Understanding Healthcare with Zack Kanter

Patient referrals with Dr. Will Morris

Stedi — Wed, 18 Mar 2026 07:44:08 -0400

Dr. Will Morris is Chief Medical Officer at Tennr. He's also a practicing hospitalist, a former hospital CIO, and former Chief Medical Officer at Google.

In this episode, Will explains how Tennr manages the full referral lifecycle from the receiving provider's perspective, why most referrals end up in a black hole for patients, and how intelligent triage and closed-loop communication can match patients to the right provider at the right time.

00:00 Introduction

01:47 What does Tennr do?

02:42 What is the self-pay referral experience like?

05:48 Is waiting for "Dr. Famous" always the right move?

06:24 What's the difference between a formal and informal referral?

11:13 Why do referrals disappear into a black hole?

13:34 How does closing the referral loop benefit everyone?

17:41 Can Tennr solve the Dr. Famous wait time problem?

24:44 What is "The Goal" and why does it apply to healthcare?

34:01 What does a Tennr implementation actually look like?

36:44 Do health systems that use Epic already have this solved?

40:11 If you could change one thing about RCM, what would it be?

Learn more about Tennr: https://tennr.com
Connect with Dr. Morris on LinkedIn: https://www.linkedin.com/in/mowilliam/

Credentialing explained with Varun Krishnamurthy

Stedi — Thu, 05 Mar 2026 07:24:49 -0500

Varun Krishnamurthy is the co‑founder and CEO of Assured Health, an AI-powered provider credentialing and enrollment platform.

In this episode, Zack and Varun talk about credentialing – how insurers check that a healthcare provider is qualified to practice. They cover how provider credentialing works, the bottlenecks it can cause, and how to improve it.

0:00 - Intro
0:44 - How Varun started Assured Health
1:57 - How long does it take for a provider to take insurance?
3:26 - Does provider experience speed up onboarding?
4:20 - How Dawn Health led to Assured Health
7:31 - What must a provider do to accept insurance?
9:11 - Is there a single application for credentialing?
12:15 - How complex is credentialing, really?
15:29 - What else besides credentialing do you need to accept insurance?
18:02 - How do you keep provider data current?
19:51 - Is credentialing a major bottleneck for providers?
22:18 - Credentialing vs. provider enrollment vs. transaction enrollment
25:17 - What are closed panels and why do they matter?
26:30 - When does a credentialing service make sense?
31:05 - What are the steps for credentialing?
34:32 - How can you tell if a provider is already enrolled for insurance?
38:13 - Has anyone tried to standardize credentialing?
40:03 - What Varun would change about RCM

Learn more about Assured Health: https://www.withassured.com/
Connect with Varun on LinkedIn: https://www.linkedin.com/in/varunakrishnamurthy/

Referenced in this episode:
- "Reality has a surprising amount of detail" by John Salvatier: http://johnsalvatier.org/blog/2017/reality-has-a-surprising-amount-of-detail
- "Estonia, the Digital Republic" by Nathan Heller: https://www.newyorker.com/magazine/2017/12/18/estonia-the-digital-republic
- Aadhaar (India's National ID system): https://en.wikipedia.org/wiki/Aadhaar

Payer enrollment with Megan Struxness

Stedi — Thu, 05 Feb 2026 08:42:43 -0500

Megan Struxness is Head of Payer Operations and Revenue Cycle Management at Bridge, a healthcare platform that helps telehealth providers accept insurance nationwide.

In this episode, Megan and Zack discuss payer enrollment – the industry term for what healthcare providers need to do to accept insurance.

They cover payer contracting, credentialing, what superbills are, how out-of-network claims work, and how small operational details – like enrollment and eligibility checks – determine what providers actually get paid.

Watch on YouTube: Click here to watch a video of this episode.

