Optimizing Complex Claims And Revenue: Strategic Insights with Mike Esworthy of EnableComp

Optimizing Complex Claims And Revenue: Strategic Insights with Mike Esworthy of EnableComp

Optimizing Complex Claims And Revenue: Strategic Insights with Mike Esworthy of EnableComp Join us for an in-depth conversation with Mike Esworthy,Chief Strategy Officer of EnableComp, as he shares how to transform complex claims into strategic assets, leverage AI thoughtfully, and foster meaningful partnerships in healthcare revenue cycle management. Key Topics: * Breaking down the specific challenges of complex claims * The evolving role of AI in healthcare revenue cycle management * Why strategic outsourcing of complex claims makes sense so often * Metrics healthcare leaders should track for complex revenue optimization * The importance of partnerships and holistic approaches in RCM In this episode: * EnableComp's mission to turn complex claims into maximum ROI through AI-driven insights * The shift from complex claims RCM being viewed as cost centers to strategic assets * How recent acquisitions like HROI bolster EnableComp’s capabilities * Key takeaways from Mike’s experience at JP Morgan Healthcare Conference * The broader definition of complex revenue and its impact on hospital finances * Clarifying the unique challenges of VA, Workers Comp, out-of-state Medicaid, and motor vehicle claims * Practical advice for healthcare leaders to improve claim performance and avoid revenue leakage * The role of proper data, guardrails, and organizational alignment in AI adoption * The strategic importance of partnerships in revenue cycle success   Timestamps: 00:00 - Introduction 01:05 - Vendor Voices Snapshot Challenge 03:40 - Introducing Mike Esworthy05:20 - Recent acquisition of HROI and strategic growth06:10 – Quick recap of 2026 JPM Healthcare Conference + the shift in AI's role from ideation to grounded application 10:00 - Redefining complex claims as "complex revenue"11:35 - Challenges specific to VA, Workers Comp, motor vehicle accidents, and out-of-state Medicaid claims + why outsourcing often makes sense16:28 - Common causes of complex claim denials: front end breakdowns, eligibility, & COB 19:41 - Metrics every healthcare leader should prioritize to track complex claims24:00 - Treating complex claims as an asset, not a cost center 25:25 - The evolution of revenue cycle optimization: Is our field finally getting the attention it deserves? It’s time to put a spotlight on our unsung revenue cycle heroes! 29:05 - The importance of proper AI implementation and guardrails: Garbage in, Garbage out31:45 - Challenges with interoperability in complex claims34:01 - Final advice: Embrace partnerships in business and at home   The episode was brought to you by: Real Partners Consulting [https://realpartnersconsulting.com/] Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ [https://www.linkedin.com/in/ryanpdowns/]  Connect with Mike Esworthy: https://www.linkedin.com/in/mike-esworthy-b4455511/ [https://www.linkedin.com/in/mike-esworthy-b4455511/]  We Want Your Input! If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at rdowns@realpartnersconsulting.com. Please rate and review – and be sure to subscribe to nevermiss an episode! Thank you for listening!

Automating the Drudgery to Liberate Rev Cycle Teams: Insights from Dave Blanchard of Candid Health

Automating the Drudgery to Liberate Rev Cycle Teams: Insights from Dave Blanchard of Candid Health Most healthcare organizations are drowning in manual tasks,frantically trying to keep up - until now. Join Dave Blanchard of Candid Health as he walks us through the process to remove avoidable friction within your revenue cycle. You'll discover how understanding your data foundation is thekey to unlocking AI’s potential, why automation is a liberation strategy, and how to combat the misconception that AI replaces people. Automation isn't about eliminating your team; it's about freeing them to focus on what truly matters -patient care and complex problem-solving.   Key Topics: * The concept of touchless claim rates and its impact on healthcare efficiency * Differentiating automation: liberation vs. replacement * Building a foundation: importance of understanding healthcare data * Overcoming misconceptions about AI and automation in revenue cycle management * Key success factors for tech implementation in healthcare organizations * Short-term opportunities for stability and growth in 2026 Timestamps: 00:00 - Introduction00:57 - Vendor Voices Snapshot Challenge 03:26 - Introducing Dave Blanchard04:25 - Defining touchless claim rate and its significance05:34 - Addressing concerns: automation as a tool for human empowerment instead of workforce reduction07:28 - How staffing challenges accelerate the need for touchless solutions 09:29 - Building a strong data foundation for AI success 12:04 - Metrics that matter; Demonstrating ROI 15:56 - Debunking common misconceptions about automation and AI 24:55 - Surprising lessons from organizations implementing automation 30:03 - Key success factors in technology implementations 34:50 – Short term strategies to stabilize revenue cycle performance in 2026 37:59 - Final advice: Trust your intuition, seek partnerships, be kind   The episode was brought to you by: Real Partners Consulting [https://realpartnersconsulting.com/] Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ [https://www.linkedin.com/in/ryanpdowns/]  Connect with Dave Blanchard: https://www.linkedin.com/in/david-blanchard-90994a9/ [https://www.linkedin.com/in/david-blanchard-90994a9/]  We Want Your Input! If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at rdowns@realpartnersconsulting.com. Please rate and review – and be sure to subscribe to nevermiss an episode! Thank you for listening!

