In today's episode, we have a captivating discussion about a groundbreaking book that turns our understanding of healthcare as we know it today. Joining us is the esteemed Dr. Henry Buchwald, a seasoned healthcare professional who has witnessed the transformation of healthcare over the past 50 years. Drawing from his vast experience and keen observ…

In this episode we delve into the critical issue of healthcare cybersecurity and its increasingly vital role in protecting sensitive patient data. As digital transformation accelerates within the healthcare industry, the risks and challenges associated with cybersecurity have become more pronounced. Join our expert guest, Britton Burton with Corl T…

In this captivating episode, we delve into the realm of digital transformation in healthcare and explore its profound impact on patient care. Our expert guest in digital transformation Unmesh Srivastava, will shed light on various facets of this transformation, including the adoption of value-based care, harnessing the power of AI technology, and t…

This episode will discuss how to build meaningful relationships with patients, caregivers, and healthcare professionals. You will learn to build strong relationships with your teams, peers and external stakeholders. We will provide insights on how to build and maintain relationships that are beneficial to the organization as a whole. We will interv…

In this podcast episode, we sit down with Joey Dizenhouse, an expert in pharmacy benefit management (PBM). We explore the latest data trends in the PBM market, including rising healthcare costs. We also delve into the growing importance of data analytics and technology in managing pharmacy benefits and improving patient outcomes.Throughout the epis…

In this episode, we are showing our support for primary care physicians and how we can help them improve documentation.Primary care physicians are the backbone of our healthcare system. They provide comprehensive health care services to patients and serve as the first line of defense against illness and disease.Unfortunately, primary care physician…

The documentation of the chief complaint is a crucial part of a patient's medical record. The chief complaint is the primary reason a patient seeks medical attention, and it is important to document it accurately to ensure proper diagnosis and treatment. In this episode, we will discuss Documentation vs Guidelines What the payers are sayingThere is…

In this episode, we are joined by our friend Glenn Krauss from CORE-CDI. Glenn and I had the opportunity to sit down and review the CDI programs for Inpatient and Outpatient and how important CDI is to the healthcare industry. We will discuss the following: The medical record as a communication tool versus a reimbursement tool Physician documentati…

In the second installment of our series on Evaluation and Management, we dive into the importance of two keys areas Prescription Drug Management Major vs Minor surgeryThere is a level of critical thinking needed by coders and auditors. Our advisors will discuss these areas in detailLet's tune in to our advisorsJennifer McNamara CCS,CPC,CPMA,CRC,CGS…

The world of healthcare is in a state of chaos. With the rising costs of medical care, the increasing complexity of healthcare systems, and the changing landscape of insurance and payment options, it can be difficult for patients and providers to navigate the system. While there are some efforts to organize healthcare chaos, there is still much wor…

In this exciting three-part series we will hear from our advisors all about how to unravel the E/M guidelines and how to interpret areas of documentation. In this episode, we will look at how to interpret some key definitions in the MDM that affect a patient's condition. The meaning of acute vs chronic Exacerbated conditions vs severe exacerbations…

In our first episode of Season two, we start out with a very important topic that affects all in healthcare-Compliance!It's more than understanding what it is, but also how we view it and how we navigate the many levels. Today we sit down and chat with Compliance and Legal expert Susan Walberg JD, a consultant, and writer in all things compliance. …

In this final episode of 2022, we are bringing back a fan favorite and a very important topic. We must continue advocating for improved access to care, a better quality of care, and better patient rights and protections.We sat down with Jared Walker the Founder of Dollar For and we dig into the importance of hospitals being transparent about their …

Do you communicate effectively with your patients? Is your business staff up to the challenge of the necessary communication needed to keep your patients happy?Let's chat about necessary conversations that require communication Explaining Financial responsibility Communication regarding Prior Authorizations Effectively communicating prior to the pa…

In this episode I had the privilege of interviewing my friend Dr. Michael Cross.Conversation with a Surgeon: Does your patient come first?-Unique challenges in Breast Oncology-Burdens physicians face-Communication with teams-Patient education -Preventative measures and cost--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthc…

In this episode we discuss Diabetes. November is Diabetes awareness month and we want to understand the impact on patient care and reimbursement and the cost of treating the condition. How Diabetes affects Cost in Value-Based Care ICD10-CM Coding Guidelines Documentation and RiskLearn more by scheduling an onsite review and education session with y…

We have a bonus episode this week, to take a look at how we portray ourselves on Linkedin. Do we understand the proper etiquette? Have we made our profile attractive to a future or current employer? Let's take a break and get Linkedin Savvy!--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/messageSupport this pod…

In this episode we discuss the importance developing a Value Based Care Mindset. What can we do to improve in documentation in light of the new EM Revisions for 2023 that now encompasses Hospital Charges?Do we understand basic definitions and how they will affect Value Based Care payments?Do we understand basic documentation guidelines?Contact jmcn…

