Podcasts about professional coders

For as hard as you work for the patient revenue you get, why risk it with bad compliance practices? Seems obvious when you hear me say it out loud, but as we speak, some of our listeners are playing with compliance fire. Why do it? My guest today has insights on where you might be at risk and how you can reduce it. Leslie Boles is the Co-Owner & President of Revu Healthcare, a healthcare consulting firm. She has the credentials of CCS, CPC, CPMA, CHC, CPC-I and CRC from the American Academy of Professional Coders, American Health Information Management Association and the Health Care Compliance Association. In this episode Carl White and Leslie Boles discuss:Why poor compliance is so prevalent in private practicesThe most common areas of a practice where compliance practices are the worstWhere private practices can get started with improving their compliance practices Want to be a guest on PracticeCare?Have an experience with a business issue you think others will benefit from? Come on PracticeCare and tell the world! Here's the link where you can get the process started. Connect with Leslie Boleshttps://www.linkedin.com/in/leslie-boles-ba-ccs-cpc-cpma-chc-cpc-i-crc-69442246/ Connect with Carl WhiteWebsite: http://www.marketvisorygroup.comEmail:  whitec@marketvisorygroup.comFacebook:  https://www.facebook.com/marketvisorygroupYouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmigLinkedIn: http://www.linkedin.com/in/healthcaremktg 

Click here for the Revenue Recovery cheat sheet: https://hubs.ly/Q02531_L0 Welcome to the fourth episode of our HeartTalk podcast series, Revenue Recovery. Host Melanie Lawson, MS, speaks with MedAxiom's Nicole F. Knight, LPN, CPC, CCS-P, executive vice president of Revenue Cycle Solutions and Care Transformation, and Linda Gates-Striby, CCS-P, ACS-CA, Revenue Cycle Solutions consultant. Together, they discuss the challenges and benefits of capturing home health certification and recertification services and share some top implementation tips your practice can use.Guest Bios: Nicole F. Knight, LPN, CPC, CCS-PExecutive Vice President, Revenue Cycle Solutions and Care Transformation Nicole's decades of healthcare experience include cardiovascular and neurology practice operations, clinical management, business office management, and consulting. The most recent years have been devoted to cardiovascular consulting in operations, LEAN process improvement, and the revenue cycle. Prior to joining MedAxiom, Nicole served as practice administrator for Baptist Neurology and Northeast Florida Cardiology and director of operations for Jacksonville Heart Center and Louisiana Cardiology Associates. She has extensive expertise in coding, compliance, and education for various specialties including cardiology, neurology, radiology, hematology/oncology, orthopedic, ENT, gastroenterology and internal medicine. Nicole has provided physician and staff coding and compliance education sessions nationally. Nicole has completed numerous education hours toward a B.S. in Health Care Administration. In addition, she maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Cardiovascular Coding Certification with the Board of Medical Specialty Coding and completed the AAPC inpatient coding and reimbursement course. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a LEAN Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA. Linda Gates-Striby, CCS-P, ACS-CAMedAxiom Consultant, Revenue Cycle Solutions Linda Gates-Striby has worked in the medical field for over 30 years and has specialized in cardiology coding and revenue cycle for 25 years. Her clinical experience includes work in the heart stations and coronary intensive care units as well as working as an EMT for a level one trauma center. As a MedAxiom Revenue Cycle Solutions consultant, Linda provides cardiovascular programs across the country with operational expertise, implementation strategies and simplification for often complex initiatives to minimize risk and maximize revenue. Linda, who has spent the past 30 years working as a specialist in compliance, revenue cycle and quality with a large cardiology and multi-specialty practice, is also the director of quality assurance with Ascension Medical Group in Indiana. Linda is a sought-after speaker and consultant and has conducted numerous national educational sessions focused on documentation, coding, auditing and revenue cycle improvement for clinicians, coders and administrators across the nation. Linda serves as a non-physician member of the American College of Cardiology's coding work group and publications subcommittee and has also served on the coding committee for the Heart Rhythm Society. Linda served as the cardiology chair on the Board of Advanced Medical Coding, lead the development of the Advanced Cardiology and Specialty Cardiology Certification examinations, and was the technical editor for cardiology-focused newsletters. Linda has served as an Independent Review Organization auditor for Office of Inspector General Corporate Integrity Agreements, and as an expert witness on behalf of cardiology practices.

