The Hospital Finance Podcast

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Aug 2026

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If you’re concerned about revenue at your hospital, then The Hospital Finance podcast is your go-to source for information and insights that can help you protect and enhance the revenue your hospital has earned. From regulatory changes to revenue cycle optimization, readmissions to bundled payments, you’ll get important perspectives, news and strategies from leading experts in healthcare finance. For show notes and additional resources from Besler Holdings, visit https://www.besler.holdings/podcasts.

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October 2, 202619 min

Locking Down Corporate AI Usage Webinar

← Back to All Podcasts Locking Down Corporate AI Usage Webinar In this episode, Jason Nadal, Besler Holdings’ and Sypher Security’s Information Security Officer, will provide us with a glimpse into the next Hospital Finance Academy Webinar, “Locking Down Corporate AI Usage,” live on Wednesday, October 7th, at 1 PM ET. Highlights of this episode include: How companies deal with artificial intelligence and how they should make the decision to embrace this technology What the benefits and detriments of AI usage are What tools out there to help protect your company and your data What other challenges you have in keeping aware of AI usage How you manage third parties not directly under your control The key takeaways Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness . Welcome back to the award-winning Hospital Finance Podcast . We’re pleased to welcome back Jason Nadal , Besler Holdings’ and Sypher Security’s Information Security Officer. In this episode, Jason will provide us with a glimpse into our next Hospital Finance Academy Webinar, “ Locking Down Corporate AI Usage ,” live on Wednesday, October 7th, at 1 PM Eastern Time. Welcome back, and thank you for joining us, Jason. Jason Nadal: Hi. Thanks for having me. Kelly: All right. Well, let’s go ahead and jump in. So, we know artificial intelligence is everywhere now. How should companies deal with this and make the decision to embrace this technology? Jason: Well, if you run a company right now, somebody on your team is likely already using AI. So ideally, that would be via an approved path that you have already set up, but maybe it’s just a browser tab they opened up at lunch, putting something in Google and getting AI results. Either way, the question is not, “Should we use AI?” It’s already embedded in a lot of the approved corporate tools that are already out there. So, the question is, “Do we know what we allow, what we forbid, and how do we keep that promise when the tools keep changing under our feet?” So those are the kinds of conversations that security and IT folks have when leadership asks for a practical plan around AI. So, over the next 10 minutes or so, I’ll walk through some of the benefits and risks. We’ll get into that a bit deeper during the webinar that’s upcoming, but this will give you a methodology of control you can actually run, some of the categories of tooling that support it, and the challenge of feature creep in tools that you’ve already approved. And we’re also going to look at how a vendor and open-source software assessment has to catch up. Kelly: Yeah. I mean, it is really everywhere. It’s embedded in everything now, it seems like. [laughter] Yeah. It’s a lot to keep up with. So, what are the benefits and detriments of AI usage? Jason: Sure. There’s a lot of benefits, and there’s definitely a lot of detriments as well. So, AI earns its value when it shortens the work that you’re already doing, especially that work that used to waste a lot of your time through just tedium, repeated tasks, and things like that. So, I find it really shines at drafting, summarizing, searching or researching, coding assists, and also triaging helpdesk tickets. So those are real-time gains when the data and the use case match the risk. So, in healthcare and