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 episode of For the Love of Revenue Cycle, Vanessa breaks down why prior authorization and eligibility verification are two of the biggest drivers of preventable denials — and how getting them right is essential to clean claims and healthy cash flow. The discussion covers the foundations of payer requirements, the difference between denials and rejections, and where most revenue leakage actually occurs across the front end of the revenue cycle. Vanessa shares practical best practices for improving accuracy and efficiency in PA and EBV workflows, along with real industry data on denial trends. The episode also explores how modern technology, including agentic AI, is transforming these processes by reducing manual work, closing operational gaps, and shifting organizations from denial resolution to true prevention. 00:00 Welcome and Introduction 03:07 Understanding Clean Claims 06:04 Claim Requirements Explained 10:41 Denials vs Rejections 12:25 Why Prevention Matters 17:05 Front End vs Backend 22:05 Prior Authorization Deep Dive 26:28 PA Process Step by Step 29:34 Prior Authorization Best Practices 32:15 Eligibility and Benefit Verification 35:55 EBV Best Practices 38:52 Technology and AI Overview 42:30 Understanding Agentic AI 44:48 AI in PA and EBV Workflows 48:04 Closing and Call to Action  

In this episode of 'For the Love of Revenue Cycle,' the focus shifts from traditional denial management strategies to understanding the power of denial data. Vanessa discusses the limitations of current systems and common misconceptions in how denial management is practiced. Emphasizing the importance of prevention over mere resolution, the episode explains how analyzing denial data can reveal underlying process flaws and drive meaningful improvements. Key points include distinguishing between denial reasons and root causes, the importance of visibility over precision, and the role of technology in optimizing denial management. A call to action encourages listeners to rethink denial management as a strategic, data-informed approach to enhancing organizational performance.   00:00 Welcome and Introduction 00:15 Understanding Denial Management 00:58 The Role of Denial Data 05:14 Challenges in Using Denial Data 06:48 From Resolution to Prevention 07:49 Practical Steps for Denial Management 08:30 The Importance of Root Cause Analysis 10:07 Impact on Organizational Performance 11:46 Leveraging Technology and Automation 13:39 Conclusion and Final Thoughts  

In this special episode of 'For the Love of Revenue Cycle,' Vanessa Moldovan presents a recording of a recent webinar focused on the topic of Agentic AI. Approved by AAPC for one CEU, this episode dives into the reality of Agentic AI in revenue cycle operations. It explains what Agentic AI is, its difference from traditional automation or RPA, and how it addresses core issues like human error, payer complexity, and inadequate legacy technology. Practical, real-world applications in prior authorizations, eligibility verification, and document management are discussed, alongside the benefits of this technology. The importance of cautious and controlled adoption is emphasized, providing listeners with essential questions to evaluate vendors and ensure effective integration of Agentic AI into their workflows.   To claim your CEU, please submit the form here: https://forms.gle/J76NCbeXiyy6B5rC6   00:00 Introduction and Webinar Overview 00:49 The Reality of Agentic AI 01:56 Understanding Agentic AI 03:08 Challenges in Revenue Cycle 07:40 The Role of Agentic AI in Revenue Cycle 19:03 Evaluating Agentic AI Vendors 25:45 Implementing Agentic AI Safely 27:26 Conclusion and Next Steps  

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan delves into the complex and pressing topics of audits, compliance, and documentation. Joined by expert Brenda Edwards, who has extensive experience in healthcare revenue cycle, they discuss the rising frequency and importance of audits, sharing insights and real-world examples, including metadata and audit trails. Brenda emphasizes the need for thorough documentation to support services billed and advises on how to handle audit letters without panic. Practical advice is given to ensure that organizations remain compliant and prepared for inevitable audits. The episode also highlights the need for internal and external audits, the importance of having a compliance plan, and the potential benefits of integrating thoughtful automation into the audit process.                                                              00:38 Meet Brenda Edwards: Background and Expertise 00:52 Understanding Audits: Who, Why, and How 00:58 Real-World Example: Incident Two and Split Shared Services 01:16 Practical Takeaways: Responding to Audits 01:26 Disclaimer and Scope of Discussion 01:59 Starting the Conversation with Brenda 02:09 The Growing Importance of Audits 03:03 Brenda's Journey in Auditing 09:54 Compliance and Documentation: Best Practices 10:58 Cardiology Audit Case Study 11:44 The Role of Metadata in Audits 16:18 The Consequences of Improper Access 26:02 The Long-Term Impact of Audits 26:52 First Offense Penalties and Compliance Plans 28:43 Case Study: EHR Upgrade Issues 30:09 Legal Implications and Repeat Offenders 31:57 Handling Sanctioned Providers 34:04 Responding to Audit Notifications 34:33 Educational vs. Recoupment Letters 42:07 The Importance of Documentation 46:39 Final Thoughts and Takeaways

