Shows
For The Love of Revenue CycleEp. 49 - Effective Strategies for Prior Authorization + Eligibility VerificationIn 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 mo...
2026-02-2449 minFor The Love of Revenue CycleEpisode 48 : Rethinking Denial Management: What the Data Is Really Telling YouIn 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...
2026-02-0315 minFor The Love of Revenue CycleWebinar Replay - Agentic AI in Revenue Cycle: Cutting Through the HypeIn 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...
2026-01-2730 minFor The Love of Revenue CycleEp. 47 - Audits with Brenda EdwardsIn 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...
2026-01-1351 minFor The Love of Revenue CycleWebinar Replay - RCM Pulse Check: What's Working, What's Broken, and What's Next?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...
2025-11-0451 minFor The Love of Revenue CycleEp. 46 - 2025 RCM Conference Season RecapConference 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...
2025-10-2818 minFor The Love of Revenue CycleFTLORC Live Q&A! 10/14/25In 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...
2025-10-2222 minFor The Love of Revenue CycleEp. 45 - Orthopedic Revenue Cycle Deep DiveIn 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 We...
2025-10-0720 minFor The Love of Revenue CycleWebinar Replay: Bridging the Gap Between Innovation and Operations 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. ...
2025-09-301h 15For The Love of Revenue CycleMy Take with Vanessa Moldovan: Revenue Integrity Is Everyone's ResponsibilityIn 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
2025-09-2508 minFor The Love of Revenue CycleEp. 44 Revenue Integrity Is Everyone's Responsibility with Felix SegreIn 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 o...
2025-09-2336 minFor The Love of Revenue CycleEp. 43 - 9/9/25: FTLORC Live Denials Q&A!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...
2025-09-1642 minFor The Love of Revenue CycleEp. 42 Navigating the First 90 Days as an RCM Leader with Doug HiresIn 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...
2025-09-0930 minFor The Love of Revenue CycleEp. 41 Preparing for Tech Downtime in Healthcare: Key Strategies and Insights with Darlene VendittelliPreparing 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...
2025-09-0231 minFor The Love of Revenue CycleEp. 40 Navigating Automation in Revenue Cycle Management with Michael LaukaitisNavigating 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...
2025-08-1937 minFor The Love of Revenue CycleEp. 39 Mastering Payment Analysis with Stacy CalvarussoMastering 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...
2025-05-0633 minFor The Love of Revenue CycleFTLORC Live! – 4/8/25 Episode: Q&A Kickoff | Denials, Technology, and RCM StrategyIn 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 com...
2025-04-1130 minFor The Love of Revenue CycleEp. 38 AI in Coding: A Conversation with Dr. Greg HobbsIn 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...
2025-03-1723 minFor The Love of Revenue CycleEp. 37 Revolutionizing Patient AR with Dugan WinkieIn 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 i...
2025-02-1721 minFor The Love of Revenue CycleEp. 36 Conferences: The Game-Changer for Your Career & BusinessEpisode 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...
2025-02-0229 minFor The Love of Revenue CycleLive Denials Q&A 1/21/25 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 i...
2025-01-271h 00For The Love of Revenue CycleLive Denials Q&A 11/7/24 - DRG Trends, Telehealth Changes + Tech TrendsEpisode 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...
2024-11-0841 minFor The Love of Revenue Cycle10/30/24 Live Q&A Mastering Payer DefenseMastering 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 I...
2024-10-3157 minFor The Love of Revenue CycleTech-Enabled RCM, Live Webinar (Recorded 10/18/24)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 p...
2024-10-221h 11For The Love of Revenue CycleLive Denials Q&A 10/15/24 - Tips for Denial BeginnersMastering Medical Billing: Overcoming Claim Denials and Utilizing Key Resources In this comprehensive episode, we dive deep into various medical billing challenges and solutions. Key discussions include handling billing issues with UnitedHealthcare, specifically around lab claims and CLIA validation, and addressing billing problems with Medicare Advantage and other insurers like Cigna and Blue Cross. We offer practical advice on resubmissions, correct coding, and documentation to avoid denials. The importance of leveraging resources such as the AAPC website, MACs for webinars, and networking for educational support is emphasized. The episode features expert insights, such as those from healthcare...
