AI for Patient Billing
The most neglected component of the revenue cycle might also be the biggest opportunity: patient billing. As patient responsibility continues to rise—making up as much as 35% of a clinic’s revenue—billing companies can no longer afford to rely on outdated, paper-heavy processes. That’s why 4D Global hosted a candid, practical discussion with two industry leaders at the forefront of AI-powered patient billing: Jeff Robertson of Nexsys Billing and John Gwin of The Auctus Group.
Both speakers shared real-world data on how AI tools like Raxia and Inbox Health are delivering immediate impact for billing companies: faster payments, reduced call volume, and fewer dropped balances. One client doubled their patient collections in just four months after implementing AI-powered outreach. The secret? Automated daily statements, behavior-based communication strategies, and real-time payment tracking—all designed to meet patients where they are.
More than just flashy tech, the panel emphasized the operational shifts required to make these tools successful. It starts at the front desk: collecting emails, mobile numbers, and credit cards on file. From there, AI and automation can take over—sending customized messages, surfacing balances, and even powering chatbots that can answer questions without human intervention.
This webinar pulls back the curtain on what technology tools are working right now in patient billing—from aesthetics practices with high-dollar claims to high volume primary care clinics. If you’re looking for actionable insights to improve cash flow, patient experience, and operational efficiency, the AI for Patient Billing webinar is a must-watch. You can view the full replay or read the transcript below.
Check out our previous webinar: The AI & Technology Tools Every Biller Needs for even more insights on emerging technology!
Webinar Transcript
Chanie Gluck: Thanks for joining us and welcome to today’s webinar, AI for Patient Billing. I’m, Chanie Gluck, CEO and Founder of 4D Global, and I’m thrilled to have all of you here as we dive into AI and automation for patient billing. Patient billing is a critical part of the revenue cycle, but often gets overlooked. The good news is that there are some really powerful AI tools out there to help streamline your patient billing and improve collections.
I’m joined by two industry experts today to discuss these AI tools for patient billing. We want these webinars to be as practical and useful as possible, which is why we invite actual users and not vendors to this conversation. that being said, I’m excited to introduce our two panelists, John Gwin and Jeff Robertson. Welcome, guys. just a little intro. Intro to both of you before we start. John is the founder and CEO of Auctus Group. It’s an RCM for aesthetic practices with a focus on technology. John serves as an advisor in the RCM tech space and is a valuable contributor to our RCM Tech forum. John is also the Vice Chair of the Innovations committee for the HBMA. And Jeff is the President and CEO of Nexsys Billing and Practice Management. With over 25 years of experience in specializing in independent physician clinics. Jeff is board certified by MGMA. As a certified medical practice executive, he’s a member of both MGMA and HBMA. Jeff is often referred to as the practice fixer and has been an early adopter of technology in the medical billing space. Thank you so much for being here.
This is an overview of what we’re going to be covering today. The pros and cons of popular patient billing, AI platforms like Raxia and Inbox Health, assessing built in patient billing tools inside your PM and EHR systems, and how AI and automation can improve cash flow, patient satisfaction and your team’s efficiency, and more. As a reminder, don’t forget to drop any questions you have throughout the webinar in the chat box below and we’ll answer as many questions as we can in the last 15 minutes. Okay, let’s dive in. Jeff, I’m going to start with you, because have been using, Raxia.
Jeff Robertson: We, like a lot of us, we’ve used almost everything that was out there. Inbox Health, Bill, Flash, the clearinghouses, we use them all over many different years with pretty much similar results. And the traditional cycle was, you know, statement after statement. And then we started to see the evolution where you could do outreach digitally. and then a couple years ago we had the opportunity to meet with a vendor who was introducing AI and we were hearing they were getting great results, so we thought we’d give them a try. So about two years ago we started with Raxia.
Chanie Gluck: Okay, so I know you have a little presentation for us. Why don’t you pull that up and share a little bit about while you pull that up? I’m just going to share. It is so important today to focus on patient billing because more and more, deductibles and patient responsibility, is happening. And so as billing companies, we really need to get a handle on this and really perfect this patient, billing piece of the, of our process. Okay, go ahead, Chad.
Jeff Robertson: That’s a great point. And that was something that I did want to address and
00:05:00
Jeff Robertson: that is there has been a shift over the last 15 years of the responsibility moving to the patient. So deductibles are increasing. you’re seeing, you know, half of them maybe around 5,000, 4,000, but some as many as 10,000. So you have to have a lot of visits to eat up that deductible. And so the patient part or the portion of the revenues that come to a practice maybe 15 years ago were less than 10%. So if a physician was very empathic or maybe a little bit too nice, less than 10% of the revenues, if they weren’t on top of that, it wasn’t going to make or break the clinic. Today, those numbers are as high as 35% of the revenue come from the patient. So it’s not something you can ignore anymore. And it’s a really, really important component to the revenue cycle for the clinic. So that, that’s why it’s so important, is it, it just can’t be ignored anymore. And it’s got to be better than it was. the old days of stuffing envelopes and signing postage and sending. All that, needed to change. I think we were. The healthcare industry, I think was keeping the, the postal service afloat, with all the paper floating around.
Chanie Gluck: Yes.
