EPISODE SUMMARY

Is your practice a "Jamey Show" or a sustainable business? In this episode, Jeremy sits down with Jamey Schrier, PT, and founder of Practice Freedom U, to discuss the messy, often painful transition from "solopreneur" to professional business owner.

Jamey shares the raw story of his practice burning to the ground—literally—and why that disaster was actually the "snow day" he needed to realize he was building a prison, not a business. We dive deep into the "Mindset Upgrade" required to stop solving the same billing and hiring problems over and over again. If you’ve ever felt like an expert clinician but a struggling amateur in business, this episode is your roadmap to turning "always effing something" into an unfair advantage.

KEYWORDS

Practice Management, Physical Therapy, Revenue Cycle Management, Entrepreneurship, Practice Owner, Mindset Shift, Business Scaling, Hiring Best Practices, Credentialing, Healthcare Leadership

TAKEAWAYS

The "Pulse Optional" Hiring Trap: Most practice owners hire out of desperation (the "warm body with a pulse" method). Success requires slowing down the process and hiring based on values and clear systems rather than gut instinct.

The Three Pillars of Practice: A healthy business needs Structure (the nails and roof), a Financial Model (the KPIs), and Mindset (the leader’s internal operating system). If your mindset is stuck in "Control" or "Limited Beliefs," the other two pillars will eventually crumble.

Hire Slow, Fire Fast: We often do the opposite—hiring fast in a panic and taking forever to let go of a bad fit. If you can tell on day one that someone isn't the right fit, your ego shouldn't stop you from making the tough call.

The 80/20 Energy Audit: Identify the 20% of tasks that drain your energy and produce the least revenue. Delegate those to someone who loves doing what you hate (like billing!) so you can stay in your "sweet spot."

The Professional vs. The Amateur: Being a "pro" means stepping out of the day-to-day "clinician" role once your revenue hits a certain threshold (typically $800k+) to protect the bigger picture and implement safety systems.

CHAPTERS

00:00 Building a Coaching Team

00:59 Introduction: From Burnout to Breakthrough

11:15 The Journey of Coaching and Business Growth

13:20 When Mistakes Become Your Best Teacher

17:39 Learning Payroll, HR, and Leadership the Hard Way

22:52 Choosing Growth Over Victimhood

26:29 The 80/20 Rule and Business Efficiency

31:46 Structure, Model, Mindset: The Missing Piece

39:24 Conclusion: The ROI of Doing the Work

RESOURCES

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

Practice Freedom U: Jamey Schrier’s Coaching & Training 

Connect with Jamey on LinkedIn

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

Are you running a practice, or are you just moving pieces around a board while your bank account stays empty? In this episode, Jeremy Zug dives into the high-tangible world of Revenue Cycle Management (RCM) to discuss the vital signs of your practice’s financial health.

As a clinician, you might be used to the "wait and see" approach in a therapy session, but in the billing world, "wait and see" is a slow-motion train wreck. Jeremy breaks down the four essential Key Performance Indicators (KPIs) that act as diagnostic tools for your business. From the "perishable good" that is your insurance aging report to the uncomfortable but necessary conversations around patient balances, this episode is a masterclass in shifting from a "starving artist" trope to a "money mind" that wins.

KEYWORDS

Private Practice, Revenue Cycle Management, Insurance Billing, KPIs, Mental Health Billing, Cash Flow, Practice Growth

TAKEAWAYS

The 90-Day Rule: Money is a perishable good. In 2026, a healthy practice should have less than 15% of its total accounts receivable in the 90+ day bucket. After 90 days, the probability of collection doesn't just dip—it collapses.

Process vs. Billing Problems: If your patient aging is spiking, it’s usually a front-end process issue. Are you verifying eligibility before the first session? Waiting 90 days to tell a client they owe $500 is unprofessional and erodes the clinical trust you've built.

The 5% Denial Benchmark: While the industry average for mental health is near 15%, you should aim for a denial rate at or under 5%. If you’re at 20%, you aren’t billing insurance—you’re a pen pal with a computer programmed to ignore you.

Speed is Leverage: Resolution on denials (appealed, resolved, or closed) should happen within 72 hours. Insurance bureaucracy is built on the hope that you’ll get tired and go away; speed is your only real leverage.

