RCM Connections- Dawn Castro Edition

Demystifying Healthcare RCM: A Comprehensive Breakdown by Specialty

Are all RCMs equal?

Senior Vice President, Revenue Cycle DAWN

welcome to

JENA R. EGGERT

CEO & Founder RCR|HUB and JER Marketing

EDITORIAL: CommUnity Talent

Hello RCM CommUnity,

Welcome to the March edition of RCM Connections. We’re thrilled to have you aboard for this month’s journey through our online magazine. As we reflect on the past year, we’ve witnessed significant challenges and changes within our industry, including the departure of one of our esteemed leaders, who embarked on a new endeavor after three decades of dedicated service.

But amidst these transitions, one question lingers: Is RCM just RCM? Well, fear not, as we delve into an exclusive interview with our friend, Dawn Castro.

CommUnity Bridging

For those unfamiliar with Dawn, prepare to be inspired by her remarkable journey and unwavering commitment to sharing her experiences.

Together with Dawn, our mission is clear: to bridge talent across all RCM organizations, bringing together individuals from diverse backgrounds and perspectives. Let’s raise a toast to unity and collaboration as we strive to strengthen our CommUnity and drive innovation forward.

A March editorial would be incomplete without mentioning my NCAA bracket! With a KY Bourbon salute, cheers to my University of Kentucky Wildcats. Go Big Blue! #BBN

Jena Eggert Editor-in-Chief RCM Connections

TABLE OF CONTENTS

01.

SPOTLIGHT INTERVIEW WITH DAWN CASTRO

07.

ABAX SPOTLIGHT WHO IS ABAX?

09.

DEMYSTIFYING

13.

SPONSORS RCM COMPANIES YOU SHOULD KNOW

19.

RCR|HUB SPONSORSHIP OPPORTUNITIES

DAWN CASTRO

senior Vice President, Revenue cycle

Are all RCMs equal?

Large Profit Delivery System to The Specialty Provider World.

The Switch-

On March 13th, I had the pleasure of a oneon-one Zoom call with an amazing RCM trailblazer, Dawn Castro. To share a bit of insight into Dawn’s career, I’d like to begin by sharing a few bullet points her current team created:

• 34+ Years of Revenue Cycle Management (RCM) and leadership roles

• Started her career @ Tenet in 1991

• Transitioned to Conifer @ Launch of the new company in 2008

• Seasoned in M&A activities throughout hospitals, ASC’s & Physicians

• Experience leading large-scale projects & operational transformation through standardization and optimization strategies

• HFMA Member for 25 years

• Participated in HFMA Large System Rev Cycle Council Member and various Leader roles 2011 - 2023

Jena: Thank you so much for taking the time to share your experience, your new current role, and what you look forward to in the coming months and years. Congratulations!

Dawn: Thank you! I’ve been busy! The move was obviously a big one! It was my whole identity, the only place I had ever worked!

Jena: Incredible! I’m extremely grateful for your time and for sharing your RCM story. Thank you for being willing to follow wherever this conversation takes us. So, let’s jump in. What led you to decide to leave after 30 years?

Dawn: Everyone asks that question! Here’s what I know: I’ve largely been on the Service Delivery side for the last 20 or so years, which I’ve thoroughly enjoyed…I couldn’t be more appreciative of the experiences I’ve had working at Tenet and Conifer over the years. We had a culture that encouraged Creativity and Problem-solving across the organization, and it became a fun Sandbox to create new Service Lines or Bring in tech-enabled solutions, etc. As I progressed in my career and Conifer’s scale grew - I got further and further away from the Enterprise strategies for our Hospitals/ Surgery Centers, Patients, and what I love most – which is Operations.

Surgery Partners was an intriguing opportunity.

1. They were looking to build an Enterprise Rev Cycle Operating model under one umbrella – I would no longer have to choose where I spent my time, Front – Middle – or Back. I was able to build a scalable solution for everything!

2. They are exactly in the space where healthcare is headed, and patients and payers expect an ASC/practice solution for cost and ease of access compared to large hospital settings.