Jeff Robertson: So, yeah, so we, we, we sort of embarked on that journey with, giving Raxia a try. and, and so two years ago, we took a client that was in desperate need a, really large AR, and we said, okay, let’s give it a try. And the sort of, the genesis was the algorithm of, okay, is it really, truly AI is, you know, if the patient’s over 75, are they just going to get paper? And if the patient is 21, are they just going to get texts? and so I think, I did meet with the CEO of Raxia, Andy, at a dinner, at a conference, and he says, yes, that’s where it started. That was sort of the genesis. But then they built the model and it started getting smarter and they were able to then sort of focus and target on where the patient responds best. And that was where that was sort of their secret sauce. Is that if the patient’s getting two texts, one on a Tuesday, one on a Friday, but they happen to respond to the ones on Friday, that then goes back into the model. and so if they respond better to email than text, are they, you know, they, they ignore all of them until they get their first paper statement. So all that stuff goes in. So the AI is really built around the texting and the emailing. Once you go to paper, there’s, there’s no AI in that process. but we saw, we saw results immediately where my client doubled their, their, their revenue for the month in terms of patient payments. They doubled it, and that sustained itself for like four months. So there you go. That’s, that’s the slide. So it sustained that for four months, a doubling of their patient revenues, and then it leveled off back to a normal range, but settled in about 40% above their normal benchmarks. And we had benchmarked their patient revenues, for the, for the prior three years. so, I mean, it was a dramatic difference. And after that we were like, okay, that’s it. Like, that’s amazing. And so can we duplicate that? Let’s try some other clients. And we just kept seeing the same results. And so the results have been there. They can actually get integration and interface to a client in five days. that’s a great slide right there. So that was their average monthly collections prior around $127,000 a month just in patient payments. Average days to payment were 126 days. And then, and then I landed like around 18179 on the right side of that slide to average days to 58, 51 days. So payments quicker, they were, you know, larger, more frequent. I mean, on every metric it was doing its job. And so we were really, really impressed. and so it’s been great. So as soon as that balance moves from insurance to patient, if you can imagine, let’s say you have 100 clinics, and the old days, if you put out statements, let’s say in the 15th of the month for all 100 clinics, you can imagine the amount of phone calls that are coming in. And it’s just not sustainable. So you have to stagger, right? And then. And so now as soon as that balance moves to patient, it goes to the patient immediately. And so you’re speeding up that cycle. and also, and maybe we’ll get into it, but the ability, to offload or take away some of those phone calls into our staff or to the clinics can then be used through chatbots or an IDR system. And that’s helping to reduce the phone calls. patients don’t always want to talk to people, and so they can resolve a lot of these balances without having to talk to anybody. and so if you can see right there, number of emails sent, number of text messages, and then how few mailed paper statements. Ah. And so that digital outreach, you can see : that patients are responding to it and they’re reacting and they’re paying. these do vary. They do vary by clinic. And if one of the drivers. And it’s a slide if you forward it, but you have to be able to get, when you’re registering patient, not only verifying eligibility, benefits, all those things that we have to do at intake, but emails and cell phone, you gotta get those too. And when we, when they do that, we get great results.
Chanie Gluck: And do you find that people are forthcoming with their cell phone and, email addresses on the Intake?
Jeff Robertson: Yeah, it’s one of the metrics. It’s a great question. It’s one of the metrics we do measure. And it’s one of the things that we go back to our clients say, hey, the front office staff is missing a lot of emails. And so, like this one right here, you can see that slide. Look at the AM of on the bottom right, the sms. So that’s how many out, of the potential total that they were able to get. Which is pretty good. You know, it’s pretty good. But we have, you know, if you look at a couple slides after of an ENT group, they’re not very good. You see that email? 83. Go back one. 83 emails out of 272. That’s not very good.
Chanie Gluck: Right.
Jeff Robertson: So, so we need to be able to respond and reach out to patients. And if you don’t have their email, then you’re only limited to text and then pa. But we’re still getting good results even on that client. 85%, is, you know, that’s, that doesn’t cost any of those emails and texts don’t cost. So there’s no postage, there’s no envelope. So it’s a really, really great solution in that sense.
Chanie Gluck: Right. okay. We got feedback that the slides are too fast to take notes. We’re going to be sending out a recording here. So don’t you worry. No need to take notes. You’ll get this recording after. Okay, talk to us about CSATs.
Jeff Robertson: Yeah, so they, they measure the results. They measure if patients were happy with their experience and, you know, 97% score of, patient satisfaction. So one of the things, and John, I’m sure is very sensitive to this with his, with his clients, is that the worst thing that could happen to us is that a, patient is upset, you know, calls the doctor’s office and says, you know, these balances are wrong and I don’t know this and what are you doing? And then ends up on Yelp or in Google. And, and it’s, it’s, it’s a real, it’s a concern that we all have. And so we take it, you know, very seriously. But these have to be correct and we have to make sure that patients are happy with it. If they’re not, it’s the, it’s the one thing that can erode that relationship with our clients the fastest is if their patients aren’t happy, our clients are not going to be happy with us. And you know, John, John, I think is even in A more difficult situation and even more sensitive to that, larger balances. And he can get into that. But, but we’ll get into this slide after when we talk about sort of the end of cadence.
Chanie Gluck: Okay, so, we could take a pause here. John, I want to hear from you. you are dealing with plastics, high dollar value claims. what’s been your experience with AI and patient billing and what, what, what systems have you used? What do you like, pros and cons?
John Gwin: Yeah, I think, I think Jeff encapsulated everything really well. But I, the issues that we’ve had have been regarding, you know, dropping things to paper once a month doesn’t really get results anymore. And I lost this argument or I never got the statement argument. And then the payment velocity that you get out of that has just traditionally been bad. The numbers that, that we’ve looked at, you know, at minimum you’re looking at like 15 of what insurance owes is probably going to drop to patient these days. And I think I can’t quote where I got this from, but the last national average I looked at was like, I think 40% of medical bills are paid. So you’re roughly looking at 7%, 6%, 8% of your top line. They’re going to lose if you don’t have a good statement solution. And I think as a billing company, you want to conserve cost, you want to conserve time because time is money. Because you’re a service business and to your customer you want to provide a good value service, you want to make it easy for the patient to play, and you want to connect or collect. Excuse me. So we, we started looking at, kind of AI or RPA solutions for patient RCM about, about two years ago as well. We started a different spot with a company that got bought up out of Cleveland, into a larger organization. We looked at Inbox Health. We, I think we trialed maybe 10 different companies and landed on Inbox was kind of the first place we planted our foot. they work on an API with a number of systems and as a billing company, we work in 50 different EMRs every day, which is operationally wildly inefficient. Inbox Health has been great in the structural function of the system, but because they require an API and all these EMRs or PMS or EHRs require their own, you know, some of them are pay to play, some of them don’t have an API, some of them pick their partner. that’s been a bit of a limitation. Although know, Inbox Health is extremely Broad, and we’re very aesthetically focused. So our PMs are a little bit kind of unusual.
