Episode 26: Collection Strategies for Healthcare Companies in the Post-Covid Era

Madhurima Gupta:
Hey, welcome to the CFO circle podcast. I’m Madhurima, your host, and this podcast is brought to you by Highradius. Today we are gonna talk about how CFOs in healthcare industry cannot wait for the current uncertainty to clear before planning for the future and navigating hospitals through the now, near and far of the industry forever has changed post-COVID 19. And that requires a new kind of finance leader, healthcare finance leaders. In addition to dealing with immediate financial needs and fallout of the crisis must find ways to close major budget gaps and develop sophisticated plans for financial recovery. And this is the time when financial leaders must deploy leadership skills as well as their financial management skills. So on that note, we are gonna welcome our guest on the show today. That’s Carolina Vira welcome to the show Carolina, how are you doing?
Carolina M. Veira:
Hi, Maddy. Thank you so much for the invite. And I’m phenomenal today. A lot of energy it’s Friday, so it’s always a great day to do anything right. So happy to be here.
Madhurima Gupta:
Thank you so much for taking time. Now, before we get started Carolina, I have a quick introduction for you that I want everybody to know. So I’ll get started with it and we’ll then drill out deep into our conversation. So Carolina, we are is an author and speaker and consultant. She has developed, interpreted monitored, complex business, Ana financial analysis, projections modeling, and reports in support of business development and operational decision making. She is also taking, taken strategic initiatives that have an impact on the quality of care for all patients. She was the director of finance at care max until 2020 and is currently director of strategic partnerships at CSRDEI she’s also a part of Hispanic star initiative and unparallel collective Goodwill effort to advance the Hispanic community in the US. So, you know, Carolina before we get started I know that you have worked a majority of your career in healthcare industry. Can you tell us a little bit about your journey as a finance leader and why did you choose to be in healthcare at that given point?
Carolina M. Veira:
Thank you for the question, Maddie. I always found business and strategy and numbers. Interesting. So I went finance out of, I guess, out of luck who I did go for an undergrad in accounting and then business entrepreneurship, business management. But I found finance a little after doing the accounting process and that financial analysis always got me right. And creating budget. And then looking, looking at how your forecast ties to the results. So that was an interesting path on my way. and I enjoyed it quite a bit. And then I started in the renewal energy sector, and then, then I moved into healthcare and I think they tie together they’re, they it’s about improving always the quality of life of people in general and something that is really close to my heart. It’s sustainable finance’s how we can implement strategy and financial analysis and getting everyone involved into not only revenue, creating additional revenue or streams of revenue reducing costs, but at the same time, how do we make things better for the community and for everyone in general? So that has been my path in finance. Then I’m now on part of the strategic team and we’re looking at developing and expanding into new markets. So it’s wonderful to see how ideas flow and we can get everyone on board and bring value-based care and transformative care to the different patients and the different areas, especially underserved communities that need the most help. So to me, finance can be more than just numbers. It can be, it can generate real impact in people’s lives. And I think especially after COVID, you can see that transformation that now financial leaders who are finance leaders are not only looking at the numbers, they’re going beyond the numbers and understanding that you need the support of the whole, all the teams, the marketing team, the strategy team, the operational, the clinical side, to really think about ways where we can not only improve our bottom line, but do it in a sustainable and a meaningful way in an intentional way to improve people’s lives.
Madhurima Gupta:
Absolutely. Thanks for sharing that. So Carolina, you know, you’ve seen how things have changed in the healthcare industry specifically because of pandemic. So what have been the emerging risks, challenges, surprises, and opportunities for finance leaders working in healthcare industry as per you?
