April 23, 2025 • 25 mins
What does successful RCM outsourcing look like in 2025? In this episode, Daniel Williams speaks with Chuck Rackley and Marvin Luz of Greenway Health about the evolution of revenue cycle outsourcing — from transactional support to fully integrated partnerships that deliver performance, accountability, and improved patient financial experiences.
Chuck and Marvin share best practices for evaluating outsourcing partners, measuring ROI and compliance, and aligning technology to reduce denials and boost efficiency. They also provide guidance for practices hesitant to outsource and explain how to maintain transparency, visibility, and control throughout the process.
Key Discussion Points
- [01:30] Marvin and Chuck share their career backgrounds in healthcare RCM
- [03:00] How RCM outsourcing has shifted toward strategic, tech-enabled partnerships
- [05:45] Why confusing and delayed patient statements impact satisfaction and collections
- [07:00] What to evaluate when selecting an outsourcing partner: expertise, transparency, tech, and ROI
- [12:00] Greenway’s five-step compliance process for adapting to payer and regulatory changes
- [14:00] The key KPIs to track: clean claim rate, days in AR, denial rate, and cash collections
- [17:30] Addressing misconceptions about outsourcing, including transparency and control
- [20:00] The growing role of AI and automation in RCM operations
- [23:30] Advice for practices considering outsourcing in 2025
- [25:00] Why communication, alignment, and references are critical for a successful partnership
Resources:
- Learn more at the Greenway Health website
- Explore Greenway Revenue Services
- MGMA Stat Poll: Outsourcing and Automating RCM in 2025
- Connect with Chuck Rackley on LinkedIn
- Connect with Marvin Luz on LinkedIn
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network.
Today, we're gonna be looking atthe topic of out sourcing
revenue cycle management. And tohelp us walk through that and
unpack that topic are twoexperts from Greenway Health.
Today, we've got Chuck Rackley,vice president of sales and
(00:26):
revenue operations, and MarvinLuz, senior director of revenue
consulting.
First of all, Chuck, Marvin,welcome to the show.
Marvin Luz (00:35):
Thank you for having us. Happy
Chuck Rackley (00:38):
to be here, man. Thank you.
Daniel Williams (00:39):
Yeah. It's great having you here as well.
So first of all, let's just takea step back before we get deep
into that topic and just learn alittle bit about each of you. I
don't know who wants to kick offfirst, but I'll turn it over to
you guys and just share a littlebit of your background into
health care and what else youmight wanna share about your
(01:00):
career trajectory.
Chuck Rackley (01:02):
Sure. I'll go first, Marvin, if that's okay.
Let's have the better better guyfor for a second. So, my my
career is split pretty much downthe middle. I have I have a
little bit of experience in bothsides of the coin.
So I've started the career onthe provider side. I worked for
a very large hospital networkcalled HCA. I'm sure everyone's
heard of that one. Andeventually matriculated over to
the dark side of the force, andI joined the the vendor partner
(01:25):
side around 02/2014. I had a lotof different roles, everything
from operations, FP and A,advisory, implementation, and
eventually into sales and salesleadership and on into the
executive roles.
So had a lot of different timeall in revenue cycle, but ended
up in the place I'm supposed tobe here at Greenway with my good
(01:46):
friend Marvin. Go ahead, Marvin.
Marvin Luz (01:49):
Sure. So I've been in the industry about twenty
four years. The first four yearsor so was actually working at a
private practice and thenjoining organizations like
Greenway for the past aboutfourteen years dealing
specifically with revenue cyclemanagement, both from an
(02:13):
operational perspective,advisory perspective. And, now I
get the privilege of leading ourour consultant team here at
Greenway.
Daniel Williams (02:23):
Alright. Chuck, let's turn back to you then.
Give us, first of all, just ahigh level overview of what RCM
outsourcing looks like today.
Chuck Rackley (02:33):
Yeah. It's a good question to start with, Daniel,
because it's really changed inin in our experience over the
last several years. At a highlevel, you know, RCM today looks
a lot different than it did evenjust a few years ago. It's no
longer just about, you know,just sending out claims to a
partner, hoping someone elsehandles it. What we're seeing
now is a much more strategicpartnership that's expanding
(02:57):
very, very rapidly.
So we're outsourcing partnersare leveraging, you know, not
just the normal technology, butthey're really taking a step
forward in the marketplace,leveraging AI analytics. And
really the most important thingis specialized expertise and
scale. That's really going todrive that both the financial
and the operational performancethat people are looking for. You
(03:19):
know, for practicesspecifically, that means moving
away from that burden ofstaffing, training, managing an
internal billing team,especially when that the
turnover is so high these daysand just keeping people on
staff. Add that to theregulatory environment that's
constantly changing.
Instead of that, with a partner,they're able to tap into that
(03:39):
scalable team that can go up anddown depending on what volumes
are, whether you add a doc hereor lose a doc here. Very much
more efficient, more accurate.And most of the time, these
partners are better equipped tohandle that everyday rigmarole
of authorization eligibility allthe way through denial
(04:00):
management and bad debt. So it'sa much different marketplace
than it was even a few yearsago. As for the why behind that
trend, it's pretty simple.
So practices are are reallyunder more pressure than ever
from both regulatory and, moreimportantly, the payers.