2024-10-1653 minFor The Love of Revenue CycleLive Denials Q&A 10/3/24 - Tackling Tough DenialsIn this engaging podcast episode, participants dive deep into the complexities of denial management and revenue cycle strategies. Led by Vanessa Moldovan, a discussion unfolds around real-world challenges in handling denials and retractions within the healthcare finance sector. Key topics explored include the importance of working in denial management to gain comprehensive insights, effective strategies for managing Medicare and Medicare Advantage issues, and dealing with common denial reasons such as duplicate claims, out-of-network, and lack of authorization denials. The podcast also emphasizes the role of technology in streamlining these processes, highlighting how automation and AI can ease the burden...
2024-10-0453 minFor The Love of Revenue CycleEp. 34 Maximizing Provider Revenue with Payer Contract InsightsMaximizing Provider Revenue with Payer Contract Insight In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan shares essential insights on how to maximize provider revenue by understanding and leveraging the nuances of payer contracts. Topics covered include addressing prior authorization denials, navigating payer reimbursement policies, ensuring clean claim submissions, and utilizing fee schedules and carve outs. Additionally, Vanessa offers strategies for managing payer plan limitations, timely filing guidelines, and escalation procedures for unresolved reimbursement issues. Listeners are encouraged to harness technology and AI-driven solutions to streamline these processes for enhanced revenue cycle...
2024-09-2332 minFor The Love of Revenue CycleLive Denials Q&A 9/17/24 - Utilizing Contracts When Resolving Denials In this episode of the bimonthly Denials Q&A, host Vanessa discusses her extensive experience and expertise in handling denials, focusing on changes and challenges in the field. She emphasizes the importance of understanding contracts, payer guidelines, and exploring new technologies to improve denial management. Vanessa shared insights on leveraging contract information and innovative technology to fight back against complex denial processes. Key topics include the use of CARCs, dealing with Medicare Advantage plans, navigating E&M downcoding, and strategies for obtaining necessary documents from payers. Listeners are encouraged to stay proactive, utilize technology, and network within the healthcare...
2024-09-1952 minFor The Love of Revenue CycleEp. 33 Insurance AR: Claims with No ResponseNavigating 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...
2024-09-1027 minFor The Love of Revenue CycleLive Denials Q&A 9/5/24 - Hospice, SNF, Home Health denials + takebacksIn this episode, Vanessa Moldovan, CEO and Founder of 'For the Love of Revenue Cycle,' leads a live Q&A session on handling denials in medical billing. Participants from different sectors of the healthcare revenue cycle, including medical billing for home visits, nursing homes, and surgery centers, discuss challenges they face with denial codes, modifiers, and reimbursement issues. Key topics include understanding the new FY 2024 hospice final rule, addressing denials related to modifier codes, and strategies for handling electronic remittance advice (ERA) take-backs. Suggestions for actionable steps and resources, such as consulting specific websites and joining relevant forums...
2024-09-0650 minFor The Love of Revenue CycleLive Denials Q&A 8/1/24 - Navigating Out of Network DenialsShow notes for today's live denials Q&A session: The differences in denials and appeals processes between in-network and out-of-network providers Strategies for appealing out-of-network denials, including involving patients and leveraging laws like the Arisa law Trends in payer requests for documentation and potential reasons behind sudden increases in these requests Frustrations with payers' downcoding practices and lack of transparency in reimbursement The shift in the medical field from a profession to a business, and the need for better revenue cycle education for providers
2024-08-0257 minFor The Love of Revenue CycleEp 32 Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa Tech-Enabled RCM: Tips and Solutions with Mike Marshall + Vanessa In this episode, Vanessa welcomes Mike Marshall to discuss the intricacies of revenue cycle management (RCM) and the challenges faced by healthcare organizations. Mike is currently the Managing Director of the North American division of e5 Workflow, with a rich background in healthcare focusing on turnaround projects for operation, finance, and revenue cycle management. They explore the root causes of common RCM issues, the hesitations around adopting new technology, and emphasize the necessity of becoming tech-enabled to survive in the current market. Th...
