Efficiency Without the Expense: Rethinking Revenue Strategy

Today, Lee, our speaker here, will share how hospitals, payers, and provider groups are achieving tangible gains by doubling down on what they already have, skilled teams, data backed education, and lightweight tools.

Lee Williams is the director of education at AAPC. She has over twenty years of experience working in both the outpatient and inpatient setting.

As an independent health care consultant, she has provided coding oversight services to organizations such as the CDC, the US Consumer Product Safety Commission, and industrial economics.

Her background encompasses coding, CDI, auditing, physician training and education, practice management, and compliance. So with that, I'm gonna turn it over to you, Lee.

Alright. Thank you so much, Steph, for the introduction. Let's go ahead and jump in. So we're gonna start. We have maybe about three independent segments, I will say, within this presentation that will focus on when we're talking about revenue optimization and just things that we can do around operational efficiencies.

So we're gonna begin discussing the problem.

And if anyone has questions, I'll try to keep my eye on the Q and A. Steph will be looking at it also. I'll look at the chat as well, but the Q and A just works better to be able to see the questions as they come in so they don't fly, too fast through the chat.

But let's start by talking about the current landscape many of us are operating in.

When revenue cycle challenges arise, the first solution that's often pitched is a high cost platform.

It might be a new AI tool, especially in today's marketplace. I think a lot of organizations are investing in or evaluating how to invest in those AI tools.

Organizations may also look at new systems for their claims management or some type of data analytics suite.

These can be powerful but they're also very expensive.

They can be complex and not always tailored to your individual needs based on your organization, the types of services that you render, the population of patients that you treat, etcetera.

In today's health care space, high cost tech platforms are often sold as the fix for revenue cycle issues, but these solutions can take months, sometimes years to implement.

And when that implementation takes a very long period of time, what we see is the value of that product or that investment being decreased or at least delayed.

Meanwhile, frontline teams are stuck dealing with the same old issues, trying to get ahead of denials, dealing with inaccurate coding and process inefficiencies.

It's leading to burnout and limited impact. So what's the core problem?

We're often overlooking simpler, faster paths to improvement, starting with the people and the tools we already have.

So sometimes it's looking at your labor and determining how you can use your labor force in a more effective manner or perhaps how you can diversify your labor force.

Instead of defaulting to massive new systems, many organizations are seeing real results by focusing on three key items.

These are the items that you see here on your slide.

These are items that can be easily adopted.

Typically doesn't require a huge investment, and can yield a positive ROI.

So what's the simpler path? We'll start with skilled people.

Your frontline teams, whether they're coders, billers, auditors, wherever their role is within revenue cycle, they know the work, they know the pitfalls and the pressure points.

I'm sure some of you on the call today, if you're a manager, when you listen to your team, whether you're having a team meeting, a team huddle, or they're reporting to you, they often can bring pain points to you and also bring solutions to those pain points. So the question is, are we listening to our team?

Do we have a good understanding of where some of their roadblocks are and how we can free up or detangle some of the issues that they are presented with in an effective manner that's again cost effective?

When equipped properly, these people can drive real change.

And if you are more on the production side, are you reporting those issues and possible solutions to your management team? There must be open dialogue in order to recognize the issue and then develop a plan to address the issue.

The second factor on this slide is data driven education.

With the right performance insights, we can target training to where it's actually needed, Closing gaps and reinforcing strengths.

At some organizations, you have employees that may have to, go through continuing education.

The education may not be meaningful.

Perhaps it's education that was created years ago.

So taking people off of production, off of the floor as we say to go through an hour educational session that doesn't apply to them is not gonna yield the ROI that you're looking for. So taking time to actually, again, look and analyze at the data. What's causing those denied claims? What's causing the decrease in patient satisfaction scores? And let's tailor our education around that. Many times you already have the data to create the education in house and it doesn't require a contract with an education provider to provide that education at least that baseline.

When it comes to more complex issues, then yes. Definitely, you wanna partner with a vendor who can provide those additional insights and perhaps data that goes beyond your organization so that you have data to compare your utilization, your denial rates and some of those other metrics against.

The third thing is lightweight tools.

These are think of it as plug and play solutions like code validators or audit tools that can fit into existing workflows and don't require long IT projects. So you codify by AAPC, for example, would be a good, resource to utilize.

