In a recent webinar conversation, Kathy Saunders, SVP of RCM at Redefine Healthcare, discussed how denials, payer behavior, underpayments and staffing pressure are reshaping RCM for provider groups running on athenahealth. For orthopedic organizations preparing for growth, her comments on high-dollar surgery claims and staffing capacity make the discussion especially relevant.
Q&A
Q: How have denials changed for your team over the last couple of years?
A: Denials are being discussed at a higher level now, and better analytics and reporting have made it easier to spot trends faster. Rather than relying on claim-by-claim AR review, Kathy said her team can look at more claims at once, fix issues faster and improve turnaround time.
Q: What does it mean in practice to be more proactive instead of reactive?
A: Kathy said Adonis helped make the team proactive rather than reactive by surfacing why claims are being denied at a high level and enabling retraining before denials pile up. She cited a recent Horizon NJ Health example where a CPT-code guideline changed mid-February, the team caught it quickly, and they fixed the claims immediately.
Q: How has your visibility into payer behavior changed?
A: “I feel like I finally have a view,” Kathy said when asked about payer transparency. Instead of discovering payer changes only after denials arrive, her team now has more detailed insight into guideline changes, denial reasons and what may or may not get paid before submission.
Q: Where are staffing constraints showing up most acutely for orthopedic groups?
A: Kathy said burnout is a huge problem, driven by phone calls, wait times and the difficulty of collecting high-dollar claims. In Redefine’s orthopedic setting, that is especially important because billers want to focus on high-dollar spine and surgery claims, not low-dollar E&M work that is tedious and contributes to burnout.
Q: Why are underpayments such a big issue for a growing multi-specialty group?
A: Kathy called underpayments “a big one” because Redefine is multi-specialty, manages many payer contracts and has carveout codes that vary by payer and provider. She said the biggest impact comes when new doctors join, since payers do not always attach them to the right contracted rates right away, which can leave groups underpaid for months if no one catches it.
Q: What is the biggest difference before and after layering Adonis on top of athenahealth?
A: Asked about the biggest change after implementing Adonis alongside athenahealth, Kathy said it feels “like a horse with blinders on, vs. and a horse without them.” Her team had reporting before, but now they can see revenue changes and denial trends faster, understand what is going on and jump into the work immediately.
Closing takeaway
Saunders said the biggest impact for her team has been catching underpayments and making sure payers are paying correctly. For orthopedic and ASC-focused groups trying to grow without burning out staff, the through-line from her comments is clear: better visibility into payer behavior helps teams protect revenue and spend human effort where it matters most.
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