Ray is the CEO of Health Business Solutions with over 25 years of experience in healthcare revenue cycle management (RCM) in both the hospital and payer environment. He created the company in 2002 with the belief that what healthcare providers needed went far beyond a traditional collection agency service.

Prior to HBS, Ray has been recognised for his service as the State of Florida regional administrator of behavioural healthcare and he continues to play an instrumental role on various boards in the behavioural healthcare arena.  In this detailed interview, Ray and I talk about critical aspects of revenue cycle management in healthcare and innovative ideas that have propelled his success in the domain.

Early days before entering revenue cycle management

A child to parents who had relocated from Lebanon, Ray was brought up with ideals to work hard from a young age. He graduated high school in 1982 and attended Troy State University in Alabama. After a year he transferred to Florida State University while working his way through college.  Berry completed his degree while working for the State of Florida at the University of Central Florida.

Ray worked various jobs while studying, from waiting tables and bartending to working as a technician for a drug treatment centre. He spent a few years there, with kids dealing with drug addiction.  During that time, Ray actively read manuals and implemented programs to help find federal grants for the organization while still working towards his degree.

His work caught the attention of state officials, who reached out to him with an offer to set up alcohol and drug abuse, and mental health programs across the state. Ray made his move to Tallahassee armed with $36 million to set those programs up around the state and that was when he found his niche.

Getting into the business of revenue cycle management

In the late 80s and early 90s, Ray was working for the state social service agency in alcohol and drug abuse and mental health. They had a billion dollars in funding that would be allocated across the state to provide mental health and substance abuse services to those who needed it. However, while the funds were given by the state there would be no specific outcomes measured.

At this point, Ray helped the state and the federal government convert what was called grant-in-aid to fee-for-service. Now the billable dollars were marked as billable increments where one would have to provide proof of service to get paid. Ray stayed with the State of Florida for 12 years promoting this work.

In 1997-98, he was hired by an outside company to run 17 psychiatric hospitals for children. There he realized that even though the hospital was functioning at full capacity they were not hitting their financial targets. Berry was surprised to find the hospital was unable to pay their own bills because their claims were being denied by the insurance companies.

Ray formed a small group and began to proactively call the insurance companies to follow up on the claims. He realized that the instant they would do that, the funds would start coming in and their financial numbers improved significantly.

A couple of years later, Ray met with a friend at the South Broward Hospital District, Memorial Hospital in Hollywood, Florida where he learned that many of their claims were being denied as well. Berry offered to get the claims paid for a contingency and recovered $3.5 million for the hospital in the first month alone.

At this point Ray realized that while it was a lot of money, the contingency would take a huge portion of healthcare revenue away from health services. He started his own company and ever since then has worked with close to a thousand hospitals across the country. His team helps hospitals with the systems and processes required to generate the funds and after 18-24 months of equipping the hospital, they make their exit.

‘We try to match the right system to the right hospital and then 18 or 24 months we exit, they keep the people, they keep the products, they keep the system and we take the denial rates from 16% on average down to 5%.’

Landing the first account

Holy Cross Hospital in Fort Lauderdale was Ray’s first end-to-end client that he signed on as a company. They are part of Trinity Healthcare, previously Catholic Health East.  Ray met with the CEO, John Johnson, on the advice of a friend. The meeting went extremely well and the contract was signed.

Ray had a team of 15 or so who worked hard to get back money for the Ministry to help the people in the community. With the money collected, the Ministries were able to buy new equipment and provide additional services to the community.

Strategy changes over the past 20 years

‘When I first started this I thought I’ll be in business for three years, I’ll make a lot of money and then I’ll have to figure out something else to do because there’s no way the government’s not going to fix this.’

Having spent over two decades in this industry, Ray has seen quite a few changes in this field. As technology gets more advanced, reliance on it has increased. Additionally, the contingency rates have dropped from 29-30% to 4-5%.

The revenue cycle part of healthcare is the most neglected. Further, the system cannot evolve as the educational system is not interested in teaching doctors in medical school about it. Even with companies like Ray and his team, who are constantly helping the healthcare industry have fewer claim denials, improved technology and well-educated staff, it isn’t enough. There is still a huge vacuum in this space that requires these companies to come in and get insurance claims paid so that the healthcare industry has the funds needed for patients.

Current business scenario and engagements

Ray currently has about 60 clients with the majority being hospitals, along with some big physician practices. Ray’s biggest clients include Trinity Healthcare with 90 hospitals and Community Health Systems which has about 175 hospitals. The company is now at a strength of 450 employees, which doubled in the past year from 200-250 people.

Even though COVID-19 hit the world hard, a lot of hospitals cut their cost down and let go of staff. At this point it was easier to hire an outside team that worked on contingency, like HBS, thus reducing their risk.

The company employees are spread over several areas ranging from about a 100 people offshore in Chennai, India, with the rest segregated across 31 states and a core management team of 15 people.

