NSCHBC Edge Podcast

In the context of medical and/or dental insurance, ADR refers to Additional Documentation Request. This is a request from an insurance payer (like Medicare) for additional records to support a claim. It's not a sign of wrongdoing, but rather a way to ensure compliance with policies and verify the validity of claims. Ignoring these requests, or failure to meet their deadlines, can result in a loss of revenue and trigger additional payers' audits and ADR's. Terry outlines the ADRs and best practices to make sure your staff is on top of these requests, which helps save your revenue.

In-house billing offers enhanced internal control and potential return on investment but entails higher costs and staffing challenges. Conversely, outsourcing is cost-effective, transparent, and consistent but may result in skewed control of financial operations and introduce hidden costs.Terry discusses this important topic with healthcare consultant Donna White, covering the best option for different-sized practices.

On this edition of the Edge Podcast, Terry welcomes Healthcare Compliance Consultant, Stephanie Allard. The hosts discuss objectives when hiring an external consultant, such as budgets, objectives, outcomes, expectations, and more.Tune into this important and informative episode to make sure you are prepared

Are Dental Billing and Medical Billing the Same Thing?Terry Fletcher discusses the similarities, differences, and where crossover between dental and medical billing.Tune in for advice that can assist clients on both sides to be accurate in their coding and billing processes.

This month on the NSCHBC Edge Podcast, Terry welcomes back, NSCHBC member, Merikay Hunt CHBC, to discuss the pros and cons of a remote versus in-person versus hybrid workforce. When comparing corporate and healthcare sectors, remote work generally tends to be a better option for corporate roles due to the nature of many corporate jobs being more easily adaptable to digital platforms. However, healthcare often requires in-person patient interaction, making remote work less feasible in most cases. The best choice depends on the specific role and individual needs within each sector.

On today's NSCHBC Edge Podcast, Terry speaks with healthcare attorney and fellow NSCHBC member, Ericka Adler, to identify suspected theft in a medical practice. Terry and Ericka discuss how to identify and prevent theft, plus educate your staff and providers so you are aware of potential red flags. Some areas to focus on include cash handling, prescription drug inventory, and billing practices. The hosts also talk about what to do if you find suspicious activity, how you can further investigate with the use of proper documentation, and the potential involvement of external auditors or legal counsel.

CPA versus bookkeeper: what is the role comparison in Healthcare, and medical practices? What does a physician or a physician practice need and why?A bookkeeper, although helpful for day-to-day accounting, payroll, and expenditures accounting. When the medical provider needs tax breaks information, provider relief funding accounting and deadlines, and retirement planning, what's the better option and why?Terry talks with Healthcare CPA and NSCHBC President Shane Pickett on the best option for success.

In this episode of the NSCHBC Edge podcast, Terry welcomes back David Zetter of Zetter Healthcare to discuss Ambulatory Surgery Centers (ASCs) versus Office Based Labs (OBLs).Topics of discussion include:Which one is easier to get funding for?Are there differences in OSHA safety protocols?Is there an approved list for each that differs?And finally, which one have you seen as more profitable?

The NSCHBC Edge Podcast welcomes fellow NSCHBC member, Rozmin Bapat to the show to discuss remote workers.Rozmin joins us from CodeRite Healthcare Consulting, based in Allen, TX. They are a billing, consulting and RCM company specializing in physician billing services.Terry and Rozmin define what it means to be a remote worker.What are some of the pros and cons of remote work and managing it. Also, how does remote work compare versus bringing everyone back in-person either hybrid or full-time?Healthcare jobs can be tricky in this sense. This episode will provide insights on how to make remote employees a success.

Many practices hire nurse practitioners and physician assistants (known as mid-level providers) along with RNs, MAs, and other clinical staff. Still, sometimes the lines get blurred on what services they can individually provide. Terry Fletcher, with fellow healthcare consultant and industry expert, Betty Hovey, discusses these compliance issues and gives medical practices insight into the pros and cons of these hires.

Healthcare policies, Medicare cuts, and election year promises and rhetoric all affect how a patient will receive or not receive benefits. We have so many Congressional policy rules on the table that will impact not only Medicare patients, but all patients as we may get a new HHS director as well when the presidency changes. Listen to this episode of the Edge podcast to know what is real and what is noise, as Terry Fletcher and Sean Weiss discuss healthcare and politics in 2024.