Optimizing Revenue Cycle from Epic Implementations through Internal Collaborations: Insights from John Freeman & Bret O’Connor of Revigate

Optimizing Revenue Cycle from Epic Implementations through Internal Collaborations: Insights from John Freeman & Bret O’Connor of Revigate Efficient revenue cycle management is crucial in healthcare.Today’s episode dives deep into how innovative consulting firms like Revigate are reshaping this landscape. Led by experienced operators, they emphasize results-driven strategies tailored to the complexities of healthcareorganizations. Key Topics: * The unique approach of Revigate as operator-led revenue cycle optimizers * Optimizers or consultants: Doing the work versus advising on the work * Challenges and solutions in Epic implementation and optimization * The evolving role of revenue integrity and charge capture strategies * Future revenue cycle challenges and technology's role, including AI * The importance of being kind, collaboration, and partnerships in driving results   Timestamps: 00:00 - Introduction 01:04 – Vendor Voices Snapshot Challenge 05:40 – Introducing John Freeman & Bret O’Connor 10:08 – The importance of “doing the work” in addition to advising; being optimizers over consultants 14:05 – Measuring client success in the revenue cycle consulting world: ROI 16:00 – Advantages of a smaller consulting firm: There is no B-Team. 18:55 – Strategies for Epic implementation, pitfalls to avoid, emphasizing revenue accountability, change management, and maximizing functionality 24:50 – The risks of approaching an EMR implementation without support 27:00 – The significance of revenue integrity efforts and proactive charge capture 33:20 – Predictions & advice for 2026 revenue cycle challenges: Do more with less, find the right partners, protectnet revenue, and leverage automation / AI 36:30 – Final Parting Advice: Be kind! Tips for fostering organizational collaboration and trust. Communicating the importance of revenue cycle outcomes. The episode was brought to you by: Real Partners Consulting [https://realpartnersconsulting.com/] Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ [https://www.linkedin.com/in/ryanpdowns/]  Connect with John Freeman: https://www.linkedin.com/in/john-freeman-crcr-235661b4/ [https://www.linkedin.com/in/john-freeman-crcr-235661b4/] Connect with Bret O’Connor: https://www.linkedin.com/in/bretoconnor/ [https://www.linkedin.com/in/bretoconnor/] We Want Your Input! If you’d like to suggest a specific topic or guest, feel free to reach out to me on LinkedIn or email at rdowns@realpartnersconsulting.com. Please rate and review – and be sure to subscribe to nevermiss an episode! Thank you for listening!

Provider, Vendor, Operator: Patient Access Insights with Keith Eggert of Abax Health

