Dallas-based Tenet Healthcare has seen denials, disputes and documentation requests increase in the years post-COVID to levels that CEO Saum Sutaria, MD, said are “not acceptable in some cases.” But, he said, the for-profit system has adapted.
Dr. Sutaria pointed to the system’s revenue cycle management arm, Conifer Health Solutions, as key to its success grappling with the increased denial environment.
“Obviously, this is part of Conifer’s job to adapt and learn to respond to those things,” he said on the system’s July 22 earnings call. “In the early days, the responses were driving up expenditures. Today, as we have evolved and realized this new normal, we have of course deployed more technology, more automation, trained up more offshore staff and other things to be able to respond to those types of requests and activities in a more efficient and, I would argue, more effective manner.”
Dr. Sutaria said they track things like their yield relative to the volume or dollars that have been disputed or denied and “Conifer is doing well there for both ourselves and our clients, relative to the overall industry.”
He said one of the advantages Conifer has is an “incredibly standardized workflow that is really critical to not only collections, but timely collections in an environment where those time frames have been increasing for a long period of time.”
“I think it’s also important that we spend our time being committed to very accurate documentation and coding,” Dr. Sutaria said. “And I think one of the things that Conifer does well is produce accurate documentation and coding and that has a tendency to also reduce the dispute activity to some extent from the health plans. It is a two-way street in the end. And both parties have to perform in that truth. And that speeds up collections to some extent.”
Dr. Sutaria said it is a “constant battle with respect to what is appropriate” and Tenet welcomes regulation and other initiatives that would “support a reduction of some of what we consider inappropriate activity.”