Staffing shortages continue to plague the healthcare industry, creating a vicious cycle where overworked healthcare professionals question their ability to continue.A recent NIL report showed that 81% of clinicians want states to implement laws governing staff-to-patient ratios, which they ranked as one of the biggest considerations when taking a job.As more medical professionals leave hospitals, physician practices, and clinics, consumers find their access to quality care threatened. It's also not just clinical staff, it is administrative staff in healthcare as well.Terry speaks with consultant Debra Phairas, on this episode of the Edge podcast on how to tackle staffing shortages in this climate of post-COVID burnout.

In the setting of AI - Artificial Intelligence - Healthcare is running head first into possible risk. In this month's episode of the NSCHBC Edge Podcast Terry and Vinny Sankaran tackle the PROS and CONS of AI in Healthcare.Data suggests AI helps health providers practice their profession and invest their time in engaging with patients rather than spending time on transcribing notes and administrative work. Also, when used safely and appropriately, this could exponentially expand evidence-based medicine to improve health outcomes and people-centered care.However, there are some CONS. Risks from AI include poor outcomes from algorithms (due to bias, low-quality data, lack of transparency, or usage in inappropriate contexts) which is a concern. HIPAA issues are a concern as well as cyber-hackers. We look at the current and future landscape of AI in Healthcare.

On this month's episode of the Edge Podcast Terry welcomes back Healthcare Consultant Jackie Coult as they discuss the ins and outs of physician and dental practice startups.Terry and Jackie talk about having a plan, financial woes and potential funding, staffing, location and of course, what kind of practice you'd like to have.Join us for a fun and engaging conversation.

More than 100,000 doctors have left private practice and become employees of hospitals and other corporate entities since 2019. Today, nearly 3 in 4 physicians are employees of larger health care entities or other corporations — a record high.The cost of managing a medical practice — whether in primary care or a specialty practice — has surged. Not to mention, reimbursement rates from Medicare have not kept pace with higher operational costs. So how does a physician make sure they are collecting all that is due to them, not just from insurance payers, but where it begins: At the front desk?In today's NSCHBC Edge Podcast, Healthcare Business Consultant David Zetter and Terry Fletcher, discuss front desk collections, making sure you have the right staff at the front desk and billing office to collect those out of pockets and share of costs. How to manage workflows, and how to insure you are getting every penny you are entitled to.

Terry welcomes fellow NSCHBC Member and Healthcare Consultant Anthony (Tony) Werner to discuss reducing administrative burden and costs incurred by meeting payer requirements.Most likely there will be resistance from most payers to incorporate intraoperability terms in contracts, including those required by legal or governmental directives. Terry and Tony discuss the complexities of these discussions and how to be successful in the process of contract negotiations.

There is always competition for patients and location in healthcare, but how do “non-compete” contracts affect patient care? Or a physician's ability for career advancement? How do different states handle this hot topic?Healthcare Attorney Amanda Waesch and Edge host Terry Fletcher tackle this discussion today looking at the legal and business angles and relationships that will factor into these agreements.Also, are non-compete clauses always valid and enforceable? Listen to find out.

Christine Hall and Terry Fletcher, both SMEs in the Telehealth space, discuss the new rules for 2024, what the flexibility extensions “really” mean to physicians, and what traps of FWA not to fall into.For anyone currently participating in the Telehealth delivery of medicine, this is an important podcast to listen to.

In this month's episode of the NSCHBC Edge podcast, Terry talks to life NSCHBC member, Kathy Moghadas, RN, CLHRM, CHBC, CHCC with Associated Healthcare Advisors, to discuss where the healthcare industry started back in the 80's and where we are headed with all of the digital advancements, including AI.Is it all good? Not even close. Listen and find out why!

As you know BH and MH services are now being covered by Medicare and many commercial payers. Also, coverage has expanded like nothing we've ever seen. Even Telehealth has made some permanent changes to coverage that is only for Behavioral Health and Mental Health Services.To discuss this topic and to look at the proposed Medicare Final Rule and Fee Schedule for 2024, Terry invites fellow NSCHBC member Sonda Kunzi to the podcast.There are some services that we are concerned about and we are wondering where the specific guardrails and payment policies are.

Cyber Security in Healthcare, focuses on preventing attacks by defending systems from unauthorized access, use, and disclosure of patient data. The primary aim is to ensure the availability, confidentiality, and integrity of critical patient data. If compromised, this could put patient lives at risk.The more we add digital access the more interconnectedness between different healthcare systems comes with increasing healthcare cybersecurity threats.Edge podcast host Terry Fletcher discusses this threat to physician and dental practices with Debi Carr of DK Carr and Associates. Debi brings light to the importance of risk analysis, security compliance plans, and knowing the limitations of your IT department when it comes to this risk.You don't want to miss out on this important podcast discussion.

