With over 32 years of experience in the field, Kristy is well-recognized as an expert in Medical Practice Management and Billing. She has worked in diverse sections of the industry including Addiction Medicine, Behavioral Health, Primary Care, and several specialties in addition to Home Health, Hospice, and Durable Medical Equipment. In this interview, Kristy talks to me about key aspects of her journey and her vision for the industry’s future.

Starting Out In The RCM Domain

Kristy got an early start in this field when she began working for her father while in high school. Being a respiratory therapist, he owned a company that provided Pulmonary Function Tests and Arterial Blood Gasses. Here, Kristy learned all the front office functions including medical billing.

A year later, she began working for a large physician group practice in a hospital in Southern California. She enrolled in coding and medical terminology classes and became certified in medical billing. Kristy believed it was important to develop her experience through different organizations and specialties and finished her college degree in Business Administration with an emphasis in HealthCare from Belmont University.

One of the things that keeps her motivated in this field is the constant challenge presented. Her current involvement in the field of substance abuse in Medical and Behavioral Health ensures constant challenges that keep her ticking.

Kristy recalls her early days in the field when she would use a typewriter to fill out paper claims. Those days as every detail was entered manually, it allowed for better recall and understanding of each case. When things went digital, figuring out concerns at the tech-end as well as rectifying any errors that were raised promptly was a challenge initially for most people.

‘A lot has changed since the day I started, evolving with tech and payment strategies is a must in RCM.’

Prior to SaVida, Kristy was working for Elements Behavioral Health as Vice President of Revenue Cycle, wherein she got her first experience in substance abuse treatment. There she operated a centralized business office with more than 60 employees for 16 inpatient Substance Abuse Treatment Centers, 14 Intensive Outpatient Centers, and a toxicology laboratory. Kristy also has prior experience in behavioral health, primary care, home health, hospice, and DME.

‘What I really enjoy about working in revenue cycle is the tremendous growth potential. The more you dive in and learn the more roles you have access to.’

Current Business Structure And Organization

Currently, at SaVida Health, Kristy oversees a team of 10 employees responsible for the complete revenue cycle management of all the locations. They also have a special arrangement with the billing and practice management platform.

Kristy’s team does all the billing including denial follow-up, but she also has a sub-team that does the posting and the regular AR follow-up. This partnership allows for additional assistance while maintaining low FTEs.

Talking about plans to make the RCM department more efficient, Kristy mentions that her company is looking into AI. Due to labor shortages and other considerations, looking at opportunities where AI can continue to grow is becoming increasingly important.

In the ongoing trend of surprise billing, Kristy reveals that they have already dealt with billing patients as they are primarily out of network with a lot of commercial payers which is by design.

‘As far as trends go, I think more organizations are going to learn about being out of network as compared to in-network with commercial payers.’

Standout Moments As Business Leader

Kristy credits the chance she got to work in every single position involved in revenue cycle management as a huge help in her career. She believes her experience helped her to better relate to others, especially as she expanded into leadership and consulting roles.

However, Kristy recalls that those days also led to some of her most challenging cases where she had to collect millions of dollars for physician group claims. In one instance, when paper claims were still the trend, Kristy personally went to the Medicaid Program and hand-delivered a large stack of claims demanding they process and pay them.

Other memorable moments include being part of numerous organizational turnarounds and being able to turn them into being profitable and operating in the black. She has also built a lot of teams over the years and enjoyed teaching others how to effectively work in AR.

At SaVida Health, Kristy has great pride in her organization’s tremendous growth. In the past 4 years, the company has grown from operating in 4 locations in 2 states to 37 locations in 5 states.

From an RCM perspective, Kristy believes the biggest challenge is with substance abuse as they cross between behavioral health and medical claims.  These are two different sides of an insurance company that don’t talk to each other making it quite challenging to operate in this space.

Another challenge was figuring out how to operate and bill their lab which is located in 1 state but services all 5 states. Developing an EHR and Billing platform to handle the nuances associated with billing in a multi-state organization was crucial and has added to the company’s success.

Overcoming Challenges Over The Years

An unexpected challenge was having to remote suddenly in 2020 owing to the pandemic. At the time, telehealth was not active in the behavioral healthcare space and the company had to introduce telehealth across the board as well as figure out the appropriate billing procedures.

‘Even in the midst of the pandemic, the opioid crisis continued to grow. And so, it was even more important that we were able to serve and treat our patients during this time.’

Top Philosophies And Core Values In Business

Kristy’s top philosophies include talking about payer strategies, understanding different aspects such as data, the population served, the payer mix, and working with payers on innovative payer strategies.

Pay for performance came out several years ago but it is still very alive and well.  In addition, determining case rates and value-based care, is important to help a company better operate in an ever-changing space of healthcare reimbursement. Finally, companies have to hold the insurance companies accountable for paying according to the contract.

Advice For Newcomers Looking To Enter The Field Of RCM

‘Network, have good mentors, and keep learning.’ 

Kristy’s best recommendation is that people take the time to continue to expand on their education, get good mentors, and never stop growing.

Vision For The Future Of The Industry

Having a well-established AI and a good understanding of data is going to be crucial to succeed. Data helps one make important decisions from a contracting standpoint as well as a resource standpoint.  It can help determine the AI and how to use that for maximum benefit.

Another aspect is being creative in payment strategies. Especially in their field of substance abuse, having case rates and value-based care is a good solution.

For companies and professionals looking to remain successful in the RCM domain, Kristy advises making AR their number one resource.  Understanding a company’s AR, their top payers, payment agreements with those top payers, patient pay strategies, and their data, all play a huge role in succeeding.

‘It is going after and making sure that your payers are paying according to contract, you validate your fee schedules. Make sure that you are never leaving money on the table when you are billing.’

Leadership Lessons Learned In Life

Kristy mentions that she has learned over the years that nothing is just black or white. There are many shades of gray and taking the time to understand the team, their strengths, and how best to utilize every member’s strength to build up the team while encouraging and motivating them along the way is a leader’s job.

‘I hold people very accountable to their work, but I also like to have a lot of fun and I think fun is missing in some of the environments.’

Follow Kristy Wright On: LinkedIn