In this episode I invite my special guest Christine Hall CHC (AAPC Instructor) CPC , CPB, CPMA, CRC, CEMC, CPC-I to discuss the Global Package. We will discuss the proposed revisions by CMS and the history of it since 1992. Are we ready for a revision? Let's find out What changes have technology and advances in medicine brought us? Are you getting …

In this episode, we sit down with my friend and fellow podcaster Terry Fletcher and discuss the relationship between Physicians and coders. This is a significant relationship that helps utilize both the clinical and business sides of medicine. This partnership ensures compliance, and accurate revenue and allows the physician to focus on patient car…

Are you feeling burdened down with the Prior Authorization processes? You are not alone.In this episode we will chat with Manish Jain, Co-Founder and VP, Business Development of Oncospark and get his insights. We will answer: Why do insurance companies require authorization? Are internal process issues delaying treatment? Tips for organization, dem…

Join me and special guest Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI as we look "Behind the curtain with an Auditor" What is behind more audits in 2022? What does a lack of Audits say about your organization? Is Compliance your priority? What does an Auditor do? Why are Auditors vital in Healthcare?Schedule your next audit by emailing…

Check out me with my friend Pam Vanderbilt as we talk about Medicare and Modifiers.We will discuss the MPFS Indicators and why all in the Revenue Cycle need to know how Medicare processes claims, because Guess What? "Coding can change based on these Indicators"--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/mes…

Join me and my special guest Leslie Boles, BA, CCS, CPC, CPMA, CHC, CPC-I, CRC as we discuss the shift that needs to happen in the Business of Healthcare. As the Co-Owner & President at Revu Healthcare Leslie and her team offer comprehensive regulatory compliance solutions to healthcare providers, hospitals, health systems, physician groups, and ot…

This week we dive into the Revenue Cycle as it relates to Medical Coding. We encourage all to think about how their role as a Medical Coder is a peice of that Cycle and how we approach that role will effect all members of a Healthcare facility. Ultimately it effects the patient. Do you know you are more than a Medical Coder?--- Send in a voice mess…

In this special episode I am joined by my friend Barbara Cobuzzi MBA CPC COC CPC-P CPC-I CPCO CENTC CMCS. We will catch up with her and see what she's been up to.We will break down the Global Package for ENT Services and discuss Common issues in ENT Audits Endoscopic Sinus Surgeries Modifier 58 vs 78 Appropriate use of Modifier 59 and CMS X(ESPU)Co…

In this weeks episode we continue our discussion from last week and discuss the purpose of the Global Surgical Package. It is a lot to discuss so we will break it up into 2 episodes. This week we will review: Modifier 57 The Medicare Physician Fee Indicators What is Included in the Global Package Interpreting 0, 10 and 90 day Packages You can learn…

In this weeks episode we are joined by Sonal Patel, CPMA, CPC, CMC, ICDCM. She is a repeat guest and we are very excited to discuss Modifier 25. It has been in the news lately and a very controversial Modifier for years now.We will discuss: Modifier 25 Definition News from Commercial Payers OIG report from 2005 Using Authoritative GuidanceCheck out…

We are on Vacation this week. Check out a replay of one of my favorite episodes with my dear friend Christine Hall--- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/messageSupport this podcast: https://podcasters.spotify.com/pod/show/healthcrossroads/support

In this episode we will chat with Jared Walker, Founder at Dollar For where the goal is Advocating for patients to eliminate medical debt. We are all patients at one point in our life. The Burdens to provide healthcare are great for providers and healthcare staff but the burden for patients are great indeed! According to Jared " Many patients are i…

We have a great Bonus Episode for everyone with my special guest Jessyka Burke. We discuss the ins and outs of Podiatry Billing and Coding Challenges. Routine Footcare NCCI Bunion Coding Hammertoe Know your LCD Policies --- Send in a voice message: https://podcasters.spotify.com/pod/show/healthcrossroads/messageSupport this podcast: https://podcast…

In this episode we highlight why we are all here in the Business of Healthcare. To provide access to care for the patient population. It doesn’t matter what our role is, we have an obligation to fight for the patient so they can get what they need to improve their quality of life and in many cases save their life. I had the privilege of speaking wi…

In this week's episode I dig into the heart of getting your providers paid. Many of the breakdown starts with the data collected at the time of the appointment. In my career I started at the front desk. The most important role beside the Physician! I will walk you through my career from Receptionist to Consultant --- Send in a voice message: https:…

In this Bonus episode I am joined by Kimberly Clayson of Jaffe Raitt Heuer & Weiss as we give you a preview of the legal issues facing the industry and some insight into No surprise billing that she we give us at the Orthopedic Conference. What is No Surprise Billing? What it means for Orthopedics? Upcoming topics for the OrthoCare Summit Join us a…

