Driving Financial Resilience with Smarter Documentation and Integrated Strategies

Summary

Becker’s Healthcare Podcast: Driving Financial Resilience with Smarter Documentation and Integrated Strategies

Release Date: July 15, 2025

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Introduction

In the July 15, 2025 episode of the Becker’s Healthcare Podcast, host Erica Spicer Mason delves into the critical topic of financial resilience within healthcare organizations. The episode, titled "Driving Financial Resilience with Smarter Documentation and Integrated Strategies," features an insightful conversation with Dr. Geralyn Morrissey, Chief Medical Officer at Koro Health. Dr. Morrissey brings a wealth of experience from both clinical practice and the financial aspects of healthcare, offering listeners a comprehensive perspective on bridging operational efficiencies and financial stability.

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Guest Background and Koro Health Overview

[00:00] Erica Spicer Mason introduces Dr. Geralyn Morrissey, highlighting her dual expertise as a primary care physician and a professional immersed in revenue cycle management. Dr. Morrissey explains her role at Koro Health, emphasizing the company’s mission to assist healthcare organizations in navigating the complex dynamics between payers and providers. She underscores the importance of customization in solutions, acknowledging that each provider has unique goals and opportunities.

“We recognize that every provider partner has different goals and different opportunities, and customization is absolutely key.”
— Dr. Geralyn Morrissey [00:41]

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Revenue Assurance Gaps and Revenue Leakage

Dr. Morrissey addresses the pervasive issue of revenue leakage in hospitals and health systems, which encompasses uncollected, underpaid, and denied payments. She points out that:

“Hospitals and health systems lose billions of dollars annually. We lose it to uncollected, underpaid, and denied payments.”
— Dr. Geralyn Morrissey [02:23]

The conversation identifies inefficiencies in billing, coding, and operational processes as primary culprits. Dr. Morrissey emphasizes that minor losses at a transactional level accumulate, significantly impacting an organization's financial health. She advocates for a strategic vantage point in addressing these issues rather than a purely transactional approach.

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The Role of Documentation in the Revenue Cycle

A pivotal segment of the discussion revolves around the indispensable role of clinical documentation in the revenue cycle. Dr. Morrissey passionately describes documentation as the backbone of financial resilience:

“Documentation has become the workhorse of the revenue cycle.”
— Dr. Geralyn Morrissey [05:12]

She traces the evolution from traditional paper records to Electronic Medical Records (EMRs), highlighting their intended benefits such as enhanced data accessibility and reduced medical errors. However, she points out that meticulous documentation is essential not only for clinical purposes but also for accurate billing and coding, regulatory compliance, and data analysis.

“The EMR was supposed to provide healthcare providers with the ability to easily access and share patient information, which would lead to better care coordination, more accurate diagnoses and reduced medical errors.”
— Dr. Geralyn Morrissey [05:30]

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AI and Generative AI in Documentation and Revenue Resilience

Transitioning to technology's role, Dr. Morrissey discusses the impact of Artificial Intelligence (AI) and Generative AI in enhancing documentation and financial outcomes. She acknowledges the current skepticism surrounding AI’s practical applications in healthcare due to overpromised results from previous automation and analytics projects.

“Leaders of health systems have grown skeptical of opportunities for tech-enabled performance improvement because they've had years of automation and analytics projects that have not generated the expected or promised value.”
— Dr. Geralyn Morrissey [08:48]

Dr. Morrissey outlines criteria for distinguishing impactful AI innovations:

1. Problem-Specific Solutions: Technologies must address specific, prioritized issues within the organization.
2. Reduction of Administrative Burden: AI should streamline resource-intensive processes without replacing essential human input.

She advocates for agile and customizable AI solutions that support organizational change, emphasizing the need for collaboration across departments to maximize the benefits of technology.

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Integrated Strategies and Collaboration

A significant portion of the podcast focuses on integrated strategies involving various departments such as Utilization Management (UM), Clinical Documentation Integrity (CDI), and denial management teams. Dr. Morrissey highlights the necessity of a cohesive approach to tackle rising payer denials effectively.

“Appeals success requires coordination of multiple departments like UM, CDI, coding, documentation, denials to be aligned in both strategy and approach in real time.”
— Dr. Geralyn Morrissey [12:31]

She cites the CMS 4208 rule as an example where integrated strategies can hold Medicare Advantage organizations accountable, stressing that a unified approach is crucial for maximizing reimbursement and reducing revenue losses.

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Future Outlook and Final Thoughts

In her concluding remarks, Dr. Morrissey offers a forward-looking perspective on the challenges and opportunities ahead for healthcare executives. She emphasizes the importance of:

• Embracing Change: Adapting to evolving reimbursement paradigms and regulatory landscapes.
• Selective Technology Adoption: Cutting through the noise of AI buzzwords to implement technologies that offer tangible benefits.
• Collaboration and Creativity: Working collectively with technology partners, payers, and internal teams to enhance care delivery and financial outcomes.

