NatRevMD

NatRevMD
  • 5.0 (27)
  • Medicine
  • Updated Weekly

Medical billing tips for healthcare professionals — by healthcare professionals.  This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use. Join the conversation in our Facebook Group: NatRevMDLearn more at www.natrevmd.com

  1. 3d ago

    #198 $300,000 in Old AR Is at Risk During Your Next Billing Transition

    Send us Fan Mail There is a revenue cliff hiding inside the billing transition most independent practices are planning right now. Not from the change itself. From the order of it. In this episode we walk through why the money in your bank account during month one of a new billing arrangement is almost entirely old AR, why simultaneous service and software change is the fastest way to lose that money, and the three questions you have to answer before any sequencing decision makes sense.  Three questions before you sequence anything: Are you replacing an in-house team or an outsourced vendor? Who owns the software? Is the software working, or is it part of the problem? Skipping these is where the error gets made.  System 1: The revenue ramp. Month one is 80 to 90 percent old AR. Month four is 95 to 100 percent new team. Every sequencing decision has to protect that ramp.  System 2: In-house vs outsourced risk profiles. In-house transitions risk institutional knowledge walking out. Outsourced-to-outsourced transitions risk data access and credentialing. Different risks, different sequences.  System 3: Three software paths. Keep functional software and transition service only. Replace failing software after service stabilizes. Or defer the outdated-but-functional software conversation until months four through six.  Three actions this week  Answer the three questions in writing before any vendor conversation. Pull your AR aging report. If more than one month of gross charges sits past 45 days, plan an AR cleanup sprint before the new team starts. Read your current vendor or software contract for data provisions, notice terms, and auto-renewal windows. Episode breakdown  00:00  Hook and big idea 02:30  The three questions 13:00  System 1: the revenue ramp 16:00  System 2: in-house vs outsourced 20:00  System 3: three software paths 24:00  Summary and action plan 26:00  CTA and cliffhanger Resources  EMR / PM Software Assessment Form (primary): https://eligibility.natrevmd.com/emp/pm-evaluation-frameworkBook a Revenue Audit: natrevmd.com/schedule-a-call Payment Posting Audit Checklist: eligibility.natrevmd.com/payment-posting-checklist Practice Revenue Leak Scorecard: eligibility.natrevmd.com/nrm-revenue-scorecard-v3 30-Day Revenue Recovery Plan: eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan

