In this episode of Practice Perfect, Jennifer McNamara and Maya Turner break down when to fight the payer, fix the claim, or fix the process.

From medical necessity and prior authorization to credentialing, patient responsibility, modifier 59, and payer policies, they discuss why understanding the reason behind a denial matters before taking action.

They also touch on Independent Dispute Resolution (IDR) and why denial data can reveal much bigger problems in your revenue cycle.

Key takeaway: Getting a claim paid isn't always the same as getting it right.

🎙️ Practice Perfect Jennifer McNamara & Maya Turner

🎧 https://www.practiceperfectpod.com/

In this episode of Practice Perfect, Jennifer McNamara and Maya Turner get into the soft skills that can make or break your professional growth.

They discuss why organizational change can feel uncomfortable, why discomfort does not automatically mean a decision is wrong, and how employees and leaders can navigate change without allowing emotion to drive their decisions.

Jennifer and Maya also break down an important distinction: project management vs. micromanagement. Accountability, deadlines, checkpoints, and expectations are not necessarily micromanagement. The difference often comes down to trust.

The conversation also turns to professional communication and social media. You can disagree. You can raise concerns. You can challenge a decision. And when there are legitimate concerns involving compliance, fraud, harassment, safety, or unethical conduct, those concerns should be reported through the appropriate channels.

But disagreement does not require destroying someone else's dignity.

In this episode, Jennifer and Maya discuss:

• Adapting to organizational change without reacting emotionally • Why soft skills matter at every level of your career • Maintaining professional relationships even when you disagree • Project management vs. micromanagement • Trust, accountability, and expectations in the workplace • Communicating concerns professionally • Knowing the difference between a personality conflict and a legitimate compliance concern • The AAPC Code of Ethics and professional conduct • Why your social media presence matters professionally • How online comments can follow you into future employment, leadership, and even expert witness work • The importance of mentors when navigating difficult professional situations

One of the biggest takeaways from this conversation:

You can disagree with someone without attacking who they are.

Instead of, “This person clearly doesn't know how to code,” consider, “I disagree with this coding interpretation.”

Instead of, “They're a terrible leader,” consider, “I have concerns about this leadership decision.”

Professionalism doesn't mean never disagreeing. It means knowing how to disagree without losing your integrity in the process.

🎙️ Practice Perfect Podcast Hosted by Jennifer McNamara with co-host Maya Turner

Practice Perfect brings real conversations about medical coding, compliance, leadership, revenue cycle, professional development, and the realities of working in healthcare.

Resources Mentioned: AAPC Code of Ethics — Review AAPC's ethical principles, including integrity, respect, commitment, competence, fairness, and responsibility.

Learn more about Healthcare Inspired and our education programs at HealthcareInspiredLLC.com.

In this episode of the Practice Perfect Podcast, hosts Jennifer McNamara (Healthcare Inspired) and Maya Turner (Turner Expert Solutions) break down the CMS 2027 Proposed Rule and what it means for physicians, ASCs, and multi-specialty practices — right now, not next year.

🔑 What we cover:

• The projected ~45% Medicare revenue decrease when the conversion factor cut and expiring temporary increase stack together

• Why CMS is treating every non-E&M service as a "secondary procedure" — and what that does to bundled reimbursement

• How to run your 12-month revenue baseline and identify your high-dollar procedure exposure

• The 60-day comment period: how to make your voice count with CMS

• Where AI helps (and where it absolutely does NOT replace certified coders and compliance experts)

• The OBGYN global package overhaul — new prenatal risk coding and Medicaid trimester considerations

• Payer contract renewals and December-to-January care overlap

🎬 Plus — Lights, Camera, Healthcare! We're breaking down The Devil Wears Prada 2 and the leadership lessons hiding in plain sight.

✅ Action items: Pull your Medicare baseline. Audit your OBGYN workflows. Submit comments during the CMS window. And whatever you do — protect your coding, compliance, and education budgets.

🎤 Coming up: Maya Turner presents on Independent Dispute Resolution (IDR) at the AMBA Association conference.

👥 About your hosts:

Jennifer McNamara — Founder of Healthcare Inspired, specializing in revenue cycle optimization, compliance, and provider education.

Maya Turner — Founder of Turner Expert Solutions, coding, billing, and IDR subject-matter expert.

