2025 Innovation Conference Package - HBMA Store

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Conscious Coupling of AI and Human Expertise for RCM Success Presented by Hanes Singh

As artificial intelligence (AI) infiltrates the revenue cycle, one key question remains: how can revenue cycle management (RCM) professionals effectively leverage AI to make quick, informed decisions that practically impact financial outcomes? While AI is still evolving, the human element is and will remain crucial in complementing AI within RCM workflows. Ultimately, strategically embracing AI is essential for achieving faster and higher reimbursements, staying competitive, and growing business.

In this session, we’ll start with the basics of AI and explore examples of how human expertise complements the technology. We’ll further share specific ROI tied to these smarter decisions and improved financial outcomes. Additionally, we’ll discuss how AI can enhance workflows by prioritizing overlooked denials, increasing the success rate of challenging cases, and streamlining processes for those likely to succeed. This conscious coupling between AI and human judgment not only has the power to boost efficiency, but also ensures focus on the denials that matter most. Join us to learn how adopting AI can transform your RCM operations.

Course Participants will be able to:

• Develop a framework for evaluating practical versus impractical AI tools in RCM
• Assess and implement an AI solution that best aligns with the needs of your team and business
• Identify where the human element is essential to maximize the effectiveness of AI
• Build a compelling case for investing in AI

What Every Revenue Cycle Leader Needs to Know About Cybersecurity Part 1 Presented by Mike Green

In February 2024, the healthcare sector was shaken by one of the most devastating cyberattacks in its history. For weeks, millions of patients were unable to fill prescriptions or schedule critical care, while hundreds of thousands of providers struggled to submit claims or receive reimbursements. This catastrophic event underscored a stark reality: even the most comprehensive risk mitigation strategies are insufficient without an equally robust incident response plan.

For revenue cycle leaders and billing professionals, the implications of such an attack are profound. The disruption of claims processing and reimbursement flows can lead to significant financial instability, erode trust with providers and patients, and jeopardize the overall operation of healthcare systems.

This presentation will explore the cyberattack’s key lessons and explore actionable
strategies for safeguarding your organization against similar threats. While no solution is foolproof, the industry must prioritize not only prevention but also rapid recovery, ensuring that clearinghouses and billing systems can maintain continuity even in the face of severe cyber threats.

Key topics include:

1. The Current Cybersecurity Landscape in Healthcare:

• An overview of the most prevalent cyber threats targeting healthcare organizations today, with a specific focus on their impact on revenue cycle operations.
• Insights into how recent high-profile breaches have affected patient data security and disrupted healthcare financial processes.

2. Regulatory Compliance and Standards:

• Understanding the critical regulations that govern healthcare data security, including HIPAA and HITECH, and their specific relevance to revenue cycle management.
• Best practices for maintaining compliance, developing redundancy, and implementing resiliency initiatives to ensure uninterrupted claims processing and reimbursement.

3. Developing Robust Security Frameworks:

• Strategies for integrating comprehensive security policies into the revenue cycle management workflow.
• The importance of continuous monitoring, leveraging threat intelligence, and implementing effective incident response planning to protect financial operations and patient data.

By advocating for a holistic approach to cybersecurity that involves all stakeholders and leverages cutting-edge technologies, this presentation will provide a comprehensive roadmap for revenue cycle leaders. The goal is to transform cybersecurity practices within their organizations, ensuring a more secure, efficient, and trustworthy healthcare system. In doing so, they can protect sensitive patient information, maintain regulatory compliance, and secure the financial health of their organizations—ultimately benefiting the entire healthcare ecosystem.

Course Participants will be able to:

• Equip healthcare leaders with actionable strategies to enhance their cybersecurity posture.
• Highlight the significance of regulatory compliance and adherence to industry standards.
• Demonstrate the value of building resilient health data systems to ensure continuity and reliability.

