3 moves to reduce payer friction in 30 days

Payer friction rarely announces itself all at once. It builds quietly in aging buckets, unworked denials, and escalation processes that no one has thought through until a crisis forces the issue.

Kem Tolliver, CEO of Medical Revenue Cycle Specialists, breaks the 30-day intervention down into three concrete moves: understanding what is driving denials by volume, dollars and complexity; identifying where cash is getting stuck in the AR cycle; and building the payer relationships needed to escalate problems before they compound.

Physicians Practice: If a practice has 30 days to get control of the friction they have with payers, what are the first three moves you would make?

Kem Tolliver: The first move is to understand what is driving your denials. You want to look at those denial drivers two ways: volume and dollars. That combination is super helpful, but you also want to look at complexity. When I was a biller working accounts receivable, my co-workers and I would sometimes gravitate toward the easiest accounts to clear them out. What we really want to encourage our teams to do is look at denial drivers, identify root causes, and dig into the complex accounts too. So: volume, dollars, and complexity.

The second area I would look at is where your cash is getting stuck. Is it stuck in the zero-to-30-day bucket? The 90-day bucket? The over-120-day bucket? That tells you a lot. If it's getting stuck in the zero-to-30-day bucket, there's often something going on with your EDI, your electronic data interchange. You want to work with your clearinghouse to address that.

The third move is to understand your payer escalation processes. We want to make sure we have sound relationships with our payers. Waiting in a queue with an insurance company is not a strategy, it's a reaction. We want to build those relationships so you know what it takes to escalate an account and you have someone available and willing to help you when it's necessary.