For The Love of Revenue Cycle

Navigating Insurance AR: Tackling Claims with No Response In this episode, Vanessa Moldovan, CEO and host of 'For The Love of Revenue Cycle,' delves into the intricacies of Insurance Accounts Receivable (AR), focusing on claims with no response. Vanessa explains the significance of managing AR to maintain financial health and provides practical strategies for identifying, resolving, and preventing claims with no responses. Key takeaways include the importance of tracking all claims, the role of technology, and assigning the right tasks to team members. Vanessa also emphasizes the need for preventive measures and invites listeners to ongoing discussions and networking opportunities. 00:00 Introduction and Welcome 01:06 Episode Overview: Insurance AR and Claims with No Response 02:00 Understanding Insurance Accounts Receivable (AR) 03:57 Managing AR: Best Practices and Key Performance Indicators 07:07 Focusing on Claims with No Response 16:13 Steps to Resolve Claims with No Response 22:22 Preventive Measures for Claims with No Response 26:05 Conclusion and Upcoming Episodes

Get ready for Season 3 of For the Love of Revenue Cycle, premiering tomorrow with Episode 30! I'm back with a deep dive into denials and accounts receivable in the revenue cycle. Listen in, as I unpack the complexities of denials and their impact on healthcare organizations. I'll share insights from recent industry events and personal experiences, highlighting key strategies for prevention and resolution. Also, stay tuned to the end for a big announcement about For the Love of Revenue Cycle.

Hello Friends!  Welcome to the kickoff of season 3!  I am overwhelmed to still be running this podcast after 2 years. Thank you as always for your support.  In this episode, I share what the topic of season 3 will be and share a big announcement.  Speaking of the big announcement, here is the link that I reference. https://fortheloveofrevenuecycle.aweb.page/p/7d25c7b7-9c16-490c-95cd-7bd2052fd396    

Hello friends and welcome to episode 28 of For the Love of Revenue Cycle.  Thank you so much for tuning in today!  A big welcome back to my loyal listeners and a special shout out if today is your first episode.  This season is part of the going back to the basics from season 2. I know that it has been about 5 months since Episode 27 was posted.  As you may recall, me and my production team were experience technical difficulties.  But here we are back again!  In this final episode of Season 2,  I’m going to share with you my experience with using reporting and analytics in revenue cycle management.  This will include discussing why I believe analytics is so vital, what my favorite reports are and how I use them to run a clean revenue cycle.

Welcome to the first episode of Season 2! Today’s episode is about credentialing, contracting, and enrollment.  These are very different concepts, but often get confused.  Hopefully, I’ll be able to sort out some of the confusion. 

In this first My Take episode, Vanessa reflects on her conversation with Felix Segre and dives deeper into the topic of payment integrity. She breaks down the difference between pre- and post-payment review, the growing role of technology, and why payment integrity looks different for providers, payers, and vendors. Tune in for perspective, encouragement, and practical insights on how to advocate for yourself, know your motivators, and never underestimate your role in the revenue cycle. 00:03 Welcome to My Take 00:21 Defining Payment Integrity 01:14 Manual Work to Technology 01:25 Pre- & Post-Payment Review 03:57 Payment Integrity is About People 04:32 Vanessa’s Homegrown Perspective 06:26 Know Your Motivators 07:46 Key Takeaway: Every Role Matters  