00:15:00
John Gwin: and then we brought in Raxia as well to fill that gap with the other PMs that we didn’t have a solution with. And they both function relatively similarly. There’s a different connection type, which I can get into, but the biggest shifts for us were, as Jeff touched on that shift of the cadence to once a month to have claims are drop or patient statements are dropping. Every day, they drop into. There’s an omnichannel communication, so the patient can text or email, and the system is going to react to it. at the end of the day, we found that the responses were just so powerful that we saved time. We’re actually funding this product to our customer at the end of the day because we’re making money by giving them something for free and our customers are making more money. But I think our payment velocity is 60. 60 to 70% of payments come in within the first 15 days and being closer to 80% of what’s owed rather than that that average of 40. So it’s just a win for everybody across the board.
Chanie Gluck: Okay, so as a billing company, you’re absorbing these costs for Raxia because it’s paying for itself, which I think is great. something to really think about. But could you tell us the difference or the pros and cons? If someone’s considering Raxia and Inbox Health and they’re trying to decide between the two, what’s. What’s your perspective?
John Gwin: Yeah, I think the connection type is a big one for us just because of the number of platforms that we’re in. if you’re with Inbox Health or Racks or anybody, you need to know that they can connect with your EMR and they have read write ability for all the data fields you need. So, for example, there’s a PM that I know that one of the two vendors can integrate with and it can do everything except for write the payments back to my PM system. And for me, that’s kind of a deal killer because now I have to go check this other place and post the payment back manually. I need to fully integrate. So integration type and if it works with your pm, I think is big. Obviously, pricing is consideration. If you’re looking at a consumption model, meaning how much revenue is processed equals how much you pay versus a platform fee, meaning I’m paying for having this software and it’s either step tier, scalable or just a flat fee, that’s Obviously a consideration as well. and I think just the, this is subjective and harder to assess. But just the state that the company is at, do they have funding? Is that publicly available information? Do you see them developing towards add on services or add on functionality that you really like? That’s the other thing I look at and I think both products are developing really well, but maybe in different spots. I can get into like a plus minus delta. But they’re better. Too much?
Chanie Gluck: Well, I think, you know, inquiring minds want to know and we want to like, you know, we’re, we’re always buying. Right. Different products, different things and we, these are the questions that we ask. Now obviously we could ask the vendors, but just high level. John. pricing. Could we talk about the pricing? I’m sure, Jeff, you also have, you know is. There is. You said one is a flat fee versus a transactional fee.
John Gwin: Yeah. And I don’t want to necessarily speak to how they’re currently pricing, but if I can have a platform that is scalable, meaning I’m paying per customer or I pay for this dollar amount and if I’m now processing 100,000 versus 200,000, it’s now this dollar amount that to me is more predictable scalability on price. And I prefer that because I can grow and I can grow the impact of the product without having a reciprocal fee. My fee essentially gets lower per customer as I grow versus a consumption model. I’m just paying per dollar collected. And so the more I put on there, the higher my bill is going to get. Totally fair, not unreasonable. But I’d prefer to pay less as.
Chanie Gluck: Long as they’re product. Absolutely. Jeff, what are your thoughts about pricing?
Jeff Robertson: Yeah, it comes up a lot from our clients and so I always try to remind them that the patients are using a credit card. The doctors don’t have a lot of control or any control over which credit card the patients are using. So the patients are using a high point benefit card. It’s going to cost the doctor more. If they’re using a debit card, it’s going to cost them less. They don’t have much control over that unless they just tell their patients which cards they can use and which ones they can’t. So what my understanding with Raxia, would just tax on a small 1% fee on top of their. Whatever their merchant processing is. So. And that’s it. And so what happens is, you know, I have to remind them that you’re going to collect a lot more money, you’re going to pay a small fee for each payment, but you’re going to bring in way more money. At least that’s what we found with all of our clients. And, and so, you know, I try to have to kind of walk them through not getting caught up so much in just an extra processing fee. because you’re really, you’re going to give up 20, $30 to save a dollar. And I have to have that conversation quite a bit.
John Gwin: I think that’s a really, really good point too because the other option of not using like a plugin is a lot of these
00:20:00
John Gwin: PMs are starting to develop their own like native good enough solution. And I, I just don’t think they compare, with all due respect, like that they maybe have the ability to you press send statements and if it has a cell phone number, it’s going to kick a text, but then they have to log into the portal, pay there and they’re trying to basically capture that revenue for themselves as a PM by charging their own payment facilitation fees. so as long as the payment’s posting back in, the practice doesn’t have to touch it or you don’t have to touch it. That extra 10, 20, 100 basis points is well worth the efficiency and well worth the additional revenue you’re going to collect. So just be cautious about getting caught captive with the, solution the PM has. And Bill Flash was, like you mentioned earlier, kind of the previous, the clearinghouses were doing it. Now the PMs are kind of trying to do it and none of them are anywhere near the plugins that are solid in the industry. I don’t think.
Jeff Robertson: I totally agree. Yeah, okay.
