Ep. 34 Maximizing Provider Revenue with Payer Contract Insights

For The Love of Revenue Cycle

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Celebration of 40+ years on the fringe of show business. Stories, interviews, and comedy sets from standup comics... famous, and not so famous. All taped Live on my Comedy stage. The interviews will be with comics, old staff members, and Friends from the world of Comedy. Standup Sets by Dana Carvey, Jay Leno, Tom Dreesen, Jerry Seinfeld, Larry Miller, Mark Schiff, Bobcat Goldthwait, Paula Poundstone, Garry Shandling, Ray Ramano, Cathy Ladman, Willie Tyler & Lester, and MORE. My web site has many pictures, items for sale, and more information www.standupcomedyyourhostandmc.com

för ungefär ett år sedan 32:51

MP3•Episod hem

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

83 episoder

#Fitness #Medicine #Vanessa Moldovan #Revenuecycle #Podcasting Education #Physicians

Ep. 34 Maximizing Provider Revenue with Payer Contract Insights

For The Love of Revenue Cycle

published för ungefär ett år sedan

Dela

MP3•Episod hem

Maximizing Provider Revenue with Payer Contract Insight

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

83 episoder

#Fitness #Medicine #Vanessa Moldovan #Revenuecycle #Podcasting Education #Physicians

Alla avsnitt

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Ep. 37 Revolutionizing Patient AR with Dugan Winkie 21:52

för 26 dagar sedan21:52

21:52

In this episode, Vanessa is joined by Dugan Winkie with Cedare to delve into 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…

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Ep. 36 Conferences: The Game-Changer for Your Career & Business 29:33

för 6 weeks sedan29:33

29:33

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.…

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Live Denials Q&A 1/21/25 1:00:16

för 7 weeks sedan1:00:16

1:00:16

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…

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Live Denials Q&A 11/7/24 - DRG Trends, Telehealth Changes + Tech Trends 41:39

för 18 weeks sedan41:39

41:39

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.…

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10/30/24 Live Q&A Mastering Payer Defense 57:27

för 19 weeks sedan57:27

57:27

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…

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Tech-Enabled RCM, Live Webinar (Recorded 10/18/24) 1:11:23

för 20 weeks sedan1:11:23

1:11:23

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…

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Live Denials Q&A 10/15/24 - Tips for Denial Beginners 53:36

för 21 weeks sedan53:36

53:36

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…

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Live Denials Q&A 10/3/24 - Tackling Tough Denials 53:38

för 23 weeks sedan53:38

53:38

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…

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Ep. 34 Maximizing Provider Revenue with Payer Contract Insights 32:51

för 25 weeks sedan32:51

32:51

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…

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Live Denials Q&A 9/17/24 - Utilizing Contracts When Resolving Denials 52:49

för 25 weeks sedan52:49

52:49

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…

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Ep. 33 Insurance AR: Claims with No Response 27:49

för 27 weeks sedan27:49

27:49

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…

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Live Denials Q&A 9/5/24 - Hospice, SNF, Home Health denials + takebacks 50:10

för 27 weeks sedan50:10

50:10

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…

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Live Denials Q&A 8/1/24 - Navigating Out of Network Denials 57:12

för 32 weeks sedan57:12

57:12

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…

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Ep 32 Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa 50:35

för 32 weeks sedan50:35

50:35

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…

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Live Denials Q&A 7/16/24 - payer denial trends creating complexity 1:00:39

för 34 weeks sedan1:00:39

1:00:39

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…

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Ep. 34 Maximizing Provider Revenue with Payer Contract Insights