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00:00 Welcome and Book News 01:00 Why This Episode Is Different 02:47 The Big Patient Impact Question 04:42 Patient Surveys and NPS 07:48 Inferring Sentiment From Errors 11:02 Worst Mistakes in RCM 11:24 Coding and Eligibility Pain Points 14:57 Surprise Billing and No Surprises Act 22:35 Prior Auth Denials and Appeals 24:32 When Healthcare Was Simple 25:11 Patient Pain Points Reality 25:52 Survey Bias and Feedback 26:27 Denials Stress Patients 27:24 Inevitable Denials Explained 28:46 CPT Mismatch Mechanics 33:06 What Teams Can Control 36:39 Compliance and Audit Risks 40:50 Metrics Next Steps 41:24 Final Wrap and Call

Vanessa Moldovan celebrates the upcoming five-year anniversary of For the Love of Revenue Cycle on October 28, sharing how the podcast grew from her For the Love of Revenue Cycle Facebook group and her shift from operations into mentoring, coaching, and education. 00:00 Welcome Back Update 01:01 Purpose And Instincts 01:57 Career Shift Begins 02:55 Facebook Group Origins 04:45 Romania Sabbatical Dreams 07:21 Podcast Idea Takes Shape 09:06 Launching The Show 10:32 Ukraine War Return 11:18 Dream Job Manifested 14:56 Podcast Evolution Ahead 16:11 Listener Feedback Invites 16:59 New AI Playbook Book 18:07 Anniversary Episodes Wrap

Host Vanessa Moldovan interviews Monte Sandler, COO of WebPT, about the technology foundation beneath revenue cycle work and why "bolting on" AI to legacy EMR and practice management platforms has a ceiling compared with rebuilding AI-native systems from the ground up. 00:00 Welcome and Big Announcement 01:04 Episode Theme AI Needs New Foundations 02:16 Meet Monty Sandler 04:57 Why Revenue Cycle Hooks You 06:46 Why Healthcare RCM Is So Complex 10:03 WebPT Going AI Native 12:18 Rebuild vs Bolt On AI 13:56 Shift Left Fix Front End Errors 16:56 Automation Examples OCR Eligibility 19:19 Will AI Take My Job 22:19 Humans Become Reviewers Strategists 27:17 Change Management and Final Advice 30:26 Wrap Up and Listener Call to Action

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Lisa Purnell, Director of Risk Adjustment at Community Health Choice in Houston. Lisa explains risk adjustment as measuring population sickness to predict future costs, centered on accurate diagnosis coding and documentation that supports patient complexity and resource needs. She describes how risk adjustment affects many health plan departments, why revenue cycle teams often misunderstand it, and how it informs premiums and care management. 00:00 Welcome and Big News 00:14 AI Playbook Announcement 01:14 Episode Topic Risk Adjustment 02:18 Meet Lisa Purnell 03:35 Lisa's Path to Risk 05:30 Risk Adjustment Explained 06:48 Who Benefits and How 10:13 Why Rev Cycle Misses It 13:45 Outpatient vs Inpatient 15:50 Documentation Storytelling 17:49 January 1 Reset Myth 20:54 Compliance Guardrails 23:40 Why It Matters Now 25:04 Action Steps to Start 27:35 Marketplace and Risk Scores 29:50 Final Takeaways and Wrap 31:31 Outro and Contact Info

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan speaks with Lisa Hoogstra, Senior Director of Revenue Cycle Front Office at Ivy Rehab Network, about why front desk teams are often under-resourced and how that impacts patient experience, billing accuracy, denials, and collections. Lisa explains how front-office work begins before the first visit through scheduling, insurance selection/registration, verification, authorizations, and setting clear financial expectations. She also describes her Front Office Excellence (FOX) program focused primarily on soft skills like communication, customer service, and leading from your seat to build ownership and critical thinking. 00:00 Why Front Office Matters 01:22 Meet Lisa Hoogstra 02:18 From Lab to Front Office 06:19 Before the First Visit 08:42 Hidden Burdens and Misunderstandings 12:42 Introducing the FOX Program 15:46 Building Ownership and Leaders 18:04 Results and Soft Skills Focus 20:35 Start Small Without a Program 26:42 Changing Culture and Respect 28:53 Tech Adoption and Change Management 34:12 Call to Action and Wrap Up

