EPISODE SUMMARY

Ever feel like you’re playing a game of "Red Light, Green Light" with insurance companies, only the light is always stuck on red? We sat down with a true healthcare game changer, Amy Turner, Deputy Director for Policy at the CMS Innovation Center (CMMI), to talk about how they are trying to fix that.

Amy breaks down the mission of CMMI—lowering costs while boosting quality—and introduces us to the WISeR model. This isn't just bureaucratic talk; it’s a look at how advanced technology and the "Kennedy Pledge" are aiming to turn prior authorizations from a provider nightmare into a streamlined, transparent process—maybe even reaching the "holy grail" of auto-approvals. We also dive into the three pillars of innovation: more preventive care, empowering patients with actionable info, and boosting competition for independent physicians.

KEYWORDS

CMMI, WISeR Model, The Kennedy Pledge, Value-Based Care, Prior Authorization, Medicare

TAKEAWAYS

Sustainability is the Goal: Healthcare costs are outpacing inflation and GDP, yet outcomes aren't keeping up. CMMI's mission is to find the "mother load": reducing costs while improving quality.

The Three Strategic Pillars:

1. Preventive Care: Nipping health issues in the bud before they become serious.

2.Consumer Empowerment: Giving patients digestible, actionable information so they can make informed choices.

3. Choice and Competition: Specifically empowering independent physicians and bringing more options to rural areas.

Prior Auth Modernization: The WISeR model aims to use technology to create consistent, timely decisions. The ultimate goal is to reach a point of auto-approvals based on proven accuracy.

Stewardship of Funds: Everything the Innovation Center does is built on being careful stewards of taxpayer money (Medicare and Medicaid).

CHAPTERS

00:00 Introduction: Inside CMMI and the WISeR Model

07:13 How WISeR Improves Patient Safety

11:03 How WISeR Is Tested and Evaluated

14:34 Where WISeR Is Launching and What It Covers

16:24 How WISeR Uses Technology Responsibly

22:46 Measuring WISeR’s Long-Term Impact

24:29 Conclusion: Staying Updated on WISeR

RESOURCES

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

Learn more about WISeR: Visit https://www.cms.gov/priorities/innovation/innovation-models/wiser

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’s revenue stuck in "limbo"? You do the work, you see the patients, you submit the claims—and then... silence. No check, no deposit, just a line item on a spreadsheet getting older by the second.

In this episode of The Claim Game, Jeremy Zug dives into what is arguably the most intimidating territory in the entire revenue cycle: Aging Follow-Up. Jeremy demystifies the aging report, moving it out of the "box of shame" and into a manageable process. We discuss why time is the enemy (claims don't age like fine wine—they rot!), how to triage your buckets, and the exact three-step strategy to work your reports efficiently without losing your mind to elevator hold music.

Don't let the insurance companies keep your hard-earned money just because they're better at "hide-and-seek" than you are. It’s time to clear out the weeds in your financial garden and get your cash flow blooming again.

KEYWORDS

Revenue Cycle Management, Aging Report, Private Practice, Medical Billing, Insurance Denials, Timely Filing, Cash Flow, Practice Growth

TAKEAWAYS

The Aging Report is a Garden: Think of your claims as seeds. Some are blooming, but others are being choked out by weeds. Your aging report is the truth-teller that shows you which plants need immediate water before they wither away.

Time is Your Enemy: Claims do not get better with age. Every payer has a Timely Filing deadline. If you wait too long to ask for your check, the insurance company essentially gets "free therapy" while you lose the right to collect that money entirely.

Triage Your Buckets: * 0–30 Days: Fresh seeds, usually just processing.

31–60 Days: A yellow flag; something might have stalled.

90+ Days: The danger zone. These need immediate attention before they hit the filing limit.

Stop the "Ostrich Strategy": Freezing and ignoring the report won't make the "check engine light" go away. Treat your aging report like dirty laundry—don't cry over it, just put it through the cycle one piece at a time.

Efficiency Over Alphabetical: Never work your report A–Z. Instead:

1. Sort by Payer: Resolve multiple claims in one phone call.

2. Sort by Age: Save the claims closest to expiring first.

3. Sort by Dollar Amount: Prioritize high-value claims for a better ROI on your time.

Get the Receipts: Always ask for a Call Reference Number. If you don't document the call, the insurance company can "erase your reality" when the check doesn't show up.