This approach is faster.

It's more cost effective and often may be more impactful than a full system overhaul. So making sure that you are really evaluating or someone within your organization is really doing a root analysis, a root cause analysis, and developing tools, resources, education that is really gonna address the root of the problem and not simply providing a band aid, which unfortunately many of us do in health care because it typically is such a massive undertaking.

To drive meaningful improvement, we first need to understand where we are starting.

And that's where baseline metrics come in.

By capturing current performance data, things like denial rates, coding accuracy, and other KPIs, we can establish a benchmark to measure ROI and progress over time.

This isn't just about numbers. It's about using that data to inform action, using that data to make informed decisions.

For example, if denials are high in one specialty or for a certain code category, that tells us where to focus education.

Again, everything we do should be meaningful especially in this day and time where cost is on the rise and many organizations are looking for ways to contain that cost.

The next step is targeting training based on that data.

Instead of a broad one size fits all sessions, we develop personalized relevant feedback to the people who need it most.

For instance, your coders, your billers. So again, moving away from some of that generalized education and making it more specific or making it more individualized based on specific groups and their roles.

This approach not only boosts accuracy and efficiency, but also shows teams that are that your organization, you're the manager, you're the director.

It shows that you are willing to invest in the success of the people that work for you. And you're developing education and training that is purposeful.

I think we have a poll question that we are gonna launch.

And the question is, which of the following do you believe is your organization's most underutilized assets in the revenue cycle? If you guys can just take a minute to review those choices that's presented and select the one you think is your organization's most underutilized asset when it comes to revenue cycle.

Alright. We've got about sixty percent participation. We're gonna go ahead and end that there.

Okay.

Here's the results.

Alright. So it seems like skilled team members who know the process, is second to internal performance data and audit insights. So internal performance data and audit insights leads the pack, followed by skilled team members who know the processes.

Then we have training and education programs, and we hear from, a lot of our members and we see from conferences and other, venues, oftentimes when organizations are looking to cut costs, they start with training and education, Things that they consider nonessential and sometimes that creates more problems for those organizations.

I think education and training is something that has to be top of mind for every organization in order to maintain that success.

Alright. So thanks for filling out that poll.

Let's move on to how again we focus on those audit and education loops.

So one of the most effective ways to improve accuracy is to embed continuous audit and education loops into your workflow.

Audits, whether real time or retrospective, helps us go beyond surface level fixes.

They reveal the why behind the errors and not just the what.

So there should be audits occurring in your organization.

Now how frequently are the audits occurring?

What are you auditing?

All of that is gonna depend on your organization. Right? That is gonna be organization specific.

But by identifying repeat issues and knowledge gaps, we can stop putting out fires and start fixing the root causes.

Not only is education and training important obviously for your coding teams, your billing teams, but also your providers.

So how often are we providing feedback to our, providers is something that we need to also look at. We may be performing audits, but then are we delivering those audit results to the providers?

Are we educating our providers?

Are we going back after an initial audit every three months, six months, whatever your policy is to see if there've been improvement in whatever it is that you were looking at.

And remember, when it comes to audits, it's not just provider, it's not just documentation. You can audit any process within your organization.

If it's infusions, for example, and you wanna make sure that you're getting the start, the stop times, you have those, drug, dosage documented.

Whatever it is, if it's the front desk regarding scheduling, are they following the appropriate processes, policies, and procedures that you have in place? We know how one activity, one role or department impacts another.

We talk about how revenue cycle starts at the front end. It starts with that patient call and that scheduling.

So don't forget to audit those other key areas that can impact your reimbursement on the back end.

The key is to feed those audit findings directly back into team training.

When staff gets timely relevant feedback tied to real examples, they're gonna learn faster and they are going to retain more. If you identify a problem, let's say back in August of last year and you're addressing it now, June of the following year, the chances of that training being as relevant as you would like to, especially if you are not tying in those real examples, that is gonna devalue the training. So we wanna make sure it's timely training and you want to incorporate examples or case scenarios into your training.

This creates a cycle of continuous improvement where teams don't just fix mistakes, they prevent them.

I've been at organizations where there are a ton of errors in the front end from the clinic side when it comes to billing, submitting charges, getting referrals, getting pre authorizations.