adjacent work, that might be a little less clear. So, a nurse or revenue cycle analyst can summarize a long chart note, draft a patient letter, or speed up some prior auth paperwork. A cost report or appeals team can find patterns faster. So done carefully, ideally with this human oversight as to what’s produced, that is time returned to care and to accurate billing. But the downside is just as concrete. So, paste the wrong note into a public chatbot, and you may have moved protected health information, PHI, or something else confidential or sensitive, outside your control. So, a helpful summarizer can invent a fact, called hallucinations, that then gets treated like clinical or financial truth. There’s really a huge downside to that if it’s not checked over by humans with clinical experience. An automation that writes into scheduling, ticketing, or an EHR-adjacent system can turn a bad model answer into a real patient or operations problem. Outside of healthcare, the pattern is much the same. So, marketing could paste customer lists into a public model. Finance could paste financial forecasts. Engineering could paste source code or API keys, maybe in a hurry or just this one time, and leak information that you don’t really intend to leak. Legal can paste contract language. You get the benefit of speed, but the detriment of leaking your data, over trusting the AI, and a trail that, once it’s out there, you can’t really tidy it up after the fact. So, a key point to establishing governance is having frank discussions of what data is acceptable to this risk if it were to leak. I really can’t say that one enough. Kelly: Yeah, I mean, I know that in marketing we use it quite a bit, but I mean, you all help us really understand what we’re really in for there. So, I know there’s a lot to keep in mind. So how do you lock this down without pretending people will stop being curious? Jason: So yeah, you do need this methodology. The first thing I’d say, write an AI usage statement. This is your company’s position on how AI is used. Let it have plain language that’s easily readable. And this company position will include what interactions are allowed and what are not. Who’s able to use what classes of AI? What data classes may never leave the building? It may not just be PHI or employee data. It could be financials, as we said before, or just confidential mergers and acquisition information. So, what AI interactions require a human in the loop? What happens when someone isn’t sure? They should always be trained to ask before they just paste data in somewhere. Publish this conspicuously, train on it, and make sure that people know what’s appropriate to do with their AI. Refresh it when the landscape moves. So, if you don’t have a written position, every employee is going to have their own assumptions on what is good or bad. That’s not really empowerment. That’s just risk that’s out there unmanaged. I’d also recommend don’t write this usage statement from scratch. See what others in the industry, especially your industry, are doing, and tailor what’s out there to yourself. Secondly, you should assess the AI that is in question, the AI that you want to use in any given situation. When a third party uses AI in a product that you buy, treat that as part of vendor due diligence. Ask the vendor, “Where are these models running?” Ask whether the prompts or the outputs of those prompts are retained with them or are they used for training. Ask about sub-processors. Maybe that vendor is using somebody else to do their AI work. Ask also whether AI features can write back into your system. Don’t just accept a blanket, “We’re AI-powered,” as a checkbox. You need enough clarity to decide, yes, this is an acceptable risk. No, this isn’t going to work for us. Or yes, but we need these conditions in place to feel good about the risk of using this tool. And keep logs. Review those regularly. What is not AI today might become AI tomorrow. I’m sure all of us have seen an application that we’ve used online tha...

