Glenn Krauss – Creator and Founder, Core-CDI
and Co-Founder, Top Gun Audit School
Glenn is a revenue cycle management professional with extensive experience in all facets of the revenue cycle. His expertise and experience lie in ICD-10 & CPT coding, focusing upon the role of medical record clinical documentation in the charge capture, reimbursement, quality & outcomes studies, & medical necessity establishment process.
In this interview, Glenn talks to me about his experience in starting two companies, his vision for the industry, and his passion for providing quality care through careful documentation.
Starting Out in the RCM Domain
Glenn recalls entering the industry in 1993 with a business degree from Hofstra. He decided to go into the Health Information Management arena and began volunteering at a hospital in Atlanta.
He went to an RHIA (Registered Health Information Administrator) Program in Seattle and his first job at the program was as a coder trainee in Little Rock, Arkansas. Since then Glenn has consistently moved up the food chain in the revenue cycle. He was a coder by trade but discovered his passion for working with physicians back in 1996, and he has been in revenue cycle management ever since.
‘Documentation integrity is the fundamental of the revenue cycle. Without documentation, there is no communication of patient care, there is no establishment of medical necessity, there is no coding, there is no billing, there is no revenue. The revenue is truly predicated upon documentation.’
Glenn has been in the CDI space since 1994 and his interest in starting his firm began after a contract assignment in Southwest at a large teaching hospital where he served as a CDI manager. He was charged with resurrecting a failed program by the CFO and COO. After that assignment was over, Glenn moved back to Vermont decided to start his consultancy firm.
‘I always wanted to start my own consultancy and promote what I am convinced to be the most logical way of CDI.’
Talking about signing up his first account, Glenn recalls being in New Jersey in 2018 where he worked through another company. The owner of the company retired and the business came to a stop at which time they reached out to Glenn and requested him and his physician Dr. Martin, to produce some educational materials, webinars, and podcasts. This was Glenn’s first foray that paved the path for his CDI business.
‘They recognized my skill sets and trusted me. That was my first client and I still talk to them. They serve as a great reference and resource.’
Current Business Structure and Organization
Glenn started both his firms Top Gun Audit School and Core-CDI in 2017. He recalls thinking at the time that CDI programs or the industry was not going in the right direction and people were on the wrong track.
During that time, he connected with Ernie de los Santos at a conference, who shared his vision of the revenue cycle and CDI as well as the overall fundamentals of the revenue cycle. They brainstormed ideas to reach critical masses without competing with any other associations in the CDI space and came up with the idea of Top Gun Audit School. The firm is a non-profit with a mission to change the outlook of CDI.
Talking about his company’s biggest clients, Glenn mentions a health system in California that has about 20 federal qualified health centers and a level I trauma academic medical center with over 250 residents working with a couple of his company’s physician colleagues, one is Dr. Martin and one is a hospitalist who is also a physician advisor.
Additionally, the company has worked on the outpatient with the residents, and now they are working with the residents in the inpatient setting to help improve their understanding, appreciation, and ability to capture their communication of patient care. This is because residents must be prepared for the business side of medicine, so when they graduate or go on for their fellowship and then start to have to bill on their own, they are ready to go.
Presently, Glenn has about four physicians and three CDI professionals working for him. As a firm, their focus is on good customer service and delivering a stellar service line
‘We do not want to grow to the extent that we lose track. When you get too big, you do not have that personal touch anymore.’
Standout Moments As a Business Leader
Glenn recalls receiving a website message recently from someone in the revenue cycle VP from a big health system enquiring if Glenn’s company did CDI assessments. He and his colleague of 24 years, Dr Jacob Martin, scheduled a call with company’s VP and were pleasantly surprised with the conversation.
According to Glenn, he felt they finally found a revenue cycle professional who understands the real fundamentals of the revenue cycle from a standpoint of documentation. Additionally, he had realized that his program was not reaching its potential because they were going down the wrong track and focusing on just diagnosis and not actual real meaningful measurable improvement in the communication of patient care.
This was a big moment for Glenn. Further, the VP mentioned that he reached out to Glenn based on his ideas and vision shared through the website, podcast, LinkedIn blogs and Top Gun presentations.
‘It was nice to see someone going in the right direction, taking the initiative to find out where they are and where they should and most importantly taking some points or recommendations and putting them to good use.’
Glenn states that a lot of times after an assessment or consulting engagement, they follow up with recommendations and ideas to hone in, on the opportunities and the strengths and the weaknesses for the client organization to move forward but often the report goes nowhere.
Talking about company achievements, Glenn has many things to be proud of but at the top of his list is seeing people comment on his LinkedIn post and articles, signing up for webinars and podcasts, and providing feedback as to what they have taken away from each article.
Overcoming Significant Challenges
For Glenn, getting a business off the ground successfully, particularly in the face of the pandemic has been a huge achievement. He states that most facilities are focusing on addressing the high acuity level of patients and the financial challenges, particularly with fewer surgeries scheduled and many postponed, people are not coming to the ED.