And then on the back end is where everything is tried.

The staff on the back end tries to implement those fixes. We'll take care of it.

We'll take care of it. We'll take care of it. All of that leads to burnout. It leads to frustration because no one is really addressing the roots of the issue.

And I believe people want to know if they're doing something incorrectly.

I believe people appreciate the education.

So rather than trying to fix everything on the back end, sometimes it is important to get your clinical people involved, teach them the right process, explain why you need things submitted in the way that you do to ensure that you have that accuracy from the start and you're not working twice as hard on the back end.

We're gonna transition and talk more about that ROI.

While education and audits are key, sometimes the fastest wins comes from giving teams better tools without overhauling your systems. Again, we wanna talk about ways to improve efficiencies but also limit the expense, limit costs.

Tools like Codify, again, is a great example. They provide real time code validation so coders can catch errors or mismatches before claims ever go out the door. We wanna make sure that we have a clean claim going out the door.

They also offer instant access to official guidelines, edits, and payer specific rules.

You wanna make sure if you're not using a tool that's gonna provide you with that information, you are building those rules into your practice management system, so that you have the appropriate edits to catch those errors again before that claim is submitted to the payer.

Having these, stop gaps, I call them, in place means coders don't have to search through multiple resources or second guess their decisions.

Think about someone who is working as a coder without some of these tools and having to go back to whether it's your code book, your ebook to determine, okay, are these codes mutually exclusive? Should I build this one ICD ten code with another or can I? And it's all being done very manually.

That makes the job of the coder a little harder.

Definitely increases the time in production from case to case that they're coding.

And perhaps most importantly, with these tools, they are lightweight. Again, meaning there's not a huge IT lift. There's no months long implementation, and training is relatively fast.

The result of this is fewer denials, more confident coders, and cleaner claims that get out the door faster with less rework.

These kinds of tools don't replace your systems making your team more efficient without that added complexity.

You don't have to bring your system down, reduce the number of patients that's being seen at the facility while people try to get acclimated to a new system.

These tools can be used hand in hand with the systems that you already have in place, and that's what makes it a real win and brings out that true value.

One of the biggest advantages of this approach is that it delivers results without the heavy lift, as I mentioned.

You don't need to take on a massive tech implementation or overhaul your existing system.

Instead, the focus is on upskilling the workforce you already have.

The people who know the workflows, they know the challenges, and they know the opportunities.

By introducing tools that fit into your current processes, you avoid long delays and chronic fatigue.

Sometimes, it may be helpful to bring maybe one or two of your line workers, again, whether that's a biller, whether that's a coder, and have some of those brainstorming or exploration calls.

Invite upper management.

Invite maybe the CEO, again, depending on your company's culture.

We sometimes get very detached within our health care organization where the people at the top making these decisions don't necessarily have all the information needed to make sure those decisions are really going to be effective.

I think about payer contracts all the time when I'm having these types of decisions.

In many cases, you have whether it's a managed care team or something similar that's handling payer contracts.

Those individuals may or may not know really what your denial rates are.

How long is it taking a payer to process a claim?

At what rate are they reimbursing?

When it comes to certain diagnoses, we know payers have edits in place where they may say we're gonna audit a hundred percent of the claims that come in with the sepsis diagnoses or we're gonna audit a hundred of claims that comes in with mod twenty five. Right? That means they're holding those claims from payment until they look at it, to determine whether or not those, claims have been validated and they can make payment.

Think about how often payment is made after it's held for thirty, sixty days before they release that check to you. That is money that your organization could use right then and there.

Rather than them continuing with that process, having someone who is more closely related to those claims going out. Right?

Seeing the reimbursement, understanding the documentation.

That person can say, when you look at your contract when it's time for renewal, instead of that payer holding a hundred percent of that sepsis claim, maybe they hold fifty percent because really and truly they are paying ninety percent. Meaning, we have a ninety percent accuracy on our claims. So what's the point of them holding it?

That's of no benefit to your organization.

But again, that managed care person may not have those details.

So that's why it's important to make sure that we are listening to our teams.

We are getting feedback from the people who are on the frontline, and we are sharing information.

That that will bring a faster return on investment.

It'll limit the disruption that you have on revenue, and then incorporating those employees also builds morale.