Click here for the Revenue Recovery cheat sheet: https://hubs.ly/Q023rDk50Welcome to the third episode of our new HeartTalk podcast series, Revenue Recovery. Host Melanie Lawson, MS, speaks with MedAxiom's Nicole F. Knight, LPN, CPC, CCS-P, executive vice president of Revenue Cycle Solutions and Care Transformation, and Linda Gates-Striby, CCS-P, ACS-CA, Revenue Cycle Solutions consultant. They discuss the challenges of capturing Advanced Care Planning services and share some practical tips to take back to your organization.Guest Bios: Nicole F. Knight, LPN, CPC, CCS-PExecutive Vice President, Revenue Cycle Solutions and Care Transformation Nicole's decades of healthcare experience include cardiovascular and neurology practice operations, clinical management, business office management, and consulting. The most recent years have been devoted to cardiovascular consulting in operations, LEAN process improvement, and the revenue cycle. Prior to joining MedAxiom, Nicole served as practice administrator for Baptist Neurology and Northeast Florida Cardiology and director of operations for Jacksonville Heart Center and Louisiana Cardiology Associates. She has extensive expertise in coding, compliance, and education for various specialties including cardiology, neurology, radiology, hematology/oncology, orthopedic, ENT, gastroenterology and internal medicine. Nicole has provided physician and staff coding and compliance education sessions nationally. Nicole has completed numerous education hours toward a B.S. in Health Care Administration. In addition, she maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Cardiovascular Coding Certification with the Board of Medical Specialty Coding and completed the AAPC inpatient coding and reimbursement course. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a LEAN Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA. Linda Gates-Striby, CCS-P, ACS-CAMedAxiom Consultant, Revenue Cycle Solutions Linda Gates-Striby has worked in the medical field for over 30 years and has specialized in cardiology coding and revenue cycle for 25 years. Her clinical experience includes work in the heart stations and coronary intensive care units as well as working as an EMT for a level one trauma center. As a MedAxiom Revenue Cycle Solutions consultant, Linda provides cardiovascular programs across the country with operational expertise, implementation strategies and simplification for often complex initiatives to minimize risk and maximize revenue. Linda, who has spent the past 30 years working as a specialist in compliance, revenue cycle and quality with a large cardiology and multi-specialty practice, is also the director of quality assurance with Ascension Medical Group in Indiana. Linda is a sought-after speaker and consultant and has conducted numerous national educational sessions focused on documentation, coding, auditing and revenue cycle improvement for clinicians, coders and administrators across the nation. Linda serves as a non-physician member of the American College of Cardiology's coding work group and publications subcommittee and has also served on the coding committee for the Heart Rhythm Society. Linda served as the cardiology chair on the Board of Advanced Medical Coding, lead the development of the Advanced Cardiology and Specialty Cardiology Certification examinations, and was the technical editor for cardiology-focused newsletters. Linda has served as an Independent Review Organization auditor for Office of Inspector General Corporate Integrity Agreements, and as an expert witness on behalf of cardiology practices.

Click here for Revenue Recovery "Cheat Sheet" Welcome to the second episode of our new HeartTalk podcast series, Revenue Recovery, in which we aim to empower you to communicate effectively and ensure your organization does not leave any money on the table. Host Melanie Lawson, MS, speaks with MedAxiom's Nicole F. Knight, LPN, CPC, CCS-P, executive vice president of Revenue Cycle Solutions and Care Transformation, and Linda Gates-Striby, CCS-P, ACS-CA, Revenue Cycle Solutions consultant. They share tips for capturing counseling services for a low-dose CT scan and why shared decision-making with the patient is essential.Guest Bios:Nicole F. Knight, LPN, CPC, CCS-PExecutive Vice President, Revenue Cycle Solutions and Care TransformationNicole's decades of healthcare experience include cardiovascular and neurology practice operations, clinical management, business office management, and consulting. The most recent years have been devoted to cardiovascular consulting in operations, LEAN process improvement, and the revenue cycle.Prior to joining MedAxiom, Nicole served as Practice Administrator for Baptist Neurology and Northeast Florida Cardiology and Director of Operations for Jacksonville Heart Center and Louisiana Cardiology Associates. She has extensive expertise in coding, compliance, and education for various specialties including cardiology, neurology, radiology, hematology/oncology, orthopedic, ENT, gastroenterology and internal medicine. Nicole has provided physician and staff coding and compliance education sessions nationally.Nicole has completed numerous education hours toward a B.S. in Health Care Administration. In addition, she maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Cardiovascular Coding Certification with the Board of Medical Specialty Coding and completed the AAPC inpatient coding and reimbursement course. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a LEAN Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.Linda Gates-Striby, CCS-P, ACS-CAMedAxiom Consultant, Revenue Cycle SolutionsLinda Gates-Striby has worked in the medical field for over 30 years and has specialized in cardiology coding and revenue cycle for 25 years. Her clinical experience includes work in the heart stations and coronary intensive care units as well as working as an EMT for a level one trauma center.As a MedAxiom Revenue Cycle Solutions consultant, Linda provides cardiovascular programs across the country with operational expertise, implementation strategies and simplification for often complex initiatives to minimize risk and maximize revenue. Linda, who has spent the past 30 years working as a specialist in compliance, revenue cycle and quality with a large cardiology and multi-specialty practice, is also the director of quality assurance with Ascension Medical Group in Indiana.Linda is a sought-after speaker and consultant and has conducted numerous national educational sessions focused on documentation, coding, auditing and revenue cycle improvement for clinicians, coders and administrators across the nation.Linda serves as a non-physician member of the American College of Cardiology's coding work group and publications subcommittee and has also served on the coding committee for the Heart Rhythm Society. Linda served as the cardiology chair on the Board of Advanced Medical Coding and lead the development of the Advanced Cardiology and Specialty Cardiology Certification examinations, as well as the technical editor for cardiology focused newsletters. Linda has served as an Independent Review Organization auditor for Office of Inspector General Corporate Integrity Agreements, and as an expert witness on behalf of cardiology practices.