Reimbursements tighten everysingle year. We see a new trend
(04:21):
every year on what denials looklike. It gets harder to keep
people on staff. You have HobbyLobby or McDonald's coming to to
pillage your your staff everysingle year, it seems like, for
a couple dollars more.
Daniel Williams (04:33):
Mhmm.
Chuck Rackley (04:34):
And when when you have the right RCM outsourcing
partner, when done right, it canhelp practices stay financially
healthy without sacrificing thatclinical focus. And that that's
where Marvin and I really try tomake the difference.
Daniel Williams (04:47):
Okay. Marvin, let's turn to you then. Let's
look at it through the lens ofthe patient's financial
experience and satisfaction. Sowhen you look at it through that
lens, what does that mean to dothat outsourcing, that
partnership, really with the thepatient, the customer in mind?
Marvin Luz (05:08):
Yeah. This is a topic I'm very passionate about,
Daniel. So, one of the thingsthat drives patient
dissatisfaction, in my opinion,is patient statements. They can
be confusing, inaccurate, andnot timely. This trifecta not
only erodes at a patientsatisfaction level, but also it
(05:29):
contributes to potential revenueleakage for a practice.
Look. With more and morepatients having high deductible
plans, more and more of thefinancial responsibility is
falling on patients. It'simperative that patient
statements are accurate, timely,and easy to understand. When
(05:50):
partnering with a revenue cyclemanagement organization, I would
recommend fully understandingtheir patient financial
experience. What are theirworkflows and processes?
And what is their philosophy oninteracting with your patients?
At the end of the day, we're allpatients. Put yourself in their
(06:10):
shoes and review things fromtheir lens. One of the things
that I'm most proud of withGreenway Revenue Services is how
our people treat patients withempathy and understanding. This
goes a long way for for patientsatisfaction.
Daniel Williams (06:28):
Yeah. Marvin, I love that you said that to put
ourselves in the patient's shoesbecause we're all patients at
one time or another. So to beable to empathize with that, to
be able to see it through theireyes, because we're all patients
as well, then we get a betterunderstanding of what that would
look like. So thank you forsharing that. Chuck, I'll move
(06:49):
to you then.
When we talk about, outsourcing,you gotta do your due diligence.
So what are the steps, aprovider should take in really
studying those options out thereand what are the steps they
should make too so they can makethe best decision possible?
Chuck Rackley (07:11):
Yeah. Awesome question. Marvin and I see this
all the time where people make avery reactive choice to start
this process. It's usually donein haste because something has
happened. There's someonethey've lost or there's some,
you know, very critical factorthat's happened.
But one thing people usuallyskip as administrators is
(07:32):
sitting down with their theirleadership and understanding
what the specific internalchallenges are and what the
goals are, more importantly,what they wanna get out of that
partnership. So is are theytrying to get down their denial
rates? Do they have slowcollections? Do they have
staffing issues?
Marvin Luz (07:49):
Are are
Chuck Rackley (07:49):
you just want more predictive predictability?
So there there's lots of thingsthat people complain about, but
it's rare that people get realfocused on what they
specifically wanna get out of apartnership. So the next thing
is they really need to startevaluating on four major things
that that Marvin and I reallyfocus on when working with new
(08:10):
practices. The four things areexpertise of the of the partner.
So and this goes beyond, youknow, do do you have the ability
to collect money?
This goes into specialtyspecific. So there there are so
many specialties out there thatreally require an in-depth
knowledge and experience. Sothings like anesthesia and, you
(08:34):
know, neurosurgery are not thesame things as pediatrics and
family practice. So just becauseone one vendor does incredibly
well with one means zero for howthey will do with the other. And
it's really important to matchthat expertise with what your
practice is looking for.
The second thing is ontransparency. The thing you
(08:54):
wanna avoid here is if if you'rein a vendor situation where
they're just sending you a bunchof reports and they've got these
these decks at the end of themonth that are 70 pages long,
and you and you're yawning
Daniel Williams (09:06):
Yeah.
Chuck Rackley (09:06):
Halfway through. Like, that's where you not want
you don't wanna be there. Sosomeone's just reporting the
news back to you, that's wherepeople go that's where the deals
go to die. So you want someonethat's really giving insights to
your business and that's reallymoving you forward. The third is
is on technology.
And you can lump a lot of thingsin here, your AI, your machine
(09:27):
learning, the general technologythey have for follow-up and
submission. All those thingsneed almost I evaluate those on
a a completely separate basis onhow they're doing that. And the
fourth thing, and I specificallyput this fourth because I a lot
of people go here first, It's onprice and ROI. So a lot of
(09:49):
people will make this decisionjust on price. And I can't tell
you how many times Marvin and Ihave lost a deal because of
price, and they go to someoneelse.
And, uh-oh, it didn't work. Andnow we're down worse than we
were before, and they come backto us. So that happens all the
time. So you have a lot of theseand and forgive me for saying,
(10:12):
but the regional mom and popplayers that really try to just
buy business a lot of times, andthey end up hurting the
practices more than than theyneeded to get into. So it is
important, but it's important tomarry price with what the ROI is
out of that.
So price is one component, butmake sure you're not missing the
forest for the trees. That's thebiggest thing.