  2. 6d ago

    #197 The $40,000 Hire With the Perfect Resume

    Send us Fan Mail 👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic  The exact framework we use when we walk into a new practice. Takes five minutes. Results are immediate.  Missed Part 1? EP196: https://podcasts.apple.com/us/podcast/196-%24112-000-buried-by-a-billing-manager-who-was/id1624182351?i=1000777197553 ────────────────  A billing manager with seven years of experience and a certified coding credential took a job at an independent practice doing $300,000 a month. Six months later she was gone. The practice was $40,000 short. Not because she lacked skills. Because the moment she hit a problem she had not seen before, she buried it for three months rather than admit she did not know what she was doing.  The credentials were real. The mindset was wrong.  This is the close of the two-episode arc we opened in EP196. Part 1 was about the culture cost: culture is a revenue decision. Part 2 tells you which decision. The mindset you hire is the culture you build.  What Microsoft Actually Proves.  In 2014, Satya Nadella inherited 220,000 people operating under stack ranking, a performance system that rewarded knowing things and punished not knowing. The result was a workforce where the safest strategy was ensuring someone else failed before you did. Nadella named the framework he wanted to replace it with in four words: from know-it-all to learn-it-all. He did not fire 220,000 people. He changed what he selected for, what he rewarded, and what he modeled.  Hiring for Mindset Over Credentials.  Skills can be developed in six months. Mindset takes years. Three interview questions do most of the work: tell me about a time you were wrong at work; what have you learned in the last six months that changed how you do your job; walk me through a denial pattern you found that the practice had not noticed yet.  High Performance vs High Potential.  These are not the same thing. A high performer executes the current job excellently. A high-potential employee also demonstrates the capacity for significantly more complex responsibility in the future. Four signals: learning agility, emotional intelligence, proactive problem-solving, influence without authority. The HiPo you do not recognize and develop will leave, and it will look like a resignation instead of the talent management failure it actually is.  Graduating Responsibilities.  As individuals develop, their role in the practice must change with it. The billing coordinator builds mastery. The senior coordinator builds ownership. The billing manager builds strategy. The graduation must be structured explicitly, or the promoted employee does two jobs for one salary and burns out.  Role Level Focus Reference  Billing Coordinator  Primary focus: Queue execution, denial processing, eligibility verification Stop doing as they advance: Nothing yet, this is the mastery phase  Senior Coordinator / Lead  Primary focus: Process ownership, protocol updates, training new staff  Stop doing: Working claims the coordinator can handle  Billing Manager  Primary focus: Denial trend analysis, weekly reviews, reporting to leadership  Stop doing: Queue work, individual claim decisions  Director of Operations  Primary focus: Revenue cycle strategy, vendor oversight, cross-site performance  Stop doing: Managing individual billing staff daily tasks     Three Actions This Week  • Change one interview question. Replace one credential-verification question with: tell me about a time you were wrong at work and how you found out.  • Name your one high-potential employee. Schedule 15 minutes with her this week and ask: what part of your work do you find yourself most drawn to.  • Map one responsibility graduation. Identify one task a higher-level person is doing that a lower-level person should be. Write down the task, the person, and the transition date.  Episode breakdown  00:00 — The $40,000 hire with the perfect resume  02:30 — What Microsoft actually proved  06:00 — The four-word framework  09:15 — Hiring for mindset over credentials  13:40 — The three interview questions  17:00 — High performance vs high potential  21:00 — The four signals of high potential  25:00 — Graduating responsibilities  28:00 — Three actions this week  30:00 — Free resource + close  👉 RECOVER Diagnostic (free, 5 minutes)  eligibility.natrevmd.com/recover-diagnostic  Website: natrevmd.com  Trusted Resources: natrevmd.com/trusted-resources/  Referenced in episode:  Hit Refresh by Satya Nadella  Mindset: The New Psychology of Success by Carol Dweck

