Transcript
Kyle Bettencourt (00:00) hey, Kirsten. Hey, good.
Kirsten Neville (00:03) Morning. How are you?
Kyle Bettencourt (00:04) Doing good. How are you doing?
Kirsten Neville (00:07) I’m good. Thanks, excited for this meeting.
Kyle Bettencourt (00:11) Yes, should be good.
Kirsten Neville (00:13) And Noah can come. I wasn’t sure if he had a conflict.
Kyle Bettencourt (00:17) Yeah, he should be hopping on.
Kirsten Neville (00:18) All right, sweet. I didn’t see him at qsrs. Was he there? Oh, or maybe not?
Kyle Bettencourt (00:24) No, he was… he’s at home. His wife is kind of full time. She works in healthcare, so, she’s all got to be in the office and they got a newborn that he’s.
Jonathan Irizarry (00:35) been trying.
Kyle Bettencourt (00:37) To keep alive, so.
Kirsten Neville (00:39) Oh, my gosh. Yeah, we’ll have to debrief on qsrs when we chat later.
Kyle Bettencourt (00:46) Yeah, definitely. Yeah, I’m going to get some accounts… queued up for next week after this call here. So, awesome.
Jonathan Irizarry (01:00) I’m.
Kyle Bettencourt (01:01) thinking we also need to add empower back into the fold. I sort of left them off when I was looking at priority accounts, but.
Kirsten Neville (01:08) Yeah. When was that a few weeks ago? Now? I guess?
Kyle Bettencourt (01:12) I mean, we hit them really hard for like the first two months and then nothing and then, okay, maybe just got to get them back in a sequence. And, okay, great. Keep on them.
Kyle Bettencourt (01:30) Hey, team. What’s up? Hey, Noah. Hello. How was your day? It’s good. I was doing.
Jonathan Irizarry (01:44) Some role playing for metro.
Kirsten Neville (01:49) Nice. Did you guys do a demo for them?
Kyle Bettencourt (01:52) Yeah, we had a call yesterday. It was a tough one. Yeah. I didn’t tell you Eric responded at like nine P. M last night to my email that I fired off that one that I put in the deal. Yeah. What’d he say he, I mean, he still seems bought in. I’m reaching out to cam now to get him connected with matt Ortiz. Sweet that’s going to be cute. Yeah. So, we’ll see. He said he wants to like really evaluate. Sorry, I’m.
Kirsten Neville (02:24) going to let this Guy in.
Kyle Bettencourt (02:26) Okay. Oh, cool. Yeah, we can talk.
Jonathan Irizarry (02:27) Later. Yeah.
Kirsten Neville (02:33) Hey, Jonathan. Good morning. Good.
Jonathan Irizarry (02:35) Morning. Everyone. Apologies for running a little late. It’s one of those days where just meetings run into other meetings. So, apologies for that.
Kirsten Neville (02:45) We’re familiar with those days. Yeah.
Jonathan Irizarry (02:47) Yeah, I’m sure, you know, very well. Yeah, right. Especially on a Friday. Nicole’s actually, she’s coming as well. She might be a minute late. She’s actually, she was on a separate meeting that ran over. So she’ll be joining us as well, but nice to meet you guys.
Kyle Bettencourt (03:00) Yeah, nice to meet you as well. Excited to chat this morning.
Jonathan Irizarry (03:03) Yeah, no, thank you. So I don’t know where you guys want to start with some intros have to kind of talk about like where we are and a little bit about ourselves and you tell me?
Kyle Bettencourt (03:13) Yeah, that’d be great. So typically how we like to do these calls, yeah, definitely start with some intros. We’d love to learn just a little bit about kind of your business and sort of how you’re thinking about finding some efficiency in credentialing and then really just kind of ultimately making sure that there’s you know, agreement that there is a problem that’s worth solving and something that we can help with. So I guess just to quickly introduce like the medallion side here. So I’m Kyle bettencourt, I oversee neurabilities here. We’ll be kind of your main point of contact from this call, moving forward. We’re closely here with Kirsten on the account team here as well, who you obviously connected with. And then Noah is a solution consultant, so on for helping with any technical questions and vetting out any questions that you guys have around the software specifically. So yeah, I understand you guys are looking to evaluate credentialing and find efficiencies. So we’d love to just kind of hear a little bit about what’s driving that and your role.