Daniel Williams (10:33):
Alright. Thank you for that. Marvin, one other
aspect to look at when you'relooking at outsourcing that RCM
component is the compliance sideof it. So what are some of the
indicators that a providershould be looking at, from a
compliance side? And perhaps ifyou wanna share what, Greenway
(10:54):
is doing in that regard as well.
Marvin Luz (10:57):
Yeah. Sure. So ensuring that billing stays
aligned with, you know, payerrequirements, and and regulatory
requirements is a full time jobfor a team. Right? So at
Greenway, not only does thisresponsibility, lie with our
(11:17):
business excellence team, buteveryone at Greenway is focused
on ensuring that we stay alignedwith payers and regulatory
requirements.
Our team uses several differentresources, right, from payer
notifications and bulletins toreviewing payer websites and
portals and manuals. So oncewe've identified any changes
(11:40):
that are needed, we then createwhat we call our standard
operating procedures. Once wehave those standard operating
procedures, then we provide thattraining to the appropriate team
that's affected. Then onceeveryone is trained, we
follow-up with quality assuranceprocedures to ensure adherence
(12:00):
to that as well. Right?
So we have five easy steps. One,identify the change. Two,
determine the relevance and theimpact. Three, document the
action that's needed to addressthat change. And then four,
train the appropriate teammembers.
And then finally, following itup with quality checks, again,
(12:22):
ensuring compliance to thosechanges.
Daniel Williams (12:26):
Chuck, I wanna come back to you. Now let's
assume that you've done all yourdue diligence as a provider. You
have found your outsourcingpartner for your RCM. It's in
place. Now you gotta measure it.
You gotta make sure that thingsare working. What are those
(12:49):
KPIs? What are you measuring?What are you looking at to make
sure that relationship isworking?
Chuck Rackley (12:55):
The best way to think about this in our
experience has been think aboutthe path of cash along the way.
So what is stopping this frombeing paid and being paid as
fast as possible? So, a, let'sstart with the end of the path.
What is the cash? So a lot ofplaces really struggle with
putting a number on what shouldI have been paid.
(13:19):
What is the amount of cash Ishould get every month? And
there are a myriad of cashcollection goals or formulas out
there. There's there's lots ofthem. There's the GCR rates
people use. Some people use NCR,so net collection rate versus
gross collection rate.
I've seen people do a price tocharge ratio goal. Some some
(13:41):
more sophisticated practiceshave a contract management
system where they're actuallyable to determine the allowable
on every single claim. That'llbe the most accurate, but not a
lot of practices can't affordthat kind of system. But having
some sort of goal that youmeasure yourself against and
measure, more importantly, yourpartner against is the first
thing that I always look at. Ilook at it every single day as
(14:04):
an operator.
What is happening from a cashperspective? Am I on track? Am I
below track? Am I ahead?Etcetera.
Second part of that, you go backto the beginning. What is
stopping my claims from goingout the door, and how are they
being adjudicated? So the bestone to look at there is clean
claim rate. What is goingthrough the door without anyone
(14:24):
touching it and beingadjudicated first time at bat?
So, obviously, you wanna be asas high as possible there.
The best practices we have arearound that 95% rate, some a
little higher, some a littlelower, but you wanna be up
there. Third one would be somesort of AR measure. So whether
that be days in AR or aging over90 or one twenty or whatever it
(14:49):
is, that but to have some sortof AR measure so where you can
make sure your balance sheet isin check and and ensure that you
have proper cash collectionmetrics going on there. Last but
not least here is denial rate.So you wanna measure your
initial denial rate that you'regetting from the payers.
So this is that firstadjudication back. You're seeing
(15:09):
what was denied and measuringagainst both your dollar and
your count of your grosscharges. So a really, really
good practice is gonna come inthere around seven to 8% of an
initial denial rate. We've seensome as low as two and three,
and we've seen some as high as25 or 30. But what's more
important there is how you lookat that denial rate to ascertain
(15:30):
what's causing them so you canreally get down to the root
cause.
Other than that, so if youmeasure that that path to cash,
so your clean claim rate,something in AR, so be it days
or or aging, your denial rate,and ultimately, what cash did
you get versus what you shouldhave gotten. That's where you
need to be measuring.
Daniel Williams (15:48):
Thank you for that. Let's come back to you,
Marvin. You're really focused onbuilding those relationships,
with those providers. Whenthey're looking at outsourcing
their RCM, what are some of themisconceptions you're seeing
that they may have about thoseoutsourcing partners, and how do
you overcome those?
Marvin Luz (16:09):
It's a great question. Because I I feel like
one of the most frequentmisconceptions that I know Chuck
and I encounter is thatpractices will lose visibility
and control, and especiallyaround quality and
accountability. Now can thathappen? Sure. Absolutely.
(16:30):
But that's where it's criticalto partner with the right type
of revenue cycle vendor. Now atGreenway, we do all of our work
within our client system. Theclient system remains the source
of truth for our clients. Right?Documentation on the actions
(16:51):
we're taking provide visibilityand transparency to our clients.
At any time, clients can viewthe work and actions our team
members have taken on the work.Having quality reporting like
Chuck mentioned earlier, thatprovides insight into financial
(17:13):
health of our clients, helpsprovide the visibility and
control that practices need inorder to run a successful
practice. Now having a partnerthat sits down with leaders of a
practice to understand thepractice's short term and long
term goals, that also ensuresaccountability is part of the
(17:38):
partnership of your revenuecycle management organization.