  3. Jul 17

    #196 $112,000 Buried by a Billing Manager Who Was Afraid to Speak Up

    Send us Fan Mail 👉 Free RECOVER Diagnostic: eligibility.natrevmd.com/recover-diagnostic  The exact diagnostic we use when we walk into a new practice. Takes five minutes. Results are immediate.  A billing manager at a family medicine group found an $8,000-per-month denial pattern in her first month. She never said anything. It ran for fourteen months before a billing audit caught it. $112,000 in leaked revenue, not from a system failure, but from a management culture that made staying quiet the safer choice.  This episode is not about billing. It is about the environment that determines whether your team tells you the truth or buries it. We introduce Douglas McGregor's Theory X vs Theory Y framework and show you exactly what fear-based leadership costs an independent medical practice.  What Enforcer Culture Looks Like in a Practice.  Fear-based management rarely announces itself. It looks like pointed questions in staff meetings, silent audits, and a billing manager who learned early that flagging problems creates more work for her than absorbing them. A billing team operating under enforcer culture surfaces about 60 percent of the problems it finds. The other 40 percent get absorbed into workarounds, write-offs, and queue backlogs that nobody owns.  The Four Things Enforcer Culture Destroys.  Innovation stops. Turnover compounds. Truth goes underground. People do the minimum. All four appear consistently in fear-based workplaces, and all four have direct revenue consequences in a medical practice.  What Theory Y Looks Like Operationally.  Theory Y is not soft management. It is a structural decision about what you are optimizing for. Standards are high, expectations are clear, and the response to a problem is curiosity rather than blame. The information flow is faster, more accurate, and more complete. Problems surface earlier. Fixes run sooner.  Theory X vs Theory Y — Comparison  Theory X — Enforcer  View of work: Inherently disliked. People avoid it.  Motivator: Paycheck and fear of punishment  Management style: Micromanagement, control, scrutiny  Employee role: Avoid responsibility, need supervision  Practice outcome: Burnout, turnover, hidden problems     Theory Y — Trust  View of work: Natural and fulfilling. People seek it.  Motivator: Purpose, growth, and autonomy  Management style: Coaching, empowerment, open dialogue  Employee role: Seek responsibility when given the chance  Practice outcome: Retention, trust, problems surfaced early     Three Actions This Week  • Name the last problem someone brought you and how you responded. That expectation is your current culture.  • Ask your billing manager one question: what is the one thing in this workflow you would fix if you could fix anything.  • Change one response. Receive the next problem as information. Ask what caused it. Ask what it would take to fix it. Three times in a row shifts the signal.     Episode breakdown  00:00 — The $112,000 mistake  02:15 — Theory X vs Theory Y  05:40 — Enforcer culture in a practice  09:20 — The four destructions  14:10 — Theory Y operationally  18:00 — The five principles  22:30 — Three actions this week  25:00 — Free resource + close Resources 👉 RECOVER Diagnostic (free, 5 minutes) : eligibility.natrevmd.com/recover-diagnostic  👉Website: natrevmd.com  👉Trusted Resources: natrevmd.com/trusted-resources/  Referenced in episode:  The Human Side of Enterprise by Douglas McGregor  Forbes / Fierce Inc. — 10 Unmistakable Signs of a Fear-Based Workplace

  4. Jul 14

    #195 The GLP-1 Bridge Just Broke Your Prior Auth Workflow

    Send us Fan Mail FREE — SEE WHERE YOUR PRACTICE IS BLEEDING REVENUE IN 3 MINUTES Take the RECOVER Diagnostic Quiz: https://eligibility.natrevmd.com/recover-quiz-lp More free resources: https://natrevmd.com/trusted-resources/ Payment Posting Audit Checklist: https://eligibility.natrevmd.com/payment-posting-checklistWE ARE RE-AIRING THIS EPISODE BECAUSE IT MATTERS RIGHT NOW.  On July 1, 2026, the Medicare GLP-1 Bridge went live. Every independent practice with Medicare patients on Wegovy, Zepbound KwikPen, or Foundayo for weight management is now facing retrospective prior authorizations routed through a central processor most billing teams have never worked with.  The AMA released physician guidance on June 26. The workflow is new. The documentation burden is heavier than most practices have modeled. And prior auth was already the fastest-growing revenue threat independent practices face.  In this episode Dr. Heather walks through:  WHAT WE COVER  Why prior auth denials are silently eating clinical time and revenue The dollar amount your practice is losing every month (and how to calculate it) The 5-step workflow to manage prior auth without drowning your team What every practice needs to change this week "Prior auth has a dollar amount attached to it. Most practices never calculate it."  THREE ACTIONS THIS WEEK  1. Calculate what prior auth is costing your practice in staff hours, denied claims, and clinical time  2. Set up a central prior auth tracker (do not run this out of email threads)  3. Train the team on the Medicare GLP-1 Bridge central processor workflow before the backlog compounds