The Clean Report Mirage: Don't let a "perfect" aging report fool you. Verify your net collection rate against what is actually arriving in your bank account to ensure the data isn't being manufactured to look clean.

CHAPTERS

00:00 Introduction: The Hidden Tension Between Care and Cash Flow

03:11 KPI #1: Measuring What You’re Owed (Before It Disappears)

05:39 KPI #2: Managing Patient Receivables Effectively

06:57 KPI #3: Denial Rate and Claim Performance

09:10 KPI #4: How Fast You Resolve Denials

10:15 Case Studies: Two Practices, One Hidden Problem

12:59 Practice Owners: Focus on Care, Not Claims

14:18 Conclusion: Building a Measurable, Sustainable Practice

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: Aging Follow-up KPI Dashboard

EPISODE SUMMARY

In our second-ever practice audit, we’re heading up north—way up north. We’re joined by Meg Wright, a licensed professional counselor and the visionary behind Maitri Holistic Therapy and Wellness in Homer, Alaska. 

Meg has built a thriving practice based on the Sanskrit concept of maitri—developing an unconditional friendship with yourself. But even with a successful practice and a "land-informed" perspective on trauma, Meg found herself facing a "perfect storm" when she transitioned from a solo practitioner to a group practice owner. 

From the "bureaucratic abyss" of credentialing in rural Alaska to the technical wobbles of switching EHRs, Jeremy and Meg dive deep into the "nuts and bolts" of her practice. They discuss the grit required to run a business when you aren't paying yourself yet, and how to have those uncomfortable—but clinically vital—conversations about money with your clients. 

KEYWORDS

Private Practice, Revenue Cycle Management, Group Practice, Insurance Billing, Mental Health Billing, Alaska Healthcare, EHR Transition, Accounts Receivable, Credentialing, Healthcare Business

TAKEAWAYS

The "Group Practice Learning Curve": Moving from solo to group isn't just "solo tenfold"—it requires a total overhaul of your systems, from marketing to your EHR.

The Data Transfer Trap: When switching EHRs, remember that sensitive data like credit card numbers often don't transfer. Plan for a "bridge period" where you manually re-collect this info to avoid an AR nightmare.

Reciprocity as Culture: In remote areas like Alaska, survival depends on looking out for one another. Meg has successfully infused this "we stop for people" mentality into her clinical team.

Money is a Clinical Conversation: Discussing balances and insurance changes isn't just "business"—it’s an opportunity for authenticity and growth in the therapeutic relationship.

The "Meg Plan" for Growth: Don't try to outsource everything at once. Be intentional: master a task yourself first, then hire someone to take that specific "headache" off your plate each year. 

CHAPTERS

00:00 Alaska's Unique Climate and Lifestyle

02:53 Meg's Journey to Private Practice

05:58 Therapeutic Approaches in Alaska

08:57 Challenges of Running a Group Practice

12:01 Navigating EHR Transitions

15:01 Insurance Dynamics in Alaska

17:54 Financial Management and Growth Strategies

29:11 Creating Effective Processes for Client Communication

32:46 Navigating Difficult Conversations with Clients

36:18 Understanding the Impact of Insurance Changes

39:50 Streamlining Administrative Processes

43:02 Building a Supportive Team Culture

46:14 Leveraging Resources for Practice Growth

51:12 Strategies for Improving Accounts Receivable

RESOURCES

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

Maitri Holistic Therapy and Wellness: Visit Meg’s Website

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 of The Claim Game, host Jeremy Zug breaks down one of the most misunderstood and frustrating domains of the revenue cycle: Appeals.

While many providers’ knee-jerk reaction is to fight every denial with a passionate letter, Jeremy explains why an appeal should actually be your fifth line of defense, not your first. We’re pulling back the curtain on how insurance companies actually process these requests and giving you a systematic, five-phase playbook to turn those denials into deposits.

KEYWORDS

Revenue Cycle Management, Appeals, Eligibility Verification, ERA, EOB, Corrected Claim

TAKEAWAYS

The "Fifth Line" Philosophy: An appeal is a last resort. Most denials can and should be resolved much earlier in the aging follow-up stage with a simple corrected claim or a phone call.

