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Leadership Profile:  How to Find Gold in a Stream of RCM Distractions

Posted by Meduit RCM on Aug 31, 2019 11:11:06 AM

Sandra Locascio

Director of Meduit Insurance Operations

Editor’s Note:  In each edition of Cycle Up, we hear from a key leader within Meduit to gain insights from top national revenue cycle thought leaders in the industry. In this edition, we sat down with Sandra Locascio, Director of Insurance Operations


  • Sandra brings a complex and comprehensive understanding of healthcare revenue cycle processes and technology improvement to her role at Meduit.
  • Her management experience in the front, middle and back end of the revenue cycle drive her ability to implement effective change and empower dynamic teams for client success.
  • She is a Lean Six Sigma Green Belt.
  • In her free time, she is a mission pilot and serves as a Captain in the Civil Air Patrol in Lexington, South Carolina. As the Unit Commander for the Lexington Squadron, she oversees young cadets and adults in areas of emergency services, aerospace and cadet programs.

Q&A with Sandra

Q: Can you share a bit of your history and what attracted you to working in revenue cycle management?

A: I started in healthcare as a patient counselor at Plantation General in Florida, counseling patients on the financial end. I found that I really liked working in healthcare, and it was an industry that wasn’t going to go away. By working on the back end of the revenue cycle, identifying issues in areas such as denials and missed opportunities for revenue, I was able to identify where we could implement changes that reduced denials and improved processes.

Memorial Hermann Healthcare System

When I moved to Memorial Hermann Healthcare System’s Pasadena Hospital, I managed all the revenue cycle areas and focused on the revenue cycle processes at the front and middle. By doing so, we reduced collectors to only two, and at one point, case management reported to me that we had no denials at all. The process worked because we got the buy-in from the physicians, and whatever we recommended, they would do. I then moved to Memorial Hermann’s corporate office as PFS Director for all but two of the hospitals.

Palmetto Health

One of my most successful projects was at Palmetto Health. By updating our front end case management and registration processes with the VA and thus reducing denials, our average collections, which at that time were $120,000 to $125,000, increased to over $1 million from the VA within a few months after processes were incorporated. 

Over time, I worked in all of the areas of the revenue cycle and IT. The cumulation of those experiences taught me to ask “What can we do to make this work better and solve problems at the front and middle of the revenue cycle instead of at the back end when we’re dealing with collections.” I tripped over Meduit through a friend of a friend of Mark Kostreba’s and began working here a little over a year ago.

“What can we do to make this work better and solve problems at the front and middle of the revenue cycle instead of at the back end when we’re dealing with collections?”

Q: What are the biggest revenue cycle issues that hospitals and physician practices struggle with?

A: The two biggest challenges providers face are:

  • Not doing what they need to do upfront to assure collections later, and
  • Holding on to accounts way too long.

If you clean up your front end processes, when you discharge the patient, if the account has been coded properly and it hits billing with no errors, it goes out to the payor and the payor pays it appropriately. If the patient liability has been collected upfront, touch by a collector should be minimal. 80% to 90% of the accounts shouldn’t even require human touch.

Refocusing Collection Team

When I was at Memorial Hermann Pasadena, I refocused my collection team on the front end of the revenue cycle so when the patient was discharged, someone was cleaning up the claims before they went out to billing. Nearly 90% of our accounts went through and paid without a human touch.

Outsource Accounts Older Than 120 Days

Regarding keeping accounts way too long, if providers would take accounts that are 120 days and older and outsource those accounts, they would be able to focus their limited resources on the newer accounts. Staffing is the highest budget item, and staff also is the first thing that is cut. When I came on at Memorial Hermann corporate, my collectors were working an average of 8,200 accounts each, which is way too many for a person to manage. Accounts with charges lower than $5,000 represented approximately 79% of volume but only about 18% of the hospital’s dollars. I started outsourcing those accounts after 60 days and sending them out on an early out so my people could concentrate on those larger dollars. Within 60 days, the net impact began to rise from $10 million to eventually $60 million per month. All we did was focus our people on what they needed to focus on.

We have some client projects with accounts that are 360 days old. That’s well beyond the time frame when you can do anything with that account. I encourage clients to set a break at 120 days if you haven’t gotten payment. Outsource those old accounts, and outsource smaller dollars. Additionally, consider the patient portion. Most hospitals don’t have the staff to effectively manage self-pay. They need to let go of those accounts and send them out the door so they can concentrate their staff on new large balance insurance claims, which is where the money resides.

"You've got to focus on the gold and the gold dust."

Q: You’ve been leading the charge on MedAccuPay, formerly Meduit Zero Balance Review. How can MedAccuPay benefit providers?

A: I always advise providers to focus on the gold, or the initial claim containing the larger dollars. MedAccuPay is an excellent way for providers to outsource what I call the gold dust, or the residual lost dollars that account for a small amount of collections in the relative scheme.  With MedAccuPay, Meduit creates a way for providers to let somebody else go after the gold dust so those providers can reallocate their team to go after the bigger payor dollars and move accounts through the appropriate secondary processes, albeit secondary billing or patient liability.

Q: What do you think clients should look for in AI and Robotics Process Automation (RPA) to advance their accounts receivable?

A: The ability to scrape payor websites for information on the status of denied claims is a big plus for our clients, and we offer that technology through our RPA process, which reduces human touches and increases efficiency. We can get more information about denied claims using RPA so those claims can be resolved faster and cheaper than our clients can do on their own.

I’m also heavily involved in our MedSpanTech product. We’re advancing this technology with robotics. As the claim status comes in, it sends it to the right team to take the next action to get the claim paid.  If a claim has not adjudicated within 60-90 days, that means it is broken, and we have to fix it. With the use of robotics, we now have the ability to identify what are the issues and address them. Within MedSpanTech and its reporting categories, we can report to our clients how many claims we received that were denied, how many are pending, how many are in process and how many are paid and need something else done to them. We can then send that information to the client so they know the makeup of their aged receivables and report the trends in their old accounts, plus where those accounts reside today. We can alert them to the problems where they can take action to resolve the accounts earlier in the process.

Q: Can you share a story about Meduit’s client success?
A: We set up one of our clients with the robotic processing automation (RPA) tool to scrape the payor websites to identify the status of each claim. This allows our staff to focus on the specific issues that the bots identified and get them corrected and paid. It also allows us to identify accounts now in the patient bucket and move them to the next phase of collection, which is also managed by Meduit.

We recently set up one of our newest clients with automation throughout their system. In 90 to 120 days, we’ll be able to show some strong results from that automation. It’s an exciting time to be on the Meduit team. We are charging ahead of the industry in AI and RPA technologies, which is going to benefit our clients tremendously.

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