Medicare Cost Report Appeals and Reopenings—Commonly Appealed Issues–A Deep Dive Webinar

Besler Holdings — Fri, 12 Jun 2026 03:17:00 -0400

In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, presented live on Wednesday, June 17, at 1 PM ET.

Highlights of this episode include:

What is this webinar about?
Who will be joining Kristin on the webinar
Key takeaways
What this series about
Who can benefit from this webinar

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Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ next webinar in its Medicare Cost Report Appeals & Reopenings Series, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues: A Deep Dive, live on Wednesday, June 17, at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Thank you for having me again. I appreciate it.

Kelly: All right. Well, let’s go ahead and jump in. So would you please tell us a little bit about this webinar?

Kristin: Well, as you mentioned, it is the second webinar in the series on cost report appeals and reopenings. And we’re really going to focus on the appeals side and the commonly appealed issues before the Provider Reimbursement Review Board. So hopefully, we kind of gave a little bit of a glimpse into what we were going to talk about in the other webinar. So hopefully, everyone coming will be ready to take that deep dive.

Kelly: Awesome. Yeah. Sounds like it’s going to be a great webinar. And you have some guests joining you on this webinar. Can you tell us a little bit about the people that will be joining you?

Kristin: I do. I have Leslie Goldsmith and Page Smith from Bass, Berry & Sims joining me. And we have done some webinars in the past together. We complement each other really well. Both Page and Leslie have an extensive background in appeals, both at the Provider Reimbursement Review Board level, the administrative level, and the court level. So, they are ready to help me kind of dive into the issues. And where they have more expertise in the area, they’ll be able to lend you their thoughts as to the status of those issues and kind of where we approach it from a legal standpoint and more of a cost reporting standpoint. So, I think together, it’s going to be a great webinar.

Kelly: I agree. I’m really looking forward to hearing you all kind of come together and complementing one another. Please share what you think some of the key takeaways will be from this webinar.

Kristin: Greatest thing will be not only an insight into what exactly the issue is that’s been appealed and determining, “Well, is this something that would apply to me, to my hospital? Are there others out there with the same issue?” and then also where it is today. Where is the issue? Are we still waiting on a decision at the Provider Reimbursement Review Board, or are we waiting on a hearing decision? And where we are in court, are these issues there? Are we expanding the ideas behind these appeals? All those insights that a provider who may not have an outside consultant or an outside lawyer that’s privy to the ongoings– I think it’s going to be a great webinar to dive into that.

Kelly: Right. I totally agree. Can you tell us a little bit more about this webinar series? The first one that we had, last month. We’re going to have another one in July. Can you just tell us a little bit about why the series came about?

Kristin: The series is really focusing on the cost report and more an appeals focus, although a lot of the issues that we appeal can also be reopening issues. And kind of the goal is once we appeal it, if we get a favorable decision, it tends to lead to the issue being more of a reopening issue and getting providers that reimbursement a little bit quicker than the appeals process tends to take. But we’re looking at it high level. We started with, “Well, what is the board? And why do we appeal? And what are the processes behind filing those appeals? And how they differ from reopenings.” But then we’re now going to move into really the meat: not only the why, but here’s what we appeal. And the status of that leading to providers having a better understanding of what might be available to them out there that are– maybe there’s other groups, they’re not comfortable doing it on their own and they want to join a group. Well, then they can see, “Okay, well, where do I fall in that? Is there opportunities for me to join that?” I think that’s really the biggest thing. And then we’re going to end kind of on a best practices from all parts and parcels, not only from the board itself, but maybe how to file the issue. Maybe there’s ways to tailor it a little bit better. So, the best practices, I think, is a great way to end the webinar. And I’m hoping that all of them together, that the people attending will be able to avail themselves of all three together, because I just think it’s a great series to help figure out, again, what do I appeal and where am I at in this process?

Kelly: Right. No, I think it’s going to be a great webinar series. Looking forward to this one and the next one. And you mentioned the people who are going to be watching this. What is the target audience for this webinar series?

Kristin: So, it really is what I call on the front lines. Those people preparing the cost reports, attending the audits, and whether it be a desk review, and then there’s a final review, final review meeting, that’s probably the front line. But we also have to have those who make the decisions, who decide, “Okay, my reimbursement manager has told me, this is an issue I need to tackle, something I need to handle. Why?” So those decision makers, the CFOs, maybe even the corporate reimbursement directors, maybe even up to the CEO, whoever’s making those decisions and really needing to understand why we have the process. And then, of course, the what. So, I think at all aspects. And then maybe if there’s documentation required – which, quite frankly, there is – maybe getting the patient financial or accounting, or whoever does the data, who would handle the data requests and the data needed to pursue these appeals. So, I think it really spreads across the organization. And so, I think those people attending really would have the best full, complete picture of the process.

Kelly: Right. No, that makes a lot of sense. Well, thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: Commonly Appealed Issues–A Deep Dive. Join us live on Wednesday, June 17, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristin.

The Financial Burden of Pressure Injuries

Besler Holdings — Wed, 10 Jun 2026 02:35:00 -0400

In this episode, Dr. William Padula, Health Economist and Professor at the University of Southern California, and Martin Burns, CEO at Bruin Biometrics discuss the financial burden of pressure injuries.

Understanding the Escalating Costs of Musculoskeletal Care

Besler Holdings — Wed, 03 Jun 2026 03:29:00 -0400

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Understanding the Escalating Costs of Musculoskeletal Care

In this episode, Scott Linthorst, Senior Vice President of Value-Based Care for TailorCare, discusses understanding the escalating costs of musculoskeletal care.

Highlights of this episode include:

Why musculoskeletal care is such a major financial challenge in healthcare
Where costs escalate in MSK episodes
What role early navigation plays in controlling costs
What role data or predictive analytics play
Predictive analytics results
What metrics hospital/health plan leaders should track

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Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Scott Linthorst. Scott is the Senior Vice President of Value-Based Care for TailorCare, a leading provider of specialty value-based care solutions focused on improving patient outcomes for joint, back, and muscle conditions. Scott leads the organization’s efforts to optimize outcomes under value-based care arrangements. He oversees the actuary, medical economics, and analytics teams to drive a data-informed strategy that improves clinical, financial, and operational performance. Scott has a diverse background in finance, patient engagement, and healthcare services. In his previous role at Babylon, he led the Value-Based Care Finance Function, managing over $1 billion in deals from contracting to forecasting and ongoing performance management.

Prior to that, he spent eight years at CVS Aetna and also served as the CFO of an internal startup that empowered physician-led organizations to assume medical cost risk and led FP&A teams focusing on digital health, member engagement, and virtual care initiatives. Scott also has a decade of experience as a management consultant, enhancing his strategic and analytical capabilities.

He earned a Bachelor of Science in Engineering from Columbia University. In this episode, we’re discussing understanding the escalating costs of musculoskeletal care. Welcome, and thank you for joining us, Scott.

Scott Linthorst: Hey, Kelly, great to be here with you.

Kelly: Well, let’s go ahead and jump in. So why is musculoskeletal care such a major financial challenge in healthcare?

Scott: Well, I think there are a couple things. I mean, first, musculoskeletal conditions affect about half of all adults. And in the United States, it’s about $420 billion in annual spend, the single largest specialty, more than cardiology, cancer, kidney, and it’s really closely aligned with a lot of other comorbidities, cardiovascular health, metabolic health, behavioral health. I think one of the big challenges is that it’s a mix of both chronic, think degenerative arthritis and hip or knee, and episodic costs, think acute injuries from falls or lifting something too heavy. And for patients, often the biggest challenge is just knowing where to start. Patients begin their journeys in a variety of different places. It might be their PCP, it might be with a physical therapist, it might be with other downstream specialists. And so, it’s just really fragmented and hard to figure out where the costs start and where they escalate.Kelly: Yeah, no, that makes sense. The chronic and episodic costs that you talked about, that makes sense with this particular care that we’re discussing. So where do you typically see costs escalate in MSK episodes?

Scott: Well, the anecdote I often hear from orthopedic specialists is that patients will suffer a functional decline in silence, think you’ll put your salt shaker on the counter instead of up on a shelf. But when they get to pain, that’s what really begins to motivate action. What we see in the data is there’s little consistency across different patients’ care journeys. There’s imaging. There are specialist visits. And especially when those come before conservative care treatment options are attempted, they predispose patients towards surgery at a much higher rate than if you start with some of those conservative care options. And if there isn’t some form of clinical triage that starts at the beginning, some guidance to those patients, they often end up on the most intensive care pathways as opposed to those that might work best for them.

Kelly: No, that makes a lot of sense. Thanks for explaining that for us, Scott. So, what role does early navigation play in controlling costs?

Scott: I think there’s several things that influence cost. I think the first is just educating patients about their conditions, spending time with them, really understanding not just what is the diagnosis, but what are the functional constraints? What is the impact? And then talking to them about what are their goals, what do you want to accomplish? Are you trying to walk your grandchild down the aisle? Do you want to get back to your gardening habit? What is the thing that you want to be empowered to do? And then really exploring what are the different treatment options and modalities, and what has worked for patients similar to you? Going through that kind of shared decision-making process and navigating patients to the best providers downstream can really help control costs. When patients go through that type of navigation, they’re more likely to start with physical therapy or exercise programs, and those may help them avoid those more invasive procedures downstream.

Kelly: Yeah, no, I love what you said about shared decision-making. That totally makes a lot of sense in this particular instance. So, Scott, what role does data or predictive analytics play here?

