For The Love of Revenue Cycle

Vanessa Moldovan
  • 0.0 (0)
  • MEDICINE
  • UPDATED WEEKLY
For The Love of Revenue Cycle Podcast

Did you ever wish that you had a physician revenue cycle expert and mentor with over 20 years of experience whispering success secrets in your ear? That’s exactly what you will get when you tune into For the Love of Revenue Cycle hosted by me, Vanessa Moldovan. My career and my life have brought me a wealth of knowledge and I can’t wait to share with you. My passion is to help others in the industry to reach their full potential and find success in the wonderful, crazy world of physician revenue cycle. Whether you are a beginner, expert, physician, consultant, educator or just plain curious, each episode is designed to immediately apply to your career, business and operations. Join me each week as we tackle the topics, trivia and triumphs of revenue cycle. Let’s discover our full potential together.

  1. 2 DAYS AGO

    Ep. 34 Maximizing Provider Revenue with Payer Contract Insights

    Maximizing Provider Revenue with Payer Contract Insight In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares essential insights on how to maximize provider revenue by understanding and leveraging the nuances of payer contracts. Topics covered include addressing prior authorization denials, navigating payer reimbursement policies, ensuring clean claim submissions, and utilizing fee schedules and carve outs. Additionally, Vanessa offers strategies for managing payer plan limitations, timely filing guidelines, and escalation procedures for unresolved reimbursement issues. Listeners are encouraged to harness technology and AI-driven solutions to streamline these processes for enhanced revenue cycle performance.  00:00 Introduction to the Podcast and Host 01:23 Episode Overview: Maximizing Provider Revenue 02:01 Understanding Payer Contracts 03:04 Prior Authorization Guidelines 05:28 Payer Reimbursement Policies 08:08 Clean Claim Requirements 11:34 Carve Outs in Payer Contracts  14:03 Payer Plan Limitations 16:24 Fee Schedules and Contracted Rates 21:29 Requests and Recoupments of Overpayments 23:34 Denials Without Proper Justification 25:10 Timely Filing Guidelines 27:17 Escalating Reimbursement Issues 29:11 Conclusion and Next Steps

    33 min

  2. 5 DAYS AGO

    Live Denials Q&A 9/17/24 - Utilizing Contracts When Resolving Denials

    In this episode of the bimonthly Denials Q&A, host Vanessa discusses her extensive experience and expertise in handling denials, focusing on changes and challenges in the field. She emphasizes the importance of understanding contracts, payer guidelines, and exploring new technologies to improve denial management. Vanessa shared insights on leveraging contract information and innovative technology to fight back against complex denial processes. Key topics include the use of CARCs, dealing with Medicare Advantage plans, navigating E&M downcoding, and strategies for obtaining necessary documents from payers. Listeners are encouraged to stay proactive, utilize technology, and network within the healthcare billing community to address evolving denial issues effectively. Email Chester Montefering at Recon.health at chester@recon.health for more information on utilizing contract automation.   00:00 Welcome to the Bimonthly Denials Q&A 00:26 Introduction to Denials and Career Background 01:27 Starting a Company and Industry Engagement 03:19 Denial Codes and Industry Changes 04:37 Complexity in Reversing Denials 06:35 Importance of Contracts in Denial Management 08:50 Accessing and Understanding Contracts 12:01 Technology Solutions for Denial Management 15:06 Open Q&A Session 23:12 Networking and Sharing Experiences 52:18 Final Thoughts and Next Steps

