For The Love of Revenue Cycle

Vanessa Moldovan
  • 5.0 (24)
  • MEDICINE
  • UPDATED WEEKLY

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. MAR 18

    FTLORC Live Denials Q&A! 03/10/26

    FTLORC Live Denials Q&A! 03/10/26 *Please note, the connection on the call dropped at the end, which is why there is a sudden cut-off. Vanessa Moldovan hosts a live community Q&A on denials and reimbursement, emphasizing end-to-end operational knowledge and root-cause fixes rather than siloed work. Nicolette shares a Medicare claim-rejection issue traced to offshore staff creating duplicate Medicare payer records with incorrect addresses, prompting new claim-entry guidelines. Participants discuss appeal effectiveness over sheer volume and trends in California denials, including Blue Shield requests for additional information and heightened scrutiny of 99213/99214 tied to fraud concerns and diagnosis ordering. Perva describes Medicare wellness/preventive denials for newly eligible members that required rebilling with 99214 instead of a G code and asks about Medicare crossover failures tied to patients updating secondary coverage with Medicare. Guadalupe details out-of-network underpayments driven by third-party pricing vendors like MultiPlan/Data iSight, ERISA-based appeal strategies, obtaining pricing in writing, NCCI/edit disputes, and escalation up to payer leadership. The group also covers documentation precision for time-based behavioral health codes and an orthopedic prior-authorization scenario where an authorized arthroscopy code was denied after a meniscectomy was coded, raising compliance and documentation questions. 00:00 Live Q&A Kickoff 00:55 Medicare Address Setup Errors 02:12 Root Cause Denial Fixes 04:46 99213 Denial Surge 06:57 Wellness Visit Coding Timing 09:09 Medicare Crossover Issues 10:50 Out of Network Underpayments 13:00 ERISA Appeals Strategy 16:40 Bundling and NCCI Disputes 21:05 Escalating to the CEO 24:53 Community Shoutouts and Teaching 26:28 Out Of Network Gap 28:03 Manual And LLM Help 29:05 Automation And Pricing Games 30:39 Multiplan Data Eyesight 32:32 Specialties And New Markets 33:36 Behavioral Health Denials 34:47 Time Based Documentation 36:42 Ortho Prior Auth Denial 42:15 Coding Billing Compliance 46:16 Wrap Up And Thanks

    47 min

  2. FEB 24

    Ep. 49 - Effective Strategies for Prior Authorization + Eligibility Verification

    In this episode of For the Love of Revenue Cycle, Vanessa breaks down why prior authorization and eligibility verification are two of the biggest drivers of preventable denials — and how getting them right is essential to clean claims and healthy cash flow. The discussion covers the foundations of payer requirements, the difference between denials and rejections, and where most revenue leakage actually occurs across the front end of the revenue cycle. Vanessa shares practical best practices for improving accuracy and efficiency in PA and EBV workflows, along with real industry data on denial trends. The episode also explores how modern technology, including agentic AI, is transforming these processes by reducing manual work, closing operational gaps, and shifting organizations from denial resolution to true prevention. 00:00 Welcome and Introduction 03:07 Understanding Clean Claims 06:04 Claim Requirements Explained 10:41 Denials vs Rejections 12:25 Why Prevention Matters 17:05 Front End vs Backend 22:05 Prior Authorization Deep Dive 26:28 PA Process Step by Step 29:34 Prior Authorization Best Practices 32:15 Eligibility and Benefit Verification 35:55 EBV Best Practices 38:52 Technology and AI Overview 42:30 Understanding Agentic AI 44:48 AI in PA and EBV Workflows 48:04 Closing and Call to Action

    49 min

  3. FEB 3

    Episode 48 : Rethinking Denial Management: What the Data Is Really Telling You

    In this episode of 'For the Love of Revenue Cycle,' the focus shifts from traditional denial management strategies to understanding the power of denial data. Vanessa discusses the limitations of current systems and common misconceptions in how denial management is practiced. Emphasizing the importance of prevention over mere resolution, the episode explains how analyzing denial data can reveal underlying process flaws and drive meaningful improvements. Key points include distinguishing between denial reasons and root causes, the importance of visibility over precision, and the role of technology in optimizing denial management. A call to action encourages listeners to rethink denial management as a strategic, data-informed approach to enhancing organizational performance.   00:00 Welcome and Introduction 00:15 Understanding Denial Management 00:58 The Role of Denial Data 05:14 Challenges in Using Denial Data 06:48 From Resolution to Prevention 07:49 Practical Steps for Denial Management 08:30 The Importance of Root Cause Analysis 10:07 Impact on Organizational Performance 11:46 Leveraging Technology and Automation 13:39 Conclusion and Final Thoughts

    15 min

  4. JAN 27

    Webinar Replay - Agentic AI in Revenue Cycle: Cutting Through the Hype

    In this special episode of 'For the Love of Revenue Cycle,' Vanessa Moldovan presents a recording of a recent webinar focused on the topic of Agentic AI. Approved by AAPC for one CEU, this episode dives into the reality of Agentic AI in revenue cycle operations. It explains what Agentic AI is, its difference from traditional automation or RPA, and how it addresses core issues like human error, payer complexity, and inadequate legacy technology. Practical, real-world applications in prior authorizations, eligibility verification, and document management are discussed, alongside the benefits of this technology. The importance of cautious and controlled adoption is emphasized, providing listeners with essential questions to evaluate vendors and ensure effective integration of Agentic AI into their workflows.   To claim your CEU, please submit the form here: https://forms.gle/J76NCbeXiyy6B5rC6   00:00 Introduction and Webinar Overview 00:49 The Reality of Agentic AI 01:56 Understanding Agentic AI 03:08 Challenges in Revenue Cycle 07:40 The Role of Agentic AI in Revenue Cycle 19:03 Evaluating Agentic AI Vendors 25:45 Implementing Agentic AI Safely 27:26 Conclusion and Next Steps

