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

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