What Every Revenue Cycle Leader Needs to Know About Cybersecurity Part 2 Presented by Mike Green

In February 2024, the healthcare sector was shaken by one of the most devastating cyberattacks in its history. For weeks, millions of patients were unable to fill prescriptions or schedule critical care, while hundreds of thousands of providers struggled to submit claims or receive reimbursements. This catastrophic event underscored a stark reality: even the most comprehensive risk mitigation strategies are insufficient without an equally robust incident response plan.

For revenue cycle leaders and billing professionals, the implications of such an attack are profound. The disruption of claims processing and reimbursement flows can lead to significant financial instability, erode trust with providers and patients, and jeopardize the overall operation of healthcare systems.

This presentation will explore the cyberattack’s key lessons and explore actionable
strategies for safeguarding your organization against similar threats. While no solution is foolproof, the industry must prioritize not only prevention but also rapid recovery, ensuring that clearinghouses and billing systems can maintain continuity even in the face of severe cyber threats.

Key topics include:

4. Potential Cybersecurity Regulations for Healthcare Clearinghouses:

• A look into the latest regulatory developments aimed at enhancing the cybersecurity posture of healthcare clearinghouses and billing companies.
• How these regulations, if implemented, will affect revenue cycle management and what steps organizations should take to comply.

5. Building Resilience in Health Data Exchange:

• Techniques for ensuring the resilience of health data systems against cyber threats, with a focus on maintaining the integrity of financial transactions.
• The role of accreditation and certification in strengthening data exchange infrastructure, with an emphasis on organizations like DirectTrust.

6. Fostering Trust Among Stakeholders:

• The importance of transparency and proactive communication in building trust with patients, providers, and payors.
• How revenue cycle leaders can engage stakeholders in cybersecurity efforts, leveraging technology to enhance trust and secure financial data exchanges.

By advocating for a holistic approach to cybersecurity that involves all stakeholders and leverages cutting-edge technologies, this presentation will provide a comprehensive roadmap for revenue cycle leaders. The goal is to transform cybersecurity practices within their organizations, ensuring a more secure, efficient, and trustworthy healthcare system. In doing so, they can protect sensitive patient information, maintain regulatory compliance, and secure the financial health of their organizations—ultimately benefiting the entire healthcare ecosystem.

Course Participants will be able to:

• Equip healthcare leaders with actionable strategies to enhance their cybersecurity posture.
• Highlight the significance of regulatory compliance and adherence to industry standards.
• Demonstrate the value of building resilient health data systems to ensure continuity and reliability.

Speaker Bio:
Mike Green is an engaging and innovative information technology, security, and risk professional with over 20 years of experience in diverse global roles. He served as the Global Leader for Threat Intelligence and Security Operations at Deloitte for a decade, where he developed Deloitte’s Global OSINT and threat research organizations, providing essential service solutions to firms and clients. Mike has also contributed as an AI Leadership Council Member at Ai4 and is a full-time Commissioner at EHNAC, which sets standards and accredits organizations that exchange healthcare data.

Currently, as the Chief Information Security Officer at Availity, Mike leads the creation and implementation of robust security strategies and policies that align with Availity’s mission to facilitate secure and efficient healthcare data exchange. He ensures compliance with industry regulations such as HIPAA, HITECH, and other relevant standards, conducting regular audits and assessments. Additionally, Mike oversees the execution of incident response plans, ensuring swift and effective management of security breaches.

Recently, Mike played a pivotal role in developing proposed regulations presented to Congress, aimed at enhancing the cybersecurity posture of clearinghouses and strengthening the resilience of our healthcare infrastructure against cyberthreats. His efforts are instrumental in advancing national security measures and safeguarding sensitive healthcare data from emerging threats.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Using AI to Reduce the costs of the RCM Billing and Pre-Certification Processes, while Increasing Revenues Presented by Steven Chamberlin

We will discuss how utilizing AI in the RCM process and how it is making dramatic differences in how fast and how much more providers are being paid. He will discuss how the AR days have effectively been cut in half due to AI filing claims in exactly the way each individual payor wants to see them. Since denials go way down, providers are getting paid so much faster and at higher rates, due to AI adjusting filing as payors requirements change.

