Mini Episode: Breaking Down Interest & Penalties with Adam Cartabiano

Join Ryan Downs & Adam Cartabiano as they discuss interest and penalties on late claims, especially where state prompt pay laws create collectible dollars that many teams never track.

Key Topics- Interest & Penalties 101- PLBs, prompt pay laws, and more

- What is ERISA and why does it matter for interest & penalties

- Why managed care contracts need clearer interest & penalty language

- The importance of defining a clean claim with payers

- Challenges with interest: EMRs cannot calculate interest at the claim level

- A real example of underpaid interest

- How big is the provider interest opportunity

- The complex math equations behind calculating compounding interest

- Advice for organizations attempting to track interest: start small

Mini Episode: Explaining What Accounts Qualify for the IDR Process with Adam CartabianoJoin Ryan Downs & Adam Cartabiano as they clarify some misconceptions and explain what accounts actually qualify for the No Surprises Act Independent Dispute Resolution (IDR) process.

Overlooked Revenue Opportunities: Breaking Down Interest, Penalties, and the IDR Process with Adam Cartabiano, Chief Growth Officer at Knowtion Health

This episode breaks down two overlooked revenue cycle opportunities inside hospitals and health systems: interest and penalties, and the No Surprises Act Independent Dispute Resolution (IDR) process. Adam Cartabiano of Knowtion Health explains how these workflows work, why they are easy to miss, and why they can materially improve cash recovery when handled systematically. We discuss the operational, contractual, and technical barriers that keep these dollars hidden, plus the specific ways Knowtion Health uses AI, automation, and services to identify and recover them.

Key topics• How Knowtion combines proprietary technology, AI, and services to improve revenue cycle outcomes for health systems• Why an operational background in revenue cycle operations helps translate client pain points into contract language and measurable P&L impacts• Interest and penalties on late claims, especially where state prompt pay laws create collectible dollars that many teams never track• How prompt pay rules vary by state, why ERISA plans complicate the picture, and why managed care contract language matters• Why defining a clean claim is essential for interest calculations• Why EMRs generally cannot calculate interest successfully• A breakdown of the No Surprises Act Independent Dispute Resolution (IDR) process• The account categories that qualify for IDR• The full IDR workflow from remit receipt to binding determination• Why the IDR process is resource intensive, how different IDREs interpret cases differently, and why provider win rates can be very strong• The positive externalities of tracking interest: better payer behavior and a return to network participation

Timestamps(0:00) Introduction(1:06) Vendor Voices Snapshot Challenge(3:31) Introduction to Adam Cartabiano(5:35) How having operational experience supercharges sales(7:57) The most overlooked revenue opportunities(12:40) Interest & Penalties 101- PLBs, prompt pay laws, and more(15:20) What is ERISA and why does it matter for interest & penalties(16:56) Why managed care contracts need clearer interest & penalty language(19:56) The importance of defining a clean claim with payers(24:30) Challenges with interest: EMRs cannot calculate interest at the claim level(28:23) A real example of underpaid interest(29:54) How big is the provider interest opportunity (33:41) The complex math equations behind calculating compounding interest(35:19) Advice for organizations attempting to track interest: start small(37:44) NSA IDR 101 & why IDR became such a major revenue opportunity(41:30) Which types of claims qualify for IDR(44:42) Federal states, bifurcated states, and self-insured versus fully funded plans(46:25) Walking through the full IDR workflow(52:54) An import aside on IDRE selection and outcomes(54:52) Walking through the full IDR workflow (continued)(55:43) Astonishing provider win rates: what average recovery looks like(56:33) How winning IDR cases can improve future payer behavior (58:17) Quick recap of the NSA IDR process(60:38) How to estimate your organization’s IDR opportunity(62:06) Why workflow tracking and dedicated resources are essential to the IDR process(64:34) Final advice: evaluate overlooked areas with an informed partnerThe episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ Connect with Adam Cartabiano: https://www.linkedin.com/in/adamcartabiano/ We Want Your Input!