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Laura Miller, founder and CEO of TempDev, about how to bring technology into the revenue cycle responsibly. They discuss why organizations often underuse existing system functionality, how automation can reduce manual work and avoid hiring, and why denial reporting is essential for pinpointing fixable causes such as credentialing, prior authorizations, coding, or front-desk insurance selection. 00:00 Welcome and Episode Focus 02:10 Meet Laura Miller 04:12 Bridging Tech and Rev Cycle 06:36 Practice Management Assessment 12:23 Automation Over Hiring 15:17 Red Flags and Root Causes 19:18 Denials Reporting Explained 22:03 Fixable Problems Upstream 23:13 Patient Pay Made Easy 25:03 Online Payments For All Ages 26:15 Building The Business Case 27:46 KPI Dashboards And Benchmarks 30:18 ROI Beyond Revenue 34:04 Fix Denials One By One 35:20 Listen Before You Build 37:07 Solve The Business Need 39:16 AI Hype Reality Check 40:35 Episode Wrap And Takeaways

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews orthopedic coding expert Lynn Anderanin about clinic-based orthopedic coding amid payer policy changes, focusing on modifier 25, E&M documentation, compliance, and payer down-coding. Lynn, a longtime coder and coding compliance manager, explains that modifier 25 is intended to indicate an office visit that is significantly and separately identifiable from a same-day procedure. She discusses auditing for unrelated problems, risks of over-documentation, cloning, and outdated templates, and emphasizes that notes must reflect patient-specific care and legal accountability. The episode also covers payer practices such as down-coding without records review by relying on assessment/plan and diagnosis, and more. 00:00 Welcome and Episode Focus 01:32 Meet Lynn Anderanin 04:51 Compliance Role and Audits 07:28 Modifier 25 Basics 10:42 Globals and RVU Breakdown 13:05 Auditing Injection Visits 16:28 E&M Templates and Cloning Risks 19:14 Legal Exposure and Note Specificity 21:54 Notes Not Black White 22:50 Audit Ready Compliance 23:44 Write Policies Down 26:22 Payers Versus Guidelines 27:19 Contracts Appeals Leverage 30:54 Provider Documentation Change 31:57 Pre Op Visit Confusion 34:08 AI Driven Downcoding 37:43 Modifier 25 Action Steps 40:13 Closing Reflections Outro

In this episode of For the Love of Revenue Cycle, host Vanessa Moldovan interviews Molly Cueto, a licensed professional counselor and COO overseeing five behavioral health clinics in Houston, about aligning clinical care with revenue cycle operations. Cueto explains why clinicians, trusted by patients, are often best positioned to discuss costs, emphasizing transparency to prevent cancellations and ruptures in care. 00:00 Welcome and Episode Setup 01:03 Meet Molly Cueto 02:29 Clinicians Owning Revenue Cycle 04:55 Documentation Culture Cadence 06:17 Front End Verification Workflow 07:23 Transparency Shift and Bottlenecks 11:20 Diagnosis Labels and Lifelong Impact 16:20 Rule Outs Versus Confirmed Dx 20:16 Building Billing Teams Over Time 24:09 Clinician Led Money Conversations 28:30 Collections With Empathy 30:42 Call to Action and Wrap Up 32:09 Host Takeaways and Sign Off

In this episode of "For the Love of Revenue Cycle," host Vanessa Moldovan welcomes Kane Tomlin, who describes his path to state government work at the Mississippi Department of Health on data modernization and AI. They discuss how decades of point solutions created siloed public health data (e.g., TB and STI systems) that slow decisions such as infant mortality reviews, and how integrated, properly segmented data could automate case-file assembly for review boards and enable faster cause-and-effect learning. 00:00 Welcome 00:38 Meet Kane Tomlin 01:38 Kane's Career Path 03:30 Why Health Data Modernization 06:11 Dotcom Digitization Lessons 08:25 Keeping Humans in Control 08:47 Where to Find Kane's Work 09:30 Silos in Public Health Decisions 09:56 Infant Mortality AI Example 13:16 Blockers Privacy and Ecosystems 16:58 Responsible Integration and De-ID 20:11 What AI Enables in Healthcare 23:31 Pandemic Potential and Risks 25:41 Call to Action for Interoperability 28:47 Revenue Cycle Data Integrity Role 30:32 Closing