We have a nice blend of 16 IP Surgical Hospitals w/half of them having Emergency Rooms which is an excellent feeder to the ASCs and Practices in the community. The ASC business is growing at a very rapid pace. SP has a fantastic vision for that growth through JV partnerships, DeNovo’s—it’s very impressive. Now that there is a Playbook for Integration of People, Processes, and Technology throughout, the sky’s the limit on what we can do to be the High-Quality, Low-Cost Partner in the Markets/ Patients/ Physicians we serve! I’ve truly enjoyed my first year here. It has an amazing culture, and they get the value of RCM and are supportive of the Change Management we need to undergo to achieve Improved performance.

Taking the posting got me back to doing what I love most!

Jena: Let’s discuss your new role. To give readers insight, above is a visual of Surgery Partners Locations:

How did you decide to take the new role?

Dawn: I interviewed for about four months, which was probably the longest. “They were like, are you ever going to make a decision?” I interviewed with ten people throughout the journey. They probably thought I was nuts. But I kept saying to myself, these are people that I’d be working with, and I want to make sure that it’s a fit for both sides. I wanted to make sure that if I made a move, I was moving for the right reasons and that they were going to hold true to what they were committing to. They were embarking upon a large operational transformation. I kept asking the executive team, you understand what you’re trying to do will be very hard? And the CFO kept reassuring me, “We know.”

Jena: What role did your educational background and personal experiences, including family

involvement in Healthcare, play in shaping your career? Into RCM?

Dawn: In my Junior year of high school, my mom told me they were looking for candy stripers at our Community hospital. So, a group of us volunteered. It happened to be the location of my first job out of high school as a PBX Operator and ED clerk at the same community, Tenet Hospital in Orange County, CA. The exact facility My Great-Grandmother had worked there in the 1970s, my mother worked there as a nurse off and on as a floater, and my sister was born there as well, so I guess that was a nice family connection. I’m more appreciative of where I came from and what we’ve built. It shaped our children as well. When we had our son, my husband worked the day shift, and I needed something flexible. I started working the night shift, the 3 to 11 shift. I would

literally pick him up. We had one car, and in 30 minutes, he’d quickly drive me to the hospital to drop me off and start my shift at 3 pm. With my son in tow, they’d come to pick me up after my 11 o’clock shift. It was a fun time to be young and poor, is what I always say!

Jena: Let’s talk about your mentors. What advice or insights can you share regarding Mentorship, education, and relationship building?

Dawn: I was fortunate to have a few key mentors at Tenet/Conifer that were critical in my personal development – Norma Zeringue is the most prominent memory of excellent career coaching and friendship – even when it wasn’t easy… she kept it real! She is still in my life. She even came to town for my 50th birthday party, she’s great about making visits when comes back to Texas!

I was also very fortunate to build strong working relationships internally and externally over the years with colleagues – in fact, several friends who were at Conifer or recently left took an Alaskan Cruise together and it was like a Big Reunion of people I treasured; we all thoroughly enjoyed being with one another for that week…and reflected on our good times together and realized it would have never happened had we all still been working with one another. There were about 45 of us when we included our family members.

RCM is a very small community! You have to have fun together and never want to burn any bridges.

Jena: How different are the two worlds? How much do they parallel one another? Is RCM, RCM?

Dawn: It’s interesting. In some regards, it’s night and day from where healthcare is today; we are more outpatient-driven and trying to be more nimble. The basic blocking and tackling of pre-service financial clearance and issues that you would have regarding denials and authorizations are the same. We’re

working on maturing our Operating Model from a highly decentralized model on multiple patient accounting platforms with a lot of third-party vendors. We’re measuring Cost to Collect and typical RCM metrics like Unbilled, Aging, and AR days. What’s different is the ownership models, who we must link to drive change. That’s probably the most challenging thing I’ve encountered this year. Three-way joint ventures and going to board meetings to explain wanting to change an eligibility vendor is different. We are trying to drive some transformation. Several of our surgery centers were established by a physician or a small physician group that we then acquired to become a JV that was using antiquated processes, hand schedules, and no tech-enabled solutions. We started from scratch in many cases and crawled in some areas. My team and I showed them what unbilled reports look like across the enterprise as a Win – so one metric at a time, it’s been fun. So, yes, there are some parallels.