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Building a Patient-First Revenue Cycle: Early-Out Strategy and Responsible Automation with Adam Plotkin of Healthcare Outsourcing Network

In this episode of Vendor Voices, Ryan Downs talks with Adam Plotkin of Healthcare Outsourcing Network about creating better financial experiences for patients while strengthening revenue-cycle performance. Adam shares the origin story behind HON’s early-out model, explains why automation works best when it preserves access to real people, and offers practical advice on patient communication, staff training, and vendor selection. The conversation also explores responsible use of AI in policy and compliance work, plus the growing need for healthcare organizations to build stronger contingency plans around cybersecurity and vendor concentration.

Key Topics:

• How HON helps hospitals improve early-out collections and reduce bad debt
• Why patient experience and recovery performance should reinforce each other
• Using automation, texting, virtual agents, and digital payments without losing the human touch
• Responsible AI use: treating it as a research aid, not a replacement for professional judgment
• The cybersecurity lessons healthcare organizations should take from major industry breaches
• Why diversified partners and contingency planning matter for operational resilience
• Practical early-out communication strategies, including phased outreach and multiple contact channels
• Hiring and training for empathy, customer service, and long-term performance
• How to evaluate outsourcing partners based on values, fit, and patient-centered service

Timestamps:

00:00 - Introduction

01:03 - Vendor Voices Snapshot Challenge

07:17 - Introducing Adam Plotkin

09:35 - Adam’s decision to leave his legal practice to focus on HON

11:04 - Keeping up with changing healthcare policy and compliance requirements

13:45 - Can ChatGPT (AI) serve as your lawyer?

15:17 - Using AI responsibly as a starting point for research

16:51 - Why the human element still matters in service

17:11 - A prime example of why technology should be a choice

18:54 - Verifying AI-generated information and checking sources

20:51 - Cybersecurity, vendor concentration, and contingency planning

22:46 - The business and patient-care risks of major system outages

26:26 - Practical early-out advice: modern communication and gradual rollout

29:25 - Why healthcare still requires empathy and access to people

30:38 - Identifying accounts that need a different collections path

32:04 - A self-check-up on patient follow-up, moving beyond statements and calls

33:23 - Creating a quality contact through training and hiring

36:31 - Using communication variety to keep patients engaged

38:48 - Final advice: patient-centric service and choosing partners with diligence

40:48 - Closing thoughts and episode wrap-up

The episode was brought to you by: https://realpartnersconsulting.com/

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/

Connect with Adam Plotkin: https://www.linkedin.com/in/adamplotkin/

We Want Your Input!

If you’d like to suggest a specific topic or guest, feel free to reach out to me on LinkedIn or email at [email protected].Please rate and review – and be sure to subscribe to never miss an episode!

Thank you for listening!

Using AI to Prevent and Appeal Healthcare Denials with Protego Health's Corey Feldman

Join Founder & CEO Corey Feldman and me as we dive into the world of revenue cycle to untangle how AI-driven solutions like the one at his company, Protego Health, are transforming claims denial prevention and appeals. Come explore the challenges, innovations, and future of AI in healthcare with tons of practical prevention, appeal, reporting, and technology implementation tips along the way.

Key Topics:

• Combating claim denials using AI
• The root causes of healthcare claim denials and how AI can address them
• The importance of seamless workflow integration for providers and payers
• Core challenges in adopting AI solutions within health systems
• The importance of appealing well, appealing fully, and appealing often
• Corey’s personal story and its influence on product development
• The evolving role of AI in revenue cycle management and automation
• Practical advice for organizations looking to implement AI effectively
• Future trends: self-regulating AI and agentic automation in healthcare
• How regulation and speed to deployment impact AI adoption in healthcare

Timestamps:

00:00 - Introduction

00:58 - Vendor Voices Snapshot Challenge

04:18 - Introducing Corey Feldman & his family’s healthcare finance journey

07:25 - Financial toxicity is clinical toxicity / No margin, no mission

09:05 - How software can aggregate important revenue cycle datapoints within workflows

