• Live Denials Q&A 11/7/24 - DRG Trends, Telehealth Changes + Tech Trends
    Nov 8 2024

    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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    42 mins
  • 10/30/24 Live Q&A Mastering Payer Defense
    Oct 31 2024

    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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    57 mins
  • Tech-Enabled RCM, Live Webinar (Recorded 10/18/24)
    Oct 22 2024

    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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    1 hr and 11 mins
  • Live Denials Q&A 10/15/24 - Tips for Denial Beginners
    Oct 16 2024

    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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    54 mins
  • Live Denials Q&A 10/3/24 - Tackling Tough Denials
    Oct 4 2024

    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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    54 mins
  • Ep. 34 Maximizing Provider Revenue with Payer Contract Insights
    Sep 23 2024

    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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    33 mins
  • Live Denials Q&A 9/17/24 - Utilizing Contracts When Resolving Denials
    Sep 19 2024

    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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    53 mins
  • Ep. 33 Insurance AR: Claims with No Response
    Sep 10 2024

    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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    28 mins