Scott: Because there are such a different variety of places that people will start in their care journeys, try to identify patients early and before they get to some of those escalated care modalities is really important. You can identify, using predictive analytics, those patients that are just more likely to have surgery. And if you can look at those patterns and engage those patients early, sometimes you can engage them even before they get to those places that they were likely to get to downstream.

Kelly: I’m always so fascinated by predictive analytics. And I think engaging patients early, that also makes a lot of sense to me. So, what results have you seen from this model?

Scott: When we see patients that begin with that kind of structured evaluation that I talked about, when it’s clear to those patients what are the pathways that they could choose, what we frequently see is that patients choose to start on conservative care pathways, conservative treatment options, exercise programs, physical therapy before they would then continue on to more invasive or more escalated options. And I think when they do that, what we typically see is a decent number of those patients stick to those pathways and report really meaningful improvements in pain and in their function. And they also report a lot higher satisfaction. When patients feel informed, they feel supported through the process, they generally just have a more warm, fuzzy ...

Why AI ROI Becomes Guesswork Once Systems Scale

Besler Holdings — Wed, 27 May 2026 03:45:00 -0400

In this episode, Dave Trier, CEO of ModelOp, discusses why AI ROI becomes guesswork once systems scale.

Fixing the Systems Professionals Depend On--The Hidden Operational Drivers of Hospital Financial Performance

Besler Holdings — Wed, 20 May 2026 03:18:00 -0400

Fixing the Systems Professionals Depend On--The Hidden Operational Drivers of Hospital Financial Performance

The Hidden Cost of Healthcare Distribution--What Hospital CFOs Need to Know

Besler Holdings — Tue, 12 May 2026 23:09:00 -0400

In this episode, Tony Paquin, Co-founder, Chairman, and CEO at iRemedy Healthcare Companies, here to discuss the hidden costs of healthcare distribution, what hospital CFOs need to know.

Medicare Cost Report Appeals and Reopenings--What You Need to Know Webinar

Besler Holdings — Wed, 06 May 2026 08:51:33 -0400

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Medicare Cost Report Appeals and Reopenings–What You Need to Know Webinar

In this episode, Kristin DeGroat, Besler Holdings’ Chief Legal Officer, provides us with a glimpse into Webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, presented live on Wednesday, May 13, at 1 PM ET.

Highlights of this episode include:

What is this webinar about?
Who would benefit most from this webinar and why?
Key takeaways
Best practices

Subscribe Today!

Kelly Wisness: Hi, this is Kelly Wisness. We’re pleased to welcome back Kristin DeGroat, Besler Holdings’ Chief Legal Officer. In this episode, Kristin will provide us with a glimpse into Besler Holdings’ first webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know, live on Wednesday, May 13, at 1 PM Eastern Time. This is our first in our Medicare Cost Report Appeals and Reopenings Series.

Welcome back and thank you for joining us, Kristin.

Kristin DeGroat: Well, thank you for having me back.

Kelly: Well, let’s go ahead and jump in today. So can you tell us what’s this webinar about?

Kristin: So, we’re going to talk about the Provider Reimbursement Review Board, at least a background of that. And then we’re really going to focus on what you need to do to preserve your appeal rights as well as your reopening rights, which are different and are handled differently. And we’ll get into a little bit of the differences and provide some best practices.

Kelly: Awesome. Sounds like it’s going to be a great webinar. So, who would benefit most from this webinar and why?

Kristin: So, most people immediately think, “Oh, this is just for reimbursement people.” But actually, people in patient financial services, even executives that maybe don’t deal with the cost report and appeals and reopenings and really don’t get into the depth. But there are data elements that we need, which usually come from patient financial services. There are cost report elements needed. And again, you need the buy-in at the top so that they understand what it takes and maybe the costs associated with filing appeals and/or reopenings.

Kelly: Well, that makes a lot of sense. So, what will be some of the key takeaways from the webinar?

Kristin: So, the key takeaway, I think, really will be, “I can have an appeal that preserves my rights, and I can have a reopening at the same time.” Most people don’t realize that. And so, I think that’s beneficial where it’s an issue that can be settled. So, the problem we’ve got with the board, right, in filing appeals is that they often take a number of years. And so, the reopening may be the faster route, not always, but maybe the faster route to getting the dollars.

Kelly: That makes sense. And yeah, I didn’t know that you could do an appeal and a reopening at the same time, so I’m sure others don’t know that as well. So, what best practices do you have for those going through an appeal or reopening?

Kristin: So don’t take any chances. Don’t just assume you’re going to be able to appeal or reopen. You need to understand the specifics of those rules and how they apply to your cost report. Protest, protest, protest, protest, that is the key. And again, file your reopenings, even if you have an appeal.

Kelly: Those are some great best practices. Thanks for sharing those with us. So why is having an external partner important for this very complex and often long process?

Kristin: The change in rules between the cost report rules, the reopening rules, the board’s rules. There are many pitfalls. And if you don’t understand how they fit together, you could lose your right to appeal or reopen. So, you’ve got to understand how that comes together. And having an external partner that focuses on the rules, the changes, ensuring that everything is filed properly, that you have the right tools to ensure that your appeal rights are protected.

Kelly: No, that makes a lot of sense. Sounds like finding the right partner is important for this process. Well, thank you–

Kristin: Definitely.

Kelly: Yeah, so thank you so much for joining us, Kristin, and for giving us this glimpse into Besler Holdings’ free webinar, Medicare Cost Report Appeals and Reopenings: What You Need to Know. Join us live on Wednesday, May 13th, at 1 PM Eastern Time. And as a bonus, you can also earn CPE. Thanks again, Kristen.

Kristin: You’re welcome. Looking forward to seeing everyone Wednesday.

Kelly: Sounds great. And thank you all for joining us for this episode of the Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.holdings/podcasts. The Hospital Finance Podcast is a production of Besler Holdings.

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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Using Tech to Boost Patient Care and Streamline Operations

In this episode, Beth Raboin, Founder & CEO of Global Medical Virtual Assistants, discusses using tech to boost patient care and streamline operations.

Highlights of this episode include:

What is a medical virtual assistant?
Where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?
How GMVA ensures medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely
How the virtual assistant model scale for larger hospital systems or multi-facility organizations compared to smaller practices
Where’s the best place to start to ensure long-term ROI?
What other hospital departments are a good fit for medical virtual assistance?

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Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Beth Raboin. Beth is leading GMVA in vision in the day-to-day business operations securing the functionality of the business to drive extensive and sustainable growth. Combining her strong leadership and determination with over 22 years of corporate experience in the private and public sector of surgical device, pharmaceutical, and specialty pharmacy industries, she keeps the company moving forward with high-level strategy while understanding the details of day-to-day execution to ensure steadfast success.

Prior to Beth’s corporate and entrepreneur experience, she competed as a full athletic scholarship athlete as a Division 1 gymnast at the University of Florida, where she graduated with a Bachelor of Science in Health Sciences.

In this episode, we’re discussing using tech to boost patient care and streamline operations. Welcome, and thank you for joining us, Beth.

Beth Raboin: Oh, thank you so much for having me, Kelly. I’m so excited to be here.

Kelly: We’re excited to have you. So, let’s go ahead and jump in. So, for listeners who may be newer to the concept, what exactly is a medical virtual assistant? And how do they differ from traditional outsourcing models?

Beth: Yeah, oh thank you so much. Starting with a big question there, Kelly. So, first of all, medical virtual assistants are additional staff that you can bring into your hospital or medical practice to help facilitate some of the back office work that needs to happen. So, we do not do clinical care. Medical virtual assistants do all of the clerical and/or administrative patient care that happens behind the scenes. So that’s the differentiator between your typical in-hospital setting versus bringing in a medical virtual assistant. And how we’re different from other models is you’re not outsourcing. You’re not sending and outsourcing all of the work elsewhere. That’s not how it works. We are actually more like an insource. We’re additional staffing that’s brought into your medical practice and/or hospital to do the work that needs to get done within your tools, within your systems, within your workflows. And so, we’re actually integrated as part of the team.

Kelly: I love that. It’s so intriguing. From a financial standpoint, where do hospitals typically see the most meaningful cost savings or efficiency gains when using the medical VAs?

Beth: Oh, gosh. Well, so we’re a fraction of the cost of what it would be to hire someone here in– within the hospital system within the United States. We are outside of the United States, so we’re mainly in the Philippines where the cost of living is lower. So therefore, the cost structure for our business model is also lower. And where they can utilize our services is just, it’s endless. Where we’re seeing where we’re a huge asset– for example, we just were onboarded this past year with a huge healthcare hospital system on the West Coast. They brought us just in to do patient access to fill in some open appointments, making sure patients are going to show up to their appointments, and then backfilling the appointments within the schedule that those patients were not going to show up to. And they saw an immediate, an immediate, I think it was like $2 or $3 million difference in their bottom line just within two quarters. So that’s just one simple example. We’ve also been brought in heavily within the hospital systems, within revenue cycle management. Collecting dollars is critical for hospital systems, making sure that denied claims are in fact paid. And so the resubmittal of claims, following up on denied claims, making sure that patient balances are paid, all of that. So that also is a really big– a really great place to be able to bring in our staff to help and augment the way things are being done within that hospital.

Kelly: Wow, I mean, so some significant savings there. That’s awesome. So how does GMVA ensure medical virtual assistance remain fully HIPAA-compliant and safeguard patient information while working remotely?