Jonathan Irizarry (04:09) Yeah. No. So a little bit about me, I’ve been neurabilities here for six years, started as a staff accountant, you know, a couple months ago, I got moved up to VP of finance. And now along with that promotion came handling of RCM and credentialing and a whole world of problems. So little context there is that neurabilities, we have pretty much two main lines of service. We have like a medical practice and a behavioral health practice. Our behavioral health practice is probably like 80 percent of our business. So medical oftentimes gets the redheaded stepchild kind of treatment where, you know, most of the focus isn’t on them, but there’s most of our credentialing issues seem to be on the medical side… for some historical background years. I think about when I started and up until about three years ago, we had outsourced our credentialing to a company called CPC. About three years ago. We brought it in house. And we have currently one person doing credentialing for the whole company. We have about on the medical side, right? 15, 20 providers, medical providers. On the Aba side, we have about 50 to 60 behavioral health providers that need credentialing. My recent understanding is that this one person in credentialing, when she came on board, she didn’t have any prior credentialing experience. So I’m at the point where I don’t know enough about credentialing to understand if there are any gaps or inefficiencies going on. My concern is that bringing in someone having someone in that role without that credentialing experience, whatever issues we have, are they internal? Is it something we’re doing incorrectly? Is it a process we’re not following? Is it a problem with the insurance payers? I know any issues we have with most of our payers. The feedback I get is like they’re backed up there’s a log jam and they’re not taking any providers or they’re slowly like they’re backlogged with new applications. So really, I don’t know. And that’s why I’m trying to get some clarity on where the problems lie. And the reason I wanted to bring Nicole in here is because she’s the director of operations on the medical side. She has really good visibility.
Kyle Bettencourt (06:14) Like.
Jonathan Irizarry (06:14) in depth, detail of visibility on the like, all right, like who are the providers? We have issues with? Who are the insurance companies that we have issues with and stuff like that. So that’s kind of why I was like let’s see if we can start to make some headway here.
Kyle Bettencourt (06:26) Got it. That makes sense. And definitely helpful there. So I guess just kind of like first question on like efficiencies right there’s. Sort of, I guess three main buckets that we’re generally helping customers with that’s. Like one celebrating revenue and that’s just mainly by reducing turnaround times, getting your providers activated and billing patients as soon as quick as possible. Excuse me. Yeah. The other aspect of that is helping to reduce claim delays or denials just due to missing or inaccurate info that can be missed during the credentialing or parent enrollment application process. The other main area that we help with is just general operational cost, right? So one of the big challenges that we see with growing provider groups is ultimately having to add credentialing headcount to keep up with provider growth and the obvious complexity that will kind of come with that. Yeah. And then also being able to just consolidate software tools, even potentially repurpose headcount into things that are more meaningful and helping the providers be onboarded as opposed to just being weighed down with administrative work of trying to go back and forth and collect data and.
Jonathan Irizarry (07:32) Well, not to cut you off. But to that point, I think a lot of maybe operational issues we have is maybe our processes are so manual. It just is very administrative and time consuming. And I think maybe that’s part of this whole evaluation I’m trying to do is where the optimization’s at. And I think one thing you just mentioned that’s something I also want to consider as well.
Noah Laack-Veeder (07:52) Yeah. And hey, Nicole didn’t give you a chance to introduce yourself. We’re the medallion team. Could you just tell us a little bit more about who you are and what your role is at the organization?
NicolHartnett (08:01) Yeah, absolutely. Nice to meet you. So, I’m the director of operations for the medical team. So kind of oversee the overall medical operations and work hand in glove with John regarding just kind of front office and how it connects to billing. The provider’s schedules their appointments, and kind of trying to accelerate cash collections in any way we can. So, one of the more of the more important barriers I find with credentialing is we have a new provider that will start with us. A lot of our providers are licensed in New Jersey and Pennsylvania and we offer services in both in person and telehealth. And what we find is there’s a huge delay with application being submitted to provider being credentialed. There’s also been some confusion with this provider is credentialed but not contracted. And I don’t know a bunch about that or what would cause that delay. And then sometimes we find that individual providers are credentialed with, you know, cigna for example, but not cigna epo plans. And I don’t know if that’s is that like a checkbox when we’re submitting applications? Is there a way to credential with all cigna plans that are not on the medical side? We don’t participate with medicaid or medicare, but.
Noah Laack-Veeder (09:21) They’re.
NicolHartnett (09:22) kind of like the hiccups that we find. And unfortunately, we don’t know the individual plans that a provider is participating with, unless we’re manually calling the insurance company, which obviously, the volume is greater than the staff we have to make those calls. Yeah.
