During a featured session at Becker's 21st Annual Spine, Orthopedic and Pain Management-Driven ASC +The Future of Spine Conference, Reid Zeising, founder and CEO of Gain, discussed the company's mission, payer trends and complex claims.
Mr. Zeising highlighted various challenges faced by medical practices and surgery centers, including declining reimbursements, rising costs of delivering care and shifting payer requirements. He highlighted the benefits of using Gain's platform, such as increased collections, reduced write-offs, and simplified communication with law firms and insurance carriers.
Individuals involved in personal injury litigation often struggle to get access to healthcare due to insurance and legal complexities. Gain was founded to help patients injured through no fault of their own get access to quality medical care.
Three takeaways from the session:
Note: Quotes have been edited for length and clarity.
1. Declining reimbursements and payer complexity pose significant challenges for ASCs.
"The financial strain facing providers is so challenging right now because they're dealing with government and commercial payer sources declining reimbursements year over year. Providers have to navigate this while also dealing with the rising cost of care delivery." - Reid Zeising
2. Revenue cycle management for complex claims — which can require extensive documentation, high-cost treatments and navigating medical lien collections — presents healthcare providers with a unique set of challenges.
"When it comes to revenue cycle processes for personal injury patients, there is a lack of billing software that effectively manages letters of protection. Maybe you've modified your EHR and added 'personal injury' as a payer source and you've got a billing company that is trying to get you status updates, but this is not effectively managing those receivables." - Reid Zeising
3. In addition to RCM management for complex claims, Gain offers ASCs several services and solutions.
"Our platform and services do several things. Our platform makes your bills, notes and records easily available. Our partners also become part of the largest provider map in the nation where patients with personal injury cases can still access care. And we connect attorneys and healthcare providers to increase efficiency and reduce insurance defense risks for personal injury cases." - Reid Zeising
To learn more about Gain and its services, click here.