For The Love of Revenue Cycle

In this webinar replay, host Vanessa Moldovan leads a discussion on the current state of the revenue cycle management (RCM). The episode kicks off the 'Drive to ViVE' webinar series, focusing on the lead-up to the event next year in Los Angeles, which will feature industry leaders discussing healthcare IT, business, and more. Vanessa addresses the major challenges in RCM, such as rising denial rates, fragmented workflows, and the dynamic changes in regulations and policies. She shares insights on denial prevention, education, and the adoption of smart technology, specifically Agentic AI, to improve RCM processes. The episode also highlights the importance of leadership accountability, continuous learning, and genuine industry collaboration to drive significant change while preparing for the future of healthcare reimbursement.

00:00 Welcome and Introduction to Drive to ViVE

00:53 Current Challenges in Revenue Cycle Management

02:53 What's Broken in Revenue Cycle Management

07:30 What's Working in Revenue Cycle Management

11:32 Strategies for Future Improvements

25:02 The Role of Technology in Revenue Cycle Management

28:44 Involving Users in the Process

29:48 The Role of Technology in Revenue Cycles

31:03 Understanding Agentic AI

31:28 The Evolution of Navigation Technology

32:38 Agentic AI in Revenue Cycle Management

36:49 Q&A Session Begins

37:28 Addressing Denial Prevention

40:39 The Importance of Front-End Processes

42:04 Skills for Future RCM Teams

43:56 Networking and Education in RCM

46:35 Supporting Frontline Teams

49:30 Final Thoughts and Future Directions

Conference Season Recap: Maximizing Value from Industry Events In this episode of 'For the Love of Revenue Cycle,' host Vanessa Malon offers a comprehensive review of the conferences she attended this season, including Becker's, HBMA, MGMA, the Medical Cost Containment Series in Chicago, and the Invest Behavioral Health Conference. Vanessa discusses the key takeaways, the value of attending these events, and provides practical advice on how to maximize ROI, whether you're a leader or frontline worker. She emphasizes the importance of choosing the right conferences based on your goals, whether it's for education, networking, or vendor evaluation. Vanessa also shares tips on how to prepare, what questions to ask, and the benefits of small group sessions, making this episode a must-listen for revenue cycle professionals planning their conference schedules.

00:00 Introduction and Podcast Overview

00:40 Season Review: Conferences Attended

02:11 The Value of Conferences

04:10 Becker's Conferences Insights

06:49 Medical Cost Containment Series

08:00 HBMA and MGMA Conferences

10:00 Networking and Practical Tips

16:15 Final Thoughts and Recommendations

17:30 Conclusion and Contact Information

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

In this webinar replay, Vanessa Moldovan tackles a critical healthcare challenge: bridging the gap between innovation and operations in the revenue cycle. She explores the disconnect between RCM leaders and technology innovators, revealing how resistance to change, staffing shortages, and fragmented systems fuel inefficiencies and reimbursement setbacks.

Vanessa explores root causes such as human error, denial management breakdowns, and rising costs to collect, while offering practical solutions to close the divide. By emphasizing knowledge, empathy, and a shared understanding of the full revenue cycle, she outlines how leaders and innovators can work together more effectively.

Listeners will walk away with actionable insights on clean claims, leveraging technology for accuracy, and building more productive conversations between RCM teams and tech partners, ultimately paving the way for stronger collaboration and better financial outcomes.