Revenue Cycle Reality Check w/ Chris Caspar

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Erik Sunset: All right. Hello and welcome back. I’m Erik Sunset, your host of the DocBuddy Journal. I wanna thank you, uh, for joining us today. Whether you’re listening on YouTube, Apple Podcast, Spotify, or right there on DocBuddy.com. Welcome and welcome also to Chris Caspar, our special guest today. He is the CEO of Altruis.

Erik Sunset: Chris, thanks for joining us.

Chris Caspar: Thanks, Erik. Thanks for having me. Happy to be here.

Erik Sunset: Oh, it’s totally our pleasure. And before we dive into our main topics for the day, take a minute, tell the audience a little bit about yourself, your background, and then what you’re doing at Altru.

Chris Caspar: Yeah, absolutely. So, um, Chris Caspar, I’m actually here in Louisville, Kentucky. Um, been in Kentucky most of my life. Um, went to school at the University of Louisville, actually for mechanical engineering. So, um, spent the first 20 years of my career, uh, in technology, product development, um, product [00:01:00] marketing, um, e-commerce, all of those great things before I got into healthcare.

Chris Caspar: Um, and getting into healthcare. I first started that journey at ed. Um, it is now called Waystar. Probably at the top tier, uh, clearinghouse in the com in the country. Um, and one of the things when I first got into healthcare that I noticed that was very different from what I had experienced in my technology time was, you know, seeing trends that were basically showing a lack of use of technology in order to impact and improve productivity in healthcare.

Chris Caspar: Uh, when I first got in and, and again, this was, you know, 15 years ago. Uh, it, it very much healthcare was a dinosaur, uh, compared to what was happening outside of healthcare. Um, and, and from from that, you know, as you start working with companies that are in technology and healthcare, you know, you just see this tremendous opportunity to drive, um, improvement, um, being able to help.

Chris Caspar: The providers that are [00:02:00] providing care, uh, be able to do a better job, be able to be more efficient, effective, and again, whether that’s from the front office and how they’re handling things, you know, all the way through the back office, but definitely in the clinical operations. Um, just to be able to help people be more effective, more productive and, and be able to deliver higher quality care.

Chris Caspar: Um, and so that was very exciting for me. Um, I actually joined Altruis a little over 10 years ago. Um, first was brought in to kind of help grow marketing and sales, how to, how to, uh, rebrand the company. Uh, the previous name of the company was Claims Review Corporation, uh, which is was a very large mouthful.

Chris Caspar: Um, and I think if you were to find that online, anywhere. You know, what do you think they do? I don’t know. Uh, so, um, you know, that, that’s how I started. Um, so getting in, you know, working with Altruis, uh, getting the opportunity to rebrand, uh, the company, one of the, one of the ways we landed on [00:03:00] Altruis, um, if you think about healthcare, uh, as a whole, it is a very. Um, mission driven type of, of, um, job and role for the, for the community and, and, you know, very important vocation. Um, you know, and for the most part, I mean, they, they take their Hippocratic oath, um, but they’re there to serve people. Um, and, and when you look at Altruis ourselves, you know, our, our organization started out with serving, uh, federally qualified health centers.

Chris Caspar: That was our core. Core place of service. Um, you know, also working with behavioral health organizations and community, uh, behavioral health organizations. Um, and when you look at those organizations, well, they have the additional mandate of providing care regardless of the patient’s ability to pay. And so when you think about that, that combination of the mission driven and the without the ability to pay aspect, um, [00:04:00] that’s what leads you to thinking about the term.

Chris Caspar: Altruis, which is serving people selflessly. Um, and that’s where Altruiss, that’s where our name comes from, is from the word Altruis. Um, and, and that’s how we, how we got our start as far as the rebrand. We’ve been around for over 23 years, um, and continue to serve those same need. Communities, uh, the underserved communities of the country.

Chris Caspar: Uh, we’ve now expanded some of the stuff that we do to also include, you know, regional hospitals and physical therapy and, and some other things. But, um, that is still the core business, that that’s what we do. That’s, that’s what we’re all about.

Erik Sunset: Well, and, uh, the, the places of service that you lifted off, listed off their FQHCs rural hospitals, they, they need some help. Uh, they need some help. Those, those care teams and those support staff are doing really important work to deliver care in areas where there’s just not a whole lot of it to go around.

Chris Caspar: Right.

