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

Navigating Automation in Revenue Cycle Management with Michael Laukaitis In this episode of 'For The Love of Revenue Cycle', host Vanessa Moldovan dives into the world of automation with healthcare IT expert Michael Laukaitis. With over two decades of experience, Mike shares his journey from rural Montana to UT Southwestern, highlighting the evolution of automation in healthcare. The discussion covers the importance of evaluating processes before automation, the differences between RPA and agentic AI, and the need for human oversight in automated systems. Mike emphasizes the necessity of stable, high-volume processes for successful automation and warns against over-promising vendors. Mike and Vanessa provide practical advice for healthcare leaders on selecting and implementing automation tools, ensuring measurable outcomes, and maintaining system integrity.

00:00 Introduction to the Episode

00:36  Meet Mike Laukaitis 

01:00 Early Automation Experiences

02:05 Current Automation Projects

03:53 Challenges and Considerations in Automation

04:47 When Not to Automate

07:15 Human Element in Automation

09:58 Technical Aspects of Automation

17:54 Evaluating Automation Vendors

25:39 Best Practices and Lessons Learned

33:37 Conclusion and Final Thoughts

What makes a process a good candidate for automation? Use this quick scorecard (1=low, 5=high). Aim for 24+ out of 35.

• Volume and frequency: high, daily work.

• Rule clarity: clear decision rules or prompts a model can follow.

• Input quality: structured data, stable forms, reliable sources.

• System stability: few UI changes, APIs available, or predictable portals.

• Exception rate: historically under 15% and well-defined.

• Impact: measurable time saved, faster cash, fewer denials, fewer clicks.

• Risk profile: errors are detectable and reversible.

Questions leaders should ask before building or buying automation tools

• What is the exact business outcome and how will we measure it monthly?

• Where is the waste today: rework, wait time, over-processing, or motion?

• Is the process stable and documented, or do we need to fix it first?

• What is the current exception rate and why do exceptions happen?

• What data sources are required and who owns their quality?

• What are the failure modes and how will we detect, alert, and roll back?

• What access, audit, and compliance controls are required end-to-end?

• Build vs buy: which option reduces time to value and long-term maintenance risk?

• What’s the realistic total cost of ownership, including rebuilds after system or payer changes?

• How will staff be trained, and what tasks will they do when the bot takes over the boring parts?

• Who is the named process owner and who shuts it off if metrics slip?

• What is the decommission plan if the upstream system adds a native feature?

Implementation guardrails that save pain later

• Fix the process first. Map it, remove steps, standardize inputs, then automate.

• Start in “shadow mode.” Let the bot run in parallel for 2 weeks and compare outcomes.

• Instrument everything. Log starts, stops, exceptions, and outcomes. Alert on drift.

• Keep humans in the loop for edge cases and approvals above risk thresholds.

• Review quarterly. If payer or EHR changes make it brittle, redesign or retire it.

Mastering Payment Analysis: Best Practices with Stacy Calvaruso In this episode of 'For The Love of Revenue Cycle,' host Vanessa Moldovan and expert Stacy Calvaruso discuss the often-overlooked yet crucial topic of payment analysis. The episode differentiates between contract modeling and payment analysis, addressing common issues like underpayments and silent downcoding. They share actionable steps for ensuring proper payment using both advanced technologies and spreadsheets. The discussion also covers the importance of data in running a revenue cycle, triggers for payment analysis, and strategies for contract negotiation. Practical advice on identifying and rectifying underpayments is provided, emphasizing the need for regular review and collaboration within the organization. Whether you're a large hospital or a smaller clinic, this episode offers valuable insights into maintaining revenue integrity.  Here is the link to the analysis sheet referenced in the call: Payment Analysis Lost Revenue Tracker

00:00 Introduction and Episode Overview

00:56 Meet Stacy Calvarusso: Revenue Cycle Expert

02:49 The Importance of Data in Revenue Cycle Management

03:52 Contract Modeling vs. Payment Analysis

05:50 Understanding Payment Variances and Underpayments

08:53 Contract Negotiation Strategies

14:51 Triggers and Tools for Payment Analysis

18:47 Practical Tips for Payment Analysis

32:14 Conclusion and Final Thoughts