“We need to embrace change and new technologies. And we need to do that with creativity and collaboration.”
— Dr. Geralyn Morrissey [16:45]

Dr. Morrissey concludes with an optimistic note on being constructively destructive, advocating for meaningful transformation rather than reactive measures in the healthcare paradigm.

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Conclusion

This episode of the Becker’s Healthcare Podcast offers a deep dive into the intricacies of financial resilience in healthcare through smarter documentation and integrated strategies. Dr. Geralyn Morrissey’s expert insights shed light on the critical areas of revenue leakage, the pivotal role of documentation, and the strategic implementation of AI and integrated departmental approaches. Her optimistic outlook encourages healthcare executives to navigate the complexities of the industry with innovation, collaboration, and a focus on sustainable financial practices.

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For more insightful discussions, visit Becker's Healthcare Podcast.

Transcript

[Erica Spicer Mason]

Hello, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning in to the Becker's Healthcare podcast series. Today we're going to talk about driving financial resilience through smarter clinical and operational alignment. And joining me for this important discussion is Dr. Geralyn Morrissey, the Chief Medical Officer at Koro Health. Dr. Morrissey, welcome to the podcast. Thank you so much for joining us today.

[Dr. Geralyn Morrissey]

Hi, Erica. Thanks for having me. Happy to be here.

[Erica Spicer Mason]

Well, we're so happy to have you with us. And before we get into our questions, I wanted to see if you'd like to share just a little bit more about yourself, Choro Health. Whatever you think would be helpful for listeners to know as we dive into this discussion.

[Dr. Geralyn Morrissey]

Oh, fantastic. Yep. So, as you said, I'm the Chief medical officer at ChoroHealth. I was a and am a primary care physician by training, and after several years in practice, entered into the revenue cycle. And in that role, I have sat as the provider, the patient, the representative from the payer, and now the representative of the hospital and providers. And as far as Koro goes, we are focused on helping healthcare organizations of all sizes navigate the very complex relationship between payers and providers. We want to facilitate smoother operations and effective revenue cycle management through our comprehensive suite of technologies and analytics. And we recognize that every provider partner has different goals and different opportunities, and customization is absolutely key.

[Erica Spicer Mason]

Such great notes, Dr. Morrissey. Thank you so much for telling us a bit more about Coro Health and yourself. It's so fascinating that you have this dual experience in the finance part of healthcare and also the clinical space. I'm sure that gives you so much fantastic perspective for your role and for everything that you're doing in healthcare. But bringing this back to kind of this theme of financial resilience, I want you to talk to our listeners about revenue assurance gaps. So can you tell our listeners a bit more about what revenue assurance gaps are and what perhaps overlooked contributors to this issue is? We'd love to know how hospitals can also address those more proactively.

[Dr. Geralyn Morrissey]

Yeah, you know, I'm sure most people listening to this podcast right now know that hospitals and health systems lose billions of dollars annually. We lose it to uncollected, underpaid, and denied payments. And that's revenue leakage. That revenue leakage commonly occurs due to inefficiencies in billing, coding and our operational processes. And I think one of the most overlooked aspects of it is that these losses often seem minor on a case by case or transactional basis, but they accumulate over time and significantly impact the financial stability of an organization. So one of the biggest gaps that hospitals and health systems face is getting the operators, the folks who do the work, the folks whose expertise we lean on to evaluate new solutions, approaches or technologies, and getting those folks to look at those losses from a strategic vantage point instead of that typical transactional approach or that day to day activity. Now, the most common or major occurrence causing the gap in any one hospital or health system can be entirely different in another hospital or health system, just depending on where they are in their revenue cycle journey. Hence why I lean into the importance of that customization aspect of solutions. But that being said, most hospitals will point to inaccurate or incomplete documentation as the primary contributor or the root cause of their revenue leakage. And this in turn leads to billing and coding errors. Billing and coding errors lead to denied or underpaid claims. And at this point in time, in mid-2025, simply working harder or throwing more resources at this cascade of events is just not going to be enough anymore to close the gap. And that's where technology and automation can really jump in and help an organization to become proactive in addressing that revenue leakage instead of reactive.

[Erica Spicer Mason]

Yeah, Dr. Morrissey, really appreciate the explanation and appreciate too how you've connected this issue to documentation. So for, for listeners who are with us today, Dr. Morrissey recently was on a webinar that Beckers and Coral Health hosted on documentation. And Dr. Morrissey, I remember in that conversation you mentioned that clinical documentation is quote, unquote, the workhorse of the revenue cycle. So can you unpack that a little bit and take us a little bit further in this direction?

