For The Love of Revenue Cycle

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 [email protected] 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

In this episode, Vanessa Moldovan, CEO and Founder of 'For the Love of Revenue Cycle,' leads a live Q&A session on handling denials in medical billing. Participants from different sectors of the healthcare revenue cycle, including medical billing for home visits, nursing homes, and surgery centers, discuss challenges they face with denial codes, modifiers, and reimbursement issues. Key topics include understanding the new FY 2024 hospice final rule, addressing denials related to modifier codes, and strategies for handling electronic remittance advice (ERA) take-backs. Suggestions for actionable steps and resources, such as consulting specific websites and joining relevant forums, are also shared. 

00:00 Introduction and Purpose of the Q&A Session

00:49 Challenges in Revenue Cycle and Denials

02:07 Participant Introductions and Their Goals

03:11 Open Forum for Questions and Discussions

04:14 Lauren's Denial Issue with Chronic Care Management

09:26 Exploring Possible Solutions and Resources

21:08 Roseanne's Issue with Take Backs on ERAs

28:22 Provider Targeting by Payers

28:38 Options for Receiving Take Backs

29:03 Challenges with Electronic ERAs

29:44 Appeal Deadlines and Paper Forms

30:11 Denials Due to Grouper Edits

30:53 Hospital Denials and Resources

33:13 Questions on Prolonged Services Billing

37:08 Issues with Nursing Home Billing

45:29 Seeking Expert Advice and Final Thoughts

Show notes for today's live denials Q&A session:

• The differences in denials and appeals processes between in-network and out-of-network providers

• Strategies for appealing out-of-network denials, including involving patients and leveraging laws like the Arisa law

• Trends in payer requests for documentation and potential reasons behind sudden increases in these requests

• Frustrations with payers' downcoding practices and lack of transparency in reimbursement

• The shift in the medical field from a profession to a business, and the need for better revenue cycle education for providers

Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa

In this episode, Vanessa welcomes Mike Marshall to discuss the intricacies of revenue cycle management (RCM) and the challenges faced by healthcare organizations. Mike is currently the Managing Director of the North American division of e5 Workflow, with a rich background in healthcare focusing on turnaround projects for operation, finance, and revenue cycle management.

They explore the root causes of common RCM issues, the hesitations around adopting new technology, and emphasize the necessity of becoming tech-enabled to survive in the current market. The conversation delves into innovative solutions, actionable data, optimizing human resources, and technological advancements like AI and automation. They also provide guidance on selecting vendors and the importance of staying informed about industry innovations through networking, conferences, and professional advice.

00:00 Welcome and Introduction

00:31 Introducing Mike Marshall

01:03 Industry Challenges in Revenue Cycle Management

02:09 Hesitancy in Adopting Technology

03:48 The Pain of Outdated Systems

07:35 Fear of Change in Revenue Cycle

11:32 Importance of Training and Support

16:47 Encouragement to Explore New Solutions

21:19 Leveraging Technology for Efficiency

33:15 Medicare Challenges and Strategic Technology Integration

33:52 Middle Management and Delegation with Technology

35:08 Industry Changes and Knowledge Gaps

36:04 Leveraging Technology for Delegation and Efficiency

36:53 Outsourcing and Onshoring in Revenue Cycle Management

39:34 Navigating Vendor Selection and Industry Resources

45:16 Maximizing Conference and Vendor Interactions

53:40 Evaluating Automation and AI Claims

57:55 Strategic Technology Integration and Conclusion

In this episode, Vanessa Moldovan hosts a Q&A session focused on the challenging issues of denials in revenue cycle management. Vanessa, along with the attendees, discusses the complexities around denial prevention, resolution, and best practices. The session covers specific payer issues, including downcoding by Anthem and Humana, as well as rampant documentation requests from UnitedHealthcare. The discussion also provides strategies for handling denials, escalating issues to provider representatives, utilizing contracts, and ensuring accurate coding practices. Expert insights are shared on balancing the administrative burden, proactively managing claims, and leveraging technology to streamline processes. The conversation aims to empower healthcare providers and billers to tackle denials effectively while advocating for systemic changes in payer operations.

00:00 Introduction and Welcome

03:27 Purpose of the Q&A Session

04:28 Host's Background and Experience

05:25 Community and Participation

07:00 First Question: Handling Downcoding 1

1:44 Discussion on Denial Trends and Strategies

23:02 Challenges with Payers and Denials 

31:41 Industry Trends and Payer Practices

35:26 Frustrations with Office Testing and Pre-Authorization

37:22 Tactics for Fighting Unjustified Denials

38:27 Challenges Faced by Small Practices

40:21 Importance of Documentation and Predetermination

42:16 Role of Professional Organizations and Social Media

49:12 Differences in Denials: In-Network vs. Out-of-Network

54:53 Leveraging Contracts and Provider Networks

58:46 Final Thoughts and Recommendations

Get ready for Season 3 of For the Love of Revenue Cycle, premiering tomorrow with Episode 30! I'm back with a deep dive into denials and accounts receivable in the revenue cycle. Listen in, as I unpack the complexities of denials and their impact on healthcare organizations. I'll share insights from recent industry events and personal experiences, highlighting key strategies for prevention and resolution.

Also, stay tuned to the end for a big announcement about For the Love of Revenue Cycle.

In this episode, we dive into effective strategies for preventing and resolving denials in healthcare billing. Our speakers cover essential tips like checking the place of service, sharing experiences, and networking with other professionals. We explore various types of rejections in healthcare claims, emphasizing the need to understand their origins and track them meticulously. Discover valuable insights on managing appeals and reconsiderations, staying organized, using timely filing tools, and navigating complex appeal letters. Plus, learn about the importance of resources for identifying plan types and tackling excessive medical documentation delays. Join us for this comprehensive discussion on mastering healthcare billing challenges.

During today's live Q&A we had some great discussion about important denials that you and your organization are probably experiencing.  We had some great interaction with 28 attendees.  Check out the conversation!