Noah Laack-Veeder (09:37) That makes sense. So just so I’m hearing that correctly, it sounds like I mean to what John said earlier, we have someone who’s doing credentialing and we, I think when I hear things like we don’t know if we’re getting enrolled in the cigna epo plan or we don’t know if they’re contracted, that seems to be around like visibility. Like do we even have these providers associated to our group contract with the payer? Do we have a group contract with the payer? So it sounds like that visibility is a bit challenging and I think the downstream impacts of that, John and Nicole could be like if you don’t know if someone is in network or part of something, what’s going to happen is you’re going to get a rejection downstream from a payer and I think you talk and you’re nodding there, John. I see that it’s the, that could result in a lot of things obviously delays and timelines like you talked about. But it also can be like if this person is seeing patients, then there’s going to be right after denials downstream. So I just love to hear kind of, I think I heard you mention Nicole, that there are delays in the process.
Noah Laack-Veeder (10:32) But I talked to organizations like who say that we’re looking at delays to credentialing being 120 to 180 days. Is that consistent with what you all are seeing? Like what does the delays look like for you all today?
NicolHartnett (10:46) Yeah. I mean there’s some applications that we submit. I can pull it up and tell you sometimes it’s like five or six months later after we submit an application that we’re still not sure of where we stand with the process of where we are with the application process, I think.
Jonathan Irizarry (11:05) Part of that, that’s where we get the question. Like is it something we’re doing internally or is it like an insurance payer that’s just dragging their feet or whatever it is? And part of me feels like maybe it’s a mix of both, you know, so.
Noah Laack-Veeder (11:17) And it could be, yeah. And I think the, what we typically like to say at medallion is like the payer’s always gonna drag their feet but they can drag their feet a lot longer if you’re not doing the internal process perfectly. So that’s kind of like where we come in Nicole to your point, the kind of the five to six months when I talk to other organizations that can lead to some provider access issues, like what’s going on in the meantime? Are those providers seeing patients like what’s are they? Well.
NicolHartnett (11:47) Yes. So we have six major payers that we are credentialed with or contracted with. And yeah, we kind of have to put holds on those payers until they become credentialed. So, you know, we obviously build budgets in the beginning of the year. We’re anticipating providers are credentialed with all the payers and we have a healthy payer mix with patients and the schedules are kind of full at all times.
NicolHartnett (12:13) So yeah, definitely causes some access issues and financial issues. I do know previously and I don’t know if there’s a best practice credentialing’s not my wheelhouse. So I’ll start with that. But previously… before this credentialing team that we currently have came in, we credentialed as a group like our group npi and would just basically add providers as we had them to our group. And from what I’m understanding now it seems like we’re credentialing each provider individually. So I don’t know if that is like again best practice or if that’s they link them, I think to our contract obviously, but they’re credentialing them each individually. I don’t know what way is the right way or wrong way or if there is a right or wrong? Or if there’s just preference. But that’s another thing that I’ve noticed, you know, before I was in this position many years ago, I kind of worked in the scheduling team and we would just always call and give our group npi number and say, like are we, you know, does this patient need an authorization? And they would say, nope, you’re good. You’re they’re in network covered. Now we have to give like individual npis of the providers.
Noah Laack-Veeder (13:18) That’s interesting. Yeah. At the, that, yeah, that is interesting because typically, and I guess we’d have to like maybe you all know this like when you’re billing for claims, are you doing it at a group tin level or are you doing at the individual npi level? Because most organizations we work with, every provider is going to be linked to a group because the group contract has associated rates and group rates are typically better than individual rates. So that’s what, like in terms of best practice, especially a provider group of your size, they’re usually doing it through a group link process. We still call it like credentialing, but that’s how it is, but maybe kind of thinking broadly sounds like there’s a lot of areas to help. I think the things I’m hearing is we want to work with someone who like knows what to do with credentialing because we have, and I don’t you’re not the first organization I’ve talked to who said that, right? The other piece is that the ultimate initiatives that are going right now is we want to make sure we’re increasing provider access and reducing some of the financial implications there. Given that’s the case, what is like the, is this like an immediate priority for you right now? Jonathan like, what is it? How does this seem like in terms of projects and urgency? I.
Jonathan Irizarry (14:37) mean, the medical practice as a whole, even though it’s smaller than the behavioral health practice, the medical practice as a whole seems to have more pronounced issues and I think this is one of them. And another main issue that they have is cash collections. And I think this also goes hand in hand with this because if we have providers doing services, they’re done our preventative report, then we’re getting denials. Then our cash collections are lower. So I would put this probably up there as like our top two or three priorities at the moment. Got.
