For The Love of Revenue Cycle: Recent Episodes
Vanessa Moldovan
Did you ever wish that you had a physician revenue cycle expert and mentor with over 20 years of experience whispering success secrets in your ear?
That’s exactly what you will get when you tune into For the Love of Revenue Cycle hosted by me, Vanessa Moldovan. My career and my life have brought me a wealth of knowledge and I can’t wait to share with you. My passion is to help others in the industry to reach their full potential and find success in the wonderful, crazy world of physician revenue cycle.
Whether you are a beginner, expert, physician, consultant, educator or just plain curious, each episode is designed to immediately apply to your career, business and operations.
Join me each week as we tackle the topics, trivia and triumphs of revenue cycle. Let’s discover our full potential together.
Mastering Payment Analysis: Best Practices with Stacy Calvaruso In this episode of 'For The Love of Revenue Cycle,' host Vanessa Moldovan and expert Stacy Calvaruso discuss the often-overlooked yet crucial topic of payment analysis. The episode differentiates between contract modeling and payment analysis, addressing common issues like underpayments and silent downcoding. They share actionable steps for ensuring proper payment using both advanced technologies and spreadsheets. The discussion also covers the importance of data in running a revenue cycle, triggers for payment analysis, and strategies for contract negotiation. Practical advice on identifying and rectifying underpayments is provided, emphasizing the need for regular review and collaboration within the organization. Whether you're a large hospital or a smaller clinic, this episode offers valuable insights into maintaining revenue integrity. Here is the link to the analysis sheet referenced in the call: Payment Analysis Lost Revenue Tracker
00:00 Introduction and Episode Overview
00:56 Meet Stacy Calvarusso: Revenue Cycle Expert
02:49 The Importance of Data in Revenue Cycle Management
03:52 Contract Modeling vs. Payment Analysis
05:50 Understanding Payment Variances and Underpayments
08:53 Contract Negotiation Strategies
14:51 Triggers and Tools for Payment Analysis
18:47 Practical Tips for Payment Analysis
32:14 Conclusion and Final Thoughts
In this inaugural live Q&A episode, Vanessa Moldovan, CEO of For the Love of Revenue Cycle, answers real-time questions on denials, RCM technology gaps, billing strategies, and more. Tune in for practical insights on tech adoption, denial resolution, and how to evaluate in-house vs. outsourced billing.
- [00:03:00] – Where do you think the biggest gaps are between what technology promises and what it actually delivers in revenue cycle?
- [00:07:45] – What makes a revenue cycle leader actually adopt a new product or tool?
- [00:13:20] – What is the number one mistake you see practices or companies make when it comes to denials?
- [00:22:30] – Who should be handling your billing—in-house or outsourced?
In this episode of 'For the Love of Revenue Cycle,' host Vanessa welcomes Dr. Greg Hobbs, the Chief Medical Officer and co-founder of Milagro, a provider of autonomous coding solutions for healthcare.
Dr. Hobbs discusses his background as an emergency physician, his journey through the academic and IT sectors, and his subsequent focus on healthcare technology. The conversation delves into the challenges and benefits of adopting technology in healthcare, particularly autonomous coding. They explore physicians' skepticism towards AI, the need for transparency in automated systems, and the importance of finding the right vendor for technology solutions. Dr. Hobbs highlights the necessity of real-time coding to avoid preauthorization mismatches and enhance efficiency. Emphasizing a partnership approach with technology providers, the discussion underscores the value of integrating smart software with human expertise to optimize healthcare workflows.
00:00 Introduction and Guest Introduction 00:20 Dr. Greg Hobbs' Background and Experience 01:37 Challenges with Technology Adoption in Healthcare 03:54 Importance of Accurate Coding 04:37 Addressing Skepticism and Legal Responsibilities 08:30 Autonomous vs Automated Coding 11:35 Real-Time Coding and Preauthorization 15:55 Integration and Implementation Challenges 19:03 Vendor Selection and Partnership 22:35 Conclusion and Final Thoughts
In this episode, Vanessa is joined by Dugan Winkie with Cedar to explore the integration of innovation within the revenue cycle. The discussion focuses on patient accounts receivable (AR) and the transformative role of technology in making patient financial experiences more efficient and personalized. Dugan shares insights from his career and Cedar’s approach to bridging the gap between technology and revenue cycle management. The conversation touches on the need for simpler payment processes, the impact of AI in answering billing questions, and the importance of finding healthcare solutions that balance operational efficiency with patient care.
For further information go to https://www.cedar.com/
00:00 Introduction and Guest Introduction
02:44 The Importance of Patient AR
06:30 Challenges and Innovations in Patient Financial Experience
10:09 Leveraging AI and Technology for Efficiency
15:59 Strategies for Improving Patient Engagement
19:19 Choosing the Right Partner for Revenue Cycle Management
20:58 Conclusion and Final Thoughts
Episode Summary:
Conferences can be a game-changer for your career, whether you attend in person or virtually. In this episode, we dive into how to maximize your return on investment (ROI) from industry conferences, choose the right events, and make the most of opportunities—even if you can’t attend in person.
🔥 What You’ll Learn in This Episode:
• The tangible and intangible benefits of attending conferences.
• How to calculate your ROI to determine if a conference is worth it.
• Key differences between in-person and virtual attendance.
• Alternative ways to gain value if you can’t attend in person.
• How to select the right conference for your career or business goals.
• Two major conference announcements where Vanessa will be speaking!
✈️ Upcoming Conferences & Speaking Engagements
🏥 RCM Summit – Nashville (February 5-7, 2024)
📍 Speaking Session:
🔹 Panel: “Creating Common Ground – Strategies for Payer-Provider Synergy”
🕑 February 6th at 3:45 PM Eastern
💡 Why Attend?
• A must-attend for revenue cycle professionals.
