In this webinar replay, host Vanessa Moldovan leads a discussion on the current state of the revenue cycle management (RCM). The episode kicks off the 'Drive to ViVE' webinar series, focusing on the lead-up to the event next year in Los Angeles, which will feature industry leaders discussing healthcare IT, business, and more. Vanessa addresses the major challenges in RCM, such as rising denial rates, fragmented workflows, and the dynamic changes in regulations and policies. She shares insights on denial prevention, education, and the adoption of smart technology, specifically Agentic AI, to improve RCM processes. The episode also highlights the importance of leadership accountability, continuous learning, and genuine industry collaboration to drive significant change while preparing for the future of healthcare reimbursement.

00:00 Welcome and Introduction to Drive to ViVE

00:53 Current Challenges in Revenue Cycle Management

02:53 What's Broken in Revenue Cycle Management

07:30 What's Working in Revenue Cycle Management

11:32 Strategies for Future Improvements

25:02 The Role of Technology in Revenue Cycle Management

28:44 Involving Users in the Process

29:48 The Role of Technology in Revenue Cycles

31:03 Understanding Agentic AI

31:28 The Evolution of Navigation Technology

32:38 Agentic AI in Revenue Cycle Management

36:49 Q&A Session Begins

37:28 Addressing Denial Prevention

40:39 The Importance of Front-End Processes

42:04 Skills for Future RCM Teams

43:56 Networking and Education in RCM

46:35 Supporting Frontline Teams

49:30 Final Thoughts and Future Directions

Conference Season Recap: Maximizing Value from Industry Events In this episode of 'For the Love of Revenue Cycle,' host Vanessa Malon offers a comprehensive review of the conferences she attended this season, including Becker's, HBMA, MGMA, the Medical Cost Containment Series in Chicago, and the Invest Behavioral Health Conference. Vanessa discusses the key takeaways, the value of attending these events, and provides practical advice on how to maximize ROI, whether you're a leader or frontline worker. She emphasizes the importance of choosing the right conferences based on your goals, whether it's for education, networking, or vendor evaluation. Vanessa also shares tips on how to prepare, what questions to ask, and the benefits of small group sessions, making this episode a must-listen for revenue cycle professionals planning their conference schedules.

00:00 Introduction and Podcast Overview

00:40 Season Review: Conferences Attended

02:11 The Value of Conferences

04:10 Becker's Conferences Insights

06:49 Medical Cost Containment Series

08:00 HBMA and MGMA Conferences

10:00 Networking and Practical Tips

16:15 Final Thoughts and Recommendations

17:30 Conclusion and Contact Information

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan engages the community in a live Q&A session. The discussion covers the pressing issue of denials and reimbursement challenges in the healthcare industry. Key topics include recent policy changes by Cigna on automatic downcoding, the implications of DRG downgrades, and strategies for identifying downcoded claims. The episode also addresses how to measure denial rates, manage medical necessity denials, and successfully overturn denied claims. Expert insights and community contributions make this episode a valuable resource for anyone involved in the revenue cycle. 00:00 Introduction and Welcome 00:12 Open Q&A: Community Challenges 01:10 Discussion on Cigna's Downcoding Policy 03:01 Identifying and Handling Downcoding 07:33 Measuring Denial Rates and Overturns 12:00 Government Shutdown Impact on Telehealth 12:57 Combating Medical Necessity Denials 17:25 Escalating Denial Issues with Payers 22:20 Conclusion and Community Engagement

In this webinar replay, Vanessa Moldovan tackles a critical healthcare challenge: bridging the gap between innovation and operations in the revenue cycle. She explores the disconnect between RCM leaders and technology innovators, revealing how resistance to change, staffing shortages, and fragmented systems fuel inefficiencies and reimbursement setbacks.

Vanessa explores root causes such as human error, denial management breakdowns, and rising costs to collect, while offering practical solutions to close the divide. By emphasizing knowledge, empathy, and a shared understanding of the full revenue cycle, she outlines how leaders and innovators can work together more effectively.

Listeners will walk away with actionable insights on clean claims, leveraging technology for accuracy, and building more productive conversations between RCM teams and tech partners, ultimately paving the way for stronger collaboration and better financial outcomes.

In this first My Take episode, Vanessa reflects on her conversation with Felix Segre and dives deeper into the topic of payment integrity. She breaks down the difference between pre- and post-payment review, the growing role of technology, and why payment integrity looks different for providers, payers, and vendors.

Tune in for perspective, encouragement, and practical insights on how to advocate for yourself, know your motivators, and never underestimate your role in the revenue cycle.

00:03 Welcome to My Take

00:21 Defining Payment Integrity

01:14 Manual Work to Technology

01:25 Pre- & Post-Payment Review

03:57 Payment Integrity is About People

04:32 Vanessa's Homegrown Perspective

06:26 Know Your Motivators

07:46 Key Takeaway: Every Role Matters

In this episode of 'For the Love of Revenue Cycle', host Vanessa Moldovan and guest Felix Segre, Director of Revenue Integrity, delve into the crucial topic of revenue integrity. With nearly 30 years of experience in revenue cycle management, Vanessa explores Felix's two decades of expertise spanning front, middle, and backend operations. They discuss the significance of revenue integrity, why it should be everyone's responsibility, and share actionable steps for fostering a culture of recognition and support within an organization.

