Introducing the Board Landscape

EPISODE SUMMARY

Is your practice tired of wrestling with insurance denials, deciphering EOBs, and watching your revenue slip through the cracks? You are not alone! Welcome to The Claim Game, the podcast designed to cut through the confusion and provide you with the best practices for revenue cycle management (RCM) success. Join Jeremy and Kathryn Zug as they simplify the complex landscape of RCM, explaining it as a game with rules that can be played well or poorly. They introduce the six key "territories" on the RCM game board: Credentialing, Patient Registration, Eligibility and Benefits, Payment Posting, Aging Follow-Up, and Claim Submission.

In this foundational episode, learn how credentialing is the crucial first step to even "get on the board" and why it can feel like an impossible hurdle for many providers. Discover why meticulous patient registration is vital for smooth billing and strong patient relationships, affecting everything from patient retention to claim rejections. The Zugs then detail Eligibility and Benefits (E&B), emphasizing its role in setting expectations for patient payment and the importance of checking it regularly, not just once. You'll understand the critical distinction between a claim rejection (from the clearinghouse) and a denial (from the insurance company) and why Payment Posting should always happen before Aging Follow-Up to avoid wasting time and money. Finally, they cover Claim Submission, highlighting the importance of completed clinical notes and strategic frequency.

Jeremy and Kathryn share their own journey of founding Practice Solutions in 2017 with the mission to remove the burden of billing and educate providers. They believe "you don't have to do it yourself, but it's not that hard to understand." Tune in to gain clarity, confidence, and practical tools to win at "The Claim Game" and return to focusing on patient care. "

KEYWORDS

revenue cycle management, insurance billing, credentialing, patient registration, eligibility and benefits, payment posting, claim submission, healthcare podcast, billing solutions, Practice Solutions

TAKEAWAYS

Credentialing gives you your "game piece": You can't even play The Claim Game without proper credentialing. It's the foundational step to becoming in-network with insurance partners.

Patient Registration brings players to the board: Meticulous patient registration, including collecting accurate ID and insurance information, is crucial to avoid claim rejections and build strong patient relationships. This also includes streamlining your checkout process.

E&B sets the expectations: Verifying Eligibility and Benefits ensures you and your patients understand coverage, deductibles, copays, and prior authorization requirements before services are rendered. This information should be checked regularly, not just once.

Payment Posting is about clarity: Always post payments before working your aging report. Understanding Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) through accurate payment posting prevents wasted time and helps identify fixable claim errors.

Aging Follow-Up tackles outstanding revenue: Proactively managing your insurance and patient aging reports, prioritizing older and larger balances, is essential to avoid timely filing write-offs and ensure consistent cash flow.

Claim Submission ensures accurate billing: A claim is ready for submission when the appointment is completed and the clinical note is finalized. Understanding the difference between a "rejection" (clearinghouse data errors) and a "denial" (payer issues) is key to efficient claims management.

Practice Solutions' Mission: We exist to empower providers by removing the burden of billing and educating on best RCM practices, aiming to provide clarity in a confusing industry

CHAPTERS

00:00 Introduction to the Claim Game

04:12 Round 1: Introducing the 6 Key Territories

04:31 Territory 1: Credentialing

10:27 Territory 2: Patient Registration

21:19 Territory 3: Eligibility & Benefits

30:21 Territory 4: Payment Posting

38:14 Territory 5: Aging Follow-up

44:53 Territory 6: Claim Submission

53:53 Case Study Card: The Birth of Practice Solutions

59:04 Conclusion to The Claim Game Podcast

RESOURCES

Learn More About The Claim Game: Visit practicesol.com/theclaimgame

Terminology Guide: For a full list of RCM definitions discussed in this episode, check out our .css-j9qmi7{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;font-weight:700;margin-bottom:1rem;margin-top:2.8rem;width:100%;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:start;justify-content:start;padding-left:5rem;}@media only screen and (max-width: 599px){.css-j9qmi7{padding-left:0;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;}}.css-j9qmi7 svg{fill:#27292D;}.css-j9qmi7 .eagfbvw0{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;color:#27292D;}