In Healthcare, is credentialing the same thing as contracting?No, credentialing is the process of reviewing the doctor's qualifications while contracting. Payer enrollment is the process of applying for and obtaining participation contracts with insurance plans for your provider or entity.Award-winning podcast host Terry Fletcher and Healthcare Consultant Scott Graham navigate through these differences while giving tips on how to be successful in payer contract negotiations and provider credentialing.Join us for these important business of medicine tips.

An MSO is a company that provides non-clinical services to medical practices, ambulatory care facilities, or other healthcare providers. Services provided by an MSO may include some or all of the following: Billing and Collection. Accounts Payable. RCY, Contracting and Credentialing, and Staffing. What can an MSO do for your practice? Can you create your own?In this episode, Terry discusses all options with Healthcare CPA and Financial Consultant Jacki Jacox. Don't miss this important topic that could provide many practices with administrative relief.

Is your practice considering a merger? Is the phrase “bigger is better” a true statement when it comes to private medical practices?Join us on this episode of the NSCHBC Edge podcast as SME Reed Tinsley CPA discusses the complexities of practice mergers.It's not an overnight process to be successful in a merger. Reed offers tips to work your way through the myriad of issues and processes.

On this episode of the Edge Podcast, Terry welcomes fellow NSCHBC member Sandy Shecter. Sandy is a CPA and the Director of Solutions for Rehmann, a fully integrated, professional advisory and asset management firm working to empower success for businesses of all sizes and industries.Our topic today is physicians and medical practices who manage their finances in-house. Should they outsource to a CPA who knows the healthcare environment?

In today's world of marketing, the healthcare provider is sometimes overlooked.Have you asked these questions?What is it about Google that is important to know in the healthcare space?What does SEO presence mean and can anything alter those algorithms?How can a medical or dental practice be sure they are being found in the right space but also the most positive light?In this month's NSCHBC Edge podcast, Marketing Consultant and SME Expert Carl White joins Terry Fletcher to discuss the best strategy for marketing your practice and where to start.

Is your staff suffering from spring fever? And how can you motivate the “keepers” with the nationwide landscape of staffing shortages?In this episode, Terry Fletcher is joined by healthcare consultant and fellow NSCHBC member Merikay Hunt to discuss the employer-employee relationship, and how to keep the staff you not only want, but also need.

On this episode of the NSCHBC Edge Podcast, Terry welcomes NSCHBC member and Certified Healthcare Business Consultant, Jackie Coult, who doubles as an SME in practice and revenue cycle transparency and negotiations.Physicians: we have your back! Jackie shares her expertise on how to set gross charges, and what the best practice methods are for setting rates so revenue isn't lost. The hosts also discuss how practices and providers should monitor the payor reimbursement annually so that changes don't harm your bottom line.

This month on the NSCHBC Edge Podcast, Terry welcomes a new member, Healthcare Consultant Christine Hall, to discuss the importance of Compliance Programs, Policies, and Accountability for actions in a physician's practice.They discuss how to start the process of implementing a Compliance Program, and what departments need to have clear rules and best practice policies to be successful. Don't forget the ACA and OIG state clearly that to collect government funds (Medicare payments, PRF, etc.), as it is “required” to have a compliance program in place.Also, commercial insurance contracts now require some kind of compliance program as part of a your contract participation. Are you prepared?

Terry welcomes back, our own “compliance guy” and NSCHBC member, Sean Weiss, to discuss the last-ditch regulatory add of CFR 42, on self-reporting, and the proposed changes to the 60-day rule for Medicare. This means that if you find an overpayment from a federal payer, what is your responsibility to identify it, return it, and what is the timeline? Terry and Sean discuss the ins and outs of this process and the importance of being proactive in your compliance and self-auditing policies.

In this episode of the NSCHBC Edge podcast, Terry welcomes back Healthcare attorney and NSHCBC member Amanda Waesch Esq, to discuss the Single Audit Requirements, for providers and recipients that spent $750,000 or more in federal funds, including Provider Relief Fund (PRF) payments.There is some confusion on who has to report, when and why. Amanda and Terry try and clear up this confusion, and give you the tools and cited references for compliance.

What is PE? At its core, PE is an alternative investment class consisting of capital that is not listed on a public exchange. PE is comprised of funds and investors that directly invest in private companies. Most PE firms invest in companies and then look to sell their stake in 3 to 5 years for a substantial profit. So how does this translate to the Healthcare field with Medical and Dental practices being courted daily by PE investors? Listen to the NSCHBC Edge Podcast this month to get insights from healthcare attorney Bill Kalogredis and podcast host Terry Fletcher to consider your pros and cons options.