• The only event uniting RCM professionals from healthcare and insurers.
• Features 25+ senior-led sessions, networking, and exclusive discussions.
• FREE for healthcare providers and those who work for healthcare organizations!
🔗 Register Here
🌐 ViVE – Nashville (February 16-19, 2024)
📍 Speaking Sessions:
🔹 February 16 – Bridging the Gap Between RCM & Technology
🔹 February 19 – First Ever RCM Summit at ViVE
💡 Why Attend?
• Premier event for digital health transformation.
• Unmatched networking with tech innovators, revenue cycle experts, and healthcare leaders.
• Exclusive RCM Summit featuring the top minds in the space.
🔗 Register Here
💰 Save $250 on Registration! Use promo code: v25p_FTLRC250
📌 If you found this episode valuable, please share it with a friend or colleague!
💡 Join the conversation: Follow Vanessa on LinkedIn for more industry insights.
🎤 For the Love of Revenue Cycle – Helping you navigate RCM with clarity, strategy, and innovation.
Navigating Denial Management and Best Practices in Medical Billing
In this episode, our host addresses common issues and questions related to claims denial in the healthcare industry. The session kicks off with a briefing about the recording process and the host’s recent absence due to business commitments in Europe. The conversation delves into topics such as the upcoming conferences in Nashville, including the RCM Summit and Vive, and moderating panels on collaboration between providers and payers. The Q&A covers detailed discussions on claims denied for timely filing, challenges faced with behavioral health billing, the importance of accurate reason codes, and the complexities of dealing with authorization denials. Specific case studies are examined, including issues with Blue Cross of Massachusetts and UnitedHealthcare denials. The episode emphasizes the need for resilience, thorough research, and the use of technology in managing billing processes effectively.
00:00 Introduction and Housekeeping
02:34 Welcome and Updates
03:45 Upcoming Conferences
04:41 Panel Discussion Preparation
09:54 Q&A: Denial Management
15:28 Common Denial Issues
25:41 Behavioral Health Billing Challenges
31:06 Challenges with Authorization Denials
31:59 Manual vs. Technological Solutions
32:54 Dealing with Out-of-Network Denials
34:54 Frustrations and Resilience in Billing
35:50 Escalating Appeals and Insurance Company Tactics
38:22 Utilizing Support Networks
41:47 Specific Case Discussions and Policies
01:00:04 Conclusion and Final Thoughts
Episode Overview:
In this episode, we dive into the latest trends and challenges in the world of healthcare denials, focusing on payer-driven issues and solutions. The discussion spans denial trends, specifically around inpatient DRG downgrades, and the nuances of navigating denials and claim processes. We also cover technology gaps, regulatory shifts, and emerging solutions in the revenue cycle, particularly for claims with no response and payer-driven reimbursement barriers.
Key Topics Discussed:
• DRG Denials and Humana’s Query Compliance: Robin brings up a denial trend where Humana denies inpatient DRG claims based on “non-compliant queries,” prompting insights on how other professionals are tackling this issue.
• Technology for Claims Without Response: A compelling case is made for creating automation around claims that have not received a denial or payment. This includes potential decision trees for follow-up actions on claims without EDI data to improve efficiency.
• Prior Authorization and Payer Challenges: The conversation highlights the industry’s struggle with prior authorization, arguing that innovation should focus on reducing the overall burden rather than automating current processes, which only minimally alleviate providers’ challenges.
• The Telehealth Dilemma Post-2024: With telehealth flexibilities set to expire at the end of 2024, Whitney raises concerns over how practices primarily based on telehealth services, especially those offering behavioral health, will adapt. Regulatory changes are dissected, with possible strategies suggested to navigate this impending change.
• Innovations in Denial Management: Attendees discuss tools for denial tracking and payer insights, like Cleopatra Queen of Denial, a software solution developed to trend denial types across categories for better negotiation leverage.
• Building Technology That Truly Helps the Revenue Cycle: A call is made for technology that directly addresses payer-driven issues, rather than administrative burdens, suggesting a focus on innovation that simplifies payer policies and medical necessity criteria.
• Professional Events and Resources: The episode includes a discussion on upcoming events, like Joe Rivett’s denial forum, offering listeners insight into where they can learn more about denial management, payer perspectives, and effective appeals writing.
Listeners are encouraged to reach out and share their own experiences with denial management challenges, particularly around DRG downgrades and telehealth changes, fostering a community of shared insights and solutions.
Mastering Payer Defense
In this episode, Vanessa Moldovan, CEO and founder of 'For the Love of Revenue Cycle,' dives deep into the complexities of downcoding and mastering payer defense strategies. She discusses essential steps including understanding contracts, interacting effectively with payers, and leveraging legal options and state insurance commissions. Vanessa also shares insights gathered from a healthcare attorney specializing in defending providers against insurance companies. Tune in to learn actionable strategies to safeguard revenue and ensure fair payment while maintaining professional relationships with payers.
00:00 Introduction and Overview
00:13 Understanding Downcoding
00:53 Expert Insights and Strategies
02:20 Importance of Contracts in Payer Defense
03:49 Presenter's Background and Expertise
06:00 Webinar Disclaimer and Initial Questions
07:10 Best Practices for Denial Escalation
11:39 Identifying and Addressing Downcoding
19:58 Effective Payer Conversations
29:22 Navigating Payer Relations and Contracting
31:01 Effective Appeal Strategies
33:40 Documentation and Professionalism
37:43 Leveraging State Insurance Commissions
43:33 Filing Grievances: Medicare and Commercial Plans
48:47 Legal Complaints and Final Steps
52:19 Q&A and Closing Remarks
Transforming Healthcare Revenue Cycle with Technology and Human Expertise
Join Vanessa Moldovan, CEO and founder of For the Love of Revenue Cycle as she delves into the intersection of innovative technology and Revenue Cycle Management (RCM). Discover the critical role of technology such as Artificial Intelligence (AI), Large Language Models (LLMs), and Software as a Service (SaaS) in optimizing financial processes and patient data management.
