with Eliana on LinkedIn: https://www.linkedin.com/in/elianaberger/

Patient referrals with Dr. Will Morris

Dr. Will Morris is Chief Medical Officer at Tennr. He's also a practicing hospitalist, a former hospital CIO, and former Chief Medical Officer at Google. In this episode, Will explains how Tennr manages the full referral lifecycle from the receiving provider's perspective, why most referrals end up in a black hole for patients, and how intelligent triage and closed-loop communication can match patients to the right provider at the right time. 00:00 Introduction 01:47 What does Tennr do? 02:42 What is the self-pay referral experience like? 05:48 Is waiting for "Dr. Famous" always the right move? 06:24 What's the difference between a formal and informal referral? 11:13 Why do referrals disappear into a black hole? 13:34 How does closing the referral loop benefit everyone? 17:41 Can Tennr solve the Dr. Famous wait time problem? 24:44 What is "The Goal" and why does it apply to healthcare? 34:01 What does a Tennr implementation actually look like? 36:44 Do health systems that use Epic already have this solved? 40:11 If you could change one thing about RCM, what would it be? Learn more about Tennr: https://tennr.com Connect with Dr. Morris on LinkedIn: https://www.linkedin.com/in/mowilliam/

Credentialing explained with Varun Krishnamurthy

Varun Krishnamurthy is the co‑founder and CEO of Assured Health, an AI-powered provider credentialing and enrollment platform. In this episode, Zack and Varun talk about credentialing – how insurers check that a healthcare provider is qualified to practice. They cover how provider credentialing works, the bottlenecks it can cause, and how to improve it. 0:00 - Intro 0:44 - How Varun started Assured Health 1:57 - How long does it take for a provider to take insurance? 3:26 - Does provider experience speed up onboarding? 4:20 - How Dawn Health led to Assured Health 7:31 - What must a provider do to accept insurance? 9:11 - Is there a single application for credentialing? 12:15 - How complex is credentialing, really? 15:29 - What else besides credentialing do you need to accept insurance? 18:02 - How do you keep provider data current? 19:51 - Is credentialing a major bottleneck for providers? 22:18 - Credentialing vs. provider enrollment vs. transaction enrollment 25:17 - What are closed panels and why do they matter? 26:30 - When does a credentialing service make sense? 31:05 - What are the steps for credentialing? 34:32 - How can you tell if a provider is already enrolled for insurance? 38:13 - Has anyone tried to standardize credentialing? 40:03 - What Varun would change about RCM Learn more about Assured Health: https://www.withassured.com/ Connect with Varun on LinkedIn: https://www.linkedin.com/in/varunakrishnamurthy/ Referenced in this episode:  - "Reality has a surprising amount of detail" by John Salvatier: http://johnsalvatier.org/blog/2017/reality-has-a-surprising-amount-of-detail - "Estonia, the Digital Republic" by Nathan Heller: https://www.newyorker.com/magazine/2017/12/18/estonia-the-digital-republic - Aadhaar (India's National ID system): https://en.wikipedia.org/wiki/Aadhaar

Payer enrollment with Megan Struxness

Megan Struxness is Head of Payer Operations and Revenue Cycle Management at Bridge, a healthcare platform that helps telehealth providers accept insurance nationwide. In this episode, Megan and Zack discuss payer enrollment – the industry term for what healthcare providers need to do to accept insurance. They cover payer contracting, credentialing, what superbills are, how out-of-network claims work, and how small operational details – like enrollment and eligibility checks – determine what providers actually get paid. Watch on YouTube: Click here to watch a video of this episode. [https://www.youtube.com/watch?v=uNXk49dDXro] * (00:00) - Intro * (00:27) - What is Bridge? * (02:20) - How Bridge helps providers accept insurance * (04:36) - Can a brand new practice work with Bridge? * (07:31) - What is an EMR? * (10:27) - What it takes for a provider to accept insurance * (13:15) - What are super bills? * (15:41) - How out-of-network payments work * (18:35) - What is payer enrollment? * (22:41) - The alternative to self-managing revenue cycle management (RCM) * (28:50) - How does Bridge onboard providers in 45 days? * (32:44) - What are MSOs? * (37:05) - Why eligibility checks can’t guarantee payment * (41:42) - What is guaranteed payment? * (44:48) - The source of truth for provider contracts * (51:36) - What would Megan change about RCM? --- Learn more about Bridge: https://www.usebridge.com/ Connect with Megan on LinkedIn: https://www.linkedin.com/in/megan-struxness-79962866/ Referenced in the episode:  - "Reality has a surprising amount of detail" by John Salvatier: http://johnsalvatier.org/blog/2017/reality-has-a-surprising-amount-of-detail --- Listen and subscribe to the Understanding Healthcare with Zack Kanter podcast: YouTube: https://www.youtube.com/playlist?list=PLZ4o7H5Som0Zlo2dGH4jMJy0nlL1oqxDo Spotify: https://open.spotify.com/show/6cyz5JaAoG3R995QokLR2d Apple Podcasts: https://podcasts.apple.com/podcast/understanding-healthcare-with-zack-kanter/id1860618431 RSS feed: https://feeds.transistor.fm/understanding-healthcare-with-zack-kanter