CHAPTERS

00:00 Introduction: Understanding Aging Follow-Up and Why It Matters

05:50 What an Aging Report Is (and Why Time Matters)

11:35 The Psychology of the Aging Report

14:16 A Three-Step System for Tackling Aging

18:20 Conclusion: Building a Sustainable Aging Workflow

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: Denial Resolution Guide, Claim Management Spreadsheet, Appeals Packet

EPISODE SUMMARY

Is your practice’s bank balance giving you a false sense of security? In this episode, Jeremy Zug moves the game piece into the territory of Payment Posting. While it might sound as exciting as watching paint dry, Jeremy breaks down why this "menial chore" is actually the scorecard for your entire practice. We’re moving from the dopamine hit of seeing money in the bank to the precision of knowing why it's there.

Jeremy dives into the three critical KPIs you need to track today to ensure you aren't "guessing" with your finances or accidentally billing your patients "ghost money." If you want to know if you're actually winning the game or just slowly bleeding out, this episode is your diagnostic check-up.

KEYWORDS

Revenue Cycle Management (RCM), Payment Posting, Key Performance Indicators (KPIs), Claim Denials, Electronic Remittance Advice (ERA), Explanation of Benefits (EOB), Timely Filing, Practice Health Check, Mental Health Billing

TAKEAWAYS

The Bank Balance Trap: Seeing a deposit is great, but if you don't know if it matches your contract, you aren't winning; you're guessing. 

Time to Post (The Speed Score): Don't drive with a delayed GPS. If your posting lags, your aging reports become fiction, leading to wasted hours calling insurance companies for money they've already sent. 

Payment Posting Accuracy (The Precision Score): Use a simple pass-fail audit. Even a one-cent variance is a fail. Precision prevents "ghost money" errors that destroy patient trust. 

Days to Denial Discovery (The Friction Score): This is the ticking bomb. You have to find denials before the "timely filing" clock runs out, or that revenue is gone forever. 

The Power of Auditing: Tracking these metrics is like checking your blood pressure; it's the only way to prevent a financial "heart attack" down the road.

CHAPTERS

00:00 Introduction: Advancing the Game Board — Payment Posting KPIs

02:37 Playing Blindfolded: Why KPIs Matter

05:27 KPI #1: Time to Post Payments

07:45 KPI #2: Payment Posting Accuracy

11:22 KPI #3: Average Days to Denial Discovery

13:41 Case Study: One Million Dollars in Preventable Denials

15:18 Conclusion: Stop Guessing, Start Tracking

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: Payment Posting KPI Dashboard

EPISODE SUMMARY

In this episode, Jeremy breaks down the critical distinction between your Billed Amount (your "sticker price") and the Allowed Amount (the "club member price" you negotiated in your contract). Using the story of "Sarah," a clinician frustrated by receiving $112.50 for a $180 session, Jeremy explains the "Lesser of Two" rule. You’ll learn why setting your fees too low prevents you from capturing automatic raises when insurance companies update their rates, and why your fee schedule needs to be a "bucket" big enough to catch every drop of revenue available.

KEYWORDS

Revenue Cycle Management, Allowed Amount, Billed Amount, Contractual Adjustment, Lesser of Two Rule, Balance Billing, Fee Schedule

TAKEAWAYS

The "Lesser of Two" Rule: Insurance computers are programmed to pay the lower of two numbers: their internal fee schedule or your billed amount. If you lower your price to match them, you'll miss out on future rate increases. 

The "Bucket" Analogy: Think of your billed amount as a bucket. If the insurance company wants to pour $115 into a $112 bucket, that extra $3 spills over the side and is lost forever. 

Strategic Fee Setting: We generally recommend setting your fee schedule at 150% to 200% of the Medicare rate in your area to ensure you aren't undercutting yourself on better-paying commercial contracts. 

Stop Balance Billing: The difference between your billed rate and the allowed amount is a "contractual adjustment." You are legally obligated to write this off—trying to collect it from the patient is a fast track to getting kicked out of the network. 

Know Your Data: You can find your allowed amounts through portal hunts, direct calls to provider relations, or by reviewing your last five paid claims. 