This episode covers essential topics including vendor selection, key technological terms, and the importance of human factors in successful technology adoption. She tackles common objections to new technology, and provides practical strategies for evaluating software solutions and maximizing the benefits of software demos.
Learn how to balance human intervention and automation to achieve efficiency and long-term financial success. For more information, contact Vanessa at vanessa@ftlorc.com and connect via LinkedIn or Facebook.
00:00 Introduction and Webinar Overview
00:11 About Vanessa Moldovan
00:48 Mission and Services
01:58 Importance of Technology in Revenue Cycle
05:50 Key Terms in Technology
09:37 Understanding Information Technology
11:31 Software as a Service (SaaS)
28:50 Human Factor in Technology
35:49 Challenges in Revenue Cycle Management
36:57 Understanding Common Objections to Technology Adoption
37:55 Overcoming Resistance and Bad Experiences
40:07 Perception of High Costs and Value Challenges
42:34 Preparing for Technology Demos
44:46 Maximizing Demo Effectiveness
50:39 Evaluating Technology Integration and Support
01:03:36 Exploring Innovative Technologies in Revenue Cycle
01:10:29 Conclusion and Contact Information
Mastering Medical Billing: Overcoming Claim Denials and Utilizing Key Resources
In this comprehensive episode, we dive deep into various medical billing challenges and solutions. Key discussions include handling billing issues with UnitedHealthcare, specifically around lab claims and CLIA validation, and addressing billing problems with Medicare Advantage and other insurers like Cigna and Blue Cross. We offer practical advice on resubmissions, correct coding, and documentation to avoid denials. The importance of leveraging resources such as the AAPC website, MACs for webinars, and networking for educational support is emphasized. The episode features expert insights, such as those from healthcare attorney on combating downcoding and dealing with insurance companies. New and experienced billers alike can benefit from tips on maintaining contact lists, timely filings, and utilizing payer portals effectively.
00:00 Introduction and Initial Query
00:18 Clarifying the Issue with Modifier 90
01:00 Understanding CLIA Requirements
05:25 Dealing with UnitedHealthcare Denials
07:12 Exploring Other Potential Issues
09:33 Addressing Sentara Insurance Glitch
12:00 Blue Cross Medical Advantage Claim Issues
18:06 Cigna Appeal Process Challenges
22:01 Medicare Advantage Plan Denials
26:44 Medicare Billing Challenges
27:17 Humorous Anecdotes and Introductions
28:02 Addressing New Biller Concerns
30:06 Sharing Tips and Resources
31:33 Useful Websites and Tools
34:08 Insurance Company Contacts
35:02 AAPC Website Resources
36:32 Medicare Denial Codes and Policies
37:43 Importance of Bookmarking Resources
39:20 Access to Payer Portals
40:47 Training and Networking
42:00 Medicare Billing Programs
44:42 Final Thoughts and Suggestions
In this engaging podcast episode, participants dive deep into the complexities of denial management and revenue cycle strategies. Led by Vanessa Moldovan, a discussion unfolds around real-world challenges in handling denials and retractions within the healthcare finance sector. Key topics explored include the importance of working in denial management to gain comprehensive insights, effective strategies for managing Medicare and Medicare Advantage issues, and dealing with common denial reasons such as duplicate claims, out-of-network, and lack of authorization denials. The podcast also emphasizes the role of technology in streamlining these processes, highlighting how automation and AI can ease the burden of manual claims review. Participants are encouraged to utilize contracts proactively to fight against unjust denials, and valuable resources, like subject matter experts and tech solutions, are shared to empower professionals in the industry. For further guidance, listeners are invited to reach out to Vanessa at denials@ftlorc.com.
00:00 Introduction and Newcomers
00:18 Challenges with Denials
01:12 Colonoscopy Coding Issues
01:54 Connecting with Experts
03:55 Educational Resources and Support
07:07 Podcast Discussion
08:27 Using Contracts to Fight Denials
10:54 Preparing for Payer Meetings
20:26 Duplicate Claims and Denials
24:05 Understanding Adjudication and Denials
25:33 Credentialing Denials: Challenges and Solutions
28:18 Common Issues with Authorizations and Network Status
30:47 Fighting Back Against Incorrect Denials
37:06 Technology and Tools for Managing Denials
42:08 Addressing Underpayments and Downcoding
50:06 Final Thoughts and Best Practices
Maximizing Provider Revenue with Payer Contract Insight
In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares essential insights on how to maximize provider revenue by understanding and leveraging the nuances of payer contracts. Topics covered include addressing prior authorization denials, navigating payer reimbursement policies, ensuring clean claim submissions, and utilizing fee schedules and carve outs. Additionally, Vanessa offers strategies for managing payer plan limitations, timely filing guidelines, and escalation procedures for unresolved reimbursement issues. Listeners are encouraged to harness technology and AI-driven solutions to streamline these processes for enhanced revenue cycle performance.
00:00 Introduction to the Podcast and Host
01:23 Episode Overview: Maximizing Provider Revenue
02:01 Understanding Payer Contracts
03:04 Prior Authorization Guidelines
05:28 Payer Reimbursement Policies
08:08 Clean Claim Requirements
11:34 Carve Outs in Payer Contracts
14:03 Payer Plan Limitations
16:24 Fee Schedules and Contracted Rates
21:29 Requests and Recoupments of Overpayments
23:34 Denials Without Proper Justification
25:10 Timely Filing Guidelines
27:17 Escalating Reimbursement Issues
29:11 Conclusion and Next Steps
In this episode of the bimonthly Denials Q&A, host Vanessa discusses her extensive experience and expertise in handling denials, focusing on changes and challenges in the field. She emphasizes the importance of understanding contracts, payer guidelines, and exploring new technologies to improve denial management. Vanessa shared insights on leveraging contract information and innovative technology to fight back against complex denial processes. Key topics include the use of CARCs, dealing with Medicare Advantage plans, navigating E&M downcoding, and strategies for obtaining necessary documents from payers. Listeners are encouraged to stay proactive, utilize technology, and network within the healthcare billing community to address evolving denial issues effectively. Email Chester Montefering at Recon.health at chester@recon.health for more information on utilizing contract automation.