Erik Sunset: Well then on a, on a strictly [00:05:00] revenue cycle related note, listeners of the show, uh, will have heard that I’ve got a little bit of experience in revenue cycle, not nearly as much as yours, Chris, uh, but competing in that space. It’s, it was always interesting to me, and I think someday there will be a Harvard Business Review on this, but sort of the lowest common denominator for marketing.

Erik Sunset: Was get paid more, get paid faster. If that wasn’t, uh, you know, the core of your offering, it was like, well these guys, they could get me paid more and get me paid faster. But that’s hardly ever the case. Uh, so when you look at this highly fragmented revenue cycle market, how do you stand out? How do you differentiate when so many offerings are just a commodity?

Chris Caspar: Yeah, it’s a great question. You know, and I, and I think that, um, coming back to what I talked about on the rebrand, you know, one of the things, there are so many, uh, billing companies out there. There are some really large ones too. Um, you know, I’ve, I’ve had the opportunity actually just this last couple of years.

Chris Caspar: To not only [00:06:00] be doing this, but to also be the chief administrative officer for a very large, uh, physical therapy organization across the country. And with that, I got to work with hospitals, very large health systems that have revenue cycle outsourced there. You know, they have partners that they’re working with.

Chris Caspar: Um, but when, for us, you know, what it started out is like, let’s not just go be a billing company. You know, let’s talk, let’s, let’s, let’s have a focus on number one, who we serve, right? So if we, if we can be focused, it’s not that we can’t. Do revenue cycle for larger organizations, we absolutely can, but let’s make sure we stand out for at least some people, right?

Chris Caspar: So that when they’re looking for someone who knows federally qualified health system or, or you know, behavioral health or, you know, physical therapy or, you know, regional hospitals, that they can find us, right? Um, and, and the other thing is, you know, so we, we actually use the term, uh. Healthier [00:07:00] revenues, healthier mission. Right. And, and definitely one of the things that, that we try to do to stand out, because I think a lot of people, when they’re hiring an outsourced revenue cycle company, uh, some organizations just view ’em as a vendor. Um, you know, push a button they need to take care of the back office, you know, and that’s very important.

Chris Caspar: I think one of the things that we really take pride in is being a true partner with the organization. Um, and that’s where, you know, when we find things that are. As an, as you mentioned, slowing down payment or reducing payment. We wanna make sure that we are getting in front of our partners organizations, making sure that they understand the things that can be done to drive improvement.

Chris Caspar: Right. And that’s really the name of the game in RevCycle is improvement. Um, one of my favorite things when I first got into this role and started looking at how we were showing things, um. Two customers. One of the, one of the classic thing, you know, you meet monthly, you go through reports, right? You’re [00:08:00] talking about a, here’s your revenue, this is what the AR looks like, the AR days AR over 90, you know, all of that great terminology, and that’s all well and good.

Chris Caspar: But I have never met A CFO who, if I told them how much revenue they made this month would say, wow, that’s great. It’s never high enough for them. Right. And their ar same thing. It’s never low enough. Um, and so one of the things that we make sure we do, um, in those conversations that we have with our clients, and we do this every single month, is we’ll go through here’s the progress that’s been made.

Chris Caspar: How are we, what are the things that have improved month over month? What are the opportunities for continuing improvement? And by the way, a lot of that comes from your rejections and your denials. What are the things that are getting slowed down because they’re getting rejected or denied? Um, and then we’ll also talk about challenges and, and those things are just different from opportunities and the fact that we may need a third party to work with us to be able to solve it.

Chris Caspar: It’s not something that the [00:09:00] provider can solve on their own, or Altruis can solve on their own. You know, we may have to get a payer involved. Um, and, and that’s the things that, but we wanna make sure that we’re bringing those to them so that we can attack ’em and drive that improvement in cashflow, getting it in there faster and reduce the, the denials that they’re getting so that they get greater reimbursement.

Chris Caspar: So conversations and connections. sure that you’re not afraid to tell them what, ’cause some organizations might view those types of discussions as bad news. We don’t wanna talk about the bad news. We only wanna talk about the good things that are happening. And I think it is so important that you’re highlighting those opportunities for improvement.

Chris Caspar: And, and the other key thing is when we have those meetings, we show the KPIs. And when we show revenue, we don’t just say, Hey, here’s how much money you have or you made. We’re showing it on a trended basis. You know, we like to look at it trended rolling 12 month view versus prior rolling 12 month view so that we can [00:10:00] see how things are improving.

