Payer enrollment with Megan Struxness

Agentic AI for the revenue cycle with Ayo Omojola

Ayo Omojola is the co-founder and CEO of Substrate, an AI agent platform for revenue cycle automation. Before starting Substrate, Ayo saw the friction firsthand working in primary and urgent care. In this episode, Ayo explains why Substrate moved from browser automation to agentic AI, why there's so much friction in the revenue cycle, and how healthcare billing could be 5x faster and cheaper using the tools we have. 00:00 Introduction 00:22 What does Substrate do? 01:16 Where does the revenue cycle start? 04:03 Ayo's start in primary and urgent care 07:27 Are payers incentivized not to pay? 12:13 Why do payers still send critical info via snail mail? 15:48 How did Substrate get started? 23:37 Why is revenue cycle so homogeneous? 25:43 Rabbit holes and Substrate's policy agent 38:02 Depth on big payers vs. the long tail? 44:36 How much better could RCM be today? 46:42 What's one thing you'd change about RCM? Learn more about Substrate: https://www.substrateai.com/ Connect with Ayo on LinkedIn: https://www.linkedin.com/in/omojola/

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