September 30, 202615 min

Healthcare Has a Revenue Problem, But It's Really a Decision Problem

← Back to All Podcasts Healthcare Has a Revenue Problem, But It’s Really a Decision Problem In this episode, Angelica Landers, Healthcare Executive & Growth Strategist, discusses how healthcare has a revenue problem, but it’s really a decision problem. Highlights of this episode include: Before a hospital or healthcare organization launches a new service line, what financial questions should leadership answer first How to determine whether the service is actually worth offering Will the service actually make money? How to determine whether your payer mix can support a service line or business model before you invest significant capital into it How healthcare organizations can build stronger relationships with their payers to improve reimbursement and resolve issues What a true service line profitability analysis looks like What the financial and operational questions you want answered before you ever get to the purchase price When a healthcare organization is trying to grow, how do to decide whether to build internally, acquire another organization, or partner with someone else Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness . Welcome back to the award-winning Hospital Finance Podcast . We’re pleased to welcome Angelica Landers . Angie is a healthcare executive and growth strategist with more than 18 years of experience working at the intersection of healthcare operations, sales, M&A, revenue cycle, technology, and startup growth. Her experience spans provider organizations, MSOs, DSOs, digital health, telehealth, healthcare technology, and high-growth startups. She has directed 58 concurrent M&A integrations, managed revenue cycle operations generating up to $45 million in monthly collections, sold more than $500 million in managed services agreements, and built scalable operating models for healthcare organizations navigating growth and transformation. Angie brings a unique perspective that connects the financial decision to the operational reality behind it. Her work includes acquisition strategy and integration, revenue cycle transformation, payer and reimbursement strategy, healthcare commercialization, P&L and financial analysis, operational scalability, strategic partnerships, and startup growth. Through Alleviate Strategy & Solutions, Angie advises healthcare executives, investors, founders, and growth-stage organizations on the systems behind performance, helping them make better decisions about growth, acquisitions, technology, operations, and revenue. In this episode, we’re discussing: Healthcare has a revenue problem, but it’s really a decision problem. Welcome, and thank you for joining us, Angie. Angelica Landers: Thank you for having me, Kelly. I’m so excited to be here today. Kelly: Yeah, we’re excited to have you. Well, let’s go ahead and jump in. So, healthcare finance isn’t just about collecting the money. It’s about making better decisions before the service ever happens. Before a hospital or healthcare organization launches a new service line, what financial questions should leadership answer first, and how do you determine whether the service is actually worth offering? Angelica: When everyone first proposes this question, everyone automatically assumes demand or growth equals revenue. And when everyone assumes this, before everyone can get their answers out, the CFO walks in and asks the most difficult question, but I would say the most correct question. Will this service actually make money, given our payer mix, our cost structure, and our referral patterns? Or, in just the shorthand question, is this a profitable demand? Will we make money, or our ROI off of implementing this new service? So, a service line can have strong community need, excellent clinical outcomes. Your neighbor practices might be doing this, and you might have heard of their uplift in revenue. You might have heard of their growing patient population. But are those transferable to your practice is the question. Before launching any new service, leadership must determine whether the opportunity creates that sustainable economic value within their practice. So, the goal is not simply to generate revenue. The goal is to generate revenue that exceeds the cost of care. By the time a claim reaches your billing department, leadership has to make these decisions beforehand that determine whether that claim is profitable or payable. So many healthcare organizations, to start with demand is great, but we should also look at margin. Kelly: Right. No, I mean, I love what you said. I wrote it down. Will the service actually make money? It’s a great question. Angelica: Yeah. Kelly: So how do you determine whether your payer mix can support a service line or business model before you invest significant capital into it? Angelica: Yeah, so I would start with the obvious question, is there really a revenue opportunity? There’s a series of analyses and just questions that leadership should go through, grouped together with their committee, their investors, and really go through each variable of economic value. So, starting with, obviously, what service to offer? Everyone is being innovative in the healthcare industry. Within tech, the startup rise of telehealth, value-based care, I mean, all of this brings different payment models, different strategies, different positions you can bring to your practice. But the key question here is, does this service create strategic and financial value, again, to your unique situation? Not every clinical service creates that economic value. Some services just generate direct profit. They create downstream referrals, straighten payer relationships, even support other strategic growths. So, looking at just the variable of, ‘How much does this service make by revenue position?’ isn’t the entire story. Leadership should evaluate community need, of course, competitors’ offerings, strategic alignment. But a service with moderate demand and strong reimbursement may outperform a high-demand service with weak reimbursement. I would say look at both the economical value and also the community need and demand that comes with it. Kelly: That makes a lot of sense. And I think the bottom line that I kept– and the word I kept hearing over and over again was value. So that’s definitely key. So beyond negotiating the contract, how can healthcare organizations build stronger relationships with their payers to improve reimbursement and resolve issues? Angelica: So, payer collaboration does not end after a payer contract is executed. It’s just the beginning. Your payer contract director should not be the only one talking to your payers. This is a collaboration between RCM, your ...

