Thank you for Subscribing to Medical Care Review Weekly Brief
Jerald M Archibeque is a seasoned healthcare revenue cycle veteran who brings extensive expertise to his critical position as Director of Hospital Billing at Presbyterian Healthcare Services. With years of specialized experience in medical billing and reimbursement management, Jerald has cultivated an in-depth understanding of the complex payer landscape and changing healthcare finance regulations.
In his directorial role, Jerald spearheads Presbyterian's hospital billing operations with a keen eye for maximizing earned revenues and ensuring full compensation for services rendered.
Through the article, Archibeque shares his insights on the evolving healthcare landscape and his perspectives from decades of experience in revenue cycle management. He discusses strategies for navigating prevalent challenges like denials management, which involves analyzing denial trends, cross-departmental collaboration, and effectively appealing incorrect denials from payers.
What are some of the key roles and responsibilities that you have daily? What has the journey been like for you in the industry?
I oversee hospital billing for Presbyterian, including shared responsibilities for departments like cash posting, patient collections and revenue recovery, which encompasses our underpayments teams. These departments span both hospitals and physician billing and report directly to me. My primary focus for each day is to ensure revenue collection and confirm that we're receiving proper payment as outlined in our contracts with payers or fee schedules, whether they're government-based like Medicare or Medicaid or through other payer arrangements. My role is to ensure we capture all owed revenue for the organization.
As an industry veteran, what are some of the major challenges and trends in the marketplace today?
Our most pressing challenge currently revolves around denials. As a non-profit organization, every dollar counts, so we analyze denial trends to pinpoint areas for improvement. This involves collaborating with different units to refineworkflows or processes to prevent future denials. However, it’s also crucial to recognize that denials aren't always the provider's fault. Payers may incorrectly or unjustly deny claims, placing the burden of proof on us to demonstrate why the claim should have been paid. We closely monitor our overturn percentage to track our success in converting denials into payments.
Another significant challenge stems from our entire revenue cycle team at Presbyterian operating remotely. While the pandemic initially drove this transition, it has since become a permanent arrangement due to the nature of our work, which can be done anywhere in the country. Our focus now lies on keeping our remote employees engaged within their teams and the broader organizational culture. This has prompted us to rethink our hiring processes, enabling us to recruit talent nationwide. 
