Practice Perfect

Jennifer McNamara
  • 5,0 (1)
  • ADMINISTRAÇÃO
  • SEMANAL

"Practice Perfect" focuses on achieving excellence in healthcare practices by addressing key aspects such as compliance, documentation, billing, coding, and revenue cycle management. It emphasizes practical strategies, attention to detail, and continuous improvement to optimize efficiency and ensure success in medical practices. This concept encourages learning, adaptability, and adherence to industry standards to maintain top-tier performance.

  1. HÁ 1 DIA · BÔNUS

    Bonus - September 2025 Mashup

    This special bonus episode pulls together some of the most valuable conversations and updates across coding, compliance, and healthcare operations. We dig into the everyday realities of being a coder and how much more it takes than just knowing the rules. You’ll hear a fresh perspective from Cameron Lewellen, plus a big announcement from Turner Consulting that impacts how practices can get the support they need. We also shine a light on compliance in behavioral health—a space where regulations are constantly evolving and documentation is critical. From there, we unpack the gray areas of “medical necessity,” why payers care, and how providers can protect themselves. And because no coding mashup is complete without it, we close with a look at new codes you should have on your radar to stay ahead of payer changes. This episode is a quick hit of education, industry updates, and inspiration—perfect for coders, consultants, and practice leaders who want to stay sharp without spending hours in the weeds.

    29min

  2. 7 DE SET.

    Episode 21 - Payer games we're still paying in 2025

    In this episode, we dive into the power of communication and how it shapes everything from workplace culture to payer negotiations. We start by unpacking why communication is key—not just in theory, but in the day-to-day challenges of healthcare teams. You’ll hear real stories that bring these points to life, showing how small details can make a big difference. From there, we turn to the payer games that practices are still stuck playing—denials, delays, and shifting rules—and talk about strategies to level the playing field. More stories and lessons keep it real and relatable, before wrapping up with takeaways you can apply right away. This episode blends storytelling, real-world payer frustrations, and practical insight, making it perfect for anyone trying to navigate the realities of healthcare operations and coding.

    30min

  3. 25 DE AGO.

    “But That’s How We’ve Always Done It”: Dangerous Words in Compliance

    In this episode of the Practice Perfect Podcast, Jennifer McNamara and Maya Turner tackle one of the most dangerous phrases in healthcare operations: “But that’s how we’ve always done it.” From ophthalmology documentation pitfalls to outdated CPT codes, and from billing inefficiencies to ignored payer contracts, Jennifer and Maya shine a light on the risks of clinging to old habits. Along the way, they weave in stories from real-world compliance challenges, including patient safety, revenue loss, and the dangers of relying on AI tools without human oversight. This candid discussion highlights why every compliance and revenue cycle professional should question “the way it’s always been done” and instead build a culture of accountability, adaptability, and continuous improvement. Why tradition in compliance and coding often creates risk rather than safety A real-world case where poor documentation and unchecked templates led to denied claims and even patient harm How outdated CPT codes and robotic billing processes drain revenue silently over years Why documentation is the backbone of both compliance and AI effectiveness Contract review essentials—why rates, payer requirements, and responsibilities can’t be ignored How common “we’ve always done it” attitudes in billing, collections, and claims management create avoidable losses 🚫 The ophthalmology case that exposed the danger of “unspecified” documentation 💸 Outdated CPT codes still being billed years later—and the thousands lost 🤖 The limits of AI in coding: garbage in, garbage out 📄 The compliance risks buried in payer contracts not reviewed for 8+ years 🧾 Copay and deductible collection myths that delay payment unnecessarily Jennifer’s Substack – Insights on payer contracts, compliance, and healthcare operations AMA CPT® Code Book – the official “source of truth” for coding CMS Medicare Coverage Database – LCDs, NCDs, and coverage policies McVey Seminars – National healthcare training programs (Jennifer presents quarterly ENT updates) Healthcare Inspired – Learn more about our services in coding, compliance, and practice efficiency 👉 Coming soon: a special episode on the Medicare Physician Fee Schedule Proposed Rule for 2026 (dropping Monday the 18th). Don’t miss it!