Subscribe for more practical, no-fluff healthcare operations education from Healthcare Inspired and Turner Expert Solutions.

In this episode from the Bone & Joint Summit 2026, we bring together Sandy Giangreco Brown and Sonal Patel—respected voices in healthcare revenue cycle, compliance, and leadership—to explore how today's leaders can modernize operations, build resilient teams, and drive sustainable revenue performance without losing sight of the people, providers, and patients at the center of it all.

Our guests discuss the real challenges orthopedic leaders face: modifier accuracy and coding complexity, prior authorization bottlenecks, ASC expansion strategy, implant vendor negotiation, provider education, and how to bring AI into your practice the right way. Most importantly, they explore how leaders can support their teams through change, foster psychological safety, invest in career growth, and turn frontline staff into champions of transformation.

Whether you're running a practice, ASC, or health system, this conversation will reshape how you think about revenue cycle leadership in 2026 and beyond.

Guests: Sandy Giangreco Brown & Sonal Patel From: Bone & Joint Summit 2026 Hosted by: Healthcare Inspired | Remote Healthcare Consulting & Education

In this episode, Jennifer McNamara (Healthcare Inspired) sits down with Elizabeth Johnson, CEO of MedicoCX, to tackle one of healthcare's biggest challenges: how to communicate honestly about costs without eroding trust.

They explore:

✓ Why chargemasters and allowables confuse patients (and what to do about it)

✓ How every healthcare worker needs basic revenue cycle literacy—not just billing staff

✓ The real reason the No Surprises Act hasn't solved surprise bills

✓ How physicians can navigate insurance requirements without gaming the system

✓ Why AI in healthcare communication is creating new trust problems

✓ Young adults and medical debt: an emerging crisis

✓ How to place staff in roles where they actually succeed

✓ Why employer investment in education pays dividends

This conversation reveals that financial transparency isn't a billing problem—it's a leadership and communication problem. When everyone from front office to clinical staff understands the revenue cycle, patients feel more prepared, less betrayed, and more likely to trust your practice.

Perfect for practice leaders, revenue cycle professionals, clinical staff, and anyone working to improve patient experience and practice performance.

Elizabeth Johnson — CEO of MedicoCX, serving 600+ community-based providers across 50 states. Passionate about medication access, healthcare advocacy, and building organizational competency around patient financial communication.

📍 Connect with Elizabeth: https://www.linkedin.com/in/ej-biologics/

• Financial literacy is a team sport, not a billing department function
• Patients need education about chargemasters, allowables, and EOBs to understand their bills
• Transparency builds trust; avoidance builds resentment
• Technology enhances communication but shouldn't replace human connection
• Employee development is a competitive advantage in healthcare recruiting

Attend the Healthcare Advocate Summit (September, Vegas) to connect with like-minded healthcare professionals focused on patient advocacy, financial transparency, and healthcare transformation.

📌 Learn More: https://www.healthcareadvocatesummit.com/

Healthcare Inspired helps medical practices, hospitals, and ambulatory surgery centers optimize operations and strengthen performance through practical consulting, education, and professional development.

Listen now and discover how better communication creates better patient outcomes and healthier practice finances.

In this panel discussion from the 2026 Bone & Joint Summit, Jennifer McNamara is joined by Preston Alexander, Shannon Cameron, and Maya Turner to discuss the financial, operational, and leadership strategies that help orthopedic and musculoskeletal organizations thrive despite increasing reimbursement pressures.

The conversation explores how meaningful analytics, payer strategy, operational excellence, and collaboration can transform data into better business decisions while keeping patient care at the center of every decision.

Whether you're an executive, practice administrator, revenue cycle leader, coder, auditor, or physician leader, this episode offers practical insights you can immediately apply to strengthen your organization.

• Why "revenue resilience" is more important than ever
• The unique financial challenges facing orthopedic and musculoskeletal practices
• The evolution of analytics in revenue cycle management
• Which KPIs leaders should monitor regularly—and why
• Using data to drive decisions instead of assumptions
• Identifying underpayments and strengthening payer contract performance
• The growing role of cash-pay and concierge services
• Revenue cycle trends affecting independent practices
• Why operational collaboration is essential across departments
• Leadership perspectives on building financially sustainable organizations

Jennifer McNamara CEO & Founder, Healthcare Inspired LLC

Preston Alexander Founder & CEO, Forward Slash Health

Shannon Cameron Chief Operating Officer, Harvard Medical Faculty Physicians

Maya Turner Founder & CEO, Turner Expert Consulting Services

• Reliable data is the foundation of effective decision-making.
• KPIs only create value when organizations act on what they reveal.
• Underpayment monitoring should be an ongoing operational priority.
• Understanding payer contracts is essential to protecting revenue.
• Financial resilience requires collaboration between operations, coding, billing, finance, and leadership.
• Practices must continually adapt to changing reimbursement models and patient expectations.
• Strong organizations focus on long-term sustainability rather than reacting to short-term challenges.