2024-07-3050 minFor The Love of Revenue CycleLive Denials Q&A 7/16/24 - payer denial trends creating complexityIn this episode, Vanessa Moldovan hosts a Q&A session focused on the challenging issues of denials in revenue cycle management. Vanessa, along with the attendees, discusses the complexities around denial prevention, resolution, and best practices. The session covers specific payer issues, including downcoding by Anthem and Humana, as well as rampant documentation requests from UnitedHealthcare. The discussion also provides strategies for handling denials, escalating issues to provider representatives, utilizing contracts, and ensuring accurate coding practices. Expert insights are shared on balancing the administrative burden, proactively managing claims, and leveraging technology to streamline processes. The conversation aims to empower...
2024-07-181h 00For The Love of Revenue CycleEp. 31 Patient Accounts Receivablen episode 31 of 'For the Love of Revenue Cycle,' the host discusses patient accounts receivable (AR) in a clinic setting, emphasizing the importance of professional billing over facility billing. Key topics include naming conventions in billing systems, the role and definition of a guarantor, and the nuances between insurance processing and payment. The episode delves into best practices for managing patient AR, handling self-pay arrangements, and understanding patient financial responsibility, especially under high deductible health plans. The host also explores the impact of technological innovations on both pre-service and post-service collections, strategies for reducing collection costs, and compliance with...
2024-07-1636 minFor The Love of Revenue CycleEp. 30 Denials/AR Introduction + FTLORC AnnouncementGet 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.
2024-07-0227 minFor The Love of Revenue CycleLive Denials Q&A 6/18/24- telehealth billing guidelines, claim rejection challenges, & denial resourcesIn this episode, we dive into effective strategies for preventing and resolving denials in healthcare billing. Our speakers cover essential tips like checking the place of service, sharing experiences, and networking with other professionals. We explore various types of rejections in healthcare claims, emphasizing the need to understand their origins and track them meticulously. Discover valuable insights on managing appeals and reconsiderations, staying organized, using timely filing tools, and navigating complex appeal letters. Plus, learn about the importance of resources for identifying plan types and tackling excessive medical documentation delays. Join us for this comprehensive discussion on mastering healthcare...
2024-06-1958 minFor The Love of Revenue CycleLive Denials Q&A 6/6/24 - timely filing, authorizations & credentialingDuring today's live Q&A we had some great discussion about important denials that you and your organization are probably experiencing. We had some great interaction with 28 attendees. Check out the conversation!
2024-06-071h 00For The Love of Revenue CycleExtra Episode: Reducing the Denial Headache with Corey Feldman, founder of Covered HealthCorey started Covered Health to automate the most challenging element of appealing denied medical claims by streamlining the access to diverse databases and sources to pinpoint denial root causes. I decided to partner with Covered because we share the same vision: preventing patients from getting stuck with bills that should be covered by their insurance, and helping to empower revenue cycle management experts to resolve those denials with greater efficiency. We discussed Corey's motivations for starting Covered - his brother Russell's experience with unfair insurance denials during his struggle with Ulcerative Colitis. Corey's family was hit with...
2024-05-0619 minFor The Love of Revenue Cycle*Special Episode - Stop Revenue LeakageDive into the world of healthcare industry in our special episode of PM Symposium where we uncover the many facets of the revenue cycle. Hosted along with Jennifer McNamara, we discuss the impact of practice managers, the importance of understanding the revenue cycle, and how to combat revenue leakage. We explore some of the major challenges including staffing shortages, the lack of standardization and the crucial role of both management and line workers. Tune in to gain invaluable insights, understand the power of community teamwork and informed decision-making. See you at the practice management symposium on February 16th!
