Blog, Reimbursement, The Hospital Finance Podcast®

The future of Medicare reimbursement [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Jon Besler, President & CEO of BESLER, and Jeff Wolf, Director of Reimbursement Services at BESLER, to discuss the future of technology in reimbursement.

Learn how to listen to The Hospital Finance Podcast® on your mobile device. 


Highlights of this episode include:

  • Background on how hospitals these days are managing their data to complete their Medicare cost reports.
  • The advantages of staffing technology gurus and ways that their intellect and experience can be leveraged across hospitals and health systems.
  • Ways that technology is being leveraged to help Medicare reimbursement professionals.
  • Actions that hospitals can take to prepare themselves for implementing technology and processes for reimbursement.
  • And more…

The Medicare cost report can be complicated to complete, and some simple errors can have a substantial impact on provider reimbursement. BESLER’s Medicare Cost Report Reviews and Preparation service can help ensure that your hospital submits an accurate cost report that optimizes revenue potential. 


Mike Passanante: Hi, this is Mike Passanante. And welcome back to the award-winning Hospital Finance Podcast®. So, in today’s show, we’re going to be talking about the future of technology in reimbursement. I’m joined by Jon Besler who is the CEO of BESLER. I’m also joined by Jeff Wolf who is the Director of Reimbursement Services here at BESLER. Gentlemen, welcome to the program.

Jon Besler/Jeff Wolf: Thank you very much. Glad to be here.

Mike: So, why don’t we start out today’s discussion by talking about the process as it is today and how hospitals are managing data to get their cost reports done and do the work that they need to do?

Jeff Wolf: Well, in reimbursement today, what we’re finding is a lot of organizations are still doing a lot of their work manually. What that means is, you know, Excel and processing data in a very antiquated, manual process, very person-oriented.

And it needs to be something that changes because when you have individuals doing the same work over and over again, repetitiveness causes inattention. And the massive amounts of detailed data that we’re now dealing with, whether you’re talking about S10 or you start talking about DSH or you start talking about the cost report itself, the amount of data that we’re dealing with is just massively voluminous.

There are times when our software like Excel and Word and stuff like that runs out of space. And so, you’re having to break files apart, you’re having to do these things because it’s a manual process that computers don’t necessarily have to do, but the way that we as human beings process data and manipulate the data makes it much more difficult. And that causes inattention. It causes errors. And it causes missed items and mistakes.

And that’s really where technology can come in and start helping out.

Jon Besler: And I would just add to that. Reimbursement really has sort of a unique function of being not a pure accounting function, and also not a pure patient accounting function. However, the reimbursement department is unique in the sense that it needs to be able to live and manipulate data in both of those worlds.

And so, when you take the cost report, for example, the input is the general ledger. And for the most part, it sits very happily in Excel. You can move it around and manipulate it. Well, what happens when you get to Jeff’s point to schedules like your DSH log or your bad debt log or your S10 blog, and you really start to need to manipulate a large amount of data in a very efficient way, in a very structured way, in a very streamlined way… because at the end of the day, you’ve got a deadline to hit with that cost report, and you’ve got to be able to move in and out of that world very efficiently in order to get that whole process streamlined and done in an efficient way.

Mike: And you know, we’ve talked to a lot of hospitals about this. And I think one thing that you see—which is probably not uncommon—is everyone does it a slightly different way. They all use different technology.

And I’ve heard myself on more than one occasion, we’ve got a guru who handles Excel or some other process for us: “What are the dangers in having a guru?”

Jeff Wolf: Well, you know, there’s advantages to having a guru. It’s a very knowledgeable person that can get some things done. But it is a single person that’s responsible for a very critical part of your process, whether it’s the guru who has everything in Access or it’s the person who knows what all the little links work within your Excel files. You’re trying to automate to some degree using Excel and Access.

But if that one person, whether they retire or they move on to another organization, or heaven forbid, something happens, and they have emergency, they’re not there, what happens if the other staff don’t know how to handle that? And when you have the one guru, that happens actually frequently enough that the facilities that have that issue, they either end up late with their cost reports, they end up scrambling, now they got to bring new people in. They abandon the old process and have to now redo things a new way, in a very, very short timeframe. And that doesn’t lend itself to being consistent and accurate… the things that we expect out of reimbursement amount of cost reports,

Mike: And even in trying to be consistent, and even if you had the same staff year to year, you’ve got notes, right? When you’ve got simple things like that, adjustments and things that you’re making to the cost report year in and year out, that need to get passed through, right?

