Meet Brian McGraw, the President & CEO of Intersect Healthcare and the Denial Research Group (AppealMasters). As a fierce advocate for hospitals and physicians in their right to be fully paid, he consults with and educates revenue cycle and compliance leaders throughout the U.S. on government and commercial claim dispute resolution management. The denial technology and revenue recovery methods he designed are currently used by over 300 hospitals and health systems nationwide.
He is a nationally recognized speaker and sought-after expert in Revenue Risk Management, Regulatory Audit Management, and Payer Compliance. Brian pioneered the early design and development of BPM software for revenue compliance and next-generation RCM technology to improve hospital net revenue performance. Over the last twenty years, he has worked with hundreds of hospitals and many of the nation’s largest healthcare systems to improve their managed care reimbursements, denied claim recoveries, billing integrity, RAC audit management, and Medicare compliance. Each firm is a national leader in appeal support services and next-generation Denial/Appeal Management categories.
Hi, I’m Brian McGraw, and I’m the founder and CEO of Intersect Healthcare and Appeal Masters located in Towson, Maryland. Well, I think what made me want to start intersect healthcare was that there was a disparity between organizations that were delivering care and not being reimbursed for services they had delivered, and organizations that were denying either levels of care or payment on services that had already been rendered. And to me, it really seemed like an unfair proposition that these not for profit organizations who are serving their communities were in fact being terribly affected by denying claims, whether it’s for medical necessity, some technical reason that the insurance company found a way not to pay. And so I, my moral compass took me there and said, there has to be a way to support these organizations that are delivering care to their communities. And frankly, I didn’t think it should be the decision that the insurance companies should even be making. To me, it makes perfect sense that the treating physicians should be the one that defines whether or not a patient needs to be in observation or in an inpatient setting, it shouldn’t be the choice of the insurance company. And so I started to develop tools that would assist in that process of fighting back and leveling the playing field, utilizing evidence based guidelines, utilizing federal statutory and contract law that would really give the provider a little bit better of a chance to recover on an inappropriately denied claim. Well, I think what makes us unique is that we have developed an effective technology that interfaces with equally with any patient accounting system, that also brings in disparate data sources into a data mine that allows us to develop process engineering around the data, using Boolean logic and using stages, tasks and timeframes. This is something most organizations do not have. They don’t have an agile, nimble technology, to re engineer a process quickly, to be able to identify a workflow process, respond to it, make it actionable, and then make everyone accountable for getting the work done. The interesting thing about our technology is that really does connect multiple departments that are involved in the denial and appeals process, whether it be health information management, revenue cycle, utilization, management, compliance, and revenue integrity. They’re all in one central repository in one central, what’s called a platform that ensures that they are being paid for the work that they’ve been done. So that’s unique there, there isn’t any other technology like it in the marketplace. And so we’re very proud of our position, that it can assist and serve these not for profit organizations.
The advice I would give to health care hospital and health system providers today is ensure that you have within the confines of your agreement, language that’s protects you in terms of audit limits, similar to what the RAC statement of work can encourage you to utilize your dispute resolution clauses if in fact, an insurance company upholds a denial that you feel is egregious Lee wrong. Make sure you go all the way. And if there’s one thing to use their internal grievance process, there’s another to ensure that if you are convinced that that was a reimbursable service, and that you’re unfairly being denied, you should be able to go to some independent review organization external review, or utilize the dispute resolution processes in your contractual agreements. Not enough providers are doing that. I am beginning to see a switch in managed care departments becoming a bit more protective of the hospitals right to be paid. So again, that’s my advice is make sure you consider language that protects the organization in all parts of your contracting. And that might include independent review, independent decision making, when it comes to what’s right and what’s wrong in the payment of a claim. So that’s that’s the advice I would give my provider client