2024-02-0843 minFor The Love of Revenue CycleEp. 28 Reporting + AnalyticsHello 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 experie...
2023-10-3010 minFor The Love of Revenue CycleEp. 29 Season 3 Kickoff + Big AnnouncementHello 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
2023-10-3012 minFor The Love of Revenue Cycle6/5/23 Live Q&A - End of PHE; State of the industry; Operational challenges & moreHello Rev Cycle Lovers! This episode is a recording of our live Q&A session today. It is raw and unedited, but that does not diminish the great conversation. We discussed some challenges with the end of PHE, operational challeges that cause denials and also different options for assigning individuals within the revenue cycle. We also spent some time talking about the current state of affairs in our industry related to payer guidelines and staffing shortages. I hope that you enjoy this conversation.
2023-06-0642 minFor The Love of Revenue CycleEp. 27: Prior Auth, Referrals, Precertification, etc.In today's episode, we go back to the "Language of Revenue Cycle" to discuss the differences between the concepts of prior auth, referrals, precertification and predeterminations.
2023-04-2316 min2023-04-0400 minFor The Love of Revenue CycleThank You For Your Patience...In this short episode I thank the listeners for their patience while I took some time off and announce the new podcast schedule with new episodes.
2023-03-2203 minFor The Love of Revenue CycleAnnouncementThis is an announcement regarding upcoming changes to the podcast schedule.
2022-12-0504 minFor The Love of Revenue CycleEp. 26: Revenue Cycle Management with 2022 challengesThe topic I have today kind of covers several topics. I had a hard time coming up with the title of this episode because it isn't about just one thing. But let's just say that if you are struggling with most of the country to run your revenue cycle with staff shortages, crazy payer expectations and the patient as a consumer, then you have come to the right place. Let's jump in!
2022-11-1432 minFor The Love of Revenue CycleEp. 25: Institutional vs. Professional BillingToday, we are going to talk about some of the differences between institutional vs. professional billing or hospital vs. physician billing. I want to remind you this is very high level and basic. But I think it's a good introductory into those differences.
2022-10-3116 minFor The Love of Revenue CycleEp. 24: Medicare A, B, C and DToday, we are going to talk about the various part of Medicare: A, B, C, and D. I'll share with you what each part is and then share some of the payment or reimbursement models for Medicare.
2022-10-2418 minFor The Love of Revenue CycleEp. 23: AppealsToday, we are going to discuss appeals. What are they? What is their purpose? What makes a great appeal?
2022-10-1124 minFor The Love of Revenue CycleLive Q&A 10/4/22 - Free CEUs, accessing payer policies, and moreDuring today's live Q&A, we talked about billing emergency visits with procedures in the inpatient setting, options for free CEUs, how to access payer policies and how we can integrate the topic of specialties into the podcast. Great conversation!
2022-10-0555 minFor The Love of Revenue CycleEp. 22: Revenue Cycle KPIsToday, we are going to discuss five KPIs. Common key performance indicators in physician revenue cycle. We'll discuss how the KPIs are formulated and how they can be used to maintain an efficient and effective revenue cycle.
2022-10-0316 minFor The Love of Revenue CycleEp. 21: Edits, Rejections, Status and DenialsToday, we are going to discuss edits, rejections, claim statuses and denials. We'll be taking a look at each concept to understand their differences and how it is so easy to confuse them.
2022-09-2820 minFor The Love of Revenue CycleEp. 20: Quick Hit Acronyms HIS, HIM, HIE, HITIf you have been in healthcare for more than 10 seconds you know that we love our acronyms. I'll be sporadically talking about acronyms over the coming weeks. Today's episode is about the acronyms HIS, HIT, HIE and HIM (and we are throwing a few others in there). Let's jump in.