CHAPTERS

00:00 Introduction: Zooming In on Billing Domain Strategies

02:46 Understanding Allowed Amounts and Fee Schedules

12:27 How to Look Up Insurance Allowed Amounts

16:30 Payment Posting and Claim Tracking Essentials

18:31 Conclusion: One Simple Check to Maximize 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 Management Spreadsheet, Payment Posting Guide

EPISODE SUMMARY

Ever opened your EHR expecting a paycheck only to find a big fat zero staring back at you? It feels like adding insult to injury—you’ve done the credentialing, nailed the notes, and submitted everything on time, yet you’re left with nothing but frustration. 

In this episode of The Claim Game, Jeremy Zug dives into the most dreaded part of the revenue cycle: denials. Instead of treating a denial like a dead end or a failure, Jeremy re-frames it as a "treasure map" full of clues. We explore why physically recording every denial is the anchor to your practice's financial health and how to use the right "Rosetta Stone" to decode the secret language insurance companies use to keep your money.

KEYWORDS

Revenue Cycle Management, Insurance Denials, Private Practice, Medical Billing, Credentialing, EOB, Patient Care, Practice Growth, Mental Health Billing

TAKEAWAYS

Denials are Data, Not Defeat: A zero-dollar payment isn't a dead end; it's a symptom that helps you diagnose and cure "diseases" in your intake or billing processes. 

The Danger of "Ghost Money": Failing to post denials inflates your Accounts Receivable (A/R), leading to hiring or purchasing decisions based on money that isn't actually coming. 

Respect the Appeal Clock: If you don't record the denial date, you might miss the 90-day or 6-month window to legally appeal and rectify the issue. 

Decode the "Alphabet Soup": To win, you must read both the CARC (the headline/reason) and the RARC (the article/details) to understand exactly what went wrong. 

Know Who Owes the Money: Group codes like CO (Contractual Obligation) and PR (Patient Responsibility) tell you if you need to write it off or bill the patient—getting this wrong can break patient trust or even the law.

CHAPTERS

00:00 Introduction: The Hidden Information in a Zero-Payment Claim

04:55 Why Zero-Dollar Payments Must Be Posted

08:39 Learning the Language of CARCs and RARCs

12:55 Group Codes and Legal Responsibility

14:57 Documenting Denials the Right Way

17:08 Case Study: Solving a $2,000-a-Month Denial Problem

18:31 Conclusion: Turning Denials Into Forward Motion

RESOURCES

Today Sponsors: Blueprint

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, Payment Posting Guide

EPISODE SUMMARY

Jeremy breaks down the critical distinction between an EOB (what the patient sees) and a Remittance Advice (the professional version for the provider). He walks through the "detective work" required to audit these documents, highlighting why the Allowed Amount—not just the paid amount—is the number that determines if you’re being underpaid. The episode also explores the "digital pipeline," comparing the speed of ERAs to the "snail mail" of paper and warning about the hidden dangers of "set-and-forget" auto-posting. Finally, Jeremy shares a real-world case study where forensic remittance auditing recovered significant underpayments for a large agency. 

KEYWORDS

Revenue Cycle Management, RCM, Remittance Advice, Explanation of Benefits, EOB, Electronic Remittance Advice, ERA, 835 File, Contractual Obligation, CO Codes, Patient Responsibility, Payer Portals

TAKEAWAYS

The Remittance as a Scorecard: A deposit without a remittance is like a box without a packing slip; you can’t post the money accurately without knowing the patient, date of service, and CPT code. 

The Trap of the "Paid Amount": Never stop at the paid amount. You must audit the contractual adjustments (CO codes) and patient responsibility (PR codes) to ensure you aren't writing off money you should have collected. 

ERAs vs. EOBs: Electronic Remittance Advice (ERA) files (835 files) arrive days or weeks faster than paper. However, always look for the PLB segment (provider level adjustments) to find "missing" money buried in recoupments. 

Portals are a Fast Pass: Use payer portals like Availity or Optum to skip the 45-minute hold times. Portals allow for instant remittance downloads and "correction speed" for fixing claim modifiers in days rather than months.

CHAPTERS

00:00 Introduction: Making Sense of Remittances and Portals

02:48 Remittance vs. EOB: Knowing the Difference

06:48 From Paper to Digital: Understanding ERAs

09:56 The Secret Weapon: Payer Portals

12:20 Case Study: Finding Hidden Underpayments

15:47 Conclusion: The Winning Formula for Remittances and Portals

RESOURCES

Today Sponsors: Blueprint

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: Guide to the Components of an EOB, Guide to the Components of an ERA

EPISODE SUMMARY

Jeremy and Dr. Dylan Ross explore the "back door" of managed healthcare, tracing Dylan's journey from direct care delivery to the high-level strategic world of major payers. They dive deep into the current "recalibration" of behavioral health—where stigma is eroding and utilization is up, but the backend business models are struggling to keep pace. Dylan explains why payers are often "blind" to whether patients are actually getting better and how Measurement-Based Care (MBC) is the key to unlocking better reimbursement and clinical outcomes. They also discuss how AI scribing and a reimagined EHR are helping independent practices fight back against administrative burnout.

