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