RCM Connections: Our RCM Interconnected CommUnity by rcrhub

Our RCM Interconnected CommUnity December 2023

KEITH EGGERT

Vice President, Revenue Cycle

KARTHIK POLSANI Founder and Group CEO at ECLAT Health Solutions Inc.

e m o c l e w to

EDITORIAL:

A Journey Welcome to the first edition of RCR|HUB’s online digital magazine, RCM Connections. This edition features two RCM leaders - one provider and one business partner - and explore how they met and have supported one another in their RCM journeys. In November, I spoke with my favorite Revenue Cycle Executive, Keith Eggert. Keith isn’t just a professional colleague; he’s also my partner in crime! We recently celebrated our 32nd wedding anniversary. Our story began in Orlando, where two wildcats from different corners of the country, one from The University of New Hampshire and the other from The University of Kentucky, found themselves on a unique journey in the “sunshine state.” Despite our collegiate differences, the good Lord and the love of warm weather brought us together in Orlando.

y in Revenue Cycle Keith started his healthcare career as a self-pay collector at Orlando Regional Medical Center (ORMC), now known as Orlando Health. He was one of four exceptional candidates chosen for a unique training program at ORMC. This marked the start of his impressive career in the Revenue Cycle, where he continues to make a significant impact.

JENA R. EGGERT CEO & Founder RCR|HUB and JER Marketing

Meanwhile, I began my professional journey as a customer service representative at Humana Health Care. I found my niche in family practice and eventually transitioned into the office administrator role for an OB/GYN practice in Winter Park, FL. Our different career paths have led us to RCM. Despite industry changes, our commitment to excellence remains steadfast. In December, I had the pleasure of interviewing Karthik. I have known Karthik for several years, and during our conversation, I was fascinated by his unfaltering devotion to his family, his unwavering work ethic, and his commitment to assembling the best team to provide unparalleled solutions. I am certain you will thoroughly enjoy reading about his journey and how Keith transformed his trajectory with a single signature. I hope that with each issue, we can unite and “break bread” virtually! Please take a moment to immerse yourself in the stories of two RCM leaders and discover why they wholeheartedly embrace our RCM CommUnity. Peace and Joy, Jena Eggert

TABLE OF CONTENTS

01. 15. 07. 19. 09. PROVIDER SPOTLIGHT INTERVIEW WITH KEITH EGGERT

HUBBUB BLOGS YOU SHOULD READ NOW

ABAX SPOTLIGHT WHO IS ABAX?

RCR|HUB SPONSORSHIP OPPORTUNITIES

BUSINESS PARTNER SPOTLIGHT KARTHIK POLSANI

PROVIDER SPOTLIGHT

KEITH EGGERT Vice President Revenue Cycle

Online Interview between Jena Eggert and Keith Eggert.

Please introduce yourself, including your organization, and share some insights about your demographic reach? KEITH: I’m Keith Eggert, the Vice President of Revenue Cycle at the University of Miami Healthcare System, which encompasses the University of Miami Hospital and Clinics, the University of Miami Medical Group, consisting of around 1,400 faculty physicians, and a prominent NCI-designated cancer center program. Our presence spans Miami and South Florida.

How many locations? KEITH: Daily, our patient access department staffs 132 locations How many departments and team members fall under the title of Revenue Cycle? KEITH: At the U, there are 1,350 revenue cycle employees that span everything from onsite patient access to all components of health information management, revenue integrity, HB-hospital billing and follow-up, PB professional billing and follow-up, shared services, and etc. How many direct reports do you have in your area? KEITH: I have seven direct reports. •Exec Dir System Onsite Patient Access •Exec Dir Health information Management •Exec Dir Revenue Cycle Shared Services •Exec Dir of HB revenue cycle •Exec Dir PB revenue cycle •Director of revenue cycle payer relations •Director of analytics and reporting

What inspired you to pursue Healthcare Revenue Cycle Management (RCM)? How did your family background, educational journey, and personal experiences influence your path toward RCM? Was there someone in your family who paved the way into healthcare, or was it primarily your firsthand experiences in hospitals that played a significant role in shaping your career? KEITH: Let me take you back a bit. I was always intrigued by managerial accounting, not financial accounting, but managerial accounting. After months of visiting a hospitalized family member, my curiosity about the financial operations of hospitals peaked. That in turn lead me to pursue a Bachelor of Science in health management and policy, followed by a master’s in health services administration. Throughout my career, I have always been a revenue cycle guy. I began my career in revenue cycle in a management training program, and from there, my career took shape. In 2005, I became a vice president, a role I’ve held in various organizations since then. In today’s digital era, what are the key performance indicators you find most critical for measuring the success and efficiency of RCM in your organization? KEITH: Two of the most important KPIs that I monitor are the calculations of cash to net revenue and Net/Net AR Days. I always try to get as close to, if not over, 100% cash to net revenue. And maintaining Net/Net Days down in the 40s, shows a high-performing revenue cycle. Those two components, plus your cost to collect on the expense side, I would say are the most important. How do you obtain those Key Performance Indicators (KPIs)? Is it a daily review for you? Do you monitor them through dashboards? Are there dedicated teams or systems in place to collect this data, or do you depend on your business partners to provide you with this information? 2