Additionally, he has been able to go back to previous denials and get those paid as well by utilizing the power of AI. He will discuss how AI will and has changed the Pre-Approval / Pre-Certification process.

All of these areas have dramatically reduced time to get paid and increased the amounts paid all while using less labor to do so. The power of AI will transform the whole Billing, Pre-Approval / Pre-Certification dramatically reducing labor costs, halving AR days, all while increasing revenues. Using AI in the RCM, and Pre-Certification / Pre-Approval process will change the health care industry in big ways and all for the better for, Providers, Payors and Patients, all while reducing costs and increasing revenues.

Course Participants will be able to:

• Understand how AI will reduce the costs, and halve the AR Days Outstanding of RCM while increasing revenues.
• Understand how AI will speed up and reduce costs associated with the Pre Certification Process.
• Understand how AI will speed up the Arbitration Process while reducing costs.

Speaker Bio:
Steven Chamberlin was a Technical Executive at PeopleSoft and Oracle for 10 years, and left to found Sensa Analytics in 2014. His vision of the company was to provide the most current and insightful information to Health Care Executives to more effectively manage the daily operations of Hospitals, Clinics or even Doctors offices. This has helped them to make the most impactful decisions in order to provide the highest quality health care available.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Can AI Heal the Wounds Between Payors and Providers? Presented by Jonathan Wiggs

Let’s be honest, the relationship between payors and providers has never been easy. For decades, providers have been critical of the administrative burdens associated with getting paid, yet for the most part, these burdens persist. Can and will artificial intelligence be the solution we so desperately need?

In this session, we will explore the answer to that very question. In the process, we will debunk myths surrounding artificial intelligence, explore current uses cases and look ahead to what the future holds.

Course Participants will be able to:

• Evaluate artificial intelligence to solve for administrative burdens and staffing constraints within medical billing and claims management
• Identify the kinds of tasks and transactions most amenable to artificial intelligence
• Advocate for use of artificial intelligence to reduce tedium, allow greater focus on high value work, and improve employee retention and well-being
• Apply the concepts of human-agent teaming
• Set appropriate expectations surrounding the implementation of artificial intelligence
• Overcome fears that artificial intelligence will replace jobs and/or create havoc in the workplace
• Structure key performance indicators and calculate the economic ROI of implementing artificial intelligence

Speaker Bio:
Jonathan’s career in engineering leadership spans more 30 years with private and public companies ranging from small startups to established global leaders. He currently serves as co-founder and Chief Technology Officer of Outbound AI, where he oversees development of the company’s applied AI technology platform and AI-as-a-Service solutions as well as the maintenance, support and security of the company’s infrastructure and networks. Directly prior, Jonathan spent seven years as VP of Engineering & Architecture at Avalara. Earlier positions include Manager of Research Operations & Analytics at Nuance, where he directed the development of language models for Siri, Product Group Director & Senior Architect at NetMotion Wireless, Principal Engineer & Architect at Jott Networks, and Software Engineering Manager at Envision Telephony. Jonathan is an author on five U.S. patents related to speech recognition and interoperability.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Human-Generated Data: The Missing Link in AI-Powered Revenue Cycles Presented by Matt Seefeld

Adoption of automation, analytics and AI to streamline and improve revenue cycle functions remains a top strategy for healthcare organizations. A 2023 McKinsey analysis points to significant cost savings associated with these efforts. Yet many financial leaders are overlooking a critical opportunity due to the limitations of their existing technology stack: the power of “human-generated” data.

Existing infrastructures for revenue cycle processes in most organizations are limited to analyzing “common data,” such as information related to denials and claims status. This leaves out a critical influencer of success—the touchpoints of staff members and the effectiveness of their work. Without this information, financial leaders are missing visibility into insights that could significantly improve processes and operational margin by reducing the administrative waste associated with getting claims paid.

Attendees of this presentation will learn the power of applying automation and AI to both common and human-generated data via a case study presentation that showcases the journey of Future Care Consultants, a leading healthcare management company servicing hundreds of provider clients nationwide. Presenters will demonstrate how the organization went from managing staff worklists in spreadsheets to having full visibility into the staff productivity and effectiveness.