    53 min

  3. 10 SEPT

    Ep. 33 Insurance AR: Claims with No Response

    Navigating Insurance AR: Tackling Claims with No Response In this episode, Vanessa Moldovan, CEO and host of 'For The Love of Revenue Cycle,' delves into the intricacies of Insurance Accounts Receivable (AR), focusing on claims with no response. Vanessa explains the significance of managing AR to maintain financial health and provides practical strategies for identifying, resolving, and preventing claims with no responses. Key takeaways include the importance of tracking all claims, the role of technology, and assigning the right tasks to team members. Vanessa also emphasizes the need for preventive measures and invites listeners to ongoing discussions and networking opportunities. 00:00 Introduction and Welcome 01:06 Episode Overview: Insurance AR and Claims with No Response 02:00 Understanding Insurance Accounts Receivable (AR) 03:57 Managing AR: Best Practices and Key Performance Indicators 07:07 Focusing on Claims with No Response 16:13 Steps to Resolve Claims with No Response 22:22 Preventive Measures for Claims with No Response 26:05 Conclusion and Upcoming Episodes

    28 min

  4. 5 SEPT

    Live Denials Q&A 9/5/24 - Hospice, SNF, Home Health denials + takebacks

    In this episode, Vanessa Moldovan, CEO and Founder of 'For the Love of Revenue Cycle,' leads a live Q&A session on handling denials in medical billing. Participants from different sectors of the healthcare revenue cycle, including medical billing for home visits, nursing homes, and surgery centers, discuss challenges they face with denial codes, modifiers, and reimbursement issues. Key topics include understanding the new FY 2024 hospice final rule, addressing denials related to modifier codes, and strategies for handling electronic remittance advice (ERA) take-backs. Suggestions for actionable steps and resources, such as consulting specific websites and joining relevant forums, are also shared.  00:00 Introduction and Purpose of the Q&A Session 00:49 Challenges in Revenue Cycle and Denials 02:07 Participant Introductions and Their Goals 03:11 Open Forum for Questions and Discussions 04:14 Lauren's Denial Issue with Chronic Care Management 09:26 Exploring Possible Solutions and Resources 21:08 Roseanne's Issue with Take Backs on ERAs 28:22 Provider Targeting by Payers 28:38 Options for Receiving Take Backs 29:03 Challenges with Electronic ERAs 29:44 Appeal Deadlines and Paper Forms 30:11 Denials Due to Grouper Edits 30:53 Hospital Denials and Resources 33:13 Questions on Prolonged Services Billing 37:08 Issues with Nursing Home Billing 45:29 Seeking Expert Advice and Final Thoughts

    50 min

  5. 2 AUG

    Live Denials Q&A 8/1/24 - Navigating Out of Network Denials

    Show notes for today's live denials Q&A session: The differences in denials and appeals processes between in-network and out-of-network providers Strategies for appealing out-of-network denials, including involving patients and leveraging laws like the Arisa law Trends in payer requests for documentation and potential reasons behind sudden increases in these requests Frustrations with payers' downcoding practices and lack of transparency in reimbursement The shift in the medical field from a profession to a business, and the need for better revenue cycle education for providers

    57 min

  6. 30 JUL

    Ep 32 Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa

    Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa   In this episode, Vanessa welcomes Mike Marshall to discuss the intricacies of revenue cycle management (RCM) and the challenges faced by healthcare organizations. Mike is currently the Managing Director of the North American division of e5 Workflow, with a rich background in healthcare focusing on turnaround projects for operation, finance, and revenue cycle management.   They explore the root causes of common RCM issues, the hesitations around adopting new technology, and emphasize the necessity of becoming tech-enabled to survive in the current market. The conversation delves into innovative solutions, actionable data, optimizing human resources, and technological advancements like AI and automation. They also provide guidance on selecting vendors and the importance of staying informed about industry innovations through networking, conferences, and professional advice.   00:00 Welcome and Introduction 00:31 Introducing Mike Marshall 01:03 Industry Challenges in Revenue Cycle Management 02:09 Hesitancy in Adopting Technology 03:48 The Pain of Outdated Systems 07:35 Fear of Change in Revenue Cycle 11:32 Importance of Training and Support 16:47 Encouragement to Explore New Solutions 21:19 Leveraging Technology for Efficiency 33:15 Medicare Challenges and Strategic Technology Integration 33:52 Middle Management and Delegation with Technology 35:08 Industry Changes and Knowledge Gaps 36:04 Leveraging Technology for Delegation and Efficiency 36:53 Outsourcing and Onshoring in Revenue Cycle Management 39:34 Navigating Vendor Selection and Industry Resources 45:16 Maximizing Conference and Vendor Interactions 53:40 Evaluating Automation and AI Claims 57:55 Strategic Technology Integration and Conclusion

