Using AI to Prevent and Appeal Healthcare Denials with Protego Health's Corey Feldman

Using AI to Prevent and Appeal Healthcare Denials with Protego Health's Corey Feldman

Using AI to Prevent and Appeal Healthcare Denials with Protego Health's Corey Feldman Join Founder & CEO Corey Feldman and me as we dive into the world of revenue cycle to untangle how AI-driven solutions like the one at his company, Protego Health, are transforming claims denial prevention and appeals. Come explore the challenges, innovations, and future of AI in healthcare with tons of practical prevention, appeal, reporting, and technology implementation tips along the way. Key Topics: * Combating claim denials using AI * The root causes of healthcare claim denials and how AI can address them * The importance of seamless workflow integration for providers and payers * Core challenges in adopting AI solutions within health systems * The importance of appealing well, appealing fully, and appealing often * Corey’s personal story and its influence on product development * The evolving role of AI in revenue cycle management and automation * Practical advice for organizations looking to implement AI effectively * Future trends: self-regulating AI and agentic automation in healthcare * How regulation and speed to deployment impact AI adoption in healthcare Timestamps: 00:00 - Introduction 00:58 - Vendor Voices Snapshot Challenge 04:18 - Introducing Corey Feldman & his family’s healthcare finance journey 07:25 - Financial toxicity is clinical toxicity / No margin, no mission 09:05 - How software can aggregate important revenue cycle datapoints within workflows 11:36 – Diving into data-driven appeal strategies 12:45 - Making denials compelling and undeniable 13:40 - The lesser-discussed importance of fighting back on denials 15:16 - Rising denials and lowering technological hurdles 16:41 - The impact of large language models (LLMs) and AI innovation 18:40 - How inconsistent/inaccurate use of denial codes makes for unreliable denials data22:15 - Barriers to AI adoption and the importance of focus23:45 - How Epic and other EHR vendors are entering the AI space24:40 - The paradox of AI regulation and speed 25:30 - Discussing a widening technologygap between EHRs and point solution companies29:04 - The future of AI in revenue cycle management33:45 - Next big features in AI for healthcare: self-regulation for factual answers 36:47 - Final advice: Change is inevitable - embrace AI 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 Corey Feldman: https://www.linkedin.com/in/csfeldman/ [https://www.linkedin.com/in/csfeldman/] 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 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!