11:36 – Diving into data-driven appeal strategies

12:45 - Making denials compelling and undeniable

13:40 - The lesser-discussed importance of fighting back on denials

15:16 - Rising denials and lowering technological hurdles

16:41 - The impact of large language models (LLMs) and AI innovation

18:40 - How inconsistent/inaccurate use of denial codes makes for unreliable denials data22:15 - Barriers to AI adoption and the importance of focus23:45 - How Epic and other EHR vendors are entering the AI space24:40 - The paradox of AI regulation and speed

25:30 - Discussing a widening technologygap between EHRs and point solution companies29:04 - The future of AI in revenue cycle management33:45 - Next big features in AI for healthcare: self-regulation for factual answers
36:47 - Final advice: Change is inevitable - embrace AI

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ 

Connect with Corey Feldman: https://www.linkedin.com/in/csfeldman/

We Want Your Input!

If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!

Optimizing Complex Claims And Revenue: Strategic Insights with Mike Esworthy of EnableComp

Join us for an in-depth conversation with Mike Esworthy,Chief Strategy Officer of EnableComp, as he shares how to transform complex claims into strategic assets, leverage AI thoughtfully, and foster meaningful partnerships in healthcare revenue cycle management.

Key Topics:

• Breaking down the specific challenges of complex claims
• The evolving role of AI in healthcare revenue cycle management
• Why strategic outsourcing of complex claims makes sense so often
• Metrics healthcare leaders should track for complex revenue optimization
• The importance of partnerships and holistic approaches in RCM

In this episode:

• EnableComp's mission to turn complex claims into maximum ROI through AI-driven insights
• The shift from complex claims RCM being viewed as cost centers to strategic assets
• How recent acquisitions like HROI bolster EnableComp’s capabilities
• Key takeaways from Mike’s experience at JP Morgan Healthcare Conference
• The broader definition of complex revenue and its impact on hospital finances
• Clarifying the unique challenges of VA, Workers Comp, out-of-state Medicaid, and motor vehicle claims
• Practical advice for healthcare leaders to improve claim performance and avoid revenue leakage
• The role of proper data, guardrails, and organizational alignment in AI adoption
• The strategic importance of partnerships in revenue cycle success

 

Timestamps:

00:00 - Introduction 01:05 - Vendor Voices Snapshot Challenge

03:40 - Introducing Mike Esworthy05:20 - Recent acquisition of HROI and strategic growth06:10 – Quick recap of 2026 JPM Healthcare Conference + the shift in AI's role from ideation to grounded application
10:00 - Redefining complex claims as "complex revenue"11:35 - Challenges specific to VA, Workers Comp, motor vehicle accidents, and out-of-state Medicaid claims + why outsourcing often makes sense16:28 - Common causes of complex claim denials: front end breakdowns, eligibility, & COB
19:41 - Metrics every healthcare leader should prioritize to track complex claims24:00 - Treating complex claims as an asset, not a cost center
25:25 - The evolution of revenue cycle optimization: Is our field finally getting the attention it deserves? It’s time to put a spotlight on our unsung revenue cycle heroes!
29:05 - The importance of proper AI implementation and guardrails: Garbage in, Garbage out31:45 - Challenges with interoperability in complex claims34:01 - Final advice: Embrace partnerships in business and at home

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ 

Connect with Mike Esworthy: https://www.linkedin.com/in/mike-esworthy-b4455511/ 

We Want Your Input!

If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!

Automating the Drudgery to Liberate Rev Cycle Teams: Insights from Dave Blanchard of Candid Health

Most healthcare organizations are drowning in manual tasks,frantically trying to keep up - until now. Join Dave Blanchard of Candid Health as he walks us through the process to remove avoidable friction within your revenue cycle. You'll discover how understanding your data foundation is thekey to unlocking AI’s potential, why automation is a liberation strategy, and how to combat the misconception that AI replaces people. Automation isn't about eliminating your team; it's about freeing them to focus on what truly matters -patient care and complex problem-solving.

