The Claim Game

Jeremy and Kathryn Zug
  • 5.0 (2)
  • Management
  • Updated Weekly

The Claim Game podcast, hosted by Jeremy and Kathryn Zug, is designed to help healthcare providers navigate the complexities of revenue cycle management (RCM). Each episode aims to cut through confusion by breaking down complex billing processes and sharing real-world solutions. The podcast uses a "game board" metaphor to simplify the RCM landscape, offering strategies and practical tips to help practices "win" at revenue cycle management. Jeremy and Kathryn draw on their extensive experience to empower providers to take control of their revenue, turning claim denials into deposits and allowing them to focus more on patient care. The podcast covers key territories of billing, such as credentialing, patient registration, eligibility & benefits, payment posting, aging follow-up, and claim submission, with the ultimate goal of providing clarity in a confusing, frustrating, and outdated industry. jeremyzug.substack.com

  1. 4d ago

    The AI Social Worker: Marina Badillo-Diaz on AI, Ethics & Mental Health

    EPISODE SUMMARYIn this episode of The Claim Game, Jeremy Zug sits down with Dr. Marina Badillo-Diaz, LCSW, founder of The AI Social Worker, to explore how artificial intelligence is transforming mental health and human services. Dr. Badillo-Diaz shares practical guidance on using AI ethically, protecting client privacy, and maintaining clinical judgment while embracing new technology. Together, they discuss AI documentation tools, HIPAA compliance, AI companions, and how therapists can confidently integrate AI into their practice without losing the human connection. TAKEAWAYSAI Should Support, Not Replace, Clinicians: Dr. Badillo-Diaz's "Co-Star" framework emphasizes that providers must review, edit, and guide AI outputs to preserve clinical judgment. Always Verify AI Documentation: AI scribes can save significant time, but every note should be carefully reviewed before becoming part of the client's record. Know the Risks of AI Companions: AI can improve administrative workflows, but relying on AI for emotional support raises important ethical concerns, especially for younger users. Use AI Transparently: The AI Assessment Scale encourages thoughtful, transparent AI use while recognizing when human expertise is essential. Choose Secure AI Tools: Paid, HIPAA-compliant platforms with Business Associate Agreements (BAAs) provide stronger privacy protections than free consumer AI tools. CHAPTERS00:00 Dr. Marina Badillo-Diaz's Background and Journey 10:38 Using AI in Therapy Without Losing the Human Touch 13:03 Beyond ChatGPT: Smarter Ways to Use AI 19:54 Choosing the Right AI Tool for the Job 27:11 The Risks of AI Becoming a Companion 39:09 Why AI Needs Human Oversight 40:50 Helping Therapists Embrace AI 46:43 Connect With Dr. Marina Badillo-Diaz RESOURCESToday Sponsors: Visit practicesol.com Learn more About The AI Social Worker: Visit theaisocialworker.com  Connect with Dr. Marina on LinkedIn Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

  2. Jul 17

    How to Sell a Therapy Practice: Dan King on Valuation, M&A & Private Equity

    EPISODE SUMMARYIn this episode of The Claim Game, Jeremy Zug sits down with Daniel King of Fireside Strategic to explore the realities of healthcare mergers and acquisitions (M&A). Together, they discuss what makes a practice attractive to buyers, how valuations are really determined, and why factors like payer diversification, clinician retention, and operational readiness can significantly impact practice value. They also examine how AI is reducing administrative burden and helping practice owners build stronger, more sustainable businesses. TAKEAWAYSPractice Value Is About More Than EBITDA: Strong valuations come from reducing risk, maintaining healthy operations, and building a sustainable business—not chasing industry myths. Diversify Your Payer Mix: Heavy reliance on one insurance payer increases financial risk and can reduce your practice's appeal to potential buyers. Retention Drives Long-Term Value: Keeping clinicians engaged strengthens culture, improves patient continuity, and creates a more valuable organization. Prepare for Due Diligence: Buyers closely examine compliance, operations, and financial processes. Addressing issues early can protect your practice's value. Use AI to Reduce Burnout: AI is most effective when it supports clinicians by automating administrative work, allowing them to spend more time with patients. KEYWORDSPrivate Practice, Revenue Cycle Management, Practice Growth, Healthcare Business, Mental Health Billing, Medical Billing, Practice Valuation, Healthcare AI, Clinician Retention, Cash Flow CHAPTERS00:00 Welcoming Back Dan King 08:47 What Is Your Practice Really Worth? 12:03 What Investors Look for Before Buying a Practice 23:21 How Due Diligence Impacts Practice Value 29:25 Why AI Matters in Practice Growth 35:02 Conclusion: Buy, Sell & Grow with Confidence RESOURCESToday Sponsors: Visit practicesol.com Learn More About Fireside Strategic: Visit firesidestrategic.com Learn More About Your Group Practice Podcast: Visit yourgrouppractice.com Learn More About The Claim Game: Visit practicesol.com/podcast Email Dan: dan@firesidestrategic.com The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