KEITH: No, I monitor those three KPIs on a monthly basis. From a daily perspective, being an Epic shop, we monitor a number of revenue cycle dashboards. The use of dashboards varies from being monitored daily, multiple times a day. They provide valuable trending, which provides insight regarding things operating within acceptable parameters, and looking at what I call the assembly line, with the ability to drill down on accounts/visits that have fallen off and may not be performing the way they should be. With the evolving healthcare landscape, how do you stay informed about regulatory changes and industry trends? How do you adapt? KEITH: So, there is no easy answer to that. One size does not fit all. I generally utilize a decentralized methodology; if it is revenue integrity related, meaning CDM, HCPCS, rev code, or anything associated with regulatory changes on CPTs; I have my head of revenue integrity monitoring that on a continual basis, along with our software. Also, professional associations and trade magazines, each leader is plugged into information sources for their appropriate area of responsibility and monitoring that information. So that the minute something comes out, we can share the information across the leadership team/ organization. Of course, it is nice to be able to go to a one-stop shop like The HUB for information. But as I said, one size does not fit all in this case. So, you must divide and conquer to remain up to date.

KEITH: So, and this is how I know Karthik. Back in the day, before Epic and all the EHRs took off; at my prior organization, we were state-of-theart in adopting a document imaging platform. Not only did we do document imaging immediately of all medical records, but we also did chart completion and facilitated coding workflow via the image platform, which allowed us to do remote coding way before remote coding became a true lifeline in the industry. This led to a long-term business relationship, which I’m sure Karthik will talk about in his interview, they were our partner to really start offshore coding at least 15, 18 years ago. So yes, that was state-of-the-art at the time. I’ve always been a proponent of doing things more efficiently, more effectively, and more accurately using technology. I mean, technology as a supporter, not a hindrance. So, you know, now that we’ve moved into more and more digital and electronic records, with AI-based coding solutions and so forth, the advancement is becoming more and more rapid on a continual basis.

I’ve always been a Revenue Cycle guy

As a forward thinker, how do you encourage your teams to research and adopt new technology and data analytics to enhance your organization’s revenue cycle processes and decision-making? 3

What strategies have proven successful in securing favorable reimbursement rates? How do you maintain these relationships, and how do you call BS when you see it? KEITH: Let’s delve into the revenue cycle aspect. Our role isn’t centered on negotiating actual rates; instead, we focus on ensuring we receive accurate and timely payments. To achieve this, we’ve established a payer relations department within the revenue cycle at the University of Miami. This department, led by a director and supported by a team of analysts, continuously monitors payer performance. When we encounter issues such as underpayments, payment problems, or denials, we employ a unique approach.

Instead of having our collectors attempt to resolve these issues, we divert the accounts to what I refer to as the payer relations area. The team packages and manages the problem, engaging directly with the payer. We employ various methods like demand letters, joint operating committees, and other avenues to drive issue resolution and secure the rightful payments owed to our organization. Our goal is simple: we don’t aim to be paid a penny more than what we’re owed, but we strive to collect every penny that is rightfully ours. This meticulous approach extends to addressing denials, underpayments, and even, in some cases, overpayments. We are equally vigilant about avoiding overpayments, which can occur due to contract discrepancies or unexpected software changes made by the payer. As such, we invest significant effort in this area. Additionally, we have collaborated with our contracting division to incorporate revenue cycle performance language into contracts, emphasizing joint operating committees and other mechanisms for effective communication with payers to drive optimal performance. How can we, as a community, work together to address these challenges effectively? KEITH: Collaborative efforts can be incredibly effective in this regard. In Florida, for example, the Florida Hospital Association is working on a data-sharing process akin to what Ohio has successfully implemented. This involves pooling data at the state level to gain insights into individual payers across the region. The idea is to determine whether issues with a particular payer are unique to our organization or if they affect other providers in the state or a specific geographic area. This collaborative approach leverages collective intelligence, providing a more comprehensive understanding of payer performance beyond what individual organizations possess. We are actively participating in such initiatives, as they hold great potential for enhancing transparency in payer performance.