Daniel Williams (17:43):
Alright. Couple of questions I'd like to ask
y'all before we sign off today.I wanna come back to you, Chuck,
and I feel like it would be adisservice to be talking about
RCM in 2025 without talkingabout the impact technology has
on it. I mean, I think in everyconversation we have, there's
(18:04):
automation, there's AI, there'smachine learning. So let's
really talk about that, Chuck.
When we look through that lensof technology and transforming
outsourced RCM, how technologycan play a role there. Talk
about that.
Chuck Rackley (18:20):
Yeah. For sure. And this is such a great point
because we spend, I would say,75 to 80% of our time internally
working on what is the nextthing we can bring to this
market. And all of it has to dowith automation and AI. It's
completely reshaping how wethink about RCM at Greenway and
(18:41):
how the overall market is reallygoing after this.
So traditionally, RCM has beenthat manual labor intensive
process. Just think about allthe hours we used to spend
checking eligibility one at atime, you know, checking claim
status one at a time or evenappeals for the most part now.
So with automation in AI, we'reable to take a lot of that
(19:03):
repetitive work and and dumpthat to a bot or some sort of
agent as it were. Sotraditionally like, for example,
bots can now verify insuranceeligibility in seconds. You have
manual interfaces with all sortsof payers.
They can flag missinginformation before claims are
(19:24):
submitted and even post paymentsautomatically. That's happening.
That's been around. But whatreally separates what's been
there versus what's going upforward is when we get into that
agentic AI, that's really takeninto the next level, which is
really cool to be around rightnow because now we're starting
to see AI agents actually makingcalls to insurance companies.
(19:47):
We're seeing AI agents takescheduling from patients.
We're seeing automatic languagelanguage processors really look
at what a denial is and figureout what what to pull from the
medical record in order tosubmit an appeal. And even some
on the authorization side too,which has been kind of the the
the the holy grail for a longtime. How do we automate
(20:10):
authorizations? And AI evensteps takes that a step further.
So it's not just about speed.
It's about what intelligence itcan bring back to you too. So AI
tools can analyze patterns that,you know, even professionals
like myself and Marvin won'tsee. They can predict what
claims are gonna be at risk andrecommend that proactive
proactive step to get there evenbefore a human even sees it. So
(20:34):
there's a lot of stuff that wecan do now that was the moon to
us even a year ago. For ourproviders, most importantly,
that translates into that higherclean claim rate that we talked
about Mhmm.
Faster payments, reduced price,reduced spend, and reduced time
that they spend looking at thisso they can actually go focus on
their patients. So in short,technology is gonna is gonna
(20:56):
continue to transform RCM rightnow. It's a really exciting time
to be in the in the in themarket. I probably say that
every year because somethingelse cool has come along. But
now now this is really, reallyneat, what we're seeing.
And I think it's gonna be a big,big change that we see going
forward in the marketplace forsure. You're gonna have better
control, more visibility, andbetter financial results, and
(21:20):
with less workload. That'sthat's that's where I see it.
Daniel Williams (21:23):
Alright. Thank you for that. I have one last
question. So, Marvin, I'll turnto you. We had a November MGMA
stat poll.
Our our listeners will knowabout those MGMA stat polls.
This one, I wanna get thisright, it found that 36% of
medical groups will outsource orautomate at least part of their
(21:44):
revenue cycle in 2025. So what'syour advice for practice leaders
who are still hesitant aboutoutsourcing?
Marvin Luz (21:53):
I'm gonna try to recap what what we've talked
about today because I thinkthere have been some some great
pieces of information today. SoI I would say first, understand
what your objectives are as anorganization. That's critical to
your success. Secondly,understand where your practice
(22:14):
is in its financial healthjourney. Right?
Mhmm. Third, vet your potentialpartner to ensure that your
goals, your values, and yourobjectives are aligned with that
partner. Fourth, I would saypartner with a vendor who's an
(22:35):
expert in your system andunderstands how to utilize its
functionality to the fullest.Fifth, have biweekly, weekly,
monthly meetings with yourvendor to understand challenges
and utilize that time tocalibrate on any upcoming goals
(22:56):
or changes in your practice. Andfinally, and I think Chuck will
agree with this onewholeheartedly, is communicate,
communicate, communicate.
That's the key to a successfulpartnership with your revenue
cycle vendor.
Daniel Williams (23:14):
Alright. Well, Marvin
Chuck Rackley (23:15):
Daniel, can I add one more?
Daniel Williams (23:17):
Please. Oh, please do. Please do.
Chuck Rackley (23:19):
And and this is one that we find very, very
helpful. Don't ever be afraid toask to talk to other people. So
if if you're if you're nervousabout how to partner with
someone, ask for a referencethat you can actually get in
there and and see what's theirresponsiveness. You know, what's
their reporting like? What'stheir performance been?
(23:40):
And even the ones that so Marvinand I use a lot of references
for different things, but it'snot all beautiful even with the
references that we choose.
Daniel Williams (23:49):
Yeah.
Chuck Rackley (23:49):
So don't be afraid to ask for that. It would
be my last little bit of advicehere. And that goes for when
you're picking a provider andespecially for the people that
are a little nervous aboutoutsourcing. Talk to other
people that have done it and seehow it went.