Click Here for Revenue Recovery "Cheat Sheet"While you may or may not be the person coding revenue cycle services, many of you are responsible for your program's overall success with revenue recovery and know all too well the challenges that come with it. Welcome to the first episode of our new podcast series, Revenue Recovery, where we aim to empower YOU – physicians, administrators and revenue cycle managers – to effectively communicate and ensure your organization does not leave any money on the table. On MedAxiom HeartTalk, host Melanie Lawson speaks with MedAxiom's Nicole F. Knight, LPN, CPC, CCS-P, executive vice president of revenue cycle solutions and care transformation, and Linda Gates-Striby, CCS-P, ACS-CA, revenue cycle solutions consultant. Together, they discuss some challenges, tips and solutions for capturing services involving smoking and tobacco cessation.Guest Bios:Nicole F. Knight, LPN, CPC, CCS-PExecutive Vice President, Revenue Cycle Solutions and Care TransformationNicole's decades of healthcare experience include cardiovascular and neurology practice operations, clinical management, business office management, and consulting. The most recent years have been devoted to cardiovascular consulting in operations, LEAN process improvement, and the revenue cycle.Prior to joining MedAxiom, Nicole served as Practice Administrator for Baptist Neurology and Northeast Florida Cardiology and Director of Operations for Jacksonville Heart Center and Louisiana Cardiology Associates. She has extensive expertise in coding, compliance, and education for various specialties including cardiology, neurology, radiology, hematology/oncology, orthopedic, ENT, gastroenterology and internal medicine. Nicole has provided physician and staff coding and compliance education sessions nationally.Nicole has completed numerous education hours toward a B.S. in Health Care Administration. In addition, she maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Cardiovascular Coding Certification with the Board of Medical Specialty Coding and completed the AAPC inpatient coding and reimbursement course. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a LEAN Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.Linda Gates-Striby, CCS-P, ACS-CAMedAxiom Consultant, Revenue Cycle SolutionsLinda Gates-Striby has worked in the medical field for over 30 years and has specialized in cardiology coding and revenue cycle for 25 years. Her clinical experience includes work in the heart stations and coronary intensive care units as well as working as an EMT for a level one trauma center.As a MedAxiom Revenue Cycle Solutions consultant, Linda provides cardiovascular programs across the country with operational expertise, implementation strategies and simplification for often complex initiatives to minimize risk and maximize revenue. Linda, who has spent the past 30 years working as a specialist in compliance, revenue cycle and quality with a large cardiology and multi-specialty practice, is also the director of quality assurance with Ascension Medical Group in Indiana.Linda is a sought-after speaker and consultant and has conducted numerous national educational sessions focused on documentation, coding, auditing and revenue cycle improvement for clinicians, coders and administrators across the nation.Linda serves as a non-physician member of the American College of Cardiology's coding work group and publications subcommittee and has also served on the coding committee for the Heart Rhythm Society. Linda served as the cardiology chair on the Board of Advanced Medical Coding and lead the development of the Advanced Cardiology and Specialty Cardiology Certification examinations, as well as the technical editor for cardiology focused newsletters. Linda has served as an Independent Review Organization auditor for Office of Inspector General Corporate Integrity Agreements, and as an expert witness on behalf of cardiology practices.