Chanie Gluck: Yeah, well, so could we just talk about, different systems that are doing it that you guys have tried. Do you want to share like, who, who did it and because I think people are wondering that. I think that’s the thing. Should I go with a PM System Plugin vs using Raxia or Inbox Health? I remember Bill Flash days. I mean, I definitely remember those days.
Jeff Robertson: Yeah, I mean I, we, I haven’t tried anybody else with regards to AI. I’ve tried everybody prior to AI, sort of the legacy systems. But, you know, I, I still, I don’t have RAXIA in every client, although I would love to. I don’t, I have EPIC clients and I can’t get them into epic. So I got to use pos. And so I was like, I’m, you know, turn my watch back. I’m going back 10 years to how I used to do this. So. But, you know, I have to deal with what I have and what, what we have control over. We just can’t right now. So I, I can’t speak to any other vendors in terms of their AI capabilities and what they’re doing because we’ve just sort of gone all in on Racks, and once we saw the results, we just did that. I agree with John completely. I don’t. The clearinghouses, the PM systems trying to do this stuff. No, yeah, they’re trying to get into everything. Like, you know, like they’re trying to get into RC<. They just don’t do it well.
Chanie Gluck: Right. I. Yes. go ahead.
John Gwin: I would say, like Collectly Flywheel Med Pilot, which is now vitalized Patient pay promptly. We’ve talked about Raxia and Inbox Health well, pay, I think is out of business, but they were out there. And then Health IPASS is another one. You’re going to get different flavors of similar products, I think, across the board. Not that they’re all the same, but again, looking at why you care about the product, does it integrate? What’s the cost? Is it effective? You can kind of evaluate the vendors from there, but there’s a ton of them out there, and that’s not even an exhaustive list.
Chanie Gluck: Right.
Jeff Robertson: We just touched on that real quick, John. So I did speak with Collectly the, other day, and, you know, some of them are better at certain features. So, Raxia, I think, is really strong in their AI in terms of helping to profile and target the text and email. where I think Collectly was doing a good job, was they have a chatbot. So they’re, you know, these, these platforms are introducing chatbots. And how advanced or knowledgeable is that chatbot? In other words, what percentage of those calls or resolution rate can that chat bot do now? and as we all know, this will get better. Right? And. But they’re. They’re getting like 80% resolution through their chatbot. And the chatbot is pulling from the pm, so it’s pulling that patient’s sort of, you know, claim responsibility and having that kind of educated conversation with a patient. So. So that’s good. but, yeah, so. And then the IVR stuff too. Again, some, like the ICR. You know, I don’t know that that’s there. The outreach and calling patients. Nobody answers from, an automated call. You know, no one’s gonna answer this. I’m not, you know, I’m not waiting for that too much. But, but the chat and the, the chat’s A good thing. And the, and the text and email.
John Gwin: That luckily feels like a pretty enterprise solution. Like I come across that when we have a group that’s maybe backed by PE or has multi state, multi location, that seems to be the market segment they’re in. I think. I think Raxia and Inbox are both Bilco SMB mid market and, and thus a better fit for us at least.
Chanie Gluck: Right. I, encourage you to put your questions in the Q and A bot in a Q and a bot in the Q and A chat. and we’ll try to get to all the questions. but somebody asked how’s Raxia’s chatbot? And do they have one?
Jeff Robertson: So they just launched it. We were, I think one of the beta testers. We’ve been working with it. it’s been great. But it’s also my. So I have staff outside my door here, that take this phone calls. Right. And my staff’s all bilingual and so they have to be able to take all those patient phone calls. But they can get on there and chat with the patient too
through Raxia. So they can actually chat directly and pull up the stuff. as far as like a completely automated chatbot
00:25:00
Jeff Robertson: that’s not there yet. I think they’re in the early stages of that. but we all know how quickly, these are growing and the functionality is growing. So, I expect that’ll come along and get better. But we have the ability to chat with patients and my staff’s been doing it and it’s been great.
John Gwin: We just launched the chatbot with racks as well. I think it is early stage based on the timeline I understand they have. I think it’ll be a totally different platform and that much more functional in like 90 days. As quick as that. Not to over promise for them, but Inbox Health on the other end has a chatbot that’s been around for a while. And then thinking about chatbots, there’s Voice ivr, which is like an AI actual like fake human talking on the phone, which we can talk about later. Then there’s like the actual like chat function. and then Inbox Health does have their own solutions for picking up the phone. So if you don’t have the resources internally to have people handle that chat bot and actually talk back, they’ve got a BPO solution where they’ve got staff that will do that. We’ve seen it be pretty successful on our end. I also really don’t love having customer service outside of my house. So although they do a good job. I still don’t love it because I want to keep that on our end. but I think it’s going to head towards. Both of them will probably head towards an unattended bot where it’s literally pulling historical notes, pulling the ledger, pulling the call history, pulling whatever data you can give them, and having it interact with the customer without human intervention. And I think what we all have to be really sensitive to is what’s our level of customer service expectation, what’s our client’s level, and do I even want that much AI in front of the customer at the end of the day for certain things. So I just suggest keeping an eye on deflection rate and CSAT, as Jeff had talked about earlier.
Chanie Gluck: Right. That’s really great advice. I mean, it’s really good, things to think about because. Right. How much AI does a patient want and are the younger patients more open to it and more used to that? but these are very, very interesting times we’re living in where the tech is coming. You somehow got to embrace it. And as a patient, just thinking through those touch points. Okay, I want to get into how to deal with patients who don’t pay their bill. we have a slide, that, Jeff, you want to talk about this?