Daniel Williams (24:03):
Alright. Well, Chuck, Marvin, thank you so much
for joining us today.
Chuck Rackley (24:08):
Our pleasure.
Marvin Luz (24:09):
Thank you for having us.
Daniel Williams (24:11):
Alright, everybody. That is gonna do it
for this episode of the MGMABusiness Solutions Podcast. We
have been joined today by ChuckRackley and Marvin Luz from
Greenway Health. They've beensharing their expertise and
giving us a deeper look at thebenefits, challenges, and future
of outsourcing your revenuecycle. So until then, I just
(24:34):
wanna let everybody know we aregonna put direct links in the
episode show notes so you canclick through to some of these,
practices and processes thatMarvin and Chuck have been
talking about.
So I just wanna thank everybodylistening for being MGMA podcast
listeners.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network.
Today, we're gonna be looking atthe topic of out sourcing
revenue cycle management. And tohelp us walk through that and
unpack that topic are twoexperts from Greenway Health.
Today, we've got Chuck Rackley,vice president of sales and
(00:26):
revenue operations, and MarvinLuz, senior director of revenue
consulting.
First of all, Chuck, Marvin,welcome to the show.
Marvin Luz (00:35):
Thank you for having us. Happy
Chuck Rackley (00:38):
to be here, man. Thank you.
Daniel Williams (00:39):
Yeah. It's great having you here as well.
So first of all, let's just takea step back before we get deep
into that topic and just learn alittle bit about each of you. I
don't know who wants to kick offfirst, but I'll turn it over to
you guys and just share a littlebit of your background into
health care and what else youmight wanna share about your
(01:00):
career trajectory.
Chuck Rackley (01:02):
Sure. I'll go first, Marvin, if that's okay.
Let's have the better better guyfor for a second. So, my my
career is split pretty much downthe middle. I have I have a
little bit of experience in bothsides of the coin.
So I've started the career onthe provider side. I worked for
a very large hospital networkcalled HCA. I'm sure everyone's
heard of that one. Andeventually matriculated over to
the dark side of the force, andI joined the the vendor partner
(01:25):
side around 02/2014. I had a lotof different roles, everything
from operations, FP and A,advisory, implementation, and
eventually into sales and salesleadership and on into the
executive roles.
So had a lot of different timeall in revenue cycle, but ended
up in the place I'm supposed tobe here at Greenway with my good
(01:46):
friend Marvin. Go ahead, Marvin.
Marvin Luz (01:49):
Sure. So I've been in the industry about twenty
four years. The first four yearsor so was actually working at a
private practice and thenjoining organizations like
Greenway for the past aboutfourteen years dealing
specifically with revenue cyclemanagement, both from an
(02:13):
operational perspective,advisory perspective. And, now I
get the privilege of leading ourour consultant team here at
Greenway.
Daniel Williams (02:23):
Alright. Chuck, let's turn back to you then.
Give us, first of all, just ahigh level overview of what RCM
outsourcing looks like today.
Chuck Rackley (02:33):
Yeah. It's a good question to start with, Daniel,
because it's really changed inin in our experience over the
last several years. At a highlevel, you know, RCM today looks
a lot different than it did evenjust a few years ago. It's no
longer just about, you know,just sending out claims to a
partner, hoping someone elsehandles it. What we're seeing
now is a much more strategicpartnership that's expanding
(02:57):
very, very rapidly.
So we're outsourcing partnersare leveraging, you know, not
just the normal technology, butthey're really taking a step
forward in the marketplace,leveraging AI analytics. And
really the most important thingis specialized expertise and
scale. That's really going todrive that both the financial
and the operational performancethat people are looking for. You
(03:19):
know, for practicesspecifically, that means moving
away from that burden ofstaffing, training, managing an
internal billing team,especially when that the
turnover is so high these daysand just keeping people on
staff. Add that to theregulatory environment that's
constantly changing.
Instead of that, with a partner,they're able to tap into that
(03:39):
scalable team that can go up anddown depending on what volumes
are, whether you add a doc hereor lose a doc here. Very much
more efficient, more accurate.And most of the time, these
partners are better equipped tohandle that everyday rigmarole
of authorization eligibility allthe way through denial
(04:00):
management and bad debt. So it'sa much different marketplace
than it was even a few yearsago. As for the why behind that
trend, it's pretty simple.
So practices are are reallyunder more pressure than ever
from both regulatory and, moreimportantly, the payers.
Reimbursements tighten everysingle year. We see a new trend
(04:21):
every year on what denials looklike. It gets harder to keep
people on staff. You have HobbyLobby or McDonald's coming to to
pillage your your staff everysingle year, it seems like, for
a couple dollars more.
Daniel Williams (04:33):
Mhmm.
Chuck Rackley (04:34):
And when when you have the right RCM outsourcing
partner, when done right, it canhelp practices stay financially
healthy without sacrificing thatclinical focus. And that that's
where Marvin and I really try tomake the difference.
Daniel Williams (04:47):
Okay. Marvin, let's turn to you then. Let's
look at it through the lens ofthe patient's financial
experience and satisfaction. Sowhen you look at it through that
lens, what does that mean to dothat outsourcing, that
partnership, really with the thepatient, the customer in mind?
