Oct 31 2024 57 mins 1
Mastering 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 Insights and Strategies
02:20 Importance of Contracts in Payer Defense
03:49 Presenter's Background and Expertise
06:00 Webinar Disclaimer and Initial Questions
07:10 Best Practices for Denial Escalation
11:39 Identifying and Addressing Downcoding
19:58 Effective Payer Conversations
29:22 Navigating Payer Relations and Contracting
31:01 Effective Appeal Strategies
33:40 Documentation and Professionalism
37:43 Leveraging State Insurance Commissions
43:33 Filing Grievances: Medicare and Commercial Plans
48:47 Legal Complaints and Final Steps
52:19 Q&A and Closing Remarks