Chris Caspar: The other thing is it visually, lets you say, if it’s down, why is it down? If it’s up, why is it up? Right. Um, it allows you to then ask the right questions of the data that’s behind it, um, and, and really dig into how we’re going to fix it, um, and bringing solutions, not just problems, right? So that, that’s a little bit about it, but, but a lot of those opportunities come from, again, those rejections and denials and those are the things that people are typically most concerned about.

Erik Sunset: Well, yeah. Uh, as you, as you rightly point out, that that’s your area for improvement and one of the things that always fascinated me was speaking to a physician, uh, in private practice where in my case, we were already their software vendor for their PM DHR. So they already knew us. They already liked us.

Erik Sunset: To the extent that’s possible that a physician like their EHR vendor, we worked hard for ’em, and I get it. But occasionally they’d say, Hey, can you check in on something for me? My, my billing team, like, she’s gonna be out of the office for a month. I need to know [00:11:00] kind of like what we’re looking at here, like what’s gonna be the impact if I don’t do anything.

Erik Sunset: So you dial in, you give ’em the free audit, you have a couple of sort of canned reports and dashboards. You can push their data through and get the KPIs out of it. And in some cases we’d bring back numbers that would floor me. They would, they would jump off the sheet at me, you know? Overall pretty healthy collection rate.

Erik Sunset: Like there isn’t one metric that’s terrible, but you just have a bunch of metrics that were just kind of okay. And you go to like the owner of a large orthopedic group and say, Hey, there’s a couple million bucks that you’re just leaving on the cutting room floor if you do this, and obviously we’re here to help you.

Erik Sunset: And they look at you and they go, eh, everything’s fine the way it is. So, uh, this is a really long walk for a short drink of water. When you’re talking to that, to that person that you, that physician, you’ve got the relationship with. You obviously want to help them Altruiss, right? Coming back to the core, Hey, there’s more money you can make and you don’t really have to do anything different except your documentation.

Erik Sunset: Uh, but there’s also a problem here where you’re a chronic, [00:12:00] either under coder or you’re writing off too much and your contracts say different. How, how do you get somebody to see the light, uh, and help themselves?

Chris Caspar: Yeah, I, I think that it’s kind of interesting what you just said there, I think, I think one of the biggest things is it’s not just coming in and saying, Hey, you’ve got a problem. Um, you’ve got a problem with documentation as an example, or undercoating or overcoding. Um, it, it, it’s, it’s really easy to throw those words out, right?

Chris Caspar: I, I think that there is very much importance, and again, it was something that you just said, which is the quantification of the issue. Right. If you’re not bringing, how big of a problem this is, like, you know, we have it all the time and, and you know, documentation is definitely one piece of it, but front office is, is huge too.

Chris Caspar: Right? Where, um, you know, we’re not doing verification properly or we’re not identifying the right plan to start with. And so, you know, we have to go, um, chase. [00:13:00] What, what the problem is. And if we just come in and say, Hey, your front office, we really need to have improvement in documentation of, you know, the right plan, getting the right demographics in place so that we can actually make sure we’re billing the right thing to the right person in the first place.

Chris Caspar: Um, a lot of times they’re like, yeah, yeah, yeah, but they don’t wanna go have the difficult conversation. But whenever you, you highlight the fact that, oh, there’s. X number of hundreds of thousands of dollars. Or it could even be a small organization. Maybe it’s $10,000 and, and they’re like, wow, okay. That’s important, right?

Chris Caspar: I need to go. It’s, it’s not just that, hey, I told, I told ’em they need to do better.

Erik Sunset: Yeah.

Chris Caspar: It’s also bringing the, okay, what training might we need to provide so that they, because it’s, you know, it’s one thing to just tell ’em, it, it’s kind of the, the old adage, like, if you’re losing a game, uh, well, you know, how, how could we do, what do we need to do?

Chris Caspar: Well, we need to score more points. You know, so, so it, it’s real easy to walk into the front office and say, [00:14:00] do a better job. Well, okay, maybe they’re doing what they thought was right. What are the tools or the training that we can provide to them to kind of help them with. How can we maybe get this better?

Chris Caspar: You know, as an example, if it’s front office verification, if, if you will do just a quick verification check, it’s not that, you know, we need you to go fill out all of the detailed information, but if you at least quickly check, it’s gonna come back and tell you, yes, they have that plan, or no, they don’t.