  3. Jul 10

    Danny Freed on How Blueprint Is Reinventing the Mental Health EHR with AI

    EPISODE SUMMARYIn this episode of The Claim Game, Jeremy Zug sits down with Danny Freed, founder and CEO of Blueprint, to discuss how AI is transforming mental health practice management. Danny shares the personal journey that led him to healthcare, why Blueprint reimagined the traditional EHR model, and how AI is helping therapists spend less time on documentation and more time with clients. From automated billing workflows to real-time insurance eligibility and payer rate transparency, this conversation explores the future of efficient, therapist-first technology. TAKEAWAYSRethinking the Traditional EHR: Blueprint's approach is simple: the core EHR should be free, and providers should only pay for AI tools that save meaningful time. From Session to Submitted Claim in Minutes: Integrated AI can automate documentation, treatment plans, claim submission, and invoicing in just a few clicks. Clinical-Grade AI Matters: Effective healthcare AI relies on secure clinical data and context—not generic chatbot responses—to support therapists safely and accurately. Simplifying Insurance Eligibility: AI can translate complex eligibility data into clear, real-time coverage and out-of-pocket cost information for providers and clients. Bringing Transparency to Payer Rates: Benchmarking tools help therapists better understand market reimbursement rates and negotiate stronger insurance contracts. CHAPTERS00:00 Introduction: From a Personal Mission to a Full-Stack EHR 06:10 Building Around Therapists, Not Software Limitations 10:31 AI, Automation, and the Future of Therapy Billing 20:15 Clinical-Grade AI: Beyond Generic Chatbots 29:04 How Therapists Can Stop Accepting Below-Market Rates 32:12 Keeping Therapists at the Center of AI 37:52 Personalization at Scale: Training the AI Assistant 41:51 Conclusion: Better Tools, Better Care, Better Outcomes RESOURCESToday Sponsors: Visit practicesol.com Learn more About Blueprint: Visit blueprint.ai  Connect with Danny on LinkedIn Email Danny: danny@blueprint.ai Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

  4. Jul 8

    Practice Audit: Danielle Hayes on Building a 150-Clinician Cash-Pay Therapy Practice