Beth: Yeah, well, so there’s a few different ways we do that. Number one, we’re hiring professionals, right? We’re hiring people who have a bachelor’s degree, a bachelor’s degree, typically in nursing. They understand healthcare. They understand HIPAA and PHI. And so, they’re put through obviously a HIPAA certification class, so they’re HIPAA-certified, but that’s not enough. That’s just not enough to ensure patient information is– it’s just not enough to make sure patient information is protected, right? So, we put in additional safeguards and everyone works remotely, they’re not working within a call center, they’re working from their home. So, we’ve put additional software security on their computer systems to make sure that they’ve got a closed network that they’re working within. So, they’re logging directly into the client’s EMRs, directly into the client’s tools, and we need to make sure that there’s no nefarious actors or viruses are able to penetrate the system. So, we’ve got a pretty substantial, what we call a blue box on their computer, and they’re working within the safeguards of that system. It’s amazing. It’s been one of the things that we heavily invested in just to ensure that we’re protecting patient information. But beyond that, we’re also protecting the tools of our clients because we all know that viruses and/or nefarious actors are working consistently to try to break into hospital systems, break into hospitality, break into banks, and any possible way that they can try to penetrate a closed off system. So, we do everything within our power to make sure that we’re keeping patient information protected.

Kelly: Yeah, I know HIPAA compliance is so important. And for lack of a better term, it’s an epidemic that we’re just kind of hitting. We’re being hit with all these bad actors all the time. So, it’s just a constant issue, isn’t it?

Beth: Oh, constantly. So, I mean, we’re all getting them even into our private email addresses, work email addresses, people sending over what you think looks like a real invoice, but it’s not a real invoice. You click on it, before you know, you’re in trouble. So yeah, we’re trying to do the absolute best we can to keep up to date on protecting any and all software that we’re logging into.

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The AI Security Blind Spot That Healthcare Can’t Afford to Ignore

In this episode, Tom Furr, CEO and Founder of PatientPay, discusses how the Shift in ACA enrollment is driving more high deductible health plans.

Highlights of this episode include:

How the reduction in ACA enrollment numbers are affecting out-of-pocket payments
How should providers prepare for this change in coverage
Long-term projections

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Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Vrajesh Bhavsar. VJ is an engineer with a Master’s in Computer Science from USC and over 20 years of experience building hardware and software products. VJ built core technologies for iOS and Mac OS, including dynamic tracing, data protection, and secure enclave at Apple. He holds eight patents in distributed systems, data, and security. He is passionate about building technology-first businesses that drive positive human impact at scale.

In this episode, we’re discussing the AI security blind spot that healthcare can’t afford to ignore. Welcome, and thank you for joining us, VJ.

Vrajesh Bhavsar: Hey, thank you for having me.

Kelly: Well, let’s go ahead and jump in. So, AI is being deployed across healthcare at a remarkable pace. From a cybersecurity standpoint, what’s the risk that most hospital leaders still don’t fully appreciate?

VJ: That’s a great question. And it’s such an exciting time that we are living in. There are so many new innovations coming to the entire space. And the impact of AI in so many different areas gets really exciting for a lot of industries where this kind of innovation is needed. And, of course, healthcare has so many different areas where AI can be applied, but also there are a lot of risks that come in when you are exposing this kind of critical area of safety and care to this kind of new innovation. And so the big risks that we see in a lot of interactions we are having is how when you have a lot of kind of new innovation getting sprinkled across use cases and areas where you didn’t really understand the full scope and things are operating without a lot of visibility, especially in the deep areas where sensitive data is in question and you have patient information as well as ways that a lot of the third party systems are going to interface with these things. That’s where there are so many risks that it’s not fully understood and appreciated.

And the thing that really gets people is that we are used to kind of operating with these innovative systems in kind of traditional systematic ways, that A plus B results in something. But in the world of non-determinism, where there are a lot of new attacks coming in, the level of risk really, really goes to the roof. And the kind of attacks that have come through in terms of prompt injection or zero-click, and a lot of things that have been reported across the industry, and we have done some of the work ourselves. It really throws people back into like, “Oh, wow, I didn’t realize that this can really exfiltrate the data at such scale and such speed.” And the level of protections and defenses that people had through traditional tools are now out of question.

Kelly: Yeah, it’s definitely an interesting time in healthcare and AI, and there’s a lot to consider there. You recently discovered a zero-click vulnerability that can silently extract complete patient records without leaving a trace. What does that mean in plain terms, and why is it a signal of a much larger industry problem?

VJ: That’s a very interesting question. And I think as an industry, we have been trying to get everyone to kind of understand that, “Hey, don’t respond to random emails, don’t share credentials, don’t go chase random links and all that, right? But what’s happening in the world of AI is that without users taking any of such risky actions, now you can have a massive exposure and that’s what zero click refers to. And what we discovered is that a lot of these AI systems as they are interfacing with so many different data sources and all the records and all that, they can actually go take the credentials and access that you have given them and try to be helpful in ways that can actually result in data exfiltration and leakage at a massive scale. And so, what we are finding is there are the kind of attacks that come through in AI systems that are prompt injection or jailbreak attempts. And those things are getting embedded in documents, in ways that are invisible to the human eye, but those instructions mean a lot to what an AI system or an agent bot is going to do.

And that’s where, now, you are bringing– you have so many, so much intelligence baked into these AI stacks that they are trying to be super helpful and trying to kind of take all these instructions that are embedded and the users didn’t do anything wrong, but this is where some of the attacks that are coming through. Some of the ones that we have discovered and the industry has discovered, even Anthropic reported several different types of attacks. And there is a lot of education needed in the industry to really kind of understand the scale and scope of what these intelligent, non-deterministic systems bring in these critical environments.

Kelly: Completely agree. There’s definitely a lot of education required for us. VJ, HIPAA was built for predictable human-reviewed workflows. How does autonomous AI fundamentally challenge the compliance model healthcare has spent decades building?

VJ: I know. This is where we are really passionate about like there is so much to be done, and I know HIPAA is trying to catch up on a lot of the new innovation. But at the end of the day, there is kind of like an inert way in which HIPAA assumes there are human accountability layers behind all the different decisions that are getting made. And I think that’s the thing that gets thrown out the window when you bring in agentic AI. And in these environments where you are passing responsibility, you’re passing autonomy, you’re passing decision-making capabilities to agents and at a speed of machine speed at which you can access so many different systems all at once and try to be helpful. That’s where there is no mechanism in place to even understand what these systems are trying to do. And beyond understanding, you need to actually govern and bring controls into these environments, right? And I think that’s kind of the core to a lot of the challenges and what we refer to it as runtime visibility and runtime controls.

And when these agents are getting born and they are trying to figure out, like, “Okay, what are the instructions given to me?” And I’m going to try to make sense of that. I’m trying to access the systems that are available to me, and sometimes they overreach. And that’s when these breaches happen. That’s when, kind of, unexpected consequences happen. That’s when you end up with a non-compliant system. So, I think there is a lot to be done. I think the industry was still just catching up on what was happening in the world of microservices and all the API ecosystem. And now we have leaped directly into agentic environments. And I think that requires a full depth understanding of what all things are happening to stay compliant.

Personalizing Healthcare: Strategies to Drive Patient Engagement and Financial Impact

Besler Holdings — Tue, 14 Apr 2026 22:58:00 -0400

In this episode, Casey Williams, SVP of Patient Engagement at RevSpring, discusses personalizing healthcare, strategies to drive patient engagement, and financial impact.

Highlights of this episode include:

What RevSpring does and the difference it makes for healthcare organizations
Biggest challenges healthcare organizations face when trying to protect their finances while also helping patients
Personalization and how it impacts patients and providers
Practical strategies for meeting patients where they are financially
RevSpring’s approach
What trends or innovations that will shape healthcare communications and finance

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Casey Williams. Casey leads solution consulting and sales efforts for new direct healthcare customers at RevSpring. He has 20 years of experience in developing customized patient engagement and payment solutions for over 100 healthcare revenue cycle clients. His knowledge of patient engagement strategies, including self-service optimization, has made him an advocate for change for RevSpring clients and the wide healthcare revenue cycle market.

In this episode, we’re discussing personalizing healthcare, strategies to drive patient engagement, and financial impact. Welcome, and thank you for joining us, Casey.

Casey Williams: Kelly, thanks for having us. We appreciate it.

Kelly: Yeah, we’re glad to have you here. So, let’s go ahead and jump in. So, Casey, can you tell us about your background? And how did you end up in your position at RevSpring?

Casey: Yeah, it’s a great question, Kelly. I think by default is probably the most honest answer. Coming out of Bowling Green State University, studying interpersonal communication, there was nothing that screamed healthcare finance from that background. But actually, I think kind of started as most people start their jobs or their careers where I had a friend working in a company, a smaller company, at that time called Data Image. And they had just had some transition in their sales environment. And the owner, founder had asked me to join. And that kind of began the path into communication, payments, and engagement overall. And really started at that smaller company involved in the hospitals in and around central Ohio and then expanded into the greater Midwest. But really got a great appreciation for when you’re a small company at that time, you not only position what the value is, but when you do that successfully, then you actually do the setup or the implementation, and then you service it. And then when there’s a billing question, you’re actually the finance arm as well. So, I was very blessed to be able to have such exposure at such a young time in my career to where I got a lot of different experiences within that and have just enjoyed it ever since. And we at RevSpring, which Data Image then sold into what then became RevSpring in 2010– and we’ve continued to acquire value across the market in how we are trying to build our technology stack today. So, by happenstance, I got into it, but I have been fully immersed and fully engaged ever since.

Kelly: That’s awesome. It’s great how those things happen. For someone who isn’t– for someone who isn’t familiar, how would you describe what RevSpring does and the difference it makes for healthcare organizations?

