In this episode of The Claim Game, Jeremy Zug sits down with Shannon Hiser, founder of The Wellness Counseling Center LLC, to discuss the realities of scaling a multi-location therapy practice. Shannon shares the administrative and compliance challenges that tested her business—from staffing turnover and insurance audits to billing setbacks—and how she built a reliable in-house billing system with the help of Practice Solutions. Together, they explore practice growth, leadership, AI in healthcare, and creating a business that aligns with your values.

Revenue Cycle Management, Private Practice Scaling, Insurance Audits, W2 Therapists, 1099 Therapists, Supervisory Billing, In-House Billing, Practice Management Software, Value-Based Business

1099 vs. W2 Matters: Understanding worker classification is essential when clinicians bill under your Tax ID. Misclassification can lead to costly audits and compliance issues.

Verify Insurance Policies in Writing: Don't rely on verbal guidance from payer representatives. Always confirm billing rules through contracts and provider manuals.

Build a Business That Doesn't Depend on You: Sustainable growth requires systems and infrastructure—not an owner carrying an unsustainable caseload.

Use AI Thoughtfully: AI can reduce administrative burden through documentation and billing support, giving providers more time to focus on patient care.

Lead with Your Values: When challenges arise, solve problems one step at a time while keeping your practice aligned with your mission and long-term goals.

00:00 Introduction to Shannon Hiser and The Wellness Center

12:27 Navigating Administrative Storms and Compliance Challenges

26:58 From Founder-Dependent to Future-Ready

29:50 The AI Dilemma: Efficiency vs. Ethics

34:57 Growing the Team Without Compromising the Mission

37:14 Conclusion: Lead with Values, Not Just Goals

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Wellness Counseling Center

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

In this solo episode of The Claim Game, Jeremy Zug breaks down one of the most common—and most fixable—revenue cycle challenges: claim rejections. Learn the difference between rejections and denials, why small technical errors delay payment, and how to identify the issues preventing your claims from reaching the payer. From EDI enrollment problems and provider directory mismatches to telehealth modifiers and payer ID mix-ups, Jeremy shares practical strategies to help you resolve rejections faster and improve cash flow.

Private Practice, Revenue Cycle Management, Claim Rejections, Medical Billing, Insurance Billing, Mental Health Billing, Cash Flow, EDI Enrollment, Credentialing, Practice Growth

Rejections vs. Denials: Rejections are "soft failures" caught by the clearinghouse before a claim reaches the payer. Denials occur after the payer processes the claim and refuses payment.

Rejections Are Data, Not Disaster: Rejections aren't personal—they're technical alerts pointing to errors that can often be corrected and resubmitted quickly.

Your Digital Footprint Matters: Mismatches between your NPI, taxonomy, tax ID, or address and the payer's records can trigger preventable rejections.

Billing Requires Precision: Missing or incorrect modifiers, place of service codes, and EDI enrollment details can cause claims to bounce before they're processed.

Avoid the Sister Company Trap: Always verify the exact payer ID on the patient's insurance card. Similar company names don't always route claims to the correct payer.

00:00 Introduction: Claim Rejections—The Simplest Problem to Solve

02:12 Common Rejections and How to Fix Them

09:10 Small Errors, Big Rejections

11:46 Payer IDs, Prior Auths, and Preventable Delays

13:13 When Diagnosis Codes Trigger Rejections

13:59 Conclusion: Turning Rejections Into Solutions

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Rejection Resolution Guide

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Danielle Hayes, founder of Therapy Austin, to unpack the journey of growing a cash-pay therapy practice from three clinicians to more than 140 providers across multiple locations. Danielle shares the systems, leadership principles, and clinician development strategies that fueled that growth—and why investing in people was always the foundation of the business.

Together, they explore what it takes to build a sustainable group practice, including hiring and onboarding therapists, creating a strong culture, developing future leaders, and navigating clinician retention. Danielle also offers a candid look at the realities of selling a therapy practice, including valuation challenges, private equity interest, and the importance of finding values-aligned buyers.