Welcome to Episode 1 of Season 6! We are happy to invite our first guest of the Season Laurie Bouzarelos MHA,CPC on the show today to talk about Behavioral Health audits. Laurie Bouzarelos, MHA, CPC is a health care consultant with a special interest in supporting the unique business needs of behavioral health practices. Laurie works with psychiatr…

In todays episode we dive into LCD policies, Coverage and Evaluation and Management tips for Diagnosis Documentation. It is so important to understand the impact that Medical Necessity and Coverage guidelines play in reimbursement. Outside of direct care providers many patients rely on their insurance coverage to get the services they need. By acce…

In this Episode I welcome my colleague and Fellow Physician Educator Crystal Watters. Remote vs Onsite jobsPassing an exam doesn't guarantee a jobSocial media ettiqiteTrue value of CEUS Apprentice Credentials, do we need them? What does having a credential tell a prospective employer? Different Credentials Earn a CEU for this episode by joining our…

In this final episode of our 4 part series with Behavioral Health I wanted to close out with awareness of Stress and Anxiety awareness. April is #stressawarenessmonth and we discuss the damage prolonged stress can have on our mental and physical health. 🔸️Stress and Anxiety Awareness 🔸️Final Rule and Behavioral Health 🔸️Exam Anxiety Exam Anxiety Ti…

Let's discuss the Clinical side of Personality Disorders. I have a special guest Paul Sheesley MA, LPC,LCPC,LCADC a clinical Psychotherapist and Consultant specializing in Personality disorders and Substance Abuse. We will discuss: Personality Disorders Presentation of these disorders Effect on Family and Society Risks Early Detection Effect on Anx…

In this episode I am joined by my colleague and friend Barbara Shaw, CPC, CPCO, CDEO, CRC, CEDC . W will discuss Risk adjustment and Social Determinants of health as it relates to Mental Health Services What is Risk Adjustment? Important reminders about SDOH Risk Adjustment Documentation Mental Health and SDOH Join the Risk Adjustment Masterclass c…

In this episode we begin our four part series on the Behavioral Health Crisis. I will be sharing my thoughts on mental health in the workplace. I share what I have learned in my career and the things that have contributed to my professional growth. We can all improve in our way of dealing with others at home and in the workplace. Mental Health in t…

In this Episode I'm joined by Sarah Ragan. A seasoned coder and auditor. She's a great educator and mentor. Today we talk about the benefits of Virtual Education and why it is a valuable way to get our education. Value of Education Virtual Education before and after the pandemic Benefits of Virtual Education on the community Networking Value Learn …

Join me and my special guest Stephanie Thebarge CPC, CPMA, CPPM, CPB, CEMC, CHONC, PESC talking about all things #Oncology We discuss the differences in Surgical Oncology, Medical Oncology and Radiation Oncology. We discuss the necessity of a proper understanding of Guidelines, Payer requirements and the natural desire to be a good reseacher. This …

In this Bonus Episode Kimberly Jolivette Williams CPC CPB CPMA CANPC CCC CEMC is my special guest. Its March Madness with Modifiers and we are here to talk about our favorite ones and some very important tips and guidance. *Always check your state and local plan websites for Modifier guidance Why do we use modifiers? Modifier 24,25, and 57 Modifier…

In this episode we will be joined by our special guest Mia Reddick-Smith, PMP, MBA, CPC-I. She has over 16 years’ experience working in healthcare revenue integrity and project management with enterprise system implementations. She is a results-oriented professional leading development of reimbursement and charge capture programs as well as executi…

In this Episode I invite back my friend and fellow Podcaster Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM. She is the host of the #codecast podcast. In our years working in the business of healthcare we have seen so much fraud, waste and abuse. Much of the waste is simply not understanding the appeals process. So much money is …

Join me and my Special Guest Jessyka Burke, BSHA, CPC, COSC, CASCC as we dive into the world of billing for Workers Compensation, Tricare and Auto Insurance Billing. We thought these are areas of Billing that often get misunderstood or billed incorrectly. It takes organization and constant follow up. We give you the tips to be successful. Getting o…

Everyone has a role to play in the Revenue Cycle. Its important that we understand each other's role to work better as a team. Join Vanessa Moldovan and myself as we discuss: Overview of revenue cycle What is the difference in billing vs coding? Job responsibilities of a coder vs a biller What other roles in RCM can a coder be utilized in? Ways to …

I get many questions about how to read and dissect an operative report. In an effort to answer some of those questions I have decided to talk about the process in this episode. Operative Report Elements Getting Organized Understanding the Medical Necessity Learn more about Surgery coding for OBGYN Services at our conference Saturday 2/12/22 www.obg…

During the Public Health Emergency our world in the Business of Healthcare is constantly changing. One area we see constant movement in is Telehealth Services. Today my special guest Christine Hall and I will discuss this topic and some reminders on Coding based on the current IC10-CM Covid 19 Guidelines. What is the difference between Telehealth b…