September 23, 202611 min

The Growing Denials Crisis and What Healthcare Leaders Can Do

← Back to All Podcasts The Growing Denials Crisis and What Healthcare Leaders Can Do In this episode, Noah Breslow, CEO of Revecore, discusses the growing denials crisis and what healthcare leaders can do. Highlights of this episode include: Why denials are becoming such a significant challenge for health systems What the financial implications are on health systems Why so many organizations struggle to prevent denials before they happen What the biggest reasons denials continue to slip through the cracks How health systems can shift from reacting to denials to preventing them How AI and automation can help identify and address denial risks earlier What roles dedicated denial prevention processes play in improving outcomes What revenue cycle leaders should do now to strengthen their denial strategy Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness . Welcome back to the award-winning Hospital Finance Podcast . We’re pleased to welcome Noah Breslow . As CEO of Revecore, Noah brings more than 20 years of executive leadership experience with a focus on driving growth, innovation, and transformation in complex, highly regulated industries. Most recently, Noah was a partner at Bain Capital Ventures, or BCV, where he led their portfolio support team, built out data-driven investment tooling, and helped incubate two startups at the forefront of applying AI in the insurance claims processing and wealth management industries. Prior to BCV, Noah served as chairman and CEO of OnDeck, a pioneering online small business lender where he built the business from its earliest stages, took it public, and ultimately facilitated its acquisition. Earlier in his career, Noah held leadership roles in product, engineering, and marketing. He holds a Bachelor of Science in Computer Science and Engineering from MIT and an MBA from Harvard Business School. In this episode, we’re discussing the growing denials crisis and what healthcare leaders can do. Welcome, and thank you for joining us, Noah. Noah Breslow: Thanks so much, Kelly. It’s really great to be here. Kelly: It’s great to have you. Well, let’s go ahead and jump in. So why are denials becoming such a significant challenge for health systems? And what are the financial implications on health systems? Noah: Yeah, it’s a trend that’s obviously been there for a long time. But it’s getting worse and worse. So, denials have really moved from a back-office kind of nuisance to a real top-line, front and center margin issue. So, research from McKinsey shows that nearly 3% of net patient revenue is written off due to clinical denials alone. And then if you add in underpayments, the cost of appealing those denials, timely filing issues, you might get another percent or two as well, hitting hospitals. So, I think you have a big financial set of changes going on, and we can get more into that. And then you’ve also got the fact that payers have gotten a lot more sophisticated. So, they’re using AI to do AI-driven claims review, deny claims in a more automated way, in a more nuanced way, maybe than they did before. And we’re seeing just denial trends going up across the board. Kelly: Yeah, I mean, I know denials are a huge issue with such significant financial implications. So, Noah, why do so many organizations struggle to prevent denials before they happen? Noah: It’s got a variety of reasons here. I think organizations struggle to prevent denials, not because they don’t intend to stop denials. So, 47% of organizations cite improving clinical denials as a top priority, yet only around 36% have standardized processes to actually do it. So even though they want to make this an issue, actually implementing the process and the infrastructure to better manage denials is more of a challenge. The other thing about denials is you can obviously engage in that firefighting motion, right? You get a claim denied, you appeal the claim, you go back and forth to adjudicate that one claim. That’s a very different thing than fixing that root cause of the denial upstream. And I think most organizations are better positioned to do that firefighting on a claim-by-claim basis than really do that systemic analysis. “Why is this denial happening? What process do I have to fix on patient intake, or on clinical documentation, or on billing and coding to make sure that that denial doesn’t happen again in the future?” And that fragmentation is a huge challenge for hospitals. Kelly: Yeah, it seems like doing that hard work is key there. So, what are the biggest reasons denials continue to slip through the cracks? Noah: Yeah, I think it’s a multidisciplinary thing. So, you need kind of that combination of data intelligence, the reporting that says, “Hey, we’ve been submitting claims to this particular payer and these types used to get denied at this rate, but we’re seeing this uptrend in these particular types.” You have to connect that intelligence piece. What’s actually happening, and trend analysis, but then you need really human expertise to go, “Okay, why is this trend happening? What could I change upstream to maybe prevent this denial from happening in the future?” And that’s a very multidisciplinary thing. It could involve changing processes. It could involve retraining staff. It could involve system changes, collecting different pieces of information at different points in the process. So, I think it’s that multidisciplinary way to integrate the data on the back end and the intelligence gathering with the process engineering upfront to prevent those denials from happening in the future. Kelly: Yeah, I love what you said there about the combination of data intelligence and human expertise. That totally makes sense to me. Probably to others as well. So, you know how can health systems shift from reacting to denials to preventing them? Noah: Yeah. There’s a few different ways I think health systems can go from reactive mode to prevention mode. First is organizational. You have to set up processes and teams inside your revenue cycle organization that are dedicated, that make it someone’s full-time job to making those structural changes to prevent denials from happening in the future. So, organizations with those dedicated processes to prevent denials have a much higher appeal success rate than organizations who don’t have those dedicated teams. And then the other piece of it is around timing. If you imagine you go to the doctor’s office and they hit your knee with a hammer, and it takes you two months to kick, your reflexes are pretty slow, right? And so, two months later, that procedure happened a long time in the past. The patient has already gone home. The documentation may be locked down. And so working on your feedback loop, that rapid cycle from the moment that denied claim comes in to the trend analysis to going upstream and working to make those changes, it’s a gove...

September 16, 202621 min

Why Patient Access Is the Missing Link in the Revenue Cycle

In this episode, Jake McCarley CEO and Co-Founder of Alluvium, discusses why patient access is the missing link in the revenue cycle.