2022-09-2808 minFor The Love of Revenue CycleZoom Live Q&A 9/20/22 - Welcome backThis is a recording of our Live Q&A from 9/20/22. We are back after several months off. This is an open forum time to discuss anything with me or between those who attend. Today's discussion was some catching up and getting to know you and discussing some of the challenges of billing. Please send me your email address if you would like to be added to this call every other week.
2022-09-2242 minFor The Love of Revenue CycleEp. 19: Credentialing, Contracting, EnrollmentWelcome 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.
2022-09-1515 minFor The Love of Revenue CycleSeason 2 TeaserI am thrilled to be back! Thank you for your patience and support. As the title would indicate, this episode is a teader of what is coming up in Season 2. First episode of the season will be streaming on September 12th!
2022-09-0812 minFor The Love of Revenue CycleEp. 18: Day in the Life of a Medical BillerToday is the second episode in our Day in the Life Series. I've been really looking forward to bringing you this series. In the next few episodes, we will be talking about the various roles within the revenue cycle. I believe that it is important for all of us to understand the responsibilities, pressures and expectations involved in these roles. Understanding the people around us is the first step to compassion and empathy in our relationships. And when we work together with compassion and empathy, we have more efficient and effective revenue cycles. In today's episode, I am chatting with...
2022-05-1919 minFor The Love of Revenue CycleEp. 17: Boost Your Career with Emily HawkinsAre you stuck in a job that you are desperate to get out of? Do you feel like your loyalty is holding you back? Have you been searching for a job and just not getting anywhere? Today's episode is the one for you. Emily Hawkins mission is empowering the unfulfilled and unrecognized to amplify their job search and career to make a salary they deserve doing what they love. Here is the link to her master class as mentioned in the podcast. https://learn.emilyhawkins4u.com/burn2break-masterclass/
2022-05-121h 092022-05-0701 minFor The Love of Revenue CycleEp. 16: Day in the Life of a Revenue Cycle ManagerToday is the first episode in our Day in the Life Series. I've been really looking forward to bringing you this series. In the next few episodes, we will be talking about the various roles within the revenue cycle. I believe that it is important for all of us to understand the responsibilities, pressures and expectations involved in these roles. Understanding the people around us is the first step to compassion and empathy in our relationships. And when we work together with compassion and empathy, we have more efficient and effective revenue cycles. In today's episode, I am chatting with...
2022-04-2830 minFor The Love of Revenue CycleEp. 15.3: Common Modifiers, Part 3Today's episode is the final part in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider's documentation, then it's in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in t...
2022-04-2127 minFor The Love of Revenue CycleEp. 15.2: Common Modifiers Part 2Today's episode is part 2 in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider's documentation, then it's in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in the outs...
2022-04-1429 minFor The Love of Revenue CycleZoom Live Q&A 4/5/22 Breaking Down Billing for New Drugs with Stephanie ThebargeIn this live Q&A, Stephanie Thebarge CPC, CPMA, CPPM, CPB, CEMC, CHONC, PESC shares with us her extensive knowledge of drug billing. If you have any further questions or would like a copy of the presentation, please reach out to her at sthebarge@gmail.com.
2022-04-071h 27For The Love of Revenue CycleEp. 15.1: Common Modifiers Part 1Today's episode is part 1 in our 3-part series on modifiers in the clinical or office setting. As many of you know, modifiers are an essential part of the revenue cycle. They have a direct effect on the revenue flow of the organization. Decisions on appending the correct modifier starts with the provider's documentation, then it's in the hands of the coding and charge capture teams. Claims review before submission is the final opportunity to append the appropriate modifier before it gets to the payer. Unfortunately, most of us learn about modifiers when we are resolving unpaid claims in the outs...
2022-03-2530 minFor The Love of Revenue CycleZoom Live Q&A 3/22/22 - Modifier introIn this live Q&A we have a sneak peek into the modifier series. We discuss modifiers 24, 25 and 79. If you love it, check out the next 3 episodes as we dive into common modifiers.
