For The Love of Revenue Cycle

Show 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

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 [email protected] 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

Maximizing 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 performance.

00:00 Introduction to the Podcast and Host

01:23 Episode Overview: Maximizing Provider Revenue

02:01 Understanding Payer Contracts

03:04 Prior Authorization Guidelines

05:28 Payer Reimbursement Policies

08:08 Clean Claim Requirements

11:34 Carve Outs in Payer Contracts

14:03 Payer Plan Limitations

16:24 Fee Schedules and Contracted Rates

21:29 Requests and Recoupments of Overpayments

23:34 Denials Without Proper Justification

25:10 Timely Filing Guidelines

27:17 Escalating Reimbursement Issues

29:11 Conclusion and Next Steps

Are 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.