In this episode of 'For the Love of Revenue Cycle', host Vanessa Moldovan and guest Felix Segre, Director of Revenue Integrity, delve into the crucial topic of revenue integrity. With nearly 30 years of experience in revenue cycle management, Vanessa explores Felix's two decades of expertise spanning front, middle, and backend operations. They discuss the significance of revenue integrity, why it should be everyone's responsibility, and share actionable steps for fostering a culture of recognition and support within an organization.  The episode also offers practical advice for leaders on using data to guide decision-making and creating a culture of open communication. It highlights how every role in the revenue cycle plays a critical part, underscoring the interconnected nature of the process and the need for both individual accountability and collective ownership to ensure accurate reimbursement and an optimal patient experience. Bonus: This episode is also available in video format at youtube.com/@FTLORC! 00:00 Introduction and Host Background 00:34 Guest Introduction: Felix Segre 01:34 The Importance of Revenue Integrity 03:38 Personal Stories and Realizations 07:29 Defining Revenue Integrity 17:36 Challenges and Solutions in Revenue Cycle 21:32 Advice for Frontline Workers and Leaders 30:26 Closing Thoughts and Takeaways 35:00 Conclusion and Listener Engagement  

FTLORC Live Returns with Vanessa Moldovan In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares her extensive industry experience and the mission behind the podcast. Listeners are introduced to Vanessa's background in revenue cycle management, her current role at Agentic AI company Magical, and the goals of the podcast, which include offering practical guidance and fostering community discussions. The open Q&A session features real-world challenges such as AI-driven rejections, anesthesia reimbursement nuances, and payer dynamics. Vanessa and participants discuss issues like increasing denials due to AI, leveraging provider contracts for claim escalation, and strategies for dealing with payer resistance. The episode emphasizes the importance of community, the need for technology to ease revenue cycle management, and the value of sharing knowledge among professionals.  00:00 Introduction to Vanessa and the Podcast 00:36 Today's Episode Overview 01:33 Community and Facebook Group 02:16 Vanessa's Career and Focus on Denials 03:08 Participant Introductions 03:20 Nicolette's Experience and Challenges 04:37 Angie's Experience in Anesthesia Billing 09:16 Discussion on AI and Claim Rejections 21:23 Escalating Denied Claims 21:41 Challenges in Claim Resolution 23:04 Strategies for Effective Escalation 27:16 Dealing with Overseas Call Centers 28:45 Leveraging Contracts and Technology 37:00 Community and Continuous Learning 39:15 Conclusion and Next Steps  

In this episode of 'For The Love of Revenue Cycle,' host Vanessa Moldovan and expert Doug Hires discuss crucial strategies for revenue cycle management (RCM) leaders in their first 90 days. Doug, with decades of healthcare operations experience, provides actionable guidance on assessing priorities, making a case for technology investments, and achieving quick wins to build credibility. The episode emphasizes the importance of communication, transparency, and keeping a business-focused perspective. Vanessa and Doug also delve into change management and how to address resistance in staff. The conversation provides a comprehensive framework for new leaders to navigate their roles effectively and make meaningful impacts quickly. 00:00 Introduction to the Podcast and Host 00:40 Today's Episode Overview: Prioritizing the First 90 Days 02:20 Guest Introduction: Doug Hires 02:37 Doug's Career Journey and Experience 03:40 Challenges for New Revenue Cycle Leaders 05:27 The Importance of Observation and Feedback 08:42 Triage and Prioritization in Revenue Cycle Management 14:08 Quick Wins and Business Impact 16:49 Justifying Technology Investments to Leadership 17:42 Understanding the Impact of Technology Changes 21:01 Change Management and Communication Strategies 23:22 Addressing Fears and Resistance to Change 27:53 Final Thoughts and Key Takeaways  

Preparing for Tech Downtime in Healthcare: Key Strategies and Insights with Darlene Vendittelli In this episode of 'For The Love of Revenue Cycle,' host Vanessa Muldoon and guest Darlene Vendittelli, Director of Digital Revenue Management at South Coast Health, discuss crucial strategies to prepare for technology downtime in healthcare settings. The conversation covers the inevitability of system outages and emphasizes the importance of having a well-crafted downtime plan. Darlene shares five key steps, including inventorying systems, creating paper processes, developing a recovery plan, and establishing a strong communication strategy. They also talk about the necessity of rehearsals and regular reviews to ensure readiness. With practical tips and real-world examples, this episode provides valuable insights for healthcare professionals to maintain operational continuity during tech downtimes. Additional Episode Resources: The SAFER Guides (Safety Assurance Factors for EHR Resilience) — government-published checklists and self-assessment tools for contingency planning and downtime preparedness: https://www.healthit.gov/topic/safety/safer-guides A one-page tip sheet Darlene created summarizing her five-step downtime framework: Please email podcast@ftlorc.com to receive your free copy. 00:00 Introduction and Host Background 00:33 Episode Overview and Guest Introduction 02:38 Importance of Downtime Preparation 06:10 Steps to Build a Downtime Strategy 16:34 Communication and Recovery Plans 26:56 Practical Tips and Resources 30:20 Conclusion and Call to Action  

