RevDive

Welcome to RevDive! For those of you who are new to the Podcast, we use this space to hear from and share with healthcare leaders inside and out of the Revenue Cycle. Our Guest today is Kevin Mulcahy, Senior Director of Payer Relations, Special Billing & Provider Enrollment for Mass General Physician Organization. Kevin discusses the trickle-down effect Provider Enrollment and Payer Contract management plays in the overall Revenue Cycle.

What You’ll get out of this episode:

·         Remote Central Business Office workforce optimization best practices

·         National trends and solutions to address provider enrollment delays

·         Incorporating provider enrollment and payer contracting compliance standards into RCM workflows

·         Cross-functional knowledge sharing to avoid loss of information in the midst of workforce turnover

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Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

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Kevin Mulcahy

Welcome to RevDive! For those of you who are new to the Podcast, we use this space to hear from and share with healthcare leaders inside and out of the Revenue Cycle. Our Guest today is Kevin Dedner, Founder and CEO of Hurdle Health. Mr. Dedner talks about the revolutions his company has been making in virtual therapy services, publishing “The Joy of the Disinherited-Essays on Trauma, Oppression and Black Mental Health.”, how new CMS policies will impact the future behavioral health landscape, and how to lead multi-faceted teams.

What you’ll get out of this episode

• How do you find and collaborate with mental health services providers to close gaps in care?
• What are the key takeaways from “The Joy of the Disinherited-Essays on Trauma, Oppression and Black Mental Health” by Kevin Dedner?
• How will the CMS’ new focus on mental health services affect the behavioral health landscape?
• How do you lead a multi-faceted team through adversity?

Quotables

“For the people who we wanted to serve, there were a lot of barriers that we needed to overcome. The ability for insurance to be accepted, I saw as a critical point for us.” 

“The hard truth is that the mental healthcare system is not designed for everyone. We have a system that was really designed for one segment of our population. For far too long, mental health has been a luxury and a privilege.”

“Teletherapy and telehealth are here to stay. If you start to think about work supply shortages and geographical shortages. There are real solutions in telehealth, particularly in the mental health field.”

Recommended Resources

• “The Joy of the Disinherited: Essays on Trauma, Oppression, and Black Mental Health” by Kevin Dedner https://www.amazon.com/dp/1737931311/ref=cm_sw_r_sms_api_glt_fabc_3TBG6FCP1DNVR7F2JPB5 

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

Rev Dive on LinkedIn

RevDive on Twitter

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Follow our Guest on LinkedIn:

Kevin Dedner https://www.linkedin.com/in/kevin-dedner-mph-/ 

Welcome to RevDive! For those of you who are new to the Podcast, we use this space to hear from and share with healthcare leaders inside and out of the Revenue Cycle. Our Guest today is Amy Weiser, lead project coordinator at Quality Insights for the QPP service project. Ms. Weiser explains what a Quality Improvement Organization (QIOs) is and how they support other organizations. Additionally, she explains pressing CMS MIPS updates to help keep listeners up to date.

What you’ll get out of this episode

• What is a Quality Improvement Organization (QIOs) and what is their relationship with CMS?
• What kind of support does a QIO provide?
• What key areas should medical practices focus on to avoid penalties brought on by changes to the Quality Payment Program (QPP)?
• What is the MIPS Value Pathway (MVP) Program and what changes will it bring?
• Where to get more information on the new SAFER annual EMR self assessment?

Quotables

“We collaborate with providers, communities, and people with Medicare through data driven initiatives.”  

“[To improve quality] Selecting measures that are meaningful to your practice is the first thing.”

“In a nutshell, the MIPS Value Pathway program, is designed to reduce provider burden.”

Recommended Resources

• “MIPS Value Pathways (MVPs)” https://qpp.cms.gov/mips/mips-value-pathways  

Sponsored by: Inovalon

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Welcome to RevDive! For those of you who are new to the Podcast, we use this space to hear from and share with healthcare leaders inside and out of the Revenue Cycle. Our Guest today is Alexandra Pecci, freelance writer for Health Leader Media and other top health news outlets. Ms. Pecci takes her experience from interviewing health industry leaders at every-level and gives us the ins and outs of revenue cycle management from the perspective of an outsider.