    EPISODE SUMMARYIn this episode of The Claim Game, Jeremy Zug sits down with Danielle Hayes, founder of Therapy Austin, to explore how she grew a cash-pay therapy practice from three clinicians to more than 140 providers across multiple locations. Danielle shares the leadership strategies, hiring philosophies, and operational systems that supported sustainable growth, along with lessons on clinician development, practice culture, and selling a successful therapy business. Whether you're building your first team or planning your long-term exit strategy, this episode is full of practical insights for practice owners. KEYWORDSGroup Therapy Practice, Therapy Austin, Private Practice Growth, Practice Leadership, Selling a Therapy Practice, Behavioral Health Business, Practice Operations, Private Practice Coaching, Healthcare Entrepreneurship TAKEAWAYSInvest in Clinician Development: Strong onboarding, mentorship, and leadership opportunities help clinicians grow while improving retention and practice stability. Culture Is Your Competitive Advantage: Shared values and a supportive environment create consistency, strengthen teams, and drive long-term growth. Hire for Character: Skills can be taught, but curiosity, accountability, and values alignment are essential for building a successful team. Growth Requires Systems: Scaling a practice means shifting from founder-driven relationships to structured processes, leadership, and operational excellence. Selling Takes Preparation: Successful practice sales require realistic expectations, careful planning, and finding a buyer who shares your vision. Patience Wins: Sustainable growth comes from focusing on quality, consistency, and long-term goals—not chasing every new opportunity. Build Strong Referral Networks: Trusted advisors and industry relationships provide valuable guidance as your practice grows. CHAPTERS00:00 Introduction: From Solo Practice to a Mentorship-Driven Team 06:11 The Therapist Growth Mindset: Investing in Your Craft 14:33 The Shift from Relationships to Systems 17:26 Hiring for Character, Training for Skill 28:22 When It Was Time to Sell 33:17 Selling a Practice: More Than Just the Numbers 38:55 Conclusion: Patience Is the Ultimate Growth Strategy RESOURCESToday Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO Email Danielle at danielle@hayestherapy.net  Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

  5. Jul 8

    Practice Audit: Building a Multi-Location Therapy Practice with Shannon Hiser

    EPISODE SUMMARYIn this episode of The Claim Game, Jeremy Zug sits down with Shannon Hiser, founder of The Wellness Counseling Center LLC, to discuss the realities of scaling a multi-location therapy practice. Shannon shares the administrative and compliance challenges that tested her business—from staffing turnover and insurance audits to billing setbacks—and how she built a reliable in-house billing system with the help of Practice Solutions. Together, they explore practice growth, leadership, AI in healthcare, and creating a business that aligns with your values. KEYWORDSRevenue Cycle Management, Private Practice Scaling, Insurance Audits, W2 Therapists, 1099 Therapists, Supervisory Billing, In-House Billing, Practice Management Software, Value-Based Business TAKEAWAYS1099 vs. W2 Matters: Understanding worker classification is essential when clinicians bill under your Tax ID. Misclassification can lead to costly audits and compliance issues. Verify Insurance Policies in Writing: Don't rely on verbal guidance from payer representatives. Always confirm billing rules through contracts and provider manuals. Build a Business That Doesn't Depend on You: Sustainable growth requires systems and infrastructure—not an owner carrying an unsustainable caseload. Use AI Thoughtfully: AI can reduce administrative burden through documentation and billing support, giving providers more time to focus on patient care. Lead with Your Values: When challenges arise, solve problems one step at a time while keeping your practice aligned with your mission and long-term goals. CHAPTERS00:00 Introduction to Shannon Hiser and The Wellness Center 12:27 Navigating Administrative Storms and Compliance Challenges 26:58 From Founder-Dependent to Future-Ready 29:50 The AI Dilemma: Efficiency vs. Ethics 34:57 Growing the Team Without Compromising the Mission 37:14 Conclusion: Lead with Values, Not Just Goals RESOURCESToday Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO Learn More About The Wellness Counseling Center Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

  6. Jul 8

    How to Fix Insurance Claim Rejections in Private Practice

    EPISODE SUMMARYIn this solo episode of The Claim Game, Jeremy Zug breaks down one of the most common—and most fixable—revenue cycle challenges: claim rejections. Learn the difference between rejections and denials, why small technical errors delay payment, and how to identify the issues preventing your claims from reaching the payer. From EDI enrollment problems and provider directory mismatches to telehealth modifiers and payer ID mix-ups, Jeremy shares practical strategies to help you resolve rejections faster and improve cash flow. KEYWORDSPrivate Practice, Revenue Cycle Management, Claim Rejections, Medical Billing, Insurance Billing, Mental Health Billing, Cash Flow, EDI Enrollment, Credentialing, Practice Growth TAKEAWAYSRejections vs. Denials: Rejections are "soft failures" caught by the clearinghouse before a claim reaches the payer. Denials occur after the payer processes the claim and refuses payment. Rejections Are Data, Not Disaster: Rejections aren't personal—they're technical alerts pointing to errors that can often be corrected and resubmitted quickly. Your Digital Footprint Matters: Mismatches between your NPI, taxonomy, tax ID, or address and the payer's records can trigger preventable rejections. Billing Requires Precision: Missing or incorrect modifiers, place of service codes, and EDI enrollment details can cause claims to bounce before they're processed. Avoid the Sister Company Trap: Always verify the exact payer ID on the patient's insurance card. Similar company names don't always route claims to the correct payer. CHAPTERS00:00 Introduction: Claim Rejections—The Simplest Problem to Solve 02:12 Common Rejections and How to Fix Them 09:10 Small Errors, Big Rejections 11:46 Payer IDs, Prior Auths, and Preventable Delays 13:13 When Diagnosis Codes Trigger Rejections 13:59 Conclusion: Turning Rejections Into Solutions RESOURCESToday Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance. Images: Rejection Resolution Guide