The conversation closes with Danielle's advice for practice owners feeling pressured to chase rapid growth: focus on patience, sustainability, and doing meaningful work well. This episode is packed with practical lessons for therapy practice owners who want to build something that lasts.

KEYWORDS

Group Therapy Practice, Cash-Pay Therapy Practice, Therapy Austin, Private Practice Growth, Mental Health Practice Management, Therapist Recruitment, Therapist Retention, Clinical Supervision, Practice Leadership, Therapy Practice Culture, Group Practice Scaling, Practice Acquisition, Selling a Therapy Practice, Behavioral Health Business, Practice Operations, Clinician Development, Private Practice Coaching, Healthcare Entrepreneurship

TAKEAWAYS

Invest Heavily in Clinician Development

Therapy Austin built extensive onboarding programs, mentorship structures, continuing education opportunities, and leadership pathways to help clinicians succeed and stay engaged. 

Culture Is a Competitive Advantage

Strong training, shared values, and a supportive clinical environment helped create consistency across a rapidly growing organization and fueled word-of-mouth growth. 

Hiring for Character Beats Hiring for Skill

Danielle emphasizes that clinical skills can be taught, but curiosity, emotional maturity, accountability, and alignment with the organization's values are harder to develop. 

Growth Requires Systems and Leadership

As practices scale, founders must transition from individual relationships to structured processes, leadership teams, performance metrics, and operational frameworks. 

Selling a Practice Is More Complex Than Most Owners Expect

Practice valuations are often lower than owners anticipate, and successful transitions require significant due diligence, relationship-building, and post-sale involvement. 

Values Alignment Matters More Than the Purchase Price

The right buyer isn't simply the highest bidder. Shared values, long-term vision, and commitment to clinicians and clients are critical to a successful transition. 

Patience Beats FOMO

Many practice owners feel pressure to chase every growth tactic, platform, and trend. Danielle argues that sustainable growth comes from focusing on quality, consistency, and the work you do best. 

Strong Referral Networks Are Essential

Building relationships with trusted advisors, consultants, accountants, bankers, and industry partners creates long-term stability and better decision-making. 

CHAPTERS

00:00 Introduction: From Solo Practice to a Mentorship-Driven Team

06:11 The Therapist Growth Mindset: Investing in Your Craft

14:33 The Shift from Relationships to Systems

17:26 Hiring for Character, Training for Skill

28:22 When It Was Time to Sell

33:17 Selling a Practice: More Than Just the Numbers

38:55 Conclusion: Patience Is the Ultimate Growth Strategy

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Email Danielle at [email protected] 

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

Ever feel like running your practice has turned into a high-stakes wrestling match against insurance denials, cryptic EOBs, and vanishing revenue? You are not alone, and it’s time to change the game. In this episode of The Claim Game, Jeremy sits down with Shannon Hiser, founder of The Wellness Counseling Center LLC, to talk about the real, raw journey of scaling a multi-location practice in Missouri and Kansas. 

Shannon opens up about the massive administrative hurdles that almost brought her business to its knees, including a sudden mass exodus of her administrative team, a grueling three-year self-reported employment audit, and a "gut-punch" billing horror story that forced her to transition over 100 clients. Shannon also shares the eye-opening reality of managing a community-mental-health-sized caseload of 35 clients a week as an owner, and how she finally built a rock-solid, predictable in-house billing infrastructure by partnering with Practice Solutions and training her husband to take over the reins. If you’re a practice owner feeling overwhelmed by administrative friction, this episode is your roadmap from operational chaos to values-based peace of mind. 

KEYWORDS

Revenue Cycle Management, Private Practice Scaling, Insurance Audits, W2 Therapists, 1099 Therapists, Supervisory Billing, In-House Billing, Practice Management Software, Value-Based Business

TAKEAWAYS

The 1099 vs. W2 Reality Check: If you are a therapist running a therapy business and other clinicians are performing therapy under your Tax ID, regulatory bodies increasingly view that as an employer-employee relationship, not a contractor setup. Knowing the rules protects your business from devastating back-end audits.

Don't Trust Verbal Insurance Approvals: Shannon's team spent hours calling payers, and customer service reps repeatedly verified that supervisory billing was allowed. The lesson? Always look at the actual contract and provider manuals—verbal "yeses" won't save you from a gut-punch clawback or termination.