Jeff Robertson: Yeah, there you go. okay. Yeah, and I’m glad you brought that up, because this is. We can’t ignore the responsibility of the patients. And we’re talking about AI and patient billing and how effective these solutions are. But at the end of that cadence, you’ve texted them, you’ve emailed paper, all these things, and the patient is just not responding, they’re not paying, and they have an obligation, responsibility under the terms of their payer, the plan that they chose. They are responsive to that balance. So what happens is that the doctors in clinics are very afraid of having upset patients going out either to Google or Yelp or to the papers. but so it often gets ignored and those balances get ignored. And it’s a really, it’s a huge problem because there’s time limits on this stuff. And so if you look here at this graph, like, you know, what do you do? The patient owes you money? What do you do you, know, do you ignore it? Do you write it off? Do you send them to collections? Do you have your staff call the patient? So what we always tell our clients is, okay, you know, at the end of that cadence, we’ve given that patient numerous opportunities to pay, and they’ve chosen not to. We have three options at this point. Number one, and it’s, it’s our client’s money, it’s their choice. We say, do you want to write it off? Do you want to make a call to those patients? Because this, they have, you know, relationship with some of those patients, or do you want to put them in collections? But you got to do one of the three. You can’t just leave it sitting there in ar. So the way collections break down, and these are sort of the rough guidelines and they break down by state, but there’s different time limits on this. So the first there, the first bullet is, you know, the clinic has three years to go after that balance and then it can’t litigate. Not that doctors are going to sue a patient for $100 balance, they’re just not. But they, after three years, they don’t have any option. Six years and 10 months, they can no longer even put them in collections. and we’re probably all familiar with under one year, $500, you can’t, you know, you can’t even report it to the credit agencies. There’s a new legislation that’s, that’s going into effect July 1st and the doctors will have to have this. Is California, by the way, specific? And what will happen is other states might adopt this later, But California, after July 1, if the physician doesn’t have an agreement with the patient, quoting or you know, discussing or agreeing to the new terms.
00:30:00
Jeff Robertson: you can’t even send the balance to, you can’t even collect on the balance for dates of service after July 1st. So it’s getting much, much harder to collect on patients. But sometimes the only option you have is, is a letter from a collection agency and it may or may not end up on the credit report and it may or may not affect their score. Likely it won’t. But the patients have, you know, it’s another step to kind of get their attention and get them to pay. But once patients learn and the consumers learn that there is no real recourse, to paying because it’s not going to affect their credit score and may not even land on their credit report, there’s no incentive to pay. So all of this, all these things that we’re talking about of, ah, you know, outreach and using AI is to get the patient to meet their obligation. And, and then at the end of that cadence, we’ve got to get them to collections, a patient centered and patient focused collection agency where that’s all they do. it has to be part of the equation. It just has to because we’re never going to get these patients to pay if we don’t.
Chanie Gluck: Right. Okay, so talk to us about collection agencies and then AI within these collection agencies.
Jeff Robertson: Yeah, so, so like, like Raxia is doing where they’re saying, okay, this patient responds better to a text on Friday than Tuesdays. The collection agencies and the third party vendors that they use are also helping to kind of build out that patient profile or that likelihood to pay, with much a wider range of payment history and all the databases that they have access to. So they’re trying to target those patients and get them to meet their obligation in a way that they’ll respond to. So you’re seeing that come into the collection world as well as the patient outreach. Like the racks in the inbox.
Chanie Gluck: Yeah, pros and cons. I know we could talk about many doctors, and John, I’m sure you’re familiar with this a lot don’t want to send their bills to collections. Right. What do you guys think is a proper process for and at what point, like so walk us through when you know, at what point does it stop with a billing company?
John Gwin: I, I mean on my end we really try to avoid collections. Not that collections agencies are bad or unsuccessful. It’s just our customers because they’re in aesthetics. It may be that 10, 20% of the revenue is even running through insurance and the rest is a breast dog or a laser service or whatever that may be. And so we really try to just avoid collections in the first place because our customers are so scared to send because of that one Google review that drives away the $10,000 cosmetic surgery.
Chanie Gluck: Right.
John Gwin: The two solutions we have outside of a patient RCM solution that’s solid are hard on file, which both Raxia and a MOX Health and other solutions will have a PCI compliant vault. PCI compliance is just like don’t write your credit card down on a spreadsheet and leave it in your Google Drive, basically.
Jeff Robertson: Good point.
John Gwin: Or you know, a lot of the PM systems, especially if they have their own payfac or they are their own processor, they’ll have vaults there as well. And then the next step from that is potentially having an office policy that we’re going to try to send you statements for X amount of time. It’s arbitrary, it’s subjective and if we don’t hear from you, we’re going to charge your card on file. And if your card on file doesn’t run, you can’t book with us again unless, you know, extenuating circumstances, unless you provide an updated card.
Chanie Gluck: Right.
John Gwin: That last step is hard to bite off. Like I don’t even know if, as a consumer if I would sign that. But I am seeing practices do it and I think it’s their right to protect their bottom line at the end of the day because these are not, it’s their services they’re offering.
Jeff Robertson: Yeah, yeah, I just want to touch on that. That’s a great point. John and I. For, for maybe higher dollar visits, you know, surgeries, all this stuff they’re, they’re getting, they’re not going to be chasing a patient after that. They got to get that up front. It’s just too much money at stake.
Chanie Gluck: Right.
Jeff Robertson: Same as urgent cares. If you go to urgent care, you can’t make it into. I know I seem like my daughters are in urgent care every other weekend, but you have to get a credit card up front. Right. They’re not going to go chasing. You think specialists, sub, specialists, urgent care have done a good job of getting that credit card on file. The message that I’ve been preaching is to all the primary care and everybody else in between is you have to have that, you have to get credit card. Because the days of chasing patients, even like with the solutions like we’re talking about and we’re seeing the success that we have, you’re still going to have 40%, 30%, sometimes 70% of patients that aren’t going to pay. And so you just can’t afford to ignore that. So credit card, you know, John makes a great point. Credit card on file. Get the email, get the text, get all that stuff. You have to do all this stuff up front and avoid chasing.