  7. Jun 12

    How to Submit Clean Insurance Claims for Private Practices

    EPISODE SUMMARY In this episode of The Claim Game, we’re moving to the front lines of your Revenue Cycle Management (RCM). Most practices focus on the back end—chasing late, old money. But the true masters of the game focus on the front end. They make sure a claim is perfect and pristine so insurance companies have no choice but to pay them immediately. We call this mastering the first-pass strategy, and today, we're breaking down the exact checklist you need to achieve a high first-pass rate. KEYWORDS Revenue Cycle Management, Private Practice, Medical Billing, Claim Denials, First Pass Rate, Insurance Billing, Practice Management, CPT Codes, Credentialing TAKEAWAYS Billing Starts at the Front Desk: Most people think billing begins when you hit "submit" in your EHR, but that's actually the final move. Winning the game requires pristine setup, and patient registration is the most critical step in the entire cycle. Most denials are actually "intake diseases" that start before the client even sees a provider. The One-Payer Filter Rule: Never allow your biller (or yourself) to bounce randomly from one insurance company to another. Every payer has its own personality, portal, and specific rules. Work in batches—filter by one payer, complete all their reviews, and stay in that flow to prevent simple errors from mutating into thousands of dollars in delayed revenue. Insurance Companies Don't Do Nicknames: If a card says "Robert," do not type "Bob" into your EHR. Payers are incredibly picky eaters; if the first name, last name, middle initial, date of birth, biological sex, or address doesn't perfectly match their system, they will reject it outright. The Anatomy of the Infrastructure: A single missing digit in an insurance ID or group number is a 100% guarantee of a rejection. Treat these numbers like keys to the insurance company's bank vault. Additionally, you must verify the exact Payer ID and insurance type (checking the private box for a Medicare claim makes it dead on arrival). Clinical Logic vs. Billing Logic: You have to weed your revenue garden by reviewing CPT codes and modifiers. A missing modifier is like forgetting to put a stamp on an envelope—everything inside might be correct, but it isn’t going anywhere. Check your contracted rates relative to your charged rates so you stop leaving money on the table. When to Submit a Test Claim: If you have a newly credentialed provider onboarding clients, do not blindly submit a batch of 50 claims at once. If there is a small typo or credentialing misalignment on the insurance side, you’ll end up with 50 headaches. Submit a single test claim first to verify their NPI and tax ID details are clean. CHAPTERS 00:00 Introduction: The Clinical Mindset vs. The Business Reality 03:50 The One-Payer Workflow Strategy 07:28 The Intake Checklist That Prevents Denials 12:16 The Clinical & Financial Claim Audit 16:30 The Final Review Before Submission 19:04 Conclusion: The Details Drive the Revenue RESOURCES Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance. Images: Claim Information Review Guide, Modifier Usage Guide Get full access to The Claim Game at jeremyzug.substack.com/subscribe

  8. Jun 5

    Practice Audit: How Nicole Brewer Built a High-Performing Insurance-Based Group Practice