Saying "No" Dictates Your Success: Taking on a massive caseload of 35 clients a week out of a structural emergency goes against a healthy business philosophy. True scale requires building an infrastructure where the business is not 100% dependent on the owner.

AI as an Administrative Friction-Fighter: While the environmental and critical-thinking impacts of AI spark valid worries, responsibly utilizing AI for progress notes and rapid billing guidelines can save billions in wasted provider time and keep you present with patients.

Eat the Elephant with Your Values: When group practice overwhelm sets in, look at your resources and tackle the issues piece by piece. Aligning your business operations directly with your personal values brings clarity and sustainable growth.

CHAPTERS

00:00 Introduction to Shannon Hiser and The Wellness Center

12:27 Navigating Administrative Storms and Compliance Challenges

26:58 From Founder-Dependent to Future-Ready

29:50 The AI Dilemma: Efficiency vs. Ethics

34:57 Growing the Team Without Compromising the Mission

37:14 Conclusion: Lead with Values, Not Just Goals

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Wellness Counseling Center

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this solo deep dive of The Claim Game, host Jeremy Zug breaks down the RCM category that everyone dreads but is secretly the easiest to fix: claim rejections. While a session allows for a "wait and see" approach, applying that same logic to billing is a slow-motion train wreck. Jeremy strips the emotion out of rejections, reframing them not as personal failures, but as simple, technical data points caught at the gate by your clearinghouse.

Tune in as we break down the critical semantic difference between a rejection and a denial, unmask the "sister company trap," and walk through the common technical typos—from EDI enrollments to provider directory mismatches—that are keeping your hard-earned dollars from hitting your bank account. Let's turn those rejections into deposits!

KEYWORDS

Private Practice, Revenue Cycle Management, Claim Rejections, Medical Billing, Insurance Billing, Mental Health Billing, Cash Flow, EDI Enrollment, Credentialing, Practice Growth

TAKEAWAYS

Rejections vs. Denials: A rejection is a "soft failure"—the claim had an error caught by the clearinghouse and never actually reached the payer. A denial is a "hard failure"—the claim made it to the insurance company, but they processed it and explicitly chose not to pay due to a policy discrepancy.

Rejections are Emotional Data Points: Seeing rejections pile up can cause panic, but they aren't personal. They are simply a clearinghouse's way of saying, "Fix this typo before the insurance company has a chance to say no."

The Four Pillars of the Digital Footprint: An "invalid billing combination" rejection means your NPI, tax ID, address, or taxonomy code doesn't match the insurance company's provider directory. If you change your address or tax ID in your EHR without updating your credentialing first, the system won't recognize you.

Clinical Logic vs. Billing Reality: Computers run on binary algorithms, not common sense. Leaving off a required telehealth modifier or pairing a telehealth modifier (like 95) with an incompatible place of service code (like 11) will make it look like you're trying to be in two places at once, causing the claim to bounce.

Beware the Sister Company Trap: Just because the parent name on the building is the same doesn't mean it's the right payer. Sending an Optum commercial plan claim to Optum Medicaid, or mixing up sister companies like Cigna and Allegiance, results in an immediate wrong payer rejection. Always verify the exact payer ID on the back of the card.

CHAPTERS

00:00 Introduction: Claim Rejections—The Simplest Problem to Solve

02:12 Common Rejections and How to Fix Them

09:10 Small Errors, Big Rejections

11:46 Payer IDs, Prior Auths, and Preventable Delays

13:13 When Diagnosis Codes Trigger Rejections

13:59 Conclusion: Turning Rejections Into Solutions

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Rejection Resolution Guide

EPISODE SUMMARY

In this episode of The Claim Game, we’re moving to the front lines of your Revenue Cycle Management (RCM). Most practices focus on the back end—chasing late, old money. But the true masters of the game focus on the front end. They make sure a claim is perfect and pristine so insurance companies have no choice but to pay them immediately. We call this mastering the first-pass strategy, and today, we're breaking down the exact checklist you need to achieve a high first-pass rate.