September 9, 20267 min

Modern Identity Defense for Healthcare Series—Passkeys in Practice

← Back to All Podcasts Modern Identity Defense for Healthcare Series—Passkeys in Practice In this episode, Eric Englebretson, Besler Holdings’ VP of Information Technology, provides us with a glimpse into our next Hospital Finance Academy Webinar, the second in the Modern Identity Defense for Healthcare series, Passkeys in Practice , live on Wednesday, September 16, at 1 PM ET. Highlights of this episode include: What we can expect in this second installment in this series? Why passkeys specifically? How MFA isn’t solving the identity security problem What actually is a passkey? What makes passkeys phishing-resistant? HIPAA and compliance rules What’s next? Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Eric Englebretson , Besler Holdings’ Vice President of Information Technology. In this episode, Eric will provide us with a glimpse into our next Hospital Finance Academy Webinar, the second in its Modern Identity Defense for Healthcare series, Passkeys in Practice , live on Wednesday, September 16th, at 1 PM Eastern Time. Welcome back, and thank you for joining us, Eric. Eric Englebretson: Thank you for having me yet again. Kelly: All right. Let’s go ahead and jump in. So, Eric, the last time you talked about identity attacks in healthcare. What can we expect in this second installment in this series? And why passkeys specifically? Eric: Well, Kelly, because if part one was about why attackers go after identities, part two is going to be about the single biggest fix we’ve seen in at least 15 years. Passwords are, and I can say this without hyperbole, one of the worst security tools we have for protecting a digital identity. And honestly, passkeys are the industry’s answer. Google, Microsoft, Apple, Amazon, PayPal, if you’ve logged into any of those lately, you’ve probably already been nudged to create one. And this session is going to take the mystery out of what’s actually happening when you do. Kelly: Yeah, no, I’ve seen a lot more passkeys myself lately, so this will be interesting for me too. So, we already have MFA. Isn’t that solving the identity security problem already? Eric: So, it does help, but it doesn’t solve it. SMS codes can get intercepted via either SIM swapping and just general insecurities in the protocols behind text messages. The one-time codes you get from apps like Google Authenticator, those can still be phished and replayed if someone tricks you into typing your password and code into a fake site. And then, of course, push-based MFA has what we call and what we identified in the last session as MFA fatigue where people just approve prompts to make them stop. That’s literally how Uber got breached, in fact. Passkeys sidestep all three because they’re inherently multi-factor: something you have, the device, plus something you are or know, like a biometric or a PIN. So, it’s one seamless step, nothing to fatigue approve and nothing to get intercepted and replayed. Kelly: Very, very interesting. So, Eric, in plain English, what actually is a passkey? Eric: And this is so fun because at its core, it’s really complicated, but it’s a pair of cryptographic keys. Don’t let your eyes glaze over when I say that. I’ll explain a little bit more in the session. And ultimately, of those keys, one lives on the website server and one lives on your device, and they never trade that secret part back and forth. So, think of it like a locked suggestion box. Anyone can drop a message in using the public key portion, but only the person holding the private key can open that message box and, in this case, sign something to prove that it’s really them. The signature is what gets checked, not a password, not your private key. So, the important bits don’t go back and forth where they could be intercepted. Kelly: I mean, it sounds easy enough. So, what actually makes passkeys phishing-resistant? I mean, it sounds like a big claim given how easily we can be tricked into giving away passwords and authenticator codes. Eric: It actually is a big claim, but I think it holds up. So, each passkey you create is bound to a specific domain, and that’s one of the important bits. So, if somebody builds a pixel-perfect clone of Microsoft.com at, let’s say, micronsoft.com and you don’t notice, your device actually won’t even offer the passkey. It actually simply won’t even respond. When implemented properly, there’s no password to type, so there’s nothing to divulge and put in the wrong place. And that one property right there basically neutralizes phishing and the adversary-in-the-middle attacks, which we talked about and were the star villains of our last session. Kelly: Very interesting. So, healthcare has HIPAA and compliance rules around all of this. Do passkeys actually check that box? Eric: So, this is great. They don’t actually just check it. They exceed it. So, HIPAA Security Rule requires verifying that a person accessing e-PHI is who they claim to be, but they don’t mandate a specific technology. So, passkeys deliver cryptographic proof of identity, and that eliminates the number one credential theft vector. And that also aligns with, and I’ll explain this as well in this session, something called NIST SP 800-63B. Again, don’t let your eyes glaze over. And basically, they have what are called authenticator levels. And these meet or even go up to the next level depending on whether or not you’re using hardware keys. And then for HHS’s own 405(d) program, they’ve been recommending FIDO2 and passkeys as a priority mitigation for healthcare specifically for quite a while now. So yes, definitely, this far exceeds the things that we need for HIPAA. Kelly: Well, that is great news. And I’m looking forward to learning more about that. So, this all sounds almost too good. What’s the catch? Eric: That’s a really fair question. I get it a lot. So, in this case, we’ve got– we’re building a front door that is genuinely rock solid, made out of metal. The catch is actually a backdoor here, account recovery. So as an example, let’s say you’re storing all your passkeys on your phone. If your phone dies and you lose your passkeys, what’s guarding your way back in? Because you’ve got to have one, right? Well, usually it’s a password reset email plus an SMS code. Well, that’s the absolute weakest link protecting the strongest lock we’ve ever built. We’ll dig into exactly how to close that gap in the full session, but that’s really the only downside.</...