Cardiac device techs are in hot demand, but gaps in staffing and education are causing difficulties for this role. On MedAxiom HeartTalk, host Melanie Lawson talks with Kelli Shifflett, MHA, FACMPE, AVP of Revenue Growth and Business Development, HCA Physician Services, Sirena Bridges, MSPH, MSN, FNP-BC, CCDS, Clinical Director, Melissa Hauck Center for Device Therapy at Centennial Heart, and Nicole Knight, LPN, CPC, CCS-P, SVP of Revenue Cycle Solutions and Care Transformation, Medaxiom. Together, they discuss innovative strategies that your organization can use to help address this growing issue. Guest BiosKelli Shifflett, MHA, FACMPE, AVP of Revenue Growth and Business Development, HCA Physician Services – Kelli has been with HCA Physician Services for 20 years in a variety of practice operation roles from Practice Manager to Division Vice President. She resides in Austin with her family and is passionate about process improvement and finding practice efficiencies in a constantly changing healthcare environment. She enjoys her current role of partnering with companies whose products improve the daily workflows and needs patients, providers and healthcare teams. Sirena Bridges, MSPH, MSN, FNP-BC, CCDS, Clinical Director, Melissa Hauck Center for Device Therapy at Centennial Heart – Sirena has worked in the healthcare field for over 20 years; with the last 10 years working as a Nurse Practitioner in Cardiac Electrophysiology with a focus on device management of Cardiac implantable electronic devices at Centennial Heart. She became the inaugural Clinical Director of the Melissa Hauck Center for Device Therapy at Centennial Heart in Nashville in November 2021. In her role as the Clinical Director, she brings a wealth of clinical and technical expertise on interpretations, programming and troubleshooting of cardiac implantable electronic devices and remote transmissions. She also serves as a clinical resource for patients, peers and colleagues. Sirena has a Bachelor's Degree in Cardio-respiratory Care Sciences from Tennessee State University and a Master's Degree in Public Health from Meharry Medical College in addition to a Master's Degree in Nursing from Vanderbilt University. She is also a Certified Cardiac Device Specialist (CCDS) through the IBHRE (International Board of Heart Rhythm Examiners). Nicole Knight, LPN, CPC, CCS-P, EVP of Revenue Cycle Solutions and Care Transformation, Medaxiom - Nicole's decades of healthcare experience include cardiovascular and neurology practice operations, clinical management, business office management and consulting. The most recent years have been devoted to cardiovascular consulting in operations, LEAN process improvement and the revenue cycle. Prior to joining MedAxiom, Nicole served as Practice Administrator for Baptist Neurology and Northeast Florida Cardiology and Director of Operations for Jacksonville Heart Center and Louisiana Cardiology Associates. She has extensive expertise in coding, compliance and education for various specialties including cardiology, neurology, radiology, hematology/oncology, orthopedic, ENT, gastroenterology and internal medicine. Nicole has provided physician and staff coding and compliance education sessions nationally. Nicole has completed numerous education hours towards a B.S. in Health Care Administration. In addition, she maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Cardiovascular Coding Certification with the Board of Medical Specialty Coding and completed the AAPC inpatient coding and reimbursement course. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a LEAN Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA. This episode is supported by an independent educational grant from Medtronic.

Here you are opening mail to find that your insurance sent a letter which is apparently not a bill, yet it says you owe money for your recent doctor's visit. Once we translate this letter into English, you'll have nothing to worry about.This letter I'm talking about usually arrives in the coming weeks after any given medical visit or service. This document states, in bold lettering, that it's not a bill, yet the number of dollar figures on there raises your blood pressure anyway. This letter is an explanation of benefits (EOB). It's supposed to show how your insurance is covering or not covering medical care. If there are times in life where you need to keep your expectations low, reading your EOB is one of those times. Before we dive in, there are two main reasons why you should take a glance at your EOB: 1) to check if you will owe any medical bills later and 2) to make sure your provider billed you correctly. Soon you'll be able to take care of these two goals no problem. This is how we'll dip our toes in the muddy water that is American health insurance so we can get more comfortable with time.Even though there are probably more EOB formats than flavors of vanilla ice cream, the core pieces stay the same. Usually, there is a table with various numbers. The top left or top right of that same page would have the patient and insured person's name, claim and policy numbers, and the medical provider's info. The real star of the show is the table, so for now we will focus on how to read that in particular. I will have an example diagram in this post and on my newsletter's home page at rushinagalla.substack.com if you want to follow along. Even if