Chris Caspar: And if they don’t, you’re right there, you know, and maybe you’ve got this information before they came in, or you’re doing it right as they’re in front of you. Either way. When they are in front of you because you got it and it wasn’t right. When they step in the office, you’re able to say, excuse me, Erik.

Chris Caspar: Um, you know, I tried to run your, your verification. Um, it, it looks like maybe you possibly had an insurance changed. You have a new insurance card and you can ask for it then, and, and get it. You know, conversely, maybe, maybe they gave you the right thing and [00:15:00] you fat fingered it when you put it in the system. You’re gonna then pull it up, look at it, okay, let me go fix it right now. And the there, therefore, it’s, it’s better set and ready to go to the billing team, make sure they’re gonna take care of it, you know, authorizations, same type of thing. You know, a lot of times that means working with the, with the clinicians to make sure you have proper documentation of the, the plan of care or the reason that the auth auth is needed to be able to justify it.

Chris Caspar: So making sure that we’re getting those things. To the people that need ’em in a timely fashion. You know, those things are so important. Um, I saw a, a stat, uh, MGMA does this thing where they send texts out to people to kind of ask, you know, certain questions, right? And one of the questions they were asking was, they were asking medical group leaders, you know, what are.

Chris Caspar: The biggest issues with your revenue cycle leaks and, and the, the thing that it, it makes people like me laugh, right? Is, is well, they’re like, well, [00:16:00] 48% of ’em said it’s, it’s denials and appeals.

Erik Sunset: Yeah.

Chris Caspar: And it’s like, yeah, but what was really funny was the other buckets that they put in there, 23% are from the front end, 2% are from charge posting, 13% are from coding. Guys, a hundred percent of your denials and appeals, or probably about 90% of them are generated from those issues. Right. And so it’s like we’re talking about the same thing.

Chris Caspar: They, you know, they’re, they’re all. Denials and appeals. A hundred percent agree with that. I think really the better question is what are the biggest things causing your denials and appeals, right? And, and those are the barriers to payment. So, uh, anyway, I just thought it was funny, but it was back to your point, like you go to a doctor, they’re not really gonna know, right?

Chris Caspar: They aren’t, they aren’t coders, they aren’t billers. And most, most of the time they don’t, they don’t fully appreciate how what they do or don’t do is gonna impact what, what they’re gonna receive on the backend.[00:17:00]

Erik Sunset: Well, yeah. Yeah. And I, you know, there was a a point in my career where I would kind of scratch my head and go like, man, as a business owner, wouldn’t you care like, a little bit more about how the sausage is made? But I’ve come full circle on that. Chris. I, I think it should be out of their hands. I don’t think they should have to think about it nearly half as much as they currently do.

Erik Sunset: I think it’s a shame that you’re putting the medical brain to use and, and for things like this.

Chris Caspar: Hundred percent. I think one of the biggest, um. You know, and I talked about, like at the very beginning, I talked about how when I came in I was like, why aren’t we using technology in healthcare? But I, but I do believe one of the biggest challenges that’s been posed now is the fact that we’ve now set that laptop in between the doctor and the patient.

Chris Caspar: Right. And the fact that I’m, I’m sitting here and I’m having my patient visit, but my doctor is face down typing on a. Keyboard to be able to document what’s going on as opposed to spending that time [00:18:00] with me. Right. And while it’s definitely important that we get the proper documentation, and I think this is, this is something, you know, we can talk about a little more, is how the, you know, ambient AI and those types of things are now going to start removing that screen from in between the doctor and the patient and allow them to focus on the patient.

Chris Caspar: Um, you know, the, the other thing that I’ve heard quite, quite a lot lately from, from providers, um, kind of in that same vein, is. You know, there’s more and more of this push for, um, the, the whole productivity piece, right? And, and they feel like they’re, they’re machines now. Hey, I gotta get this patient in and out.

Chris Caspar: I have to see X number of patients a day. You know, I’ve gotta get x number of units billed, you know, whatever it is. Um, you know, and I think some of those things on, on the business side, outside of technology, is also another barrier to care. You know, we need to make sure that we’re providing quality care.

Chris Caspar: It’s, I mean, yes. [00:19:00] Um, there’s definitely money involved and we wanna go collect all of that money, right? Um, and we wanna make sure that we’re doing all the things required to, to make sure that happens. Um, but we also need to make sure, ’cause the whole reason we are here is to provide care for these patients.

