For The Love of Revenue Cycle

00:00 Welcome and Book News 01:00 Why This Episode Is Different 02:47 The Big Patient Impact Question 04:42 Patient Surveys and NPS 07:48 Inferring Sentiment From Errors 11:02 Worst Mistakes in RCM 11:24 Coding and Eligibility Pain Points 14:57 Surprise Billing and No Surprises Act 22:35 Prior Auth Denials and Appeals 24:32 When Healthcare Was Simple 25:11 Patient Pain Points Reality 25:52 Survey Bias and Feedback 26:27 Denials Stress Patients 27:24 Inevitable Denials Explained 28:46 CPT Mismatch Mechanics 33:06 What Teams Can Control 36:39 Compliance and Audit Risks 40:50 Metrics Next Steps 41:24 Final Wrap and Call

Vanessa Moldovan celebrates the upcoming five-year anniversary of For the Love of Revenue Cycle on October 28, sharing how the podcast grew from her For the Love of Revenue Cycle Facebook group and her shift from operations into mentoring, coaching, and education. 00:00 Welcome Back Update 01:01 Purpose And Instincts 01:57 Career Shift Begins 02:55 Facebook Group Origins 04:45 Romania Sabbatical Dreams 07:21 Podcast Idea Takes Shape 09:06 Launching The Show 10:32 Ukraine War Return 11:18 Dream Job Manifested 14:56 Podcast Evolution Ahead 16:11 Listener Feedback Invites 16:59 New AI Playbook Book 18:07 Anniversary Episodes Wrap

Host Vanessa Moldovan interviews Monte Sandler, COO of WebPT, about the technology foundation beneath revenue cycle work and why "bolting on" AI to legacy EMR and practice management platforms has a ceiling compared with rebuilding AI-native systems from the ground up. 00:00 Welcome and Big Announcement 01:04 Episode Theme AI Needs New Foundations 02:16 Meet Monty Sandler 04:57 Why Revenue Cycle Hooks You 06:46 Why Healthcare RCM Is So Complex 10:03 WebPT Going AI Native 12:18 Rebuild vs Bolt On AI 13:56 Shift Left Fix Front End Errors 16:56 Automation Examples OCR Eligibility 19:19 Will AI Take My Job 22:19 Humans Become Reviewers Strategists 27:17 Change Management and Final Advice 30:26 Wrap Up and Listener Call to Action

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Lisa Purnell, Director of Risk Adjustment at Community Health Choice in Houston. Lisa explains risk adjustment as measuring population sickness to predict future costs, centered on accurate diagnosis coding and documentation that supports patient complexity and resource needs. She describes how risk adjustment affects many health plan departments, why revenue cycle teams often misunderstand it, and how it informs premiums and care management. 00:00 Welcome and Big News 00:14 AI Playbook Announcement 01:14 Episode Topic Risk Adjustment 02:18 Meet Lisa Purnell 03:35 Lisa's Path to Risk 05:30 Risk Adjustment Explained 06:48 Who Benefits and How 10:13 Why Rev Cycle Misses It 13:45 Outpatient vs Inpatient 15:50 Documentation Storytelling 17:49 January 1 Reset Myth 20:54 Compliance Guardrails 23:40 Why It Matters Now 25:04 Action Steps to Start 27:35 Marketplace and Risk Scores 29:50 Final Takeaways and Wrap 31:31 Outro and Contact Info

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan speaks with Lisa Hoogstra, Senior Director of Revenue Cycle Front Office at Ivy Rehab Network, about why front desk teams are often under-resourced and how that impacts patient experience, billing accuracy, denials, and collections. Lisa explains how front-office work begins before the first visit through scheduling, insurance selection/registration, verification, authorizations, and setting clear financial expectations. She also describes her Front Office Excellence (FOX) program focused primarily on soft skills like communication, customer service, and leading from your seat to build ownership and critical thinking. 00:00 Why Front Office Matters 01:22 Meet Lisa Hoogstra 02:18 From Lab to Front Office 06:19 Before the First Visit 08:42 Hidden Burdens and Misunderstandings 12:42 Introducing the FOX Program 15:46 Building Ownership and Leaders 18:04 Results and Soft Skills Focus 20:35 Start Small Without a Program 26:42 Changing Culture and Respect 28:53 Tech Adoption and Change Management 34:12 Call to Action and Wrap Up