2022-03-2421 minFor The Love of Revenue Cycle3/17/22 No Surprises Act Live Q&A Panel The No Surprises Act has definitely been a surprise to many of us! Do you still struggle with details in the policy and how to be compliant when applying them to operations? This is a recording of the Live Q&A Panel we held today with our subject matter experts. I have no doubt that you will find helpful information within this great conversation.
2022-03-171h 03For The Love of Revenue CycleEp. 14: AAPC and Careers with Rae JimenezI am so excited to introduce the guest in this episode. I have to admit that I was fangirling a little bit. If you are involved with AAPC or have taken advantage of their educational opportunities, you have probably heard of her. So without further ado, my guest today is Rae Jimenez. In our conversation you will learn that her current role at AAPC is VP of products. But you will also find out so much more about her and probably figure out why I admire her so much. She is smart, gracious, and eager to be a part of tea...
2022-03-1759 minFor The Love of Revenue CycleEp. 13.2: Marketing a Billing Company with Quiana CraigToday's episode is part 2 in a series in which Quiana Craig shares with us her journey in growing her company. If you didn't catch part 1, press pause on this one and go back to listen. If you have been thinking about starting your own company or are looking for ways to freshen up your current one, stay tuned and get some great tips from a pro.
2022-03-1021 minFor The Love of Revenue CycleZoom Live Q&A 3/8/22- AppealsAre you feeling overwhelmed with how to properly create and submit an appeal. Well, In this live Q&A we talked all about appeals. Be sure to stay tuned to the end because there are a lot of great questions from the attendees.
2022-03-0955 minFor The Love of Revenue CycleEp. 13.1: Starting a Billing Company with Quiana CraigToday we have a treat for you. Quiana Craig will be hosting the podcast. She is a certified professional biller, licensed AAPC approved instructor and the owner of Express Medical Billing & Consulting. Quiana reached out to me last summer to bolster my courage in starting the podcast. She had so much belief that she agreed to be the first sponsor. Words cannot express how much I have appreciated her encouragement and excellent promotion on Instagram. Today she is going to share with us her journey to starting her business in 2008. If you have been thinking about starting your own compan...
2022-03-0320 minFor The Love of Revenue CycleEp. 12: Revenue Cycle ManagementAs the title suggests, today's episode is all about managing the revenue cycle. I'll share with you the processes that I've used over my career to improve and maintain best practices and KPIs. You might want to take notes on this one! I will be sharing the various reports that I use and it might get tough to retain the details. Let's get to it!
2022-02-2445 minFor The Love of Revenue CycleEp. 11.3: Common Denials, Part 3Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
2022-02-1730 minFor The Love of Revenue CycleZoom Live Q&A 2/16/22In this live Q&A we had a great conversation about difficulty resolving PTAN issues, emergent denials and is bundling a payment or coding issue. There are also some big announcements.
2022-02-1646 minFor The Love of Revenue CycleEp. 11.2: Common Denials, Part 2Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
2022-02-1041 minFor The Love of Revenue CycleZoom Live Q&A 2/2/22We had some great collaboration on today's live Q&A. The attendees shared their struggles with being new to billing, billing and coding without a software and some great modifier questions. Take a minute and listen!
2022-02-0353 minFor The Love of Revenue CycleEp. 11.1: Common Denials, Part 1Have you ever been overwhelmed with denial management? Maybe you are responsible for a list of denied claims or maybe you are responsible for reducing the number of denials. In today's episode we will reduce the overwhelm by simplifying common denials by breaking them down into what they are, how they are caused, suggestions for resolution and best practice tips for prevention.
2022-02-031h 00For The Love of Revenue CycleZoom Live Q&A 1/26/22In today's Live Q&A we had a great discussion regarding operational challenges with the Good Faith Estimate as required by CMS' No Surprise Act. We also discussed a challenge that Ashley is having with out of network denials on inpatient procedures stating non-emergent. As referenced in the recording, Stephanie Thebarge and Ashley Szocinski can both be reached through LinkedIn. If you are interested in being on the No Surprise Act Panel, please contact me.