Erik Sunset: Yeah. Yeah, I mean this is, this is gonna be kind of like a dog whistle for my, for my listeners. You know, you’ve, you’ve got this super scarce and super valuable resource in physicians and mid-level providers. And instead of treating them, uh, that way, like as a very important cog in the machine of medicine, maybe the most important can make a case for nurses.

Erik Sunset: We love our nurses of course. Um, but, um. You’re asking ’em to be their own scribe, to be their own biller, to be their own coder, to to be all things. And it’s killing the profession. But then on the other end of this, with all these, uh, seemingly well-meaning programs, and this is going back a few years now, quite a few years with, uh, with value-based care, uh, but [00:20:00] you’re seeing provider organizations and payers enter into these agreements for value-based care.

Erik Sunset: And this is more than just anecdotal. I’ll point folks to prior episodes here. You have a physician organization do and everything that the contract says they need to do to be paid in full and the payer Renes at the very end and goes, actually, we didn’t like this value-based arrangement. After all, it was cool that you did that.

Erik Sunset: Thank you. But we’re just gonna treat this as fee for service. So it’s over for you. How is that fair? What do we do to fix that, Chris?

Chris Caspar: Right. I apologize man. I don’t have a good answer for that one, but, but it is, it is. It is the, the biggest challenge, I mean, I, I think some, some of the biggest challenges we have is how our insurance companies are getting in between, you know, the doctor and the patient and, and in my mind, providing barriers to care in a lot of ways.

Chris Caspar: Right. Um, how, how is it, how is it that they get to choose what treatment I [00:21:00] receive? You know, it seems like my physician, the one who’s sitting here with me. And has looked at my tests and evaluated me and knows me right? Has known me for years. Uh, when they see something, they’re, they’re wanting to make sure that they’re working on addressing it and, and to get down the line.

Chris Caspar: And, you know, and especially, you know, one of the challenges that you face and, and this happens with RevCycle a lot, is. People changing plans? Well now, just because I changed the plan, the new plan wants me to go revalidate all the stuff I already did for the PRI previous plan, and I gotta go through it all over again and stair step through all the triage of the various treatments that I could have looked at when I’ve already done that last year or the year before.

Chris Caspar: And you know, we’ve already gotten through it and gotten to what works and now I’ve gotta go revalidate everything, you know? Um. Didn’t mean to get off on that tangent there, but, um, I, I do think that that’s, that’s definitely a concern for a lot of people.

Erik Sunset: Hey, that’s what we’re here [00:22:00] to do. We want to go off on tangents and we want to ask questions that don’t have answers. Um, there, there’s a lot, there’s been a lot of really smart folks on this show. I’ve posed a lot of these type questions to physician shortages. What’s AI healthcare gonna shake out to, you know, how do you fix the payer relationship with practices and with their, uh.

Erik Sunset: Enrollees and that, that actually brings to mind another revenue cycle sort of, uh, question for you. We talked about, about, uh, denials and that adjudication and appeals process a little bit. Are you seeing that practices and, uh, maybe CBOs at your FQHCs or RHCs, you know, the billing staff there, the billing teams there, or, um, the revenue cycle teams?

Erik Sunset: You know what I’m trying to say here? That they’re in an arms race with the payers, that these denials are a game and it’s a game that maybe you can’t win, but it is a game that maybe you can lose a little bit less.

Chris Caspar: Um, absolutely. I mean, things, things change so much, you know, and I, [00:23:00] and I think that. You know, as an example, just the, the types of things we do. Of course, we we’re very plugged into understanding what those new changes are, barriers are, you know, those types of things. Because quite frankly, it’s a, it’s a revenue generator for us, right?

Chris Caspar: One of the challenges with a lot of healthcare organizations, when they look at their CBO or their internal billing teams, those guys are cost centers. Right. And because they’re cost centers, there’s not as much focus put on, Hey, I need to invest in training, or I need to make sure that I add appropriate resources to be able to address all of those denials and appeals that are coming through my ar.

Chris Caspar: Right. Um, and, and that’s where a lot of them then may turn to. Outsourcing or, you know, leveraging external organizations and, and it’s [00:24:00] viewed as a cost reduction, right? That’s how they’re viewing it initially. I, I think what, what you see though, when you get a good one, um, is that it’s actually going to improve revenue and back to your getting paid faster, getting paid more, you know, those are the things that you’re gonna benefit from.

