The healthcare industry is rapidly changing, particularly this year. And one of the best people to talk to about the effects of the pandemic is someone who has lived and breathed revenue cycle management in healthcare for over 2 decades. Our own VP of RCM & Operations, Axel Perez, sat down with us to discuss his background, how the insurance industry is changing and more on our last episode of DrChrono’s podcast. Check out On the Health Record for the full version.
Oleg: How did you get started working in healthcare?
Axel: Right after I got out of school, I just needed to earn some money and started doing prescription deliveries for a local pharmacy in New York. One day the owner of the pharmacy stopped me and said that the person who was doing their insurance reimbursements quit, and he needed somebody to jump in and wanted to train me how to do it. So, literally in the middle of the afternoon, he taught me how to do some follow-ups on claims and I was off. And I’ve been doing it for 22 years now.
Oleg: You head our revenue cycle management business. I was hoping you could explain what that is to me because honestly, I find it complicated and confusing.
I get this question a lot. A lot of people equate revenue cycle management with medical billing. The way that I describe it to people who know nothing about what I do is that it’s the process from when a patient first engages with a practice, whether they’re scheduling or walking through their office, all the way until their claim for their services is at a $0 value. It’s taking that and everything in between and reducing the number of clicks it takes to get from A to Z. And then of course that the medical billing portion is done well and done cleanly. How we measure ourselves in revenue cycle is how fast we get paid from the time a doctor sees the patient to the time that claim payment comes in.
Oleg: Whenever I hear about this topic, I feel like there’s so many players involved- you kind of imagine it should just be the practices and the patients- but then you get insurance and there’s a lot of people that do all those jobs. Can you tell me the major players involved in seeing a patient and getting a billing claim submitted and completed?
Axel: Yeah. So it all starts on the very front end before the patient is even seen. We need to make sure that they have the correct insurance information, and it’s loaded into the software, because a big reason doctors don’t get paid is that they have incorrect information about the patient’s insurance. And then of course we expect the doctor to not only perform his or her clinical duties, but they have to then turn around and also make sure that they understand the software well enough to put the data in correctly so that when the claim flows from that office to the biller, the claim is relatively ready to go.
On the backend, not only do you have your billing team, but then you have a clearinghouse that’s involved as well. And in US healthcare, we have to bill through a clearinghouse, which is essentially, a company whose software checks claims before they go to insurance companies. It doesn’t mean it won’t get denied, but they just check to make sure the primary pieces are there. And then it goes to the payer. Hopefully the payer is going to process it in an automatic way, but if not, it kicks out and it goes to an adjuster, or somebody who reviews it and looks at that claim and any notes associated with that account to make sure that it should be covered. Once that comes back, it goes back to the billing team and they finish whatever needs to happen on the backend.
Oleg: So we’ve established that this is a complicated process. What is it about working in this space that keeps you around?
Axel: Man that’s a great question. Maybe I shouldn’t be around. No, honestly, I actually love it. My employees will tell you that I’m crazy because I just kind of live and breathe medical billing and RCM. For me, it’s a couple things. I love technology and in RCM, there’s always new technology that’s coming out to make the processes better.And now we’re getting into things like machine learning and AI and robotic process automation, and those things are exciting and fun for me. So I love that part of it. I’m also a guy who just likes to learn and adapt quickly to situations.
For me, it’s pretty much been my whole professional life and I still love it to this day.
Oleg: How have our clients that use DrChrono been affected by coronavirus?
Axel: Well, I think we’re seeing a wide range of impacts. We have practices that have really been hit hard- what I would call some of the physical type practices, like chiropractors, physical therapy, and elective type practices, like plastic surgery. I would say the greater percentage of our clients just saw a reduction in their volume. You know, not getting the appointment volume that they are used to, and as a result missing out on a lot of revenue over the last few months. So not different than many other businesses in our country at this point.
Beyond that, we have some practices that have thrived, like the telehealth practices that were ready to go even before COVID hit, and they were ready for it- another great example of how being proactive on technology really helps. I think we’re seeing volumes come back as the country continues to reopen. Obviously it’s a little tenuous at this point, and we don’t know what’s going to happen, but at this point we are starting to see volumes come back, and we’re happy to see our practices reopening, and we’re doing all we can to get them there, especially on the telehealth side.
Oleg: I love that. So we touched a little bit on billing and RCM in the beginning. I just want to ask, why is this part so confusing? Why does it seem like there’s so many ways for doctors to not get paid and only one way to actually get paid? Why is it so different?
Axel: Well, if we really look more deeply at it, insurances are not incentivized to pay claims. And they would never admit that. Your claim has to meet every single rule that insurances set up and, unfortunately, insurances to some degree are allowed to create their own rules and parameters to get paid. So it’s really just a headache for somebody who’s not focused on it full time. That being said, this is why we’re moving more to a value-based payment model or quality care model. We want to be proactive about healthcare. We want to reward doctors for doing a good job at treating their patients in between visits, with care plans and tracking diets and all those kinds of things like remote patient monitoring.
And I could get into a whole list of those things that are evolving right now in healthcare to help a practice get paid in different ways that also benefits and creates a healthier patient. Why are we doing that? The outcome is supposed to be that we just have healthier people, so that’s the goal, right? And that complicated sort of billing, I think that that’ll change- it’ll be a different sort of complication-but it should be something that’s a little more straightforward.
Oleg: Yeah, definitely. So you mentioned the shift towards value based care and everything we’re doing so far as a country to make that happen. We’re in the early stages of seeing this shift, so have you seen any changes? What’s going to happen in the next 10 years with insurance and billing?
Axel: That’s a great question. There’s a lot of data being collected around value based care right now. I think it’s too early to definitively say that the incentives that doctors get from doing this is enough to have made the nation healthier. I don’t know that we have that information today. I think there’s more forward-thinking insurance companies out there who are trying to do more. Kaiser Permanente, for example, is a very forward-thinking insurance company, and they’re really leaning heavily towards value based care. And I think it’s going to be companies like that who lead the way here, and the government will fall in line as needed. I think the data collection that happens over the next few years is going to be really interesting to understand exactly where we stand with value based care and its impact on people themselves.
Oleg: Yeah. I mean, frankly, it’s just a really exciting time to be in this space. We’ve alluded to how COVID has affected things like telehealth. What had you seen in regards to telehealth in the first four months of lockdown, and do you see telehealth as being here to stay during and after COVID?
Axel: Yeah, I mean if there’s any good that could come from a pandemic, it’s the fact that doctors and health tech systems and insurance companies were forced to acknowledge telehealth as a real thing. We’re going to come out of COVID knowing that just about every practice is going to have some form of telehealth connectivity for their practice and understanding that most insurances are going to cover this moving forward, including our federal insurances, like Medicare and Medicaid. Will they be here to stay? Will they reimburse at the same level as an office visit always as they do right now? That’s yet to be determined. But, I can tell you as the father of a teenage daughter, getting her to get on the phone with a doctor and talk to them is way easier than scheduling her to try and get to an office.
There’s definitely benefits of telehealth that are here to stay. I think that we will have a much more willing patient demographic too, that will engage with their practice, their local practice, their family doctor, their pediatricians way more fully than they would have if they’re just going in every six months for that checkup or whenever they feel bad.
I don’t think it will totally replace face-to-face medical care, but what it does do is open up a new avenue or line of communication between the doctors and patients, and that can really only be a good thing.
Oleg: Awesome. All right, Axel, we’re going to end it there. Thanks for joining me.
Listen to the full version on our podcast “On the Health Record”, available on Spotify.