NSCHBC Edge Podcast

In the context of medical and/or dental insurance, ADR refers to Additional Documentation Request. This is a request from an insurance payer (like Medicare) for additional records to support a claim. It's not a sign of wrongdoing, but rather a way to ensure compliance with policies and verify the validity of claims. Ignoring these requests, or failure to meet their deadlines, can result in a loss of revenue and trigger additional payers' audits and ADR’s. Terry outlines the ADRs and best practices to make sure your staff is on top of these requests, which helps save your revenue.

In-house billing offers enhanced internal control and potential return on investment but entails higher costs and staffing challenges. Conversely, outsourcing is cost-effective, transparent, and consistent but may result in skewed control of financial operations and introduce hidden costs. Terry discusses this important topic with healthcare consultant Donna White, covering the best option for different-sized practices.

On this edition of the Edge Podcast, Terry welcomes Healthcare Compliance Consultant, Stephanie Allard. The hosts discuss objectives when hiring an external consultant, such as budgets, objectives, outcomes, expectations, and more. Tune into this important and informative episode to make sure you are prepared

Are Dental Billing and Medical Billing the Same Thing? Terry Fletcher discusses the similarities, differences, and where crossover between dental and medical billing. Tune in for advice that can assist clients on both sides to be accurate in their coding and billing processes.

This month on the NSCHBC Edge Podcast, Terry welcomes back, NSCHBC member, Merikay Hunt CHBC, to discuss the pros and cons of a remote versus in-person versus hybrid workforce. When comparing corporate and healthcare sectors, remote work generally tends to be a better option for corporate roles due to the nature of many corporate jobs being more easily adaptable to digital platforms. However, healthcare often requires in-person patient interaction, making remote work less feasible in most cases. The best choice depends on the specific role and individual needs within each sector.

On today’s NSCHBC Edge Podcast, Terry speaks with healthcare attorney and fellow NSCHBC member, Ericka Adler, to identify suspected theft in a medical practice. Terry and Ericka discuss how to identify and prevent theft, plus educate your staff and providers so you are aware of potential red flags. Some areas to focus on include cash handling, prescription drug inventory, and billing practices. The hosts also talk about what to do if you find suspicious activity, how you can further investigate with the use of proper documentation, and the potential involvement of external auditors or legal counsel.

CPA versus bookkeeper: what is the role comparison in Healthcare, and medical practices? What does a physician or a physician practice need and why? A bookkeeper, although helpful for day-to-day accounting, payroll, and expenditures accounting. When the medical provider needs tax breaks information, provider relief funding accounting and deadlines, and retirement planning, what’s the better option and why? Terry talks with Healthcare CPA and NSCHBC President Shane Pickett on the best option for success.

In this episode of the NSCHBC Edge podcast, Terry welcomes back David Zetter of Zetter Healthcare to discuss Ambulatory Surgery Centers (ASCs) versus Office Based Labs (OBLs). Topics of discussion include:

The NSCHBC Edge Podcast welcomes fellow NSCHBC member, Rozmin Bapat to the show to discuss remote workers. Rozmin joins us from CodeRite Healthcare Consulting, based in Allen, TX. They are a billing, consulting and RCM company specializing in physician billing services. Terry and Rozmin define what it means to be a remote worker. What are some of the pros and cons of remote work and managing it. Also, how does remote work compare versus bringing everyone back in-person either hybrid or full-time? Healthcare jobs can be tricky in this sense. This episode will provide insights on how to make remote employees a success.

Many practices hire nurse practitioners and physician assistants (known as mid-level providers) along with RNs, MAs, and other clinical staff. Still, sometimes the lines get blurred on what services they can individually provide. Terry Fletcher, with fellow healthcare consultant and industry expert, Betty Hovey, discusses these compliance issues and gives medical practices insight into the pros and cons of these hires.

Healthcare policies, Medicare cuts, and election year promises and rhetoric all affect how a patient will receive or not receive benefits. We have so many Congressional policy rules on the table that will impact not only Medicare patients, but all patients as we may get a new HHS director as well when the presidency changes. Listen to this episode of the Edge podcast to know what is real and what is noise, as Terry Fletcher and Sean Weiss discuss healthcare and politics in 2024.