Key Topics:

• The concept of touchless claim rates and its impact on healthcare efficiency
• Differentiating automation: liberation vs. replacement
• Building a foundation: importance of understanding healthcare data
• Overcoming misconceptions about AI and automation in revenue cycle management
• Key success factors for tech implementation in healthcare organizations
• Short-term opportunities for stability and growth in 2026

Timestamps:

00:00 - Introduction00:57 - Vendor Voices Snapshot Challenge

03:26 - Introducing Dave Blanchard04:25 - Defining touchless claim rate and its significance05:34 - Addressing concerns: automation as a tool for human empowerment instead of workforce reduction07:28 - How staffing challenges accelerate the need for touchless solutions

09:29 - Building a strong data foundation for AI success

12:04 - Metrics that matter; Demonstrating ROI

15:56 - Debunking common misconceptions about automation and AI

24:55 - Surprising lessons from organizations implementing automation

30:03 - Key success factors in technology implementations

34:50 – Short term strategies to stabilize revenue cycle performance in 2026

37:59 - Final advice: Trust your intuition, seek partnerships, be kind

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ 

Connect with Dave Blanchard: https://www.linkedin.com/in/david-blanchard-90994a9/ 

We Want Your Input!

If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!

Optimizing Revenue Cycle from Epic Implementations through Internal Collaborations: Insights from John Freeman & Bret O’Connor of Revigate

Efficient revenue cycle management is crucial in healthcare.Today’s episode dives deep into how innovative consulting firms like Revigate are reshaping this landscape. Led by experienced operators, they emphasize results-driven strategies tailored to the complexities of healthcareorganizations.

Key Topics:

• The unique approach of Revigate as operator-led revenue cycle optimizers
• Optimizers or consultants: Doing the work versus advising on the work
• Challenges and solutions in Epic implementation and optimization
• The evolving role of revenue integrity and charge capture strategies
• Future revenue cycle challenges and technology's role, including AI
• The importance of being kind, collaboration, and partnerships in driving results

 

Timestamps:

00:00 - Introduction

01:04 – Vendor Voices Snapshot Challenge

05:40 – Introducing John Freeman & Bret O’Connor

10:08 – The importance of “doing the work” in addition to advising; being optimizers over consultants

14:05 – Measuring client success in the revenue cycle consulting world: ROI

16:00 – Advantages of a smaller consulting firm: There is no B-Team.

18:55 – Strategies for Epic implementation, pitfalls to avoid, emphasizing revenue accountability, change management, and maximizing functionality

24:50 – The risks of approaching an EMR implementation without support

27:00 – The significance of revenue integrity efforts and proactive charge capture

33:20 – Predictions & advice for 2026 revenue cycle challenges: Do more with less, find the right partners, protectnet revenue, and leverage automation / AI

36:30 – Final Parting Advice: Be kind! Tips for fostering organizational collaboration and trust. Communicating the importance of revenue cycle outcomes.

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ 

Connect with John Freeman: https://www.linkedin.com/in/john-freeman-crcr-235661b4/

Connect with Bret O’Connor: https://www.linkedin.com/in/bretoconnor/

We Want Your Input!

If you’d like to suggest a specific topic or guest, feel free to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!

Provider, Vendor, Operator: Patient Access Insights with Keith Eggert of Abax Health

Take a journey through the ins and outs of Patient Access with Keith Eggert – a former patient access employee turned VP of Revenue Cycle - and now COO of Abax Health. Gain valuable insights into the challenges, innovative solutions, and future trends shaping this critical part of the revenue cycle, including specific tips on best practice scheduling and referrals.