Casey: Yeah, Kelly, it’s a great question. I think the most simplistic answer to that question and one that I get from my kids all the time is they see me going into hospitals and thought for many years that I was a doctor. And then at one time, we had an office inside a bank, and then they thought I was a banker. So, I practiced this answer a lot over the years. But primarily, we are a patient engagement and communication company with an emphasis on payments. And the sense of this is that when patients need services, we handle everything from the intake to the scheduling to the registration at time of service to estimating the balance that that patient would owe, do our absolute very best in terms of trying to capture payment at that time or a method of payment so that autopay could be performed. Once that individual service, if not collected in full at time of service, goes to be billed from an insurance standpoint and that amount is adjudicated, then there’s a self-pay after insurance balance. We are then engaging within that patient population to let them know that there is a balance to meet them where they are, meaning that if they are unable to pay that balance in full, we have predictive analytics that address how much that patient can afford to pay on a monthly basis.

And so, whether that engagement is print, we produce about a billion and a half communications a year from that standpoint, or we engage digitally within that to be able to facilitate payment and those outcomes. And so, I think that’s probably the simplistic answer to that question. And I think why that matters is…is you look at healthcare in terms of the ecosystem in which everything is operating today, there’s a great strain in healthcare. As high-deductible healthcare plans continue to progress, patients continue to pay more for the health insurance, continue to be pushed off from their employers of having to pay more themselves within that. That then puts a strain within healthcare, is that 20, 25% now of the receivables that are within the total revenues of healthcare are now to the patient, meaning self-pay/self-pay after insurance. And so, without our technologies, without our sophistication, without our intelligence, it becomes very tough to engage, as well as getting patients to respond to what they owe.

Kelly: Wow, that’s very fascinating. Thanks for sharing that with us, Casey. Yeah. So, what are some of the biggest challenges healthcare organizations face when trying to protect their finances while also helping patients?

Casey: Yeah, that’s another great follow-up to that, Kelly. And I think probably the number one answer you would get within a healthcare finance type of roundtable would be insurance denials. And so when you, when you look at the ecosystem and the landscape of healthcare, about 75, 80 percent of all revenue that comes into an IDN/hospital provider is generally on the commercial Medicare and Medicaid side. And then about 20 to 25 percent of that revenue comes in on the patient responsibility. And what that means is, is after their insurance is paid, what is their responsibility? Or if they’re uninsured, what is their responsibility? And so, denials continue to play a large part in that 80% of the revenue stream. But if we’re looking at the 20, 25% of revenue, it is around the patients continue to owe more, but yet the wages have not continued to go up at the same levels in which they’re either paying for their healthcare or their healthcare insurance. And so that creates kind of that massive strain that I was mentioning in terms of how do they collect? How do they give pathways for those individual patients to be able to engage in order to pay their balances? And if that doesn’t happen, we look at rural healthcare as an example, continued consolidation, even closures within that environment, when that doesn’t happen.

Kelly: Well, yeah, there are quite a few challenges in healthcare right now, that’s for sure. We hear a lot about personalization these days, but how does it actually impact patients and providers in terms of engagement and financial outcomes?

Casey: I oftentimes give bad examples or metaphors. And for those of you that are old enough listening to this, know the old TV show Cheers is that kind of the opening song is, “Everybody wants to know your name.” I think it’s a…I think it’s a really good illustration in the sense of what personalization means to any commercial engagement that we have as a patient, as a human, from a commerce perspective. And the more that the business knows about me and can perfect that engagement, can perfect that pathway, to where I don’t have to continue to repeat myself. Once I’ve answered a question, I don’t have to answer it again, or meeting me where I am, meaning that if I if I don’t have $1,000 in my bank or if I’m like 50% of Americans that do not have $500 in their account to pay for a surprise bill, that you’re not just sticking a $2,500 bill in my face and saying, “Pay me.” So, the personalization really gets down to meeting the patient where they are. To give you a couple of practical examples of that is if I am a patient, let’s even say I’m a millennial to where I do not like to receive paper and all I receive is paper. But if you send me a text, I’m going to pay within 15 seconds as long as I can afford that. That’s a good example of meeting the patient where they are, as well as personalizing that.

If you have, let’s say a person like me that is midlife, I think 47 is midlife. Maybe that’s on the older side of the life. I’m not sure. But I actually still like paper. Now maybe that’s because we print and mail a billion and a half communications. But let’s say I’m one of those individual patients that cannot afford $2,500. So am I receiving a communication in printed form to where I can touch, feel, and interact with that, but yet see a pathway to where I can potentially hit a QR code taken into a payment application where it’s giving me the option of 10 payments of $250. That is where the dynamic of patient engagement is massively changing and it has been massively changing ...

From Inventory to Insight--Rethinking Medication Management for Clinical and Operational Performance

Besler Holdings — Tue, 07 Apr 2026 23:33:00 -0400

In this episode, Randall Lipps Founder, Chairman, President, and CEO of Omnicell, discusses from inventory to insight, rethinking medication management for clinical and operational performance.

Highlights of this episode include:

How to reduce costs within medication management
How system wide visibility can change decision making for health system leaders
Centralized medication distribution and automation
AI-driven analytics
Efficiency and caregiver support
How to drive enterprise-wide cost optimization

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Randall Lipps. Randy is the founder, chairman, president, and CEO of Omnicell, a company transforming pharmacy care delivery with a comprehensive portfolio of medication management solutions. Inspired by inefficiencies he observed during his daughter’s birth and his experience in airline operations, he founded Omnicell in 1992, growing it into a publicly traded company in 2001 that now serves healthcare systems worldwide. Recognized for his industry leadership, he was elected to the Bellwether League Hall of Fame in 2014 and has served on the American Nurses Foundation Board of Trustees. Randy and his wife, Kathy, actively support a range of charitable endeavors, while Omnicell fosters volunteerism and charitable initiatives through its Omnicell Cares program. He holds bachelor’s degrees in economics and business administration from Southern Methodist University.

In this episode, we’re discussing, from inventory to insight, rethinking medication management for clinical and operational performance.

Welcome, and thank you for joining us, Randy.

Randall Lipps: Well, Kelly, thank you so much for having me here today. It’s always fun to talk about the numbers, especially with folks who are thinking about the numbers all the time.

Kelly: Yeah, exactly. Well, let’s go ahead and jump in. So, Randy, as I read your bio, you don’t have a healthcare background initially, so what drove you into healthcare from the airline industry? It must be an interesting story there. [laughter]

Randy: Yeah, when I got out of school, I went to work for the airlines, and the airlines had a ton of numbers, kind of like healthcare, I guess. And it had some of the same profile: it had a lot of employees in order to run an airline, a lot of capital, and a lot of regulation, things you will also find in healthcare. And in order for us to survive in the airline industry – at that time, it was American Airlines – we had to lower our cost. There was no other mandate other than to lower our cost, and we had to do that by eliminating work that we didn’t really have to do, minimizing the necessary work, centralizing it so that we could then really get a good perspective on it, and then eventually automating it. As I experienced healthcare through my own daughter’s long-term stay in a hospital, I realized there were some of the same opportunities that existed in the airline that there is in healthcare, so some Stanford students and I launched a venture to go find out ways to make things more efficient and easier, particularly for nurses and pharmacies to do their jobs with less cost. I mean, what was ingrained with that thought process when I entered the airline is it’s great to think about soft costs, but you’ve got to save hard dollars when you come up with new technology and new automation, and so that’s always been on the front of my mind in the way I think and we move the company forward.

Kelly: I love that story. I mean, it’s just so interesting that you’re kind of sharing those commonalities between two industries that we wouldn’t think have anything in common but seemingly do. With U.S. healthcare spending nearing $5 trillion, where do hospitals have the biggest untapped opportunity to reduce costs within medication management?

Randy: Well, that is a great question, and medication management is really the– it’s a tale of two cities, right? One, it’s the cost side, particularly on inpatient, and the other side, of course, is the revenue opportunity or the earnings opportunity that you have with the outpatient side. And so, a good organization must take advantage of both of those, so let me just cover those. On the inpatient side where everything is a cost, it’s really important to eliminate unnecessary work. And this is clearly seen as you see the consolidation of providers and hospitals and sites, that there’s duplicate work done at these sites. So, first step, eliminate unnecessary work, and then minimize the necessary work. The things that you have to do, be sure that you don’t do– that you do them, but that you don’t exaggerate them. And here’s the key. And many of these organizations have already figured this out. You then centralize it. You bring that critical work that you’ve minimized into a central location. There you have the expertise, you have the enterprise mindset, and you can make better decisions because you’re not looking at an individual basis, but as an enterprise, and then you create standards and roll those out. And then of course, the final step is after you centralize, you automate. Then now you’re automating the processes that you centralize and really understand well. And we begin to see this happen with these consolidated service centers where hospitals with 20, 30, 40, 50 hospitals move their medication management process to a central site that’s automated, reducing headcount and processes at individual locations so that the deliveries can be done once a day at these sites through technology like ours, automated dispensing, and really reduce the burden and the need to run full out pharmacies at every location.

This is a huge savings in terms of inventory cost, huge savings in terms of people cost, and probably more importantly, it allows you to execute to a standard. Everybody’s running the same way and reducing the variance by which you run, and it can be measured. And so that opportunity is there. We’re starting to see the industry take more steps on that side, and it’s a game changer. The amount of savings we’ve seen in some cases has been a third of the total cost of onsite inventory, reduction in over half of wasted products, the reduction of shortages, which takes people and time to cover are reduced because you’re now managing those shortages from a central location. It’s just been a beautiful thing to watch and makes a lot of sense. But it’s a strategic move. It’s an investment, but it has very hard returns. And it is a scalable way to grow as well as you acquire more assets, whether they’re inpatient or outpatient. Servicing them from a centrally consolidated service center makes a lot of sense, and makes the scaling and tracking of those costs, and understanding what those costs will be as you scale, easy to understand.