When teams are empowered with the right support, their performance improves and engagement goes up. It's a smarter and faster path to real improvement, and it meets people where they are. So again, think about the people that you are investing in and how you can utilize them more.

Let's look at this case example.

We have a mid size community hospital where monthly audits revealed a consistent spike in denials related to spinal injection procedures.

This issue wasn't based on coding errors. It was due to missing documentation to support medical necessity.

Rather than sending generic training, the audit team worked with the education department to build a twenty minute focus session for the physicians and the coders involved.

It included real cases, documentation examples, and tips for streamlining the process.

Within two months, denials for that procedure type dropped by forty one percent and coder confidence in reviewing those charts went up significantly.

This was based on post training surveys.

Many times, departments do not collaborate or speak to each other.

Coding is focused on productivity and accuracy, whereas you have CDI that may be focused on documentation improvement and clinical validation.

Then we have the billing team that's focused on getting those claims out.

If you do not have some type of connection, good collaboration between all of these fronts, the disconnect can lead to business decisions that are not well informed and resources invested in areas that will not result in the ROI that an organization hopes to see. So we have to speak to each other, and we have to stop working in silos.

That has been proven time and time again, but yet we continue to see organizations operate in that manner.

It's time to bring everyone together again to be able to realize the ROI that we're looking for at our organizations.

I think we have another poll question, Stephanie. Would you like to launch that for me?

Yes. Here it is. Question number two.

Alright. So here's the second poll question, and it asks, what KPIs are being measured at your organization where you think more education is needed but not being focused on?

So where do you think more education is needed, but there is lack of focus in that area or for that topic?

Alright. We're about fifty percent there, so I'm gonna go ahead and pull. And then here's our results.

Alright. Great. Okay. We have a overwhelming forty four percent saying that denial management is the top of the list. Not surprised.

And I think some of that just has to do again with many do not have a denial management team or department, whether we can afford to have that or, again, it's just not the focus, but it needs to be. As we continue to see denials on the rise, we must focus more of our resources and attention on managing those denials.

And denial management is not just looking at those claims. Again, it's the front end processes.

It's looking at your contracts.

It's involving a whole, a whole number of different activities within your organization to get a hold on that denial management.

Provider education, coder education, all of that is going to play a a part. Understanding what insurance a patient has, what's covered, making sure you have a solid pre cert or preauthorization team, making sure you stay in contact with your payer reps and that you bring issues to them. All of that is gonna help in that area.

Under denial management, we have prior auth followed by payer contracts, followed by clinical operations, value based care, and then some other or unknown.

Alright. Let's close that and let's go ahead to the next slide.

Now when we're talking about tools, a huge consideration is how whatever tool or process you implement will impact a provider or employee workflow. So we always need to analyze how that process or how that tool is going to work within someone's workflow, how it's gonna change their workflow. Is it gonna be for the better?

Is it going to, require additional time, in order for people to get used to the process?

So making sure that we do the proper evaluation is going to yield the appropriate result.

Thinking about a smarter approach, for example, to MIPS data capture, one that doesn't rely on expensive platforms or major EHR customizations.

Again, we're gonna use MIPS as an example.

On the left, you see whatever your organization needs in order to be successful with MIPS.

You need accurate coding obviously, depending on the measure that you are, working on or submitting for, documentation.

You need a staff that's going to do all the steps or activities that's required to capture and report in that measure.

So you need engaged staff and you need clean and reportable data.

On the right, you will see some lightweight, low barrier tools that deliver exactly that without, again, having that heavy IT investment.

This can be extremely valuable to smaller practices or new solo providers entering the space without the budget or backing of a parent health network.

Rather than investing in expensive platforms or custom built EHR modules, you can achieve accurate MIPS data by utilizing these lightweight tools that fit into your current system.

Whether it's real time code validation, whether it's documentation guidance, or measure specific alerts, making sure you have those alerts in your EMR that's gonna tell your provider when it's time to capture certain details in order to meet that measure.

Smoking, weight assessment, what, alcohol use, whatever that measure is again that you are capturing.

Better compliance, faster reporting, less overhead.

That should be the strategic focus. Better compliance, faster reporting, less overhead.

Managers are the linchpins in revenue cycle optimization.