Jena: Can you share your experience of using the power of the RCM community and LinkedIn to establish your new team? Once you have assembled the right people, what steps do you take as a leader to ensure their satisfaction and keep them motivated?

Dawn: People were honestly amazing! LinkedIn has been incredible for finding people. Online users reposted it and sent me suggestions. Remember, I had to deal with my non-solicitation, which was difficult. I received permission to avoid my non-compete in taking the job. I did not directly solicit. I’ve been very careful not to burn any bridges. We’ve brought in some incredible people! A new Supply Chain executive started the same day I did. She knows the connectivity between revenue cycle, managed care, and supply chain. They had a fantastic managed care individual named Shannon Yarrow in place. So, the three of us spend a lot of time together solving all the fun issues. We’ve got this wonderful triad in place between the three of us. I’ve had success in the past in developing large-scale teams and investing in leadership

development programs. There are two key programs that I really appreciated and benefited from

a) Internship Program

b) Leadership Rotation & Development Program

They created well-rounded leaders throughout Hospital RCM. Working through development strategies in my existing role, I’ve been fortunate that I’ve been able to hire a few very Strong Leaders that I’ve worked with in the past; they are truly helping us with our Transformation Journey.

Jena: As you look forward. What are your thoughts on your career journey?

Dawn: I probably have eight to ten more years to work. I could see myself finishing up my career here. I do. One of the commitments I got from our leadership when I started the role was that I wanted to continue to be actively engaged in HFMA and hone in, like where I wanted to spend my time and where my happiness was. And so, they have given me a bit of free reign to continue in the HFMA space and potentially take on additional roles, which I think would allow me to do more from a regional perspective.

Together, during our discussion, we talked about bridging the gap:

Dawn: I did talk with HFMA representatives about figuring out where this ASC space hits because I’m somewhere in between. And even though I don’t meet the criteria to participate in the large, I do want to start to join some of the other sessions, either at a regional or national level. That’s why I talked about the affiliation.

Jena: I agree. We need to bridge the gap. Our industry, our CommUnity can’t afford to lose the talent in our RCM CommUnity. I know it is a need-something I’ve been trying to solve. Maybe it’s a new “bridge group supported by The Hub!”

Last Takeaways:

Dawn: I have several.

Client Relationships Matter – becoming their trusted advisor and confidant was a very important role for me.

Externally, Collaboration within the Large System Rev Cycle Council has been beneficial for sharing best practices and thought leadership.

Externally – having great Business Partners with strategic Vendor Partners has always been important to me; they are an extension of our existing team, and we always want to treat them with dignity and respect.

I have done a lot of lateral moves in my career. I like to call it my jungle gym because I was a jack of all trades. People should not become stagnant in their careers. Even though it was scary, my husband was more scared than I was about me making the move. He kept asking me if I would like it and if they would like me. But change is inevitable, and I regret being scared not to try something new earlier. You should not be afraid to try something new, either. If something cool comes up in an offer, you should consider it.

You have the power to drive your own career.

In family life, love is the oil that eases friction, the cement that binds closer together, and the music that brings harmony.

“ “

Scott Friesen| CEO - scott@abaxhealth.com

Kevin Sleeper| Chief Growth Officer - kevin.sleeper@abaxhealth.com

Keith Eggert| Chief Strategy Officer- keith.eggert@abaxhealth.com

Is RCM the same in healthcare systems, specialties, and dental practices? A seamlessly functioning revenue cycle is fundamental for ensuring the financial stability of healthcare providers. However, navigating the complexities makes managing this cycle akin to a sophisticated dance. This article delves into examining revenue cycle management’s fundamental operations and spotlighting the distinctive nuances between RCM practices in three different care delivery settings: hospitals, ambulatory surgery centers, and dental practices.