KEYWORDS

Revenue Cycle Management, Private Practice, Medical Billing, Claim Denials, First Pass Rate, Insurance Billing, Practice Management, CPT Codes, Credentialing

TAKEAWAYS

Billing Starts at the Front Desk: Most people think billing begins when you hit "submit" in your EHR, but that's actually the final move. Winning the game requires pristine setup, and patient registration is the most critical step in the entire cycle. Most denials are actually "intake diseases" that start before the client even sees a provider.

The One-Payer Filter Rule: Never allow your biller (or yourself) to bounce randomly from one insurance company to another. Every payer has its own personality, portal, and specific rules. Work in batches—filter by one payer, complete all their reviews, and stay in that flow to prevent simple errors from mutating into thousands of dollars in delayed revenue.

Insurance Companies Don't Do Nicknames: If a card says "Robert," do not type "Bob" into your EHR. Payers are incredibly picky eaters; if the first name, last name, middle initial, date of birth, biological sex, or address doesn't perfectly match their system, they will reject it outright.

The Anatomy of the Infrastructure: A single missing digit in an insurance ID or group number is a 100% guarantee of a rejection. Treat these numbers like keys to the insurance company's bank vault. Additionally, you must verify the exact Payer ID and insurance type (checking the private box for a Medicare claim makes it dead on arrival).

Clinical Logic vs. Billing Logic: You have to weed your revenue garden by reviewing CPT codes and modifiers. A missing modifier is like forgetting to put a stamp on an envelope—everything inside might be correct, but it isn’t going anywhere. Check your contracted rates relative to your charged rates so you stop leaving money on the table.

When to Submit a Test Claim: If you have a newly credentialed provider onboarding clients, do not blindly submit a batch of 50 claims at once. If there is a small typo or credentialing misalignment on the insurance side, you’ll end up with 50 headaches. Submit a single test claim first to verify their NPI and tax ID details are clean.

CHAPTERS

00:00 Introduction: The Clinical Mindset vs. The Business Reality

03:50 The One-Payer Workflow Strategy

07:28 The Intake Checklist That Prevents Denials

12:16 The Clinical & Financial Claim Audit

16:30 The Final Review Before Submission

19:04 Conclusion: The Details Drive the Revenue

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Claim Information Review Guide, Modifier Usage Guide

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy sits down with Nicole Brewer, owner of reTHINK Your Practice and reTHINK Therapy in Henderson, Nevada. Celebrating a massive 10-year milestone this year, Nicole has managed to scale an insurance-based group practice to 23 therapists while keeping her sanity intact.

Even better? Nicole officially holds the highest score out of all the practice audit episodes recorded to date!

Jeremy and Nicole look under the hood of her exceptionally high-scoring practice. They break down how a robust task management system eliminates mental fatigue , the rigorous boundaries required to manage 5 to 10 insurance panels , and the reality of the "$200,000 mistake" when navigating rate negotiations. If you want to know what it actually takes to scale ethically, remain stickler-compliant, and defend your revenue, this episode is your masterclass.

KEYWORDS

Private Practice, Revenue Cycle Management, Insurance Billing, Group Practice, Practice Growth, Credentialing, Claim Denials, Healthcare Business, Cash Flow, Asana

TAKEAWAYS

The Two Pillars of Billing Success: Eliminate the mental energy of tracking "what comes next". Use a task management system (like Asana) to build out workflows for AR and follow-ups , and ensure that whoever oversees your billing deeply understands how the mechanics work.

Clean Data Front-Loading: To prevent "oopsie daisy" claim errors, implement a culture where client paperwork must be 100% completed before they can ever touch the calendar. This ensures both the intake team and the client know exactly what the copay and deductible expectations are upfront.

The "Seasoning" of a Clinician: Expect a timeline. While you can take a graduate to fully licensed in two years, true "seasoning" and expert specialty focus typically takes an additional three years post-licensure.

The Math on Dropping a Payer: High-endurance for insurance headaches isn't always a badge of honor. If a specific payer introduces a 10% denial or re-work rate, calculate the practice expense of appealing those claims. Sometimes, giving a 90-day contract notice and converting clients to a sliding-scale courtesy fee saves both your revenue and your team's administrative capacity.