Can you share your approach to motivating and developing your entire revenue cycle management team, nurturing their career growth? What strategies have been instrumental for you, both in the past and in your current role? KEITH: My leadership philosophy centers around being prepared and leading by example. If I expect someone on my team to undertake a task, I make sure I am equally prepared to tackle it myself, whether that involves acquiring relevant knowledge or mastering a particular skill. In my view, empowerment is about fostering individual growth equipping team members with the tools they need to enhance their knowledge and capabilities. It’s essential to elevate the team collectively. I never ask anyone to do something I’m not willing to do myself, and I treat others the way I would want to be treated in similar situations. This approach has enabled me to build strong, highperforming teams consistently. However, fostering such an environment also requires a particular leadership persona, which I often refer to as the “hunter personality,” especially in accounts receivable. When you’re hunting for dollars, you must possess the determination to navigate through the complexities and minutiae to identify root causes and drive resolutions, ultimately maximizing cash flow. In our world, a strong grasp of EPIC and a deep understanding of revenue cycle functions within one’s area of responsibility, whether it’s PB or HB, are invaluable. This comprehensive knowledge not only enables effective day-to-day management but also facilitates change, improvement, team motivation, and growth. It’s a collaborative effort, but leadership and the right environment are pivotal. A stagnant, disempowering environment will not yield positive results. Shifting to trends and technology, how are you preparing your leaders in the organization for emerging trends in technology? While we can’t predict the future, how do you equip your team to adapt to evolving technological landscapes?

KEITH: Staying abreast of technological advancements is crucial. I’ve always advocated for being at the cutting edge, though not necessarily the bleeding edge. One of my key principles is to encourage experimentation. If there’s a new technology or process to try, I believe in taking the initiative. The philosophy is to either succeed quickly or recognize failure promptly. We don’t want to linger on unsuccessful endeavors. Instead, we aim to learn and progress swiftly. This mindset extends to adopting new technologies, be it robotic process automation, new vendors, or any innovation that has the potential to enhance our operations. Our goal is to identify solutions that outperform our current methods and measure their impact. We even employ a “champion-challenger” strategy where two entities operate in parallel to assess their performance, whether individuals, products, or companies. Eventually, the better performer takes on the bulk of the business, eliminating the need for a split environment. This not only drives efficiency but also reduces risks associated with relying on a single vendor or process.

This accomplishment is a testament to the collective efforts of a skilled team guided by the right knowledge, partnerships, and technology.

Would you please share a recent success story of yours and your team

KEITH: The revenue cycle community is a great network of dedicated individuals across the nation. I am so grateful for my mentors and all my, (our) lifelong friends that we’ve made since 1991. They are irreplaceable. We’re all striving for excellence, and what truly makes a difference is the exchange of ideas and best practices. Learning from each other’s successes can lead to substantial improvements, not just within organizations but for the entire industry.

KEITH: My tenure at the University of Miami Healthcare System is a remarkable success story. When I arrived, the revenue cycle was severely broken, characterized by a less then functional leadership team and an inadequately implemented Epic system within the revenue cycle. Over a span of approximately three and a half years, we executed a substantial turnaround. Today, our revenue cycle is widely recognized as best-in-class, marked by high performance. While we continue fine-tuning our processes, these minor adjustments translate into continuous cash flow improvements Our adoption of automation, as described earlier, has allowed us to avoid adding any back end full-time equivalents (FTEs) over the past three years. In fact, we have reduced FTEs, showcasing the effectiveness of our approach. 5

It’s truly an impressive transformation! I’ve heard there were accolades from Epic recognizing your organization’s achievements as well. KEITH: Indeed, one of our notable achievements is in the area of patient access. We excel in collecting out-of-pocket patient payments, including co-pays, deductibles, and insurance-related expenses, at the front end, prior to service. Our performance consistently ranks us among the top tiers, often placing us between the emerald and diamond levels. Our patient access team takes immense pride in this accomplishment, and we’ve equipped them with the necessary technology, including Epic tools, kiosks, and e-arrival processes, to facilitate this success. Last thoughts you’d like to share with our RCM CommUnity?

Follow Keith on LinkedIn Editor’s Note: I interviewed Keith before he decided to depart from his current position at The U. He begins his new role as Chief Strategy Officer at Abax Health in January 2024.