Marvin Luz (05:08):
Yeah. This is a topic I'm very passionate about,
Daniel. So, one of the thingsthat drives patient
dissatisfaction, in my opinion,is patient statements. They can
be confusing, inaccurate, andnot timely. This trifecta not
only erodes at a patientsatisfaction level, but also it
(05:29):
contributes to potential revenueleakage for a practice.
Look. With more and morepatients having high deductible
plans, more and more of thefinancial responsibility is
falling on patients. It'simperative that patient
statements are accurate, timely,and easy to understand. When
(05:50):
partnering with a revenue cyclemanagement organization, I would
recommend fully understandingtheir patient financial
experience. What are theirworkflows and processes?
And what is their philosophy oninteracting with your patients?
At the end of the day, we're allpatients. Put yourself in their
(06:10):
shoes and review things fromtheir lens. One of the things
that I'm most proud of withGreenway Revenue Services is how
our people treat patients withempathy and understanding. This
goes a long way for for patientsatisfaction.
Daniel Williams (06:28):
Yeah. Marvin, I love that you said that to put
ourselves in the patient's shoesbecause we're all patients at
one time or another. So to beable to empathize with that, to
be able to see it through theireyes, because we're all patients
as well, then we get a betterunderstanding of what that would
look like. So thank you forsharing that. Chuck, I'll move
(06:49):
to you then.
When we talk about, outsourcing,you gotta do your due diligence.
So what are the steps, aprovider should take in really
studying those options out thereand what are the steps they
should make too so they can makethe best decision possible?
Chuck Rackley (07:11):
Yeah. Awesome question. Marvin and I see this
all the time where people make avery reactive choice to start
this process. It's usually donein haste because something has
happened. There's someonethey've lost or there's some,
you know, very critical factorthat's happened.
But one thing people usuallyskip as administrators is
(07:32):
sitting down with their theirleadership and understanding
what the specific internalchallenges are and what the
goals are, more importantly,what they wanna get out of that
partnership. So is are theytrying to get down their denial
rates? Do they have slowcollections? Do they have
staffing issues?
Marvin Luz (07:49):
Are are
Chuck Rackley (07:49):
you just want more predictive predictability?
So there there's lots of thingsthat people complain about, but
it's rare that people get realfocused on what they
specifically wanna get out of apartnership. So the next thing
is they really need to startevaluating on four major things
that that Marvin and I reallyfocus on when working with new
(08:10):
practices. The four things areexpertise of the of the partner.
So and this goes beyond, youknow, do do you have the ability
to collect money?
This goes into specialtyspecific. So there there are so
many specialties out there thatreally require an in-depth
knowledge and experience. Sothings like anesthesia and, you
(08:34):
know, neurosurgery are not thesame things as pediatrics and
family practice. So just becauseone one vendor does incredibly
well with one means zero for howthey will do with the other. And
it's really important to matchthat expertise with what your
practice is looking for.
The second thing is ontransparency. The thing you
(08:54):
wanna avoid here is if if you'rein a vendor situation where
they're just sending you a bunchof reports and they've got these
these decks at the end of themonth that are 70 pages long,
and you and you're yawning
Daniel Williams (09:06):
Yeah.
Chuck Rackley (09:06):
Halfway through. Like, that's where you not want
you don't wanna be there. Sosomeone's just reporting the
news back to you, that's wherepeople go that's where the deals
go to die. So you want someonethat's really giving insights to
your business and that's reallymoving you forward. The third is
is on technology.
And you can lump a lot of thingsin here, your AI, your machine
(09:27):
learning, the general technologythey have for follow-up and
submission. All those thingsneed almost I evaluate those on
a a completely separate basis onhow they're doing that. And the
fourth thing, and I specificallyput this fourth because I a lot
of people go here first, It's onprice and ROI. So a lot of
(09:49):
people will make this decisionjust on price. And I can't tell
you how many times Marvin and Ihave lost a deal because of
price, and they go to someoneelse.
And, uh-oh, it didn't work. Andnow we're down worse than we
were before, and they come backto us. So that happens all the
time. So you have a lot of theseand and forgive me for saying,
(10:12):
but the regional mom and popplayers that really try to just
buy business a lot of times, andthey end up hurting the
practices more than than theyneeded to get into. So it is
important, but it's important tomarry price with what the ROI is
out of that.
So price is one component, butmake sure you're not missing the
forest for the trees. That's thebiggest thing.
Daniel Williams (10:33):
Alright. Thank you for that. Marvin, one other
aspect to look at when you'relooking at outsourcing that RCM
component is the compliance sideof it. So what are some of the
indicators that a providershould be looking at, from a
compliance side? And perhaps ifyou wanna share what, Greenway
(10:54):
is doing in that regard as well.
Marvin Luz (10:57):
Yeah. Sure. So ensuring that billing stays
aligned with, you know, payerrequirements, and and regulatory
requirements is a full time jobfor a team. Right? So at
Greenway, not only does thisresponsibility, lie with our
(11:17):
business excellence team, buteveryone at Greenway is focused
on ensuring that we stay alignedwith payers and regulatory
requirements.
Our team uses several differentresources, right, from payer
notifications and bulletins toreviewing payer websites and
portals and manuals. So oncewe've identified any changes
(11:40):
that are needed, we then createwhat we call our standard
operating procedures. Once wehave those standard operating
procedures, then we provide thattraining to the appropriate team
that's affected. Then onceeveryone is trained, we
follow-up with quality assuranceprocedures to ensure adherence
(12:00):
to that as well. Right?
