← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Erin Hodson, MSN, Vice President of Revenue Cycle at Inova Health
00:19:45
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- [00:02]
A
@ Athenahealth, we know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom Practicing medicine is complex, but running a practice can be that much simpler. With Athenahealth, see how simpler is healthier@athenahealth.com.
- [00:44]
B
This is Alan Condon, back with another episode of the Becker CFO and Revenue Cycle Podcast. And today I'm delighted to be joined by Aaron Hudson, who's a vice President of Revenue Cycle at Inova Health, headquartered in Northern Virginia and also serves the Washington, D.C. metropolitan area. Aaron, a real pleasure to have you on the podcast with us today. For those of our listeners who might be as familiar with the work that you do at Inova, do you mind giving us a little bit more insight into your background and your role at the health system?
- [01:16]
C
Yes, absolutely, and thank you for having me. I am over the entirety of the revenue cycle, front, middle and back and I've been in my role since August of 2024 so not that long. Actually was an operational leader at Inova. I've been in an executive role here for about 15 or so years. I'm from the area and I have learned so much. I have to tell you over the last almost year and a half it's been really exciting, fantastic.
- [01:53]
B
So obviously in the front, the middle, the back of the revenue cycle. Like you said, I think revenue cycle always been so, so critical to hospitals, the health systems across the board. Is it fair to data has been more to the forefront of health systems operations and how they get paid in recent years. But with that in mind, what are two or three of the key trends that you're paying most attention to today in healthcare or in the revenue cycle and why?
- [02:22]
C
Yes, there are many trends that we're following quite closely. Three that I'd name. Number one, I would tell you the number of the amount of intelligent tools that we literally didn't have a couple of months ago that we either have today or will have in the coming months is pretty, pretty phenomenal. At the end of the day I envision that we will be able to, on a more granular level be able to predict denials better than we ever have before and not only Predict them, but also prevent them in ways that we haven't before. So I think that's incredibly exciting. The next trend, I would tell you, are the development of AI agents to actually manage denials, because we all know denials will just continue as much as you try to prevent them. Yes, you'll be able to prevent some. I think we'll be in a much better position to work with our payers and escalate where we're seeing trends in our AR on a much more granular level than we have in the past. And you have to be able, however, to manage what's coming at you at a faster pace. There's just no doubt about that. So the development of these AI agents, I think we're just at the forefront and it's really exciting to see that come to fruition. We're at the beginning stages here at inova, but I am cautiously optimistic regarding what that will do for us in the coming year. And I would say the third trend is really the changing dynamic of our team and the skill sets that we didn't need a year ago are changing. Right. And I think the complement of the team is changing and it's exciting to see I should, you know, bulbs go off in people's heads, a level of critical thinking that we didn't, that we didn't see before, people expanding into new roles that didn't exist a year ago. So that's really exciting and I look forward to seeing continue to see all of our leaders and frontline team members excel and their journeys within revenue cycle.
- [04:49]
B
Fantastic. So if I'm getting you right, changing dynamics of your team, certainly in the revenue cycle. So, so top of mind for leaders like yourself, like you mentioned, skill set changing new roles, AI agents as well, which you touched on, and kind of the excitement around being able to better predict, possibly better prevent denials. I'd love to follow up and just kind of hear maybe one bit deeper on that. Aaron, I think the new tools that you had mentioned, in terms of the ones that have come on board in the last few months, the ones that are coming down the pipeline for anova, do you mind kind of diving a little bit deeper into that? What specific tools are you referencing? Are these kind of AI based tools or automated tools and kind of how you see them being able to better protect your financial performance, like you said, in terms of those denials?
- [05:39]
C
Yeah, I'm happy to expand on that. I think I've seen new partners, potential technology, data science partners emerge over the last six months that I don't think many of us had ever heard of before. And even speaking to my fellow peers out there, other VPs of revenue cycle throughout the country, I think to go a little bit more deeper on that we have a, we have a hard time as every revenue cycle team does with CARC and code mapping, remittance code mapping to understand how one payer is using a denial code for you know, just for ease of language versus what another payer is doing or the granularity of what they're what's coming back at you. And I think through the ability to have those Karp and work code mappings prepare I think is going to open us up to a world of information that we didn't have before. Also these data science partners that can help you chain your 837 claim data that's going out to your 835 denials coming back and really provide insights I would say down to a 10 foot level of what's happening. Is it because of an internal process, something that you're not following correctly and you're, you know you're getting hit with a denial but that denial is not specific enough that you don't know why you're getting denied and you might send for example the medical record then get denied again. Maybe there's something more specific within the medical record that the payer wants to then eventually you're paid to where in the future I envision a world where we don't have to go through that guessing game which delays payment at the end of the day. So that's what's very exciting. I do think the new tools that we'll have access to are going to require a different level of thinking and working on our level. How do we manage claims in bulk, how do we work with our payer and payers in a new way that we haven't in the past. So that's what I would just going deep in that topic.