Chris Caspar: And that’s because the other thing that you see, and I definitely saw this, um, when I was working. In that large physical therapy practice, um, most of the time the billing functions really aren’t talking to the front office, and they’re not able to have the conversations with operations or with the clinicians about the things that really need to happen that are providing the biggest barriers to driving the growth in payment.

Chris Caspar: Right. And, and that’s, that’s where being outside you have a little bit of a different perspective and you, and you’re allowed a little bit of a different audience because in a lot of cases, we’re talking to the CFO. Right. And, and so because of that, that person then has the ability to pull the [00:25:00] appropriate people in so that we’re talking to the right parts of the organization and helping them, you know, and bringing the understanding of what’s going on or what may need to be done to drive improvement.

Chris Caspar: And so, you know, there’s a lot of value that can come out of that. Um. I also know, you know, there, there are some larger organizations that I, I still see, um, you know, so we talked earlier about, you know, some of these large, um. companies and many of ’em do a very good job, but one of the things that you’ll see happen, and it, you know, it’s not unexpected.

Chris Caspar: You know, they are directed and they do focus on the things that make them the most money. Right. And, and make the hospitals the most money too. Right. But one of the biggest opportunities that I see in those kinds of organizations is, is they’ll have what they call a small balance write off, and that’s because they’re focused on. Hey, we need to get everything, all the AR out there, that’s anything that’s over $5,000 as an example, or [00:26:00] a thousand dollars, right? Um, and anything under that, if it gets denied, it just is written off. Okay. Um, which of course me, you know, I’m coming from an organization that focuses on organizations who most of their billings are under a thousand dollars, right?

Chris Caspar: And so for me, I’m like, wow, I don’t understand. Why would you be walking away? There’s a ton of money there. Um, that could be beneficial to the organization as a whole. Um. And, and, and so when I was working with the physical therapy company that I mentioned, well, you gotta think they’re, they’re providing out outpatient physical therapy for these health systems.

Chris Caspar: Right? Well, again, most of their charges are gonna be under that amount. And so because of that, like any denials they were getting, they were, weren’t being surfaced by the internal rev cycle organization. Um, and it was something that I really fought for. You know, and that, that’s where you get into a little bit of a catch 22.

Chris Caspar: It’s like, okay, the company that I’m working [00:27:00] for isn’t paying attention to the denials that are being generated. Do I really wanna go tell ’em, Hey, can I get a denial report so that I can make sure you guys get paid for everything that we’re doing? You know, and, and that’s where you walk a, a fine, fine line.

Chris Caspar: But again, back to telling people bad news, and I believe that engenders trust. You know, when, when you’re willing to bring forward something that may not be going perfectly. And, and wanting to work with the organization to fix it to their benefit. Right? Um, I think that’s when they go, oh wow, these guys really are looking out for us, right?

Chris Caspar: So, again, it’s very, very, very important to have those difficult conversations. I, I just truly believe in that.

Erik Sunset: Chris, I’m curious if you have any, uh, any anecdotes around hard conversations. And it could either be something where you saw a tremendous gain in, uh, in documentation or some

Chris Caspar: Yeah,

Erik Sunset: huge improvement, but strictly around clinical documentation [00:28:00] improvement. Because if.

Chris Caspar: yeah,

Erik Sunset: Limited perspective. You’ve got everything else working okay, but your physician’s documentation’s just not there.

Erik Sunset: That’s where you like, that’s a big, uh, a big ground to gain. It seems.

Chris Caspar: yeah. A lot of times what you’ll find, um. And I got a couple, couple of items here. Um, it it as an example, and let’s just take a basic ENM code, right? Um, you know, am I coding it as a nine, nine, uh, 2 1 1 or a 9 9 2 1 5, right? Um, and all that has to do with the level of complexity of the visit or the patient that you’re seeing, you know, those kinds of things. And so. You’ll have, you’ll have certain providers and it’s, you know, who knows it, it could be because management’s telling them, Hey, we really need you to focus on getting the, this, that, or the other. Um, but um, I, I’ve seen it when we do coding audits, it, it was kind of really interesting. We were [00:29:00] doing this for a pretty large fq and, um, I’ll, I’ll give a, a, a complete anecdote, but it was kind of funny.

Chris Caspar: I just happened to notice it. Um, was that, um. We, we saw that the male physicians had a tendency to over code and the female physicians were having a tendency to under code. Um, but regardless of which way it’s going, you know, I think the point is making sure that we’re billing appropriately for the services provided.