They are the ones that's gonna translate strategy into action by nurturing their teams.

Using data to educate where it matters most and ensuring that lightweight tools actually get used.

Without their support, even the best tools and training can fall flat.

By aligning workflows and smoothing out inefficiencies, managers help create a culture where continuous improvement is part of the daily rhythm and not an added burden.

And we say managers, we know how important it is for managers to also be leaders.

I'll say this, you don't have to be a manager to be a leader. Again, so even though we're talking about management, You doesn't you don't necessarily have to be a manager to be a leader. Anyone can be a leader. So if you are a coder on your team and again, you've identified a process, a tool that can help you do your job more effectively, that's something you wanna bring up to your management team. If you are using a tool that is not effective, that is something you wanna bring to your management team.

Is it time to evaluate the tools that we're currently using? Is there something that's gonna bring us a more optimal result?

Is everyone using the tool appropriately?

Do we all have the correct amount of training?

All of those things again is going to help yield the results that organizations need.

The c suite sets the tone and direction for revenue cycle success. Their commitment to leveraging what the organization already has, which are skilled people, targeted education, and lightweight tools are essential.

By prioritizing workforce investment and practical tech adoption, leadership helps avoid costly delays and complexity.

So your c suite leaders also play a critical role in fostering data driven cultures, enabling managers with clear metrics, and breaking down silos so the revenue cycle can operate smoothly and efficiently.

And that's what we're looking for at the end of the day. Again, how do we optimize our revenue cycle? How do we make our processes and our procedures more effective?

And how do we contain costs?

These are things that your leaders are looking to either implement, to grow, to make sure it's part of their strategic planning, for future years. As things get more and more expensive and we continue to deal with the uncertainties we have around funding, around reimbursement.

It's even more important that we start thinking about the big picture and how we can help our organization to continue to be successful in difficult times.

So on this slide, you just have a comparison, c suite versus managers and, again, what their role should be.

So at the very top, we have our c suites. These are the executives, our CEOs, our CFOs, our compliance officers, so on and so forth.

They are the ones who set the vision for a lean, efficient, and data driven revenue cycle.

They're the ones that's gonna support workforce development by some of the decisions they make around budgets and being able to fund some of the education and training that's needed in those departments.

They are the ones that's gonna approve again those budgets when it comes to the tools. So they are managing how the organization is going to make their investments.

The managers then translate that vision into those daily workflows and your goals.

Managers are to identify skill gaps and help deliver that focused training, help direct or advise on the appropriate tools that's needed to, again, work with your workflows or within your workflows, and then provide those coaching sessions evaluations as needed.

Alright. So let's go ahead and look at another case study.

And I'll have time at the end of the presentation to answer any questions that, haven't been addressed yet in the q and a. But if you have questions, you can make sure that you put it in the q and a.

So this case study, we look at, AAPC University Hospital, and the challenges they face during the ICD ten migration.

Like many health care organizations, they experienced a significant drop in coder productivity and an uptick in claim denials.

Now ICD ten is the example we use because everyone can relate to that if you were a coder during that transition time.

But these types of work, productivity production decreases can occur at different areas. You may have lost some senior coders, you're bringing on newer coders, you may have taken on a new service line, perhaps you purchased a OBGYN practice if you're a hospital, and you have coders who need to learn that specialty.

So there are different activities within an organization that can lead to that decreased productivity.

So this particular organization had that decrease in productivity and also had uptick in claim denials, both of which have direct impacts on revenue and operational performance. To address this, they implemented an encoder and claims scrubber solution.

This tool provided real time coding support and streamlined their workflow, which in turn enhanced coding accuracy and sped up claim processing.

The results were substantial. As you can see, they saw approximately a thirty percent reduction in rejected claims.

They also witnessed a thirty six percent decrease in their DNFB, which is their discharge not final build, and a twelve percent drop in complex denials. Those are huge wins.

Importantly, these improvements were achieved without large scale IT infrastructure changes.

By leveraging a lightweight tool like computer assisted coding or other CAC program, they were able to enhance performance and outcomes efficiently.

This is a great example of how targeted technology can lead to measurable improvements in both revenue cycle and operational efficiency.

You have to use those tools. When you have payers who are heavily invested again in tools for scrubbing claims, in AI validation methodology, If your practice, your organization that is not looking to invest in some of these tools even at the base level, it's going to be increasingly more difficult to keep up with those denials.

