Revolutionizing Hospitals by Transforming Financial Systems with CFO Chelle Keplinger

Chelle Keplinger: When I started working with MEDHOST, the hospital had some issues with our setup. And so we had to really learn what the system could do for us and realized very quickly that we weren't utilizing the system to its capabilities. And that became a big piece to us because we had no idea how much we were missing.

Host: That's the voice of Chelle Keplinger. Chelle's been a CFO in critical access hospitals for 14 years. In this episode, she talks us through the day-to-day of being the CFO in the hospital industry. And how perceived billing errors can severely affect the reputation of a hospital, especially in a small community. Faced with the inability to hire billing staff, her hospital partnered with MEDHOST to revolutionize their payment and contract management system.

Chelle: Having the outside expertise of people that understand the system and know the system from the inside and out is incredibly beneficial.

Host: This is Health IT on the Record, presented by MEDHOST. A show that dives into how health information technology innovations impact every aspect of a health system, from multi-hospital networks down to individual patients.

In just a moment, you'll hear how this increased cash flow into her hospital, restoring half a million dollars in underpayments in addition to helping her hospital to manage a small staff, clean up its billing system, and make collection and self-pay systems more efficient. The end result? More core healthcare services for community members who need them. Enjoy the conversation.

Chelle: Hello, my name's Chelle Keplinger. I have been a CFO in the hospital industry for 14 years, specifically in critical access hospitals. I've been in healthcare since I graduated from high school. So I actually have 25 years experience, but 14 years in this role. And I'm happy to answer any questions that you have.

Host: Excellent. Chelle, thank you so much for taking the time to talk with us. And with this series, the main goal is to connect with people just like you who have tremendous experience and passions and insights into this space. And we're just trying to gain your perspective and kind of hear about some of the trends that you've been seeing, some of the challenges that you have overcome in your career.

And through that, I think we're going to hear of some of your best advice. We're going to hear from your best insights that you would share to other folks in this space. So to start things off, the main topic here is how revenue cycle services can positively impact a CFO's workflow. And in that theme, would you want to begin by just kind of giving us a quick snapshot of just the day in a life of being a CFO at a hospital. What are the pains? What are the pressures you're facing? Kind of walk me through that.

Chelle: Okay. Well, the first that I would do when I get there in the morning is look at cash. How much cash did we get the previous day? It is very difficult in a critical access setting, cash purposes. It's very difficult expense-wise. So everyday we have to view our expenses. We have to view what our revenues are coming in. Are we going to make budget? If we're not going to make budget, how are we going to come up with the shortfall?

And really focus on increasing our cash, decreasing our expenses, and getting the services that our patients need in the amount of – I guess it depends on what state you're in. I've been in multiple states. Some states are easier to get qualified candidates in there to help with the professional side. Other states are not as easy. And so you have to be willing to juggle day to day and figure out what resources you need. How you're going to get them, how you're going to make them integrate within your system, and how, ultimately, are you going to be able to bill your patients appropriately, make sure that you're charging for everything you need to charge, and at the end of the day, come out with a bottom line that is positive?

Host: In these last 14 years, was there a point when you found yourself really surprised by the kinds of things you were having to do in the job? Maybe things that they didn't tell you you'd have to be doing, it just kind of happened. So does that make sense?

Chelle: It does. I'm a very detailed-oriented person and so it's very easy for me to get in the detail. But a lot of people would think of a CFO as a high-level individual instead of in the day-to-day details of creating financial statements, making sure the chargemaster is set up correctly, making decisions on what systems we want to use, what vendors we want to use. And so I would say that I've probably done a little bit of everything. Not everyone is geared that way. It's just who I am.

And so in the last 14 years, I have found myself consistently surprised at the things that you don't know. And so everyday, you learn something in this job that you have to take forward, pass on, and implement. And I can honestly say I don't know that there's a day that's gone by that there's not been something that I've learned how to do.

Host: That makes sense. Kind of earlier in those 14 years, what were the things that would keep you up at night? And then we're going to start getting to that point to how you started to solve those kinds of problems.