Now the same thing is somewhat true on specialty. Today, we have crossed the threshold. Over half the drug spend in the United States now is specialty pharmacy. And 25% of that drug spend– as we go into ’26 and ’27, 25% of that specialty drug spend will be spent on outpatient infusion centers. In other words, a provider has to execute the delivery of that medication management. And if that’s true, then that’s an opportunity for these hospital and providers to gain and garner lots of revenue. You have to be an expert in those types of infusion outpatient situations. They’re new drugs, new protocols. They’re not easy to ontake. You have to get alignment with the manufacturer and the payer to do those, but those represent significant revenue and earnings opportunities for all systems and optimizing that. A lot of systems do have those, but the amount of influx of new opportunities in the next even 24 months is significant, and you don’t want to miss out on those because it’s revenue that should be in your P&L because they’re your patients, they’re passing through your hands, and it just makes sense for you to manage those specialty drugs.

Now, on the other side of, of course, the specialty drug management is the 340B. We continue to see a lot of changes, or small changes, in 340B and reimbursement, and you’ve got to keep up with those 340B changes are, but it is still a profitable program that you need to be executing in your institutions. And many of the institutions we see are doing a great job executing the 340B program, but there’s still another 10 or 20% they’re missing out on just because of the changes and the dynamic nature of these 340B reimbursements. So, you’ve got to be able to take advantage of the outpatient specialty pharmacy and outpatient mail order pharmacy opportunities, and you’ve got to be able to consolidate in the inpatient area in order to automate and centralize and minimize and eliminate the workload so that it turns out to be a beautiful picture.

Now, what we’re starting to see is that in some situations, institutions are putting their outpatient pharmacy and their inpatient pharmacy in the consolidation center together. In other words, they’re utilizing the space to both manage inpatient and outpatient. And one area that has been sort of poorly managed is clinics or ambulatory care sites, which are under the responsibility of the provider pharmacy in many cases, but there hasn’t been the tools or the technology to manage medication management out at these distant spaces that use a few drugs, maybe expensive, but don’t use a lot of drugs. And with the new technologies that we have and that are in the marketplace, suddenly these become part of th...

The Role of Remote Work in Healthcare and Its Impact on Patient Care

Besler Holdings — Tue, 31 Mar 2026 23:56:00 -0400

In this episode, Chris McShanag, Founder and CEO of Virtual Teammate, discusses the role of remote work in healthcare and its impact on patient care.

Highlights of this episode include:

What operational intelligence is
How it changes the way hospitals function day-to-day
How AI can be applied in hospitals
Examples where operational improvements directly impacted patient care

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Chris McShanag. Chris is the founder and CEO of Virtual Teammate, which has helped more than 2,500 talented virtual professionals find their place in organizations worldwide, supporting over 600 clients along the way. His mission is simple but bold to reshape the virtual assistant industry by creating an experience that feels seamless, supportive, and genuinely valuable for both clients and assistants. At Virtual Teammate, culture comes first. Chris makes sure every assistant blends effortlessly into client teams, delivering immediate impact and dependable support. Many of these professionals are registered nurses and HIPAA certified, a testament to the company’s dedication to excellence in healthcare and beyond. Chris is passionate about building real relationships. His drive to help clients succeed and streamline operations is setting fresh standards in the world of virtual staffing.

In this episode, we’re discussing the role of remote work in healthcare and its impact on patient care.

Welcome, and thank you for joining us, Chris.

Chris McShanag: Thank you, Kelly. It’s a pleasure to spend some time with you today and excited to kind of share some important information about this topic and ever-evolving capabilities it provides for healthcare providers to really buy back their time.

Kelly: Great. Well, let’s go ahead and jump in. So, what shifted in the industry that made remote work not just possible, but necessary?

Chris: Well, what’s really shifted really in the last 10 years, we’ve gone from a workforce that 5% of the time was remote to well over 50%. And of course, we had a bump through COVID, but what we realized very quickly, particularly in the healthcare space, is there’s so many tasks that don’t involve touching a patient that can really be leveraged at a better pace and a better capacity and the right resources. And so, what we focus on at Virtual Teammate is really helping our customers and our clients and the clinic owners focus on the highest and best use of their time, which is patient care, and really delegating those tasks that don’t require their technical expertise or the technical expertise and capability of those in the office. And so, for us, it’s really been a game changer to have healthcare providers catch up with the insurance industry that for the longest period of time has been leveraging remote team members to really support their ongoing operations.

Kelly: Yeah, I know remote work is just so prevalent right now in healthcare and in other industries. Which healthcare roles are truly optimized for remote work, like medical scribes, billers, or admin support, and why?

Chris: Really, I mean, they’re optimized because they’re very much consistent, what I would like to refer to as kind of rinse, repeat the same process, the same task over and over. And that’s where our team accelerates is, as you mentioned, 80 to 90 percent of our folks are RNs healthcare trained. They’re all HIPAA certified, and a lot of them have come from the insurance industry. And so they have that deep experience from insurance verification, eligibility, precerts, billing claims. And so really, it’s about buying the clinics’ time back of the providers, but also getting reimbursed in a timely fashion for the work they do, and I know that’s what your company specializes in as well. And that’s where we really come alongside to support that and be intentional to really optimize the workflows for our clinics. And we leverage technology to really support that. So, it’s not just about a person or virtual assistants, a virtual assistant that’s enabled by technology to really improve and optimize the productivity. And because of that, we can confidently say that our team is about 47% more productive than having somebody in the office and allows for, yeah, exceptional revenue growth.

Kelly: Wow, no, that makes a lot of sense. So, I know some practice owners worried that remote staff might reduce the quality of care. What would you say to those who fear that outsourcing admin work affects the patient experience?

Chris: I would really challenge them to think about the patient experience starts when they come to the office, right? But it starts well before that. It’s when they interact with somebody. So many of my doctors and clients will say, “I love you, doctor, but I can never get in touch with you.” And so, by leveraging our teammates handling phone calls, handling scheduling, that really starts to enhance that patient experience well before they come in to the clinic. And so being able to connect with your doctor, being able to interact with them, that’s where our team takes a lot of that administrative support, phone calls, scheduling, off the doctor’s hands and those in the office so they can enhance the patient experience when they’re in front of them. And they can enhance that experience of feeling like they’re being heard and they’re connected and they have the necessary information, thereby allowing the doctors to spend more time with their patients. And what’s driven a lot of this is reimbursement has really declined, but costs have grown. And so, our team can really allow that opportunity for doctors to be intentionally spending time with their patients, particularly on the medical scribe side, where we’re real-time updating documentation while the doctor is spending time with the patient, instead of spending time in front of a computer.

Kelly: No, definitely. So how does removing administrative burden from doctors and clinicians directly impact patient outcomes and satisfaction?

Chris: So, I mean, I think it buys back their time. So, they spend more time doing what they do best and are educated to do is interact with the patient, get to understand the patient’s needs, where their struggles are, and really be able to respond in an empathetic manner, where they’re not overburdened. And we’re seeing such a burnout in the healthcare industry of doctors, dentists, veterinary folks really burning out because they’re spending the majority of their time, whether during the office hours or after hours, doing unnecessary paperwork that’s not the best for them. And then that has direct impact on the customer satisfaction in regards to their mood and how they feel and how they present themselves to work. And then, of course, the outcomes, they’re not getting that one-on-one interaction with the doctor because the doctor’s too distracted by making sure they update the notes, making sure they do all that information, or they’re following up on billing and things like that. And it also improves the satisfaction outcomes by streamlining the scheduling process and making sure that your patients can get in touch with the doctor’s office and get the care that they need and deserve.

Kelly: No, I love that. It’s so important to keep those doctors focused on what they really should be spending their time on. So, Chris, what measurable improvements have you seen in practices that embraced remote healthcare support, financially, operationally, or clinically?

Chris: So financially, and really clinically, on the financial side, we’ve seen huge bumps. And so a number of our clients have reported 40-50% increase in the number of claims and precerts that can get completed in a day, thereby really accelerating their reimbursement. And so being paid for the services. If you think about it, healthcare is one of the only industry that extends credit with the hope of payment, right? We deliver the services, but we don’t get paid at that exact time for the services. We have to go kind of chase that down. And so, for us, it’s really about enhancing that experience so the doctors can get the money that they’re paid or owed. Follow up with the insurance company, work through denials, and really reduce the AR days, which is such a burden for practices because they’re incurring all this cost with the hope of payment down the line. And so, for me, I’m really passionate about the little bit I can do to give back to doctors so they feel like they’re getting compensated for the work they’re doing, but also not spending all their time on paperwork, but being able to really invest in nurturing the relationships with their patients.

Kelly: No, I love that so much. Chris, looking ahead, 5 to 10 years, do you see remote staffing becoming the norm in private practices? And what happens to clinics that resist this shift?

Chris: Yeah, I definitely do see this continually being embraced because, on the provider side, we’re probably 5 to 10 years behind the insurance companies and other areas. I really see it embraced because, as we move more to technology and more to kind of some of these online visits, particularly we’re seeing a lot of growth in the behavioral health, mental health space with our clients. I think that’s definitely the trend is going to continue. But I think on top of that is not just having remote team members. It’s having remote team members like what we’ve put in place with Virtual Teammate, because the focus of Virtual Teammate isn’t ju...

AHLA 2026 Recap

Besler Holdings — Tue, 24 Mar 2026 23:49:00 -0400

In this episode, Kristin DeGroat, Besler Holding’s Chief Legal Officer, provides us with a recap from the recent AHLA event in Baltimore.