Rigid Payer Standards: Don't throw spaghetti at the wall. Establish a minimum floor rate for your tiers of therapists. If a commercial panel doesn’t meet the floor, pay reliably within 60 days, or allow for EDI/ERA processing, choose not to panel with them.

Relationships Are Everything: Rate negotiation is a human game. Treat payer reps like human beings—memorable gestures like sending a thank-you note can go a long way. Conversely, letting a negotiation turn acrimonious can result in years of being "ghosted" without a raise.

CHAPTERS

00:00 Introduction: The First 10 Years of Group Practice Growth

05:17 Systems Over Stress: How Great Billing Teams Stay Organized

11:38 Building a Culture of Training and Development

15:47 When Insurance Denials Stop Being Worth It

28:30 How to Build a Smarter Insurance Panel Strategy

36:45 How reTHINK Built a Faster Credentialing System

42:27 Why Compliance Is the Real Growth Strategy

45:27 Conclusion: The Future of Practice Operations and AI

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Consulting with Nicole: Rethink Your Practice

Visit reTHINK Therapy

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode, host Jeremy Zug dives straight into one of the most frustrating translation issues in the entire billing universe: modifiers. While many practice owners and CEOs think that typing in a CPT code tells the whole story, insurance company board-game logic demands a whole lot more. CPT codes are just the verbs—they tell the payer what you did. Modifiers are the syntax, the adjectives, and the location codes that give that verb a complete sentence. Without them, your claim is dead on arrival.

Jeremy breaks down what he calls the Matrix of Context—the four primary variables that govern your modifier usage: Industry, Insurance Partners, Geography, and License Type. If you’re tired of playing guessing games with your cash flow or letting automated batch-denial bots hold onto your money, this episode is your blueprint for moving from billing poetry to sheer, boring precision.

KEYWORDS

Revenue Cycle Management, Insurance Billing, Medical Billing, Behavioral Health, Practice Management, CPT Codes, Billing Modifiers, Cash Flow, Clean Claims

TAKEAWAYS

CPT Codes Are Only Verbs: A CPT code tells the insurance company what service you performed, but it doesn't communicate how, where, or by whom. Modifiers provide the vital context that turns an incomplete sentence into a clean claim.

The Matrix of Context: Your modifier usage is dictated by four primary variables that you or your billing team must actively govern: your industry, your specific insurance partners, your geography (where both you and the patient are located), and your exact license type.

Static Information is Dead Information: You cannot memorize the matrix, and relying on a single staff member's mental notes is a recipe for an aging A/R nightmare. High-performing practices map their core CPT codes against every contract, layer on local modifiers, and update their internal dictionary dynamically when rules shift.

Precision Creates Clinical Freedom: When your billing plumbing isn't leaking all over the floor, your leadership meetings can shift from stressful aging reports to expanding your organization’s vision. Boring business accuracy bulletproofs your cash flow and protects the container you’ve built for your staff and patients.

Real-Time 2026 Payer Traps: Payer platforms (like Optum) are now cross-referencing federal databases in real time—if your billing data or taxonomy codes are even 1% off, automated denial bots will kick it back instantly.

CHAPTERS

00:00 Introduction: Why Modifiers Make or Break Your Revenue

02:37 Modifiers: The Language Insurance Companies Actually Speak

04:24 Modifier Rules Change Everything

09:00 The Modifier Usage Guide Every Practice Needs

11:02 How Clean Billing Creates Better Care

13:01 2026 Modifier Updates You Can’t Ignore

14:40 Conclusion: From Guessing to Governing

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Modifier Usage Guide

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with the incredible Dr. Dominique Dor, owner of SOTM Life Skills Center in Duncanville, Texas. Dr. Dor’s journey is anything but typical. Born in Haiti and raised in Brooklyn, she overcame an ACES (Adverse Childhood Experiences) score of 10—a score that statistically suggests a life of hardship—to build a thriving group practice and a life of financial independence.