The Essence of RCM: A Fundamental Cadence

At its core, RCM, across all healthcare settings, adheres to a universal rhythm. It commences with patient scheduling and registration, emphasizing precise insurance verification and the capture of demographic particulars. Subsequently, medical coding translates procedures and diagnoses into standardized codes essential for billing purposes. This is succeeded by the submission of claims to insurance companies, entailing adept navigation through the intricate realm of denials and appeals. Finally, the cycle culminates with patient and insurance payments, and account reconciliation.

“ At its core, RCM, across healthcare settings, to a universal rhythm“

Variations within the Harmonic Spectrum: RCM by Specialty

Despite the overarching similarity in core functions, the specifics of RCM exhibit variations across specialties owing to disparities in service delivery, coding requisites, and patient demographics. Let’s delve deeper into each specialty:

Hospitals: These institutions undertake intricate procedures and emergency admissions which necessitates meticulous coding and a heightened emphasis on pre-authorization/ auth to circumvent claim denials. Furthermore, managing voluminous payer contracts and payment methodologies introduces an additional layer of complexity to the RCM process.

Ambulatory Surgery Centers and Outpatient Clinics: ASC/Outpatient clinics, including specialty clinics such as orthopedics or gastroenterology, encounter a diverse range of procedures and patient cases. RCM in these settings often revolves around efficient scheduling, financial clearance, coding practices, streamlined claim submission processes, and diligent denial management to optimize revenue streams.

Dental Practices: Dental practices typically handle a high volume of lower-cost procedures. Their RCM workflows prioritize efficiency and automation to manage claims accurately and effectively. Additionally, dental insurance plans often feature unique coverage rules necessitating the use of D-CODES and meticu

core, across all healthcare adheres universal “

lous attention to service and claim detail.

Tailoring Solutions to Specialized Needs: The Market for RCM Solutions

Given these discrepancies, RCM solutions are tailored to suit specific requirements. Hospitals with broad services often deploy robust RCM systems boasting advanced coding functionality and sophisticated contract management features. Dental practices, conversely, may opt for user-friendly solutions equipped with strong automation capabilities to expedite claims processing.

Reaching Across the Symphony: Opportunities for RCR|HUB Vendors

Without a doubt, yes! While nuances may exist, the core challenges of RCM—precise coding, expeditious claims processing, and revenue optimization—are universally pertinent across these care delivery models. RCR|HUB vendors offering a spectrum of solutions ranging from simple to complex can adeptly cater to the diverse needs of this expansive market.

The Melody of Success: Parallels and Distinctions

Let’s conduct a comparative analysis to underscore the major parallels and distinctions in RCM across these specialties:

Similarities:

• Fundamental RCM functions (scheduling, coding, billing)

• Emphasis on accurate and prompt clas submission

• Imperative for robust denial management strategies

Differences:

• Procedure complexity (hospitals vs. dental)

• Claim specificity (typically higher in dental practices)

• Contract management (pertinent for hospitals and ASC/Outpatient Clinics)

• Pre-authorization focus (critical for hospitals and ASC/Outpatient Clinics

• Specific coding requisites (distinctive rules in dental coding and insurance plan requirements)

By comprehending these intricacies, RCR|HUB vendors can customize their outreach and solutions to resonate with each healthcare specialty. By offering a symphony of options, they can establish themselves as trusted partners in the multifaceted dance of RCM.

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Evaluating Your Credential Risk Conceal and Encrypt:

Conceal Usernames and Passwords from users when accessing payor portals (PHI)

Automatically encrypt passwords on the user’s behalf. Ensure that passwords are changed regularly across your organization for all payor portals and other online applications. Consider enhancing password security (very strong) by increasing the minimum length and incorporating special character requirements.

Audit All Users Accessing Payor Portals:

Stay vigilant by monitoring user access. This helps detect suspicious behavior, such as unauthorized access attempts or data breaches

Who are my Users?

Which Portals are being accessed? How Often? And How Long?

Review IP Whitelisting Configurations:

Avoid new, un-authorized, selfregistration portal access without receiving proper authorization from management or internal compliance.

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We are thrilled to unveil a special edition of RCM Magazine on Monday, March 25th. The edition will be dedicated exclusively to the announcement of a pivotal position within RCM!

OPPORTUNITIES AT A GLANCE