there are more than ten columns on an EOB table, three major categories should stand out to you. 1) The medical care, 2) the charges/what you are billed, and 3) the money you actually owe after insurance coverage (or lack thereof).In terms of the medical care, you should be seeing a brief one-line description for the actual service you got done in one of the left-most columns whether that be something like an office visit, lab draw, or a surgical procedure. That written description gets paired with a five-digit number called a CPT code, which I will talk about later, but you should make sure a date is there along with that code. That “date of service” should match with your own record of when you were at the clinic.Now for the charges. The largest dollar number on that table is likely the full amount billed or claimed by your provider. This is where your insurance company begins to cut that number down with things like allowables and discounts. Most providers negotiate with your insurance to get pre-approved rates for every visit and procedure. Let's say your doctor bills you $100 for a typical office visit. Your insurance might say the doctor can only bill $90 for the appointment and on top of that, the insurance applies another $30 discount because you saw that doctor within the health plan's preferred list of physicians. Suddenly the balance so far is $60 (= $100-($100-$90)-$30 insurance discount), which is the final amount the provider should be paid. Now we're at the moment of truth to see if your insurance feels like paying that leftover $60. If you're lucky enough to have bulletproof coverage, then your insurance pays that $60 to the clinic and you can now enjoy the rest of the day with whatever you do after five o'clock. However, that $60 is also the point where your deductible, copay, and coinsurance may apply. I will spend much more time on those concepts in the next episode, but for the purposes of this example, let's just keep things simple.Say your copay is $40 and you spent that amount already when you went to the clinic. A copay is just a fixed payment you give to the office on the same day you get seen. Now your EOB's final column might state that you now owe $0 from that $60 balance which means, after your copay, the insurance covered the other $20 (= $60 balance -$40 copay).Whenever you owe any more money to the doctor's office, your EOB will highlight that amount as “patient responsibility” which is a fancy way of saying that you should be happy when paying up. I have yet to meet someone who enjoys paying their doctor more than necessary. Overall, I would suggest that you keep all your EOBs saved in one place so you can easily check how effective (or not) your coverage is over time.A couple quick side notes before we move on: the EOB will have a little footnote or other number in the table called a remark code, which you should make sure to check, because those comments might explain why parts of your visit charges were adjusted or denied. Also: every time you get official, on-the-record healthcare visit or service, you should get an EOB even if you do not have a bill to pay. If you don't receive an EOB statement that you're expecting, go ahead and contact your insurance company or medical office ASAP (some health plans may just give you a copay receipt instead of an EOB). If one of your parents or your spouse is the primary insurance holder, that person should receive the EOB first.I realize that I've thrown a lot of stuff at you so far but now we can talk about the big picture on how to check if your medical charges and coverage are kosher. The first two things you should check for accuracy on your EOB besides your basic info are the date of service and the procedure code for that service. That five-digit procedure or visit code is shorthand for any kind of medical care you receive. Most providers use the CPT code system when sending a claim. You don't need to be a coding expert to know if your EOB is proper. Just take the CPT number on your EOB (e.g. 99213, 11102) and Google “that number + AAPC.” That acronym (AAPC) is for the American Academy of Professional Coders which is by far the best resource for defining any of the services you get. That page is another link I'll have on my Substack. If that code you looked up from your EOB does not match with the actual experience of what you had at the clinic, like if you went for a visit but the letter shows you had a surgical procedure instead, something is definitely wrong. At this point you should call the doctor's office to check why they coded the visit incorrectly and if they possibly overcharged you.With all that done we've accomplished the two basic goals for how to read your EOB and get your beak wet for understanding the link between your medical care and insurance. Now you can see how much you owe for medical care and get an idea of the clinic billing you appropriately for corresponding services. Even though I've seen and written my own fair share of medical claims, my head still explodes when I talk about insurance too much, so we'll save our discussion about major concepts like deductibles, coinsurance, and copays for the next podcast.Stay tuned and subscribe to Friendly Neighborhood Patient for more healthcare tips and tricks. I'll catch you at the next episode. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