Highlights of this episode include:

How attendance was this year
Reimbursement-related content
Medicare Advantage changes

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Kristin DeGroat, Besler Holding’s Chief Legal Officer. In this episode, Kristin will provide us with a recap from the recent AHLA event in Baltimore. Welcome back, and thank you for joining us, Kristin.

Kristin DeGroat: Well, thank you for having me.

Kelly: Well, let’s go ahead and jump in. So how was attendance this year at the recent AHLA Institute on Medicare and Medicaid payment issues event in Baltimore?

Kristin: I think it was well attended. Last year, we weren’t able to hear from the Centers for Medicare and Medicaid Services or the Department of Health and Human Services, as they were unable to attend. However, this year they attended. I thought the attendance in terms of providers as well as government, and of course, the lawyers, but the consulting firms as well, I thought the attendance was great.

Kelly: That’s always a good thing to have everybody there. So, I know you’ve attended this event for more than 20 years now. How does this year’s AHLA event stack up to previous years’ events, you know, especially in regards to content?

Kristin: The content they provided was very helpful, especially in terms of reimbursement-related issues. And the speakers were amazing. We had the Office of General Counsel, the Office of the Inspector General, and, CMS all speak. And in fact, they were all female leaders. Beth Kelly, in particular, who’s the Deputy General Counsel in the Office of OGC, who also serves as the Chief Legal Officer, she said that the U.S. spends $4 trillion. That’s T, trillion, a year on healthcare.

Kelly: Wow.

Kristin: Yes, that’s the entire GDP of some countries. And by far, the U.S., the government spends more money on healthcare than it does in anything else. But I think we’ve seen that too. What we spend as individuals and for our family on healthcare is by far the largest spend as well. So, there is so much money flowing through this and so much going on with it because you need healthcare. And it’s just amazing. I didn’t realize that it was that much of an impact. So, I think that really set the tone and put things in perspective, because a lot of what was talked about was dealing with deciphering dollars and how the payment system works and the decrease in payments. Even though there’s a lot of spend, there’s a lot of issues for providers in the provider community that really impacts how they deliver that healthcare. And I think that focus kind of set the tone for how the content impacted me. As I attended the sessions, I really kept kind of that focus about this is a lot. And how we as consultants and even me as a lawyer in the industry can shape and mold the future of how that healthcare is delivered is what this conference brings to fruition every year.

Kelly: Wow. I mean, it does sound like it was pretty impressive, and I love that there were so many female speakers there. This conference, like you said, it offers a lot of sessions and content impacting both reimbursement and revenue cycle. So, what sessions did you attend?

Kristin: So, I focused on the reimbursement sessions, but being a lawyer, I also focused on the legal side of it. So, there’s some topics in fraud and abuse. There’s legal ethics and the use of AI. Of course, this conference wasn’t solely focused on the use of AI, but there was a lot of discussion about AI and how it can shape the future of healthcare, and maybe next year at this conference, there will be more on AI. But overall, the topics really were, I think, geared, again, as I mentioned, more towards the payment side of healthcare and the cost of that delivery.

Kelly: Right. And I think it’s a guarantee there’ll be more on AI next year, right?

Kristin: I would think so.

Kelly: Yeah. AI sessions and all the marketing sessions I attend are lately too. So yeah, I think it’s here to stay for a while.

Kristin: It is. It is. And from my perspective, and this wasn’t really talked about there, because it’s not really a conference on cybersecurity and data-driven. But my thought, and I mentioned this while I was there, to the AHLA members or the leadership. I mentioned that really, the focus, I think– I understand with AI and molding it to deliver healthcare, but my thought is, especially again, being a lawyer, is that the AI and the data, the PHI that is required to deliver the healthcare, you have to have– again, it’s all about your insurance, right, and purchasing your healthcare. So, your date of birth, your healthcare ID, all of that. And I said, really, what we should also be looking at is AI and its uses in cybersecurity and protecting the data and reducing those costs to the hospitals for, again, delivering that care. So, I do think we’ll see a lot of that, or maybe that should be a topic for next year.

Kelly: Right, yeah. Sounds like it. So, I know we’ve talked a lot about content already here, Kristen, but can you tell us about some of the things you heard at the conference from speakers and/or your peers?

Kristin: So, a lot of what we heard about were the changes coming for Medicare Advantage. So, I would say the biggest topic was around Medicare Advantage providers and, of course, the beneficiaries. Because it is a Medicare and Medicaid conference, the focus is more on Medicare, but those supplemental payments that do flow in as well from Medicaid for helping with the delivery of healthcare. But again, I do think it’s the Medicare advantage and how that is shaping the future of, especially, Medicare enrollees.

Kelly: Yeah, definitely. So, Kristin, what makes this one of the few conferences that you attend every year? What keeps you coming back?

Kristin: Partially, it’s the amount of continuing education I get for it, but it’s good content. Something I look forward to and want to listen to. The topics are very relevant to what I do, as well as what Besler Holdings does and what our clients– the topics that they need to know about.

Kelly: Right. Makes total sense. Well, thank you so much for joining us, Kristen, and for giving us this recap of the recent AHLA event. We really appreciate it.

Kristin: Well, I appreciate you as well. Looking forward to next year already.

Kelly: Awesome. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at contact@besler.holdings.

The post AHLA 2026 Recap [PODCAST] appeared first on Besler Holdings.

The Hidden Cost of Hospital Inefficiency

Besler Holdings — Tue, 17 Mar 2026 23:12:00 -0400

In this episode, Sam Yeruva, Founder and CEO of Pycube, Inc., discuses the hidden cost of hospital inefficiency.

Highlights of this episode include:

What operational intelligence is
How it changes the way hospitals function day-to-day
How AI can be applied in hospitals
Examples where operational improvements directly impacted patient care

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Sam Yeruva. Sam is the founder and CEO of Pycube, Inc., a company transforming the way hospitals operate behind the scenes. With a background in electrical and computer engineering and training from Harvard Business School, his decade working inside hospitals revealed a systemic problem. While clinical care is world-class, operations are often unpredictable. Motivated by a personal experience where critical biopsy samples were lost for 10 days, Sam launched Pycube to bring true operational intelligence to healthcare. Today, Pycube helps hospitals track assets and supplies in real time, saving caregivers hours and unlocking millions in recovered efficiency. In this episode, we’re discussing the hidden cost of hospital inefficiency. Welcome, and thank you for joining us, Sam.

Sam Yeruva: Well, thank you, Kelly. Thanks for having me.

Kelly: All right. Well, let’s go ahead and jump in. So, what is operational intelligence, and how does it change the way hospitals function day-to-day?

Sam: Well, operational efficiency is a day-to-day operations that hospitals have. They’re like a well-oiled machine that actually runs millions of people who come in and get into the hospital. I call hospitals as nothing but– some people call them mechanic shops, which they actually– if you look at a repair shop where you take your cars, they actually make them better and send them back. The same way we all get sick and we go there and get taken care of, and then they fix us and they send us back into the productivity mode. I was talking to some doctors and they call it expensive hotel rooms. They’re providing a specific service. It’s just they’re full all the time, but they’re very complicated, run by very smart people, and they save our lives. So, it’s a well-oiled machine. It has a lot of components to it. There are very complicated things that they do to save our things.

While doing that, they have to work with different disciplines to make sure that a particular patient is taken care of. While doing that, they have a lot of inefficiencies that pop up. It’s a process thing, right? People with good intentions come together who are well-trained in certain things. They do the job as well as they can. But you and I both know that recently the new technologies have come in. Now we are actually writing– when you go in patient registration, you have an iPad where you’re actually putting the information in. But when you go inside the hospital, there are a lot of places where there are still manual processes, they’re writing it on paper. There are good people, good nurses, and good people working in the health systems. They are doing the best they can to make sure they cater the patients. But what happens is things get lost. Things don’t appear. [laughter] It’s chaos inside that machine, and that is what we’re trying to fix to make sure it’s clean, it’s neat, the process flows are known so that the patient is taken care of properly in that area. So that affects us, you, me, and everyone who’s going into hospitals, and that’s what we are trying to fix.

Kelly: That’s a great goal. I most definitely agree with all that. So how can AI be applied in hospitals in a way that is practical, safe, and measurable, not just hype?

Sam: Well, [laughter] yeah, I’m very bullish about AI, and that’s a very good question that you asked. How do we do that? That’s a quick question. I was talking to one of the CFOs of a big health system and he would call me, and said, “Sam, is it true that I will have to change all my processes to make sure AI works in my environment?” I’m like, “No, no, no. AI should be used as a layer on top of what we’re doing. It should help us do things better. It should not change the way we are doing things drastically, but they should definitely help us do things better.” So, it’s a challenge to actually put AI in everywhere because it’s a common folklore right now that people think that, “Hey, this is not working. Maybe I’ll throw AI at it. Let’s see if it works.” No, it doesn’t work that way. I always go with a statement saying, “AI without PI is not going to work out.” Artificial intelligence is not working out– it will not work out without your practical intelligence. If you can’t fix it, if you don’t know how to fix it, then you can’t tell artificial intelligence to fix it for you, because it might give you something that you don’t like.

So, there are definitely different ways. So, I think, first, there are different ways of implementing AI. The first, you have to understand, what is happening in the environment? What is going to happen in a particular workflow? A patient who’s giving you the sample, the sample is taken to the lab, which might be in that hospital or the hospital next door, or a couple of miles away. It’s been diagnosed, and then the report is given back to the provider, or in this case, the doctor. The doctor reviews it and gives you right diagnosis. In this entire process, there are many parameters that can go wrong, and you could be misdiagnosed or mistreated. So how do you ensure these things? If this is tightly coupled and if it’s tightly maintained, the data, if you’re collecting it, then you’re able to apply AI to make it better. But if anything in this entire thing is not properly working, then applying AI might give you wrong information. Garbage in, garbage out. So, it’s very important for you to have a digitized workflow which is properly maintained so that you can apply AI in a proper way and you can have a measurable outcome significantly improving the entire workflow efficiency and helping patients and helping providers to take care of their patients.