Dr. Dor shares the "Wall Street Journal" moment that changed her life, why she once decided to live on only 50% of her income, and how she uses her unique I-PROFESS model to help clients move from surviving to thriving. This conversation is a masterclass in curiosity, financial accountability, and the "life skill gaps" that trauma leaves behind.

KEYWORDS

Private Practice, Revenue Cycle Management, Financial Literacy, Mental Health Billing, Practice Growth, Trauma Informed Care, Group Practice, Cash Flow

TAKEAWAYS

The Power of Financial Literacy: Dr. Dor’s career began with an unexpected mentor who taught her how to read the Wall Street Journal, proving that "language" is often the barrier between being broke and building wealth.

The I-PROFESS Model: Healing isn't just about treating symptoms; it's about addressing the eight dimensions of life: Intellectual, Physical, Relational, Occupational, Financial, Emotional, Spiritual, and Social.

Radical Financial Accountability: To gain the freedom to start her private practice, Dr. Dor negotiated her salaries to "buy her time back," eventually learning to live on half of her paycheck to fund her dreams.

Diversifying Your Payer Mix: As a group practice owner, Dr. Dor emphasizes the importance of not becoming "top-heavy" with one insurance payer, ensuring the practice stays stable for the clinicians and staff who depend on it.

Bridging the Life Skill Gap: Trauma doesn't just leave scars; it leaves gaps in the skills needed to navigate life. True clinical success involves teaching clients the skills they were never shown.

CHAPTERS

00:00 Introduction: From Haiti to Healing — Dr. Dor’s Journey into Practice

05:25 The Library That Changed Everything

12:44 The Financial Accountability That Built a Practice

19:52 The Difference Between Coping and Thriving

28:18 The Economics of Preventive Care

31:13 Why Payer Mix Matters in Private Practice

33:11 Conclusion: Systems, Strategy, and the Courage to Grow

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Visit SOTM Life Skills Center

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

Is your practice tired of wrestling with insurance denials and watching hard-earned revenue slip through the cracks? In this episode of The Claim Game, Jeremy Zug goes upstream to the "point of inception": Claim Submission.

While many providers view submitting a claim as a simple keystroke, Jeremy challenges that rudimentary thinking. He breaks down why claim submission is actually a sophisticated discipline of translation—where your clinical work is converted into the rigid, bureaucratic data points that insurance carriers demand. If your translation is off by a single letter, you’ve essentially engineered a cash flow crisis 90 days down the line.

Tune in to learn the four critical tools you need to master this domain, move from clinical logic to billing logic, and ensure your "last stop" internal process leads to a deposit, not a denial.

KEYWORDS

Revenue Cycle Management, Claim Submission, Medical Billing, Private Practice, Insurance Denials, RCM, Healthcare Administration, Billing Logic, Practice Management

TAKEAWAYS

Claim Submission is Translation: It is the bridge between clinical logic (I treated the patient, I should get paid) and billing logic (you followed the rigid rules or you forfeit payment).

The "Two-Centimeter" Rule: A tiny administrative error at the point of submission can spiral into a $2,000 problem 90 days later.

Modifiers are Not Optional: View modifiers as vital context, not optional adverbs. Without correct codes and modifiers, a claim is "dead on arrival".

The Pre-Flight Discipline: Never risk a week's worth of revenue on a hypothesis. Test new payers or providers with a single claim, verify it pays, and then scale.

Data Over Drama: Rejections and denials aren't personal; they are diagnostic data points. Use them to reroute your strategy rather than just feeling frustrated.

Revenue vs. Mission: A financially fragile practice can help very few people. Maximize your contracted rates to ensure your mission remains sustainable.

CHAPTERS

00:00 Introduction: The Territory of Claim Submission

03:28 Why Small Errors Become Big Denials

05:16 Learning the Language of Billing

08:20 The Pre-Flight Checklist for Claims

12:57 Rejections Are Data, Not Defeat

14:51 Navigating Insurance Rate Negotiations

17:48 Case Study: The Telehealth Modifier Crisis

20:21 Conclusion: What You’re Really Searching For Is Freedom

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Claim Information Review Guide, Modifier Usage Guide, Rate Increase Notification, Rejection Resolution Guide, Claim Management Spreadsheet