    28min

  4. 21 DE AGO. · BÔNUS

    2026 MPFS Proposed Rule – What It Really Means for Your Practice

    The 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule is here — and it’s packed with changes that will impact providers, coders, billers, and compliance teams across the country. In this special episode, Jennifer McNamara and Maya Turner break down the proposal, cut through the legal language, and highlight exactly what practices need to know to stay ahead. From reimbursement shifts to compliance updates, this episode goes beyond the surface to answer the real question: What does this mean for your practice, your patients, and your bottom line? Key highlights from the 2026 MPFS Proposed Rule How reimbursement changes could affect different specialties Compliance implications you can’t afford to overlook The role of documentation and medical necessity in the new environment Action steps for practices to prepare before the rule is finalized Medicare rules don’t just affect Medicare patients — they set the tone for payers across the board. Ignoring the proposed rule until it becomes final can leave your practice scrambling. Jennifer and Maya explain what to watch now, how to get your voice heard during the comment period, and what proactive steps can protect your revenue and compliance moving into 2026. CMS Medicare Physician Fee Schedule Proposed Rule Healthcare Inspired – Learn more about coding, compliance, and practice efficiency services Jennifer’s Substack – Articles and insights on compliance and payer policy AMA CPT® Code Book – Official source of truth for CPT coding 👉 Don’t miss this breakdown of the MPFS Proposed Rule 2026 — because knowing what’s coming is the first step to protecting your practice.

    31min

  5. 13 DE AGO.

    Seasonal Slowdown or Silent Revenue Leak?

    Seasonal Slowdown or Silent Revenue Leak? Every practice expects a dip in revenue during certain times of the year—but what if it’s not seasonal at all? In this episode, Jennifer McNamara and Maya Turner dive into how to tell the difference between predictable slowdowns and silent revenue leaks that quietly drain your bottom line. They’ll explore how patterns in claims, scheduling, and payer response times can either confirm seasonal trends or expose deeper operational issues. From front desk to back office, you’ll hear practical strategies from two industry pros to keep revenue steady year-round. Spotting the difference between natural seasonal fluctuations and revenue leaks Key data metrics to track during slow periods How to pinpoint operational bottlenecks that impact cash flow Ways to keep your revenue cycle healthy even during patient volume dips Why payer behavior might be a bigger factor than you think When every dip in revenue gets chalked up to “seasonality,” practices risk ignoring the underlying issues that could be costing thousands—sometimes for years. By understanding your patterns and knowing what to look for, you can prevent these leaks before they become permanent losses. Learn more about Healthcare Inspired’s auditing and business intelligence services: healthcareinspiredllc.com Follow Jennifer McNamara on LinkedIn: Jennifer McNamara Follow Maya Turner on LinkedIn: Maya Turner Book a complimentary billing and coding assessment Episode Summary - 00:00 - Intros 04:15 - Revenue Leaks - Is Vacation the culprit? 10:53 - What is the solution? 14:28 - Another Critical Element 21:30 - The Hard Truth 26:21 - Wrapping up

    30min

  6. 23 DE JUL.