Kelly: No, I love that. And I actually took down– when you said PI, the practical intelligence, I really loved when you said that. So, Sam, can you share a real example where operational improvements directly impacted patient care or reduced burnout?

Sam: Oh, yes. So, I’ll give you an example in one of the hospitals, that healthcare we were actually working on. So, I’ll give you anecdotal– I shouldn’t say anecdotal, but without naming names here. One of the health systems where we are working, we showed them our tools where– it’s a big health system. It’s a big hospital that we’re working at. About a 700-bed hospital when they’re coming in. What happens is they collected the sample from one of the patients in the OR room, operating room, when they collected some samples. Millions of samples, thousands of samples that are collected every day, and one of the hospitals was actually doing the same thing. So, whenever you collect a urine sample or a blood sample, they’re supposed to go– based on their diagnosis or what they’re supposed to do, they’re supposed to go to A-lab, any lab, cyto lab, or a molecular lab, etc. It’s a clinical sample. And whenever you have a cancerous or a tumorous sample that they actually have a procedure on you, by giving you anesthesia or collecting them, they actually have to go to certain labs.

We were just standing there and the nurse comes in– not a nurse, but a person who actually picks it up. He put them in the wrong spot. He picked up a sample which was supposed to go to A-lab, he put it in a B-lab, and the B-lab, he put it in A-lab and wrote it down and signed off and left. We were just watching there [inaudible] and I could figure that out. I’m like, “Oh, God, this might be in the wrong space.” It happened. And next day when we went back, and I was curious, and I asked the nurse, “Did you notice that?” And she was like, “Wow, would that happen? I didn’t know that.” She went back and started looking at it, and she caught it. And she tells me that these kind of things do happen. It goes to the wrong place. They don’t know where it is. Well-intentioned, but they’re all stressed out. They’re in a hurry. They write it down in the wrong space. That was one of the things that intrigued me because the intention of the person was not to go wrong, but when they’re writing it down, putting in the wrong bin, it just got routed to a different place.

I’ll give you an example. We were standing in an ER room as well, and there was a patient coming in, and the nurse was actually looking for the tools. There are different kinds of tools that are required to take care of a patient. They couldn’t find it. They were running around. They were actually calling people to see– “Go find me some tools. I don’t have it.” They’re called PAMs. They’re different kinds of tools that they use for this ER. They were not able to find it. So, we showed them how to actually go and look for using the right tools with our technology, and they found it in five minutes. And they were very thankful to us because normally it takes– in a chaotic environment, imagine it takes about three months. Imagine you’re losing keys in your house, if it’s a big house or in your office, and you’re not able to find it. That’s the kind of chaos they have.

So, we provide some technologies around it, which immediately they can go back and look for them. Having these tools, having this right technology to improve the workflow in the hands of the clinician...

Data Stewardship as a Risk Strategy--Protecting Revenue in a Transparent Healthcare Market

Besler Holdings — Tue, 10 Mar 2026 14:26:18 -0400

In this episode, Konstantin Gorelik, HFMA Certified Healthcare Analytics and Operations Consultant, discusses how healthcare finance and revenue cycle leaders can use data stewardship and external benchmarking to proactively reduce compliance, reimbursement, and regulatory risk.

Highlights of this episode include:

What data stewardship means in the context of revenue cycle and compliance risk.
How organizations think about the strategic value of internal and external data.
What proactive monitoring looks like in practice.
How strong data practices make a difference in a high-risk situation.
How finance teams can use data to objectively evaluate issues.
Practical steps toward building a more proactive, data-driven risk monitoring approach.

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Konstantin Gorelik. Konstantin is an HFMA certified healthcare analytics and operations consultant with over 10 years of experience advising hospitals and provider organizations on reimbursement strategy, compliance risk, and revenue cycle performance. He previously served as a managing consultant at BRG, where he led complex claims analysis, payor provider dispute engagements, regulatory assessments, and multi-hospital monitoring initiatives. Konstantin focuses on data stewardship as a strategic tool, helping healthcare leaders translate internal and public data into structured, proactive risk monitoring frameworks that protect revenue in an increasingly transparent and regulated healthcare market.

In this episode, we discuss how healthcare finance and revenue cycle leaders can use data stewardship and external benchmarking to proactively reduce compliance, reimbursement, and regulatory risk.

Welcome, and thank you for joining us, Konstantin.

Konstantin Gorelik: Thanks so much, Kelly. It’s great to be here.

Kelly: It’s great to have you. Well, let’s go ahead and jump in. So, when healthcare finance leaders hear data stewardship, it can sound abstract. So, what does it actually mean in the context of revenue cycle and compliance risk?

Konstantin: That’s an excellent question, and it’s not the first time or the last time that I get that when I start pitching on what exactly the importance of all of this is. Data stewardship is synonymous in my mind and hopefully in the industry as well with intentional management of how data is collected, validated, stored, and used across the organization. So, to that light, it would allow you to connect your finance, compliance, your operations team, and even your clinical documentation team. It’s not just your IT and their analytics team anymore. In our day and age where everything is becoming more interconnected and interoperable and able to be assessed by not only yourselves internally, if you’re a hospital organization, but externally by any type of group that’s taking a look at you, it’s important to have strong stewardship. It ensures that your reports are defensible and not just informative because honestly, many times you’re going to want to get to the beef of why things are happening at an organization. Numbers work, but numbers also need to tell a good story. And poor stewardship office services during audits, litigation, investigations, which you touched upon when you introduced me, and that’s when it’s the most expensive to fix. A lot of organizations will balk at the fact that they might want to invest a little bit more than they probably should upfront. But then once one of those investigations does come down the line, it’s better that they have done this proactively.

Kelly: Interesting. I really like what you said about intentional management of that. That was something I took down because it just kind of stuck with me. You talk about internal and external data. How should organizations think about the strategic value of each when it comes to mitigating financial and regulatory risk?

Konstantin: So when you hear internal and external data, regardless of what type of organizational vertical you’re in within the healthcare space, so if you’re an RCM, if you are a hospital, if you’re a provider, if you’re a biller or a payer, internal data typically will mean what you have in-house and what you have at your fingertips. So that comes in to you and your organization based on your standard course of business. So hospitals have a little bit of a different flow than maybe a payer would, but the bread and butter of this for hospital finance leaders would be like your revenue cycle data, your claims analytics, all of your metrics that have to do with your dollars and your cents and your bed counts and all the utilization that you have there. It allows you, when you’re internally investigating, to contrast your claims and billing data with past trends and essentially live in a closed container. External data is everything that’s out there in today’s world that wasn’t something that was mainstream maybe 10, 15 years ago, but is now. That includes implementing CMS’s public data sets, which include cost report data. We now have transparency in coverage, which is the payer side of price transparency, which this administration has really flaunted as a way to get transparency for patients. You have hospital transparency data, which is the other side of that type of data, which is the hospitals posting their charges and how much things cost.

And so you have these two juxtapositions of internal and external data, and risk emerges in the gap between your internal performance, which is that closed container of how am I doing this month? How am I doing this year? How many claims did I see this year versus last year? That internal performance, in comparison to external benchmarks is, like I just said, where the risk emerges because you might have a very good view of your own world and your own realm, but if you’re not conscious of everything around you and how you sit relative to peers in the market, you’ll end up in that risky pool, as I like to call it. And external data is particularly powerful for benchmarking, like I mentioned. So, figuring out where you sit as an organization, whether you’re a hospital, a provider, a smaller entity, a health center, whatever it is, versus peers in the market, whether that’s in your area or abroad, also helps you identify outliers. So, if you guys have some sort of– there’s so many outliers that I could probably name off. But for example, you’re identifying conditions that have higher complications than maybe others do in the market for the same one. Like your knee replacements for some reason are 10 times more likely to be complicated.

Those are types of things that maybe internally you, as your organization, can contextualize and understand, but when an auditor or the government is looking at that, they’re going to have questions and those are going to come down the line for you. And when they start asking questions, you got to know how to defend yourself there. And the last piece that external data is very powerful for is, like I said, so it supports or defends your reimbursement position. So context is everything in today’s world, and data is amazing, and there’s so much of it, and it’s beautiful to be able to access all of it, but contextualizing it and marrying it up so that there’s a story to tell will be incredibly beneficial in the years to come as other organizations, namely the government, become more tech-savvy and more proactive with their monitoring and strategy into finding fraud, waste, and abuse.

Kelly: That makes a lot of sense. Thank you for that explanation. Many organizations are still reactive, responding when an audit lawsuit or denial trend appears. What does proactive monitoring look like in practice?

Konstantin: That’s a good question. So, to understand proactive monitoring, you have to also understand reactive monitoring, and reactive in the context of these investigations and things that I’ve been a part of are responding after your denials, for example. So, you have a way that you’ve been billing as an organization for five years, the policies change, you don’t change anything, and then all of your money is hung up in a denial pool. And then now you have to figure out, well, what’s going on here? That’s one way where the reaction comes in. You also have a whistleblower claim that could come in. So that’s your qui tams, for anyone listening who’s in the compliance side of hospital finance, as well as payer disputes that come in. So those are ones that we’ve seen publicly. I live in Massachusetts. We had a public article posted about a dispute between Blue Cross Blue Shield and UMass Memorial Hospital. And those disputes are something that could have been solved privately out of the view of the public if proactive monitoring took place, which sets me up nicely to tell you what proactive monitoring really is.