    EPISODE SUMMARY In this episode of The Claim Game, Jeremy sits down with Nicole Brewer, owner of reTHINK Your Practice and reTHINK Therapy in Henderson, Nevada. Celebrating a massive 10-year milestone this year, Nicole has managed to scale an insurance-based group practice to 23 therapists while keeping her sanity intact. Even better? Nicole officially holds the highest score out of all the practice audit episodes recorded to date! Jeremy and Nicole look under the hood of her exceptionally high-scoring practice. They break down how a robust task management system eliminates mental fatigue , the rigorous boundaries required to manage 5 to 10 insurance panels , and the reality of the "$200,000 mistake" when navigating rate negotiations. If you want to know what it actually takes to scale ethically, remain stickler-compliant, and defend your revenue, this episode is your masterclass. KEYWORDS Private Practice, Revenue Cycle Management, Insurance Billing, Group Practice, Practice Growth, Credentialing, Claim Denials, Healthcare Business, Cash Flow, Asana TAKEAWAYS The Two Pillars of Billing Success: Eliminate the mental energy of tracking "what comes next". Use a task management system (like Asana) to build out workflows for AR and follow-ups , and ensure that whoever oversees your billing deeply understands how the mechanics work. Clean Data Front-Loading: To prevent "oopsie daisy" claim errors, implement a culture where client paperwork must be 100% completed before they can ever touch the calendar. This ensures both the intake team and the client know exactly what the copay and deductible expectations are upfront. The "Seasoning" of a Clinician: Expect a timeline. While you can take a graduate to fully licensed in two years, true "seasoning" and expert specialty focus typically takes an additional three years post-licensure. The Math on Dropping a Payer: High-endurance for insurance headaches isn't always a badge of honor. If a specific payer introduces a 10% denial or re-work rate, calculate the practice expense of appealing those claims. Sometimes, giving a 90-day contract notice and converting clients to a sliding-scale courtesy fee saves both your revenue and your team's administrative capacity. Rigid Payer Standards: Don't throw spaghetti at the wall. Establish a minimum floor rate for your tiers of therapists. If a commercial panel doesn’t meet the floor, pay reliably within 60 days, or allow for EDI/ERA processing, choose not to panel with them. Relationships Are Everything: Rate negotiation is a human game. Treat payer reps like human beings—memorable gestures like sending a thank-you note can go a long way. Conversely, letting a negotiation turn acrimonious can result in years of being "ghosted" without a raise. CHAPTERS 00:00 Introduction: The First 10 Years of Group Practice Growth 05:17 Systems Over Stress: How Great Billing Teams Stay Organized 11:38 Building a Culture of Training and Development 15:47 When Insurance Denials Stop Being Worth It 28:30 How to Build a Smarter Insurance Panel Strategy 36:45 How reTHINK Built a Faster Credentialing System 42:27 Why Compliance Is the Real Growth Strategy 45:27 Conclusion: The Future of Practice Operations and AI RESOURCES Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO Consulting with Nicole: Rethink Your Practice Visit reTHINK Therapy Learn More About The Claim Game: Visit practicesol.com/podcast The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub. Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog. Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance. Get full access to The Claim Game at jeremyzug.substack.com/subscribe

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About

The Claim Game podcast, hosted by Jeremy and Kathryn Zug, is designed to help healthcare providers navigate the complexities of revenue cycle management (RCM). Each episode aims to cut through confusion by breaking down complex billing processes and sharing real-world solutions. The podcast uses a "game board" metaphor to simplify the RCM landscape, offering strategies and practical tips to help practices "win" at revenue cycle management. Jeremy and Kathryn draw on their extensive experience to empower providers to take control of their revenue, turning claim denials into deposits and allowing them to focus more on patient care. The podcast covers key territories of billing, such as credentialing, patient registration, eligibility & benefits, payment posting, aging follow-up, and claim submission, with the ultimate goal of providing clarity in a confusing, frustrating, and outdated industry. jeremyzug.substack.com

Information

  • Creator
    Jeremy and Kathryn Zug
  • Years Active
    2025 - 2026
  • Episodes
    56
  • Rating
    Clean
  • Copyright
    © 2026 Jeremy and Kathryn Zug
  • Show Website
    The Claim Game

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