Jeff Wolf: Well, I mean, every organization, every hospital, is going to have their unique issues. Some of them, it may be that we have to do a particular type of analysis. And so there may be notes specific to that analysis. There may be issues and we have to have specific data elements that are different from other hospitals.

And again, when you have a manual process, someone has to remember, or they have to know where things were put or I’m trying to follow last year’s work paper—and this happens quite a bit. I’ll use last year’s work paper and delete the numbers and put this current year number in. But they’ll forget one and one of the numbers will actually be out of date, which makes the answer incorrect.

And you know, one mistake, that’s not a big deal… but they start compounding. And that’s where places get into trouble. Their cost reports aren’t accurate enough, and they have to start dealing with those issues.

It all comes back to you want to have a consistent process. You want to have a way to make sure that whether the person has to rotate to another facility, and a new person comes in and looks at this hospital, they need to understand what are the issues with that particular hospital and how to process the data without necessarily knowing where “John” hid all of his papers or his PDF files or his notes on his desk or his laptop or whatever.

And so, that’s part of that process of one man/one shop manual process that needs to be changed.

Jon Besler: And I would just add that, if you have a guru, you want to do to the best of your ability to keep her or him being an absolute guru, right? So that person really needs to be sharp when it comes to many different issues. Like we talked about, reimbursement sees a very broad view of the world. And so, how can we really think about leveraging the intellect of that particular guru really across the organization as hospitals and health systems obviously continue to not only become larger, but with that scale, certainly comes a larger complexity as well.     

And so, if we really want to leverage this information and knowledge from this guru really across the organization, we have to figure out collectively, well, how do we take away some those mundane tasks from that individual, so her/him can really put their brain to the highest and best knowledge and researching the new issues or figuring out, “Well, what’s the future of my organization?” and really starting to think about, “Okay, this reg might have this particular effect on me,” and let someone else or let the computer automate as much as they can with a lot of that minutiae.

Mike: So, back in April 2019, BESLER and Essential Consulting came together. And Jeff comes to us from Essential Consulting. And he has a vast background in reimbursement. And that’s given us the opportunity to take a step back and really look at how technology can help solve some of the problems we just discussed.

So Jeff, can you give us a rundown of what BESLER is doing in the technology area to help Medicare reimbursement professionals do their job better?

Jeff Wolf: Well, yeah… I’ll give you a quick background. One of the reasons that we merged together is because both organizations were independently looking at how to automate and make a better process for filing cost reports and specific issues within reimbursement, whether it’s the cost report itself with easy work papers or S10 or bad debts, whatever the issue is. We were independently making these products that clients could use to help process this data in an accurate, consistent and efficient manner.

By coming together, we really were talking about how do we make this a platform to allow all clients have access to all of the issues in one place to manage those issues without having to go to seven different consultants. They have one place that can manage it. It has the ability to do bad debts, DSH, S10, cost reports, interns and residents, whatever the issues are.

And one place to manage that—whether the consultant does the work or in-house people do the work, it’s irrelevant—they have one place. If it’s a tool that’s used, one place to look and manage. And the interactions between all of those issues do have an effect on the cost report.

So again, one place to manage that. And that’s really our vision, our goal for going forward, is how do we provide these tools to the clients—which is something that, really, we haven’t seen in the industry. There might be one, little aspect or another little aspect that people are picking off and trying to do, but nobody’s really looking at it from a holistic view, how do we help the entire process for these clients?

Mike: Jeff, what would you say hospitals should be thinking about or doing right now to prepare themselves for implementing technology to get these things done or to hop on that train immediately?

Jeff Wolf: Well, you know, the hardest thing with reimbursement is there is some uniqueness to each facility. So, you need to have a process, tools that allow you to be flexible enough to handle your issues but standardized enough to allow you to make the decisions and move through data quickly.

As we said earlier, we’re talking about massive amounts of data and issues that have repetitive information. And we need to have a computer take care of those issues. So, the reimbursement person can make decisions at those critical points and junctures to guide the computer but let the computer do the work.

And so, as organizations evolve from here going forward, they need to take a look at their processes and identify what tools are there out there for me to use that can help me have my staff be more efficient.