Carolina M. Veira:
I truly believe that not being afraid of taking risks when hiring talent has been detrimental. I mean, I’ve, met with I’ve been in different conversations and different panel discussions and how we’re thinking outside of the box. And when we think finance, it’s no longer, oh, this person with this long resume, just producing financial analysis in month and close. Now we’re going beyond that. and we’re using talent from other areas because they have original ideas that maybe we can, we see things in a certain way, but if we bring talent from other areas, then we can not only create more inclusive environments but also create, make room for innovation for just thinking outside of the box and trying to do things differently. But it also opened the door for technology, right? It also opened the door for improving processes. I mean, before COVID, I’m sure that many companies had their AP processes probably manual 50% manual, or I would dare to save, you know, 60, 70% manual. And then now after COVID guess what we have to find a way to make it, to streamline it and to use technology. And we can no longer rely on mail where everything has to be a some type of platform that facilitates things and make things faster. and technology by using this technology, it allows us to create efficiencies, to do, to make payments faster, to receive revenue faster. We also, because of COVID, I think we had to be intentional and find new ways of generating income. and that also played a role bringing that innovation and that talent who thinks outside of the box, like I mentioned before, that helps and threatening the relationships with the suppliers, with the vendors, with the hospitals, with the help plans, making sure that it’s no longer one-sided, but more like a win-win situation where they benefit. And we benefit and we work together and we streamline processes. We know that now we have to send information credentialing and, you know, everything that is required. I mean, from the front desk to the, to when the patient is discharged, it all, we all need to work together to make sure not only that the patient is healthy, but also that the partners, the ones offering the services, the ones, the insurance, everyone gets, sees the benefits. So technology, talent creating, efficiencies all has been the result in a faster way, cuz I think we would have gotten there, but it was definitely faster. Thanks to the pandemic
Madhurima Gupta:
Since we’ve talked about how healthcare industries evolved and specifically because of pandemic acting as a catalyst, where is Caremax placed on its digital journey?
Carolina M. Veira:
With Caremax and thank you for mentioning that we manage medical centers. We operate medical centers in Florida and New York and Tennessee here in the states. There’s some plans to continue expanding and now we’ve acquired MSOs and we’re expanding into 10 new markets. So it’s the growth it’s exponential. But I think that on the technology side we also have programs and applications that allows us to look at the patient’s data in real time and be informed about what’s happening and in a way prevent what could happen. I mean, by having that data, you know, that the patient or ex-patient may need some type of additional support. And that’s when we go back to the social determinants of health, but maybe the patient is not eating right. So we know that we need to provide additional resources or connect them to the partners that provide those resources. Also telehealth, everyone has been using telehealth, not only to see their doctor to connect with a doctor, but even to provide additional services, let’s do Zumba online, right? Let’s use some type of application like this one to connect and to see how, what other patients are also doing and create a sense of community. So we have benefited from using the technology, but also creating, using what’s available to create, to provide the same type of services in a different way. And before it was there, it was available, it was accessible. But I think that we had to take the risk and it, unfortunately, it had to be something like a pandemic to take that risk, right? Because we were thinking it’s either it was impossible or the patients were not be technology technologically savvy, and guess what? They’re very aware. And they love technology and they ver they’re very adapt, but then you have to work on partnerships with other vendors, with other suppliers, with help plans to provide the resources to them. Cuz now if we’re, we’re gonna use technology in our services, we need to ensure that they have the equipment they have access to internet or to wifi. So there’s a lot of real partnerships that had to be created and that’s part of the, it is technology-driven, but it’s also, it also made room for a lot of interaction and human interaction, more than anything, coincidentally.
Madhurima Gupta:
And what do finance leaders need to do to ensure that they read the full benefit of digitization, let’s say in back office operation processes.
Carolina M. Veira:
So I think that, to me, it’s always important to communicate and to talk to our talent and to understand what their needs are. I see a lot of ideas and a lot of programs being brought to companies and not really understanding the people, the decision makers, not really understanding what’s really needed. And sometimes we end up getting our companies end up buying things that are not creating any efficiencies. So to me, the starting point should be, talk to your teams and understand what the needs are. Obviously there’s big corporations who can invest a lot of money in, programs and see what works, determine what works later down the road with corporations like CareMax, we’re very adamant about really understanding what’s needed, how we can benefit from it and then making the decision to get that technology component and implement it. But yeah, listening to them also, obviously by bringing technology, you are able to allocate resources in a different way, right? And now you’re not dedicating so much time to the manual processes for what can be avoided and you are releasing that that person, that time to try to find or create efficiencies in other areas. So that’s why I think I’m a big proponent of technology for many reasons, but it really makes life easier for everyone. I mean getting paid, it could take three months and now, or three to six months now we reduce the time to like a month if we do it right. If we have all the information, if we follow all the steps, but then we can avoid write-ups, we can avoid hiccups, right. Along the way. So to us, it’s important to understand what’s truly needed, have those diff those conversations with the teams how we can use those resources, not only for one team, but different teams as well, that’s important. And then once we have implemented, we have discovered that that works for us, how we can ensure that that time is used for other areas. So we can also create efficiencies and build efficiencies in areas that we would have never had time to work on.
Madhurima Gupta:
And you know, you mentioned difficulty in collection of the invoices bills that often are there in healthcare space. So I wanna talk a little more about the outstanding pace payments that are often seen at you know, healthcare spaces. And I think one of the main reasons for aged accounts receivables in healthcare space is insurance companies inability or unwillingness to accept a claim leading to outstanding payments, how challenging it is to collect these payments specifically during, you know, pandemic and even, and how has it changed now?