How much does the average physician retire with? When is too soon to start planning? What age does a physician usually retire? Did the pandemic change the retirement mindset? Are physicians retiring early due to financial readiness or burnout? Traditional 401(K)s? Pensions? IRA's? What is the right fit for a physician and/or dentist? Listen to this edition of the NSCHBC Edge podcast for all of the answers to these important questions, as Terry talks with fellow NSCHBC member and Healthcare CPA Marc Lion.

Many practices will hire coders for coding jobs or billers for the billing department, relatives or newbies for the front desk, or hire from within to fill RCM positions in Medical and Dental Practices. But when mistakes are made, or updates are not realized, the RCM suffers. Host, and Healthcare Coding and Reimbursement Consultant, Terry Fletcher, joins fellow NSCHBC Member and industry expert, David Zetter of Zetter Healthcare, to discuss staffing issues and problems that can arise when the wrong people are in the wrong job: and the positives and expectations when the right fit happens. Listen to this episode of the NSCHBC Edge Podcast for answers to the right questions.

In this edition of the NSCHBC Edge Podcast, Terry Fletcher invites NSHCBC members Vinod Sankaran and Misty Haralson for an RCM Round table discussion.Hear fellow healthcare consultants in the RCM space discuss physician and dental practice pain points and how to be efficient in your Revenue Cycle Management efforts. Join us for this important discussion focusing on verifying eligibility, billing errors, denial management, and IT.

This edition of the NSCHBC Edge Podcast targets Physician Practice Valuations. Are you asking yourself: "Is it time to sell my practice?", "How do I get started?", or "How long will it take to sell my practice?"If so, you've come to the right place! Terry Fletcher, along with fellow NSCHBC member and certified valuation consultant Alex Nechay, CVA CHBC, will be talking about knowing when it is the right time, the process of valuation, and who to go to, to begin the process.

In this month's NSCHBC Edge Podcast, Terry dives into the ASC (Ambulatory Surgery Center) and OBL (Office Base Lab) start-ups and what the market is telling us now when it comes to giving patients options when having their procedures and surgeries.As we all know hospital costs have risen and continue to do so, so what are the pros and cons and options for physicians when considering opening an ASC? What are the Costs? What are the legal challenges?Terry welcomes back NSCHBC members, Healthcare Business Consultant David Zetter, and Healthcare Attorney Amanda Waesch to discuss this topic and help you make that decision.

In this month's NSCHBC Edge Podcast, Terry dives into the ASC (Ambulatory Surgery Center) and OBL (Office Base Lab) start-ups and what the market is telling us now when it comes to giving patients options when having their procedures and surgeries.As we all know hospital costs have risen and continue to do so, so what are the pros and cons and options for physicians when considering opening an ASC? What are the Costs? What are the legal challenges?Terry welcomes back NSCHBC members, Healthcare Business Consultant David Zetter, and Healthcare Attorney Amanda Waesch to discuss this topic and help you make that decision.

Can Behavioral Health and Mental Health services be integrated into all specialty practices? Or are they limited to General Practice, Family Practice, Internal Medicine, Psychology Practices, or Psychiatric Practices?In this episode of the NSCHBC Edge Podcast Terry welcomes back Adam Middleton, SME, to talk about this topic.The hosts also discuss how to look at financials and staffing for the Behavioral Health specialty.

Can Behavioral Health and Mental Health services be integrated into all specialty practices? Or are they limited to General Practice, Family Practice, Internal Medicine, Psychology Practices, or Psychiatric Practices?In this episode of the NSCHBC Edge Podcast Terry welcomes back Adam Middleton, SME, to talk about this topic. The hosts also discuss how to look at financials and staffing for the Behavioral Health specialty.

To date, there has been a swing toward physicians becoming employed by hospitals. Initially, joining an academic medical center or hospital system can be a great start for physicians coming out of training. But we NEED private practice providers. Private practice, as we know it, will progressively evolve with new restrictions as we see the consolidation of practices under equity buyout models. Talking about this is Terry Fletcher and Debra Phairas, NSCHBC, Certified Healthcare Business Consultant and owner of Practice Liability Consultants in Napa, CA.The hosts chat about how physicians can get back to private practices, and how to understand the entrepreneurial mindset needed for success. This is the best time in history to be self-employed and be your own CEO of your life, CEO of your medical and/or dental practice, and find that work-life balance model everyone wants. 