KEYWORDS

Measurement-Based Care (MBC), Revenue Cycle Management (RCM), AI Scribing, Value-Based Care, Clinician Burnout, Outcome Data, Behavioral Health Innovation

TAKEAWAYS

The Data Gap in RCM: Unlike physical health, where "vital signs" like blood pressure are standard, behavioral health has historically lacked a lab-equivalent data point. 

The Power of Measurement-Based Care: Aggregating patient-reported outcome data doesn't just help the clinical dyad; it allows practices to "tier" their value to payers and secure better contracts. 

Fighting the "Tyranny of the Urgent": Administrative tasks, documentation, and fighting clawbacks are eating the "widget" of healthcare: Time. 

AI as a Clinical Ally: Modern tools like Blueprint's AI scribe are saving clinicians 7–10 hours per week, allowing them to focus on high-quality care rather than staring at a screen. 

Reimagining the EHR: Most current systems were built for physical health and "duct-taped" together for therapists. The future is a bottoms-up EHR built specifically for the behavioral health workflow. 

CHAPTERS

00:00 Introduction: Dr. Dylan Ross and the Systems Behind Behavioral Health

12:03 Navigating the Healthcare Landscape: Insights from Experience

23:48 Reality Checks in the Insurance Industry

30:24 The Data Gap Holding Back Value-Based Behavioral Health

35:17 How Blueprint Is Changing Measurement in Private Practice

39:33 Above the Red Line: Where Measurement-Based Care Actually Happens

46:21 The Future of Blueprint and EHR Innovations

56:27 Conclusion: Using Technology to Reclaim Time, Purpose, and Autonomy

RESOURCES

Today Sponsors: Blueprint

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 introduces the fourth billing domain, Payment Posting, and explains why it must follow eligibility and benefits. He defines posting as the reconciliation of your expectations (contracts and CPT codes) versus reality (what the payer actually sends). The episode covers the four macro-moves of the territory: Receipt, Posting, Denial Capture, and KPIs. You'll learn the difference between paper EOBs and electronic ERAs, the dangers of "bucket posting," and why a zero-dollar payment is one of the most important transactions you’ll ever document.

KEYWORDS

EOB, CARC, ERA, Payment Posting, Private Practice, Insurance Billing, Medical Billing, Eligibility and Benefits, Insurance Denials, Claim Denials

TAKEAWAYS

Move Beyond "Monopoly Money": Don't just high-five when money hits the bank. Without meticulous posting, you might only be collecting 60-85% of what you're actually owed. 

Line-Item Posting is King: Avoid "bucket posting" (lump sums). Matching payments to specific dates of service and CPT codes ensures clean data and prevents missed appeal opportunities. 

Zero Dollars is Still a Transaction: When a payer sends a $0.00 remittance, it’s not an invitation to move on. It’s a signal to document the specific CARC (Claim Adjustment Reason Code) to prevent the "tangled ball of yarn" that is unresolved A/R. 

Watch Your KPIs: Aim for a Net Collection Rate of 95% or higher and a First Pass Denial Rate of less than 5%. If your days-to-post exceeds two weeks, your financial reports are essentially a lie.

CHAPTERS

00:00 Introduction: Setting the Stage for Payment Posting

05:17 Payment Posting Defined: The Scoreboard of Billing

07:38 The Four Moves That Make Payment Posting Work

11:32 The Payment Posting Workflow: Intake to Line Items

15:47 The Payment Posting Workflow: Denial Documentation

19:38 The Payment Posting Workflow: KPIs

22:10 Case Study: Recovering $78,000 in Lost Receivables

24:24 Conclusion: Mastering the Payment Posting Game

RESOURCES

Today Sponsors: Blueprint

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 domain-specific deep dive, Jeremy explains why tracking metrics for eligibility and benefits (E&B) is the secret weapon of a proactive practice. Many providers view E&B as a "time suck," but without clear KPIs, you’re flying blind. Jeremy breaks down three essential metrics—Time to Completion, Accuracy Rate, and Call Time Logs—to help you identify which payers are dragging their feet and which staff members might need a little extra support. The goal is simple: ensure your patients never walk through the door without knowing exactly what they owe, preserving both your trust and your bottom line. 