Additionally, attendees will learn how the organization leveraged revenue cycle workflow and financial clearance automation tools—applying AI to both common and human generated data—to achieve a 40% reduction in administrative waste in the revenue cycle. The new strategy which incorporates generative AI to better inform the workflows and RPA solutions to automate repetitive manual tasks expedited collections and improved overall margin by reducing the number of “touches” it takes to get a claim paid

Course Participants will be able to:

• Explore the opportunities of using automation and AI in revenue cycle functions and why it should be a top consideration
• Define the differences between common data and human-generated data and why both are critical to optimizing revenue cycle processes
• Analyze the data limitations of today’s practice management and EHRs and the importance of deploying infrastructures that can support greater insights into staff touch points along the revenue cycle
• Detail how one managed services organization improved processes by implementing workflow automation and effective intelligence solutions that support visibility into human generated data

Speaker Bio:
Matt Seefeld oversees all revenue operations for MedEvolve including marketing, sales, implementation, support and client success. Additionally, Matt continues to be the lead visionary and strategist around the Effective Intelligence workflow automation, task management and analytics.

He brings 25 years of management consulting experience in the healthcare industry. Matt has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle. Matt began his career with Stockamp & Associates, Inc. and worked for both PricewaterhouseCoopers LLP and Deloitte Consulting LLP in their healthcare and life sciences practice lines. In 2007, he developed a business intelligence and workflow automation solutions and founded Interpoint Partners, LLC, where he served as Chairman and Chief Executive Officer. In 2011, he sold his business to Streamline Health Solutions where he then served as Chief Strategist of Revenue Cycle followed by Senior Vice President of Solutions Strategy until 2014.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

The Dark Side of Innovation: The Weaponization of AI in RCM Part 1 Presented by Landon Tooke

This presentation explores how cybercriminals weaponize artificial intelligence technologies to threaten Revenue Cycle Management cybersecurity. It examines how bad actors use AI to target healthcare data and RCM systems, employing advanced phishing techniques, developing exploits with generative AI, and leveraging deepfake technology for healthcare identity theft and fraud. Landon will analyze AI-integrated hacking tools designed to breach RCM systems, as well as AI-enhanced malware and social engineering tactics. The discussion will cover recent advancements in password cracking and evasion techniques, and how attackers use AI to discover vulnerabilities in RCM platforms. To counter these threats, the presentation will explore defensive strategies, including AI-driven security measures and staff training approaches.

Course Participants will be able to:

• Understanding of AI's role in evolving cyber threats
• Awareness of specific vulnerabilities in RCM systems
• Insights into defensive strategies and best practices
• Perspective on the ethical implications of AI in healthcare security

The Dark Side of Innovation: The Weaponization of AI in RCM Part 2 Presented by Landon Tooke

We will address ethical considerations in AI development for healthcare and examine future trends such as autonomous attack systems and quantum computing threats. This session aims to equip the audience with a comprehensive understanding of AI's role in evolving cyber threats. Attendees will gain awareness of specific vulnerabilities in RCM systems, learn defensive strategies and best practices, and develop perspective on the ethical implications of AI in healthcare security. The knowledge gained will help participants enhance their cybersecurity preparedness in an increasingly AI-driven threat landscape.

Course Participants will be able to:

• Understanding of AI's role in evolving cyber threats
• Awareness of specific vulnerabilities in RCM systems
• Insights into defensive strategies and best practices
• Perspective on the ethical implications of AI in healthcare security

Speaker Bio:
Landon Tooke is the COO and Chief Compliance Officer of Impact Healthcare Solutions. He has over 23 years of experience in hospital administration, sales, compliance, cybersecurity, medical practice management, and revenue cycle management. Landon is also an attorney practicing in health law, elder law, cyber law, regulatory compliance, tech law, business law, privacy law, intellectual property, and dispute resolution.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Transforming RCM: How AI is Revolutionizing Revenue Cycle Management Presented by Vinod Sankaran

In today's rapidly evolving healthcare landscape, physician practices, Hospitals and revenue Cycle Companies face mounting pressure to optimize operations, streamline workflows, and maximize revenue. Traditional methods are no longer enough. That's where Artificial Intelligence (AI) comes in.

