Archives: Interviews

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

Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield. Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases, and presented hundreds of cases at the Administrative Law Judge level.

Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.

I’m Denise Wilson and I am a Senior Vice President at Intersect Healthcare and Denial Research Group. And my role really is to provide support for the clinical team, the clinical team that’s doing actually the the writing of the appeals that we do for intersect healthcare and appeal masters, I kind of help guide us to what is our best practices, help develop what kind of tools we need to get our job done successfully. And make sure that education is on point for our team making sure we’re putting out good quality work, and that we’re being successful for our clients.

So the work that we do in revenue cycle for healthcare providers is important because anytime anyone provides services or products to customers, you deserve to get paid appropriately and in a timely manner. And it’s no different in healthcare. When hospitals or physicians or other health care providers provide medical services to folks in the community, they deserve to be paid appropriately and timely for those services provided. Now it’s a little different in healthcare, because they rely very heavily on insurance companies, medical insurance companies to make those payments and to reimburse them for the services that they provide. Because if they don’t, then that impacts their ability to provide the necessary medical services in the community. So what we do is we advocate for fair and timely compensation on behalf of healthcare providers. And we assist those health care providers in ensuring that the partnerships that they have with those insurance providers that that partnership is providing equitable benefits to the patient, as well as the provider as well as the insurer. So that’s why the the work that we do is so important.

I got into appeal writing accidentally, as I think a lot of people do who work in this industry. So I went to work for a management consulting company. And they were faced with some denials, they were seeing for the services, they are providing these denials, were coming from Medicare. And so I learned while I was working for this company from the nurse who was doing appeals before me who learned from the nurse who was doing the appeals before her, Yes, I just fell into it. But I found that it was interesting work, because I could put my clinical background, my clinical experience to use even though I wasn’t working clinically, to help, you know, ensure that hospitals were being reimbursed correctly. And so it’s a little bit of that, you know, standing up for the hospital standing up for the patient, and making sure that the rules are being followed on both sides, you know, by the hospital and by the provider. And that’s what made it interesting. And when you would see the insurance company actually pay and say, okay, yeah, we agree with you, you’ve you know, you’ve made a good argument, and we agree with you, and we’re gonna pay for those services. It just made you feel like you, you did a good thing.

So what makes intersect healthcare and appeal masters unique from other companies is that from the time the company was created, we have focused on advocating for and assisting our healthcare providers in obtaining appropriate reimbursement for services they provide. So that doesn’t stop with just installation of our software or outsourcing of appeal work to the company. We work with our clients. We collaborate with them to understand what their unique situation is, what their unique set of Payers are, what are the pain points that they’re experiencing? What are the obstacles that they need to overcome? And we work with them as a partner to help provide those solutions to help provide education and not just be seen as an outsourcing agency or the software company that assist them in their revenue cycle.