FTLORC Live Denials Q&A! 05/12/26

Ep. 54 - Orthopedic Coding with Lynn Anderanin

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 She discusses auditing for unrelated problems, risks of over-documentation, cloning, and outdated templates, and emphasizes that notes must reflect patient-specific care and legal accountability.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

Ep. 53 - Where Clinical Care Meets Rev Cycle with Molly Cuerto

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

Ep. 52 - Data Interoperability & AI with Kane Tomlin

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

FTLORC Live Denials Q&A! 05/12/26

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

Ep. 51 - RCM Leadership in FQHCs with Kara Onorato and Jason Lafayette

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