• Orthopedic Practices
• Ambulatory Surgery Centers (ASCs)
• Revenue Cycle Leaders
• Practice Administrators
• Physicians
• Medical Coders
• Auditors
• Healthcare Consultants
• CFOs and Financial Leaders

Learn more about Healthcare Inspired LLC: https://healthcareinspiredllc.com

Listen to more episodes of the Practice Perfect Podcast for conversations on revenue cycle management, compliance, coding, leadership, and healthcare innovation.

Follow Jennifer on LinkedIn for weekly insights on:

• Revenue Cycle Management
• Medical Coding
• Auditing & Compliance
• Healthcare Leadership
• Practice Operations
• Education & Professional Development

Subscribe to Practice Perfect so you never miss conversations with healthcare leaders who are helping practices improve performance, strengthen compliance, and build organizations designed for long-term success.

In This EpisodeMeet the PanelKey TakeawaysWho Should Listen?ResourcesConnect With Jennifer McNamara

In this episode of the Practice Perfect Podcast, Jennifer McNamara and Maya Turner discuss why healthcare organizations shouldn't wait until implementation day to prepare for the FY2027 ICD-10-CM diagnosis code updates.

From documentation changes and coding revisions to compliance risks and provider education, this conversation focuses on practical steps every organization can take now to ensure a smooth transition. Whether you're a coder, auditor, provider, CDI specialist, or revenue cycle leader, this episode will help you prepare your team before the annual code update takes effect.

Jennifer and Maya also share implementation strategies, common pitfalls they see during ICD-10 transitions, and recommendations for educating providers before October Why early preparation matters for ICD-10 implementationarrives.

Jennifer McNamara, CCS, CPC, CDEO, CRC, CPMA, COSC, CGSC, COPC, CPCI CEO & Founder, Healthcare Inspired LLC

Jennifer is a nationally recognized healthcare consultant, educator, author, and speaker with more than 20 years of experience in medical coding, auditing, compliance, documentation improvement, and revenue cycle management. She is passionate about helping healthcare organizations improve compliance while simplifying complex coding and regulatory changes.

Maya Turner, CPC, CPCO, CPMA, CPC-I, CFPC, CRC Director of Auditing, Healthcare Inspired LLC

Maya is a nationally recognized coding, auditing, and compliance expert with more than 30 years of healthcare experience. As an AAPC Approved Instructor, consultant, and national speaker, she specializes in coding compliance, audit methodology, provider education, quality assurance, and operational excellence. Maya is known for translating complex coding guidance into practical strategies healthcare professionals can apply immediately.

🌐 Healthcare Inspired LLC: https://healthcareinspiredllc.com 🎙️ Practice Perfect Podcast 📅 Bone & Joint Summit 2026: July 16–17, 2026

Follow Healthcare Inspired LLC for educational resources, webinars, podcasts, and industry updates designed to help healthcare organizations improve compliance, strengthen documentation, and optimize revenue cycle performance.

If you enjoyed this episode, subscribe, leave a review, and share it with a colleague. Together, we can stay ahead of the changes—and ahead of the challenges.

Network Adequacy & Access to Care

• The disconnect between provider directories and actual participation status
• Real-world patient scenarios: arriving at offices only to find providers no longer participate
• The gatekeeper model in Medicare HMO plans vs. traditional Medicare
• CMS regulations on network adequacy testing and the 2030 deadline
• Shared responsibility between insurers and medical practices for accurate information

Provider Education & Communication Gaps

• Lack of education from Medicare Advantage plans to providers
• Shift from in-person representative visits to electronic-only communication
• Conflicting guidance between state payers and Medicare managed care programs
• The need for clear, consistent communication about covered services

