AI Versus People in RCM

Episode Summary

In this episode of Get Agrippon Claims, hosts Shane Billings and Brad Billings sit down with Keenan Toward, an operations and billing leader. They explore how teams get stuck in duct-tape workflows and why “catching up” keeps you buried.

Keenan argues that tools must match culture. Spreadsheets, email threads, and whiteboards hide work, break handoffs, and create HIPAA and remote problems. When one key person leaves, the office loses context and momentum. A shared system should show who touched a claim last, what comes next, and where the team left off.

The conversation turns to reporting. Keenan explains how analytics spot repeat errors, like missing perio charts on comprehensive exams, so leaders can coach once and cut rework. He ties time to dollars by surfacing open balances, including $30,000 on stalled claims. The fix starts with a choice: drop low-priority tasks long enough to build the process across the office.

Key Insights

Stop chasing “catch-up” and build the system

Running buried feels productive. It isn’t. Constant catch-up locks the team into the same cycle of late claims, messy follow-up, and missed handoffs. The way out starts with a hard trade: protect patient experience and clinical quality, but pause lower-value tasks long enough to build process. That can mean letting insurance follow-up sit for a short window while you set a new workflow, train a backup, or clean up the handoff rules. The goal isn’t perfection this week. The goal is to reduce the work next week. When a process cuts a task down to one-eighth of the time, you don’t just “get time back.” You change what the team can reliably finish every day.

Your tools have to match your culture

A “structured culture” can’t run on sticky notes, scattered emails, and whiteboards. Those tools hide ownership, bury context, and break the moment someone works remote or steps out for a day. They also create compliance risk when patient details sit in plain view or travel through untracked channels. Strong operations need a single place where communication lives with the work. Each item needs a clear owner, a last touch, and a next step. That record matters most when turnover hits. One key person leaves, and the office shouldn’t lose the map. A shared system turns tribal knowledge into a process the next person can pick up without guessing.

Use reporting to fix repeat errors once

Most teams try to manage quality by checking everything. That burns time and still misses patterns. Reporting flips the approach. Start with volume. Find the top reasons work bounces back and fix those first. Missing perio charts on comprehensive exams is a clean example. It forces back-and-forth with clinicians, delays submission, and ties up accounts receivable (AR) time that never earns revenue. A simple coaching moment, backed by data, removes the error at the source. The same reporting ties time to money by showing what sits open while teams wait on actions. When one repeated issue stalls $30,000 in claims, it stops being “an ops problem.” It becomes a cash problem with a clear fix.