This session will delve into the transformative potential of AI, showcasing how this cutting-edge technology can revolutionize operations in every aspect, including:

• Enhanced Patient Care: AI-powered tools can analyze medical data to predict patient needs, personalize treatment plans, and automate administrative tasks, freeing up valuable time for doctors & their staff to focus on what matters most – their patients.
• Streamlined Revenue Cycle Management (RCM): Say goodbye to tedious billing and coding errors. AI can automate Coding, claim submission, identify denial risks, and even negotiate insurance payments, boosting your client’s financial health.
• Improved Operational Efficiency: From scheduling appointments to managing inventory, AI can automate repetitive tasks, minimize human error, and optimize resource allocation, leading to a smoother, more efficient practice for your clients. 

Course participants will be able to:

1. Discover the latest AI applications specifically designed for healthcare, especially for RCM companies and their clients. 
2. Learn how AI can enhance patient care, streamline RCM, and boost operational efficiency.
3. Gain insights into the real-world benefits and challenges of implementing AI in your company and your client’s practice. 
4. Example of how to use available generative AI applications to draft emails, and appeal letters to insurance companies. Also, do market research and get a list of potential practices and help with sales. 

Speaker Bio:
Vinod (Vinny) Sankaran is a seasoned leader with 20 years of experience in operations, financial analysis, strategy, business development, sales and marketing. As the CEO and Founder of Medical Billing Wholesalers (MBW), Vinny leverages his extensive background to optimize revenue cycle processes, enhancing profitability and performance for clients across the healthcare industry.

Since co-founding MBW in 2010, Vinny has played a pivotal role in expanding the company from a small team of 3 employees to a robust organization with over 400 employees. Under his leadership, MBW now operates multiple locations in the US, with delivery centers in India.

As CEO, he drives company growth, spearheads new client acquisition, and integrates cutting-edge technologies to boost revenue and profitability. Vinny holds dual master's degrees in Quantitative Finance and Industrial Engineering from Oklahoma State University. He also holds certifications in AI for Business from Wharton and Digital Marketing, Customer Engagement, Social Media, Planning & Analytics from Columbia University.

In his personal life, Vinny is an avid traveler, having explored over 60 countries. He also has a passion for kickboxing and enjoys teaching it as an instructor in his spare time.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Unlocking Revenue Potential: How Automation and AI can Transform RCM Presented by Sara Nofziger-Drew

As Revenue Cycle Management (RCM) companies face financial pressures from lower insurance payments, competitive and client rate reductions, rising wages, and increasing operational costs, the need for effective automation has never been more critical. Leveraging technologies through automation such as Robotic Process Automation (RPA), Large Language Models (LLM), Machine Learning (ML), generative AI, and advanced analytics can significantly enhance revenue cycle performance and optimize human capital expenditure.

This presentation will explore how automation improves efficiency, enhances accuracy, boosts patient satisfaction, and accelerates revenue generation. Attendees will learn how to assess their organization’s readiness for automation, identify specific processes that can benefit from AI integration, and successfully initiate the transformation of their revenue cycle processes. Additionally, we will discuss the essential criteria for evaluating and selecting the right AI path for your organization. Join us to discover the practical steps necessary for revolutionizing your revenue cycle workflow through automation.

Course Participants will be able to:

• Assess Automation Readiness: Understand how to evaluate your company’s current capabilities and readiness for implementing automation solutions.
• Identify Key Processes: Explore critical revenue cycle processes that are prime candidates for automation deployment and expansion, ensuring targeted and effective integration.
• Launch Automation Successfully: Learn strategies for effectively launching identified automation processes, ensuring a smooth transition, and maximized impact on revenue cycle performance.
• Select the Right Solutions: Discover four essential criteria to consider when choosing AI and automation solutions and partners, enabling informed decision-making for successful implementation.