    51 min

  7. 18 JUL

    Live Denials Q&A 7/16/24 - payer denial trends creating complexity

    In this episode, Vanessa Moldovan hosts a Q&A session focused on the challenging issues of denials in revenue cycle management. Vanessa, along with the attendees, discusses the complexities around denial prevention, resolution, and best practices. The session covers specific payer issues, including downcoding by Anthem and Humana, as well as rampant documentation requests from UnitedHealthcare. The discussion also provides strategies for handling denials, escalating issues to provider representatives, utilizing contracts, and ensuring accurate coding practices. Expert insights are shared on balancing the administrative burden, proactively managing claims, and leveraging technology to streamline processes. The conversation aims to empower healthcare providers and billers to tackle denials effectively while advocating for systemic changes in payer operations. 00:00 Introduction and Welcome 03:27 Purpose of the Q&A Session 04:28 Host's Background and Experience 05:25 Community and Participation 07:00 First Question: Handling Downcoding 1 1:44 Discussion on Denial Trends and Strategies 23:02 Challenges with Payers and Denials  31:41 Industry Trends and Payer Practices 35:26 Frustrations with Office Testing and Pre-Authorization 37:22 Tactics for Fighting Unjustified Denials 38:27 Challenges Faced by Small Practices 40:21 Importance of Documentation and Predetermination 42:16 Role of Professional Organizations and Social Media 49:12 Differences in Denials: In-Network vs. Out-of-Network 54:53 Leveraging Contracts and Provider Networks 58:46 Final Thoughts and Recommendations

    1h 1m

  8. 16 JUL

    Ep. 31 Patient Accounts Receivable

    n episode 31 of 'For the Love of Revenue Cycle,' the host discusses patient accounts receivable (AR) in a clinic setting, emphasizing the importance of professional billing over facility billing. Key topics include naming conventions in billing systems, the role and definition of a guarantor, and the nuances between insurance processing and payment. The episode delves into best practices for managing patient AR, handling self-pay arrangements, and understanding patient financial responsibility, especially under high deductible health plans. The host also explores the impact of technological innovations on both pre-service and post-service collections, strategies for reducing collection costs, and compliance with federal and state regulations. Finally, the session provides practical recommendations for managing self-pay balances and patient shares, offering financial assistance, and ensuring consistency in collections policies. 00:00 Welcome and Introduction 01:27 Understanding Patient Accounts Receivable (AR) 01:54 Naming Conventions and Guarantor Responsibilities 05:40 Insurance Processing and Patient Responsibility 19:26 Collecting Patient Payments 22:58 Technological Innovations in Revenue Cycle 25:34 Best Practices for Self-Pay Balances 27:00 Handling Balances After Insurance 28:03 Developing Effective Collection Policies 34:45 Conclusion and Final Thoughts

    36 min
See All (75)

About

Did you ever wish that you had a physician revenue cycle expert and mentor with over 20 years of experience whispering success secrets in your ear? That’s exactly what you will get when you tune into For the Love of Revenue Cycle hosted by me, Vanessa Moldovan. My career and my life have brought me a wealth of knowledge and I can’t wait to share with you. My passion is to help others in the industry to reach their full potential and find success in the wonderful, crazy world of physician revenue cycle. Whether you are a beginner, expert, physician, consultant, educator or just plain curious, each episode is designed to immediately apply to your career, business and operations. Join me each week as we tackle the topics, trivia and triumphs of revenue cycle. Let’s discover our full potential together.

Information

You Might Also Like

To listen to explicit episodes, sign in.

Stay up to date with this show

Sign in or sign up to follow shows, save episodes and get the latest updates.
Select a country or region

Africa, Middle East, and India

Asia Pacific

Europe

Latin America and the Caribbean

The United States and Canada