  5. Jul 10

    #194 Who Does What, Who Answers, and Who Just Needs to Know

    Send us Fan Mail A household runs on clarity, not effort. So does a practice. Most performance problems in independent practices are clarity problems: somebody thought somebody else was handling it. This episode builds the RACI model (Responsible, Accountable, Consulted, Informed) into your billing workflow and your hiring.  What RACI actually means.   Four roles, each assigned to a person for a task, with one hard rule: never more than one Accountable person. If two people are accountable, nobody is.  Mapping RACI to your practice.   A denial slips through when the billing manager assumes the front desk verified eligibility and the front desk assumes the billing manager caught it at scrubbing. With RACI, every role is named and the gap disappears. An unowned weekly denial review at a $350K-a-month practice can run 3 to 5 percent above its potential clean claim rate, $10,500 to $17,500 a month lost in a gap nobody owned.  Hiring into the RACI structure.   Define the RACI role before the job description. A person wired to execute will struggle in an Accountable seat that requires sitting with ambiguity. That is a role mismatch, not a character flaw. Three actions this week  Map the RACI for your weekly denial review (if you cannot name the Accountable person in thirty seconds, the task has no owner). Audit your current team against the RACI role definitions: right role, right wiring? Use RACI in your next hire, before you write the job description. Resources  30-Day Revenue Recovery Plan (primary):  eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan  Book a call with Heather:  calendly.com/heather-natrevmd  Payment Posting Audit Checklist (supporting):  eligibility.natrevmd.com/payment-posting-checklist  Referenced: The Five Dysfunctions of a Team by Patrick Lencioni; High Output Management by Andy Grove.

  6. Jul 7

    #193 The 90-Day Plan for 2027 OB Billing

    Send us Fan Mail Q1 2027 cash flow crisis. That is what is waiting for every OB practice that does not have a plan in motion by October. Not because the codes are hard. Because the time ran out to prepare for them. Knowing what is changing and being ready for it are two completely different things. In the OB Global Coding Series finale, Dr. Heather Signorelli walks through the exact ninety-day month-by-month plan to be ready on January 1, 2027 — payer contracts in July, EHR templates and workflows in August, provider training and shadow audits in September, refinement through Q4.  Month 1 · July · Payer contracts:  Your contracts reference specific CPT codes. When 59400 and 59510 disappear January 1, those contracted rates disappear with them. Identify your top five payers by maternity volume. Reach out to each provider rep with a written timeline question. Model your current revenue per episode before negotiating. Use the ACOG payer advocacy toolkit. Submit written notice of intent to renegotiate before July 31 to get into the Q4 queue.  Month 2 · August · EHR + workflows:  Systems first, people second. Rebuild prenatal, postpartum (inpatient and outpatient), and labor management templates. The labor management templates are built from scratch since 59080 – 59083 have no legacy. Build the multi-provider attribution protocol, the same-day postpartum hard stop, and the modifier TH automation.  Month 3 · September · Provider training + shadow audits:  Mandatory training for all clinical staff. Show providers their own notes and the dollar difference between what they wrote and what they could have written. Run shadow audits monthly: twenty prenatal notes, ten labor management, ten postpartum rounding. Track results by provider. Brief the front desk on the patient-facing talking points. September 1 is the ACOG testing date — NOT a payer compliance deadline. Submit test claims to your top three payers and watch what comes back.  Q4 · Refinement, not crisis:  October: follow up with payers for written fee schedule confirmations. November: CMS finalizes RVUs — update your revenue model with real numbers. December: billing team readiness check. January 1: go live. The practices that did the Q3 work transition smoothly. The ones that did not are scrambling.  The reframe:  The elimination of the global OB codes is not a threat to your practice. It is a correction. OB/GYN has been undercompensated for the complexity of maternity care for thirty years. That ends January 2027, if you are prepared. RESOURCES BLOCK  Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Full series playlist: EP188 · EP189 · EP190 · EP191 · EP192 (https://natrevmd.com/podcast/#) Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz

