Podcast
PayerWatch
Hosted by Payerwatch · EN
PayerWatch is the nation’s leading provider of payer denial, audit, and appeal solutions. Our Veracity platform powers your clinical revenue cycle with the most comprehensive denial and audit solutions. We combine services, education, consulting, and Veracity to reduce denial and audit risks, streamline appeals, and decrease denial write-offs.
10episodes
Episodes
Newest firstAll episodes
From Denial to Access: Rethinking Oncology Care Through AI, Clinical Trials, and Patient-Centered Innovation
Apr 200:35:44Tap to summarizeThe rapid expansion of precision medicine, biologics, and targeted cancer therapies is transforming oncology—but it’s also overwhelming a system not built to keep pace. In the U.S., cancer drugs now account for some of the highest-cost treatments in healthcare, and with that has come a surge in prior authorization requirements and denials. Studies suggest physicians spend nearly two business days per week on administrative tasks like authorizations, contributing significantly to burnout and delayed care.So how can clinicians ensure patients receive timely, life-saving treatments in a system increasingly shaped by cost controls and automation? And more importantly—can AI become part of the solution rather than just a tool for denials?On this episode of PayerWatch, host Brian McGraw is joined by Dr. Arturo Loaiza-Bonilla, Co-Founder and Chief Medical AI Officer of Massive Bio, and Dr. Kendall Smith, Chief Medical Officer and Chief Physician Advisor at PayerWatch, for a conversation about oncology denials, prior authorization burden, and the emerging role of AI in appeals and access. Together, they examine how payer decision-making affects cancer patients, why clinical trialsPay are often overlooked in denial workflows, and how human oversight must remain central as AI becomes more common on both sides of the claims equation.Key Takeaways from the episode:Oncology denials are uniquely high stakes. Expensive biologics, chemo regimens, and precision therapies are often subject to heavier scrutiny, creating delays that can worsen outcomes and increase financial toxicity for patients.AI can help, but only with human oversight. The guests discuss how AI can support appeals, clinical trial matching, and documentation, while warning that hallucinated citations and unchecked outputs can undermine care decisions.Clinical trials should be considered earlier, not later. Instead of treating trials as a last resort or administrative complication, the episode argues they should be more proactively presented as care options that may reduce costs and expand access.Dr. Arturo Loaiza-Bonilla is a practicing medical oncologist and hematologist, as well as the Co-Founder and Chief Medical AI Officer of Massive Bio. He has spent years working at the intersection of oncology, patient access, and artificial intelligence, helping develop AI-driven tools that connect patients to clinical trials and treatment options. In the episode, he also references his leadership role in a large hematology-oncology network and his long-standing interest in applying data science and computational tools to real-world cancer care.Dr. Kendall Smith serves as Chief Medical Officer and Chief Physician Advisor at PayerWatch, where he brings deep expertise in chemotherapy and biologic denials, appeals strategy, and payer-provider disputes. His contributions to the episode focus on the practical realities of appeal workflows, the risks and opportunities of AI-assisted case preparation, and the importance of maintaining a human-in-the-loop approach when patient lives are on the line.
Transcribe →Turning Denial Data Into Action: How Healthcare Organizations Can Fight Back Against Payer Denials
Mar 600:24:57Tap to summarizeHealthcare providers across the U.S. are facing a growing wave of claim denials that is putting pressure on already strained hospital finances. Industry research from the American Hospital Association shows that nearly 15% of medical claims submitted to private payers are initially denied, forcing hospitals and health systems to spend about $19.7 billion annually attempting to overturn those denials through appeals and administrative processes. As payer rules grow more complex and denial rates climb, denial management is no longer just a revenue cycle task—it has become a strategic priority affecting operations, staffing, and even patient outcomes.But collecting denial data is only the first step. The real challenge is turning that information into meaningful improvements. How can healthcare organizations transform denial data into actionable insights that reduce denials, improve documentation, and ultimately protect both revenue and patient care?On this episode of PayerWatch, host Brian McGraw sits down with Reggie Allen, Chief Clinical/Business Operations at PayerWatch, and Dr. Kendall Smith, Chief Medical Officer and Chief Physician Advisor at PayerWatch, to unpack how organizations can use denial analytics to identify root causes, challenge payer behavior, and drive meaningful operational change. Their conversation explores the intersection of clinical documentation, payer accountability, and data integrity in modern healthcare revenue cycle management.Key topics discussed in this episode include:Why actionable denial data matters: How granular analytics can reveal root causes, from payer behavior to internal workflow gaps, allowing organizations to move from denial management to denial prevention.Holding payers accountable: Strategies for responding to questionable payer practices, including documenting approvals, citing regulations, and escalating disputes when necessary.Connecting denials to patient care: How revenue loss from denied claims can affect staffing, hospital resources, and ultimately the quality of care delivered to patients.Reggie Allen, RN, serves as Chief Clinical/Business Operations at PayerWatch. A nationally recognized expert in clinical denials and appeals, Allen brings decades of experience helping healthcare organizations overturn denials and develop proactive strategies to prevent them. His work focuses on leveraging denial analytics, operational insight, and regulatory knowledge to improve both revenue cycle performance and clinical documentation processes.Dr. Kendall Smith is the Chief Medical Officer and Chief Physician Advisor at PayerWatch. A hospitalist by training, Dr. Smith has extensive experience in utilization review, clinical documentation improvement (CDI), and payer dispute resolution. Throughout his career, he has worked closely with health systems to translate clinical data into operational improvements and advocate for fair payer practices.
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Power Hour: Why I Started PayerWatch: The Story of Michael
Feb 400:04:23Tap to summarizeNo description available
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Power Hour: ERISA Plans, Employer Risk, and the Real Denial Problem
Feb 400:01:44Tap to summarizeNo description available
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Power Hour: 850 Million Denials: The Hidden Epidemic in Healthcare
Feb 400:00:24Tap to summarizeNo description available
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Power Hour: Healthcare Denials Are Personal—And We’re Here to Fight Back
Feb 400:00:32Tap to summarizeNo description available
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Power Hour: Even Healthcare Execs Need Help Navigating Denials
Feb 400:01:19Tap to summarizeNo description available
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Power Hour: Fighting for Anna: The Real Battle Behind Healthcare Denials
Feb 400:01:51Tap to summarizeNo description available
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Power Hour: The Fatal Cost of Insurance Denials
Feb 400:01:24Tap to summarizeNo description available
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Power Hour: Who’s Joining the Deny This! Podcast?
Feb 400:01:38Tap to summarizeNo description available
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