Healthcare finance with Dr. Eric Bricker

Dr. Eric Bricker is an internal medicine physician and Chief Medical Officer at ‪AHealthcareZ [https://www.youtube.com/@ahealthcarez], a popular healthcare finance YouTube channel. In this episode, Eric and Zack break down revenue cycle management (RCM), the flow of money in U.S. healthcare. They cover how healthcare plans are funded, how Medicare Advantage differs from traditional Medicare, how eligibility checks work, medical coding, and why what doctors bill insurers isn't what they're paid. * (00:00) - Intro * (00:31) - Starting the AHealthcareZ YouTube channel * (02:03) - The clinical vs. administrative sides of healthcare * (04:05) - When does clinical care transfer to administration? * (06:00) - The four buckets of funding * (09:10) - The shift to Medicare Advantage * (11:20) - How real-time eligibility checks are used * (14:13) - The history of real-time eligibility checks * (15:54) - Why insurance verification still relies on phone calls * (17:24) - Traditional Medicare and MACs * (18:45) - Medicare Advantage * (19:17) - What is capitation in healthcare billing? * (21:22) - Why traditional Medicare claims are easier to process * (22:28) - How medical coding and billing work * (26:22) - Why medical coding is so complex * (27:05) - Upcoding in medical billing * (28:17) - What is charge capture? * (29:13) - Billed vs. allowed amounts in healthcare billing * (30:41) - Why billed and allowed amounts differ * (32:52) - What is repricing? * (34:14) - Why small practices sell to hospital systems * (35:04) - How AI and RCM tools are changing small practices * (37:26) - How much of revenue cycle management (RCM) can be automated? * (41:07) - Insurance float and why it matters * (41:56) - The economic impact of more efficient RCM * (43:28) - Patient responsibility and out-of-pocket costs * (45:26) - What Stedi customers are building * (46:05) - What Dr. Bricker would change about RCM --- AHealthcareZ [https://www.youtube.com/@ahealthcarez] videos related to this episode: * Revenue Cycle Management in Healthcare Explained: https://www.youtube.com/watch?v=rqdWr9ynZ_o [https://www.youtube.com/watch?v=rqdWr9ynZ_o] * Do Insurance Carriers Want Healthcare Costs Up or Down? https://www.youtube.com/watch?v=ELyvOLkxADU [https://www.youtube.com/watch?v=ELyvOLkxADU] * Traditional Medicare vs Medicare Advantage vs Medicare Part D vs Medicare Supplement Explained: https://www.youtube.com/watch?v=KRzBxPj-eQk [https://www.youtube.com/watch?v=KRzBxPj-eQk] * Healthcare Uncovered Ep 2: Denied Requests: Medicare Advantage and the Rise of Prior Authorizations: https://www.youtube.com/watch?v=5hwCF1HPjOI [https://www.youtube.com/watch?v=5hwCF1HPjOI] * Medical Coding Overview: https://www.youtube.com/watch?v=fqNBNE_YSro [https://www.youtube.com/watch?v=fqNBNE_YSro] * Health Insurance Claims Adjudication: https://www.youtube.com/watch?v=bM9e2EPUg0g [https://www.youtube.com/watch?v=bM9e2EPUg0g] * Health Insurance Claim Repricing: https://www.youtube.com/watch?v=u8upoDe0nwI [https://www.youtube.com/watch?v=u8upoDe0nwI] * Hospital Chargemaster Explained: https://www.youtube.com/watch?v=2PUwLXW2-sw [https://www.youtube.com/watch?v=2PUwLXW2-sw] * Insurance Float Explained: https://www.youtube.com/watch?v=WBOYDnPfkUU [https://www.youtube.com/watch?v=WBOYDnPfkUU] * Patient Out-of-Pocket Healthcare Costs Explained: https://www.youtube.com/watch?v=ilfgZiJNwyM [https://www.youtube.com/watch?v=ilfgZiJNwyM] * Hospital Finance Explained: https://www.youtube.com/watch?v=O1CGDi50Nys [https://www.youtube.com/watch?v=O1CGDi50Nys]