00:00 Welcome to the Bimonthly Denials Q&A
00:26 Introduction to Denials and Career Background
01:27 Starting a Company and Industry Engagement
03:19 Denial Codes and Industry Changes
04:37 Complexity in Reversing Denials
06:35 Importance of Contracts in Denial Management
08:50 Accessing and Understanding Contracts
12:01 Technology Solutions for Denial Management
15:06 Open Q&A Session
23:12 Networking and Sharing Experiences
52:18 Final Thoughts and Next Steps
Navigating Insurance AR: Tackling Claims with No Response
In this episode, Vanessa Moldovan, CEO and host of 'For The Love of Revenue Cycle,' delves into the intricacies of Insurance Accounts Receivable (AR), focusing on claims with no response.
Vanessa explains the significance of managing AR to maintain financial health and provides practical strategies for identifying, resolving, and preventing claims with no responses.
Key takeaways include the importance of tracking all claims, the role of technology, and assigning the right tasks to team members.
Vanessa also emphasizes the need for preventive measures and invites listeners to ongoing discussions and networking opportunities.
00:00 Introduction and Welcome
01:06 Episode Overview: Insurance AR and Claims with No Response
02:00 Understanding Insurance Accounts Receivable (AR)
03:57 Managing AR: Best Practices and Key Performance Indicators
07:07 Focusing on Claims with No Response
16:13 Steps to Resolve Claims with No Response
22:22 Preventive Measures for Claims with No Response
26:05 Conclusion and Upcoming Episodes
In this episode, Vanessa Moldovan, CEO and Founder of 'For the Love of Revenue Cycle,' leads a live Q&A session on handling denials in medical billing. Participants from different sectors of the healthcare revenue cycle, including medical billing for home visits, nursing homes, and surgery centers, discuss challenges they face with denial codes, modifiers, and reimbursement issues. Key topics include understanding the new FY 2024 hospice final rule, addressing denials related to modifier codes, and strategies for handling electronic remittance advice (ERA) take-backs. Suggestions for actionable steps and resources, such as consulting specific websites and joining relevant forums, are also shared.
00:00 Introduction and Purpose of the Q&A Session
00:49 Challenges in Revenue Cycle and Denials
02:07 Participant Introductions and Their Goals
03:11 Open Forum for Questions and Discussions
04:14 Lauren's Denial Issue with Chronic Care Management
09:26 Exploring Possible Solutions and Resources
21:08 Roseanne's Issue with Take Backs on ERAs
28:22 Provider Targeting by Payers
28:38 Options for Receiving Take Backs
29:03 Challenges with Electronic ERAs
29:44 Appeal Deadlines and Paper Forms
30:11 Denials Due to Grouper Edits
30:53 Hospital Denials and Resources
33:13 Questions on Prolonged Services Billing
37:08 Issues with Nursing Home Billing
45:29 Seeking Expert Advice and Final Thoughts
Show notes for today's live denials Q&A session:
- The differences in denials and appeals processes between in-network and out-of-network providers
- Strategies for appealing out-of-network denials, including involving patients and leveraging laws like the Arisa law
- Trends in payer requests for documentation and potential reasons behind sudden increases in these requests
- Frustrations with payers' downcoding practices and lack of transparency in reimbursement
- The shift in the medical field from a profession to a business, and the need for better revenue cycle education for providers
Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa
In this episode, Vanessa welcomes Mike Marshall to discuss the intricacies of revenue cycle management (RCM) and the challenges faced by healthcare organizations. Mike is currently the Managing Director of the North American division of e5 Workflow, with a rich background in healthcare focusing on turnaround projects for operation, finance, and revenue cycle management.
They explore the root causes of common RCM issues, the hesitations around adopting new technology, and emphasize the necessity of becoming tech-enabled to survive in the current market. The conversation delves into innovative solutions, actionable data, optimizing human resources, and technological advancements like AI and automation. They also provide guidance on selecting vendors and the importance of staying informed about industry innovations through networking, conferences, and professional advice.
00:00 Welcome and Introduction
00:31 Introducing Mike Marshall
01:03 Industry Challenges in Revenue Cycle Management
02:09 Hesitancy in Adopting Technology
03:48 The Pain of Outdated Systems
07:35 Fear of Change in Revenue Cycle
11:32 Importance of Training and Support
16:47 Encouragement to Explore New Solutions
21:19 Leveraging Technology for Efficiency
33:15 Medicare Challenges and Strategic Technology Integration
33:52 Middle Management and Delegation with Technology
35:08 Industry Changes and Knowledge Gaps
36:04 Leveraging Technology for Delegation and Efficiency
36:53 Outsourcing and Onshoring in Revenue Cycle Management
39:34 Navigating Vendor Selection and Industry Resources
45:16 Maximizing Conference and Vendor Interactions
53:40 Evaluating Automation and AI Claims
57:55 Strategic Technology Integration and Conclusion
In this episode, Vanessa Moldovan hosts a Q&A session focused on the challenging issues of denials in revenue cycle management. Vanessa, along with the attendees, discusses the complexities around denial prevention, resolution, and best practices. The session covers specific payer issues, including downcoding by Anthem and Humana, as well as rampant documentation requests from UnitedHealthcare. The discussion also provides strategies for handling denials, escalating issues to provider representatives, utilizing contracts, and ensuring accurate coding practices. Expert insights are shared on balancing the administrative burden, proactively managing claims, and leveraging technology to streamline processes. The conversation aims to empower healthcare providers and billers to tackle denials effectively while advocating for systemic changes in payer operations.
