Episode Overview

Podcast: Becker’s Healthcare Podcast
Host: Madeline Ashley
Guest: Tom Buckley, Senior Vice President of Revenue Cycle and Managed Care, Virtua Health
Date: November 29, 2025
Episode Focus:
This episode dives into the evolving landscape of the healthcare revenue cycle, payer-provider dynamics, the role of AI and digital tools, and strategies for engaging and resilient finance teams. Tom Buckley--drawing on 37 years at Virtua Health--offers insights into persistent industry challenges, tactical responses to payer tactics, technology adoption, and leadership evolution.

Key Discussion Points & Insights

1. Tom Buckley’s Background & Virtua Health’s Scope

[00:22]

• Tom Buckley oversees patient accounting, access teams, managed care contracting, revenue integrity, and cash collections at Virtua Health—a $3.5B South Jersey health system offering acute care, home care, hospice, and ambulatory services.
• Buckley has served Virtua for 37 years, witnessing immense industry evolution.

2. Leading Revenue Cycle Challenges

[01:39 – 05:49]

Payer Denials and “Payer Shenanigans”

• Denials Complexity: Issues commonly revolve around disagreements on DRG assignments and physician visit coding downgrades, both leading to reduced payment and complex appeal processes.
  • Quote: "We use the phrase here at Virtua, payer shenanigans..." – Tom Buckley [01:45]
• Communication Challenges: Payers may send denials to disparate departments, complicating appeals.
• Vendors & Appeals: Vendor partners often exceed allowable appeals, creating additional administrative hurdles.
• Financial Responsibility Shift: Rising patient out-of-pocket costs make collections harder and require clear communication and assistance tools.
• Support Programs: Use of financial assistance (e.g., ClearBalance, AblePay) and online tools to help patients estimate out-of-pocket costs.

3. Digital Transformation: AI & Robotic Process Automation

[06:14 – 08:33]

Combating Payer Tactics

• AI in Status Determinations: New AI-driven tools assist physicians in discerning inpatient versus observation case status under tight timelines.
  • Quote: "We've tried to add tools to our physician community to help them identify what is indeed an inpatient case versus an observation case." – Tom Buckley [06:29]
• Robotic Processing for Claim Status: Automated bots check claim progress, freeing staff from tedious payer follow-ups and improving efficiency.
  • Quote: "We've added tools where we can let bots, in essence, go in and do that work for us." – Tom Buckley [07:41]

4. Keeping Finance & Revenue Teams Resilient and Engaged

[08:53 – 11:11]

Engagement and Motivation Tactics

• Transparent Leadership: Virtua’s CFO shares organizational strategies and revenue allocations (like new patient towers) directly with teams to foster purpose and alignment.
  • Quote: "...Bob Sagan, he just came to our respective teams and gave everybody...an insight into the strategy that Virtua has." – Tom Buckley [09:02]
• Frequent Communication: Monthly staff meetings, goal-setting, and linking cash collections or patient satisfaction goals directly to staff contributions.
• Clear Value Chain: "I understand what my cash goal is every month. And more importantly, I understand where that money is going within the organization." – Tom Buckley [09:33]

5. Evolving Leadership Roles in Revenue Cycle

[11:41 – 13:11]

From Billing to Customer Experience

• Expanded Scope: The role now prioritizes not only revenue integrity and claims but also patient communication and satisfaction.
• Focus on Patient Experience: Ensuring patients aren’t lost or frustrated in the insurance, coverage, and billing maze--as this can affect overall satisfaction.
  • Quote: "The thing that we don't want to hear...is that somebody came in and he had a great clinical experience, but they didn't have a great billing experience too..." – Tom Buckley [12:38]

6. Workforce Management in a Post-COVID Era

[13:11 – 15:07]

Hybrid Work, Training, and Competition

• Hybrid Staffing: While remote work is more common post-COVID, Virtua emphasizes in-person collaboration, citing it as a factor in being ranked #1 in national Epic HB revenue cycle performance for three years running.
  • Quote: "I think one of our secret sauces...is the fact that we do have our team coming in..." – Tom Buckley [14:01]
• Recruitment Challenges: A hot market for Epic-proficient staff in the South Jersey/Philly area intensifies competition and the need for engagement.

Timestamps for Key Segments

• [00:22] Introduction to Tom Buckley and Virtua Health
• [01:39] Revenue cycle and payer denial challenges
• [05:49] AI, automation, and digital tools in revenue cycle management
• [08:53] Strategies for team engagement and resilience
• [11:41] Changing responsibilities of a revenue cycle leader
• [13:11] Workforce management, hybrid work, and the impact on staff quality

Memorable Quotes

• "We use the phrase here at Virtua, payer shenanigans..."
  – Tom Buckley, on the complexities and tactics of payers [01:45]

• "We've tried to add tools to our physician community to help them identify what is indeed an inpatient case versus an observation case."
  – Tom Buckley, on deploying AI decision aids [06:29]

• "We've added tools where we can let bots, in essence, go in and do that work for us."
  – Tom Buckley, on robotic process automation for claims [07:41]

• "I understand what my cash goal is every month. And more importantly, I understand where that money is going within the organization."
  – Tom Buckley, on team alignment and motivation [09:33]

• "The thing that we don't want to hear...is that somebody came in and he had a great clinical experience, but they didn't have a great billing experience too..."
  – Tom Buckley, on the importance of the patient financial experience [12:38]

• "I think one of our secret sauces...is the fact that we do have our team coming in..."
  – Tom Buckley, on fostering engagement through in-person collaboration [14:01]

Summary

This episode offers a deep, candid view into revenue cycle leadership at a major health system. Tom Buckley details persistent payer tactics, ongoing digital transformation, and the importance of transparent, purposeful leadership. Virtua’s focus on both technological and human engagement has positioned them at the national forefront of revenue cycle operations, resonating with industry peers navigating similar complexities.