    Rejections vs. Denials: Know the Difference, Fix the Problem

    This episode dives deep into the confusion many practices face when it comes to rejections vs. denials. Jennifer and Maya welcome back Cameron Lewellen to talk about how AI and automation can transform how practices handle claim issues, boost efficiency, and get paid faster. From hilarious personal stories to hard-hitting truths about insurance delays, this episode is packed with real talk and practical insights. The difference between a rejection and a denial Rejections never make it through the system. Denials are processed and then kicked back due to payer rules or errors. Why automation matters AI (like Athelas) can prevent delays by correcting errors before submission, automatically resubmitting denials, and eliminating lag time. The power of site-specific vs. global rules Cameron explains how custom rulesets based on payer and specialty drastically reduce denials. Real-world examples Including one from an autism center battling denials from unlisted codes—and how automation fixed it. Domain-trained AI in action Think: bots that sit on hold with payers so your staff doesn’t have to. Yes, really. Underpayments and the dollars you're leaving on the table AI can track every claim and compare it to your fee schedule to recover revenue you didn’t even know was missing. The burnout problem We talk about billers working weekends, late nights, and how automation can protect your team’s well-being. “AI works on Saturdays.” – Cameron Lewellen “You earned every dollar. AI helps you collect it.” – Jennifer McNamara “Appeal letters should be short and to the point. If it’s two pages long, no one’s reading it.” – Maya Turner Clearing up common misconceptions about rejections vs. denials How AI augments—not replaces—your revenue cycle team Using data to identify patterns and prevent denials UI/UX in RCM software: why it matters Operational tips for using automation to protect your AR Benchmarking payer behavior and setting smarter expectations Athelas – Learn more about their AI-driven RCM platform Bone & Joint Summit – Join us July 17–18 to meet the Athelas team in person Contact Cameron Lewellen for your free financial health analysis

    45min

  7. 23 DE JUL.

    Copy, Paste, Repeat: The Hidden Risks of EMR Documentation

    Copy-paste documentation: it seems harmless, but it’s costing healthcare practices more than they realize. In this episode, Jennifer and Maya unpack the real risks behind cloned EMR notes—from audit red flags to compliance violations. We’re talking: – What copy/paste looks like in provider notes – Why it's a major liability in audits – How coders, auditors, and providers can clean it up – Tips for starting the conversation with your team – Real-world examples that prove shortcuts aren't worth it 🎧 Listen in to protect your documentation—and your bottom line. 📌 Need support with EMR audits or education? Email Info@healthcareinspiredllc.com

    31min

  8. 23 DE JUL.

    Compliance for Behavioral Health

    In this insightful episode, we dive into one of the most commonly overlooked areas in healthcare compliance—behavioral health. Sonal Patel joins Jennifer McNamara and Maya Turner to discuss why behavioral health compliance deserves more attention, especially as demand for services grows. From documentation pitfalls to the nuances of medical necessity, we highlight key risks that can lead to denials, audits, and even enforcement action if ignored. What You'll Learn: Why behavioral health is a high-risk area for compliance breaches The unique challenges providers face in documenting time-based services Medical necessity requirements that often go unmet Telehealth-specific compliance issues in behavioral care How compliance audits can proactively reduce risks Steps providers can take now to strengthen behavioral health compliance Hot Topics Covered: Time-based E/M codes and psychotherapy documentation CMS expectations for medical necessity Common audit triggers in behavioral health Modifiers and telehealth policies under scrutiny Real-world compliance examples and red flags Takeaway Message:Behavioral health is not immune from audits or enforcement. As the industry grows, so does regulatory scrutiny. Providers need proactive education and tools to remain compliant and protect their practices. Resources Mentioned: CMS Behavioral Health Guidance OIG Compliance Recommendations Telehealth Modifier Guidance

    39min
Ver tudo (22)

Sobre

"Practice Perfect" focuses on achieving excellence in healthcare practices by addressing key aspects such as compliance, documentation, billing, coding, and revenue cycle management. It emphasizes practical strategies, attention to detail, and continuous improvement to optimize efficiency and ensure success in medical practices. This concept encourages learning, adaptability, and adherence to industry standards to maintain top-tier performance.

Informações

  • Criado por
    Jennifer McNamara
  • Anos de atividade
    2 mil
  • Episódios
    22
  • Classificação
    Livre
  • Copyright
    © Jennifer McNamara
  • Site do podcast
    Practice Perfect

Você também pode gostar de