00:00 Introduction and Welcome
03:27 Purpose of the Q&A Session
04:28 Host's Background and Experience
05:25 Community and Participation
07:00 First Question: Handling Downcoding 1
1:44 Discussion on Denial Trends and Strategies
23:02 Challenges with Payers and Denials
31:41 Industry Trends and Payer Practices
35:26 Frustrations with Office Testing and Pre-Authorization
37:22 Tactics for Fighting Unjustified Denials
38:27 Challenges Faced by Small Practices
40:21 Importance of Documentation and Predetermination
42:16 Role of Professional Organizations and Social Media
49:12 Differences in Denials: In-Network vs. Out-of-Network
54:53 Leveraging Contracts and Provider Networks
58:46 Final Thoughts and Recommendations
n episode 31 of 'For the Love of Revenue Cycle,' the host discusses patient accounts receivable (AR) in a clinic setting, emphasizing the importance of professional billing over facility billing. Key topics include naming conventions in billing systems, the role and definition of a guarantor, and the nuances between insurance processing and payment. The episode delves into best practices for managing patient AR, handling self-pay arrangements, and understanding patient financial responsibility, especially under high deductible health plans. The host also explores the impact of technological innovations on both pre-service and post-service collections, strategies for reducing collection costs, and compliance with federal and state regulations. Finally, the session provides practical recommendations for managing self-pay balances and patient shares, offering financial assistance, and ensuring consistency in collections policies. 00:00 Welcome and Introduction 01:27 Understanding Patient Accounts Receivable (AR) 01:54 Naming Conventions and Guarantor Responsibilities 05:40 Insurance Processing and Patient Responsibility 19:26 Collecting Patient Payments 22:58 Technological Innovations in Revenue Cycle 25:34 Best Practices for Self-Pay Balances 27:00 Handling Balances After Insurance 28:03 Developing Effective Collection Policies 34:45 Conclusion and Final Thoughts
Get ready for Season 3 of For the Love of Revenue Cycle, premiering tomorrow with Episode 30! I'm back with a deep dive into denials and accounts receivable in the revenue cycle. Listen in, as I unpack the complexities of denials and their impact on healthcare organizations. I'll share insights from recent industry events and personal experiences, highlighting key strategies for prevention and resolution.
Also, stay tuned to the end for a big announcement about For the Love of Revenue Cycle.
In this episode, we dive into effective strategies for preventing and resolving denials in healthcare billing. Our speakers cover essential tips like checking the place of service, sharing experiences, and networking with other professionals. We explore various types of rejections in healthcare claims, emphasizing the need to understand their origins and track them meticulously. Discover valuable insights on managing appeals and reconsiderations, staying organized, using timely filing tools, and navigating complex appeal letters. Plus, learn about the importance of resources for identifying plan types and tackling excessive medical documentation delays. Join us for this comprehensive discussion on mastering healthcare billing challenges.
During today's live Q&A we had some great discussion about important denials that you and your organization are probably experiencing. We had some great interaction with 28 attendees. Check out the conversation!
Corey started Covered Health to automate the most challenging element of appealing denied medical claims by streamlining the access to diverse databases and sources to pinpoint denial root causes. I decided to partner with Covered because we share the same vision: preventing patients from getting stuck with bills that should be covered by their insurance, and helping to empower revenue cycle management experts to resolve those denials with greater efficiency.
We discussed Corey’s motivations for starting Covered - his brother Russell's experience with unfair insurance denials during his struggle with Ulcerative Colitis. Corey’s family was hit with massive bills, and at a time when they wanted to focus on Russell’s health, instead they were focused on denied claims. Covered intervenes to help providers overturn denials, and prevent bills from becoming patient responsibility.
Corey discussed his journey through the Special Forces, Parachute Health, and running sales for healthcare companies, eventually selling into insurance plans prior to starting Covered.
We discussed my career as well, and turning down Harvard undergraduate in pursuit of a life and career that aligned with my values of giving back and sharing what I've learned with others, which is why I started this podcast.
Corey and I met because he was looking for a podcast on denials and he found mine! We connected over a shared passion to create a denial resolution tool with the goal of harnessing the multitude of databases & sources of truth that a biller has to access in order to identify the root cause of a denial and create an appeal.
We are not only reducing the clicks required to gather the information, but creating a smart tool that will guide RCM professionals through the decisions required to compile the body of the appeal, and eventually generate it for them.
We addressed Covered’s competitive differentiation within the denial management space, and the rapid advancement of AI and LLMs, which have given an advantage to new companies. We touched on the slow moving nature of incumbents, and why they often don’t succeed in building product lines that are as innovative as their original core offering.
If Covered’s mission to fight back against incorrect denials resonates with you, we want to connect! Especially (but not exclusively) if you are an independent specialty provider group, an RCM company fighting denials, an, or a regional/community hospital/health system. If you are struggling to address denials as a result of staffing shortages/payer policies/behavior, or you are just passionate about denials, please reach out!
Today, Covered acts as a software enabled services company, utilizing technology to overturn denials (they’ve returned tens of thousands of dollars to physicians). In addition to helping Covered build out their product, I am helping Covered to actually fight denials as an extension of customer RCM teams. If you're struggling with denials, we can immediately step in and help you, and help identify trends and root causes. In special cases, we also provide consulting services.
One of the advantages of fighting denials on behalf of our customers is that we enter their world, and get to see their problems firsthand. That, in turn, allows us to tweak our product for each customer based on their specific pain points.
