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.

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

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan engages the community in a live Q&A session. The discussion covers the pressing issue of denials and reimbursement challenges in the healthcare industry. Key topics include recent policy changes by Cigna on automatic downcoding, the implications of DRG downgrades, and strategies for identifying downcoded claims. The episode also addresses how to measure denial rates, manage medical necessity denials, and successfully overturn denied claims. Expert insights and community contributions make this episode a valuable resource for anyone involved in the revenue cycle.

00:00 Introduction and Welcome
00:12 Open Q&A: Community Challenges
01:10 Discussion on Cigna's Downcoding Policy
03:01 Identifying and Handling Downcoding
07:33 Measuring Denial Rates and Overturns
12:00 Government Shutdown Impact on Telehealth
12:57 Combating Medical Necessity Denials
17:25 Escalating Denial Issues with Payers
22:20 Conclusion and Community Engagement

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

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.

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.

This is an announcement regarding upcoming changes to the podcast schedule.

In this webinar replay, Vanessa Moldovan tackles a critical healthcare challenge: bridging the gap between innovation and operations in the revenue cycle. She explores the disconnect between RCM leaders and technology innovators, revealing how resistance to change, staffing shortages, and fragmented systems fuel inefficiencies and reimbursement setbacks.

Vanessa explores root causes such as human error, denial management breakdowns, and rising costs to collect, while offering practical solutions to close the divide. By emphasizing knowledge, empathy, and a shared understanding of the full revenue cycle, she outlines how leaders and innovators can work together more effectively.

Listeners will walk away with actionable insights on clean claims, leveraging technology for accuracy, and building more productive conversations between RCM teams and tech partners, ultimately paving the way for stronger collaboration and better financial outcomes.

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. 

In this first My Take episode, Vanessa reflects on her conversation with Felix Segre and dives deeper into the topic of payment integrity. She breaks down the difference between pre- and post-payment review, the growing role of technology, and why payment integrity looks different for providers, payers, and vendors.

Tune in for perspective, encouragement, and practical insights on how to advocate for yourself, know your motivators, and never underestimate your role in the revenue cycle.

00:03 Welcome to My Take

00:21 Defining Payment Integrity

01:14 Manual Work to Technology

01:25 Pre- & Post-Payment Review

03:57 Payment Integrity is About People

04:32 Vanessa's Homegrown Perspective

06:26 Know Your Motivators

07:46 Key Takeaway: Every Role Matters

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/

Important podcast announcement.