Dr. Eric Bricker is an internal medicine physician and Chief Medical Officer at ‪AHealthcareZ, a popular healthcare finance YouTube channel.

In this episode, Eric and Zack break down revenue cycle management (RCM), the flow of money in U.S. healthcare.

They cover how healthcare plans are funded, how Medicare Advantage differs from traditional Medicare, how eligibility checks work, medical coding, and why what doctors bill insurers isn't what they're paid.

• (00:00) - Intro
• (00:31) - Starting the AHealthcareZ YouTube channel
• (02:03) - The clinical vs. administrative sides of healthcare
• (04:05) - When does clinical care transfer to administration?
• (06:00) - The four buckets of funding
• (09:10) - The shift to Medicare Advantage
• (11:20) - How real-time eligibility checks are used
• (14:13) - The history of real-time eligibility checks
• (15:54) - Why insurance verification still relies on phone calls
• (17:24) - Traditional Medicare and MACs
• (18:45) - Medicare Advantage
• (19:17) - What is capitation in healthcare billing?
• (21:22) - Why traditional Medicare claims are easier to process
• (22:28) - How medical coding and billing work
• (26:22) - Why medical coding is so complex
• (27:05) - Upcoding in medical billing
• (28:17) - What is charge capture?
• (29:13) - Billed vs. allowed amounts in healthcare billing
• (30:41) - Why billed and allowed amounts differ
• (32:52) - What is repricing?
• (34:14) - Why small practices sell to hospital systems
• (35:04) - How AI and RCM tools are changing small practices
• (37:26) - How much of revenue cycle management (RCM) can be automated?
• (41:07) - Insurance float and why it matters
• (41:56) - The economic impact of more efficient RCM
• (43:28) - Patient responsibility and out-of-pocket costs
• (45:26) - What Stedi customers are building
• (46:05) - What Dr. Bricker would change about RCM

AHealthcareZ videos related to this episode:

• Revenue Cycle Management in Healthcare Explained: https://www.youtube.com/watch?v=rqdWr9ynZ_o
• Do Insurance Carriers Want Healthcare Costs Up or Down? https://www.youtube.com/watch?v=ELyvOLkxADU
• Traditional Medicare vs Medicare Advantage vs Medicare Part D vs Medicare Supplement Explained: https://www.youtube.com/watch?v=KRzBxPj-eQk
• Healthcare Uncovered Ep 2: Denied Requests: Medicare Advantage and the Rise of Prior Authorizations: https://www.youtube.com/watch?v=5hwCF1HPjOI
• Medical Coding Overview: https://www.youtube.com/watch?v=fqNBNE_YSro
• Health Insurance Claims Adjudication: https://www.youtube.com/watch?v=bM9e2EPUg0g
• Health Insurance Claim Repricing: https://www.youtube.com/watch?v=u8upoDe0nwI
• Hospital Chargemaster Explained: https://www.youtube.com/watch?v=2PUwLXW2-sw
• Insurance Float Explained: https://www.youtube.com/watch?v=WBOYDnPfkUU
• Patient Out-of-Pocket Healthcare Costs Explained: https://www.youtube.com/watch?v=ilfgZiJNwyM
• Hospital Finance Explained: https://www.youtube.com/watch?v=O1CGDi50Nys