When a clinical diagnosis or procedure is not validated in the medical record, resulting in a claim denial, the health care organization loses reimbursement, the physician or clinician involved may come under scrutiny and the reputations of both clinician and hospital may suffer. Errors in documentation needlessly contribute to this problem. On this episode, we discuss what clinicians and organizations can do to avoid claim denials.   Guest speaker: Erica Braun, MS, RN, CCDS Consulting Director Vizient   Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Principal Clinical Operations and Quality Vizient   Show Notes: [01:11] Clinical validation denial [01:31] Implications for denials: downgraded DRGs and lower reimbursement [02:31] Avoiding denials [03:25] When diagnoses are at high risk for denial [03:59] Examples of disputed diagnoses [04:30] Establishing criteria for diagnoses [05:15] What physicians can do to help improve documentation [06:17] What to do when a denial occurs [07:29] Negotiating and coordinating with payers   Links | Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Erica Braun's contact email: erica.braun@vizientinc.com Fact sheet on Vizient's clinical documentation improvement services: Click here Clinical Validation: The Next Big Challenge in Inpatient Coding (American Academy of Professional Coders, AAPC): Click here   Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify Stitcher RSS Feed

Sean M. Weiss Partner, Vice President of Compliance CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean has dedicated his more than 25 – year career to helping healthcare facilities reduce the risk of noncompliance and achieve measurable financial results. An accomplished compliance and management professional, Sean has extensive knowledge of the inner workings of government agencies at both the federal and state level, including the Office of Inspector General, Department of Justice and The United States Attorney's Office. Sean has earned and maintains numerous certifications including Certified in Healthcare Compliance (CHC), Certified Evaluation & Management Auditor (CEMA), Certified Medical Compliance Officer (CMCO), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Medical Practice Executive (CMPE) and Certified Professional Coder-Payer (CPC-P). Sean is an active member in good standing with The American Health Lawyers Association, Health Care Compliance Association, The American Academy of Professional Coders and the National Society of Certified Healthcare Business Consultants. Sean Weiss on LinkedIn: https://www.linkedin.com/in/seanmweissakathecomplianceguy/ The Compliance Guy Podcast on YouTube: https://www.youtube.com/channel/UCIwYgrkkU7urrnmFJ1_V6cg/featured The National Society of Certified Healthcare Business Consultants (NSCHBC): https://nschbc.org/ Brian Cui on LinkedIn: https://linkedin.com/in/briancui/ Check out our supporting Medical Coding Geek Partners: https://medicalcodinggeek.com/partners Medical Coding Geek and NEC Podcast on Social Media https://facebook.com/medcodinggeek https://facebook.com/necpodcast https://instagram.com/medcodinggeek https://instagram.com/necpodcast https://tiktok.com/@medcodinggeek Watch this episode on the NEC Podcast YouTube Channel: https://www.youtube.com/channel/UCKh_A91__rieaSSPIRm4gBw Subscribe to Medical Coding Geek on YouTube: https://youtube.com/MedicalCodingGeekVideos Medical Coding Geek Facebook Groups: https://facebook.com/medcodinggeek/groups

Sean M. Weiss Partner, Vice President of Compliance CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean has dedicated his more than 25 – year career to helping healthcare facilities reduce the risk of noncompliance and achieve measurable financial results. An accomplished compliance and management professional, Sean has extensive knowledge of the inner workings of government agencies at both the federal and state level, including the Office of Inspector General, Department of Justice and The United States Attorney's Office. Sean has earned and maintains numerous certifications including Certified in Healthcare Compliance (CHC), Certified Evaluation & Management Auditor (CEMA), Certified Medical Compliance Officer (CMCO), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Medical Practice Executive (CMPE) and Certified Professional Coder-Payer (CPC-P). Sean is an active member in good standing with The American Health Lawyers Association, Health Care Compliance Association, The American Academy of Professional Coders and the National Society of Certified Healthcare Business Consultants. Sean Weiss on LinkedIn: https://www.linkedin.com/in/seanmweissakathecomplianceguy/ The Compliance Guy Podcast on YouTube: https://www.youtube.com/channel/UCIwYgrkkU7urrnmFJ1_V6cg/featured The National Society of Certified Healthcare Business Consultants (NSCHBC): https://nschbc.org/ Brian Cui on LinkedIn: https://linkedin.com/in/briancui/ Check out our supporting Medical Coding Geek Partners: https://medicalcodinggeek.com/partners Medical Coding Geek and NEC Podcast on Social Media https://facebook.com/medcodinggeek https://facebook.com/necpodcast https://instagram.com/medcodinggeek https://instagram.com/necpodcast https://tiktok.com/@medcodinggeek Watch this episode on the NEC Podcast YouTube Channel: https://www.youtube.com/channel/UCKh_A91__rieaSSPIRm4gBw Subscribe to Medical Coding Geek on YouTube: https://youtube.com/MedicalCodingGeekVideos Medical Coding Geek Facebook Groups: https://facebook.com/medcodinggeek/groups