Key Topics:

• The strategic role of patient access in healthcare success
• How proper referral management connects patients with care to optimize revenue
• The significance of referrals, scheduling, and real-time KPIs
• Navigating lengthy sales cycles and vendor-provider partnerships
• A lookback on the historical trends of Patient Access
• A future outlook on patient access challenges and uninsured populations
• Building a true partnership mindset between vendors and providers
• Practical advice: walk in your patient's shoes for process improvement

Timestamps:

00:00 - Introduction

01:04 – Vendor Voices Snapshot Challenge

05:09 - Keith Eggert’s background and transition fromprovider to vendor

06:57 - Challenges of lengthy sales cycles andnavigating healthcare bureaucracy

11:48 - The potential impact of AI on the sales cycle

13:54 - The importance of a vendor-providerpartnership and collaboration

17:00 – The provider challenge of balancing day-to-dayops with vendor attention

21:12 – Historical challenges in Patient Access, long-termtrends

25:38 – Patient Access themes of 2025; uninsuredpatients and OBBBA influences

29:31 - Critical KPIs for patient access success

32:25 - Enhancing referral tracking and patientengagement during scheduling

35:19 - Strategies for increasing patient appointmentscheduling

38:50 - Final parting advice: walk in your patient’sshoes for continuous improvement

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/ 

Connect with Keith Eggert: https://www.linkedin.com/in/keith-eggert-fhfma-1604434/

We Want Your Input!

If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!

Making Financial Assistance Programs Easy & UncoveringHidden Revenue by Leveraging Technology with Nick McLaughlin - Founder of Breez Health

In this episode, Nick McLaughlin, Founder and CEO of BreezHealth, shares insights on revolutionizing healthcare financial assistance programs with technology, simplifying patient experience, and preparing for upcoming regulatory changes. If you're involved in hospital revenue cycles orpatient access, these strategies could transform your approach.

In this episode:

• The mission of Breez Health tomake healthcare financial assistance easy for patients and providers
• Challenges with traditionalfinancial assistance workflows and how digitization improves patient engagement
• Key components of an effectivefinancial assistance program: clear policies, simple online applications, andproactive communication
• Impact of federal regulations like501R and state-specific requirements on hospital compliance
• Strategies for leveragingtechnology and automation to reduce labor and increase efficiency
• Preparing for regulatory shiftssuch as the One Big Beautiful Bill Act and increased Medicaid redeterminations
• The importance of promotingfinancial assistance to underinsured populations to enhance community benefits
• The role of structured,rules-based data processing versus AI in current solutions
• The ROI of effective financialassistance programs: improved patient experience, reduced audit risk, andlifetime patient value
• Practical advice for healthsystems to streamline processes and prioritize patient-centric care

Timestamps:

00:00 - Introduction
01:00 – Vendor Voices Snapshot Challenge
06:23 - Founder Nick McLaughlin's background and motivation for starting Breez
08:03 - The importance of creating simple, effective policies and applicationsfor financial assistance
11:06 - Best practices for effective financial assistance programs and patientcommunication
15:00 - Explanation of federal regulation 501R and its implications
16:42 - Simplifying financial assistance programs amidst complex regulations
18:15 - Finding the balance in income verification documents and streamliningeligibility assessments
19:29 - Addressing backlog issues and improving application screening processes
21:04 - Impact of regulatory press and the importance of promoting financialassistance
22:21 - Challenges in hospital financial assistance programs: balancing the auditorapproach with the advocate approach
24:26 - Building trust and connecting with patients' needs through advocacy
25:41 - Navigating future regulatory changes, including the One Big BeautifulBill Act (OBBBA)
26:16 - How technology can help manage increased volume of Medicaidredeterminations and coverage churn
28:24 - The critical role of automation amid staffing shortages and risingworkload
30:00 - Breez's use of rules-based logic over AI and the potential forstructured data processing
31:36 - ROI for hospitals: community benefit, reduced audit risk, and lifetimepatient value
36:14 - Final advice: focus on promoting financial assistance proactively andcaring for underinsured patients
37:54 - Summing up: the importance of simplicity, communication, and compassionin financial assistance programs

The episode was brought to you by: Real Partners Consulting

Connect with Ryan Downs: https://www.linkedin.com/in/ryanpdowns/

Connect with Nick McLaughlin: https://www.linkedin.com/in/nick-mclaughlin-fhfma/

Show Note:

If you’d like to suggest a specific topic or guest, feelfree to reach out to me on LinkedIn or email at [email protected].

Please rate and review – and be sure to subscribe to nevermiss an episode!

Thank you for listening!