(00:00) - Intro
(00:27) - What is Bridge?
(02:20) - How Bridge helps providers accept insurance
(04:36) - Can a brand new practice work with Bridge?
(07:31) - What is an EMR?
(10:27) - What it takes for a provider to accept insurance
(13:15) - What are super bills?
(15:41) - How out-of-network payments work
(18:35) - What is payer enrollment?
(22:41) - The alternative to self-managing revenue cycle management (RCM)
(28:50) - How does Bridge onboard providers in 45 days?
(32:44) - What are MSOs?
(37:05) - Why eligibility checks can’t guarantee payment
(41:42) - What is guaranteed payment?
(44:48) - The source of truth for provider contracts
(51:36) - What would Megan change about RCM?

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Learn more about Bridge: https://www.usebridge.com/
Connect with Megan on LinkedIn: https://www.linkedin.com/in/megan-struxness-79962866/

Referenced in the episode:
- "Reality has a surprising amount of detail" by John Salvatier: http://johnsalvatier.org/blog/2017/reality-has-a-surprising-amount-of-detail

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Listen and subscribe to the Understanding Healthcare with Zack Kanter podcast:
YouTube: https://www.youtube.com/playlist?list=PLZ4o7H5Som0Zlo2dGH4jMJy0nlL1oqxDo
Spotify: https://open.spotify.com/show/6cyz5JaAoG3R995QokLR2d
Apple Podcasts: https://podcasts.apple.com/podcast/understanding-healthcare-with-zack-kanter/id1860618431
RSS feed: https://feeds.transistor.fm/understanding-healthcare-with-zack-kanter

Healthcare finance with Dr. Eric Bricker

Stedi — Thu, 22 Jan 2026 08:00:00 -0500

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

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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

Healthcare interoperability with Brendan Keeler

Stedi — Wed, 14 Jan 2026 08:07:40 -0500

Brendan Keeler is Interoperability Practice Lead at HTD Health and author of the Health API Guy Substack.

In this episode, Brendan explains why healthcare standards are actually a good thing, how HIPAA and X12 enable interoperability, the history of FHIR (Fast Healthcare Interoperability Resources), how information blocking and related laws are changing health tech, and how AI may reshape the healthcare standards and regulation.

(00:00) - Intro
(00:31) - Healthcare standards are actually a good thing
(03:11) - How HIPAA helps with interoperability
(07:52) - Interoperability lessons from X12 in other industries
(10:15) - FHIR and the evolution of clinical interoperability
(14:37) - The tradeoffs of healthcare standards
(16:59) - How AI could impact healthcare standards
(23:05) - What is information blocking?
(26:08) - What is RPA?
(28:33) - The downstream effects of information blocking laws
(42:21) - The gravitational pull of systems of record
(47:50) - How much is left to unlock in interoperability?
(49:56) - What would Brendan change about FHIR?

Health plan design with Caroline Loy

Stedi — Thu, 11 Dec 2025 09:56:21 -0500

Caroline Loy is Principal Product Strategist at Turquoise Health.

In this episode, she explains what health plan design is, the decisions employers make when designing or buying plans, and how plan design affects care.

(00:00) - Intro
(00:15) - What is health plan design?
(01:35) - Who decides plan design?
(02:32) - What are self-funded vs fully insured plans?
(04:32) - How do employers choose between self-funded and fully insured plans?
(06:44) - What are the levers employers can pull during plan design?
(09:43) - How many employer plans are self-funded vs. fully insured?
(10:27) - Employer access to claims data with self-funded plans
(12:36) - How would an employer build a self-funded plan?
(13:52) - Broker, TPA, and carrier: What does each do?
(16:57) - The questions employers ask during plan design
(19:33) - What does the plan design process look like?
(21:02) - Can employers incentivize behavior through plan design?
(23:50) - How does plan design impact providers?
(25:12) - How does plan design affect collections?
(27:35) - What are accumulators? How do they affect predicting patient responsibility?
(31:53) - Revenue cycle management (RCM) for providers
(35:01) - What does Stedi do?
(36:25) - How does Turquoise Health help providers predict patient responsibility?
(38:38) - What is the difference between CPT codes and Service Type Codes?
(43:20) - What are contracted rates?
(45:42) - Who are Turquoise Health's customers?
(46:36) - How would Caroline change revenue cycle management?
(48:31) - Outro