Utilization Management & Prior Authorization Issues

• Prior authorization as a core barrier to access to care
• Gatekeeping policies preventing medically necessary procedures
• Documentation's critical role in authorization decisions
• Importance of providers thoroughly understanding their contracts
• Peer review challenges: Not all "peers" are true specialists in relevant fields
• The problem of apples-to-apples comparisons (e.g., cardiologist vs. interventional cardiologist)

Policy Review & Compliance Risks

• Insurance companies operating with outdated policies (sometimes 5+ years old)
• Annual CPT code changes not reflected in insurer policies
• Compliance risk when policies aren't aligned with Medicare updates
• Many practices still lack comprehensive compliance plans
• The need for regulatory requirements to match current medical practice and technology

Automation vs. Augmentation in Claims Processing

• Differences between automation and augmentation in AI-driven systems
• Algorithm failures: Same claims denied incorrectly multiple times
• Automation doesn't guarantee accuracy or faster processing
• Predictive AI limitations in managing complex, multi-system healthcare plans
• The imperfect system behind the "perfect idea"
• Cost containment driving automation at the expense of quality

Contract Negotiations & Fighting Back

• Why some large healthcare systems write off millions instead of appealing denials
• Importance of having healthcare attorneys review contracts
• Real-world examples of providers who fought back successfully
• Balancing "getting business" with understanding contractual rights
• The financial benefit of appeals and proper reimbursement pursuit

OIG Oversight Areas (Preview of Future Episodes)

• Improper financial incentives and behind-the-books arrangements
• Marketing practices under scrutiny
• Risk adjustment methodologies
• Quality of care validation mechanisms

Topics for Future Episodes: Risk adjustment methodologies, quality of care oversight, and deeper analysis of OIG regulatory framework for Medicare Advantage organizations

Upcoming Events:

• General Surgery & Gastroenterology Combined Conference: June 4–5, 2026
• Ortho Summit: July 2026
• E&M Symposium: Fall 2026

From social exclusion and information control to polite denial and professional gaslighting, they explore how toxic dynamics operate beneath the surface — and why high-performing, ethical professionals are often the most impacted.

You’ll learn:

• What the Mean Girl Effect actually looks like in real workplaces

• The psychology behind gaslighting and why it escalates near accountability

• How subtle manipulation destabilizes confidence and increases stress

• Why your nervous system reacts before your logic does

• Practical strategies to protect your clarity, credibility, and mental health

In the Eye on Healthcare Business segment, Jennifer and Maya provide a deep dive into the OIG’s updated Medicare Advantage Compliance Program Guidance — including key risk areas such as risk adjustment, marketing and enrollment, vendor oversight, and documentation expectations. They also discuss what increased enforcement activity from Attorneys General means for healthcare organizations today.

This episode is about naming patterns, protecting integrity, and understanding how culture, compliance, and credibility intersect.

OIG Medicare Advantage Industry Segment-Specific Compliance Program Guidance:

🔗 https://oig.hhs.gov/compliance/ma-icpg/

Same problems. Same conversations. Same frustrations—just on repeat.

In this episode, we’re talking about The Groundhog Day Effect—that feeling of reliving the same challenges over and over, even though you’re working hard and staying busy.

This isn’t about motivation. It’s about awareness, leadership, and breaking patterns that quietly keep practices stuck.

If you’ve ever thought, “Why does it feel like nothing is changing?” — this episode is for you.

The Groundhog Day Effect happens when:

• Problems repeat because systems never change

• Goals reset every year but behaviors stay the same

• Teams feel busy but not aligned

• Growth feels stalled despite effort

This episode dives into why this happens and—more importantly—how to break the cycle.

• Why repetition is often a system issue—not a people issue

• How leadership patterns create recurring outcomes

• The difference between activity and progress

• Why unresolved problems keep showing up in new forms

• How clarity and intentional goals disrupt the cycle

• The role staff support plays in creating real change

• Why awareness is the first step toward momentum

• How to stop “resetting” and start evolving

If your team keeps:

• Struggling with the same issues

• Revisiting the same conversations

• Feeling frustrated or disengaged

This episode will help you see where the loop is happening—and how to lead your way out of it.

Change doesn’t come from doing more. It comes from doing things differently.

Ask yourself this week:

“What keeps repeating in my practice—and what haven’t I changed yet?”

That answer holds the key to momentum.

