For The Love of Revenue Cycle – Détails, épisodes et analyse

In this webinar replay, host Vanessa Moldovan leads a discussion on the current state of the revenue cycle management (RCM). The episode kicks off the 'Drive to ViVE' webinar series, focusing on the lead-up to the event next year in Los Angeles, which will feature industry leaders discussing healthcare IT, business, and more. Vanessa addresses the major challenges in RCM, such as rising denial rates, fragmented workflows, and the dynamic changes in regulations and policies. She shares insights on denial prevention, education, and the adoption of smart technology, specifically Agentic AI, to improve RCM processes. The episode also highlights the importance of leadership accountability, continuous learning, and genuine industry collaboration to drive significant change while preparing for the future of healthcare reimbursement. 

00:00 Welcome and Introduction to Drive to ViVE

00:53 Current Challenges in Revenue Cycle Management

02:53 What's Broken in Revenue Cycle Management

07:30 What's Working in Revenue Cycle Management

11:32 Strategies for Future Improvements

25:02 The Role of Technology in Revenue Cycle Management

28:44 Involving Users in the Process

29:48 The Role of Technology in Revenue Cycles

31:03 Understanding Agentic AI

31:28 The Evolution of Navigation Technology

32:38 Agentic AI in Revenue Cycle Management

36:49 Q&A Session Begins

37:28 Addressing Denial Prevention

40:39 The Importance of Front-End Processes

42:04 Skills for Future RCM Teams

43:56 Networking and Education in RCM

46:35 Supporting Frontline Teams

49:30 Final Thoughts and Future Directions

Conference Season Recap: Maximizing Value from Industry Events In this episode of 'For the Love of Revenue Cycle,' host Vanessa Malon offers a comprehensive review of the conferences she attended this season, including Becker's, HBMA, MGMA, the Medical Cost Containment Series in Chicago, and the Invest Behavioral Health Conference. Vanessa discusses the key takeaways, the value of attending these events, and provides practical advice on how to maximize ROI, whether you're a leader or frontline worker. She emphasizes the importance of choosing the right conferences based on your goals, whether it's for education, networking, or vendor evaluation. Vanessa also shares tips on how to prepare, what questions to ask, and the benefits of small group sessions, making this episode a must-listen for revenue cycle professionals planning their conference schedules.

00:00 Introduction and Podcast Overview

00:40 Season Review: Conferences Attended

02:11 The Value of Conferences

04:10 Becker's Conferences Insights

06:49 Medical Cost Containment Series

08:00 HBMA and MGMA Conferences

10:00 Networking and Practical Tips

16:15 Final Thoughts and Recommendations

17:30 Conclusion and Contact Information

Navigating Automation in Revenue Cycle Management with Michael Laukaitis
In this episode of 'For The Love of Revenue Cycle', host Vanessa Moldovan dives into the world of automation with healthcare IT expert Michael Laukaitis. With over two decades of experience, Mike shares his journey from rural Montana to UT Southwestern, highlighting the evolution of automation in healthcare. The discussion covers the importance of evaluating processes before automation, the differences between RPA and agentic AI, and the need for human oversight in automated systems. Mike emphasizes the necessity of stable, high-volume processes for successful automation and warns against over-promising vendors. Mike and Vanessa provide practical advice for healthcare leaders on selecting and implementing automation tools, ensuring measurable outcomes, and maintaining system integrity.

00:00 Introduction to the Episode

00:36  Meet Mike Laukaitis 

01:00 Early Automation Experiences

02:05 Current Automation Projects

03:53 Challenges and Considerations in Automation

04:47 When Not to Automate

07:15 Human Element in Automation

09:58 Technical Aspects of Automation

17:54 Evaluating Automation Vendors

25:39 Best Practices and Lessons Learned

33:37 Conclusion and Final Thoughts

What makes a process a good candidate for automation?
Use this quick scorecard (1=low, 5=high). Aim for 24+ out of 35.

• Volume and frequency: high, daily work.

• Rule clarity: clear decision rules or prompts a model can follow.

• Input quality: structured data, stable forms, reliable sources.

• System stability: few UI changes, APIs available, or predictable portals.

• Exception rate: historically under 15% and well-defined.

• Impact: measurable time saved, faster cash, fewer denials, fewer clicks.

• Risk profile: errors are detectable and reversible.

Questions leaders should ask before building or buying automation tools

• What is the exact business outcome and how will we measure it monthly?

• Where is the waste today: rework, wait time, over-processing, or motion?

• Is the process stable and documented, or do we need to fix it first?

• What is the current exception rate and why do exceptions happen?

• What data sources are required and who owns their quality?

• What are the failure modes and how will we detect, alert, and roll back?

• What access, audit, and compliance controls are required end-to-end?

• Build vs buy: which option reduces time to value and long-term maintenance risk?

• What's the realistic total cost of ownership, including rebuilds after system or payer changes?

• How will staff be trained, and what tasks will they do when the bot takes over the boring parts?

• Who is the named process owner and who shuts it off if metrics slip?

• What is the decommission plan if the upstream system adds a native feature?

Implementation guardrails that save pain later

• Fix the process first. Map it, remove steps, standardize inputs, then automate.

• Start in "shadow mode." Let the bot run in parallel for 2 weeks and compare outcomes.

• Instrument everything. Log starts, stops, exceptions, and outcomes. Alert on drift.

• Keep humans in the loop for edge cases and approvals above risk thresholds.

• Review quarterly. If payer or EHR changes make it brittle, redesign or retire it.

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.