Navigating Automation in Revenue Cycle Management with Michael Laukaitis In this episode of 'For The Love of Revenue Cycle', host Vanessa Moldovan dives into the world of automation with healthcare IT expert Michael Laukaitis. With over two decades of experience, Mike shares his journey from rural Montana to UT Southwestern, highlighting the evolution of automation in healthcare. The discussion covers the importance of evaluating processes before automation, the differences between RPA and agentic AI, and the need for human oversight in automated systems. Mike emphasizes the necessity of stable, high-volume processes for successful automation and warns against over-promising vendors. Mike and Vanessa provide practical advice for healthcare leaders on selecting and implementing automation tools, ensuring measurable outcomes, and maintaining system integrity. 00:00 Introduction to the Episode 00:36  Meet Mike Laukaitis  01:00 Early Automation Experiences 02:05 Current Automation Projects 03:53 Challenges and Considerations in Automation 04:47 When Not to Automate 07:15 Human Element in Automation 09:58 Technical Aspects of Automation 17:54 Evaluating Automation Vendors 25:39 Best Practices and Lessons Learned 33:37 Conclusion and Final Thoughts What makes a process a good candidate for automation? Use this quick scorecard (1=low, 5=high). Aim for 24+ out of 35. Volume and frequency: high, daily work. Rule clarity: clear decision rules or prompts a model can follow. Input quality: structured data, stable forms, reliable sources. System stability: few UI changes, APIs available, or predictable portals. Exception rate: historically under 15% and well-defined. Impact: measurable time saved, faster cash, fewer denials, fewer clicks. Risk profile: errors are detectable and reversible. Questions leaders should ask before building or buying automation tools What is the exact business outcome and how will we measure it monthly? Where is the waste today: rework, wait time, over-processing, or motion? Is the process stable and documented, or do we need to fix it first? What is the current exception rate and why do exceptions happen? What data sources are required and who owns their quality? What are the failure modes and how will we detect, alert, and roll back? What access, audit, and compliance controls are required end-to-end? Build vs buy: which option reduces time to value and long-term maintenance risk? What’s the realistic total cost of ownership, including rebuilds after system or payer changes? How will staff be trained, and what tasks will they do when the bot takes over the boring parts? Who is the named process owner and who shuts it off if metrics slip? What is the decommission plan if the upstream system adds a native feature? Implementation guardrails that save pain later Fix the process first. Map it, remove steps, standardize inputs, then automate. Start in “shadow mode.” Let the bot run in parallel for 2 weeks and compare outcomes. Instrument everything. Log starts, stops, exceptions, and outcomes. Alert on drift. Keep humans in the loop for edge cases and approvals above risk thresholds. Review quarterly. If payer or EHR changes make it brittle, redesign or retire it.  