What you’ll get out of this episode

• What does the medical revenue cycle management industry look like from the outside?
• Why it is particularly important to provide medical professionals with accurate information?
• What are some issues in healthcare stemming from the provider side?
• What are some ways to get people interested in revenue cycle management?

Quotables

“You have to make sure you’re not giving bad information...If I point them in the wrong direction or at the wrong regulation, it can have some really serious consequences.” 

“I’m not an expert. I interview experts and then share what they have to say with other people who care about it.”

“…payers make the rules and break the rules, and then seemingly make them up as they go along, and change them without telling you."

Recommended Resources

• “No Surprises Act Temperature Check with Revenue Cycle Leaders” by Alexandra Pecci https://www.healthleadersmedia.com/revenue-cycle/no-surprises-act-temperature-check-revenue-cycle-leaders 
• “New Rev Cycle Leaders: Don’t Swoop Into ‘Fix-It’ Mode Until You’ve Taken These 3 Steps” by Alexandra Pecci https://www.healthleadersmedia.com/revenue-cycle/new-rev-cycle-leaders-dont-swoop-fix-it-mode-until-youve-taken-these-3-steps 
• “3 Issues that Defined 2021 for the Revenue Cycle” by Alexandra Pecci https://www.healthleadersmedia.com/revenue-cycle/3-issues-defined-2021-revenue-cycle 

Sponsored by: Inovalon

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

What you’ll get out of this episode:

• What is “cyber hygiene” and how do we achieve good cyber hygiene?
• How is employee burnout impacting cybersecurity risk?
• Are cybersecurity policies worth the expense?
• How do we protect ourselves from third-party breaches?

Quotables

“Bad Actors are targeting healthcare providers and systems because they know it has a bigger impact than targeting just one organization”

“The general rule of thumb for liability, is that whoever collects the data is responsible to protect the data. So it’s really important that you have a vendor management process”

“Carriers have really evolved into taking a more proactive, pre-breach stance, in protecting their insureds. There are a lot of resources they offer now to help you prevent breaches”

Today's guest: Jenny Jacobsen: https://www.linkedin.com/in/jenny-jacobsen-3b624082/ 

Recommended Resources

• Cyber Risk Management by Jenny Jacobsen https://drive.google.com/file/d/1BtNFWNnQmaKrkGJwoCY3VluxmEHaRQIY/view 

Sponsored by: Inovalon

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Chances are, like the rest of the industry, you are seeing significant payer delays. In this episode, Sharon Smith, Practice Manager at Virginia Beach Surgery explains the impact of payer delays and how to tackle these issues with payers.

What you’ll get out of this episode:

• How do untimely payments impact the revenue cycle?
• The role that clean claims play and how to align payer contract language with state regulations
• The role of the state insurance commissioner
• Best practices to minimize payment delays

Quotables

“Practices need to understand what their contractual obligations are as well as state regulations. One thing that is a frustration is that there are so many caveats in the legislation that allow carriers to bypass”

“Payers should be mandated to say whether or not they are subject to the state regulations to give the claims processor and the practice an indication of whether they can be held accountable”

“Provider reps used to come to the office, we used to actually have reps assigned that we could communicate trends to. With the ways the world has changed we don’t have those deep relationships anymore with provider reps and that adds to the challenge”

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Sponsored by: ABILITY Network

This episode is for revenue cycle leaders, operational leaders and those looking for ways to innovatively approach denial management and operational challenges. In this episode we talk to Lamont Louis, Chief Operating Officer for Physician Services for Einstein Physicians at Jefferson Medical Group in Philadelphia, PA. Mr. Louis talks about identifying financial variances, using the FORM approach to team success, and how to identify critical KPIs from an operational perspective.