You want to be able to, leverage those tools to help you stay abreast of trends.

And in order to do that, you're gonna have to invest in some type of IT or people.

You can have someone who is looking at those services, look at your top ten services, whether that's from an expense view or a denial view.

And use Excel.

Use Excel, someone who knows how to create those pivot tables and really able to filter data that you can present on. Again, you may not be at an organization or at a practice that can, afford some of these higher level tools and resources, but there are things that you can do from a ground level that can help kick you off.

If you don't have CDI, you can look at or CDI team, again, using some of those bells and whistles softwares for CDI.

You can plug information into a Excel spreadsheet, and you can use that information to better track your provider documentation, the number of queries that you're sending out.

How long does it take a provider to respond to your query, how many queries you need to send out to your provider before you get a response, so on and so forth. At an organization I was with when we started our outpatient CDI program, we couldn't afford to invest in a CDI program or to hire a CDI team. We used our coders, and we created a lot of Excel spreadsheets that we worked on. Again, somewhere to start that doesn't involve that high commitment to those big dollar, investments.

Let's look at another case study.

This practice was dealing with high claim rejections and payment delays due to coding and eligibility issues.

By partnering with a sister organization, they adopted billing software enhancements.

They automated their eligibility checks and provided targeted coding education.

In just two months, they were able to cut claim rejections in half from sixteen percent to eight percent.

They also were able to reduce denials from twenty five percent to fifteen percent.

Not of all of your denials are based on your diagnoses, although that is a high number. Again, sometimes it could be something very simple.

Your documentation doesn't include start stop time for drugs. It doesn't include the waste because your system isn't capturing it.

Your ED documentation doesn't include, certain things that it should. You're not collecting everything you need for your annual wellness visits.

So sometimes it's it's simple enough measures that you can put into place that's really going to help with your denials.

This particular organization also improved revenue efficiency by twelve percent, and they were able to collect around three hundred thousand, a little over, monthly through better accounts receivable efforts.

All of this was achieved without major system changes.

Just smarter use of existing tools and better trained staff.

You gotta have training.

Unfortunately, for many, when we hire is because we're significantly short staffed. We get someone in. We're not able to really provide the amount of time that's needed to get that person really trained. So we give them the basics and we put them out into production. We put them in that role wherever it is, and they're not able to perform well.

So making sure that we spend the time and the resources to train staff is important.

Using resources that doesn't require a high salary.

I always touts our newly certified coders, our CPCAs.

Many of them are eager to land that first coding job, but will really take any job within health care.

So using someone like a CPCA who has gone through a coding course or a new biller, who has been recently trained.

They understand the guidelines that are in place today.

They understand revenue cycle because they just consume that education.

Using them in some of these front entry roles or even on the back end with billing, taking away some of the maybe less, key functions that your key people have and moving them away so that they can again focus on more high level business lines within your organization.

That can help.

You can bring in a CPCA as a extern where possibly you don't even have to pay them. They are gonna value that experience, what they're learning to help get their air removed or hiring them at a lower rate in some of those areas, again, will help. Maybe you're spending less time training a newly certified coder to be a scheduler versus someone that you hire that just has customer service skills. Right?

They maybe have worked in retail or somewhere else, but they don't understand health care. So, again, looking at your organization holistically. What is your HR process? What needs to be modified to ensure that you are meeting the needs of your organization today?

Your needs today is very different than it was twenty years ago, and the labor force, as most of you are well aware, is very different than what it was twenty years ago.

People applied for a job that they were going to retire from. They plan to be there twenty years.

Today's workforce is a lot different.

So again, thinking about where do we need to shift, where do we need to focus to make sure that we are setting ourselves up for a good solid position when difficulty comes, and we are in difficult times when it comes to revenue today.

Alright. So we have one more poll question.

Steph, if you wanna launch that, that'll be great.

The question is, after today's session, which area do you feel most motivated to take action on?

Which area do you feel most motivated to take action on regardless of your role.

And once you have enough responses, Steph, you can close.

Alright. That's about sixty percent participant. We'll go ahead and end there, and here are the results.

Alright. So I can tell you guys, we have thirty five percent who say they are going to focus on leveraging audit data for targeted education. That is fantastic.