2022-01-2649 minFor The Love of Revenue CycleEp. 10.2: Marketing a Billing Company with Georgi GeorgievHello friends and welcome to episode 10 of For the Love of Revenue Cycle. Today's episode is a continuation of last week's episode in which my friend Georgi shared with us his experience in starting his own billing company. This week he is going to share with us how to market a billing company. The dos and don'ts that he learned firsthand. If you are thinking about branching out on your own, I think that you will find his tips and resources to be very helpful. This is not in an interview format. We decided that due to the nature of the...
2022-01-251h 01For The Love of Revenue CycleEp. 10.1: Starting a Billing Company with Georgi GeorgievI can't tell you how much I've been looking forward to sharing this episode with you. We are taking a little break from our Nuts and Bolts series and will be hearing from a friend of mine. I met him years ago when I was an officer of the AAPC Des Plaines Local Chapter. I will let him introduce himself because he will do much better than I. I'm really looking forward to hearing him tell his story of how he started his billing company. I personally think it's quite inspiring. This is not in an interview format. We decide...
2022-01-181h 09For The Love of Revenue CycleZoom Live Q&A 1/12/22In today's live Q&A we discuss some tips to be on the lookout for when sharing and receiving resources on social media, articles, webinars, documents, etc.
2022-01-1322 minFor The Love of Revenue CycleEp.9 Denial Management Hello friends and welcome to episode 9 of For the Love of Revenue Cycle. I am so excited to be back here again with you. I would like to thank you for tuning back in and I want to give a big welcome to our new listeners. This episode is the first segment of part 6 in a 7-part series on the Nuts and Bolts of Revenue Cycle. Due to the amount of content regarding denials, I decided to split part 6 up into two segments. Today's episode will be about denial management and then next week's episode will be about how to reso...
2022-01-1131 minFor The Love of Revenue CycleZoom Live Q&A 1/5/22In this live Q&A, we discuss in more detail some of the topics that Elisa Garn and I discussed in the most recent episode. We talked about how to create positivie work environments and how to effectively work with direct reports that we may not see eye-to-eye with. Finally, we discussed the advantages of managing teams with a more "human" approach then "employee" approach.
2022-01-0732 minFor The Love of Revenue CycleEp. 8: Elisa Garn Conversation on Resumes and Personal BrandingI am so thrilled that Elisa Garn was willing to share her expertise in human resources and recruiting with us today. I hope that you find this conversation as interesting and helpful as I did. I learned so much! Before we get started, let me tell you a little bit about Elisa. Elisa has 15+ years of experience with HR, with an expertise in modern, progressive and human-centric strategy. She specializes in personal branding, employer branding and creating work environments that foster belonging and best-of-class cultures which set people free to do great work. Here are the books she...
2022-01-041h 24For The Love of Revenue CycleZoom Live Q&A 12/29/21In this Q&A we discussed the No Surprise Bill Act.
2021-12-3127 minFor The Love of Revenue CycleEp. 7: Infusion Auditing, Billing and ComplianceHello friends and welcome to episode 7 of For the Love of Revenue Cycle. I am so excited to be back here again with you. I would like to thank you for tuning back in and I want to give a big welcome to our new listeners. I can't tell you how much I've been looking forward to sharing this episode with you. We are taking a little break from our Nuts and Bolts series and hosting our first subject matter expert. So exciting. Today's expert is Stephanie Thebarge. I hope that you find this conversation about her career path and abou...
2021-12-281h 35For The Love of Revenue CycleZoom Live Q&A 12/22/21In today's Q&A we discuss handling denials, credits and patient balance.