    30 min

  5. JAN 13

    Ep. 47 - Audits with Brenda Edwards

    In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan delves into the complex and pressing topics of audits, compliance, and documentation. Joined by expert Brenda Edwards, who has extensive experience in healthcare revenue cycle, they discuss the rising frequency and importance of audits, sharing insights and real-world examples, including metadata and audit trails. Brenda emphasizes the need for thorough documentation to support services billed and advises on how to handle audit letters without panic. Practical advice is given to ensure that organizations remain compliant and prepared for inevitable audits. The episode also highlights the need for internal and external audits, the importance of having a compliance plan, and the potential benefits of integrating thoughtful automation into the audit process.                                                              00:38 Meet Brenda Edwards: Background and Expertise 00:52 Understanding Audits: Who, Why, and How 00:58 Real-World Example: Incident Two and Split Shared Services 01:16 Practical Takeaways: Responding to Audits 01:26 Disclaimer and Scope of Discussion 01:59 Starting the Conversation with Brenda 02:09 The Growing Importance of Audits 03:03 Brenda's Journey in Auditing 09:54 Compliance and Documentation: Best Practices 10:58 Cardiology Audit Case Study 11:44 The Role of Metadata in Audits 16:18 The Consequences of Improper Access 26:02 The Long-Term Impact of Audits 26:52 First Offense Penalties and Compliance Plans 28:43 Case Study: EHR Upgrade Issues 30:09 Legal Implications and Repeat Offenders 31:57 Handling Sanctioned Providers 34:04 Responding to Audit Notifications 34:33 Educational vs. Recoupment Letters 42:07 The Importance of Documentation 46:39 Final Thoughts and Takeaways

    52 min

  6. 11/04/2025

    Webinar Replay - RCM Pulse Check: What's Working, What's Broken, and What's Next?

    In this webinar replay, host Vanessa Moldovan leads a discussion on the current state of the revenue cycle management (RCM). The episode kicks off the 'Drive to ViVE' webinar series, focusing on the lead-up to the event next year in Los Angeles, which will feature industry leaders discussing healthcare IT, business, and more. Vanessa addresses the major challenges in RCM, such as rising denial rates, fragmented workflows, and the dynamic changes in regulations and policies. She shares insights on denial prevention, education, and the adoption of smart technology, specifically Agentic AI, to improve RCM processes. The episode also highlights the importance of leadership accountability, continuous learning, and genuine industry collaboration to drive significant change while preparing for the future of healthcare reimbursement.  00:00 Welcome and Introduction to Drive to ViVE 00:53 Current Challenges in Revenue Cycle Management 02:53 What's Broken in Revenue Cycle Management 07:30 What's Working in Revenue Cycle Management 11:32 Strategies for Future Improvements 25:02 The Role of Technology in Revenue Cycle Management 28:44 Involving Users in the Process 29:48 The Role of Technology in Revenue Cycles 31:03 Understanding Agentic AI 31:28 The Evolution of Navigation Technology 32:38 Agentic AI in Revenue Cycle Management 36:49 Q&A Session Begins 37:28 Addressing Denial Prevention 40:39 The Importance of Front-End Processes 42:04 Skills for Future RCM Teams 43:56 Networking and Education in RCM 46:35 Supporting Frontline Teams 49:30 Final Thoughts and Future Directions

    51 min

  7. 10/28/2025

    Ep. 46 - 2025 RCM Conference Season Recap

    Conference Season Recap: Maximizing Value from Industry Events In this episode of 'For the Love of Revenue Cycle,' host Vanessa Malon offers a comprehensive review of the conferences she attended this season, including Becker's, HBMA, MGMA, the Medical Cost Containment Series in Chicago, and the Invest Behavioral Health Conference. Vanessa discusses the key takeaways, the value of attending these events, and provides practical advice on how to maximize ROI, whether you're a leader or frontline worker. She emphasizes the importance of choosing the right conferences based on your goals, whether it's for education, networking, or vendor evaluation. Vanessa also shares tips on how to prepare, what questions to ask, and the benefits of small group sessions, making this episode a must-listen for revenue cycle professionals planning their conference schedules. 00:00 Introduction and Podcast Overview 00:40 Season Review: Conferences Attended 02:11 The Value of Conferences 04:10 Becker's Conferences Insights 06:49 Medical Cost Containment Series 08:00 HBMA and MGMA Conferences 10:00 Networking and Practical Tips 16:15 Final Thoughts and Recommendations 17:30 Conclusion and Contact Information

    18 min

  8. 10/22/2025

    FTLORC Live Q&A! 10/14/25

    In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan engages the community in a live Q&A session. The discussion covers the pressing issue of denials and reimbursement challenges in the healthcare industry. Key topics include recent policy changes by Cigna on automatic downcoding, the implications of DRG downgrades, and strategies for identifying downcoded claims. The episode also addresses how to measure denial rates, manage medical necessity denials, and successfully overturn denied claims. Expert insights and community contributions make this episode a valuable resource for anyone involved in the revenue cycle. 00:00 Introduction and Welcome 00:12 Open Q&A: Community Challenges 01:10 Discussion on Cigna's Downcoding Policy 03:01 Identifying and Handling Downcoding 07:33 Measuring Denial Rates and Overturns 12:00 Government Shutdown Impact on Telehealth 12:57 Combating Medical Necessity Denials 17:25 Escalating Denial Issues with Payers 22:20 Conclusion and Community Engagement

    23 min
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5
out of 5
24 Ratings

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.

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