Speaker Bio:
Sara Nofziger-Drew is an experienced Revenue Cycle Management (RCM) executive with more than 28 years of experience in the healthcare industry. Her expertise includes driving operational and financial performance improvements through the implementation of best practices, process optimization, and technology solutions. Throughout her career, Sara has held various leadership roles in revenue cycle management, including owning an RCM company and working for other RCM companies. Sara has also provided consulting services to physician practices, RCM organizations and offshore entities, offering guidance on how to improve their financial and operational performance.

Her specialized areas of consulting and coaching expertise include: operational assessment and efficiencies; re-engineering office processes and procedures; vendor-client relationship optimization and resolution liaison specialist; RCM and Innovation technology vendor selection and implementation; practice management; new practice and RCM startups; vendor selection; credentialing/enrollment; contracting; fee schedule development and analysis; business process outsourcing – selection, implementation and management; quality assurance; audit as well as billing and collections.  

She is committed to advancing the healthcare industry's financial performance and believes that effective revenue cycle management is a critical component of achieving this goal. As an RCM executive speaker, Sara looks forward to sharing her insights and expertise with healthcare organizations looking to optimize their revenue cycle operations and improve their financial outcomes. Her speaking style is engaging, informative and practical, and Sara strives to ensure that her audiences leave with actionable insights that can be applied to their organization immediately.

Sara’s educational background includes a Bachelor of Science in Business Administration with a concentration in Marketing. Sara is a CHBME with HBMA, where she serves on the Board of Directors, is Chair of the Membership Committee and serves on the Government Relations and Education Committees. For RBMA, Sara serves on the Federal Affairs committee and co-chairs the Virtual Education Committee. Further, she serves on the AHRA Regulatory Affairs Committee. Sara holds certifications from the AAPC of CPC, CPB, and CPPM. She is a past member of MGMA, HFMA and past chair of the Oregon HFMA Certification Committee.

As presented at HBMA's Innovation Conference March 12th-13th, 2025.

Panel: Revolutionizing Revenue Cycle Management: Addressing Pain Points through AI, Automation, and RPA Presented by Kyle Tucker

Panel Members: Jonathan Gerber, John Gwin, Kothand Rajangam, Vinod Sankaran, Sam Schwager

Join a distinguished panel of RCM leaders, RCM company owners, and cutting-edge technology vendors specializing in automation, Robotic Process Automation (RPA), and Artificial Intelligence (AI) as they explore the most pressing challenges in the Revenue Cycle Management (RCM) industry. 
 
This dynamic session will showcase how innovative solutions such as AI agents, bots, predictive analytics, and intelligent automation are transforming RCM processes. Through actionable insights and real-world examples, panelists will discuss strategies to alleviate top pain points—ranging from manual data entry and real-time claim tracking to denial management and patient payment processing—offering a roadmap to optimize efficiency, accuracy, and revenue outcomes.

Course Participants will be able to:

• Identify Key Challenges: Provide a comprehensive overview of the most critical pain points faced by RCM professionals, including inefficiencies in workflows, denial management, patient payments, and cybersecurity concerns.
• Explore AI and Automation Solutions: Demonstrate how advanced AI technologies, RPA, and automation tools can address these challenges, improve operational efficiency, and enhance financial performance.
• Showcase Real-World Applications: Highlight examples of how RCM organizations have successfully implemented AI-driven solutions to streamline workflows, reduce errors, and accelerate cash flow.
• Discuss Future Trends: Analyze emerging trends, including predictive analytics, intelligent claim tracking, and fraud detection, and their potential to revolutionize RCM processes.
• Provide Actionable Takeaways: Equip attendees with practical insights and strategies to implement AI and automation solutions in their organizations, enhancing productivity and profitability. 

Speaker Bio:
Kyle Tucker is the CEO of Dexios Radiology Billing and an Imagine user since 2009. Kyle is a frequent speaker on RCM metrics at PaRADigm. In his free time, Kyle works with a non-profit acquiring and restoring historically or architecturally significant homes/buildings.