Ep. 6: Ken Bulow - Getting Your Claim Paid After the Bill Goes Out

Summary

This week in surgery centers podcast features Ken Bulow, discussing revenue cycle management, focusing on claim payments post-billing. Bulow shares insights on reducing patient outstanding balances, emphasizing early and effective communication. The episode also covers CMS's 2023 final payment rule, innovative low-cost tattoos for medical alerts, and the impact of medical debt on ASCs. Plus, a story about a nurse's quick response at a Broadway show.

Takeaways

• 😀 The podcast 'This Week in Surgery Centers' focuses on industry insights, featuring interviews and news recaps related to surgery centers.
• 👨‍💼 Ken Bulow, Executive Vice President of Operations at Surgical Notes, discusses strategies for improving claim payment processes in surgery centers.
• 💼 The importance of timely communication with patients about their outstanding balances is emphasized, as delays in payment collection reduce the likelihood of receiving payment.
• 📈 Ken Bulow highlights the significance of leveraging technology in healthcare, such as automated billing statements and electronic communication, to streamline operations.
• 🔍 The podcast addresses the need for surgery centers to understand and adhere to insurance carrier rules to prevent claim denials and ensure timely payments.
• 💡 Bulow suggests that surgery centers should embrace technology to improve efficiency, including electronic billing and patient communication methods.
• 📚 The discussion touches on the role of intellectual curiosity in identifying and resolving issues in the revenue cycle management process.
• 🤝 Building a strong relationship with payers is crucial, and surgery centers should understand their contracts and communicate their business goals effectively.
• 🏥 The podcast mentions the impact of medical debt on Americans, emphasizing the need for surgery centers to initiate transparent financial discussions with patients early on.
• 🌐 CMS's 2023 final payment rule for ASCs adds only four new procedures to the covered list, a move seen as disappointing by some in the industry.
• 🌟 A positive story about a nurse, Nicole Horace, who provided care for a man who collapsed during a Broadway show, illustrates the dedication and professionalism of healthcare workers.

Q & A

What is the primary focus of the conversation with Ken Bulow in this episode?

The primary focus of the conversation with Ken Bulow is on the revenue cycle process, specifically on getting claims paid faster after the bill goes out and providing workflow tips for making this process simpler and more effective.

What is Ken Bulow's role at Surgical Notes?

Ken Bulow is the Executive Vice President of Operations at Surgical Notes, where he leads a revenue cycle team for their customers, handling their billing.

How long has Ken Bulow been working in healthcare provider revenue cycle?

Ken Bulow has been working in healthcare provider revenue cycle for about 25 years, and specifically with surgery centers since 2008.

What is the significance of insurance verification prior to the day of surgery in the revenue cycle process?

Insurance verification prior to the day of surgery is crucial as it helps determine the patient's benefits, the procedure to be performed, and the allowed amount based on the insurance contract. This helps in setting accurate expectations for the patient's out-of-pocket expenses and increases the chances of collecting the payment upfront.

What percentage of patients typically leave with an outstanding balance after surgery, according to Ken Bulow?

Ken Bulow hesitates to give an exact percentage as it varies based on how the center is run and the technologies they use. However, he mentions that by the time the patient comes in, somewhere north of 60% have had a conversation about their financial responsibility, but not all have paid in full.

What are some of the biggest mistakes that surgery centers make after a patient leaves with an outstanding balance?

One of the biggest mistakes is not collecting the payment in a timely manner. The longer the time that passes, the lower the chances of collecting the outstanding amount. Surgery centers should communicate with patients continuously and utilize modern tools like text messages and automated statements to remind patients of their outstanding balances.

How can surgery centers simplify the process of collecting payments from patients?

Surgery centers can simplify the collection process by automating the statement generation and sending statements regularly. They should also escalate the communication by making phone calls after the second and third statements to remind patients of their outstanding balances and discuss potential payment plans.

What is Ken Bulow's advice for building a relationship with payers?

Ken Bulow suggests understanding and aligning the goals of the surgery center with those of the payers. He emphasizes the importance of knowing the contracts and their requirements to prevent problems upfront. Surgery centers should also communicate their business plans and how achieving certain rates can help them expand services.

What is the significance of the CMS 2023 final payment rule for ASCs?

The CMS 2023 final payment rule for ASCs is significant as it determines the procedures that will be covered and the rates at which they will be reimbursed. The rule adds only four new procedures to the ASC covered procedures list for 2023, which is less than the 47 proposed by ASCA, indicating a need for further advocacy and clarification.

How can technology help surgery centers improve their revenue cycle management?

Technology can help surgery centers improve their revenue cycle management by automating processes such as statement generation, communication with patients, and payment collection. Adopting electronic communication and payment methods can make the process more efficient and patient-friendly, potentially increasing the likelihood of timely payments.

What is the potential impact of the new tattoo technology developed by the Georgia Institute of Technology on healthcare?

The new tattoo technology, which involves low-cost, painless skin patches with microscopic needles, could serve as an alternative to medical alert bracelets. This could be particularly beneficial for patients who are uncomfortable with traditional tattoos or need a more discreet method of medical identification.