As healthcare finance leaders navigate increasingly fragmented payer rules and persistent labor shortages, Mike Esworthy, Chief Strategy Officer at EnableComp, offers a timely playbook for addressing the toughest claims.
In a recent Q&A with HIT Leaders & News, Esworthy observes, “standard claims are no longer the real challenge. The true margin drain hides in the outliers” — those complex claims linked to Veterans Affairs, workers’ compensation, TRICARE, and other non‑routine payers.
Mike explains how these outlier claims consume “disproportionate time, staff, and resources,” elevating denial rates and delaying reimbursement .
Drawing on EnableComp’s deep experience, he outlines a multi‑pronged approach to addressing the problem: deploying specialized workflows, leveraging payer‑specific expertise, and integrating advanced analytics to triage and resolve high‑impact cases faster.
For revenue cycle leaders at health systems and hospitals, the stakes are clear: mastering the edge cases can yield substantial financial gains and operational efficiency. This article is a must‑read for those determined to reclaim revenue, reduce denials, and bolster financial resilience through smarter handling of complex claims.
Read the full article: Inside Mike Esworthy’s Playbook for Claims Success – HIT Leaders and News