Favorite drink? A good German lager

TOP 5 FAVORITES

Favorite city? Vienna- especially magical during christmas

Favorite pet? Toss-up between Labradors and English Bulldogs

Favorite charity? Wounded Warriors.

Favorite vacation? Any tropical island with clear blue waters

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BUSINESS PARTNER SPOTLIGHT

KARTHIK POLSANI FOUNDER & GROUP CEO AT ECLAT HEALTH SOLUTIONS 9

Interview between Jena Eggert & Karthik Polsani

KARTHIK: I’m Karthik Polsani, and I serve as the founder and Group CEO of ECLAT Health Solutions. It’s been an incredible journey since I founded this business approximately 15 years ago in February 2008. ECLAT Health operates within the healthcare revenue cycle management sector, and our team has been dedicated to serving our clients in the ever evolving healthcare landscape.

Can you share what led you to venture into the healthcare RCM? What motivated this choice, and were there any specific factors, such as family influences, that played a role in shaping your path and establishing your presence in our industry? KARTHIK: My journey into healthcare revenue cycle management has some interesting twists and turns. It all began with my background- I grew up in a family of physicians and was surrounded by healthcare professionals during my childhood. For the longest time, I envisioned myself becoming a physician, following in the family footsteps. A pivotal moment occurred in 1998 when I visited several of my dad’s colleagues in Michigan. During that visit, there was a lot of discussion about the transformative impact of technology on healthcare. The physicians I met believed that I could make a more significant contribution through technology and entrepreneurship than by pursuing a career as a doctor. This happened during the dot-com boom era, around ‘98 and ‘99. Initially, I was planning to pursue a double major in engineering and medicine, with the intention of going into pre-med. However, upon returning to college, I made the decision to change my major to engineering, redirecting my path away from medicine. This shift was a significant turning point. I completed my engineering degree and went on to earn my master’s degree. My journey took another twist when I landed a job with a consulting firm straight out of college. While waiting for a placement, I was eager to start earning a paycheck. The firm initially offered a role in healthcare that was somewhat different from what I had anticipated. It resembled a help desk role, but I accepted it, it was an opportunity to start working and earning income.

As a healthcare consultant, and I discovered my passion for the industry. I continued to work as a consultant for several years. Being an entrepreneur at heart, I knew I wanted to explore healthcare technology at some point. My parents, both physicians, had also ventured into entrepreneurship, which inspired me. One day, while consulting at Orlando Health in Florida, I noticed the challenges they were facing in optimizing the revenue cycle, particularly in coding processes, staff shortages, and keeping up with guideline changes. It struck me as an area where I could make a significant impact. So, I began jotting down strategies and ideas on a napkin on how to start a business in this space. I took these ideas back to my consulting firm, developed a business plan, and presented it to them. After some deliberation and approvals, we embarked on the journey of setting up a business in healthcare revenue cycle management. ECLAT Health Solutions, in its current form, was established in February 2008. We initially worked as part of a consulting arrangement with CGI, a consulting firm, for several years. However, when CGI ventured into a conflict-of-interest business, specifically auditing and rack audits, we decided to branch off and rebrand ourselves as ECLAT Health Solutions in 2013. Since then, we’ve continued to grow and have assembled a remarkable team of RCM leaders dedicated to making a positive impact on the health systems we work with. That’s the story of how I found myself in healthcare revenue cycle management. Where did you go to college and grad school? What did you study? KARTHIK: I started my undergraduate studies in India, majoring in engineering. Subsequently, I moved to the United States and completed my undergraduate degree at Carnegie Mellon University. 10

There I focused on electrical and computer engineering. I also pursued a master’s degree at Carnegie Mellon in the same field. You mentioned your initial encounter with Orlando Health and its role as your first beta partner. Can you elaborate on the impact of having a healthcare provider like Orlando Health step up and collaborate with your organization?

Thepartnership partnership with The Orlando Health and with Orlando Health Keith Eggert’s team and Keith Eggert’s was huge

I didn’t have a personal relationship with Keith at the time, as I primarily worked with departmental teams within Orlando Health. However, the decision by Orlando Health and Keith’s signature on our contract to become our beta partner was monumental and shaped the course of our journey. Having a healthcare provider like Orlando Health willing to take a chance on us and embark on a collaborative journey was crucial. It’s easy to partner with large providers, but it’s not as common to find a partner willing to believe in a small vendor with innovative ideas. The team at Orlando Health decision to take that leap of faith meant a great deal. It demonstrated their willingness to empower motivated individuals that propose innovative solutions. In our industry, relationships and trust are paramount. Small, motivated entities often possess groundbreaking ideas, and having a platform like RCR|HUB allows us to interact, share ideas, and foster relationships. It’s an essential aspect of building a collaborative and supportive community within the industry. We should cherish the spirit of community and camaraderie that has traditionally characterized the healthcare sector. 11