Carolina M. Veira:
Well, it’s always challenging, you know, and I don’t think it’s ever going to stop being challenging. I think from where I, sit in managing medical centers and operating medical centers, I know that every single person is important from the front desk and the way that you’re collecting data, ensuring that the insurance is up to date ensuring that you have the right information for the patient. It all plays a role, ensuring that you have the right credentialing for your providers, your doctors, your that’s also very important because without that insurance companies are not going to execute on the payment ensuring that we file claims on a timely manner. All of that is important. So that’s why establishing a good relationship with helplines. It’s important with insurance companies, because if you run into hiccups, which we all are going to run into, at least we have somebody on their end that it’s going to advocate for us. Cuz you know, when you are, if you have a question about a claim and this is what happens, right? Usually they deny the claim and you have to go back and forth, make the changes. And typically you will have to deal with anyone anywhere in the world and try to make sense of what’s happening. And then if you need to continue that conversation on a later day, you’re not necessarily gonna have that person to deal with. It’s probably gonna be as a different person. So you lose time because now even if you want it to, you cannot continue that conversation with the same person. So having an advocate on the insurance side, on the help plan side to kind of guide you and make, I don’t wanna say make things easier for you, but provide a hand if you have this difficult claims to deal with that’s helpful. But also with tech, the technology that has been implemented now you can do, you can submit claims and everything and upload and it gets processed faster. So I think that’s also helpful. The tech that health insurance companies have and are using more and more technology to, for processes that before they wouldn’t use them for before you will have to fax the claim and wait for an answer and then connect with somebody. Now it’s, let’s upload it. You get a response back complete what needs to be completed and then resubmit it. and that process has been streamlined. Thanks to technology.
Madhurima Gupta:
What are some of the best practices that you would suggest to your peers in healthcare industry that can help them improve their collections and reduce bad debt?
Carolina M. Veira:
You’re gonna laugh at this, but I’m a bit advocate of hiding the right hiring good talent experienced collectors will be beneficial, even if you can have a couple, but they can train the other, the other collectors, you know, cuz if you bring it’s good to have a good mix of younger and inexperienced and then experienced professionals, cuz they can feed off each other. Right? the ones can provide innovative ideas things that we haven’t thought about and the experience ones can provide, okay, this is how I do it and it’s work and it’s a good way to do it. So they both benefit and they both learn and it becomes a stronger team. And by cultivating that talent, it makes our departments better. So I have to, I have to say talent. I also have to say obviously, compliance, having a strong compliance team, knowing what’s required having the, to do and your tasks, making sure that every bucket is completed being very adamant about timing and making sure that everything’s done in an efficient way, you know, on a timing manner, building strong partnerships with help plans with providers, with whom ever’s part of your, in our case, our supply chain with doctors establishing also relationships with the patients because the patients are giving you the data, right. And if they, if they’re not providing the right data, that’s another issue. So building that relationship, cultivating that relationship, it also plays a role, but also, and one of the most important things it’s investing in technology, understanding, even if we cannot do everything we can start identifying, okay, what are the key issues? Then again, talking to our people, talking to our team members, if you could have three things out of the 10 that you need, what would those be? And understanding that there’s programs and there’s technology out there that it’s not necessarily super, super expensive, but it’s going to elevate other costs, right. And kind of like doing analysis at return on investment. What for that particular piece of technology, cuz then you can estimate not only what the reduction in operational costs, but also is it producing any additional stream of income and what’s the impact, right? How many more patients are going to be healthy? that is also important as you know, we’re very value-based oriented. So to us, those outcomes are more than that’s part of the payout, right? that’s part of the return and investment. So everything plays a role. So I think all of those are important components of how to do business in this new era, after the pandemic. It’s not only then again, and that’s why I believe in that sustainable finance concept where you not, you are not only looking at what we used to see. Oh, okay. So what’s the bottom line. What was the impact there? It’s also, there’s a social impact. There’s a, an impact on, on environment. There’s an impact on your team members? Are they happy and content, if they’re happy and content and you have a good culture, they’re going to produce better results. They’re going to really wear the wear the company on and have the company close their heart and they’re gonna do what’s best for the company. So there’s many things here. There’s a lot of room to do things, right.
Madhurima Gupta:
Absolutely. And I think helping your employees upskill themselves is something that will also help keep those high-performing collectors or any other you know, area that you probably want to focus on improving. Would you agree?
