Zotec Answers - A Healthcare Podcast

Zotec Partners
  • 5.0 (3)
  • Management

If you have complex questions about your healthcare business, Zotec has answers. In this podcast series, experts at Zotec answer key questions around healthcare revenue cycle management, patient experience, business strategy, financial advice, and more. Tune in today to get the answers you seek.

  1. Aug 12

    What is really happening with the No Surprises Act and who is 'gaming' who?

    Take Action Now Contact your lawmakers today to support the No Surprises Act Enforcement Act (H.R. 4710/S. 2420). On the go? Simply text ZPNSA to 50457.   The No Surprises Act (NSA) was designed around two important goals: protecting patients from surprise medical bills and establishing a fair process for physicians and insurers to resolve out-of-network payment disputes. But as use of the Independent Dispute Resolution (IDR) process has grown, so has the debate over why physicians are filing disputes and winning so many of them. In this episode of Zotec Answers, Ed Gaines, Vice President of Regulatory Affairs and Industry Liaison at Zotec Partners, is joined by Dave Walker, Chief Revenue Officer of Radiology Associates of North Texas (RANT), one of the nation’s largest independent radiology practices and a longtime Zotec client. Together, they take a closer look at claims that physicians are “gaming” the No Surprises Act IDR process and ask a more fundamental question: Is the process functioning the way Congress intended? In this episode, you'll learn: Why physician groups are increasingly turning to the No Surprises Act IDR process How insurer initial payments can contribute to payment disputes reaching arbitration What happens after a physician submits a claim and where the process can begin to break down Why high physician success rates in IDR do not necessarily mean physicians are “gaming” the system What physician arbitration wins may reveal about insurers’ initial payment amounts Why winning a legally binding IDR decision does not necessarily mean a physician practice has received payment How delayed or unpaid arbitration awards can affect independent physician practices Whether stronger enforcement and compliance could reduce the need for IDR disputes Why patient protections and fair physician reimbursement are complementary goals What a more transparent, balanced, and effective No Surprises Act process could look like A closer look at IDR payment challenges One of the most striking examples discussed in the episode comes from RANT. The practice has reportedly won nearly $5 million in arbitration awards while receiving only about $1 million, highlighting an important distinction in the No Surprises Act debate: winning an IDR dispute and actually receiving payment are not necessarily the same thing. The episode examines whether better compliance with arbitration decisions, more accurate initial insurer payments, and stronger enforcement of existing requirements could help the IDR process function more effectively while preserving the patient protections at the heart of the No Surprises Act.

    What is really happening with the No Surprises Act and who is 'gaming' who?

  2. Aug 6

    What's in the 2027 Medicare Physician Fee Schedule Proposed Rule, and why should physicians care?

    Take action Congress is considering H.R. 8163, the Provider Reimbursement Stability Act, a long-term solution aimed at addressing ongoing Medicare physician payment instability. Physicians and stakeholders can make their voices heard by participating in advocacy efforts referenced in this episode by clicking here or by texting ZPPAY to 50457.   The Centers for Medicare & Medicaid Services (CMS) has released the 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule, introducing significant payment and policy changes that could impact physician reimbursement, practice operations, and patient access beginning January 1, 2027. In this episode of Zotec Answers, Mark Isenberg, Executive Vice President of Healthcare Advocacy, and Ed Gaines, Vice President of Regulatory Affairs and Industry Liaison, explain what healthcare organizations need to know before the rule is finalized. In this episode, you'll learn: Why CMS is proposing another reduction to physician reimbursement How payment updates differ for APM participants versus MIPS participants Which physician specialties could experience the greatest financial impact Why the proposed Evaluation & Management (E/M) payment changes are generating concern New opportunities to support primary care and coordinated, longitudinal care What CMS's Requests for Information (RFIs) reveal about the future of Medicare payment policy Why physician advocacy during the public comment period can influence the final rule Key dates July 14, 2026: CMS released the proposed rule September 14, 2026: Public comment period closes Early to mid-November 2026: Final rule expected January 1, 2027: Expected effective date

    What's in the 2027 Medicare Physician Fee Schedule Proposed Rule, and why should physicians care?

  3. Jul 22

    How are federal and state AI policies shaping healthcare?

    This episode of Zotec Answers explores the evolving landscape of artificial intelligence (AI) policy and its implications for healthcare. The discussion centers on how AI governance is shifting from creating policies to implementing them, while individual states continue introducing their own AI regulations, creating both opportunities and challenges for healthcare organizations.

    How are federal and state AI policies shaping healthcare?

  4. Jul 9

    What were the key takeaways from the recent EDPMA Leadership Hill Day?

    This episode recaps EDPMA's recent Day on Capitol Hill, where emergency medicine leaders met with members of Congress to advocate for policies that strengthen physician reimbursement and protect patient access to emergency care. Ed Gaines shares the organization's top legislative priorities, explains the value of building relationships with lawmakers, and highlights how data, including contributions from Zotec, is playing an increasingly important role in supporting advocacy efforts and influencing healthcare policy.

    What were the key takeaways from the recent EDPMA Leadership Hill Day?

  5. Jun 30

    As AI becomes more integrated into healthcare, what outcomes should matter most?

    In this episode of Zotec Answers, Jennifer Fox and Megan Applegarth explore how AI is reshaping healthcare and why the conversation is shifting from what AI can do to the outcomes it produces. From growing regulatory scrutiny of AI companies to the impact of AI on healthcare spending, documentation, reimbursement, and accountability, they discuss what healthcare leaders, physicians, and policymakers need to consider as AI adoption accelerates.

    As AI becomes more integrated into healthcare, what outcomes should matter most?

  6. Jun 16

    What current legislation could potentially impact the Medicare Physician Fee Schedule?

    Take Action Today! On the go? Simply text ZPPAY to 50457 to take action.

    What current legislation could potentially impact the Medicare Physician Fee Schedule?

  7. Jun 2

    What are the biggest impacts of the NSA IDR Final Rule?

    Take Action Today!

    What are the biggest impacts of the NSA IDR Final Rule?

  8. May 29

    As AI expands access to health data, who's responsible for protecting it?

    In this episode of Zotec Answers, Jennifer Fox and Megan Applegarth explore how AI, health data privacy, and healthcare regulation are colliding as patient information moves beyond traditional healthcare settings. From HIPAA and evolving state AI laws to growing concerns around transparency, accountability, and patient data protection, they break down what healthcare leaders, physicians, and policymakers need to understand as AI impacts the future of healthcare.

    As AI expands access to health data, who's responsible for protecting it?
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If you have complex questions about your healthcare business, Zotec has answers. In this podcast series, experts at Zotec answer key questions around healthcare revenue cycle management, patient experience, business strategy, financial advice, and more. Tune in today to get the answers you seek.

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