Mastering Payment Analysis: Best Practices with Stacy Calvaruso In this episode of 'For The Love of Revenue Cycle,' host Vanessa Moldovan and expert Stacy Calvaruso discuss the often-overlooked yet crucial topic of payment analysis. The episode differentiates between contract modeling and payment analysis, addressing common issues like underpayments and silent downcoding. They share actionable steps for ensuring proper payment using both advanced technologies and spreadsheets. The discussion also covers the importance of data in running a revenue cycle, triggers for payment analysis, and strategies for contract negotiation. Practical advice on identifying and rectifying underpayments is provided, emphasizing the need for regular review and collaboration within the organization. Whether you're a large hospital or a smaller clinic, this episode offers valuable insights into maintaining revenue integrity.  Here is the link to the analysis sheet referenced in the call: Payment Analysis Lost Revenue Tracker 00:00 Introduction and Episode Overview 00:56 Meet Stacy Calvarusso: Revenue Cycle Expert 02:49 The Importance of Data in Revenue Cycle Management 03:52 Contract Modeling vs. Payment Analysis 05:50 Understanding Payment Variances and Underpayments 08:53 Contract Negotiation Strategies 14:51 Triggers and Tools for Payment Analysis 18:47 Practical Tips for Payment Analysis 32:14 Conclusion and Final Thoughts

In this inaugural live Q&A episode, Vanessa Moldovan, CEO of For the Love of Revenue Cycle, answers real-time questions on denials, RCM technology gaps, billing strategies, and more. Tune in for practical insights on tech adoption, denial resolution, and how to evaluate in-house vs. outsourced billing. [00:03:00] – Where do you think the biggest gaps are between what technology promises and what it actually delivers in revenue cycle? [00:07:45] – What makes a revenue cycle leader actually adopt a new product or tool? [00:13:20] – What is the number one mistake you see practices or companies make when it comes to denials? [00:22:30] – Who should be handling your billing—in-house or outsourced?

In this episode of 'For the Love of Revenue Cycle,' host Vanessa welcomes Dr. Greg Hobbs, the Chief Medical Officer and co-founder of Milagro, a provider of autonomous coding solutions for healthcare. Dr. Hobbs discusses his background as an emergency physician, his journey through the academic and IT sectors, and his subsequent focus on healthcare technology. The conversation delves into the challenges and benefits of adopting technology in healthcare, particularly autonomous coding. They explore physicians' skepticism towards AI, the need for transparency in automated systems, and the importance of finding the right vendor for technology solutions. Dr. Hobbs highlights the necessity of real-time coding to avoid preauthorization mismatches and enhance efficiency. Emphasizing a partnership approach with technology providers, the discussion underscores the value of integrating smart software with human expertise to optimize healthcare workflows. 00:00 Introduction and Guest Introduction 00:20 Dr. Greg Hobbs' Background and Experience 01:37 Challenges with Technology Adoption in Healthcare 03:54 Importance of Accurate Coding 04:37 Addressing Skepticism and Legal Responsibilities 08:30 Autonomous vs Automated Coding 11:35 Real-Time Coding and Preauthorization 15:55 Integration and Implementation Challenges 19:03 Vendor Selection and Partnership 22:35 Conclusion and Final Thoughts

In this episode, Vanessa is joined by Dugan Winkie with Cedar to explore the integration of innovation within the revenue cycle. The discussion focuses on patient accounts receivable (AR) and the transformative role of technology in making patient financial experiences more efficient and personalized. Dugan shares insights from his career and Cedar’s approach to bridging the gap between technology and revenue cycle management. The conversation touches on the need for simpler payment processes, the impact of AI in answering billing questions, and the importance of finding healthcare solutions that balance operational efficiency with patient care.  For further information go to https://www.cedar.com/ 00:00 Introduction and Guest Introduction 02:44 The Importance of Patient AR 06:30 Challenges and Innovations in Patient Financial Experience 10:09 Leveraging AI and Technology for Efficiency 15:59 Strategies for Improving Patient Engagement 19:19 Choosing the Right Partner for Revenue Cycle Management 20:58 Conclusion and Final Thoughts