September 2, 202616 min

The Money is in the Note, Not the Claim

← Back to All Podcasts The Money is in the Note, Not the Claim In this episode, VerifyMedCodes Co-Founders Nathan Turock and Angelo Selitto, discuss why the money is in the clinical note, not the claim. Highlights of this episode include: What it means when they say “the money is in the note, not the claim” What problem VerifyMedCodes solves How the deterministic approach is different “You can’t defend a code. You can’t reproduce.” How to catch issues before the claim goes out, missing modifiers, unsupported codes, and linkage problems How hospital finance leaders should be thinking about readiness How to process a clinical note without patient data ever leaving the building Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness . Welcome back to the award-winning Hospital Finance Podcast . We’re pleased to welcome Nathan Turock and Angelo Selitto . Nathan is CEO and co-founder of VerifyMedCodes. He leads strategy, partnerships, and go-to market, focused on helping hospitals and RCM teams turn clinical documentation into defensible, denial-resistant revenue. He founded Verify Med Codes to close the gap between what clinicians document and what actually gets paid. We have Angelo, who’s co-founder and chief architect of VerifyMedCodes. He’s a healthcare integration architect with 13-plus years’ experience across Epic, FHIR, HL7, Identity, and Clinical AI. And he’s delivered production CDS hooks and FHIR for value – based care and led ambient AI documentation rollouts across 33, 000 providers. He designed the VerifyMedCodes deterministic PHI-safe coding engine. In this episode, we’re discussing the money is in the note, not the claim. Welcome, and thank you both for joining us, Nathan and Angelo. Nathan Turock: Thank you for having us. Angelo Selitto: Thank you for having us. Thank you for the intro, and wonderful to be here. Kelly: All right. Well, let’s go ahead and jump in. So, VerifyMedCodes started as a coding engine. What problem did you set out to solve, and why do you say the money is in the note, not the claim? And Nathan, I’m going to toss this one over to you. Nathan: Okay, that’s great. The money is in the note. The way it all works, if we’re going to make it easier for the audience, the progress note that the doctor writes is actually what gets paid by the insurance companies. The way it’s set up in the United States healthcare system is the doctor writes the note, then it goes to a coding or billing agency, and they have to put in all the codes that have been created since the ’50s and ’60s by the insurance industry to make sure it’s accurate so they get paid. The problem with that is the insurance companies have made it so convoluted and so difficult to find all the proper codes. And I won’t get too into the weeds, but you have your ICD-10 codes, your EM codes, your RAF scores, your HCCs, etc. And it gets very difficult for the physician, hospital, provider to get paid what they’re owed. We created this to make it transparent. So, it goes right from the doctor’s note, we code that the English language, then we code it into the medical nomenclature of actually the entire globe, and then we code it into the coding system that has been created by the insurance companies in the United States to maybe not pay exactly what they should. So, we’re going for clear transparency because I believe that the healthcare provider should get paid what they’re worth, and they shouldn’t be convoluted or changed up by the insurance company just because they want to put all this coding into play. Kelly: Right. No, I love that y’all made that transparent. I know there’s a lot of complexities in the coding world. So, a lot of AI coding tools make compliance teams nervous because they can hallucinate a code. How is a deterministic approach different, and why does same note in, same codes out matter for revenue integrity? And Angelo, I’m going to toss this one to you. Angelo: No, it’s a great question. And a probabilistic AI coder can read the same note twice and give you two different code sets. And for revenue integrity, that’s the whole problem. You can’t defend a claim you can’t reproduce. So, our deterministic core is same note in, same codes out every time. And that’s the type of defensibility that we want to offer, right? Is that we have the history, we have the evidence-based, we are giving you the information because of what the note stated. It’s not a hallucination. It’s there in the documents. So, we’re really just carrying it forward, and you’re going to reproduce the same information because the same defensibility and the same information always surfaces. So, it’s just the AI can do its suggestions. It could offer and flag, basically recover anything that was missed and offer options. But in the end, the AI doesn’t have the final say. And I think that’s the difference between fast and defensible. Kelly: Yeah. No, I love what you said about, “You can’t defend a code. You can’t reproduce.” I actually wrote that down because I really thought that that was very interesting that you said that. I love that. So, Nathan, where are hospitals leaving the most defensible money on the table today? Is it risk adjustment capture, denials, or is it somewhere else? Nathan: It’s in all those, to be perfectly honest with you. The denials is your holy grail, capturing the right amount of money for the service that you provided. The reason being is the insurance companies like to deny a lot. I know everybody out there in podcast land has never heard of an insurance company denying anything. Kelly: Right. Nathan: Exactly. So, with that being said, I’m going to sort of piggyback off of what Angelo said and to make this very digestible. Angelo loves when I say it’s an incredibly complex tool that we’ve created, but it’s an A plus B equals C or A plus B plus C equals money. Coding system A is the progress note, which is written in the English language. B is the medical terminology that we’ve also coded into a large LLM. C is all the codes from the insurance companies that we utilize their language against them so they can’t deny. So, we have A plus B plus C equals the correct dollar amount. It’s deterministic. It’s accurate. It’s to the point. So, where they’re leaving money on the table is a couple of different sectors. The first one is first pass rate, which means that the note goes through cleanly and insurance says, “Yep, it’s good to go. We’re going to pay you for it.” The second one is– the big one is denials, which when an insurance company says, “Nope, you don’t have enough data on that. We are denying this for XYZ reason,” it costs money to reprocess that note again. ...