Chris Caspar: So if you really did do the level of service for a 9 9 2 1 5, we wanna make sure that. There’s documentation that supports that, right? And let’s make sure that we have documented everything we did in that visit so that when we have that code, we’re gonna get paid appropriately. Um, and, you know, if you’re under coding, same type of thing.

Chris Caspar: It’s like, Hey guys, based on your documentation, this really should have been moved up another level or two. Um, and so if you [00:30:00] have certified coders in place, they can make those changes on the front end for you. They’re entitled to do that based on their license. Um. But you know, for us, if we’re doing that as an outsource company, we wanna make sure we’re aligned because when nothing, nothing’s worse than a physician who’s coming back to you, like, why did you change my

Erik Sunset: Right.

Chris Caspar: Right. Um, and, you know, you gotta make sure that you’re doing the, you know, helping them understand what’s going on here and why this is so important, you know, but, but, you know, that’s, that’s one of those examples. But then specifically we were doing some training at an FQ and, um. Our, our certified coder was going through, you know, some of the things that they needed to do and was pointing out some things that were done wrong.

Chris Caspar: Well, their chief medical officer stood up and said, no, that’s not correct. You know, this is the way I’ve been doing it for, you know, 30 years as an example. Well, then when she stepped back and just walked him through, you know, calmly what it was, and by the way, this was a guy who was known to be like. [00:31:00] Harsh and all that kind of stuff. Um, but after we went through that conversation afterwards, he came up to her and he said, Hey, I really appreciate you, you know, walking through this. Will you come spend a day with me, you know, to make sure that I’m doing this stuff right. So, you know, there, there was a light at the end of the tunnel there.

Chris Caspar: Um, but I, I can honestly tell you, um, most of the time when we are doing. Coding audit reviews and providing that feedback to most physicians, they are very appreciative of it, you know, and, and we’ve had FQs where we do coding audits. And it may be like, you know, our, our role for the coding audits that we present is to go look at like three different positions a month, as an example, and come back with how they’re doing.

Chris Caspar: You know, what are things that didn’t require anything? You know, what’s this? And almost universally they are so appreciative of it. Um, because you know, positions, you gotta think about it. I mean, the amount of school that they went to training that [00:32:00] they’ve done, um, these people are learning individuals, right?

Chris Caspar: And so if you’re able to help them learn something new and it can be helpful, um, they’re all ears. They, they definitely, it’s, it’s not where this, there’s this, because I think that’s the other thing in a lot of organizations, there’s this perception, oh, you can’t talk to the physician.

Erik Sunset: Ooh, great.

Chris Caspar: Those guys are held up on this pedestal and you’re not allowed to talk to them.

Chris Caspar: So, you know, but I, but I think the organizations that, that kind of lean in to wanting to improve documentation, you know, and, and understanding the tools that might be out there to help them do it, um, you know, I, I think those are the ones that are gonna be winning.

Erik Sunset: Yeah, and I mean, we’re talking a little bit about culture there. You know, physicians that are willing to listen and then staff that’s willing to take issues up to them, you know, on that perceived pestle. Pedestal or not? Uh, I think it’s, it’s sort of natural selection. You know, it’s, it’s evolution for the role [00:33:00] of physician as a, as a business owner that it, you have to be a good business owner right now to exist in private practice or to just not be owned by a mega health system, I guess, you know, the bar is moving.

Chris Caspar: Oh yeah. I mean, ’cause I mean, margins are tighter and tighter. You know, just like any, any other business, you know, you’ve gotta find new ways to do things, um, better, cheaper, um, you know, that’s, that’s, that’s. I, I actually also back to that MGMA, uh, stats thing. Um, the one that just came out, just got the results today about it.

Chris Caspar: Uh, they had done a survey asking if, hey have, are, how are the 2026 Medicare payment rates doing? You know, are they covering your cost of care? And 80% of organizations said, no, our cost of care is higher. The current reimbursement rates, right? Only 5% said they were above and 15% said they were equal. [00:34:00] So, you know that that’s a challenge, um, that organizations are having.

Erik Sunset: Big challenge. And, uh, this, this may lead us down a tangent that we, we may wanna talk about the next time, Chris, but one, one of the things that’s interesting to me, we talked about that, that value based care example where the organization did everything right, didn’t get paid the value based rate, they just got paid fee for service, like that stinks, that money outta their pocket.

Erik Sunset: We talked about, uh, physician burnout, tangentially, just the profession is kind of dying slowly.