Episode Summary: Conferences can be a game-changer for your career, whether you attend in person or virtually. In this episode, we dive into how to maximize your return on investment (ROI) from industry conferences, choose the right events, and make the most of opportunities—even if you can’t attend in person. 🔥 What You’ll Learn in This Episode: • The tangible and intangible benefits of attending conferences. • How to calculate your ROI to determine if a conference is worth it. • Key differences between in-person and virtual attendance. • Alternative ways to gain value if you can’t attend in person. • How to select the right conference for your career or business goals. • Two major conference announcements where Vanessa will be speaking! ✈️ Upcoming Conferences & Speaking Engagements 🏥 RCM Summit – Nashville (February 5-7, 2024) 📍 Speaking Session: 🔹 Panel: “Creating Common Ground – Strategies for Payer-Provider Synergy” 🕑 February 6th at 3:45 PM Eastern 💡 Why Attend? • A must-attend for revenue cycle professionals. • The only event uniting RCM professionals from healthcare and insurers. • Features 25+ senior-led sessions, networking, and exclusive discussions. • FREE for healthcare providers and those who work for healthcare organizations! 🔗 Register Here 🌐 ViVE – Nashville (February 16-19, 2024)   📍 Speaking Sessions: 🔹 February 16 – Bridging the Gap Between RCM & Technology 🔹 February 19 – First Ever RCM Summit at ViVE 💡 Why Attend? • Premier event for digital health transformation. • Unmatched networking with tech innovators, revenue cycle experts, and healthcare leaders. • Exclusive RCM Summit featuring the top minds in the space. 🔗 Register Here 💰 Save $250 on Registration! Use promo code: v25p_FTLRC250 📌 If you found this episode valuable, please share it with a friend or colleague! 💡 Join the conversation: Follow Vanessa on LinkedIn for more industry insights. 🎤 For the Love of Revenue Cycle – Helping you navigate RCM with clarity, strategy, and innovation.  

Navigating Denial Management and Best Practices in Medical Billing   In this episode, our host addresses common issues and questions related to claims denial in the healthcare industry. The session kicks off with a briefing about the recording process and the host’s recent absence due to business commitments in Europe. The conversation delves into topics such as the upcoming conferences in Nashville, including the RCM Summit and Vive, and moderating panels on collaboration between providers and payers. The Q&A covers detailed discussions on claims denied for timely filing, challenges faced with behavioral health billing, the importance of accurate reason codes, and the complexities of dealing with authorization denials. Specific case studies are examined, including issues with Blue Cross of Massachusetts and UnitedHealthcare denials. The episode emphasizes the need for resilience, thorough research, and the use of technology in managing billing processes effectively.   00:00 Introduction and Housekeeping 02:34 Welcome and Updates 03:45 Upcoming Conferences 04:41 Panel Discussion Preparation 09:54 Q&A: Denial Management 15:28 Common Denial Issues 25:41 Behavioral Health Billing Challenges 31:06 Challenges with Authorization Denials 31:59 Manual vs. Technological Solutions 32:54 Dealing with Out-of-Network Denials 34:54 Frustrations and Resilience in Billing 35:50 Escalating Appeals and Insurance Company Tactics 38:22 Utilizing Support Networks 41:47 Specific Case Discussions and Policies 01:00:04 Conclusion and Final Thoughts

