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