020: Join Dr. Andrew Tisser (Talk2MeDoc Podcast) with Tom Davis as they talk about healthcare in the post-COVID era. With the changes that COVID-19 has made way for, you have to accept that the world has indeed changed. Tom explains what people in the healthcare industry have to anticipate and recognize. He goes into detail with his take on credit scores, student loans, the importance of prioritizing self-sufficiency, and the value of creating multiple sources of income. By the end of this episode, you will decide what you want your life to look like and live that life. Stay tuned, and enjoy the podcast! Show Notes for this episode are on: http://talk2medocpod.com/020 ~Dr. Tom Davis, MD is THE national expert in value-based healthcare delivery and full-risk insurance contracting. A family physician for over 25 years, angel investor, founder of 6 companies, co-founder of 8, he has successfully managed thousands of patients under Medicare Advantage and other value-based care programs. He is a sought-after consultant, speaker, and trusted advisor. Before creating Tom Davis Consulting, Tom was a founder and leader of one of the nation’s first value-based health systems, Patients First Healthcare of Washington, Missouri. As a practicing physician and leader on the Board of Managers, he leveraged the resources of one of the first total-risk Medicare Advantage contracts to deliver exceptional patient care. Innovating tailored care delivery systems, creating high-performing risk code education and compliance programs and personally on-boarding new clinicians, Dr. Davis helped grow a small primary care medical group into an integrated regional powerhouse, complete with its own hospital and diagnostic, imaging, surgical and cancer centers. Today, as the founder and president of Tom Davis Consulting, Tom enables clients to leverage value-based systems for sustainable revenue generation, strong clinician engagement and the delivery of superior patient care. Driven by the tremendous improvement in patient outcomes he personally witnessed, Dr. Davis became known for empowering physicians to collaboratively innovate– creating new systems of delivering cost-effective healthcare, generating an equitable, sustainable core compensation for clinicians so they can remain engaged, in-place and high-functioning. Through consulting, educating, speaking, and cutting-edge education, Tom helps clinicians, providers, insurers, investors, healthcare executives and governments achieve true transformations in value-based care environments. A graduate of the University of Missouri–Columbia School of Medicine and its top-ranked Family Medicine residency program, Dr Davis is a current Diplomate of the American Board of Family Medicine, a Fellow of the American Academy of Family Physicians and a member of the American Academy of Professional Coders where he holds professional certifications as a compliance officer and risk adjustment coder. Having served as medical director for a regional rehabilitation facility for over 20 years, Tom shares his expertise in integrated healthcare delivery as a faculty member of the Washington University School of Medicine in St. Louis, Missouri.You can find Tom Davis on…Website: https://www.tomdavisconsulting.com/Facebook: https://www.facebook.com/TomDavisConsulting/Twitter: https://twitter.com/TomDavisConsultLinkedIn: https://www.linkedin.com/in/thomasdavismd/YouTube: https://www.youtube.com/channel/UCPDw6kNblZesskt-bfad9_Q?

We are talking about several different aspects of rural healthcare with Farrell Turner, President of the Alabama Rural Health Association.  Farrell had the experience of a lifetime when he attended the State of the Union Address this year while he was in Washington, DC, at the NRHA Policy Institute meeting.     “There needs to be a sense of urgency because we can’t just sit back on our thumbs to make incremental changes.”   Farrell began his career with St. Luke’s Episcopal and Texas Children’s Hospitals in Houston.  After that, he was CFO at South Central Regional Medical Center in Laurel, Mississippi and has served as interim CEO and CFO in a number of small rural hospitals in the South. He most recently served as CEO of Community Hospital Corp’s Jellico Community Hospital in Tennessee and Interim CEO of Medical Center Barbour in Eufaula, Alabama for Alliant Healthcare Management. He is a subject matter expert in Rural Health Clinics, especially provider-based RHCs.  He was educated in Alabama public schools, received a Bachelor’s degree at University of Alabama College of Commerce and Business Administration in Accounting and Health Care Management, and a Master’s in Finance at the University of Houston at Clear Lake. He is a CPA, a certified coder, and a Fellow with HFMA. He is President of the Alabama Rural Health Association and has been chapter President of the Anniston- Gadsden and Oxford Chapters of the American Academy of Professional Coders.  He enjoys hunting and has taken up running. He completed his first half-marathon on his 60th birthday and did it again on his next birthday. He lives in rural Cleburne County with his wife Beverly.  During our conversation, Farrell talks about an excellent tool for rural health leaders, the County Health Rankings and Roadmaps.  Hopefully you will find this a useful tool as well. 