[Dr. Geralyn Morrissey]

Absolutely. I think that's becoming my catchphrase, to be honest. So did you know, Erica, that medical records have existed since the beginning of the practice of medicine dating as far back as the 5th century BC with Hippocrates?

[Erica Spicer Mason]

I did not know that.

[Dr. Geralyn Morrissey]

Such a great fact. Yeah. This is not a new concept. Now the modern medical record was developed in the 20th century and it was where clinical data was documented and organized into a standard format and stored. And honestly, that's what I grew up with as a clinician. The paper charts, the flip chart, the color coded pages told you what you were documenting and where to look for various things. But the biggest problem with the traditional paper record was that it had limited ability to be shared across facilities. It had poor searchability, and to be honest, information could often be lost in all of that paper documentation. That scenario and the evolution of technologies and the Evolution of medicine set the absolute perfect stage for the development and institution of the electronic medical record, or emr, which really came into its own complements of the High Tech act and President Obama in 2009. Now, the EMR was supposed to provide healthcare providers with the ability to easily access and share patient information, which would lead to better care coordination, more accurate diagnoses and reduced medical errors. That was the goal of the emr. But with the EMR also came the expectation of meticulous patient documentation that would allow for everything we hoped and dreamed of, that would allow for disease coding and billing, regulatory compliance, prevention of medication errors, clinical pathway utilization, optimized workflows, Medica legal defensibility, interoperability, portability, and most importantly, data data for the compilation, for analysis. And all of that comes from and starts with that meticulous patient documentation. Hence my phrase that documentation has become the workhorse of the revenue cycle. And to quote Henry David Thoreau, men have become the tools of their tools, or in this example, clinical documentation has become the tool of the tool.

[Erica Spicer Mason]

What fantastic storytelling, Dr. Morrissey. I really appreciate that. And putting this all into context, documentation really is at the heart of so many clinical workflows, revenue cycle workflows, really the health of organizations in general, and then of course, patient outcomes too. Again, appreciate you putting that into perspective for us. I know at the heart of this conversation on documentation and revenue is technology, which you've mentioned multiple times as well. So I'd be remiss if I didn't get your thoughts here on kind of where you see AI and generative AI playing a role in improving documentation and revenue resilience. And you know, maybe if you have any thoughts on distinguishing between hype and truly impactful innovation with these tools, would love to hear your take on that too.

[Dr. Geralyn Morrissey]

Yeah, so if you go to any conference in the industry right now and you walk the exhibit flow floor, just about everybody's going to have a banner up or a product that touts AI or gen AI. And so I absolutely agree with your sentiment that they've become buzzwords in healthcare. And I think everybody recognizes that right now. And to be honest, leaders of health systems have grown skeptical of opportunities for tech enabled performance improvement because they've had years of automation and analytics projects that have not generated the expected or promised value. So when it comes to identifying a truly impactful innovation, in my mind it has two key features. First, it should solve a problem of specific interest and priority to the organization considering it. And second, it should lessen that health system's dependence on resource intensive administrative processes. I know that we all worry that AI and Genai is going to come and replace the humans. I don't worry about that so much. I don't lose sleep about that. If we implement it correctly and we look for the right solutions, they should help with administrative processes that don't require the human input in the first place. That doesn't mean we let them run wild without human input somewhere along the line. But we focus them on those tasks that are redundant and administrative. Now, the most of the value from effective technology implementations comes from applying them to areas of opportunity. But identifying those opportunities requires of the shopper, if you will, the open ended assessment looking for maximal impact and redesign of the affected processes. So you really have to be open minded and willing to embrace across your organization change to make them successful. And the new technologies that are successful are able to refine and customize solutions in an agile way, in a quick way. They allow teams to head off in a direction after doing their due diligence and then fail fast and pivot quickly if needed. And the technology needs to support them in that, not lock them into ongoing persistent failure. So successful technologies tend to feature or require partnerships across the organization, not just in one team or one department.

[Erica Spicer Mason]

Such great points here, Dr. Morrissey, and I think ones that are probably going to resonate with a lot of folks listening in. Across Becker's conferences and other conversations that I've had with healthcare leaders lately, there really seems to be this widespread focus on ensuring that the new and shiny AI tools are not embraced just because they're new and exciting, but that they are solving a specific problem. So your note about that really highlighted how that's come up as such a theme lately. I know that as you were talking about implementing technology, you mentioned this concept of partnerships and collaboration. And so I kind of want to take our discussion in that direction for just a moment. What does an integrated strategy in your mind look like between utilization management departments, clinical documentation, integrity denials, teams, you know, what does that look like in practice? And why does it matter so much right now?