The Eligibility Trap: Don’t rely solely on your EHR’s automated tools. They are notoriously inaccurate and can lead to major downstream "heartaches" like clawbacks.

Research is Your Intelligence: Never assume Payer A’s rules are the same as Payer B’s. Requirements vary by company and by state—if you don't know the specific workflow, pick up the phone and ask.

Evidence Wins, Not Stories: A long-winded letter about "fairness" rarely gets read. Your appeal is a legal-style process that needs objective evidence: EOBs, prior authorizations, correspondence logs, and clinical notes.

Track the Five Milestones: Don’t just send it and hope. Track your appeal through: Received, Under Review, Processed, Decision Made, and Final Payment.

CHAPTERS

00:00 Introduction: Where Appeals Fit in the Revenue Cycle

02:24 Appeals Are Not Your First Move

06:39 The Appeals Playbook Begins

08:10 Phase 2: Proper Appeal Formatting

09:19 Phase 3: Evidence Wins Appeals

10:04 Phase 4: Track It or Lose It

11:13 Phase 5: Build Your Appeals Playbook

11:53 Conclusion: Take Control of Your Appeals Process

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: Appeals Packet

EPISODE SUMMARY

Is your private practice’s front office running like a well-oiled machine, or a "clogged emotional drain"? This week on The Claim Game, Jeremy Zug sits down with Brent Metcalf, LCSW, founder of Tri-Star Counseling, to discuss the wild ride of scaling a multi-niche group practice in the Appalachian region.

Brent shares the "serendipitous" story of how he was essentially "voluntold" into private practice by his financial advisor and how he grew that accidental start into a thriving team of 11 clinicians. We dive deep into the "hodgepodge" of patient registration—the common headaches of missing insurance cards, tech-averse clients, and the "ickiness" therapists often feel when charging for their time. Whether you’re curious about the strategy behind buying a commercial building or wondering if AI note-taking is the "magic" your documentation needs, Brent’s "Dr. Brent" wisdom offers a masterclass in balancing clinical heart with a "business hat" mindset.

KEYWORDS

Private Practice, Revenue Cycle Management, Mental Health Billing, Appalachia, Group Practice Growth, Patient Registration, Medical Billing, Healthcare Business, Credentialing, Therapy Notes, Jane App, AI Notes

TAKEAWAYS

The "Voluntold" Entrepreneur: Brent’s journey proves that sometimes the best business moves happen when you stop overthinking and start saying "yes" to the opportunities that fall into your lap.

Registration is the Foundation: A "C-grade" registration process leads to "BAM—denied" claims. Collecting front-and-back insurance card images before the first session is non-negotiable for clean eligibility checks.

Mindset Over Money: Charging co-pays and no-show fees isn’t "mean"—it’s essential. If you want to provide high-quality care to underserved regions, you have to keep your own lights on first.

Scaling with Culture: Tri-Star uses a "finder's fee" for employees to recruit peers they actually want to work with, ensuring the "open-door policy" stays authentic as the team grows.

The Power of Commercial Real Estate: Instead of renting forever, Brent invested in a 20-office building, turning empty space into a "one-stop wellness shop" with massage therapy and psychiatric NPs.

AI as a Clinical Ally: Transitioning from "anti-AI" to an advocate, Brent uses AI scribing to stay present with the human on the couch rather than buried in a notebook.

CHAPTERS

00:00 Introduction: Meet Brent Metcalf and Tri-Star Counseling

07:33 Why Patient Registration Keeps Slowing You Down

11:37 Improving Intake Through Training and Process

17:48 Culture, Compliance, and Client Experience

22:38 Scaling the Practice: Growth, Real Estate, and Expansion

30:50 Building Community Presence and Referral Networks

32:27 Beyond the Practice: Teaching, Supervision, and Consulting

33:51 Navigating Insurance, Access, and Practice Economics

38:11 Advice for Starting and Scaling a Practice

41:56 Leveraging AI for Notes and Treatment Planning

44:32 Conclusion: Final Insights for Practice Success

RESOURCES

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

Learn More About Tri-Star Counseling: tri-starcounseling.com

Upheal: https://upheal.io/join?via=YKWVPJ74

Heard: https://affiliate.joinheard.com/ucv1vp09xwra

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 the world of Revenue Cycle Management (RCM), ignoring your aging report is like planting a garden and never pulling the weeds—eventually, you’ll lose your harvest. Jeremy Zug walks us through the anatomy of an aging report, defining the levels of urgency for claims sitting in 30, 60, and 90-day buckets. 