In this episode, we’re breaking down how to set SMART growth goals for your healthcare practice—goals that are clear, achievable, and actually supported by the people responsible for delivering patient care.

This is a deep dive into intentional growth, leadership clarity, and the often-missing link between goals, staff support, and patient success.

If you’re ready to grow smarter this year, this episode is for you.

• Why being “busy” isn’t the same as real growth

• How to redefine growth so it supports your vision—not stress it

• The SMART goal framework explained for real healthcare practices

• Common goal-setting mistakes that keep practices stuck

• Why staff support is essential for achieving patient goals

• How to align your team so goals don’t feel like extra work

• Ways to create systems, training, and clarity that empower staff

• How supported teams lead to better patient outcomes

• Why focus beats hustle every single time

• How to review, adjust, and celebrate progress without burnout

Patient goals don’t live on spreadsheets—they live in daily interactions.

In this episode, we dive into:

• Connecting goals to purpose so teams understand the “why”

• Making goals role-specific so everyone knows how they contribute

• Replacing pressure with training, coaching, and clarity

• Fixing systems instead of blaming people

• Creating psychological safety so teams can speak up and improve

• Celebrating progress to build momentum and confidence

When staff feel supported, patient care improves—and growth becomes sustainable.

• Healthcare practice owners

• Practice managers and leaders

• Clinical teams ready for better systems

• Anyone who wants growth without chaos

Check out our books on Amazon for practical strategies, leadership insights, and growth frameworks designed specifically for healthcare practices:

👉 Clear and Connected: How Effective Communication Builds Trust in Healthcare🔗 Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

This week, write down one SMART growth goal for your practice—and ask this question:

“How are we supporting the team responsible for achieving this?”

That answer changes everything.

If you found this episode helpful, be sure to follow the show, leave a review, and share it with another practice leader who’s ready for smarter growth.

Thanks for listening 🎧 Here’s to intentional, supported, sustainable growth.

💡 What You’ll Learn in This Episode:

• The Hidden Strain Behind the Scenes

  • Why healthcare teams — from clinicians to coders — are feeling more pressure than ever.

  • How after-hours stress (like worrying about documentation or denied claims) quietly fuels burnout.

• Burnout: The Red Flags You Can’t Ignore

  • Behavioral signs: sudden withdrawal, irritability, or unusual changes in tone.

  • Cognitive signs: second-guessing, rising errors, and emotional exhaustion.

• The Real Cost of Neglecting Mental Health

  • High turnover, skyrocketing training costs, and patient dissatisfaction.

  • How poor morale can quietly erode your workplace culture — and why it’s so hard to rebuild.

• How to Build a Resilient Team (That Actually Wants to Stay)

  • Communication that works: Daily huddles, honest check-ins, and clear expectations.

  • Smarter workflows: Cutting out busywork, protecting focused time, and ongoing staff education.

  • Leadership’s role: Modeling calm, setting boundaries, and creating true psychological safety.

• 📊 CMS 2026 Final Rule — What You Need to Know Now

  • Two new conversion factors, payment shifts, and a –2.5% efficiency adjustment.

  • What these changes mean for budgets, staffing, and clinic productivity.

  • Telehealth shake-up: Permanent policy changes, supervision updates, and billing compliance tips.

• 🎬 Lights, Camera, Action — The Rainmaker Meets Healthcare

  • Three striking quotes that mirror today’s healthcare challenges:

    • Fear-based decisions around policy change.

    • Moral burnout when patient care takes a backseat.

    • The emotional toll of crossing lines to meet metrics.

• Closing Thoughts

  • Building resilience isn’t a trend — it’s a leadership mandate.

  • Healthy teams deliver better care, stay longer, and weather change with strength.

In this episode, we dive into the real-world impact of unaddressed toxicity on teams, patient safety, and organizational culture. Leaders often stay quiet out of fear—fear of conflict, fear of losing staff, or fear of mishandling HR processes. But avoiding action doesn’t preserve stability; it erodes it.

• The true cost of silence: How ignoring toxic behaviors fuels burnout, increases turnover, and jeopardizes patient outcomes.

• Red flags to watch for: Early indicators of problematic behavior that leaders often overlook.

• How to act with confidence instead of fear: Practical steps for addressing staff issues without hesitation.

• Documentation that protects you: Easy, effective documentation habits that prepare you for HR-aligned action.

• Partnering with HR the right way: When to involve HR, what information they need, and how to collaborate rather than fear escalation.