Chelle: Well, billing keeps you up at night every night. Both places that I've worked in the last 14 years when I came in had billing issues. Even if you correct those billing issues, the thing that keeps you up at night is that it takes so many years to overcome the perception of billing issues that –

Host: What's that mean? Yeah, tell me more about that, years of perception.

Chelle: So in the community that you serve if you have a reputation, over a course of time, of not billing things properly or not sending statements out when they should be sent out or sending people to collections before they really should have gone to collections, you get a perception in the community that you don't know what you're doing and your billing is all screwed up. And so as a CFO, one of the biggest complaints that I get is that the billing is not appropriate. In most cases, it is appropriate. Follow-up probably is where our challenges are.

And so it takes, as anything else, one bad year of something takes two or three years of good to overcome. And so people have to get their bills consistently over a period of time. And they have to feel like we're there for them to answer questions and that we get it right the first time before they will have any faith in what we're doing.

Host: Right, that makes sense. Thanks for explaining that. So you're saying billing, years of perception, maybe overcoming that. What else comes to mind?

Chelle: A lot of times, drugs that they may get in the hospital, how much they cost, that's a big problem. We have to be able to explain that to patients, why that drug costs so much. In the years past, I'm sure you've heard of all the outcry over charging $5 for a Tylenol or $4 for an Advil. And we really have gotten away from that. But in today's world, there's such high dollar drugs that people are taking and getting infused in an outpatient setting that it is hard to tell somebody who you know needs the drug, but can't really afford it, that it's going to cost them a lot of money to get it done. And that is really a very tough thing to do.

Host: So when we began this conversation today, kind of the first question was all about walking me through the day in a life of a CFO. And you were saying you are super detail oriented. Now, is that a common theme with all these CFOs, like really trying to be involved with the most critical, the most important pieces of the revenue, the cash flow, everything? Or is that something that's more unique to you?

Chelle: I think it probably is half and half. It depends on staffing and what your profit and loss looks like. Because you may not be able to have additional staffing that you want, and you may not have a choice but to dig in and do it and work as part of the team to make sure that you're profitable and get things done. And honestly, what you have to look at is the first thing that is important is that we are still able to continue patient care. And so you do what you have to do to make that happen.

Host: Right. Well, I think this is a good place to begin transitioning to talk a little about some of your vendor relationships and specifically with MEDHOST and how they were a partner to you. I know you've been doing this for a while specifically with CFO work. But walk me through some of the ways you were able to successfully engage in a vendor like MEDHOST. How were they able to augment some of your limitations but also make you strongest in your best areas? How did that play out?

Chelle: Initially, when I started working with MEDHOST, the hospital had some issues with our setup. That was internal, that didn't have anything to do with MEDHOST. And so we had to really learn what the system could do for us. And realized very quickly that we weren't utilizing the system to its capabilities. And so once we started learning that, we started asking a lot of questions.

Where I currently worked, we had a really tough time recruiting billing staff. And so we could not do that in house. And so we partnered with MEDHOST a while back and decided to let them help us make that better. And there was a couple of different pieces. MEDHOST has a partnership with nThrive. So nThrive is a billing company. And then MEDHOST, what they had done for us is they enter all the payments. They reconcile on a daily basis. They also look at denials. They're also doing contract management work. And that became a big piece to us because we had no idea how much we were missing.

We had previously gone with a different billing company that we decided to leave. And there was a lot of money left on the table that we weren't realizing. And so with the contract management – and as complicated as contracts are today when you have DRGs, APGs, every insurance company is different. And so those being built into the system and being able to compare the payments that we received against what the system says we should have received, allows us to go back and get back to that company and say, "Hey. You didn't pay us what you should have paid us on this."

Cash is king in this world of making sure that we can provide resources. And so in the past year and a half, there's been a significant increase, even though the amount of gross revenue hadn't changed, there was an increase in percentage that we were actually collecting. So actually revenue was down, but we were collecting more cash over the past year and a half than we had prior.