[Dr. Geralyn Morrissey]

Yeah, so you know, I have been talking about an integrated, what I'd call, um, CDI and denial strategy for what feels like a long time now. And I'm super excited because as I'm out there, you know, at conferences or talking to folks in the industry, I'm really seeing that concept starting to gain traction. We're moving away from those point solutions more into those integrated solutions. And I think technology is helping us along that path. What I'm not super excited about though is the very sobering picture that the data paints regarding the escalating crisis around payer denials. And we've been talking about that as well for a couple of years now. Data across the board demonstrates an absolutely staggering increase in denials over the last five years. And the absolute tragedy in that is that a significant portion of those denials go completely unaddressed, or if they are addressed, it's with a one size fits all kind of approach and not a lot of thought or strategy behind it. Now why does that happen? Well, it's because we're already stretched so thin with staffing shortages and shrinking margins that we just simply lack the time, money and resources to thoroughly dispute every rejected claim out there. As a result, a strategic workflow optimization and denial prioritization approach is really probably more important in this conversation than it has ever been. And appeals success requires coordination of multiple departments like UM cdi, coding, documentation, denials to be aligned in both strategy and approach in real time, not after the fact, but proactively to increase overturn rates and ultimately secure fair and compliant reimbursement. So we need all departments to approach individual cases with a common strategic goal and visibility into what everybody else who's touching that case is seeing at the same time. And I know I'm kind of long winded here, but I'll give you a quick example specifically related to Medicare Advantage. CMS 4208 came out this year. It's the Part C, Part D final rule. And in it CMS clarified that for Medicare Advantage organizations that if the Medicare Advantage organization approved the furnishing of a covered item or service through like a pre author prior authorization process, a coverage or payment determination, it may not then later come back and deny based on a lack of medical necessity and they may not reopen that decision for any reason except for good cause and too long to get into the definitions of good cause, but they're pretty finite. So if you don't have an integrated UM CDI appeal strategy, you will miss golden opportunities to hold Medicare Advantage organizations accountable to this very agile and very appropriate regulatory requirement.

[Erica Spicer Mason]

That's such an important call out. Dr. Morrissey, I appreciate you sharing that with our audience and it's so interesting to hear about, you know, the, the multi pronged benefits of the UM CDI denials approach that you've outlined. So I, I hopefully our listeners have been taking notes, but again I appreciate you sharing that and I, I know that we're winding down on our time together. So I want to make sure that we get some of your final thoughts on what's ahead. So as you think about the next 12 to 24 months out and you think about what healthcare executives are thinking about and strategizing on for that time, what do you think they should be reconsidering or really pondering when it comes to their clinical revenue assurance strategy? What would you advise?

[Dr. Geralyn Morrissey]

Well, I would advise we all get crystal balls because this is a really difficult time to predict anything. What I say now could be completely different by five o' clock tonight, just based on the changing landscape that we live in. But I do think that we can all agree that the healthcare industry is on the brink of some transformative challenges and changes in reimbursement paradigms. And, you know, just the numerous regulatory changes and policy updates just help keep that all a little extra spicy for us. You can either look at this as a very exciting time to be in healthcare or a very terrifying time to be in healthcare. I choose to look at it as a very exciting time. The impending challenges related just to Medicaid alone would be enough to warrant intense revenue integrity, attention and focus from healthcare executives probably for the next two to three years. But we don't have that luxury. We can't focus just on one aspect of the quicksand that's below our feet. So I think the other thing that healthcare executives are struggling with is they're absolutely being bombarded right now with endless pitches and emails and cold calls for new platforms and point solutions and high cost technology as the solution for all of their revenue cycle issues. And I think as they weed through that and they eliminate the noise to find their path. They have to stay focused on the pressing issues for their unique facility, which will be different from facility to facility. But we are going to have to, as an industry, embrace change and new technologies. And we need to do that with creativity and collaboration. That's collaboration with technology partners, that's collaboration with payers, that's collaboration within our teams, within the hospitals. Overall, our collective goal with all of this impending change should be that we strive to be constructively destructive in the healthcare paradigm as opposed to being destructively destructive as we enter the next era.

[Erica Spicer Mason]

What fantastic thoughts to end our session on together. Dr. Morrissey, I really appreciate your optimism and this focus on collaboration and what the industry can do with technology partners, with one another with payers, to just make care delivery better and to see greater organizational outcomes. It's been such an insightful conversation. I can't thank you enough for the time today.

[Dr. Geralyn Morrissey]

Oh, I can't. Thank you, Erica. It's always a pleasure, and I appreciate joining you today.

[Erica Spicer Mason]

Yeah, it's been great having you, Dr. Morrissey. And of course, we'd also like to thank our podcast sponsor for today, KORO Health listeners, be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast [e-mail].