Noah Laack-Veeder (15:03) It, and is there kind of like a, when I hear like cash collections and provider access? Have I asked you like when do you want a solution live? You’re going to tell me like yesterday, like realistically kind of what is your timeline for an evaluation? Let’s say we do a demo. You love it. We kind of show you what we do in this space, like what does the evaluation look like?
Jonathan Irizarry (15:26) What would be like a normal timeline for you guys?
Jonathan Irizarry (15:29) Like, is it one to two months? Is it two to three months? Three? Plus, you know, you tell me like what’s average? Yeah.
Noah Laack-Veeder (15:38) I can speak to the implementation piece and then I’ll let Kyle talk through like the evaluation timeline. But what I’m doing with those questions is given what you’ve told me, it sounds like we want something live as soon as possible. So with implementation kind of post signature, we can get you live and getting value within four weeks. So if you’re like, hey, I’m trying to get this done by June first, like if we go through the evaluation at whatever timeline makes sense for you that’s kind of where I move backwards from.
Noah Laack-Veeder (16:07) But I’ll let Kyle say more but the evaluation really can go as fast as you all want, right? So, yeah, Kyle, if you want to jump in, yeah.
Kyle Bettencourt (16:17) So like generally, from here, what we would do as a next step is sort of a deep dive, solution discovery call. So we can kind of understand like the ins and outs of sort of how you guys are handling credentialing and enrollment today… on that call, Noah can then sort of prepare to understand, you know, how we would map medallion and sort of be able to sort of like present a demo back to you guys on like what it would look like using medallion. And then also on that call, what we would do is sort of prepare an initial business value assessment. So we can really understand like is this a problem that’s worth solving right now? And, you know, ultimately make sure that’s going to make sense from a business perspective before we get, you know, too far down the path and it.
Jonathan Irizarry (16:56) Makes.
Kyle Bettencourt (16:57) sense from there. So generally, we would do another call for maybe about an hour. At that point, we’d be able to kind of run through a demo and then do that business value assessment. Sorry, on another call from there. And then we can kind of figure out appropriate next steps once we kind of validate the solution itself in the business case.
Jonathan Irizarry (17:18) Yeah. I mean, I definitely, it’s one of the things where I want to move forward but I don’t want to move too quick because I don’t want to like shoot from the hip and just, you know, overhaul everything. So I’m definitely on board with that idea. Now on a second call, would it be helpful to have our current credentialing manager on that call just to give some insight on like what the current flows are? Like, I’m hesitant just because I don’t know if she’s the right person for this role. And now when we’re asking questions about her role, she’s like, hey, what’s going on. Yeah?
Noah Laack-Veeder (17:51) Yeah.
Kyle Bettencourt (17:52) I think what?
Noah Laack-Veeder (17:53) I’ll say just from my perspective is like… if she’s the person that you think would be kind of the medallion admin, then I would say, yes, she should be involved. I think the only thing to kind of highlight is, and just like you said, if… there’s kind of like the, you know, we’re talking about efficiencies and changing the way that we work, obviously, that can be perceived as threatening. So, I think it’s up to you in terms of that. But like from what you’ve said, kind of my pitch for what medallion is a partner that can more or less give you the credentialing knowledge that you don’t have today. So the individual who has kind of more or less learned the operation, she could do credentialing, more of a side of the desk activity. We typically see the need for a full time employee only if they’re managing around a 1,000 providers. So it’s going to be, it’s a lot. It’s a lot more automated as you’ll see, I know it’s a bold claim. Yeah. But I guess the question for you, Jonathan, as you’re thinking about this, I know this is only our first call is typically it would be if you see this individual doing other things besides credentialing, then I think that’s how we pitch it and saying, hey, we can reduce this credentialing piece and kind of help you focus on other things from a change management perspective. But if that’s not something that I think they’d be, I don’t think I don’t know what word I’m trying to say here. If they’re not going to receive that well, then I’d say maybe we start with this group?
Jonathan Irizarry (19:24) Yeah. And that’s definitely she definitely has her main role is credentialing. She does some work on the RCM side as well separately. So, you know, we could pitch it to her as, you know, this is, you know, kind of to help take the burden off the credentialing, let you focus more on the RCM side. I’m happy to pitch it to her. That way. I’m not entirely sold as her in any role.