- [08:03]
B
And does that tie directly into the other trend that you'd mentioned in terms of these new tools are coming on board requires a certain new skill set like you'd mentioned new level of critical thinking and potentially these new roles linked to these new tools? I imagine yes.
- [08:19]
C
I think it's so there's a new technical aspect of revenue cycle that existed before but I think really understanding the intricacies of I would say like going under the hood. How does a claim get get out the door from from the beginning of the revenue cycle to the end we have to understand on a much more granular level in order to prevent those denials and even work those denials and I think the complement of how front, middle and back end team members work will be very different in the future. I can't predict exactly what that'll look like, but I already see it happening today in terms of where we're standing up new governance structures, for example, denials, prevention. We put within our revenue integrity space, which I've asked other, you know, revenue cycle leaders. Where, where do you put that compliment in terms of function? And, and some people put that within analytics, within their team. We have analysts that work directly with our revenue integrity denials prevention team. So that's an example of where the function of the team and new roles that didn't exist even a year ago now exists.
- [09:37]
B
Yeah, no, a fascinating insight and I think even to your point where we see how deep, how widespread AI has penetrated not just revenue cycle, but healthcare more broadly over the last 12, 18 months or so, certainly exciting to see what's going to come down the pipeline in the next 1218 months. But last follow up question here before we jump to our next question. Specifically around that we know that payers, their size and their scale, they have been using these AI tools for quite some time now. It seems like we're at a point now where providers are potentially playing a little bit of catch up and kind of developing their own tools or AI agents like you'd mentioned. How do you see if you're paying devil's advocate a little bit in terms of prediction? How do you see this almost AI arms race playing out in the future? When we think about payers and providers and this revenue cycle kind of push, pull dynamic over the next few years.
- [10:33]
C
I mean, that is, I think about that a lot, to be quite honest with you. I would love to. We need a book club between all of, I feel like the big players in the space. Talk through what we predict in the future. I'd use a good sports analogy. If you have a basketball, you know, team is successful and they're really good on defense and let's say the pair has a really strong offensive strategy and you eventually figure out, you know, by the end of the game they're key players on offense and you figure out their key plays and defensively you're willing to, you win that game. Right? But the next game comes around and they have the new superstars in town that you didn't even know that, that they had access to. Right. And people that can shoot point point guards like Caitlyn Clark over and over and over and how are you going to defend against that? And that's similar. I don't know if that's the best analogy, but that's how I think about it in my head about what does it look like. My hope is if I'm being optimistic not to be too Pollyanna about this, but we eventually will come to a place with payers where we're spinning each other's wheels. Right. How do you get to the point where you're creating just as much admin burden on their end. Right. As is created on our end? How do you get to the point where you can put clauses in our contract that limit denials, that limit the what we call our revenue capture, some people call it contract yield percentage? How do you get to that point? And I think we have to go through this exercise. We have to have the tool sets that the payers have had to your point for quite some time and we've played catch up to even have those discussions with them because they will come up with new plays. Right. That we'll have to constantly evolve into from a defensive standpoint.
- [12:39]
B
Yeah, I think the basketball analogy works really well there and a lot of my editorial colleagues from Iowa appreciate, I'm sure, the Caitlin Clark analogy too. But I mean it's fascinating to kind of get your perspective there and it seems like to your point, everyone's getting better at offense, everyone's getting better at defense. What does inevitably happen in this kind of zero sum game as we kind of advance down the line and tools become more technical roles expand? Aaron, we've talked a little bit about this already in terms of kind of tools, mechanisms that you're excited about. But I guess is there anything else that you'd like to highlight whether in the revenue cycle or maybe in over more broadly, anything that you're particularly excited about?