To date, there has been a swing toward physicians becoming employed by hospitals. Initially, joining an academic medical center or hospital system can be a great start for physicians coming out of training. But we NEED private practice providers. Private practice, as we know it, will progressively evolve with new restrictions as we see the consolidation of practices under equity buyout models. Talking about this is Terry Fletcher and Debra Phairas, NSCHBC, Certified Healthcare Business Consultant and owner of Practice Liability Consultants in Napa, CA.The hosts chat about how physicians can get back to private practices, and how to understand the entrepreneurial mindset needed for success. This is the best time in history to be self-employed and be your own CEO of your life, CEO of your medical and/or dental practice, and find that work-life balance model everyone wants. 

This important and timely episode of the NSCHBC Edge Podcast focuses on Provider Relief Funding, plus all of the money spent over the past year during the COVID-19 pandemic to assist physicians, dentists, and hospitals. Are you ready for TAX season? Chris Hundt CPA joins Terry Fletcher to discuss all things Provider Relief Funding.It's time to make sure you've met reporting deadlines, and have documentation of COVID losses, expenses, and funding distributions. Plus, the hosts discuss a surprising source of income with the Employee Retention Credit.

Back in 2010, the OIG and HHS established a Medicare self-referral disclosure protocol (SRDP) that sets forth a process enabling providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute. Along with self-referrals, CMS published a final rule for the reporting and returning of overpayments that fall under the SRDP protocols. In this episode of the Edge Podcast, Terry Fletcher welcomes back healthcare attorney and NSCHBC member Amanda Waesch, to discuss these topics and how this process works: and what could happen if it's not followed.

Welcome to the first NSCHBC Edge Podcast of the new year. Terry Fletcher is joined by Maureen Uy of Associated Marketing, to explore the topic of social media for medical and dental practices. What is necessary to make sure you are on top of the information highway? A social media platform can generate both good and bad reactions, but it can also help you grow your patient population.The hosts share their insights on what content to publish and how often, plus what platforms are best suited for healthcare entities, and how to respond to the messages they can generate.

In this episode of the NSCHBC Edge Podcast Terry Fletcher welcomes fellow NSCHBC Member and Consultant Sean Weiss to discuss compliance plans for physician practices.Having a compliance program in place to address detected offenses and take corrective action is necessary with the advent of the Omnibus vaccine mandates, OSHA regulations for safety, and the OIG's requirement for Medicare and Medicaid providers.It is imperative practices take a look at their corporate compliance programs and how to respond to potential regulatory infractions. Also discussed is the difference between job descriptions versus compliance manuals, and how payer contracts are now included in their agreements.

Nearly two years into the current pandemic, Telehealth continues to make headlines.In the latest episode of the NSCHBC Edge Podcast, Terry Fletcher chats with healthcare consultant David Zetter, CHBC, of Zetter Healthcare, about a number of topics. Among those discussed include 1135 Waivers still in place, Patient Consents that have expired, Audio and Video Encounters, and the CARES Act. The hosts also mention individual states that have either extended or waived their state mandates for Telehealth. Are you on top of the current rules? Listen to find out!

In this episode of the NSCHBC Edge podcast, host Terry Fletcher is joined by NSCHBC member and healthcare attorney Amanda Waesch. They discuss the "realities" of HIPAA and what it means in terms of your privacy and rights. For example, can anyone ask you if you're vaccinated? And do you have to reply?This leads to a polarizing discussion of COVID-19 Vaccine Mandates. Is this legal to enforce? Why this virus and not others? And can this have an impact on a physician's status as a participating provider with Medicare? Listen in this month to find out the straight answers.

In this episode of the NSCHBC Edge Podcast, Healthcare Business Consultant Chris Zaenger of Z Management Group, Ltd. joins host Terry Fletcher to discuss hiring the right people in management positions in your practice. Among those decisions is whether your spouse or relative should be on the hiring list! Also on the agenda, is salaries, remote workers, and staff members who look good on paper: but are they the best fit? Join us for this fun and lively topic!

Practice start-up services can be very tedious to get a medical practice off to a solid start and firm foundation. This episode of the Edge Podcast discusses startups and practice feasibility, going to work for an established private practice, or joining a Kaiser-like model or ACO to get a new physician's feet wet. Joining Terry is NSCHBC member and Doctor's Management Healthcare Business Consultant Valora Gurganious. Valora serves clients in all medical specialties. She works with the intricacies in starting a medical practice, feasibility studies, contract, and credentialing services, and more. This podcast discusses what could be best for the new physician, or one looking to make a change: and the details that go into making this transition.

It has been reported that Medical Practices with NPP/APP's and other non-physician providers are more profitable and productive. In this episode of the NSCHBC Edge Podcast, Terry welcomes NSCHBC member and Business Consultant Adam Middleton to discuss how NPPs can increase access, hours expansion, value-based services, and profitability. Listen in to this discussion to help you make an informed decision to add NPPs or not into your practice!