• 10/30/24 Live Q&A Mastering Payer Defense

  • Oct 31 2024
  • Length: 57 mins
  • Podcast

10/30/24 Live Q&A Mastering Payer Defense

  • Summary

  • 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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