We are hearing that patient collections can be a struggle from estimating cost up front to collecting at time of visit. Nicole Knight provides ten best practices for developing a proactive collection plan for 2019.In a few weeks the calendar flips to 2019 and that means patient deductibles will reset. How prepared is your practice to collect?Many programs tell me that their patient balances are out of control. In my experience, it's usually because we lack proactive systems to facilitate patient collections.With the new year you have an opportunity to evaluate and set up these systems. Here are ten best practices to help you achieve this goal.1. Update your collection policy and get providers on the same page."You are responsible for paying your portion of the bill" is a common but vague statement that is difficult to operationalize and enforce. Update your policy language to provide details. Focus on things such as patient education, rules about establishing payment plans, and how staff should handle patients who can't pay their balance.Remember the regulatory guidelines and avoid "professional courtesy."2. Set expectations up front.The biggest complaint we hear from staff when they have trouble collecting is that patients weren't told they would have to pay, so they aren't prepared to pay. Schedulers are your first touch in the collection effort. Train them to explain your policy and provide a range of fees as well as payment options. For instance: "Mr. Johnson, in addition to the visit fee, Dr. Jones may conduct a study or test during your visit. A typical fee range for most patients is $300 - $500, and we ask that you be prepared to pay your visit copay plus any unmet deductible and coinsurance..."3. Designate a financial counselor.Practices that are most successful at collecting patient balances are the ones that have a designated person available to speak privately with patients about what they owe. Ideally, this conversation is held in-person, in a private office.I recognize the challenges of bringing on a new FTE. But if you look at the actual dollars that this person can collect against the cost of sending out months (sometimes years) of statements, plus the amount you are currently writing off to bad debt or collections, you can justify the financial case.4. Equip staff with the right data.A first step in staff knowing the amount to collect from patients is creating a reference of fee schedules for the most common office visits procedures and testing, for your top contracted plans and Medicare. Put the information in a table or spreadsheet so staff can quickly calculate what patients owe if they have not met their deductible.The batch eligibility report is another great resource. It shows who is ineligible for coverage on the date of service, and often provides copay and remaining deductible information for each patient on the schedule. I suggest running batch eligibility at least two days prior to the date of service so staff can contact patients with information and options. Communicating in advance is important to overall patient satisfaction and also will assist with managing access to fill an open slot if the patient chooses to reschedule.5. Collect pre-procedure deposits.Some practices have adapted the modern practice of giving patients a written estimate of what they will owe for procedures. Many payors offer online cost estimators that calculate the patient's out of pocket responsibility based on unmet deductible, non-covered services, and coinsurance. Enter the CPT billing codes and the estimate is quickly customized for the patient.6. Train front desk staff how to ask for money.When I'm conducting an assessment of the front desk, I often hear staff say, "Are you going to pay your copay today?" and "I'm so sorry but I have to ask you to pay today."Training and role playing are vital to building staff confidence about asking for money. Provide scripts that help them handle objections and sensitive subjects such as what to do when a patient arrives for an appointment and can't pay.7. Offer multiple payment options.I've started hearing more and more patients ask staff whether they can set up an auto payment on their credit card to pay off the balance. Patient financing is an option that's becoming popular for patients who have $1,500+ deductibles but no room left on their credit card to pay them. Typically, the practice pays a small service fee and the balance is paid in full and off the A/R; no more statements or staff calls. And, online bill pay is a convenience that can encourage patients to pay past due balances.8. Offer a discount if the patient pays in full.To clear up large, past due balances, send patients to speak with the financial counselor, who can discuss multiple payment options that include a discount when the patient opts to pay the balance in full.9. Have a plan for financial hardship.Obviously, there will be patients who cannot afford to pay their bill. Instead of letting that money languish in the A/R, offer assistance to patients who meet certain requirements, such as a household income that is a certain threshold above the U.S. Poverty Guidelines. Consider adopting the hospital's policy for a sliding payment scale. And for those patients who are indigent or unable to pay anything, don't wait: facilitate a process for "Charity Care" instead of letting the account inflate the A/R.10. Set collections goals and reward success.Staff perform better when they know someone is monitoring their work. Set metrics for collecting a specific percentage of collectible copays each quarter or reducing patient A/R over 90 days old. When the incentive is reached, reward staff with gift certificates, pizza, or an ice cream party. If you have multiple sites, make it a friendly competition to see who collects the most, and update all teams at the end of each week to keep everyone engaged.Don't wait until the end of March for uncollected high deductibles and coinsurances to show up in the A/R. Be prepared and put a plan in place before the holidays so you can hit the ground running in 2019.Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is director of Revenue Cycle Solutions at MedAxiom Consulting. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.For more information, contact: HeartTalk@medaxiom.com or visit https://www.medaxiom.com

If your revenue cycle management is all about putting out fires, there is relief in sight. Nicole Knight helps you focus on six key areas to create a more successful revenue cycle.Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is Director of Revenue Cycle Solutions at MedAxiom. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.