In this FTLORC Live Denial Q&A, Vanessa Moldovan shares takeaways from APC's HealthCon in Dallas. The episode focuses on denial/non-payment escalation beyond traditional corrected claims and appeals, tracking trends, using payer policy language in second appeals, and briefly contrasts out-of-network strategies (ERISA, patient/employer involvement, No Surprises Act). 00:00 Welcome and HealthCon Takeaways 00:47 Why Prior Auth Hurts Most 03:45 Traditional Appeals No Longer Enough 08:01 Escalation Step One Contract Review 10:37 Escalation Step Two Payer Relations 13:24 Escalation Step Three Insurance Commission 15:02 Grievances and Legal Options 19:00 Q&A Prior Auth Second Appeal Tips 24:41 Q&A When to Escalate and Trend Tracking 30:34 Wrap Up Community and Out of Network

Vanessa Moldovan hosts a first-time dual interview on revenue cycle leadership in federally qualified health centers (FQHCs) with Kara Onorato, CFO, and Jason Lafayette, Director of Revenue Cycle at MCR Health. They discuss MCR's scope (over 27 sites, three mobile units, extensive specialties, clinical trials, and 14 in-house pharmacies) and the FQHC mission to provide care regardless of ability to pay. They highlight trust, transparency, and data-driven partnership, and close with practical takeaways: stay vigilant, analyze denials and yields, educate teams, and lead adaptively. 00:00 Welcome 01:31 Meet the Guests 03:07 Kara CFO Journey 05:34 Jason Revenue Cycle Path 10:25 What Is MCR Health 11:54 Understanding FQHC Patients 15:52 Finding Community Health Centers 17:09 CFO Challenges in FQHCs 19:29 FQHC Revenue Cycle Differences 22:39 Preventing Revenue Leakage 25:32 CFO and Rev Cycle Partnership 30:11 CFO Role Shift Storytelling 32:48 Practical Takeaways and Wrap 36:22 Episode Closing

In this episode of "For the Love of Revenue Cycle," host Vanessa Moldovan speaks with Dr. Sylvia Owusu-Ansah, associate professor of pediatrics and emergency medicine at the University of Pittsburgh School of Medicine and EMS Medical Director at UPMC Children's Hospital of Pittsburgh, about what community engagement looks like in 2026 and why it's a smart investment for healthcare organizations. Dr. Sylvia (AKA Dr. O) shares examples sparked by the COVID era, including door-to-door outreach, language equity, and school-based pathway programs. They discuss why community initiatives are often treated as cost centers, how to measure impact through evaluation plans, and how community health can reduce costs by improving outcomes. Dr. O highlights measurable wins like CPR training that led to lives saved, emphasizes building trust with community leaders for sustainability, and offers calls to action for both community members and hospital leaders. 00:00 Welcome and Topic 01:28 Meet Dr Sylvia O 02:21 What Engagement Looks Like 03:19 Lessons From COVID 05:52 Why It Gets Ignored 07:19 From Research to Action 09:53 Workforce Pathway Programs 12:32 Measuring Impact 15:49 Data and Funding Sources 17:18 Building Trust Right 20:50 Sustainability and Support 25:46 Common Mistakes to Avoid 30:54 Calls to Action 34:45 Closing Thanks