Higher acuity patients hospitalized with increased cost to treat, labor cost, travelling nurses and still being able to reach out to organizations and help them and convince them that with the pandemic it is even more important to get paid and strengthen their CDI program was an accomplishment in itself, as well as being able to continue engagement and dialogue with revenue cycle professionals and CDI leaders even in the face of the pandemic.
Business Plans For the Future
Glenn says that they want to stay nimble with a focus on growing their outpatient CDI service line. There is a lot of interest and discussion on the blogs about outpatient CDI, and a lot of companies developing software.
However, he and Dr. Martin are concerned that in industry and revenue cycle professionals, VPs in revenue cycle or revenue cycle directors and CDI leadership, there is a tendency to go down the wrong path and try to emulate what the profession focused upon and continue to focus upon the inpatient setting, that is focusing upon HCCs which is outpatient equivalent to CCs and MCCs.
Glenn and his team are developing a marketing campaign to educate providers and revenue cycle decision-makers on what is outpatient CDI to avoid wrong decisions later.
Talking about marketing methods that have helped him grow the company till now, Glenn credits name recognition, respect in the industry, referrals from some of his colleagues and some marketing campaigns through LinkedIn, e-mails and other forms.
‘It is a very challenging environment and when you are small, you don’t have a large name with millions of dollars in marketing. However, we consider ourselves to be nimble and deliver service efficiently and cost-effectively.’
Top Philosophies and Core Values in Business
First philosophy is that the medical record is a patient care communication tool. Reimbursement or the coding and the case mix index is a byproduct of good communication.
This necessitates working with all the players in the healthcare delivery, whether it is face-to-face direct patient care, ancillary healthcare stakeholders like case management, coding, patient financial services, as a team because it is not a one-man shop.
The second philosophy is that in documentation, it is the physician, physician assistant and nurse practitioner who can achieve clinical documentation excellence. CDI professionals can serve as champions, advocates, guides, and coaches to physicians on how to improve their communication. It does not mean just clarifying or trying to solidify diagnosis for reimbursement because what matters is the quality of documentation.
Just because one creates a bill does not necessarily mean they are going to get paid as coded and billed, this is important to understand and recognize. Payers have tremendous data analytics and data mining capabilities, and they select cases for review prepayment and then they refute or are not willing to pay for some diagnoses.
What matters is not only optimal reimbursement but solidifying documentation as a whole to get paid for the care provided.
Advice For Success in the RCM Domain
For a newcomer looking to start a career in RCM, Glenn advises being a continual learner, and being self-motivated by signing up for all the CMS listservs and Medicare administrative listservs or OIG listservs.
He states that one of the biggest obstacles to an optimal revenue cycle process is that the revenue cycle actually is called revenue cycle processes, yet each component operates in an entrenched silo. It is from the time that the patient is prescheduled or presents to the ED. It is administrative and clinical functions that wind up in coding, billing and reimbursement and denials and appeals.
‘You must learn the entire revenue cycle process, so you can understand how the processes work and understand that the silos that we have developed in the revenue cycle are the biggest obstacles to the revenue cycle optimal performance.’
For professionals in the field, Glenn states that is important to treat the medical record as a communication tool. This can help result in a tremendous drop in avoidable costly medical necessity denials, alleviating a lot of unnecessary clinical validation denials and DRG downgrades costly to appeal. Payments will be made the first time and the cost to collect will be reduced.
Key Benefits Of Services at Core-CDI
The first benefit is that the firm is entirely customer-focused and can tailor the services to the needs of the client. Another benefit at Core-CDI is that nothing is off the shelf.
They like to listen to the client’s unique individual needs and desires, discuss with them initiatives and what they truly may need because sometimes a client may ask or think they need something or some type of consulting engagement but may not be what they need to solve a problem.
Vision For Future Of the Industry
Glenn’s vision is to continue down the road to breaking down silos. He states that he has been working with Dr. John Zelem, Tiffany Ferguson and Sam Tony, in releasing new software solution called Utilization Management 360 or UM360.
This is the first solution that promotes the revenue cycle as a process because it is intended to break down silos. The UM360 tool is a solution intended to be a powerful communication tool consisting of physician advisor, CDI, Case management, Utilization Review and Coding and it is a patient-centric communication tool where anybody can look through the solution to see what is happening with the patient encounter in terms of medical necessity, CDI, case management, utilization review and see what they are doing. It is a unified approach to revenue cycle.
‘I am very excited about the real potential for UM360 to be a definite game-changer for all hospitals and health care systems, driving real meaningful measurable sustainable cost effective efficiencies in the revenue cycle.’
Leadership Lessons Learned Over the Course of Life
Glenn believes that leadership theory “Theory Y” is the best approach. The second approach is that understanding, and learnings is that what makes a good leader, by being able to motivate and instill confidence in people that work with you.
‘A good leader recognizes that people don’t work for you, they work with you.’