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Laura Miller, founder and CEO of TempDev, about how to bring technology into the revenue cycle responsibly. They discuss why organizations often underuse existing system functionality, how automation can reduce manual work and avoid hiring, and why denial reporting is essential for pinpointing fixable causes such as credentialing, prior authorizations, coding, or front-desk insurance selection. 00:00 Welcome and Episode Focus 02:10 Meet Laura Miller 04:12 Bridging Tech and Rev Cycle 06:36 Practice Management Assessment 12:23 Automation Over Hiring 15:17 Red Flags and Root Causes 19:18 Denials Reporting Explained 22:03 Fixable Problems Upstream 23:13 Patient Pay Made Easy 25:03 Online Payments For All Ages 26:15 Building The Business Case 27:46 KPI Dashboards And Benchmarks 30:18 ROI Beyond Revenue 34:04 Fix Denials One By One 35:20 Listen Before You Build 37:07 Solve The Business Need 39:16 AI Hype Reality Check 40:35 Episode Wrap And Takeaways

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews orthopedic coding expert Lynn Anderanin about clinic-based orthopedic coding amid payer policy changes, focusing on modifier 25, E&M documentation, compliance, and payer down-coding. Lynn, a longtime coder and coding compliance manager, explains that modifier 25 is intended to indicate an office visit that is significantly and separately identifiable from a same-day procedure. She discusses auditing for unrelated problems, risks of over-documentation, cloning, and outdated templates, and emphasizes that notes must reflect patient-specific care and legal accountability. The episode also covers payer practices such as down-coding without records review by relying on assessment/plan and diagnosis, and more. 00:00 Welcome and Episode Focus 01:32 Meet Lynn Anderanin 04:51 Compliance Role and Audits 07:28 Modifier 25 Basics 10:42 Globals and RVU Breakdown 13:05 Auditing Injection Visits 16:28 E&M Templates and Cloning Risks 19:14 Legal Exposure and Note Specificity 21:54 Notes Not Black White 22:50 Audit Ready Compliance 23:44 Write Policies Down 26:22 Payers Versus Guidelines 27:19 Contracts Appeals Leverage 30:54 Provider Documentation Change 31:57 Pre Op Visit Confusion 34:08 AI Driven Downcoding 37:43 Modifier 25 Action Steps 40:13 Closing Reflections Outro

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Molly Cueto, a licensed professional counselor and COO overseeing five behavioral health clinics in Houston, about aligning clinical care with revenue cycle operations. Cueto explains why clinicians, trusted by patients, are often best positioned to discuss costs, emphasizing transparency to prevent cancellations and ruptures in care. 00:00 Welcome and Episode Setup 01:03 Meet Molly Cueto 02:29 Clinicians Owning Revenue Cycle 04:55 Documentation Culture Cadence 06:17 Front End Verification Workflow 07:23 Transparency Shift and Bottlenecks 11:20 Diagnosis Labels and Lifelong Impact 16:20 Rule Outs Versus Confirmed Dx 20:16 Building Billing Teams Over Time 24:09 Clinician Led Money Conversations 28:30 Collections With Empathy 30:42 Call to Action and Wrap Up 32:09 Host Takeaways and Sign Off

In this episode of "For the Love of Revenue Cycle," host Vanessa Moldovan welcomes Kane Tomlin, who describes his path to state government work at the Mississippi Department of Health on data modernization and AI. They discuss how decades of point solutions created siloed public health data (e.g., TB and STI systems) that slow decisions such as infant mortality reviews, and how integrated, properly segmented data could automate case-file assembly for review boards and enable faster cause-and-effect learning. 00:00 Welcome 00:38 Meet Kane Tomlin 01:38 Kane's Career Path 03:30 Why Health Data Modernization 06:11 Dotcom Digitization Lessons 08:25 Keeping Humans in Control 08:47 Where to Find Kane's Work 09:30 Silos in Public Health Decisions 09:56 Infant Mortality AI Example 13:16 Blockers Privacy and Ecosystems 16:58 Responsible Integration and De-ID 20:11 What AI Enables in Healthcare 23:31 Pandemic Potential and Risks 25:41 Call to Action for Interoperability 28:47 Revenue Cycle Data Integrity Role 30:32 Closing

In this FTLORC Live Denial Q&A, Vanessa Moldovan shares takeaways from APC's HealthCon in Dallas. The episode focuses on denial/non-payment escalation beyond traditional corrected claims and appeals, tracking trends, using payer policy language in second appeals, and briefly contrasts out-of-network strategies (ERISA, patient/employer involvement, No Surprises Act). 00:00 Welcome and HealthCon Takeaways 00:47 Why Prior Auth Hurts Most 03:45 Traditional Appeals No Longer Enough 08:01 Escalation Step One Contract Review 10:37 Escalation Step Two Payer Relations 13:24 Escalation Step Three Insurance Commission 15:02 Grievances and Legal Options 19:00 Q&A Prior Auth Second Appeal Tips 24:41 Q&A When to Escalate and Trend Tracking 30:34 Wrap Up Community and Out of Network