The episode also offers practical advice for leaders on using data to guide decision-making and creating a culture of open communication. It highlights how every role in the revenue cycle plays a critical part, underscoring the interconnected nature of the process and the need for both individual accountability and collective ownership to ensure accurate reimbursement and an optimal patient experience.

Bonus: This episode is also available in video format at youtube.com/@FTLORC!

00:00 Introduction and Host Background

00:34 Guest Introduction: Felix Segre

01:34 The Importance of Revenue Integrity

03:38 Personal Stories and Realizations

07:29 Defining Revenue Integrity

17:36 Challenges and Solutions in Revenue Cycle

21:32 Advice for Frontline Workers and Leaders

30:26 Closing Thoughts and Takeaways

35:00 Conclusion and Listener Engagement

FTLORC Live Returns with Vanessa Moldovan

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares her extensive industry experience and the mission behind the podcast. Listeners are introduced to Vanessa's background in revenue cycle management, her current role at Agentic AI company Magical, and the goals of the podcast, which include offering practical guidance and fostering community discussions. The open Q&A session features real-world challenges such as AI-driven rejections, anesthesia reimbursement nuances, and payer dynamics. Vanessa and participants discuss issues like increasing denials due to AI, leveraging provider contracts for claim escalation, and strategies for dealing with payer resistance. The episode emphasizes the importance of community, the need for technology to ease revenue cycle management, and the value of sharing knowledge among professionals.

00:00 Introduction to Vanessa and the Podcast

00:36 Today's Episode Overview

01:33 Community and Facebook Group

02:16 Vanessa's Career and Focus on Denials

03:08 Participant Introductions

03:20 Nicolette's Experience and Challenges

04:37 Angie's Experience in Anesthesia Billing

09:16 Discussion on AI and Claim Rejections

21:23 Escalating Denied Claims

21:41 Challenges in Claim Resolution

23:04 Strategies for Effective Escalation

27:16 Dealing with Overseas Call Centers

28:45 Leveraging Contracts and Technology

37:00 Community and Continuous Learning

39:15 Conclusion and Next Steps

In this episode of 'For The Love of Revenue Cycle,' host Vanessa Moldovan and expert Doug Hires discuss crucial strategies for revenue cycle management (RCM) leaders in their first 90 days. Doug, with decades of healthcare operations experience, provides actionable guidance on assessing priorities, making a case for technology investments, and achieving quick wins to build credibility. The episode emphasizes the importance of communication, transparency, and keeping a business-focused perspective. Vanessa and Doug also delve into change management and how to address resistance in staff. The conversation provides a comprehensive framework for new leaders to navigate their roles effectively and make meaningful impacts quickly.

00:00 Introduction to the Podcast and Host

00:40 Today's Episode Overview: Prioritizing the First 90 Days

02:20 Guest Introduction: Doug Hires

02:37 Doug's Career Journey and Experience

03:40 Challenges for New Revenue Cycle Leaders

05:27 The Importance of Observation and Feedback

08:42 Triage and Prioritization in Revenue Cycle Management

14:08 Quick Wins and Business Impact

16:49 Justifying Technology Investments to Leadership

17:42 Understanding the Impact of Technology Changes

21:01 Change Management and Communication Strategies

23:22 Addressing Fears and Resistance to Change

27:53 Final Thoughts and Key Takeaways

Preparing for Tech Downtime in Healthcare: Key Strategies and Insights with Darlene Vendittelli

In this episode of 'For The Love of Revenue Cycle,' host Vanessa Muldoon and guest Darlene Vendittelli, Director of Digital Revenue Management at South Coast Health, discuss crucial strategies to prepare for technology downtime in healthcare settings. The conversation covers the inevitability of system outages and emphasizes the importance of having a well-crafted downtime plan. Darlene shares five key steps, including inventorying systems, creating paper processes, developing a recovery plan, and establishing a strong communication strategy. They also talk about the necessity of rehearsals and regular reviews to ensure readiness. With practical tips and real-world examples, this episode provides valuable insights for healthcare professionals to maintain operational continuity during tech downtimes.

Additional Episode Resources:

The SAFER Guides (Safety Assurance Factors for EHR Resilience) — government-published checklists and self-assessment tools for contingency planning and downtime preparedness: https://www.healthit.gov/topic/safety/safer-guides

A one-page tip sheet Darlene created summarizing her five-step downtime framework: Please email [email protected] to receive your free copy.

00:00 Introduction and Host Background

00:33 Episode Overview and Guest Introduction

02:38 Importance of Downtime Preparation

06:10 Steps to Build a Downtime Strategy

16:34 Communication and Recovery Plans

26:56 Practical Tips and Resources

30:20 Conclusion and Call to Action