You can learn more about Covered on their website, and you can find Corey on Linkedin. As you discover more about Corey and his mission with Covered, I encourage you to check out his podcast Healthcare Reimagined (Apple or Spotify).
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Dive into the world of healthcare industry in our special episode of PM Symposium where we uncover the many facets of the revenue cycle. Hosted along with Jennifer McNamara, we discuss the impact of practice managers, the importance of understanding the revenue cycle, and how to combat revenue leakage. We explore some of the major challenges including staffing shortages, the lack of standardization and the crucial role of both management and line workers. Tune in to gain invaluable insights, understand the power of community teamwork and informed decision-making. See you at the practice management symposium on February 16th!
Hello friends and welcome to episode 28 of For the Love of Revenue Cycle. Thank you so much for tuning in today! A big welcome back to my loyal listeners and a special shout out if today is your first episode. This season is part of the going back to the basics from season 2. I know that it has been about 5 months since Episode 27 was posted. As you may recall, me and my production team were experience technical difficulties. But here we are back again!
In this final episode of Season 2, I’m going to share with you my experience with using reporting and analytics in revenue cycle management. This will include discussing why I believe analytics is so vital, what my favorite reports are and how I use them to run a clean revenue cycle.
Hello Friends! Welcome to the kickoff of season 3! I am overwhelmed to still be running this podcast after 2 years. Thank you as always for your support. In this episode, I share what the topic of season 3 will be and share a big announcement. Speaking of the big announcement, here is the link that I reference. https://fortheloveofrevenuecycle.aweb.page/p/7d25c7b7-9c16-490c-95cd-7bd2052fd396
Hello Rev Cycle Lovers! This episode is a recording of our live Q&A session today. It is raw and unedited, but that does not diminish the great conversation. We discussed some challenges with the end of PHE, operational challeges that cause denials and also different options for assigning individuals within the revenue cycle. We also spent some time talking about the current state of affairs in our industry related to payer guidelines and staffing shortages. I hope that you enjoy this conversation.
In today's episode, we go back to the "Language of Revenue Cycle" to discuss the differences between the concepts of prior auth, referrals, precertification and predeterminations.
In this short episode I thank the listeners for their patience while I took some time off and announce the new podcast schedule with new episodes.
The topic I have today kind of covers several topics. I had a hard time coming up with the title of this episode because it isn’t about just one thing. But let’s just say that if you are struggling with most of the country to run your revenue cycle with staff shortages, crazy payer expectations and the patient as a consumer, then you have come to the right place. Let’s jump in!
Today, we are going to talk about some of the differences between institutional vs. professional billing or hospital vs. physician billing. I want to remind you this is very high level and basic. But I think it’s a good introductory into those differences.
Today, we are going to talk about the various part of Medicare: A, B, C, and D. I’ll share with you what each part is and then share some of the payment or reimbursement models for Medicare.
Today, we are going to discuss appeals. What are they? What is their purpose? What makes a great appeal?
During today's live Q&A, we talked about billing emergency visits with procedures in the inpatient setting, options for free CEUs, how to access payer policies and how we can integrate the topic of specialties into the podcast. Great conversation!
Today, we are going to discuss five KPIs. Common key performance indicators in physician revenue cycle. We’ll discuss how the KPIs are formulated and how they can be used to maintain an efficient and effective revenue cycle.
Today, we are going to discuss edits, rejections, claim statuses and denials. We’ll be taking a look at each concept to understand their differences and how it is so easy to confuse them.
If you have been in healthcare for more than 10 seconds you know that we love our acronyms. I’ll be sporadically talking about acronyms over the coming weeks. Today’s episode is about the acronyms HIS, HIT, HIE and HIM (and we are throwing a few others in there). Let’s jump in.
This is a recording of our Live Q&A from 9/20/22. We are back after several months off. This is an open forum time to discuss anything with me or between those who attend. Today's discussion was some catching up and getting to know you and discussing some of the challenges of billing.
Please send me your email address if you would like to be added to this call every other week.
Welcome to the first episode of Season 2! Today’s episode is about credentialing, contracting, and enrollment. These are very different concepts, but often get confused. Hopefully, I’ll be able to sort out some of the confusion.
I am thrilled to be back! Thank you for your patience and support. As the title would indicate, this episode is a teader of what is coming up in Season 2. First episode of the season will be streaming on September 12th!
Today is the second episode in our Day in the Life Series. I’ve been really looking forward to bringing you this series. In the next few episodes, we will be talking about the various roles within the revenue cycle. I believe that it is important for all of us to understand the responsibilities, pressures and expectations involved in these roles. Understanding the people around us is the first step to compassion and empathy in our relationships. And when we work together with compassion and empathy, we have more efficient and effective revenue cycles. In today’s episode, I am chatting with April Torres. You probably remember April from our last episode when she talked about her role as a revenue cycle manager. Well, she is back again today to talk about the medical biller role. Sit back and enjoy this engaging and insightful conversation.
Are you stuck in a job that you are desperate to get out of? Do you feel like your loyalty is holding you back? Have you been searching for a job and just not getting anywhere? Today's episode is the one for you. Emily Hawkins mission is empowering the unfulfilled and unrecognized to amplify their job search and career to make a salary they deserve doing what they love. Here is the link to her master class as mentioned in the podcast. https://learn.emilyhawkins4u.com/burn2break-masterclass/
Today is the first episode in our Day in the Life Series. I’ve been really looking forward to bringing you this series. In the next few episodes, we will be talking about the various roles within the revenue cycle. I believe that it is important for all of us to understand the responsibilities, pressures and expectations involved in these roles. Understanding the people around us is the first step to compassion and empathy in our relationships. And when we work together with compassion and empathy, we have more efficient and effective revenue cycles. In today’s episode, I am chatting with April Torres. April and I met through my Facebook Group, For the Love of Revenue Cycle. When I reached out for volunteers to be guests on these series, she was my first volunteer. We will be discussing her role as a revenue cycle manager. Sit back and enjoy this engaging and insightful conversation.