Chanie Gluck: Yeah. So that brings us into a question by Erica. Erica says most of our clients are now requiring credit card on fly off for most
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Chanie Gluck: patients that we auto charge twice a month. This has increased patient collections considerably and we’ve then found that adding something like inbox health is not really adding any more value. Do you have any thoughts on that?
John Gwin: If they’re doing it so well that inbox health or actually doesn’t help, more power to you. I don’t think having it there hurts because typically again you’re going to pay on a consumption model or on a low platform fee with consumption model. So it’s, it’s still a good customer centric way to address those patients. It’s really just about where you draw the line on how much effort you want to put in. Because if you are you have that policy, you are pre collecting then they know when their card is bad and they know that they’re not paying the bill. So do you really want to put the effort in after that? I think practices probably want to but at the end of the day that’s subjective.
Jeff Robertson: Yeah, I mean we would all love to have that. You know I wish we didn’t need a racy in an inbox health or any of them. We wish that there was just a credit card on file and that’s. And once you know Freesia, you know, I don’t know if you remember if you guys work with freezer was sort of, you know, back in the day we were really hopeful that you know every patient’s a credit card on file. As soon as you move it to patient responsibility hits the, the card. It never was, it never was a reality, it never happened. So we would love for that to happen. But what happens is the, the doctor or the management tells the girls up front at the front desk to get it. But the compliance and the follow through is just not ever there. Sometimes it is, but I wish it was. And so if she’s having success doing that, wonderful, because that would be great. But you’re still going to have, then you get some people who will dispute the charges and you get some of that. But, but that’s, that’s sort of edge case and one offs. But, but you need to have both, you know, credit card on file and then a solution to outreach.
Chanie Gluck: Okay. So we’ve covered a few important things that the front desk should do to increase the collection rate. Get the cell phone number, get the email address, get the credit card. Anything else that the front desk can do to increase your success rate in collecting patient balances.
John Gwin: I think in surgical there’s another option but it is going to be more specific there. But if you’re pre authorizing services, I would strongly recommend having somebody also run a benefit estimate. it’s just math. You can do an electronic call for eligibility, then you crunch the numbers. But then you can come to that pre op appointment or to that, you know that, that consultation and say, hey, we know what you’re going to do. This is what your balance is probably going to look like. We wanted to make sure there wasn’t sticker shock on the back end. And also it happens to be our office policy that we collect 50% upfront or whatever that looks like. But you’re now arming the patient with information and helping them instead of shaking them down on the back end. Or shaking them down up front.
Chanie Gluck: That’s great. Really, really good advice.
Jeff Robertson: I just, I’d like to add, you know, one of the things that we try to do is, is to teach and mentor those front desk staff and, and how to have those conversations with patients. And if, in the way you phrase it would be, you know, according to the plan that you chose, your responsibility that your payer or your plan details is that you will be responsible for this deductible, you’ll be responsible for this much. So how much would you like to pay? They are, the doctor’s office are completely compliant with their payer agreements to get that money up front of the estimated allowable if they have not met their deductible. So, you know, sometimes they feel like, I, I don’t know, you know, the patients can say, well, don’t. It’s okay, just build my insurance. Yes, we will. But at the end of that, you’re still going to owe $180. How would you like to pay that? And so try to change that conversation and say, you know, get it up front. But it’s, it’s difficult. That’s the, you know, this is probably an issue for a different webinar, but the biggest challenge we face is front desk intake, registration problems. And so getting money upfront, verifying eligibility, benefits, prior offs, all that stuff is, is the biggest challenge we face.
Chanie Gluck: Okay, well, these are, these are good conversations to at least bring it to the forefront of what we should be doing with our clients. We have another question for you guys. So we talked about, let’s say you have the patient credit card on file and you get an EOB and there’s a $60 copay. What’s the process that you run or you think is a good practice? Do you just run the card? Do you send an email? Do you send a text? Like, how do you notify the patient about this? Or do you.
Jeff Robertson: That’s patient. That’s actually, that’s inbox. They’re getting texts and emails for their balance. They missed a copay. You know, if it’s a problem, we can, we report on it and we can report back to the client and say, hey, you got an issue up front. The girls are not collecting the copays and here’s the data behind it. You know, the last three months they’ve, you know, they have missed 20 opportunities to collect a co-pay. And by the way, here’s the staff member who checked them in. And so it’s just trying to educate and train. because what Happens is the conversations go like this. You know, doctor says to me,
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eff Robertson: I know, Jeff. I tell them all the time. And then I got to go. I got a patient. You know, they’re not. They’re watching those girls up front. They don’t know what is missed unless we report back. And so we try to do that. Was that. You know, even. Even the end of cadence report. We go back to the client. Like I was saying earlier, it’s like, okay, Doc, how do you want to handle this? Do you want to put them in collections? Do you want to write them off? And. And, you know, for collections, you have to be licensed in most states for collections. So. So we don’t. We don’t call patients if they owe the doctor a hundred dollars. My staff is not calling those patients because now I’m searching in collections and I’m collecting thing. I’m doing outreach, and I’m not licensed in certain states to do that or any state. So we put it back to the client and have them call those patients, maybe, put them on a payment plan or whatever. So.
Chanie Gluck: Okay, but my question is, if you have the credit card information on file in your system and you’re able to run the card, then you can run the card. You just run it. Okay.
John Gwin: Policy, too. Like, you should have that in your financial agreement form. The patient has to be. If. If your claim is processed, whether or not you have a statement, once the EOB is issued, we will run 15 business days or five or whatever that is. I think that’s a practice decision at the end of the day and how aggressive they want to be. But to Jeff’s point, too, if you. If. If you’re not running card on file, or if the card fails and they hit that cadence, then it drops to the collections report, and again, it’s back to practice to say, you know, I’m going to write this off, or I’m going to send it to a collections agency that is licensed. and if they. I would also strongly recommend people don’t let them get away without answering that question, because that’s the email that disappears most often for us. And I don’t polluting patient AR, where it’s just dead money sitting there, because we’re actually not making a decision on what to do with it.