ViVE Replay: Building Better RCM Automation with Agentic AI In this special episode, listen to Vanessa Moldovan present live at ViVE 2026. The talk covers identifying RCM and clinical-adjacent workflows ready for automation, ensuring automation solves rather than shifts problems, building CFO-ready ROI, implementing without disrupting operations, and using a framework to decide what to fix first. You'll learn more about high-impact automation areas (eligibility/benefits, prior auth, coding/claim review, payment integrity/contracts), get a clean explanation of agentic AI vs point solutions, hear about the six vendor-evaluation questions you need to ask, and discover what you should be tracking for ROI. After, you'll hear a panel of experts sharing real implementations and selection experiences, including Beacon's rapid care-gap outreach and MCR Health's focus on prior auth-driven cash flow. 00:00 Welcome and Intro 01:25 Session Goals Overview 03:37 Audience Poll 04:48 Why Change Now 05:56 Denials by the Numbers 07:28 Pain Across Ecosystem 10:30 Root Causes Breakdown 13:10 Path Forward and Panel 14:08 RCM Workflows to Automate 14:35 Standards and EDI Q&A 18:42 Ten Core RCM Steps 20:33 Top Automation Targets 26:36 Upstream Clinical Wins 28:11 Payer Side Opportunities 29:40 Agentic AI Explained 32:36 Vendor Questions Checklist 34:51 ROI Framework That Sells 38:39 KPIs That Prove Value 40:39 Tailored KPI Messaging 41:34 Fixing Workflows First 43:23 Agentic AI Reliability 48:19 Prioritization Framework 50:30 Meet the Panel 54:21 Beacon Care Gap Win 56:17 Choosing First Use Case 57:18 Buy In and Cash Flow 01:00:06 Data Quality and Trust 01:04:45 Compliance and Governance 01:08:35 ROI Metrics That Matter 01:10:20 PHI Learning and Feedback 01:16:12 Vendor Selection and Wrap Up

FTLORC Live Denials Q&A! 03/10/26 *Please note, the connection on the call dropped at the end, which is why there is a sudden cut-off. Vanessa Moldovan hosts a live community Q&A on denials and reimbursement, emphasizing end-to-end operational knowledge and root-cause fixes rather than siloed work. Nicolette shares a Medicare claim-rejection issue traced to offshore staff creating duplicate Medicare payer records with incorrect addresses, prompting new claim-entry guidelines. Participants discuss appeal effectiveness over sheer volume and trends in California denials, including Blue Shield requests for additional information and heightened scrutiny of 99213/99214 tied to fraud concerns and diagnosis ordering. Perva describes Medicare wellness/preventive denials for newly eligible members that required rebilling with 99214 instead of a G code and asks about Medicare crossover failures tied to patients updating secondary coverage with Medicare. Guadalupe details out-of-network underpayments driven by third-party pricing vendors like MultiPlan/Data iSight, ERISA-based appeal strategies, obtaining pricing in writing, NCCI/edit disputes, and escalation up to payer leadership. The group also covers documentation precision for time-based behavioral health codes and an orthopedic prior-authorization scenario where an authorized arthroscopy code was denied after a meniscectomy was coded, raising compliance and documentation questions. 00:00 Live Q&A Kickoff 00:55 Medicare Address Setup Errors 02:12 Root Cause Denial Fixes 04:46 99213 Denial Surge 06:57 Wellness Visit Coding Timing 09:09 Medicare Crossover Issues 10:50 Out of Network Underpayments 13:00 ERISA Appeals Strategy 16:40 Bundling and NCCI Disputes 21:05 Escalating to the CEO 24:53 Community Shoutouts and Teaching 26:28 Out Of Network Gap 28:03 Manual And LLM Help 29:05 Automation And Pricing Games 30:39 Multiplan Data Eyesight 32:32 Specialties And New Markets 33:36 Behavioral Health Denials 34:47 Time Based Documentation 36:42 Ortho Prior Auth Denial 42:15 Coding Billing Compliance 46:16 Wrap Up And Thanks

In this episode of For the Love of Revenue Cycle, Vanessa breaks down why prior authorization and eligibility verification are two of the biggest drivers of preventable denials — and how getting them right is essential to clean claims and healthy cash flow. The discussion covers the foundations of payer requirements, the difference between denials and rejections, and where most revenue leakage actually occurs across the front end of the revenue cycle. Vanessa shares practical best practices for improving accuracy and efficiency in PA and EBV workflows, along with real industry data on denial trends. The episode also explores how modern technology, including agentic AI, is transforming these processes by reducing manual work, closing operational gaps, and shifting organizations from denial resolution to true prevention. 00:00 Welcome and Introduction 03:07 Understanding Clean Claims 06:04 Claim Requirements Explained 10:41 Denials vs Rejections 12:25 Why Prevention Matters 17:05 Front End vs Backend 22:05 Prior Authorization Deep Dive 26:28 PA Process Step by Step 29:34 Prior Authorization Best Practices 32:15 Eligibility and Benefit Verification 35:55 EBV Best Practices 38:52 Technology and AI Overview 42:30 Understanding Agentic AI 44:48 AI in PA and EBV Workflows 48:04 Closing and Call to Action