Today’s episode is the final part in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider’s documentation, then it’s in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in the outstanding AR. Well, I think that means we can all learn something from this review of modifiers, right?
Today’s episode is part 2 in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider’s documentation, then it’s in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in the outstanding AR. Well, I think that means we can all learn something from this review of modifiers, right?
In this live Q&A, Stephanie Thebarge CPC, CPMA, CPPM, CPB, CEMC, CHONC, PESC shares with us her extensive knowledge of drug billing. If you have any further questions or would like a copy of the presentation, please reach out to her at sthebarge@gmail.com.
Today’s episode is part 1 in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider’s documentation, then it’s in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in the outstanding AR. Well, I think that means we can all learn something from this review of modifiers, right? Let’s waste no time and jump right in!
In this live Q&A we have a sneak peek into the modifier series. We discuss modifiers 24, 25 and 79. If you love it, check out the next 3 episodes as we dive into common modifiers.
The No Surprises Act has definitely been a surprise to many of us! Do you still struggle with details in the policy and how to be compliant when applying them to operations? This is a recording of the Live Q&A Panel we held today with our subject matter experts. I have no doubt that you will find helpful information within this great conversation.
I am so excited to introduce the guest in this episode. I have to admit that I was fangirling a little bit. If you are involved with AAPC or have taken advantage of their educational opportunities, you have probably heard of her. So without further ado, my guest today is Rae Jimenez. In our conversation you will learn that her current role at AAPC is VP of products. But you will also find out so much more about her and probably figure out why I admire her so much. She is smart, gracious, and eager to be a part of teaching others about the business of healthcare. I hope that you enjoy our conversation as much as I did. Our discussion covers many topics, but mainly we discuss her career path, resources that AAPC offers to further their members careers and education and some coming initiatives.
Today’s episode is part 2 in a series in which Quiana Craig shares with us her journey in growing her company. If you didn’t catch part 1, press pause on this one and go back to listen. If you have been thinking about starting your own company or are looking for ways to freshen up your current one, stay tuned and get some great tips from a pro.
Are you feeling overwhelmed with how to properly create and submit an appeal. Well, In this live Q&A we talked all about appeals. Be sure to stay tuned to the end because there are a lot of great questions from the attendees.
Today we have a treat for you. Quiana Craig will be hosting the podcast. She is a certified professional biller, licensed AAPC approved instructor and the owner of Express Medical Billing & Consulting. Quiana reached out to me last summer to bolster my courage in starting the podcast. She had so much belief that she agreed to be the first sponsor. Words cannot express how much I have appreciated her encouragement and excellent promotion on Instagram. Today she is going to share with us her journey to starting her business in 2008. If you have been thinking about starting your own company or are looking for ways to freshen up your current one, stay tuned and get some great tips from a pro.
As the title suggests, today's episode is all about managing the revenue cycle. I'll share with you the processes that I've used over my career to improve and maintain best practices and KPIs. You might want to take notes on this one! I will be sharing the various reports that I use and it might get tough to retain the details. Let's get to it!
Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
In this live Q&A we had a great conversation about difficulty resolving PTAN issues, emergent denials and is bundling a payment or coding issue. There are also some big announcements.
Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
We had some great collaboration on today's live Q&A. The attendees shared their struggles with being new to billing, billing and coding without a software and some great modifier questions. Take a minute and listen!
Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
In today's Live Q&A we had a great discussion regarding operational challenges with the Good Faith Estimate as required by CMS' No Surprise Act. We also discussed a challenge that Ashley is having with out of network denials on inpatient procedures stating non-emergent. As referenced in the recording, Stephanie Thebarge and Ashley Szocinski can both be reached through LinkedIn. If you are interested in being on the No Surprise Act Panel, please contact me.
Hello friends and welcome to episode 10 of For the Love of Revenue Cycle. Today’s episode is a continuation of last week’s episode in which my friend Georgi shared with us his experience in starting his own billing company. This week he is going to share with us how to market a billing company. The dos and don’ts that he learned firsthand. If you are thinking about branching out on your own, I think that you will find his tips and resources to be very helpful. This is not in an interview format. We decided that due to the nature of the topic, it would be better if he was a solo show. Is everyone settled in? Alright, let’s get started
I can’t tell you how much I’ve been looking forward to sharing this episode with you. We are taking a little break from our Nuts and Bolts series and will be hearing from a friend of mine. I met him years ago when I was an officer of the AAPC Des Plaines Local Chapter. I will let him introduce himself because he will do much better than I. I’m really looking forward to hearing him tell his story of how he started his billing company. I personally think it’s quite inspiring. This is not in an interview format. We decided that due to the nature of the topic, it would be better if he was a solo show. Is everyone settled in? Alright, let’s get started with part 1 of this 2 part series.
In today's live Q&A we discuss some tips to be on the lookout for when sharing and receiving resources on social media, articles, webinars, documents, etc.
Hello friends and welcome to episode 9 of For the Love of Revenue Cycle. I am so excited to be back here again with you. I would like to thank you for tuning back in and I want to give a big welcome to our new listeners. This episode is the first segment of part 6 in a 7-part series on the Nuts and Bolts of Revenue Cycle. Due to the amount of content regarding denials, I decided to split part 6 up into two segments. Today’s episode will be about denial management and then next week’s episode will be about how to resolve and prevent top denials. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is focused on how we can streamline processes for better efficiency and to reduce denials. Basically, we’re talking about best practices that will bring in the revenue. Is everyone settled in? Alright, let’s get started!