Chanie Gluck: Right, Right. Yeah, exactly. okay. Great conversation. I just want to remind everybody, there’s a number of questions. The Q and A chat is filling up. so if you have any questions for Jeff or John, please, drop them in the Q and A chat. I will continue to, keep this conversation going. we just got a message from one of our attendees that said we first email and text the statement. Then 24 hours later, we charge the credit card that’s on file and then email them a receipt. If the patient has questions, we then have an email address. They could address the questions, too. And that email box is monitored by our staff, and we make sure that our clients have this process listed in their credit card auth form when they have the patient sign it and explain it to them. Okay, great.
John Gwin: Yeah.
Jeff Robertson: Like I said, as long as you have that agreement with the patient, they’re not getting surprised. If they understand that that’s what’s going to happen here is if they owe a balance and they don’t respond or they don’t dispute, then it hits their card and they’re in agreement. Great.
Chanie Gluck: So let’s talk about empowering the front desk to collect. Right. because we all know billing companies, we really rely a lot. Do you have any numbers or do you have an idea? I always say this, but I have. I don’t have any strong data to support what I’m saying. When the patient’s in front of you, your ability to collect is what I mean, what percentage do you would you say if they’re standing in front of you versus when they leave your office? How does that percentage change.
Jeff Robertson: Scientifically? Better.
Jeff Robertson: Better. It’s definitely better. I don’t know the number, but it’s definitely better.
Chanie Gluck: Great.
John Gwin: I think you’re. You ostensibly can collect 100 if you know what the balance is and you have it in your system. Right. And I, I think that this communication, coaching, it’s not, did you know you have a balance? It’s, hey, we see you have a balance. And how would you like to make that payment today? You’re not telling them they have to pay, but you’re insinuating that the payment needs to be made. yes, and I think it’ll fall back to that. Even if you have a racks here, inbox Health or whatever vendor, it’s going to fall back to that. Potentially as bad as 40% collections if you don’t get it when they’re in front of you. But it’s bird in hand at the end of the day.
Chanie Gluck: Yeah, absolutely.
Jeff Robertson: Yeah. I have scripts, actually, that, you’ve gone to some seminars and conferences, and they have. The topic was just that is like, how do you have that conversation? And so we have scripts that we can share. but I Mean, just the rough idea is that this is your balance. How would you like to pay? And then stop you just. How would you like to pay? Today we take Visa, MasterCard, do a check and then just be quiet and let them respond. And so we, we try to do that too. We try to help where we can and train on that stuff. But it’s, it’s uncomfortable, you know, and that’s the thing. A lot, a lot of the, a lot of the front staff, they don’t want to have that conversation. They’re not comfortable with it. They don’t like to ask for money.
Chanie Gluck: Yeah.
Jeff Robertson: And so it’s, it’s, it’s a culture shift of the practice of that is the expectation of this practice is that these
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Jeff Robertson: patients have to meet their responsibilities.
Chanie Gluck: Yeah.
John Gwin: Gamified a little bit too. It’s, it would. If you offer to buy whoever collects the most, co pays once a month, buy them lunch, get them a car wash, whatever, that’s a, you know, fifty hundred dollars gift card essentially that’s five copays like you. And you can track this stuff in the system by running payments by user, by copay. so I think you can make it less of a burden and more of all an opportunity for the staff as well.
Chanie Gluck: That’s a great idea. I love gamification and any way you can make it fun and interesting and incentivize people, I think, I think that really does work, in many areas. Okay, here’s another question. We bill for hospital based physicians and are handcuffed by the information they obtain and transfer to us. Any suggestions on this? Our largest client is using epic.
John Gwin: I have a product we really like for that. If you’re looking for demo and insurance info, there’s a product out there called Frontrunner Health that’s essentially an eligibility check engine, but I absolutely love it. We buy it independently, use it internally. They can find demo based on name, date of birth, social or scattered data points there. And then they’ve also got a really nice insurance discovery tool where if I get bad insurance info or the hospital puts it under Medicare, but It’s like an MRP policy for AmTrust or some random payer but they have the insurance company listed wrong. It’ll actually call out to like 20 different payers and rip back the insurance info. So that’s been killer for us. And then they also have a credit check program which we don’t leverage, but ostensibly you could extend credit or understand how likely someone is to pay based on a, you know, credit number.
Chanie Gluck: Okay. Front runner.