As healthcare continues its shift towards value-based care and patient-centric models, how does ECLAT Health support healthcare providers in this transition? KARTHIK: The shift towards value-based care is a significant transformation within the healthcare industry. At ECLAT Health Solutions, we recognize the importance of assisting healthcare providers in navigating this transition effectively. To that end, we’ve developed a powerful tool named “evaire” that is specifically designed to support health systems and providers in the value-based care model. Our solution, evaire, enables us to collaborate with both payers and at-risk providers. It serves as a valuable resource for health systems, offering a comprehensive suite of services that help them stay ahead in a value-based care environment. This includes not only process optimization but also robust analytics and reporting capabilities.

With evaire, health systems can make data-driven decisions, track quality measures, and streamline their operations to align with value-based care requirements. We understand the importance of providing solutions that address the unique challenges and opportunities presented by this evolving healthcare model.

Our commitment to assisting healthcare providers in their transition to value-based care is reflected in the development and deployment of evaire, a tool that empowers our clients to thrive in this new landscape. To conclude, could you share a success story or achievement related to revenue cycle management that you are particularly proud of? KARTHIK: Retaining clients for 15 years and counting in a dynamic industry like healthcare is a testament to the trust and relationships we’ve built over the years. Not only have we retained these clients, but we’ve also continued to grow our partnerships. Over the past decade, our attrition rate has remained consistently below 1%. Even that minimal attrition is primarily due to strategic decisions, such as parting ways with a vendor that was no longer a good fit. We’ve never encountered a situation where a client decided they could no longer work with us. This high client retention rate speaks to the strength of our team, the robustness of our infrastructure, and the excellence of our processes. Additionally, over the last few years, we’ve achieved more than 60% year-on-year growth while maintaining this exceptional client retention record. This accomplishment is something we take immense pride in and serves as a testament to our commitment to delivering exceptional value and service to our clients. Congratulations! As an active CommUnity member, what improvements or enhancements do you think we should consider? Whether it pertains to educational initiatives, event planning, or strengthening connections, how can we further enrich our sense of CommUnity? In your view, what steps can we take to fortify our sense of CommUnity and foster collaboration?

KARTHIK: You’ve touched on several crucial points here. Our industry thrives on relationships, and, as you rightly mentioned, we seem to have lost the art of coming together outside the confines of business. It’s about more than just transactions; it’s about community and camaraderie. Over the years, I’ve come to realize that the healthcare sector is a tight-knit community. You keep encountering the same faces and names for 15 years, and as an entrepreneur involved in various ventures, I find myself repeatedly drawn back to healthcare because of the incredible relationships I’ve built. There’s a profound belief in the power of these relationships, but we’re lacking a platform that can unite us all. That’s where I see RCR|HUB making a difference. The trust and belief already exist in our small world, where everyone knows each other. However, we’ve somehow lost the ability to connect and engage. I’m genuinely excited to see how RCR|HUB can serve as a catalyst for bringing everyone together, fostering an environment where we can break bread, spend quality time, and exchange ideas. It may sound simple, but it’s a crucial element that’s been somewhat neglected. We’re committed to doing our best!

TOP 5 FAVORITES

* Interesting editorial note about Karthik* Favorite charity? Carnegie Mellon

Favorite city? Capri, Italy

Favorite drink? Strawberry milkshake from McDonald’s.

Favorite vacation spot? I’ll stick with Capri. As for my favorite city, it has evolved over the years, but I have a deep love for Washington, D.C. It’s my home.

I actually enrolled in medical school for nearly four years while simultaneously pursuing my undergraduate and master’s programs. This decision was influenced by my mother’s desire for me to become a physician. She had hoped I would follow in my father’s footsteps, but I continued to disappoint her career expectations. So, I enrolled in a Caribbean medical program in St. Kitts during the latter part of my undergraduate and master’s studies. I had to travel to St. Kitts each week. I completed almost three and a half years of the program and was just six months away from obtaining my MD degree. However, my mother eventually discovered this, and she believed that I would make a more significant impact as an entrepreneur. With my business ventures already underway, I decided to forgo completing my medical degree.

Favorite pet? Currently have none but growing up was obsessed with having animals & pets and went though a few over the years - Dogs, Cats, Birds, Rabbit, Fish and many more Karthik Polsani | Karthik.polsani@eclathealth.com 13

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