There’s a term we use at BESLER that a cost report has 80% of the work. That’s what we call same-same—the same analysis using the same data elements and the same processes the prior year but using current year data. That 80% or 80%+ is what you want to get through quickly with decision points in case there’s a change—new departments, new sub accounts, and things like that.

And you want to have processes that can do that and tools that can do that. And manual processes don’t do that very well. It’s rework and rework. And it takes time for those reimbursement people. And it takes time away from that other 20% where it’s a critical issue to the client, it’s a critical issue to reimbursement. And they need to be able to spend the time to do that, not on the 80% that’s what we call same-same.

So, I think in answer to your question, clients need to start looking for tools or looking for processes that allow them to efficiently get through the minutia, the details, and the processing, and gives them more time to spend on those critical issues and reimbursement.

Jon Besler: And I would just take that one step further. I really think of it—I’m trying to answer two key questions. And overall, it’s around strategy and risk. And depending on where you are in the organization and what your level of responsibility is, certainly from a strategy standpoint—again, as hospitals and health systems continue to get larger and more complex. If you’re a director of reimbursement or VP of reimbursement or a reimbursement analyst, you really have to start thinking about what does my future look like. And by default, what does the future of my organization look like. To go from a one hospital system to a three hospital health system is a very different dynamic to really take that all the way through, and go from three hospitals to six hospitals—and then, adding a rural health clinic or SNFs or these integrated delivery systems and how they’re all coming together.

And so, if I’m a VP or a director of reimbursement, I’m really thinking about do I have the right tools in place, do I have the right relationships in place to help me and my department really think about that next level of strategy and how our department can add value to that overall organizational strategy.

And then, from a risk perspective, again, if I’m director level, VP level, CFO level, whatever it might be, what are the real risks in keeping the status quo within that department?

So, we talked about before, “Hey, we’ve got a guru here on the staff. Maybe we have two or three gurus. We really like them and trust them” and so on and so forth. But to Jeff’s point, is that really the risk tolerance level that we can have?

Certainly, we see from a knowledge standpoint that reimbursement isn’t something that people can pick up naturally, and overnight, become that guru. And so, when I think about my organization, how do I manage the risk if, for example, we get more complex—which most health systems are at this point—and we start to add something? Do I have a risk of not having that resource in-house that I can leverage?

Or on the worst-case scenario, “I have that resource in house, but we just got bigger, and I only have one guru. I need three or four or five gurus to be able to process this.

Or the person that I do have on staff might look elsewhere, might retire, a whole series of knowledge risk that we lose by not institutionalizing a lot of that information and a lot of that data and a lot of that process… which technology can help with.

Jeff Wolf: And you know, you actually sparked a thought that, as systems grow and get more and more facilities, there’s an issue of consistency across the organization, making sure we’re treating the same issue the same way (with the exception of those particular facilities that have a unique slant to that particular issue).

But when we talk about something simple like medical supplies chargeable, this organization uses seven sub-accounts, we want to make sure that we’re treating that the same across the organization.

So, consistency as you’re growing is also a big issue. And, and again, when you’re talking about a manual process, very hard to ensure; whereas when you have more of a systemic process to it, there’s a lot of tools that allow you to make sure that you are consistently applying the rules that you all have agreed on across the organization.

But again, it has to be flexible because there are unique issues. There are, you know, the one critical access hospital that doesn’t book the transactions exactly the same as the rest of the organization.

So, when you’re looking at the future, there isn’t an issue. You need to have automation. You need to have technology. You need to be able to safeguard your knowledge base. And you need to be able to ensure consistency and accuracy within your reporting.

Mike: If you’d like to learn more about the technology solutions that Jeff’s reimbursement team is working on, you can head over to besler.com. Just click on the Services tab at the top of the website and click on Reimbursement Services. You’ll see all that information there.

His team also puts together some fantastic resources in the form of other podcasts and blog posts, which you can get by clicking on the Insights button on the top of besler.com and just clicking on the Reimbursement Services button underneath that.

So Jeff and Jon, thanks very much for joining me on the show today. I learned a lot. Great topic! And I’m looking forward to having you back on the show to talk about the advancements that we’re making in technology area.

Jon Besler/Jeff Wolf: Great! Thanks for having us. Thank you very much.


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