Episode Overview: In this episode, we dive into the latest trends and challenges in the world of healthcare denials, focusing on payer-driven issues and solutions. The discussion spans denial trends, specifically around inpatient DRG downgrades, and the nuances of navigating denials and claim processes. We also cover technology gaps, regulatory shifts, and emerging solutions in the revenue cycle, particularly for claims with no response and payer-driven reimbursement barriers.   Key Topics Discussed: • DRG Denials and Humana’s Query Compliance: Robin brings up a denial trend where Humana denies inpatient DRG claims based on “non-compliant queries,” prompting insights on how other professionals are tackling this issue. • Technology for Claims Without Response: A compelling case is made for creating automation around claims that have not received a denial or payment. This includes potential decision trees for follow-up actions on claims without EDI data to improve efficiency. • Prior Authorization and Payer Challenges: The conversation highlights the industry’s struggle with prior authorization, arguing that innovation should focus on reducing the overall burden rather than automating current processes, which only minimally alleviate providers’ challenges. • The Telehealth Dilemma Post-2024: With telehealth flexibilities set to expire at the end of 2024, Whitney raises concerns over how practices primarily based on telehealth services, especially those offering behavioral health, will adapt. Regulatory changes are dissected, with possible strategies suggested to navigate this impending change. • Innovations in Denial Management: Attendees discuss tools for denial tracking and payer insights, like Cleopatra Queen of Denial, a software solution developed to trend denial types across categories for better negotiation leverage. • Building Technology That Truly Helps the Revenue Cycle: A call is made for technology that directly addresses payer-driven issues, rather than administrative burdens, suggesting a focus on innovation that simplifies payer policies and medical necessity criteria. • Professional Events and Resources: The episode includes a discussion on upcoming events, like Joe Rivett’s denial forum, offering listeners insight into where they can learn more about denial management, payer perspectives, and effective appeals writing. Listeners are encouraged to reach out and share their own experiences with denial management challenges, particularly around DRG downgrades and telehealth changes, fostering a community of shared insights and solutions.

Mastering Payer Defense In this episode, Vanessa Moldovan, CEO and founder of 'For the Love of Revenue Cycle,' dives deep into the complexities of downcoding and mastering payer defense strategies. She discusses essential steps including understanding contracts, interacting effectively with payers, and leveraging legal options and state insurance commissions. Vanessa also shares insights gathered from a healthcare attorney specializing in defending providers against insurance companies. Tune in to learn actionable strategies to safeguard revenue and ensure fair payment while maintaining professional relationships with payers.  00:00 Introduction and Overview 00:13 Understanding Downcoding 00:53 Expert Insights and Strategies 02:20 Importance of Contracts in Payer Defense 03:49 Presenter's Background and Expertise 06:00 Webinar Disclaimer and Initial Questions 07:10 Best Practices for Denial Escalation 11:39 Identifying and Addressing Downcoding 19:58 Effective Payer Conversations 29:22 Navigating Payer Relations and Contracting 31:01 Effective Appeal Strategies 33:40 Documentation and Professionalism 37:43 Leveraging State Insurance Commissions 43:33 Filing Grievances: Medicare and Commercial Plans 48:47 Legal Complaints and Final Steps 52:19 Q&A and Closing Remarks

Transforming Healthcare Revenue Cycle with Technology and Human Expertise Join Vanessa Moldovan, CEO and founder of For the Love of Revenue Cycle as she delves into the intersection of innovative technology and Revenue Cycle Management (RCM). Discover the critical role of technology such as Artificial Intelligence (AI), Large Language Models (LLMs), and Software as a Service (SaaS) in optimizing financial processes and patient data management.  This episode covers essential topics including vendor selection, key technological terms, and the importance of human factors in successful technology adoption. She tackles common objections to new technology, and provides practical strategies for evaluating software solutions and maximizing the benefits of software demos. Learn how to balance human intervention and automation to achieve efficiency and long-term financial success. For more information, contact Vanessa at vanessa@ftlorc.com and connect via LinkedIn or Facebook. 00:00 Introduction and Webinar Overview 00:11 About Vanessa Moldovan 00:48 Mission and Services 01:58 Importance of Technology in Revenue Cycle 05:50 Key Terms in Technology 09:37 Understanding Information Technology 11:31 Software as a Service (SaaS) 28:50 Human Factor in Technology 35:49 Challenges in Revenue Cycle Management 36:57 Understanding Common Objections to Technology Adoption 37:55 Overcoming Resistance and Bad Experiences 40:07 Perception of High Costs and Value Challenges 42:34 Preparing for Technology Demos 44:46 Maximizing Demo Effectiveness 50:39 Evaluating Technology Integration and Support 01:03:36 Exploring Innovative Technologies in Revenue Cycle 01:10:29 Conclusion and Contact Information