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 [email protected].

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