I have about twenty six percent who say they're gonna, upscale their existing revenue cycle team.

We have just under twenty percent that's gonna focus on lightweight lightweight tools to reduce denials and then also aligning workflows with current technology. These are all good options, and these are, these are things that every organization needs to look at. Again, depending on your particular unique situation, you may select one over the other. But, really, all these options are things that we need to pay close attention to.

Labor costs are typically of most concern for organizations. Right?

If you have worked as a manager, you have to approve budgets.

You know that labor is is probably the the the thing that takes up the most money for many organizations, and that's whether you're health care or not health care. Salaries, wages, benefits, these things eats up a large portion of budget.

And then you have capital expenditures like medical equipment, facility upgrades, build outs, technology investments. These are all things, again, that can land at the top of the list. To treat patients efficiently, we must consider operating costs. So things like medical supplies, utilities, IT software needs, your business licensing, upgrades, all of this again contribute to cost. With less competition in certain markets and the type of patient population you serve, payer mix and reimbursement rates are also of, concern for many.

Regulatory and compliance costs, of course, we can't forget about that. If you are a hospital organization, or linked to a hospital organization, you have joint commission that you have to worry about, payer audits, of course, then there are things like malpractice insurance and other medical legal activities that can also strain, an organization's purse strings.

Also, cost factors to consider, price fluctuations, especially what we're experiencing now, inflation, products shortages, global disruptions, all impact inventory management and being able to strategically spend at the right times versus waiting for that right time. Right? We have billing and coding efficiency that impacts claim acceptance rates, denial rates.

Aging receivables affect cash flow and denials and appeals, places additional demand on staff time and lost revenue from denied claims. And again, that's why I say it's important to start thinking about some of those other types of staff that you may not have hired in the past, like your apprentices, and using them in areas that can help plug some of this and moving your more skilled people into some other roles that will help your organization grow and perhaps even stop leakage that you're experiencing today.

As we transition to value based care models from fee for service reimbursement, more upfront investment may be needed. And then there is also the ever growing cost for professional liability, property, casualty, and cybersecurity.

So rounding all of this up, I have ten things listed, was, just general cost, time, work effort around strategic planning, things like mergers and acquisitions, creating new service lines, and overall diversification to stay relevant and competitive. And we see that in the marketplace.

CVS buying Aetna. Right? You see these acquisitions and mergers, not just with hospitals buying up private practices, but more large scale mergers and acquisitions as well. So to wrap things up, here's the big picture. Improvement doesn't always require a big investment. It just takes a smarter use of what's already in place. Remember, you're skilled people first, how to leverage your lightweight tools, and aligning your strategy to focus on fixing the root causes and not just the symptoms.

You wanna upscale your teams, align tools with how they already work, and you'll see those ROI that you're looking for. This is a practical proven way forward, and it's already working in real health care environments based on some of the case studies that we have reviewed.

So this brings us to the end of our at our presentation, and I know that Steph has been answering some questions.

Definitely. There's one specific question in there if you that one.

In the q and a? Yes.

In the q and a.

Alright. Are major medical insurers expecting optometrists to start providing vitals as part of a routine exam?

I have had several record requests asking for vitals done during exams.

Lisa, I'm not sure. I am not familiar with this particular specialty.

I do know, I wear glasses and contacts, and I have for many, many years. And I know my optometrist, when I go, they do take my vitals. I think when it comes to certain conditions that one may have, that's like an underlying condition like diabetes or hypertension, that can cause some visual, complications or problems, then it makes sense.

I'm not a hundred percent sure. I can't say for sure they are expecting, you to do this, but this is something I think I will look into.

Alright, guys. Thank you so much. I see some comments, not really questions in the chat, so I think we got them all. But, thank you guys for attending. Stay.

You so much, Lee. That was so helpful.

Such good information and such good tips. So thank you so much. There will be a final survey following this, asking if you need any assistance as you're trying to solve any of these solutions with upscaling your team or seeking out audits or looking for some of these lightweight tools. If you can go ahead and answer that, then, if you answer yes, we'll have an AAPC expert reach out after this. Thank you so much. Have a great rest of your day.

Thank you, guys. Stay cool.

Mhmm. Bye.