Noah Laack-Veeder (19:46) Sure. Yeah. And I think that’s a that’s typically like and I have these conversations a lot like typically the resources who are kind of doing the credentialing, they’re focusing more on like value added activities as in chasing dollars like RCM activities. So I think that’s not like a that’s not a hard topic to think about. And also if you think about the work that these individuals have to do, it’s like caqh attestations, caqh updates, preparing applications, submitting them, tracking status. Like most folks aren’t upset with us automating that piece, which is the majority of the effort that is being done today. Yeah.
Jonathan Irizarry (20:28) Yeah, but yeah, listen, without a doubt. I think the current credentialing process needs like a complete overhaul. So, happy to move forward in any way that you know, we think is useful. So.
Kyle Bettencourt (20:38) Definitely looking forward cool.
Noah Laack-Veeder (20:39) As you’re doing this evaluation, are you, I’m sure. We’re not the only folks you’re talking to like, are you kind of evaluating other software as part of this as well?
Jonathan Irizarry (20:47) We’ve had a few companies reach out. This. You’re probably like one of the first of like two or three calls that we want to have just in terms of, you know, kind of exploring what our deficiencies are, like, what are ways to streamline? So we began the search in Earnest, you know, just want to get a feel for what’s out there at that point. So, but definitely want to make improvements. Definitely want to move forward with something because I think the worst thing we can do at this point is nothing and let it continue the way it is. So.
Noah Laack-Veeder (21:15) Yeah. And just to give you a quick because I know credentialing isn’t your main thing. But so like the different types of partners out there is like a completely outsourced partner like you’ve worked with in the past kind of like it’s kind of the black box thing. You send them the stuff and hope it gets done. Sometimes you have some visibility there’s a self serve market which the whole pitch would be now that your team has a self serve platform that effectively can make them more efficient at the credentialing work. But medallion’s a little bit of we’re kind of different. We’re a hybrid model where we have a software interface to get all of the status visibility et cetera. But then we also have the credentialing knowledge in house and instituted in our platform. So effectively, this can become more of a side of the desk job, not like a, you know, use the software. It might get better. The other piece is that we have contracted slas, which means that if we don’t hit the outcomes that we’re telling you, we’re putting ourselves at risk so that’s so if you’re kind of evaluating other software, I think the other things that I would think about asking would be, do you have performance guarantees? Do you have that credentialing knowledge in house? Because that’s typically in your situation, why organizations would choose a medallion because you don’t necessarily have that credentialing expertise in house yet?
Kyle Bettencourt (22:34) Right. No, 100 percent definitely something we’ll look into. So next steps, what are we, what are we looking at?
Kyle Bettencourt (22:42) Just to say, why don’t, we, if you got your calendars available now, maybe we can just find some time next week to block off about an hour. And then, but what we can do in the meantime is send over just a couple of questions just to get a sense of sort of your guys’ growth. And, and then on that call, I’ll kind of come with like an initial sort of pitch for sort of like the business value and sort of how we’re thinking about it and we can kind of talk through it and get your take on it. And, and then from there also kind of do a deep dive on, the process itself. But I think Monday is actually pretty wide open for us.
Noah Laack-Veeder (23:19) What time zone are you both in?
Kyle Bettencourt (23:21) Eastern Time? Okay. Let’s see. I’m pretty, no, I know you got a couple internal things on the calendar here Monday. Yeah.
Noah Laack-Veeder (23:32) What, what?
Kyle Bettencourt (23:38) I’m good, Nicole. Do you have, any conflicts? No.
NicolHartnett (23:41) I have an eight 30, but as long as I can get at the hard stop at nine, I can join at nine. I might be a few minutes late but.
Kyle Bettencourt (23:51) Perfect. Well, then, yeah, I’ll go ahead and send the invite out, for Monday at nine. And yeah, then I’ll follow up today with some of those questions… or the, for the bba inputs and then, we can go from there. Well, thank you guys. Appreciate it.
Noah Laack-Veeder (24:07) I’m really excited for the demo on Monday. I think this is going to give you some relief. Yeah, can’t.
Kyle Bettencourt (24:12) wait, yeah, I think.
NicolHartnett (24:14) John and I are both ready for that. So, thanks for taking the time and it was nice meeting you all.
Noah Laack-Veeder (24:19) Yeah, you too. Thanks for sharing it’s. I promise everything you’ve told me is going to make it a much better demo on Monday, so appreciate it.
Kyle Bettencourt (24:27) Perfect. Thanks, guys. Have a great.
NicolHartnett (24:29) Weekend.
Kyle Bettencourt (24:30) Thank you.