Provider, Vendor, Operator: Patient Access Insights with Keith Eggert of Abax Health Take a journey through the ins and outs of Patient Access with Keith Eggert – a former patient access employee turned VP of Revenue Cycle - and now COO of Abax Health. Gain valuable insights into the challenges, innovative solutions, and future trends shaping this critical part of the revenue cycle, including specific tips on best practice scheduling and referrals. Key Topics: * The strategic role of patient access in healthcare success * How proper referral management connects patients with care to optimize revenue * The significance of referrals, scheduling, and real-time KPIs * Navigating lengthy sales cycles and vendor-provider partnerships * A lookback on the historical trends of Patient Access * A future outlook on patient access challenges and uninsured populations * Building a true partnership mindset between vendors and providers * Practical advice: walk in your patient's shoes for process improvement Timestamps: 00:00 - Introduction 01:04 – Vendor Voices Snapshot Challenge 05:09 - Keith Eggert’s background and transition fromprovider to vendor 06:57 - Challenges of lengthy sales cycles andnavigating healthcare bureaucracy 11:48 - The potential impact of AI on the sales cycle 13:54 - The importance of a vendor-providerpartnership and collaboration 17:00 – The provider challenge of balancing day-to-dayops with vendor attention 21:12 – Historical challenges in Patient Access, long-termtrends 25:38 – Patient Access themes of 2025; uninsuredpatients and OBBBA influences 29:31 - Critical KPIs for patient access success 32:25 - Enhancing referral tracking and patientengagement during scheduling 35:19 - Strategies for increasing patient appointmentscheduling 38:50 - Final parting advice: walk in your patient’sshoes for continuous improvement   The episode was brought to you by: Real Partners Consulting [https://realpartnersconsulting.com/] Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ [https://www.linkedin.com/in/ryanpdowns/]  Connect with Keith Eggert: https://www.linkedin.com/in/keith-eggert-fhfma-1604434/ [https://www.linkedin.com/in/keith-eggert-fhfma-1604434/] We Want Your Input! If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at rdowns@realpartnersconsulting.com. Please rate and review – and be sure to subscribe to nevermiss an episode! Thank you for listening!

Making Financial Assistance Programs Easy & Uncovering Hidden Revenue by Leveraging Technology with Nick McLaughlin - Founder of Breez Health

Making Financial Assistance Programs Easy & UncoveringHidden Revenue by Leveraging Technology with Nick McLaughlin - Founder of Breez Health In this episode, Nick McLaughlin, Founder and CEO of BreezHealth, shares insights on revolutionizing healthcare financial assistance programs with technology, simplifying patient experience, and preparing for upcoming regulatory changes. If you're involved in hospital revenue cycles orpatient access, these strategies could transform your approach. In this episode: * The mission of Breez Health tomake healthcare financial assistance easy for patients and providers * Challenges with traditionalfinancial assistance workflows and how digitization improves patient engagement * Key components of an effectivefinancial assistance program: clear policies, simple online applications, andproactive communication * Impact of federal regulations like501R and state-specific requirements on hospital compliance * Strategies for leveragingtechnology and automation to reduce labor and increase efficiency * Preparing for regulatory shiftssuch as the One Big Beautiful Bill Act and increased Medicaid redeterminations * The importance of promotingfinancial assistance to underinsured populations to enhance community benefits * The role of structured,rules-based data processing versus AI in current solutions * The ROI of effective financialassistance programs: improved patient experience, reduced audit risk, andlifetime patient value * Practical advice for healthsystems to streamline processes and prioritize patient-centric care Timestamps: 00:00 - Introduction 01:00 – Vendor Voices Snapshot Challenge 06:23 - Founder Nick McLaughlin's background and motivation for starting Breez 08:03 - The importance of creating simple, effective policies and applicationsfor financial assistance 11:06 - Best practices for effective financial assistance programs and patientcommunication 15:00 - Explanation of federal regulation 501R and its implications 16:42 - Simplifying financial assistance programs amidst complex regulations 18:15 - Finding the balance in income verification documents and streamliningeligibility assessments 19:29 - Addressing backlog issues and improving application screening processes 21:04 - Impact of regulatory press and the importance of promoting financialassistance 22:21 - Challenges in hospital financial assistance programs: balancing the auditorapproach with the advocate approach 24:26 - Building trust and connecting with patients' needs through advocacy 25:41 - Navigating future regulatory changes, including the One Big BeautifulBill Act (OBBBA) 26:16 - How technology can help manage increased volume of Medicaidredeterminations and coverage churn 28:24 - The critical role of automation amid staffing shortages and risingworkload 30:00 - Breez's use of rules-based logic over AI and the potential forstructured data processing 31:36 - ROI for hospitals: community benefit, reduced audit risk, and lifetimepatient value 36:14 - Final advice: focus on promoting financial assistance proactively andcaring for underinsured patients 37:54 - Summing up: the importance of simplicity, communication, and compassionin financial assistance programs   The episode was brought to you by: Real Partners Consulting [https://realpartnersconsulting.com/] Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ [https://www.linkedin.com/in/ryanpdowns/] Connect with Nick McLaughlin: https://www.linkedin.com/in/nick-mclaughlin-fhfma/ [https://www.linkedin.com/in/nick-mclaughlin-fhfma/] Show Note: If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at rdowns@realpartnersconsulting.com. Please rate and review – and be sure to subscribe to nevermiss an episode! Thank you for listening!