Jeff Robertson: Well, yeah, yeah. So I have a different experience, John, with that. So, yeah, so what happened was with us, we were, you know, back to the front desk piece which ties into it is that, you know, we get so many registration errors and denials based on registration. So what we, what we started to do is we said, okay, rather than counting on these clinics to get better up front. And we were training and you and I talked this ani before, but we would train and train and train and train and we just weren’t getting results at some clinics. Some clinics are great, but we couldn’t train our way out of it. So we said, okay, let’s do this, let’s swim upstream, let’s pull the schedule from like two days in advance. Let’s pull that schedule, send it off to front runner P verify. We tried two or three different ones that, that do eligibility check. So then we would, we would, our goal was to
say, hey client, Friday morning you have 20 patients coming in. These three don’t have active insurance. So just so you know, when they come in, try and get it beforehand, try. Because we’re finding it’s not eligible. So we were doing that and we were reporting back to clients and we would say these five would say we’re not eligible and they would come back and they go, no, three of them are eligible. We checked the payer portal and we’re like, okay. So we were getting all kinds of false positives and false negatives and so we, we kept shifting and trying these different solutions, frontrunner being one of them. We just weren’t getting good quality information. So the client stopped trusting the information we were giving them because it wasn’t always accurate. So then I went back to the vendors and I said, what’s going on? Well, the change Healthcare Cyber incident, after that they kind of shut off reporting to a lot of these third party. And so the, the, the quality of the, of the data wasn’t very good. So we were hoping that was going to solve the problem. And by the way, those are regionally. You know, regionally they’re better in certain regions and by payer they’ll get good results and other payers, they just don’t. So that solution could work for some payers in some regions and it could be great. But the insurance discovery tool, you know, basically the patient gave you blue shield, but blue shield is not finding that patient. So insurance discovery, it’ll say, but we found them over here at Blueprint across and so that helps, but we just weren’t getting Consistent, reliable information. And so the clients stopped trusting it. But I would love for that. And, and that’s also is kind of where the AI like the Raxia they’re going to start. I think Collectly is doing it as well. They’re starting to move upstream as well and they’re going to start to look at the schedule. rather than just doing outreach is do eligibility and benefit verification which is where I think a lot of them are headed, which would be wonderful provided it’s accurate and we can trust the results. But, but if you’re getting great results John, that’s, that’s, that’s great. I, you know I dumped them about a year ago just because I just, I wasn’t getting good results. But yeah.
Chanie Gluck: Okay. I have another question here. We’re currently using our EHR to send text email statements but their automated cycle doesn’t work for us as anesthesia providers patient often forget we are by the time often forget who we are by the time they get our bill separate from the surgery center. Can you speak to the customization of text and email verbiage for these statement notices? Many don’t want to sign off for a third party site for a portal that they will use once.
John Gwin: I mean it’s
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John Gwin: essentially dunning messages. Right. To some extent and then some customized text like I think you can, you can do that on most of these plugin platforms. I don’t. Every PM is going to be different so I don’t want to speak to necessarily any specific one. But typically you’ll find that you can put messaging in there. Messaging surrounding remember who I am. I guess I, I don’t know that I would put that in the dunning message portion of a statement or where I would put that in the messaging on a text or an email. It’s a, it’s kind of a hard conversation to have over asynchronous communication. But I, I think RACS and Inbox can both provide customization on text over the course of time.
Chanie Gluck: Okay, so Jamie said she meant RAXIA or Inbox. Okay, good. Jamie, I hope this answered your question.
John Gwin: but too because you don’t want to get into customizing per customer. I don’t think you don’t want to have a different workflow, a different text, a different cadence per customer because that’s gonna be impossible to manage long term as a billing company.
Chanie Gluck: Interesting because and I trust the vendors.
Jeff Robertson: Here too that the vendors have you know, not only the metrics for my clients but everybody’s clients and they can See what works and what doesn’t. I would not, I would go with a third party in this situation. Even if you’re doing one off patients like that, you’re still going to be chasing that patient, you know, through a number of outreach, you know, a number of attempts. So yeah, I would use third party.
Chanie Gluck: Yeah. Okay, great. Okay, anyone else have any questions, please drop in the Q and A. guys, anything else you want to share that we may not have covered in the last few minutes here? Do you think we’ve covered it all?
Jeff Robertson: I just think you’ll see, an increase in functionality. You’re going to see these are platforms and they’re going to grow. As AI grows and the capabilities grow, I think
they’re going to be more agentic, they’re going to start to do more for us. They’re going to move upstream into eligibility and schedule. They’re going to, you know, be able to take phone calls and chat bots and be really intelligent chatbots and you know, basically hope, you know, reduce the amount of phone calls that, that, that you know, flow over which is, which is our, our hope. But yeah, I think that’s what you’ll see. You’ll see increased functionality.
Chanie Gluck: Okay, what are you excited about, John, about the future of AI in this space?
John Gwin: I mean, I would agree. I think the functionality is going to grow. It will be the, the agentic chatbots. It’ll be potentially voice agents. I do think there’s an opportunity to explore voice agents directly. It’s a super, super crowded space in RCM right now. I feel like there’s a new like voice bot popping up every single week, but success with a few of them actually building our own customer service agents. Although I think both inbox and racks are going to be there pretty soon, if not already to some extent. I just like the idea again of kind of controlling that specific experience. But you know, you don’t have to have a AI bot pickup during the day, but have it after hours. That’s a value add. Have it be able to take a payment when the phones are off.
Chanie Gluck: Okay, give us a little sliver of. If I wanted to start my own chop, where would I start on the, to answer patients, inquiries?
John Gwin: there are, I got a ton of platforms and a lot of them are focused on different use cases. I’ve found a lot of them want to work on like the ar, you know, no response calling functionality, but prosper AI, super dial, outbound, AI Luna. Bill, I can pull up my little list because there’s more than that.
Chanie Gluck: This is what we do, by the way, every month we talk about the latest tech, and bring it to you guys. So John and I have these conversations, on a weekly basis now. Okay. Awesome, guys. This was so helpful. You guys are amazing. Such a wealth of information. We just touched on one side sliver of the cycle, which is the patient billing. But there is just so much more to discuss. So I hope, we’ll do more of these. I have a poll here, which we will launch a little survey. you’ll see the, webinar feedback survey should be on your screen. Please share your feedback on how you like this, what you didn’t like. and, what guests do you want to see next? I’m going to. And you should see a get QR code that you can hit as well. Paul, do I have to pull up this QR code? Okay. thank you, everybody. it was amazing at how many people joined. I’m just blown away. So big thank you to Paul and Piper for pulling this off. We just show up. But they do. They did a fantastic job in running this webinar. So thank you, Paul and Piper and everybody else. Have a beautiful rest of the day. please share your feedback. the webinar survey feedback. We will continue to bring valuable, news to you. We also are launching an RCM tech forum substack, which I hope you will all subscribe and look out for that. And again, John and Jeff, thank you so much!