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