  7. Jul 3

    #192 The Postpartum Same-Day Trap

    Send us Fan Mail Deliver at 11 PM Tuesday and round at 1 AM Wednesday: paid. Deliver at 8 AM Tuesday and round at 4 PM Tuesday: included in the delivery code, and billing it separately is a compliance violation. Same clinical work, two different outcomes. The only variable is the calendar. Starting January 1, 2027 postpartum care moves to E/M billing with hospital rounds, discharge management, and outpatient checkups all individually billable. Dr. Heather Signorelli walks through the code sets, the same-day trap, the multi-provider wrinkle, and the three-step workflow that catches it every time.  The end of the postpartum bundle:  Code 59430 (postpartum care only) is deleted January 1, 2027. All postpartum care moves to E/M billing. Two settings, two code sets: inpatient (hospital rounds) and outpatient (office visits).  Inpatient postpartum codes:  Subsequent hospital care: 99231, 99232, 99233 for daily rounding visits after the date of delivery. Discharge day management: 99238 (30 minutes or less) or 99239 (over 30 minutes). Every rounding day after delivery, on a new calendar date, is a separately billable E/M encounter. Documentation has to support the level. A one-liner does not support a 99233.  Outpatient postpartum codes (with telehealth correction):  Standard office E/M: 99212 through 99215 with modifier TH. Telehealth uses the same 99212 through 99215 codes with modifier 95 or GT, and place of service 02 or 10. There is no separate “98000” telehealth code set, contrary to earlier references in this series. Modifier TH on all postpartum E/M codes communicates the maternity context to the payer.  The same-day rule:  Postpartum E/M codes CANNOT be reported on the same calendar date as the delivery code. Same-day postpartum management is included in the delivery code. Calendar date means midnight to midnight, not twenty-four hours from delivery time.  The multi-provider wrinkle:  If Dr. Smith delivers at 8 AM and Dr. Jones rounds at 4 PM the same day, Dr. Jones cannot bill an E/M for that visit. The delivery code covers same-day postpartum regardless of which provider from the same group performs it. This requires an internal compensation and attribution policy, not just a billing rule.  The workflow fix — three steps:  Timestamp discipline on every delivery and rounding note Billing team hard stop: verify delivery date before dropping any postpartum E/M charge Daily L and D reconciliation: track delivery date, rounding date, and provider by patient, daily The revenue opportunity:  Every hospital rounding day after the delivery date is a new billable E/M. Extended stays from complications (postpartum hemorrhage, severe preeclampsia, wound infection, NICU situations) all generate additional charges. Complexity matters for reimbursement. Outpatient two-week and six-week checks are now individually billable instead of absorbed into a global fee. The same-day rule is the risk. Everything after midnight is the opportunity.  Quick Reference Table: Topic                                                                             What to know Deleted postpartum code                            59430 — deleted Jan 1, 2027  Inpatient rounds                                             99231 – 99233  Discharge codes                                                      99238 (≤30 min) · 99239 (>30 min) Outpatient postpartum                                 99212 – 99215 + modifier TH  Telehealth modifier                                        Modifier 95 or GT · POS 02 or 10                                                                              NOT a separate 98000     code set  Same-day rule                                                           Postpartum E/M cannot be billed on the                                                                              same calendar date as the delivery  Calendar definition                                        Midnight to midnight  Multi-provider same-day                                    Delivery code covers regardless of                                                                                       which group provider rounds Workflow fix                                                    Timestamps · billing hard stop · daily                                                                                    reconciliation RESOURCES BLOCK  Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 3 (EP191): https://podcasts.apple.com/us/podcast/191-labor-management-is-no-longer-invisible/id1624182351?i=1000775009191