August 26, 202625 min

Impact of ‘Failure to Progress’ in Value-Based Care on Healthcare System and Patients

In this episode, Theresa Hush, CEO at Roji Health Intelligence, discusses the impact of value-based care's failure to progress in achieving the economic sustainability of the healthcare system and if or what can change the course.

August 19, 202616 min

The Revenue Walking Out Your Door--Capturing Wellness Spend at the Point of Care

In this episode, Kevin Torf, Co-Founder & Managing Partner at T2 Group discusses the revenue walking out your door, capturing wellness spend at the point of care.

August 12, 202625 min

Why Hospital CFOs are Leaving Millions on the Table and What the Best-Run Health Systems are Doing Differently

In this episode, James Jacobi VP of Employee Benefits at Hilb Group discusses something that hits every CFO and finance leader in healthcare directly, the runaway cost of employee benefits.

August 7, 20267 min

Modern Identity Defense for Healthcare Series--Defending Against Identity Attacks - When MFA Isn’t Enough Webinar

← Back to All Podcasts Modern Identity Defense for Healthcare Series: Defending Against Identity Attacks – When MFA Isn’t Enough Webinar In this episode, Eric Englebretson, Besler Holdings’ Vice President of Information Technology, provides us with a glimpse into Webinar, the first in its Modern Identity Defense for Healthcare Series: Defending Against Identity Attacks – When MFA Isn’t Enough live on Wednesday, August 12, at 1 PM ET. Highlights of this episode include: What is this webinar about? MFA still effective? How the attacks are evolving What session tokens are and why you should care about them Why healthcare is a frequent target Warning signs that an account may be compromised Next evolution beyond traditional MFA Subscribe Today! Kelly Wisness: Hi, this is Kelly Wisness.We’re pleased to welcome back Eric Englebretson , Besler Holdings’ Vice President of Information Technology. In this episode, Eric will provide us with a glimpse into Besler Holdings’ next Webinar, the first in its Modern Identity Defense for Healthcare Series– Defending Against Identity Attacks – When MFA Isn’t Enough live on Wednesday, August 12, at 1 PM Eastern Time. Welcome back and thank you for joining us, Eric. Eric Englebretson: Thank you so much. I’m happy to be here. Kelly: Well, great. Well, let’s go ahead and jump in. So can you provide a quick overview of what you’re going to be reviewing during this webinar? Eric: Absolutely. So, the thing that I think is very important for us to cover is that identity has become one of the most targeted areas in all of cybersecurity right now. It used to be that attackers focused on servers or the corporation’s network, and once they’d gotten in from there, they would pivot to get at the thing they’re really after, which is often a company’s data. In the age of cloud computing and remote work, defenses have generally gotten better because traditional defensive methods of defending the network give way to security practices like something called Zero Trust, whereby any interaction with an organization’s resources must be authenticated no matter where a location request might come from. And so, the next logical step is identity attacks. And why is that? Like I said, since attackers focus used to be on breaking into networks and servers, the payoff might be limited. A compromised web server hosting a hospital website might not have any access to any data at all, really, but in today’s integrated environments, one compromised user account. Now that can give an attacker access to email, collaboration tools, patient systems, financial applications, and cloud services, depending on your role. In most organizations, your identity becomes the new perimeter, and that’s