So we have five easy steps. One,identify the change. Two,
determine the relevance and theimpact. Three, document the
action that's needed to addressthat change. And then four,
train the appropriate teammembers.
And then finally, following itup with quality checks, again,
(12:22):
ensuring compliance to thosechanges.
Daniel Williams (12:26):
Chuck, I wanna come back to you. Now let's
assume that you've done all yourdue diligence as a provider. You
have found your outsourcingpartner for your RCM. It's in
place. Now you gotta measure it.
You gotta make sure that thingsare working. What are those
(12:49):
KPIs? What are you measuring?What are you looking at to make
sure that relationship isworking?
Chuck Rackley (12:55):
The best way to think about this in our
experience has been think aboutthe path of cash along the way.
So what is stopping this frombeing paid and being paid as
fast as possible? So, a, let'sstart with the end of the path.
What is the cash? So a lot ofplaces really struggle with
putting a number on what shouldI have been paid.
(13:19):
What is the amount of cash Ishould get every month? And
there are a myriad of cashcollection goals or formulas out
there. There's there's lots ofthem. There's the GCR rates
people use. Some people use NCR,so net collection rate versus
gross collection rate.
I've seen people do a price tocharge ratio goal. Some some
(13:41):
more sophisticated practiceshave a contract management
system where they're actuallyable to determine the allowable
on every single claim. That'llbe the most accurate, but not a
lot of practices can't affordthat kind of system. But having
some sort of goal that youmeasure yourself against and
measure, more importantly, yourpartner against is the first
thing that I always look at. Ilook at it every single day as
(14:04):
an operator.
What is happening from a cashperspective? Am I on track? Am I
below track? Am I ahead?Etcetera.
Second part of that, you go backto the beginning. What is
stopping my claims from goingout the door, and how are they
being adjudicated? So the bestone to look at there is clean
claim rate. What is goingthrough the door without anyone
(14:24):
touching it and beingadjudicated first time at bat?
So, obviously, you wanna be asas high as possible there.
The best practices we have arearound that 95% rate, some a
little higher, some a littlelower, but you wanna be up
there. Third one would be somesort of AR measure. So whether
that be days in AR or aging over90 or one twenty or whatever it
(14:49):
is, that but to have some sortof AR measure so where you can
make sure your balance sheet isin check and and ensure that you
have proper cash collectionmetrics going on there. Last but
not least here is denial rate.So you wanna measure your
initial denial rate that you'regetting from the payers.
So this is that firstadjudication back. You're seeing
(15:09):
what was denied and measuringagainst both your dollar and
your count of your grosscharges. So a really, really
good practice is gonna come inthere around seven to 8% of an
initial denial rate. We've seensome as low as two and three,
and we've seen some as high as25 or 30. But what's more
important there is how you lookat that denial rate to ascertain
(15:30):
what's causing them so you canreally get down to the root
cause.
Other than that, so if youmeasure that that path to cash,
so your clean claim rate,something in AR, so be it days
or or aging, your denial rate,and ultimately, what cash did
you get versus what you shouldhave gotten. That's where you
need to be measuring.
Daniel Williams (15:48):
Thank you for that. Let's come back to you,
Marvin. You're really focused onbuilding those relationships,
with those providers. Whenthey're looking at outsourcing
their RCM, what are some of themisconceptions you're seeing
that they may have about thoseoutsourcing partners, and how do
you overcome those?
Marvin Luz (16:09):
It's a great question. Because I I feel like
one of the most frequentmisconceptions that I know Chuck
and I encounter is thatpractices will lose visibility
and control, and especiallyaround quality and
accountability. Now can thathappen? Sure. Absolutely.
(16:30):
But that's where it's criticalto partner with the right type
of revenue cycle vendor. Now atGreenway, we do all of our work
within our client system. Theclient system remains the source
of truth for our clients. Right?Documentation on the actions
(16:51):
we're taking provide visibilityand transparency to our clients.
At any time, clients can viewthe work and actions our team
members have taken on the work.Having quality reporting like
Chuck mentioned earlier, thatprovides insight into financial
(17:13):
health of our clients, helpsprovide the visibility and
control that practices need inorder to run a successful
practice. Now having a partnerthat sits down with leaders of a
practice to understand thepractice's short term and long
term goals, that also ensuresaccountability is part of the
(17:38):
partnership of your revenuecycle management organization.
Daniel Williams (17:43):
Alright. Couple of questions I'd like to ask
y'all before we sign off today.I wanna come back to you, Chuck,
and I feel like it would be adisservice to be talking about
RCM in 2025 without talkingabout the impact technology has
on it. I mean, I think in everyconversation we have, there's
(18:04):
automation, there's AI, there'smachine learning. So let's
really talk about that, Chuck.
When we look through that lensof technology and transforming
outsourced RCM, how technologycan play a role there. Talk
about that.
Chuck Rackley (18:20):
Yeah. For sure. And this is such a great point
because we spend, I would say,75 to 80% of our time internally
working on what is the nextthing we can bring to this
market. And all of it has to dowith automation and AI. It's
completely reshaping how wethink about RCM at Greenway and
(18:41):
how the overall market is reallygoing after this.