  8. Jul 1

    #191 Labor Management Is No Longer Invisible

    Send us Fan Mail Under the global model, labor management was absorbed into the delivery code. Two hours or twenty-two, same payment. Starting January 1, 2027, the AMA introduces 59080 through 59083, the first dedicated labor management codes in CPT history. The work was always there. Now it gets paid. Dr. Heather Signorelli and Amy Hicks, CPC, COBGC, our AVP of Operations, walk through the codes, the documentation, the corrected delivery code framing, the midnight-spanning labor rule, the multi-provider attribution problem, and the three actions every OB practice should take this quarter.  Why labor management was invisible:  Under the global model, the cognitive work of managing labor was absorbed into the delivery code. Practices managing complicated labors (preeclampsia, GDM, category two tracings) have been subsidizing simple deliveries for decades.  The four new labor management codes:  59080 (initial day, straightforward) · 59081 (initial day, complex) · 59082 (subsequent day, straightforward) · 59083 (subsequent day, complex). Codes bill per calendar date. One code per date per patient.  Straightforward vs complex: the six-criteria test:  All six straightforward criteria must be met: singleton vertex, routine monitoring, no FHR intervention required on that date, normal progression or routine induction without complication, stable medical conditions, no prior cesarean. Any one criterion not met means the labor is complex. Duration of labor alone is NOT complexity unless prolonged labor is formally diagnosed.  What the complex note has to say:  Explicitly name the complicating condition. Not just “patient has GDM,” but what about the GDM you managed today. Document MDM across multiple data sources, labs reviewed, monitoring strip interpreted, imaging assessed. Document additional monitoring or intervention beyond standard, what you did and why. Document multi-provider coordination if applicable that date. For 59083 (subsequent day complex), complexity must be re-established for EACH subsequent day. A single admission note does not carry forward.  Delivery codes (corrected framing):  The 2027 delivery codes separate vaginal from cesarean, not vaginal from operative. 59431 (vaginal, no prior cesarean) · 59432 (VBAC vaginal) · 59502 (primary cesarean) · 59503 (repeat cesarean). Vacuum and forceps are separately billable add-on procedures. Included in the delivery code: placenta, first and second degree laceration repair, same-day postpartum care. Separately billable add-ons: 59433 (third degree lac), 59434 (fourth degree lac), 59623 (uterine tamponade, new 2027 code), 59504 (hysterectomy with cesarean).  Midnight-spanning labor (correcting the record):  A continuous labor encounter spanning midnight is reported as ONE labor management service on ONE of the two calendar dates. The practice decides which date. Inpatient E/M codes (99221 through 99236) do NOT stack with labor management codes. They replace each other. Inpatient E/M applies before labor begins. Once active labor management starts, switch to 59080 through 59083.  Multi-provider attribution:  Each provider bills the service they personally performed. The labor management code goes to the provider who managed labor on that calendar date. The delivery code goes to the provider who delivered. If the delivering provider also managed labor on the delivery date, they can bill both. Two failure modes: the miss (no one drops the charge), and the double-bill (both providers drop the same charge). The solution is a daily reconciliation, not monthly.  Three actions this quarter:  Map your call and cross-coverage. Find where charges go unbilled today and where two providers could overlap. Build a daily L and D reconciliation process. Assign ownership. Reconcile before shift end, not at month end. Update EHR labor management templates to prompt for the six criteria, complicating conditions, MDM elements, and same-day decisions.  RESOURCES BLOCK  Save your seat: Live OB/GYN Global Codes Update Webinar (July 7, 2026, 4:00 PM ET) · eligibility.natrevmd.com/obgyn-global-updates-webinar Book a 1:1 with Dr. Signorelli · calendly.com/heather-natrevmd/ Practice Revenue Leak Scorecard · eligibility.natrevmd.com/nrm-revenue-scorecard-v3 Payment Posting Audit Checklist · eligibility.natrevmd.com/payment-posting-checklist RECOVER Diagnostic Quiz · natrevmd.com/quiz Series Part 2 (EP190): https://podcasts.apple.com/us/podcast/190-every-prenatal-visit-is-now-a-billable-event/id1624182351?i=1000774328121

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About

Medical billing tips for healthcare professionals — by healthcare professionals.  This podcast is here to help private practices get paid what they’ve earned. We share real-world strategies for accurate coding, smoother billing workflows, and fewer denials — all from a team that’s been in your shoes. Whether you’re just getting started or trying to tighten up your revenue cycle, you’ll get practical advice you can actually use. Join the conversation in our Facebook Group: NatRevMDLearn more at www.natrevmd.com

Information

  • Creator
    NatRevMD
  • Years Active
    2022 - 2026
  • Episodes
    199
  • Rating
    Clean
  • Copyright
    © 2026 NatRevMD
  • Show Website
    NatRevMD

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