why attackers increasingly target people and accounts instead of infrastructure. This is going to be a two-part series covering modern identity security, why attackers have moved to trying to capture identities as a first attack rather than compromised servers, what we can do about it. And in part two, one of the biggest new advancements you’re probably already using in a few places, passkeys. Kelly: Awesome. Sounds like you’re going to cover a lot during this webinar. I’m really looking forward to it. So, we hear a lot about MFA and how attackers try to bypass it. So is MFA still effective? Eric: Absolutely. So, MFA really remains one of the most important security controls that has come to us in the past 10 or so years, and it really does stop the vast majority of common attacks, including password reuse, credential stuffing, and other attacks similar to those. The key message here is that MFA is definitely not broken. The message is that attackers have evolved and they’re now looking for ways to get around it. It is just that effective. They’ve got to work around it now rather than just simply trying to use a username and password. And that means organizations need additional layers of protection alongside of MFA. Kelly: Yeah, so we know that MFA is still effective. So how are attacks evolving to work around it? Eric: Modern attackers often focus on stealing authenticated sessions rather than stealing passwords. In some phishing attacks, victims enter their credentials and complete MFA successfully, but the attacker captures the resulting session that’s created. Think about it this way. Is it easier for a thief to steal your hotel room key or to try to convince the front desk to issue a new one? In most cases, it’s easier for the thief to steal your room key. After that, they can just come and go as they please, usually without so much as a second glance. We’ve put so many guardrails around the authentication process that attackers are now moving on and looking at what’s behind that, something called sessions and tokens. Kelly: So, what are session tokens and why should people care about them? Eric: So, session tokens and they are kind of background… so this is kind of we enter that realm of nerdy a little bit, but stick with me. Session tokens are what keep you log in after you’ve authenticated. They’re the reason that you don’t have to enter your password and MFA code every single time you open an email or click a new page. They’re incredibly useful, but that makes them also incredibly valuable to attackers. If an attacker does steal a valid session token, they may be able to act as though they’re already authenticated without having to have your password again. And that is what makes them so important, and that is why people should care. Kelly: Yeah, no, that makes a lot of sense. Why is healthcare such a frequent target for identity attacks? I mean, we’ve been hearing so much about this lately. Eric: Absolutely. So, the main reason for that is that healthcare combines highly valuable data with extremely time-sensitive workflows. Clinicians and staff are constantly dealing with alerts, messages, urgent requests, and attackers understand that environment, and they design their hacking and phishing campaigns specifically to exploit human pressure and urgency. Healthcare isn’t targeted because it’s careless. That’s actually quite the opposite. It’s targeted because its mission creates very unique opportunities attackers can try to exploit. Kelly: Yeah. I guess having that– always having that sense of urgency probably doesn’t help us in that way, right? Eric: Absolutely. Kelly: Yeah. So, what are some warning signs that an account may be compromised? <p class="has-text-co...

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