In this live Q&A, we discuss in more detail some of the topics that Elisa Garn and I discussed in the most recent episode. We talked about how to create positivie work environments and how to effectively work with direct reports that we may not see eye-to-eye with. Finally, we discussed the advantages of managing teams with a more "human" approach then "employee" approach.
I am so thrilled that Elisa Garn was willing to share her expertise in human resources and recruiting with us today. I hope that you find this conversation as interesting and helpful as I did. I learned so much! Before we get started, let me tell you a little bit about Elisa. Elisa has 15+ years of experience with HR, with an expertise in modern, progressive and human-centric strategy. She specializes in personal branding, employer branding and creating work environments that foster belonging and best-of-class cultures which set people free to do great work.
Here are the books she recommended:
Power of Influence by Ty Bennett
Range by David Epstein
Quiet by Susan Cain
Hello friends and welcome to episode 7 of For the Love of Revenue Cycle. I am so excited to be back here again with you. I would like to thank you for tuning back in and I want to give a big welcome to our new listeners. I can’t tell you how much I’ve been looking forward to sharing this episode with you. We are taking a little break from our Nuts and Bolts series and hosting our first subject matter expert. So exciting. Today’s expert is Stephanie Thebarge. I hope that you find this conversation about her career path and about infusion auditing and billing to be as interesting as I did. We also through a bit about compliance in there, too. I certainly learned a lot and I hope that you will too.
Hello friends and welcome to part 2 of episode 6 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. This episode is a continuation of episode 6 in which we discuss AR followup in our series on the Nuts and Bolts of Revenue Cycle. AR followup is kind of our intro into the big one about denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is focused on how we can streamline processes for better efficiency and to reduce denials. Ultimately, we’re trying to figure out best practices that will bring in the revenue. I like to make this clarification at the beginning, so everyone understands that this is not a tutorial on how to do each function. Is everyone settled in? Let’s jump in!
Today's scheduled Q&A did not actually take place because of a power outage in my area. This recorded episode is the planned topic for that day and it is a sneak peek into the top denials. I dive into COB and duplicate denials.
Hello friends and welcome to episode 6 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. This episode about AR followup is another part of our series on the Nuts and Bolts of Revenue Cycle and it will be a little different because it will be split into 2 parts. AR Followup is kind of our intro into the big one about denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is focused on how we can streamline processes for better efficiency and to reduce denials. Ultimately, we’re trying to figure out best practices that will bring in the revenue. I like to make this clarification at the beginning, so everyone understands that this is not a tutorial on how to do each function. Is everyone settled in? Let’s jump in!
In this Q&A we started off with a great conversation regarding 2022 coding updates and the best practice for distributing this information within an organization. Then we talked about the Medicare surprise billing ruling. Here is a link to more information on CMS website. We finished our call by talking about coding departments that are responsible for helping denials.
Hello friends and welcome to episode 5 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. Today is part 4 of our 7-part series called Nuts and Bolts and we’ll be talking about claims, payment posting and statements. This is the last episode before we jump into AR follow-up and denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is focused on how we can streamline processes for better efficiency and to reduce denials. Ultimately, we’re trying to figure out best practices that will bring in the revenue. I like to make this clarification at the beginning, so everyone understands that this is not a tutorial on how to do each function. Is everyone settled in? Let’s jump in!
Hello friends and welcome to episode 4 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. Today is part 3 of our 7-part series called Nuts and Bolts. Today, we’ll be talking about coding and charge capture/charge entry. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1. The content is focused on how we can streamline processes for better efficiency and to reduce denials. Ultimately, we’re trying to figure out best practices that will bring in the revenue. I like to make this clarification at the beginning, so everyone understands that this is not a tutorial on how to do each function. Is everyone settled in? Let’s jump in!
In this Q&A, we discuss federal plans as 2ndary, coding software with annual coding updates, hiring medical billers and advancing in the medical field. Don't forget to send me your email address to be included.
The Nuts and Bolts series breaks down in more detail the steps of the revenue cycle that were talked about in episode one, this will be a six-part series in which we will discuss the impact that each step has on the revenue in the practice.
This is the second episode in the nuts and bolts series. In this episode, Vanessa will be covering the front end of physician revenue cycle including appointments, scheduling preregistration, registration, and authorization. She will be focusing on how to streamline processes for better efficiency and to reduce denials. Ultimately this will create best practices that bring in more revenue.
The Nuts and Bolts series breaks down in more detail the steps of the revenue cycle that were talked about in episode one, this will be a six-part series in which we will discuss the impact that each step has on the revenue in the practice.
In this first episode in the nuts and bolts series, Vanessa will be covering Credentialing and System Set Up. She will cover the important pieces involved in these two foundational steps of physician revenue cycle and share with you how these pieces can help to bring in revenue much faster and to help prevent denials.
What is the Physician Revenue Cycle? The revenue cycle is the entire life of a patient encounter from creation to resolution.
In this episode of For the Love of Revenue Cycle Vanessa will be discussing the essential components of the revenue cycle and breaking down why each one is important.
She covers topics such as credentialing system setup, appointment scheduling, preregistration pre-certification authorization, registration, front desk (check-in checkout patient encounter charge capture, coding, charge entry), Payment posting claims statements, accounts receivable, and revenue cycle management.
Connect with Vanessa and learn more about the Physician Revenue cycle through:
Facebook Group
The For the Love of Revenue Cycle podcast is officially live! This will be your one-stop-shop for all things related to physician revenue cycle.
Each week you’ll get simple, actionable tips on career, business, and operations of physician revenue cycle. In this first episode, I’m outlining exactly what to expect from For the Love of Revenue Cycle podcast. We’re diving deeper into what inspired this podcast and how you can discover the tools, resources, and knowledge that you need in order to be successful in the physician revenue cycle.
Connect with Vanessa and learn more about the Physician Revenue cycle through:
Facebook Group