So that involves routine monitoring of patterns that regulators and payers already analyze. So, I want to let that sink in for anyone listening here. Examples of that would be length-of-stay outliers, unusually high units or charges for certain services, services that frequently trigger outlier payments for anyone in the revenue cycle space. A lot of your contracts will be paid– or, sorry, excuse me, not a lot of your contracts, but generally, there are going to be contingencies in there where, if you have an outlier case, you get paid a certain different rate. We’re seeing in the market and over the past few years, at least in my work with other clients as well, that that triggering of an outlie...

The Shift in ACA Enrollment is Driving More High Deductible Health Plans

Besler Holdings — Tue, 03 Mar 2026 16:26:52 -0500

In this episode, Tom Furr, CEO and Founder of PatientPay, discusses how the Shift in ACA enrollment is driving more high deductible health plans.

Highlights of this episode include:

How the reduction in ACA enrollment numbers are affecting out-of-pocket payments
How should providers prepare for this change in coverage
Long-term projections

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Tom Furr. Tom is the CEO and founder of PatientPay, the leading patient payments partner for acute, ambulatory, and specialty care organizations. Prior to founding Patient Pay, Tom was the CSO and COO and board member at MobileSmith Health. He was also a co-founder and president of Kinetics Inc., an early online commerce provider for small businesses with partners such as Wells Fargo, First Union, and Netscape. In this episode, we’re discussing the shift in ACA enrollment and how it’s driving more high-deductible health plans. Welcome, and thank you for joining us, Tom.

Tom Furr: Hey, thanks for having me, Kelly.

Kelly: All right, well, let’s go ahead and jump in today. So how is the reduction in ACA enrollment numbers affecting out-of-pocket payments for providers?

Tom: Yeah, obviously, the Affordable Care Act was in the media a lot back in December. And so, it kind of got me thinking of, well, if these people leave the ACA, does that mean they’ll be uninsured, or do they move back to the employer insurance? And so, I started looking at the data out there and it’s quite interesting. It’s obviously, as of, I think, a week or so ago– and these are all numbers from Google Gemini. So, if they’ve changed, blame it on Google. But there was about 1.4 million people that had– or 1.2, 1.4 million that had left the ACA. And the ACA has kind of grouped within the private insurance market. And so, the private insurance market had been growing from ‘24 to ‘25. It was up about 1.4 million folks that were subscribing to insurance and are paying for insurance. And so, the question is, if they’re uninsured, there’s a different way to approach it if you’re a hospital or you’re an ambulatory group or what have you. If it’s insurance, what is that insurance going to look like? And so, what the numbers, the stats are looking at right now is, at least according to Google Gemini, so don’t blame me, the folks that are dropping off of the affordable moving over back to business insurance. Now, not all of them, obviously, but a vast majority of them. So, then the question is, okay, if all of these people are moving over to back to their employer-sponsored insurance plans, and are they all jumping into a fully high-end insurance plan? Is it a high-deductible plan? And because dealing with that versus uninsured, now you got to deal with claims and adjudication, and then you can only start billing at that point, or trying to do estimations on the front end of any services that are rendered.

And it was the numbers…I found them very interesting, at least on the high-deductible plans that are out there. And in 2024, there was give or take 27 to 29% of covered lives were using a high-deductible plan. That number grew to 33% in 2025. So, it was up, call it, 4 or 5%. And the estimation is now with more people moving over to their employer-sponsored insurance, that the companies now are having to find a way to help control costs in healthcare. And right now, it’s estimated it’s going to grow at least 20% in 2026. So, you could have upwards of 40% of people in employer-sponsored health plans now using high-deductible plans. And the other interesting stat was that 59% of employers out there are trying to find ways to control costs, unfortunately. And this is one of the ways to do it. So, it has been kind of an eye-opening experience because PatientPay obviously helps medical groups, hospitals, other folks in healthcare collect more dollars. And if you’re doing it on an uninsured patient, you want to catch them before they come in, you want to offer discounts, you want to incent them to do it. But if they’re moving to high-deductible plans, there’s a different strategy more on the back end, some on the front end with estimation. So, we’ve been digging into the numbers, and it’s been, to be honest, really quite eye-opening compared to the narrative that was kind of given back in December of last year on the potential that could happen with the shift in the Affordable Care Act. A lot of numbers, so I’m sorry to bore you with all the stats and everything.

Kelly: No, no, I mean, those are great numbers. I mean, it is very eye-opening. I have a high-deductible plan, so I can totally understand what you’re saying. But how should providers prepare for this change in coverage?

Tom: Well, that’s the next thing is, as we know, deductibles are becoming more and more a larger part of the dollars that are paid to providers out there. And the individuals now as a standalone, the largest payer into the system of healthcare, assuming you look at individual versus UnitedHealthcare versus Blue Cross and so forth and so on. So, there are lots of areas that need to be addressed in healthcare that, to be honest with you, haven’t been because they didn’t need to, but it’s continuing to become a material part of healthcare. And there’s a couple things that are necessary when it comes to the patient. And one, front and center is clinical care, and to have the best clinical care is priority number one. But priority number two is having a good experience with this portion of it. And for younger folks out there, you see that they are very interested in being able to pay things easily, understand bills, all the different components of what they live in outside of healthcare, right? They are able to go to Shopify to buy stuff. They’re able to do Instagram and buy stuff. I mean, it’s just a part of their day in life that allows them to, if they want to buy something, they can buy it. They can buy it easily. They don’t have to get checks out or get paper statements in the mail. And so, it’s important that medical groups and hospitals allow for patients, one, to understand going in with their eyes wide open on sort of what’s going to be expected of them. It’s kind of like when you take your car in to get fixed. You don’t know exactly what it’s going to be, but at least you have an idea of what it’s going to look like.

And then have an easy way for patients to pay these bills that can be through payment plans, electronically, all the different areas that help them to handle, quite frankly, some big bills. And it’s not that people don’t want to pay, not everyone, of course, but most people want to pay their healthcare bills. There are challenges when it comes to understanding those bills. There are challenges when it comes to paying those bills. There are all kinds of challenges. So, to make it as frictionless as possible for them to understand the bill and to make it as frictionless as possible for them to pay the bill in whatever manner they have. And as you know, Kelly, if you have a high-deductible plan, you most likely have an HSA account with it, hopefully, because it’s tax-free. And you also know that you have limited dollars that are put onto that by hopefully you and your company. So even though they want to pay $1,000 bill, they might only have $200 a month on that card that they can pay towards that. So, they might need a six-month payment plan to accommodate that. And so, to be able to help the patient, one, understand the bill. And one of the things that one of our groups uses, they allow us to integrate the EOB into the patient bill. So now you’re looking at your insurance EOB, you’re looking at your bill, you go, “Okay, these match up, check.” I understand I owe it. Number two, I have an HSA card. Do I even know how much is on this HSA card? So, to give them the ability to understand the total dollars on that card is important. And then three, to give them the ability to pay it based on the limited dollars that are put onto that card each month.

All of these things sound simple, but in healthcare today, it’s pretty challenging. And to be honest with you, I have the HSA card. I have a high-deductible plan. And inevitably, my wife will call me and say, “Can I use this card? Because I don’t want it to, quote-unquote, ‘bounce’?” It’s just you don’t have enough money on it. Right. So I have to log in, look it up. Then I call her back and I say, “Yeah, it’s only a $500 bill. We have it in there.” But if it’s a much larger bill than that, we might not. So, it’s a complex world out there in healthcare and to try and make it as easy to understand and easy to pay is kind of, we feel, mission critical.

Kelly: Completely agree. And I love what you said about making it as frictionless as possible. I can totally support that. So, what are the long-term projections for patients signing up for these high-deductible health plans?

Tom: Yeah, the assumption is that they could be at 50% of the total market within the next three years or so, at least from what I’m seeing. And the expectation is it’ll continue to grow from there. So, it’s a material part of the medical group’s dollars that they collect. And as you know, if you’re a primary care group, you’re now having to collect these dollars because the patient potentially hasn’t hit their deductible yet earlier in the year. And later in the year, you don’t have as much challenging in some instances. But it’s definitely an area that is growing and will continue to be challenging based on the complexities of healthcare. But there are ways to simp...

How Patient Safety is Evolving as a Strategic and Financial Priority

Besler Holdings — Wed, 25 Feb 2026 03:55:41 -0500

In this episode, Dr. Larry Van Horn, Chief AI & Analytics Officer at Sentact, discusses how patient safety is evolving as a strategic & financial priority.

Pharmacy Purchasing and Supply in the New 340B Paradigm

Besler Holdings — Wed, 18 Feb 2026 03:54:38 -0500

In this episode, AJ Rivosecchi & Lauren Forni with Bluesight, discuss pharmacy purchasing & supply in the new 340B paradigm.

Occupational Mix Survey--Preparing for the CY 2025 Cycle Webinar

Besler Holdings — Wed, 11 Feb 2026 03:56:31 -0500

In this episode, Cody Bales shares info on BESLER's free Webinar, Occupational Mix Survey: Preparing for the CY 2025 Cycle, live on Wed., Feb. 18, at 1 PM ET.

The Future of Medical Operations--Efficiency, Empathy, and Virtual Teams

Besler Holdings — Wed, 04 Feb 2026 03:09:06 -0500

In this episode, Timothy Boyle, Director of Sales and Business Development at REVA Global Medical, is discussing the future of medical operations, efficiency, empathy, and virtual teams.