In this webinar replay, host Vanessa Moldovan leads a discussion on the current state of the revenue cycle management (RCM). The episode kicks off the 'Drive to ViVE' webinar series, focusing on the lead-up to the event next year in Los Angeles, which will feature industry leaders discussing healthcare IT, business, and more. Vanessa addresses the major challenges in RCM, such as rising denial rates, fragmented workflows, and the dynamic changes in regulations and policies. She shares insights on denial prevention, education, and the adoption of smart technology, specifically Agentic AI, to improve RCM processes. The episode also highlights the importance of leadership accountability, continuous learning, and genuine industry collaboration to drive significant change while preparing for the future of healthcare reimbursement.  00:00 Welcome and Introduction to Drive to ViVE 00:53 Current Challenges in Revenue Cycle Management 02:53 What's Broken in Revenue Cycle Management 07:30 What's Working in Revenue Cycle Management 11:32 Strategies for Future Improvements 25:02 The Role of Technology in Revenue Cycle Management 28:44 Involving Users in the Process 29:48 The Role of Technology in Revenue Cycles 31:03 Understanding Agentic AI 31:28 The Evolution of Navigation Technology 32:38 Agentic AI in Revenue Cycle Management 36:49 Q&A Session Begins 37:28 Addressing Denial Prevention 40:39 The Importance of Front-End Processes 42:04 Skills for Future RCM Teams 43:56 Networking and Education in RCM 46:35 Supporting Frontline Teams 49:30 Final Thoughts and Future Directions  

Conference Season Recap: Maximizing Value from Industry Events In this episode of 'For the Love of Revenue Cycle,' host Vanessa Malon offers a comprehensive review of the conferences she attended this season, including Becker's, HBMA, MGMA, the Medical Cost Containment Series in Chicago, and the Invest Behavioral Health Conference. Vanessa discusses the key takeaways, the value of attending these events, and provides practical advice on how to maximize ROI, whether you're a leader or frontline worker. She emphasizes the importance of choosing the right conferences based on your goals, whether it's for education, networking, or vendor evaluation. Vanessa also shares tips on how to prepare, what questions to ask, and the benefits of small group sessions, making this episode a must-listen for revenue cycle professionals planning their conference schedules. 00:00 Introduction and Podcast Overview 00:40 Season Review: Conferences Attended 02:11 The Value of Conferences 04:10 Becker's Conferences Insights 06:49 Medical Cost Containment Series 08:00 HBMA and MGMA Conferences 10:00 Networking and Practical Tips 16:15 Final Thoughts and Recommendations 17:30 Conclusion and Contact Information

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan engages the community in a live Q&A session. The discussion covers the pressing issue of denials and reimbursement challenges in the healthcare industry. Key topics include recent policy changes by Cigna on automatic downcoding, the implications of DRG downgrades, and strategies for identifying downcoded claims. The episode also addresses how to measure denial rates, manage medical necessity denials, and successfully overturn denied claims. Expert insights and community contributions make this episode a valuable resource for anyone involved in the revenue cycle. 00:00 Introduction and Welcome 00:12 Open Q&A: Community Challenges 01:10 Discussion on Cigna's Downcoding Policy 03:01 Identifying and Handling Downcoding 07:33 Measuring Denial Rates and Overturns 12:00 Government Shutdown Impact on Telehealth 12:57 Combating Medical Necessity Denials 17:25 Escalating Denial Issues with Payers 22:20 Conclusion and Community Engagement

In this episode of 'For the Love of Revenue Cycle,' we delve into the unique aspects of the orthopedic revenue cycle compared to general Revenue Cycle Management (RCM). The discussion covers four key themes: prior authorization and payer policy awareness, global surgical rules, care settings, and payer types. Practical tips are provided for various stages including scheduling, registration, coding, claims review, payment posting, and AR management. The episode also offers management takeaways and highlights common denials in orthopedics and strategies for avoiding them. The insights are valuable for employees, managers, consultants, and technology partners working within the orthopedic realm.   00:00 Welcome and Introduction 00:50 Orthopedic Revenue Cycle Overview 01:30 Patient Intake and Scheduling 03:16 Registration and Check-In 04:04 Prior Authorization and Payer Policies 05:52 Encounter and Coding 08:27 Claims Creation and Review 09:25 Denials and Resolutions 10:50 Settings of Care 11:57 Workers' Compensation 13:17 Accounts Receivable Follow-Up 16:23 Leadership and Management Tips 17:56 Common Denials and Prevention 19:17 Conclusion and Final Thoughts

In this webinar replay, Vanessa Moldovan tackles a critical healthcare challenge: bridging the gap between innovation and operations in the revenue cycle. She explores the disconnect between RCM leaders and technology innovators, revealing how resistance to change, staffing shortages, and fragmented systems fuel inefficiencies and reimbursement setbacks. Vanessa explores root causes such as human error, denial management breakdowns, and rising costs to collect, while offering practical solutions to close the divide. By emphasizing knowledge, empathy, and a shared understanding of the full revenue cycle, she outlines how leaders and innovators can work together more effectively. Listeners will walk away with actionable insights on clean claims, leveraging technology for accuracy, and building more productive conversations between RCM teams and tech partners, ultimately paving the way for stronger collaboration and better financial outcomes. 00:00 Introduction and Disclaimers 01:31 Understanding the Gap Between Innovation and Operations 03:02 Challenges in Revenue Cycle Management 08:46 Revenue Cycle 101: Components and Functions 16:47 Key Performance Indicators and Cost to Collect 22:36 The Role of Technology in Revenue Cycle Management 27:31 Common Gaps and Reconciliation Points 40:21 Understanding Eligibility and Benefit Verification Challenges 41:28 The Burden of Documentation Requests 41:57 How Technology Can Help in Revenue Cycle Management 44:41 Tech Solutions for Front-End Processes 46:52 Mid-Cycle and Back-End Tech Solutions 49:45 Preparing for Successful Tech Implementation 50:00 Bridging the Gap Between RCM Leaders and Tech Innovators 52:55 Effective Sales Conversations for Tech Solutions 01:01:53 Key Steps for Successful Product Demos 01:13:59 Final Thoughts and Next Steps    

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.