Host: Those are some really big numbers and once you were able to get everything more or less improved, fixed, finding this cash that you didn't even know was available to you. What other kind of impacts did you uncover?

Chelle: The things that we uncovered were, if we had CPT codes set up wrong, and they were erring out. And so every year those change. Actually, they change quarterly and keeping up with those and having a very small staff in a small hospital is very difficult to do. They helped us with that. They also helped us try to clean up some errors that were coming out of the system, so that our billings would go out the first time and we wouldn't have them bounce back. So we didn't have to touch them multiple times.

There were several projects going on. They were helping us with collection and self-pay. In the last place I worked, we had a particularly high amount of self-pay individuals. And so that made it even more difficult on the hospital because we don't deny services to people who need them. And so we have to do the very best and become as very lean as we can so that we can continue to provide those services even though they are very costly services. And so that means a lot to the community. It means a lot to me as an individual. I'm not a healthcare worker and could never do that, but this is the way that I can impact somebody's life in the healthcare world is by making sure that they can get services that they need.

Host: That makes sense. And if you don't have the revenue to be able to meet that to survive, then you aren't able to make that happen.

Chelle: Right. We have to decide. What do we have to cut to make sure that we can provide core services, when we have other services that aren't necessarily core services, but are necessary in our community.

Host: Health IT on the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare management through innovative workflows and technologies. For more information, visit www.medhost.com. Let's jump back in.

Host: So for you as a CFO, for you to be able to make that call and make those decisions, you have to have the data in front of you. What other advice would you give to other CFOs on how to understand the data that's in front of you so you can make the right decisions so you can deliver care to everybody?

Chelle: Well, that's a kind of a difficult question. Every hospital has different challenges, but knowing where your cash is, knowing what your plan is for capital reinvestment depending on where you're at, whether or not you have any tax income coming in to support you. But knowing where your revenue's at, knowing where your potential AR issues are, and where your collection issues are. Again, if there's anything that you can add to the bottom line by being able to bring in additional cash, that could be a half a million dollars, that could be a new CT scan, that could a new MRI that you couldn't afford before that you can provide to your patients.

And so you consistently have to just have the information in front of you. I got the information every two weeks. And we're on multiple calls so that we could talk about what our issues were and where did we stand and where did we find that we had potential. And so we would take our top two or three items every two weeks, and we would address those items. And then once they were addressed and corrected, then we would move on to new items. And eventually, you get down, hopefully, to where you have very few items or at least they're not as big of items and so that you can focus on long-term planning.

Host: So you are utilizing the monthly reporting from MEDHOST. And when you're on the calls, are you talking to MEDHOST? How did that work?

Chelle: Yes, I'm on the calls with MEDHOST, Lisa and her team there. And I'm also on the call with nThrive, Shawn and his team. And we are talking back and forth every week and saying, "You know what, we have opportunities. Here's where we fix this. Can we look in to see how can I get better data on this particular item so that we can drill down in to see if it is a problem?" And generally, one problem eases its way into potentially finding another problem. And so it's a continuous cycle.

And like I said, having the outside expertise of people that understand the system and know the system from the inside and out is incredibly beneficial. I'd like to think that I knew MEDHOST's system pretty well. But when you live it everyday and you work there, it's just different. And they have a whole different level of understanding.

Host: That's really neat. Thanks for sharing that. I know it's been a little while since you were working in this particular role, but it's cool that you still remember, of course, everyone's names. I mean, they're in the trenches with you as you're trying to solve these important problems. They make sense as you uncover one problem and solve it, that might lead to something else.

So from that chain of events of to kind of plug in the holes where you find them, can you think of any stories or examples of maybe how you were able to restore money from underpayments and maybe be able to utilize that in a good way for the hospital?

Chelle: One specific item that was reoccurring was that we had some positions that weren't credentialed with some of the payers. I would like to think that's not a common occurrence, but unfortunately, it is. And so you have to stay on top of that 100% of the time. The previous company that we engaged really didn't keep us apprised of that. Where, when we started with this relationship with MEDHOST and nThrive, if we had a denial come in, we knew immediately.