- [13:18]
C
Well, I think the use of AI agents, I touched on that from a denials management standpoint is very interesting. And it again just to go back to how our team will change. I mean it will it be and I actually heard at the last Beckers conference that I attended, one of the panelists said this very well. So I can't take credit. He said the future will be leaders managing process right through AI agents rather. And I'm not going to say we're not going to manage people. I think we will have, we'll utilize people in a whole different mechanism with a whole different skill set that we are teaching our teams today. But it will be, it's going to be interesting. It also the whole Concept of team members working with a co pilot AI agent to help them expedite their work or expedite the, you know, or improve the accuracy of their work is very interesting. I think on a claims perspective, if you think about working in a work queue, we'll be, we'll be managed. I look forward to the day where we can manage most of our claims in bulk versus on a claim by claim level. I just think it will expedite the whole process at the end of the day and hopefully get to the point where were paid much faster and much more accurately.
- [14:42]
B
Yeah, I love that example. In terms of future leaders managing processes like you said through AI agents and what potentially might else come down the line. Aaron, when you look ahead 2026 for Anova, for yourself as VP Revenue Cycle, how are you thinking about growth? Obviously we've touched on quite a few areas here, expanded new roles, but I'd love to kind of hear one bit more. Anything else you'd love to highlight there?
- [15:07]
C
Yeah, sure. We due to a lot of changes coming down the pipe with the big beautiful bill and being in Virginia, which we did expand Medicaid and that will be we'll see a hit with that certainly towards the end of next year and coming in 2027, we are thinking about roles in a new way in terms of financial counseling, front end capacity and what is the white glove service that we're offering our patients in a different way for them to understand not just Medicaid changes and where we need to, you know, handhold patients, to be quite honest with you, in a different way than we've done in the past, but also differences in patients liability outside of Medicaid. Right. High deductible plans that are changing, premiums that are changing. How do you help a patient through Medicare Advantage versus straight Medicare decisions as those policies within Medicare Advantage plans are constantly changing. So I think from a from a patient financial experience perspective, that's where I see the roles changing and from a growth standpoint and how we're going to connect with patients in a different way.
- [16:34]
B
Yeah and I guess it's such a arguably one of the most complex, arguably most challenging reimbursement landscapes that we've seen in quite some time for the patients, for the providers, no doubt. So much up in the air when we think about ACA subsidies and whatnot as well. How is Zinova thinking about that specifically in terms of how that affects patients in 2026? Granted, still so much up in the air at the time of recording, we may have a vote on HCA subsidies in December. But I guess how hard is it to have somewhat of a proactive plan in place for leaders like yourself when so much is indeed up in the air that will affect health systems like yourselves, patients? Any kind of level of detail on how you're thinking about that from a leadership level?
- [17:22]
C
Yeah, I mean that. That's a great question that every health system should be asking itself, given the immediate challenges we're going to have as of January 1st with patients and families that are dependent upon receiving their health care on the exchange and whether or not they decide to continue and pay the huge increases in premiums or go without health care. We're thinking about that in a way of how do we educate our patients as fast as possible when they do show up at our doors without health insurance? If they do decide to go in that direction, what can we offer from our own financial assistance policy? How can we assure that if they are eligible for Medicaid, we're quickly able to qualify them? And what does this look like in the future as it pertains to bad debt? We have very, very low bad debt. So we're looking at that in a new way of how do we work with patients on a different level, not only connecting regarding their bill, explanation of bills in a different way. Do we or don't we offer discounts for prompt pay, et cetera? We don't today, but we're constantly re evaluating that as I'm sure every health system is out there.
- [18:46]
B
Yeah, I think Aaron, what a pleasure to have you on the podcast. I mean, great level of insight at the work that you that your team is doing at Inova Health. So greatly appreciate you hopping on and look forward to catching up with you again down the line. Thank you so much.
- [18:59]
C
Well, thank you for having me.
- [19:03]
A
At athenahealth. We know your ambulatory practice wants healthier a healthier business, healthier care teams and healthier patients. But the complexities of modern healthcare tech make it hard for you and your care teams to focus on what matters most. That's where athenahealth can help our AI native all in one solutions reduce administrative burdens, streamline billing and payments, and deliver critical insights when clinicians need it most. That means fewer clicks, more time for patients, and stronger bottom lines. Practicing medicine is complex, but running a practice can be that much simpler with Athenahealth. See how simpler is healthier@athenahealth.com.