Standout moments in the RCM journey

‘The thing about revenue cycle, it’s not exactly the same everywhere you go, the contracts are different, the systems are different, what they’re providing is different. You cannot go in there and think you’re going to take something off the shelf and implement it everywhere.’

Ray recounts his time with Tallahassee Memorial Healthcare Hospital in Florida with pride. When his team connected with the CEO at the hospital there were no funds being generated from the claims and Ray’s team managed to recover $2.5 million a month over a period of 18 months. Ray was proud of how the money helped to solidify this critical community asset. When the project was done Ray even donated the computers used when the hospital did not have the capital budget to purchase their own to continue the project in-house. While this aspect of giving back may have put Ray out of a job, he felt a huge sense of pride and accomplishment to see the good that he and his team accomplished.

‘If you can clean up your revenue cycle, you can make your hospital profitable or self-sufficient at least.’

Ray says his company has recovered close to $5 billion for their clients over the past 20 years.  Along with the collections, he is proud of their ability to integrate with clients. Initially clients are hesitant about letting the team in, but once they see the results and the success of the program, they are left with a great sense of accomplishment and achievement.

Overcoming challenges in the RCM domain

For Ray, one of the biggest challenges in this field is resistance to the process. A lot of clients are hesitant to bring in a team that offers to enhance the efficiency of a space and get the funds for claims that have previously been denied.

‘I am on the board of Broward Health now and it took me even as a board member 12 to 18 months to convince the team that they should start looking at first pass denials.’

Top philosophies and core values in business

‘For me, it is morals, ethics and hard work. I expect everybody to work hard and to be open and honest with our clients.’

For Ray, ethics is at the top of the list. He believes in always being honest with the client and following through on commitments within the timeframes promised. He and his company always strive to reach the goals outlined without engaging the clients in a permanent residual contract.

Another thing Ray believes is to do what they are best at and find the right fit for all their clients. The revenue cycle has a variety of components and if any is outside of the wheelhouse of Health Business Solutions, Ray’s team helps find the client the right vendor.

Advice for people entering the RCM domain

Ray believes that to truly learn this field it is best to work for one of the big companies first. However, if you have your own creative ideas, you can also figure out your own niche in revenue cycle management.

‘There’s no educational path, so it’s really probably more for the non-traditional person but I would say take a job in a hospital, start at the entry level and work your way through.’

Two learnings from the RCM industry experience

1. The money you take, the revenue cycle money that is lost through inefficient billing procedures is money that takes care of people. You are putting money back where it belongs to take care of the community at large.
2. The second thing is you can make a good living. You meet a different group of people everywhere you go and you learn a lot. As this is an industry built on relationships, people skills are important to be successful in this domain.

Key benefits of Health Business Solutions services

Return on investment – clients pay 1/20th of what they get back that they would not have without HBS. Furthermore, the team helps self-empower the clients to do the work themselves.  More than just a return of investment, HBS helps integrate it back into the client’s system so that it’s flawless and seamless in the future.

Future plans for business expansion

Moving forward, Ray is hoping to continue to grow HBS and partner with companies that can handle some of the workload.

When it comes to expansion and marketing, Ray believes in old school methods and connecting with people rather than cold calling. The majority of his clients come in through word-of-mouth referrals and he and his team are also quite active in trade shows where they can interact with people and explain their services face-to-face.

Some of the trade shows Ray can be found in include the HFMA (Healthcare Financial Management Association), HIMSS and the Dixie Institute.

Vision for the RCM domain

‘Healthcare bills can be frustrating, they’re so complex and complicated, no ordinary person who doesn’t work in our space will understand them.  They have to make it simpler for the consumer.’

Ray believes tools like Epic and Cerner are going to revolutionize the revenue cycle. Additionally, an increase in IT efficiency is going to help improve and automate the system.

‘Healthcare costs are skyrocketing, they’re too high, they’re putting a huge burden on the taxpayers everywhere, we have to get more efficient in the revenue cycle process to save our healthcare systems.’

Advice for professionals and organizations to stay successful in RCM

Do the right thing.  When you work in one of these places, do the job, be thorough and complete.  Think three steps ahead and ask yourself how to prevent problems with the claims.

Figure out what works for your system and your payers. Something that worked well for one system, might not have the same efficacy in another. Until there is consistency and some regulation around it, you are going to have to build a process specific to your business.

Leadership lessons learnt over the years

Honesty and integrity are two of the most important pillars in this domain for Ray. He believes if you are honest and consistent with clients and treat people like they want to be treated, then everything else will fall into place.

‘We can’t take ourselves too seriously. You’ve got to enjoy your life. You don’t want to just be a miserable drone.  You want to be able to enjoy your work a little bit. There’s nothing wrong with laughing.  There’s nothing wrong with having fun, just get the job done.’

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