And so we didn't let it go on for three or six months. It had a huge impact on cash. And so I can't think of anything specific other than that we're able to buy more equipment to do things. I mean, we didn't use it for one particular goal. But we were able to upgrade our CAT scan with the help of a grant and extra funds. We were able to upgrade our MRI, so that we have the best images for the physicians to read. We were able to buy some new stretchers for the ER and some wheelchairs that were needed for bariatric patients because it's becoming more and more of a problem that hospitals are having to face. So there's no one thing that we did with it, but it allowed us to do a lot of different things that overall helped the hospital in general.

Host: I like how you were able to not just do one thing, but you were able to do lots of different good things. So with those kinds of activities, these are all good activities. As a CFO, how do you find the activities that need to change or the activities that aren't performing the way they're supposed to? I know you were saying earlier, every hospital, these are all very different scenarios. But as a CFO, how do you find that and take care of what needs to be done?

Chelle: Well, I'll be honest with you. The patients will let you know.

Host: They'll tell you.

Chelle: Yeah. What you're not doing right. The best example I think that I can give is that again, the perception in the community about the billing was that it was just not good. And so we went through a whole process.

We worked with MEDHOST. We revamped our statements. We made them user-friendly. We gave them more information. We added statements to them about our financial aid and financial assistance, if they wanted to apply for that. And we encouraged them to do so. But this was something that the board was very engaged in. And so we mocked up statements. We decided when we wanted to send them. We decided the intervals, what we wanted them to look like. And so ultimately, after about four or five months – which that seems like a long time, but it's a lot of detail work – we were able to take to the board the statements. They approved them.

And so what we did was, we tried to change the perception by giving information. And so the first thing that we did was, when the bill drops to the insurance company, we drop a bill to the patient that says, "This is not a bill. This is informational only." They wanted to see it. They felt like they weren't getting bills in the past. And sometimes they might have, but they're in their head that even if they threw it away, their perception is they didn't get it. And so what we were trying to be is more transparent, trying to let them know ahead of time, "Hey, we've billed your insurance. But this is just for your knowledge."

We made them very user-friendly. We got a lot of kudos from the community about the ease of the bills and how they were written. And best of all, we stopped getting as many complaints. And so even if they don't tell you you're doing well, the fact that they're not complaining means that you're doing better than you were.

Host: So earlier on as well, you were talking about reputation management was one of the things. If you have one bad year, it takes several good years to try to offset that. So in this case, before you were offering that with MEDHOST, the previous vendor it just wasn't a thing I guess.

Chelle: It was not something that was on the table to change. And so we did change them a little bit with a previous vendor, but all in all, we decided it wasn't the right vendor for us. We decided early on that we were going to partner with MEDHOST. And they were going to be our ally. And we were going to utilize the system to its fullest capabilities.

That meant using the system. And so we decided to change our focus and really utilize the system for the statements and let it do and work for us. And so, again, when I first got there, there weren't very many days I didn't get complaints. And so as time went on and we got more consistent and we saw the system working as it was designed to work, we saw that people did have less complaints. And I had time to do other things other than trying to fix those mistakes.

Host: Thanks for sharing that. And it's been a really enjoyable talking with you today to hear a little about the things you've been able to accomplish, I know it's a big team effort. But you have been leading the way to create better experiences for the teams that you're working with. So I really appreciate you taking the time to chat with me and to share your story. And I hope we can do this again soon.

Chelle: Sure. And when you said that it takes a team, you're absolutely right. And so I don't want anyone to think that I did this on my own. It's everyone that I worked with and whether they worked for me, I worked for them, we were partners with. Everybody came together and everybody wanted the same goal. And that's what made it work. And so I appreciate everyone who helped me with the transition because it's not an easy transition to make.

Host: Chelle thanks again.

Chelle: Thank you.

Host: Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this be sure to visit medhost.com/resources. Thanks.