We discuss the critical difference between a rejection and a denial, how to calculate your "Days in AR," and why your EHR might be holding your financial health hostage. This episode is all about moving from frustration to traction by treating your AR follow-up like an appointment you’d never cancel. 

KEYWORDS

Revenue Cycle Management, RCM, Aging Report, Days in AR, Claim Denials vs. Rejections, Batching, Timely Filing Limits, Electronic Health Record, EHR

TAKEAWAYS

Know Your Buckets: Think of your aging report as a map of urgency. The 31–60 day range is your "Goldilocks zone" for follow-up—not too early to be annoying, but not too late to be ignored.

The 90-Day Danger Zone: Anything over 90 days is "where money goes to die." Waiting until a claim hits this mark to check in means you’re likely bumping up against timely filing limits and appeals deadlines.

Batching is the Secret to Scaling: Don't chase the oldest claim first. Sort your report by payer and handle 10 claims in one call or portal login. It maximizes efficiency and minimizes your time on hold. 

Always Get a Receipt: Never end a call with a payer representative without a call reference number. It forces accountability and serves as your "save point" if you have to call back. 

Consistency Over Intensity: Small weeds are easy to pull; a 90-day forest is a nightmare to clear. Block out dedicated time (at least two hours) weekly to manage your aging. 

CHAPTERS

00:00 Introduction: Why Aging Follow-Up Matters for Your Claims

02:36 Breaking Down the Aging Report

08:53 Building a System for Aging Claim Follow-Up

13:16 Case Study: Solving an $8,000 Aging Claim Problem

14:16 Conclusion: Key Takeaways for Managing Aging Claims

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 Management Spreadsheet

EPISODE SUMMARY

In this episode, Jeremy Zug takes a strategic pause to interview a true healthcare game changer: Dr. Jeremy Friese, founder and CEO of Humata Health.

Dr. Friese isn't just a tech executive; he’s a "recovering Mayo Clinic physician" who spent two decades in the trenches as an interventional radiologist. After witnessing the systemic failures of healthcare during his mother’s battle with cancer, he dedicated his career to fixing the "broken fax machine" of the industry.

We dive deep into the world of Prior Authorization—the ultimate bottleneck in patient care. Dr. Friese explains how Humata is using AI to turn administrative friction into a thing of the past, reducing provider burnout and ensuring that "Barb the nurse" can get back to what she does best: caring for patients. We explore the "AI arms race," why payers actually want providers to have better technology, and how the new CMS regulations are acting as a regulatory tailwind for the entire industry.

KEYWORDS

Prior Authorization, Revenue Cycle Management, Health Tech, AI in Healthcare, Medical Billing, Practice Management, CMS 0057, Provider Burnout, Healthcare Innovation

TAKEAWAYS

Prior Auth is the Ultimate Bottleneck: It is the "middle of the hourglass" in the revenue cycle. If you don't get the authorization right, you can't deliver care, and you certainly won't get the claim paid.

The "Business of Yes": AI isn't just about automation; it's about getting to a "yes" more efficiently. Between 20% and 40% of authorizations submitted are for services that don't even require one—technology can eliminate that wasted effort instantly.

The AI Arms Race is a Myth: In the world of prior auth, the opposite is true. Payers actually benefit when providers use advanced technology because it reduces the administrative burden on their end to review manual, 100-page clinical faxes.

The "Gray Zone" of Medicine: While AI will likely handle 90% of submissions in the next five years, the "practice of medicine" will always have a gray zone that requires a human expert to interpret complex medical policies.

Post-Authorization Monitoring: Life changes in the 30 days between an approval and a surgery. If the CPT code or site of service shifts even slightly, you’ll face a denial on the back end unless you are constantly monitoring that auth status.