So traditionally, RCM has beenthat manual labor intensive
process. Just think about allthe hours we used to spend
checking eligibility one at atime, you know, checking claim
status one at a time or evenappeals for the most part now.
So with automation in AI, we'reable to take a lot of that
(19:03):
repetitive work and and dumpthat to a bot or some sort of
agent as it were. Sotraditionally like, for example,
bots can now verify insuranceeligibility in seconds. You have
manual interfaces with all sortsof payers.
They can flag missinginformation before claims are
(19:24):
submitted and even post paymentsautomatically. That's happening.
That's been around. But whatreally separates what's been
there versus what's going upforward is when we get into that
agentic AI, that's really takeninto the next level, which is
really cool to be around rightnow because now we're starting
to see AI agents actually makingcalls to insurance companies.
(19:47):
We're seeing AI agents takescheduling from patients.
We're seeing automatic languagelanguage processors really look
at what a denial is and figureout what what to pull from the
medical record in order tosubmit an appeal. And even some
on the authorization side too,which has been kind of the the
the the holy grail for a longtime. How do we automate
(20:10):
authorizations? And AI evensteps takes that a step further.
So it's not just about speed.
It's about what intelligence itcan bring back to you too. So AI
tools can analyze patterns that,you know, even professionals
like myself and Marvin won'tsee. They can predict what
claims are gonna be at risk andrecommend that proactive
proactive step to get there evenbefore a human even sees it. So
(20:34):
there's a lot of stuff that wecan do now that was the moon to
us even a year ago. For ourproviders, most importantly,
that translates into that higherclean claim rate that we talked
about Mhmm.
Faster payments, reduced price,reduced spend, and reduced time
that they spend looking at thisso they can actually go focus on
their patients. So in short,technology is gonna is gonna
(20:56):
continue to transform RCM rightnow. It's a really exciting time
to be in the in the in themarket. I probably say that
every year because somethingelse cool has come along. But
now now this is really, reallyneat, what we're seeing.
And I think it's gonna be a big,big change that we see going
forward in the marketplace forsure. You're gonna have better
control, more visibility, andbetter financial results, and
(21:20):
with less workload. That'sthat's that's where I see it.
Daniel Williams (21:23):
Alright. Thank you for that. I have one last
question. So, Marvin, I'll turnto you. We had a November MGMA
stat poll.
Our our listeners will knowabout those MGMA stat polls.
This one, I wanna get thisright, it found that 36% of
medical groups will outsource orautomate at least part of their
(21:44):
revenue cycle in 2025. So what'syour advice for practice leaders
who are still hesitant aboutoutsourcing?
Marvin Luz (21:53):
I'm gonna try to recap what what we've talked
about today because I thinkthere have been some some great
pieces of information today. SoI I would say first, understand
what your objectives are as anorganization. That's critical to
your success. Secondly,understand where your practice
(22:14):
is in its financial healthjourney. Right?
Mhmm. Third, vet your potentialpartner to ensure that your
goals, your values, and yourobjectives are aligned with that
partner. Fourth, I would saypartner with a vendor who's an
(22:35):
expert in your system andunderstands how to utilize its
functionality to the fullest.Fifth, have biweekly, weekly,
monthly meetings with yourvendor to understand challenges
and utilize that time tocalibrate on any upcoming goals
(22:56):
or changes in your practice. Andfinally, and I think Chuck will
agree with this onewholeheartedly, is communicate,
communicate, communicate.
That's the key to a successfulpartnership with your revenue
cycle vendor.
Daniel Williams (23:14):
Alright. Well, Marvin
Chuck Rackley (23:15):
Daniel, can I add one more?
Daniel Williams (23:17):
Please. Oh, please do. Please do.
Chuck Rackley (23:19):
And and this is one that we find very, very
helpful. Don't ever be afraid toask to talk to other people. So
if if you're if you're nervousabout how to partner with
someone, ask for a referencethat you can actually get in
there and and see what's theirresponsiveness. You know, what's
their reporting like? What'stheir performance been?
(23:40):
And even the ones that so Marvinand I use a lot of references
for different things, but it'snot all beautiful even with the
references that we choose.
Daniel Williams (23:49):
Yeah.
Chuck Rackley (23:49):
So don't be afraid to ask for that. It would
be my last little bit of advicehere. And that goes for when
you're picking a provider andespecially for the people that
are a little nervous aboutoutsourcing. Talk to other
people that have done it and seehow it went.
Daniel Williams (24:03):
Alright. Well, Chuck, Marvin, thank you so much
for joining us today.
Chuck Rackley (24:08):
Our pleasure.
Marvin Luz (24:09):
Thank you for having us.
Daniel Williams (24:11):
Alright, everybody. That is gonna do it
for this episode of the MGMABusiness Solutions Podcast. We
have been joined today by ChuckRackley and Marvin Luz from
Greenway Health. They've beensharing their expertise and
giving us a deeper look at thebenefits, challenges, and future
of outsourcing your revenuecycle. So until then, I just
(24:34):
wanna let everybody know we aregonna put direct links in the
episode show notes so you canclick through to some of these,
practices and processes thatMarvin and Chuck have been
talking about.
So I just wanna thank everybodylistening for being MGMA podcast
listeners.
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