What you’ll get out of this episode:

• Why does prioritizing a proactive KPI approach matter?
• What is the “Financial & Operational Review Meeting” (FORM) and why does it work?
• What trends operationally, and for staffing, are being seen right now?
• How do organizations operationalize KPI data?

Quotables

“When I arrived 40 years ago, the only metrics I saw were patient visits, and dollar signs. ” 

“If we are two years in, and we are still at a loss, then we need to change that dynamic.”

“Don’t be afraid to say, this is not acceptable and we need to be better. It comes with the responsibility of always pushing yourself and your teams to be better”

Recommended Resources

“Proactive to Reactive” by Lamont Louis, MGMA Article https://lnkd.in/e4XJzUpG

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Sponsored by: ABILITY Network

All practices, hospitals, and health systems this is a critical and timely episode. Claire Ernst, Director of Government Affairs breaks down the legislation passed last night by Congress which waived and delayed several looming cuts to Medicare reimbursement for 2022. She covers the PAYGO 4% cuts, conversion factor changes, sequester delays and phased reinstitution, telehealth coverage for 2022 and more! Tune in for essential updates to your 2022 reimbursement outlook!

What you’ll get out of this episode:

• What portion of the previously delayed 2021 budget neutrality adjustments were mitigated for the Medicare physician fee schedule conversion factor through CY 2022
• The status of the imposition of the 4% statutory pay-as-you-go sequester resulting from the American Rescue Plan Act through CY 2022;
• The new plan for the reinstatement of the existing 2% Medicare sequester through March 2022 and more!

Quotables

“Statutory PAYGO has actually never been triggered before for Medicare…we were getting down to the wire and it wasn’t getting done” @ClaireErnstJD

“Anyone who has a physician office lab would want to pay attention to this, the protecting access to medicare act (PAMA) passed in 2014 basically redid the formula for data reporting and coming up with the calculation for reimbursing labs which led certain labs to face up to 15% in cuts…many of those cuts were delayed for a year by the CURES Act through the end of this year”@ClaireErnstJD

“We went from expecting 9.75% cuts in Medicare reimbursement to removing 9% of those cuts” @ClaireErnstJD

“There is momentum [regarding audio only telehealth] if it’s something that’s important to you and your practice, especially if  you are in a rural area, get in contact with your members of congress and provide them that data or those anecdotes you may have” @ClaireErnstJD

Recommended Resources

• MGMA Washington Connection
• CMS Newsroom

Join the Conversation

We want to hear from our RevDivers! Tell us what topics and people you’d like us to cover in future episodes:

- Website - Facebook - LinkedIn - Twitter - YouTube

Follow our hosts on LinkedIn:

Taya https://www.linkedin.com/in/tayamoheiser/ 

Kem https://www.linkedin.com/in/kem-tolliver-bs-cmpe-cpc-cmom-1225b115/ 

Sponsored by: ABILITY Network

Details:
Listen in as we hear from Physician and Attorney Reza Ghafoorian on strategies to minimize alarm fatigue while remaining compliant with not so obvious threats that may leave healthcare providers vulnerable to cyberattacks. Our guest gives insight on industry best practices to remain vigilant in protecting your brand and Protected Health Information.

Interviewee:   
Reza Ghafforian, MD, Esq, Principal Attorney at G2Z Law Group, PLLC

Find out more in this timely episode and subscribe for future #RevCycle updates with RevDive.

Sponsored by: ABILITY Network

For more information on critical RCM updates, be sure to follow RevDive on our social channels:

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Details:
Luigi Leblanc joins us for a discussion right at the intersection of public health and technology. How can we optimize use of technology, how is technology being used for niche services, how are programs changing to drive reimbursement for these? Find out the answers to these and more in this episode of RevDive!

Interviewee:    
Luigi Leblanc, VP of Technology at Zane Networks 

Find out more in this timely episode and subscribe for future #RevCycle updates with RevDive.

Sponsored by: ABILITY Network

For more information on critical RCM updates, be sure to follow RevDive on our social channels:

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