2021-12-2357 minFor The Love of Revenue CycleEp. 6.2: AR Followup, Part 2 of 2Hello friends and welcome to part 2 of episode 6 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. This episode is a continuation of episode 6 in which we discuss AR followup in our series on the Nuts and Bolts of Revenue Cycle. AR followup is kind of our intro into the big one about denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is fo...
2021-12-2133 minFor The Love of Revenue CycleZoom Live Q&A 12/15/21Today's scheduled Q&A did not actually take place because of a power outage in my area. This recorded episode is the planned topic for that day and it is a sneak peek into the top denials. I dive into COB and duplicate denials.
2021-12-1733 minFor The Love of Revenue CycleEp. 6.1: AR Followup, Part 1 of 2Hello friends and welcome to episode 6 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. This episode about AR followup is another part of our series on the Nuts and Bolts of Revenue Cycle and it will be a little different because it will be split into 2 parts. AR Followup is kind of our intro into the big one about denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more...
2021-12-1435 minFor The Love of Revenue CycleZoom Live Q&A 12/8/21In this Q&A we started off with a great conversation regarding 2022 coding updates and the best practice for distributing this information within an organization. Then we talked about the Medicare surprise billing ruling. Here is a link to more information on CMS website. We finished our call by talking about coding departments that are responsible for helping denials.
2021-12-0838 minFor The Love of Revenue CycleEp 5: Payment Posting, Claims and StatementsHello friends and welcome to episode 5 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. Today is part 4 of our 7-part series called Nuts and Bolts and we'll be talking about claims, payment posting and statements. This is the last episode before we jump into AR follow-up and denial management. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1). The content is focused on how we can st...
2021-12-0734 minFor The Love of Revenue CycleZoom Live Q&A 12/1/21In this Q&A, we talked about certifications and career path in revenue cycle.
2021-12-0142 minFor The Love of Revenue CycleEp 4: Coding, Charge Capture/Charge EntryHello friends and welcome to episode 4 of For the Love of Revenue Cycle. I am so excited to be back here again with you and welcome to our new listeners. Today is part 3 of our 7-part series called Nuts and Bolts. Today, we'll be talking about coding and charge capture/charge entry. For those of you who may just be joining us, we have been walking through the steps of the physician revenue cycle (more details are in episode 1. The content is focused on how we can streamline processes for better efficiency and to reduce denials. Ultimately, we're trying to fi...
2021-11-2923 minFor The Love of Revenue CycleZoom Live Q&A 11/24/21In this Q&A, we discuss federal plans as 2ndary, coding software with annual coding updates, hiring medical billers and advancing in the medical field. Don't forget to send me your email address to be included.
2021-11-241h 01For The Love of Revenue CycleEp 3: Registration, Appointments, AuthorizationsThe Nuts and Bolts series breaks down in more detail the steps of the revenue cycle that were talked about in episode one, this will be a six-part series in which we will discuss the impact that each step has on the revenue in the practice. This is the second episode in the nuts and bolts series. In this episode, Vanessa will be covering the front end of physician revenue cycle including appointments, scheduling preregistration, registration, and authorization. She will be focusing on how to streamline processes for better efficiency and to reduce denials. Ultimately this will...
2021-11-2317 min2021-11-1840 minFor The Love of Revenue CycleEp 2: Credentialing and System Set UpThe Nuts and Bolts series breaks down in more detail the steps of the revenue cycle that were talked about in episode one, this will be a six-part series in which we will discuss the impact that each step has on the revenue in the practice. In this first episode in the nuts and bolts series, Vanessa will be covering Credentialing and System Set Up. She will cover the important pieces involved in these two foundational steps of physician revenue cycle and share with you how these pieces can help to bring in revenue much faster and...
2021-11-1635 min
The AAPC PodcastChoosing The Right Certification | Vanessa Moldovan, CPC, CPMA, CPPM | AAPC Social HourVanessa Moldovan, CPC, CPMA, CPPM joins us to discuss certifications. Learn which certifications can help you start your career and how multiple certifications can take your career to the next level.
2021-07-1547 min