KEYWORDS

​​Revenue Cycle Management, Private Practice, Medical Billing, Insurance Eligibility, Practice Management, KPIs, Patient Trust, Healthcare Finance

TAKEAWAYS

The Cost of Lost Trust: When a patient receives an unexpected bill, trust leaves your practice, and revenue usually follows right behind it. 

Move from Reactive to Proactive: Tracking metrics helps you catch "carve-outs" (where a payer subcontracts benefits) before they turn into denials downstream. 

Efficiency vs. Accuracy: It’s not just about how fast you do it; it’s about getting the right information the first time so your billing team isn't ripping their hair out later. 

Identify Payers of Concern: Use data to decide if a specific insurance company’s low reimbursement rate is worth the administrative headache of their "Byzantine" phone systems. 

The Power of Time Studies: Tracking call times for just two weeks can reveal which payers offer efficient portals and which ones are wasting your staff’s time. 

CHAPTERS

00:00 Introduction: Protecting Patient Trust Through Better Eligibility Metrics

03:42 Managing Time and Cost Through Eligibility Metrics

06:36 Key Performance Indicators for Eligibility and Benefits

13:50 The Trust Metric: Measuring Eligibility & Benefits Accuracy

17:24 The Final KPI: Eligibility & Benefits Call Time

19:36 The Eligibility & Benefit KPI Dashboard

20:53 Conclusion: Building a Stronger Revenue Cycle Through Metrics

RESOURCES

Today Sponsors: Blueprint

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: Eligibility & Benefit KPI Dashboard

EPISODE SUMMARY

Ever felt like you were crushing a game of Monopoly or Catan, only to have one bad card flip the entire board? In the world of private practice, Eligibility and Benefits (E&B) often feels exactly like that. You think your revenue is secure, and then—BAM—a missed rule or a shift in patient benefits leaves you disoriented and losing ground. 

In this episode of The Claim Game, Jeremy Zug dives deep into two "hidden" steps that often trip up even the best practices: updating accumulations and preventative patient communication. We’re moving beyond the one-time snapshot and looking at how to track the moving target of deductibles and out-of-pocket maximums. Whether you’re a solo provider or managing a large agency, mastering these domains is the only way to turn your billing system into a revenue engine rather than a drain on your mission. 

KEYWORDS

Revenue Cycle Management, Eligibility and Benefits, Private Practice, Patient Communication, Medical Billing, Deductibles, Cash Flow

TAKEAWAYS

E&B is a Snapshot, Not a Guarantee: An eligibility check is only accurate for the 15-minute window in which you looked; it is a quote, not a promise of payment. 

The Power of Accumulations: Patients rack up healthcare costs across multiple specialties throughout the year. If you aren't regularly updating their "accumulation" (how close they are to meeting their deductible), you risk overcharging them—which leads to messy refunds—or undercharging them, which makes collections nearly impossible once they leave the office. 

To Be Clear is to Be Kind: Preventative communication is the bedrock of patient trust. Surprising a patient with a $4,000 bill on the day of their appointment is a "trust-degrader" that can lead to abandoned care and a damaged reputation. 

Use the Right Tools: Don't reinvent the wheel. Using standardized E&B templates and benefit summary emails ensures your front office, clinicians, and patients are on the same page every single time. 

Process Over Magic Bullets: As shown in our Pennsylvania agency case study, injecting repeatable SOPs and clear communication into a fragmented system reduces aging AR and increases both patient and clinician satisfaction.

CHAPTERS

00:00 Introduction: Zooming In on Eligibility

02:12 Why Eligibility Isn’t a One-Time Check

04:59 Understanding and Managing Patient Accumulations

08:45 Communicating Financial Responsibility to Patients

12:42 The Consequences of Not Communicating Costs Upfront

14:02 Using Templates to Fix Accumulations and Communication Gaps

16:05 Case Study: How One Practice Recovered from Eligibility Breakdown

17:43 Conclusion: How to Protect Trust and Revenue with Better Eligibility

RESOURCES

Today Sponsors: Blueprint

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: Benefit Stages, Benefit Summary Email Template, Eligibility & Benefit Check Template