Carolina M. Veira:
Absolutely. And that’s a great point actually. Because Maddie, I mean the, if the employees are happy and I know we all say that the employees are happy, then everybody’s happy customers are happy. You know, it’s gonna produce better results, but at scaling and providing additional resources and additional opportunities for growth for your, for your team members, it not only requires the interaction with more experienced team members and younger or inexperienced team members, but also it’s the interaction with the leadership, the exposure to that, or the exposure to just sharing their ideas and involving them in the process. Right? I mean, if you are thinking, like I said, if you are thinking of investing in new technology, let’s ask them, they’re going to take responsibility, be account. They’re gonna feel like their voices are being heard and they’re gonna be part of the decision-making process. And that gives them more power gives them more, how can I say they it’s gonna align more with their purpose and it’s going to bring the best out of them to, you know, the day to day, their day, that they, their daily jobs. So that’s important too. and I think when we don’t do things like that, when we don’t invest in them, we’re missing a great opportunity cuz our talent, it’s what makes us successful too. Yes. It’s providing services. We’re there to serve communities, serve the patients, but it all starts with our team members. Not only from the, like I mentioned from, in our case, from the front desk, the minute that the patient comes in, they’re dealing with people, they’re interacting with somebody there and then the doctor and then, you know, the P via technician. So, and then after that, if there’s follow up questions, they’re gonna be getting a question from our collectors cuz they have questions about their claims. So it is time for us to really invest in our own people and make room and create opportunities for them to grow within the company. It’s, it’s only gonna be beneficial to us.
Madhurima Gupta:
Absolutely. And you know, since you talk about you know, how employees should be involved in decision making, we, should we be asking them, what kind of tools do they need to be better at what they’re doing? If we talk about technology and we talk about automation, let’s say for collections, right? How important is a structured and automated collection strategy for healthcare sector in your opinion?
Carolina M. Veira:
Well, it makes things easier, right? If everyone knows what to do next and what the different steps are, it’s easier to train people if, and it’s easier to know that there’s less room for error because you’re gonna rely on that technology to do things that maybe were time-consuming or it require additional review or additional testing and that sort of thing. So to me, the benefit is it’s right there in there. It’s like I mentioned, technology helps you to build efficiencies. It’s invaluable because once you make things, once you create that process and make it faster, you get a, you get the income that you need in a faster way. Right. But I think that we’re missing too. It’s not only to collect the income faster and to collect the revenue faster, but what we’re also not looking at as corporations is the other side, okay, how are we spending money? Right. and are we taking advantages of the discounts if we pay faster so that the, if we use technology to streamline the process of the collection and make and collect money in a, in a faster way, that gives us that makes room to have better cash flows and also opportunities to, instead of paying a hundred percent, we pay 90 because there’s a discount of 10 there. So there’s, you can, by investing in technology, you can increase revenue, but also decrease the operational in all the costs, right? The overhead costs as well. So to me, if you ask me, it’s a no-brainer, right? If anything that can help streamline the collection process, those are opportunities that companies like Caremax and other healthcare organizations cannot miss out. We need, we need that revenue. We need, we need revenue to continue operating and being sustainable. So definitely those are the technology components that I would always look to invest in. If there’s, if you have everything in available and you need to make a decision, it should be, we should start with how to streamline the collection process and make it beneficial to us. Right.
Madhurima Gupta:
Absolutely. And in your experience, what kind of challenges or, you know, what kind of details often tend to, you know, fall through cracks that you know, probably cause unpaid balances to accumulate at, let’s say care max or in general, in healthcare industry?
Carolina M. Veira:
To me, it’s been the basics, it’s been the demographics of the patients not getting the right information or the coding, right? Because then you have the ICD codes, ICD 10 codes, if you are using the wrong code, the insurance companies are going to kick are gonna send back that claim. So when I say the basics and not having the right data, that goes back to training your people to have the right information, and ensuring that you have professionals there that you have collectors there that know what to do, but it goes back to what you mentioned having like kind of like a, to-do list of, okay, this is what you need to do. Step one, step two. So having something already established a process or a processes that everyone can be, can follow that step one, training your personnel and your team members on effectively using it that’s step two. And then that tends to fall through the crack and it may seem obvious, but I’ve, I see it day after day where claims get denied for those basic things, right. Or, oh, we thought that our doctors were credentialed until 2023, but guess what? It expire on 2022. That’s another thing. And just, how are you keeping track of that if maybe you don’t have a system in place to keep track of your credential of your credentialing. So how do you create something, maybe you’re gonna use Excel, but how do you make sure that it’s something that you review on a consistent basis? And that’s where the use of technology could be beneficial to the company. So I identify and painpoint it’s important. So we know where to invest and what type of technology is needed. But yeah, I mean, to me, If you ask me, it’s, more about the basics and the talent and training and following the right process and the right procedures more than anything.