CHAPTERS

00:00 Introduction: Meet the Mind Behind Humata Health

04:55 A Decade in Prior Auth: The Problem That Sparked Humata

07:24 Why Prior Authorization Needs Both Policy and Technology

10:24 The Shared Pain: Bridging Providers and Payers

15:14 How It Actually Works: Inside Modern Prior Authorization Tech

22:02 The Hardest Part: Extracting Data from EMRs

26:49 How Automation Replaces Manual Follow-Ups

28:34 After Approval: The Risk of Prior Auth Expiration

30:26 Why Humata Wins: Focus, Speed, and a Head Start

35:38 Will AI Replace Prior Auth Jobs?

39:25 Faster Decisions, Better Care: The Impact of CMS 0057

41:52 Conclusion: Prior Auth Is Solvable—But You Have to Start Now

RESOURCES

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

Learn More About Humata Health: Visit humatahealth.com

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

Jeremy explains that accounts receivable is like a treasure chest with two different locks: Payer Aging (insurance) and Patient Aging (people). While insurance is a game of logic and data, patient aging is a game of relationships and communication. 

We dive into the "90-day mistake"—the friction created when a provider waits too long to bill, leaving patients feeling "ambushed" by a surprise $400 invoice. To fix this, Jeremy outlines the Three Pillars of Collection: a rock-solid financial policy, manual eligibility checks, and keeping a credit card on file. Finally, we walk through a systematic "battle plan" for handling debt in 30, 60, and 90-day buckets. 

KEYWORDS

Patient Aging, Accounts Receivable, Revenue Cycle Management, Financial Policy, Eligibility and Benefits, Credit Card on File, RCM

TAKEAWAYS

The Two-Lock Treasure Chest: You cannot treat patient debt the same way you treat Cigna or Aetna. Payer aging requires tenacity; patient aging requires empathy and clear boundaries.

The 90-Day Ambush: Waiting too long to collect doesn't make you "nice"—it cracks the clinical relationship. To be clear is to be kind.

Stop the Bleeding at Intake: If you get your financial policy, manual eligibility checks, and credit card on file right, your patient AR will likely drop by 80%. 

Ditch the "Green Checkmark": Never rely solely on your EHR’s automated verification. It won't tell you about specialized carve-outs or $5,000 deductibles that haven't been met. 

Link Money to Access: For balances over 60 days, move from automated emails to personal outreach. If it hits 90 days, you must be willing to link payment to their spot on your schedule. 

CHAPTERS

00:00 Introduction: The Next Billing Domain—Patient Aging Management

03:23 Payer Aging vs. Patient Aging: Two Different Games

09:35 The Three Pillars of Patient Collections

15:54 How to Handle Aging Patient Balances

19:16 Conclusion: Your Patient Aging Game Plan

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.

EPISODE SUMMARY

Dealing with insurance denials can feel like a special kind of rejection. You’ve done the work, you’ve served your patients, and then—BAM—denied. It’s the healthcare equivalent of a "check engine" light: frustratingly vague but impossible to ignore. In this episode, Jeremy Zug dives into the nitty-gritty of denial resolution, reframing these "no’s" as puzzles waiting to be solved. We’re moving from the investigation phase of aging follow-up into the courtroom drama of winning your money back.

Jeremy breaks down the critical difference between a rejection and a denial, the "secret handshake" of Box 22, and how to write an appeal letter that Gary in the insurance cubicle will actually want to approve. If you’re tired of hitting the resubmit button and getting nowhere, this episode is your roadmap to meaningful traction in your billing department.

KEYWORDS

Revenue Cycle Management, Denial Resolution, Insurance Billing, Private Practice, Medical Billing, Healthcare Finance

TAKEAWAYS

Rejection vs. Denial: Think of a rejection as being stopped by the bouncer at the door (data errors caught by the clearinghouse). A denial is being kicked out by the bartender after you're already inside (the payer processed the claim but decided not to pay). 

Stop the "Resubmit" Doom Loop: Simply hitting resubmit on a denied claim without changes is the fastest way to trigger a duplicate claim denial—the #1 denial reason in healthcare. 