Erik Sunset: The the piece of rhetoric that’s still hotter than ever in healthcare, um, and I think it’s gonna be that way for some time, is ai, artificial intelligence and healthcare. Uh, that can mean just about anything from interpreting diagnostics to the revenue cycle.

Erik Sunset: What do you, what are you seeing, Chris? What’s exciting in your world with regard to ai?

Chris Caspar: Well, you know, I think like with anything else, the promise is definitely extremely bright, right? Um. I think still working [00:35:00] on getting everything into practice, uh, specifically in, in RevCycle, um, you know, we’re definitely engaging in it. Um, you know, actually if, if you think about technology years ago, um, we were using machine learning and RPA before those terms were even coined. Um, and you know, now. Ai, you know, artificial intelligence. And, and it is kind of interesting as I start to look at some of the, the AI solutions that are out there. I mean, there are some that are really starting to be able to deliver on the promise. Um, you know, and maybe even building their own large language models that are specifically tailored for the type of work that we do.

Chris Caspar: Um, but then you see others out there where it feels like. They’re really just rebadging machine learning and RPA, and they’re calling it ai. Why? Because it’s the marketing term of today. Um, you know, just like RPA used to be called [00:36:00] bots. Nobody liked that term. Oh, no. I don’t wanna have a bot running on my stuff.

Chris Caspar: Okay. How about, how about you use robotic process automation? Oh yeah. I love that. You know, um, but, but ai, um. I think there’s a lot of promise into it because, you know, you think about the types of resources that it can pull from, you know, very quickly, you know, whether it be, Hey, let me go look at all of CMSs coding structures, or Let me go look at all of the potential or, and appropriate, uh, modifiers that should be applied to these claims.

Chris Caspar: Um, let me go look at this denial reason. Let me go look at historically what is. Allowed us to be able to get paid on those things. Let’s, let’s, you know, surface those things to make the changes right now, um, at least most of the time they’re not actually doing that final mile, you know, of, of making the changes.

Chris Caspar: You still have a human in the loop, uh, approach for a lot of it. Um, and I think that that’s, that’s very much needed right now. I mean, you know, it’s [00:37:00] like anything else we gotta get to where we can trust it and validate that we’re, we’re seeing. Um, actual results. ’cause, you know, just like anything else with technology, um, it can be a tremendous tool to drive efficiency and productivity and, and I think be able to combat everything that’s going on on the other side.

Chris Caspar: Um, but also if you, if you train it wrong, it’s going to make a lot of mistakes really fast. Um, and then cleaning it up can be very expensive. So, you know, that’s. You know, but that’s on the rev cycle side. Um, but, but there are areas where I think it can be tremendously valuable. You know, payment posting, I mean, golly, it seems like we should be able to do very quick reconciliation, make sure we have things matched up.

Chris Caspar: Let’s get this thing posted. You know, tho those things are, are, are easier, you know, some front end edits can be definitely easier. Um, denials and appeals are always gonna be a little bit harder, but I think the fact that you can use [00:38:00] AI to be able to again, surface up. For this type of appeal, this is the information’s needed.

Chris Caspar: You know, just like documentation on a, for a provider, you know, we need to make sure we have this, this, and this in order to, you know, satisfy the requirement of the appeal. So as long as we do that, it should be a one time thing and not a back and forth thing, and that’s gonna save time, get us paid more, and get us paid faster.

Erik Sunset: There we go. We’re full circle. Chris. Oh, this has been, this has been fantastic. We gotta book another, a book, another show in, so we’ll, we’ll handle the booking there offline. But before we, uh, before we bang the gavel on this one, where can folks find you online and how can they learn more about Altruis?

Chris Caspar: Absolutely. So it’s, it’s really easy. Altruis.com, A-L-T-R-U-I s.com. Um, you can find us there. Um, you can also find me out on LinkedIn. Um, Chris Caspar with an A-C-A-S-P-A-R. Um, I’m on Twitter at c Caspar. [00:39:00] Um, so any, any of those places, feel free to reach out to me. Um, happy to connect if anybody’s interested.

Erik Sunset: That’s awesome. Well, thank you again for the time Chris, and from the entire DocBuddy team. We want to thank the audience for listening. Be sure you’re subscribed on Apple Pods, Spotify, YouTube, and you can also get the newest episodes of the show on DocBuddy.com. Uh, so until next time, I’m your host, Erik.

Erik Sunset: We’ll talk to you soon.