Staffing shortages continue to plague the healthcare industry, creating a vicious cycle where overworked healthcare professionals question their ability to continue. A recent NIL report showed that 81% of clinicians want states to implement laws governing staff-to-patient ratios, which they ranked as one of the biggest considerations when taking a job. As more medical professionals leave hospitals, physician practices, and clinics, consumers find their access to quality care threatened. It’s also not just clinical staff, it is administrative staff in healthcare as well. Terry speaks with consultant Debra Phairas, on this episode of the Edge podcast on how to tackle staffing shortages in this climate of post-COVID burnout.

In the setting of AI - Artificial Intelligence - Healthcare is running head first into possible risk. In this month’s episode of the NSCHBC Edge Podcast Terry and Vinny Sankaran tackle the PROS and CONS of AI in Healthcare. Data suggests AI helps health providers practice their profession and invest their time in engaging with patients rather than spending time on transcribing notes and administrative work. Also, when used safely and appropriately, this could exponentially expand evidence-based medicine to improve health outcomes and people-centered care. However, there are some CONS. Risks from AI include poor outcomes from algorithms (due to bias, low-quality data, lack of transparency, or usage in inappropriate contexts) which is a concern. HIPAA issues are a concern as well as cyber-hackers. We look at the current and future landscape of AI in Healthcare.

On this month’s episode of the Edge Podcast Terry welcomes back Healthcare Consultant Jackie Coult as they discuss the ins and outs of physician and dental practice startups. Terry and Jackie talk about having a plan, financial woes and potential funding, staffing, location and of course, what kind of practice you’d like to have. Join us for a fun and engaging conversation.

More than 100,000 doctors have left private practice and become employees of hospitals and other corporate entities since 2019. Today, nearly 3 in 4 physicians are employees of larger health care entities or other corporations — a record high. The cost of managing a medical practice — whether in primary care or a specialty practice — has surged. Not to mention, reimbursement rates from Medicare have not kept pace with higher operational costs. So how does a physician make sure they are collecting all that is due to them, not just from insurance payers, but where it begins: At the front desk? In today’s NSCHBC Edge Podcast, Healthcare Business Consultant David Zetter and Terry Fletcher, discuss front desk collections, making sure you have the right staff at the front desk and billing office to collect those out of pockets and share of costs. How to manage workflows, and how to insure you are getting every penny you are entitled to.

Terry welcomes fellow NSCHBC Member and Healthcare Consultant Anthony (Tony) Werner to discuss reducing administrative burden and costs incurred by meeting payer requirements. Most likely there will be resistance from most payers to incorporate intraoperability terms in contracts, including those required by legal or governmental directives. Terry and Tony discuss the complexities of these discussions and how to be successful in the process of contract negotiations.

There is always competition for patients and location in healthcare, but how do “non-compete” contracts affect patient care? Or a physician’s ability for career advancement? How do different states handle this hot topic? Healthcare Attorney Amanda Waesch and Edge host Terry Fletcher tackle this discussion today looking at the legal and business angles and relationships that will factor into these agreements. Also, are non-compete clauses always valid and enforceable? Listen to find out.

Christine Hall and Terry Fletcher, both SMEs in the Telehealth space, discuss the new rules for 2024, what the flexibility extensions “really” mean to physicians, and what traps of FWA not to fall into. For anyone currently participating in the Telehealth delivery of medicine, this is an important podcast to listen to.

In this month’s episode of the NSCHBC Edge podcast, Terry talks to life NSCHBC member, Kathy Moghadas, RN, CLHRM, CHBC, CHCC with Associated Healthcare Advisors, to discuss where the healthcare industry started back in the 80’s and where we are headed with all of the digital advancements, including AI. Is it all good? Not even close. Listen and find out why!

As you know BH and MH services are now being covered by Medicare and many commercial payers. Also, coverage has expanded like nothing we’ve ever seen. Even Telehealth has made some permanent changes to coverage that is only for Behavioral Health and Mental Health Services. To discuss this topic and to look at the proposed Medicare Final Rule and Fee Schedule for 2024, Terry invites fellow NSCHBC member Sonda Kunzi to the podcast. There are some services that we are concerned about and we are wondering where the specific guardrails and payment policies are.