The Magic of Box 22: When correcting a mistake, use Resubmission Code 7 in Box 22 and link it to the original claim number. This "secret handshake" tells the computer you're replacing the old claim, not sending a duplicate. 

Decoding CARC Codes: Claim Adjustment Reason Codes (like CO-16 or CO-29) are clues. If the code is vague, don’t be afraid to call the representative and make them tell you exactly which "box" is empty. 

Write "Low-Calorie" Appeals: When the insurance company makes a mistake, your appeal letter should be clear and concise. Highlight the specific sentence in the medical record that proves your case so the reviewer doesn't have to hunt for it. 

Denial is a Game, Not a Verdict: Don't take it personally. A denial is often just a request for more information or a specific correction within a computer algorithm's rules.

CHAPTERS

00:00 Introduction: Navigating Aging Follow-Up and Denial Resolution

02:27 Why Denials Hurt — and How to Reframe Them

05:35 Decoding Denials: Rejections, Reason Codes, and What to Do Next

12:51 Fix It or Fight It: How to Handle a Denial Correctly

16:55 Why Denial Resolution Separates Thriving Practices

18:41 Case Study: Turning $900K in Denials Into Revenue

20:11 Conclusion: Tools, Takeaways, and What’s Next

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: Appeals Packet, Denial Resolution Guide, Claim Management Spreadsheet

EPISODE SUMMARY

Is your practice running like a high-performing business, or is it just surviving from one grant cycle to the next? In this episode of The Claim Game, Jeremy and Kathryn Zug sit down with Jill Steeley, a powerhouse in community health and former CEO of PureView Health Center. Jill shares the incredible story of how she walked into an organization facing a nearly $1 million deficit and transformed it into a thriving center with $5 million in cash reserves, all while doubling patient count and growing revenue fivefold. 

Jill breaks down her "business-first" philosophy for FQHCs, the five-step approach to organizational transformation, and why the "no margin, no mission" mindset is the key to sustainable patient care. Whether you are leading a large community health center or a small private practice, Jill’s insights on diversifying revenue, fixing "leaky" costs, and the power of professional rebranding are game-changers for any healthcare leader.

KEYWORDS

FQHC, Revenue Cycle Management, Healthcare Leadership, Practice Management, Community Health, Medical Billing, Patience Experience, Healthcare Marketing, AI in Healthcare

TAKEAWAYS

Run it Like a Business: Public and community health often fall into the trap of "grant dependency." To be sustainable, you must adopt the mindset that a profitable business is the only way to ensure the mission continues.

The Five-Step Transformation: Jill and her partner Steve Weinman teach a CEO Bootcamp focusing on:

1. Increasing & Diversifying Revenue: Don't just wait for grants; get out into the community and partner with large employers. 

2.Reducing Costs (Fixing Leaks): Address the "silent killers" of revenue—no-shows and high staff turnover.

3. Marketing & Branding: If the community thinks you only do travel vaccines or serve a niche population, you are losing patients with payers.

4. Exceptional Patient Experience: Move from "transactional" to "transformational" care to increase patient retention.

5. Maintaining Momentum: Long-term planning ensures you don't "coast" between funding cycles.

Invest in Technology Now: Use current funding to invest in AI scribes, automated billing, and better hardware. If your tech is "slow as molasses," your best staff will leave for a practice that respects their time.

Control What You Can Control: You cannot control federal grant cycles or Medicaid eligibility changes, but you can control your payer mix, your brand, and your operational excellence. 

CHAPTERS

00:00 Introduction: Meet Jill Steeley

05:38 Facing the Reality: A Health Center in Crisis

07:52 Transforming a health center from a $1 million deficit to reserves

07:55 The Business Playbook for an FQHC Turnaround

11:53 A Five-Step Playbook for Health Center Transformation

24:50 From Grant Dependence to Financial Sustainability

31:17 How FQHCs Can Attract Privately Insured Patients

34:19 The Role of AI in Healthcare Administration

40:16 Why Health Centers Need Better Data Tracking

43:27 Conclusion: Preparing Health Centers for 2027

RESOURCES

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

FREE WEBINAR: Why Dwindling Grant Money & Government Dysfunction Might Be the Best Thing That's Ever Happened to Your Health Center | Friday 3/13/26 3pm EST

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.