Madhurima Gupta:
My next question is on payment, write off, we did talk about it in the beginning of this podcast. But you know, I wanted to understand Carolina, you know, payment write offs, no matter how in consequential or smaller an amount can definitely have an impact on the bottom line. Do you see a lot of unwarranted writeoffs at care, max, if yes. How do you avoid them?
Carolina M. Veira:
I don’t see a lot of them, but I see them and no matter how big or how small nobody wants to, everyone wants to avoid write-offs to the best of their abilities. So it’s always a pain point there it’s having the right, having the right technology plays a part, having the knowing when your timeline, what your timelines are up to you have a month to submit a claim. Okay, how are we tracking that? How are we ensuring that we’re up to date with the information and that we’re submitting and uploading that information timely communicating, creating, building expectations with the teams even thinking how to tie. And obviously we do how we effectively tie their performance to their bonuses and their pay and their pay increases. All of that plays a role, cuz the better you do the better the company does. And the less writeoffs we may get, because it does come down to what information is being provided, how accurate it is. How fast is, is it being provided? What communi what follow up are you doing with the claims? Did some claim fell through the cracks and when they do that’s what happens with the write-offs. There’s write-offs that no matter what you do, you can be on top of them. And if the insurance company doesn’t wanna pay it, it doesn’t wanna pay it. That’s it? I mean, there’s not much you can do. And those are the ones that are painful, but those are the ones that I believe can be avoided by having the right partnerships and having those conversations with insurance companies and with those advocates and telling them, I mean, we’re doing everything we can do. What’s the problem. And then ensuring that they understand that that’s also a problem for us. And if we are not operating efficiently, they are not, they are also not going to operate efficiently. So there’s, there’s a lot of communication there. That helps with, with those writeups, not only internal communication, but also external communication, but definitely also technology using technology to ensure that the processes are streamlined. And then we do things faster and then, and efficiently as well, and using all the resources that we have to ensure that the data of the patient is correct. That the data regarding that the services provided is correct. So there’s, it has to be a combination of all those elements, internal, external communications, the partnerships, and obviously technology.
Madhurima Gupta:
And what do you feel about the payments that you get in terms of the modes in which they are made or received? And how important is it to accept payments through variety of methods and ways?
Carolina M. Veira:
Oh, imagine that, I mean, if you have many ways of getting paid don’t you love that? I mean, if, just imagine having you your own business, whatever it is, and oh, okay. I only take cash. People are gonna be like, okay, I’m not gonna buy from you cuz then the person next door, they let me use sell and they use, let me use apple pay and they let me, you know, and it’s the same thing with our business, right. It’s having different ways that our other companies can pay us is just going to increase the sources of revenue, right? I mean, not the sources, but the ways that we’re collecting revenue, so investing in that’s also another area where I would definitely spend some time and analyzing and looking at what the return on investment would be. But that’s another area that it’s quite important for us.
Madhurima Gupta:
Got it. So, you know, we come to conclusion of this podcast, Carolina, and before we wind this up, I actually wanna ask you one last question and that is how, or what are the top tips that you would give your peers to enhance collections and payments in and receive payments on time in healthcare industry.
Carolina M. Veira:
To summarize, right. And I think being adamant about the, your talent training, the talent, spending time with the talent, making sure that they understand the why we do things the way we do them. And who are we impacting that that tells a different story. It’s not only, oh, it’s patient ABC and we’re collecting 10,000, a million dollars, whatever the number is. No, it’s understanding what we’re trying to accomplish in our case, it’s access to healthcare and making sure that patients are taken care of. And that helps society in general. So investing time in your talent, time and resources but also investing in the right technology and knowing what the right technology is needed. We’ll start with your team. We’ll start with understanding what their needs are to make them more efficient along the way. And also partnerships and communication, not only like I mentioned, internal, but also external and in creating, in building those relationships with the help lens and the insurance companies ensuring that they understand that this is a partnership, this is a meaningful partnership. This is when it has to be a win-win situation for the both of us to make it successful.
Madhurima Gupta:
Absolutely. Thank you so much for sharing your opinions today on the circle podcast. Really appreciate your time for doing this and for our listeners out there. I hope this was an interesting conversation. Stay tuned. We’ll be back with more.