• Protecting your culture: Strategies for reinforcing expectations, supporting high performers, and preventing toxicity from spreading.

When leaders choose silence, teams suffer. When leaders choose courage, culture transforms.

📘 Clear and Connected: A Communication Guide for Healthcare Leaders A practical roadmap to building stronger teams, improving communication, and leading with clarity.

Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

📗 Guiding the Next Generation A powerful resource for mentoring, coaching, and shaping emerging healthcare professionals.

Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

From navigating payer rules to managing rising denial rates, Jennifer reveals how the revenue cycle intersects with clinical decision-making at every step of a patient’s journey. This conversation sheds light on the hidden administrative barriers that influence access, cost, and continuity of care — and why improving compliance isn’t just about accuracy, but compassion.

• Why Breast Cancer Awareness Month is about more than pink ribbons

• Common revenue cycle pain points in oncology, including prior authorization delays and documentation pitfalls

• Denial trends affecting breast cancer treatment and imaging services

• How payer policies shape patient access — often more than clinicians do

• Practical solutions for practices to reduce denials, streamline workflows, and elevate the patient financial experience

• The critical role of coding and billing teams in supporting both compliance and continuity of care

• Prior authorization hurdles for diagnostic imaging and treatment plans

• Complexity of breast cancer coding, documentation, and medical necessity

• The financial burden on patients when claims are delayed or denied

• Communication breakdowns between payers, clinicians, and billing teams

• Workflow strategies that improve accuracy and reduce rework

• Why revenue cycle training is essential in oncology practices

Behind every statistic is a person navigating fear, uncertainty, and hope. Administrative barriers shouldn’t be another burden. This episode empowers healthcare leaders, coders, and revenue cycle teams to make breast cancer care more accessible, compliant, and compassionate — supporting both the clinical mission and the business realities.

• Medical coders & billers

• Oncology practices

• Revenue cycle leaders

• Healthcare administrators

• Compliance professionals

• Anyone interested in how healthcare finance impacts patient care

If you’d like expanded resources, training, or consulting support for oncology revenue cycle challenges, Jennifer McNamara and Healthcare Inspired LLC are here to help.

In this special episode of Practice Perfect, host Jennifer McNamara sits down with Megan Renner — Beauty Society representative, wife, and volunteer — who is passionate about helping women feel confident and cared for.

Together, they dive into: ✅ Why skincare is about health, prevention, and confidence ✅ How simple routines can make a big difference every day ✅ Why awareness matters all year long, not just in summer ✅ How healthcare professionals can normalize conversations around skin health

💡 Whether you’re a busy professional, a healthcare provider, or simply someone who wants to feel more confident in your own skin, this episode will inspire you to see skincare as a vital part of self-care.

🎧 Listen here and be reminded: your skin deserves as much care as the rest of you.

We dig into the everyday realities of being a coder and how much more it takes than just knowing the rules. You’ll hear a fresh perspective from Cameron Lewellen, plus a big announcement from Turner Consulting that impacts how practices can get the support they need.

We also shine a light on compliance in behavioral health—a space where regulations are constantly evolving and documentation is critical. From there, we unpack the gray areas of “medical necessity,” why payers care, and how providers can protect themselves.

And because no coding mashup is complete without it, we close with a look at new codes you should have on your radar to stay ahead of payer changes.

This episode is a quick hit of education, industry updates, and inspiration—perfect for coders, consultants, and practice leaders who want to stay sharp without spending hours in the weeds.

We start by unpacking why communication is key—not just in theory, but in the day-to-day challenges of healthcare teams. You’ll hear real stories that bring these points to life, showing how small details can make a big difference.

From there, we turn to the payer games that practices are still stuck playing—denials, delays, and shifting rules—and talk about strategies to level the playing field. More stories and lessons keep it real and relatable, before wrapping up with takeaways you can apply right away.

This episode blends storytelling, real-world payer frustrations, and practical insight, making it perfect for anyone trying to navigate the realities of healthcare operations and coding.

From ophthalmology documentation pitfalls to outdated CPT codes, and from billing inefficiencies to ignored payer contracts, Jennifer and Maya shine a light on the risks of clinging to old habits. Along the way, they weave in stories from real-world compliance challenges, including patient safety, revenue loss, and the dangers of relying on AI tools without human oversight.

This candid discussion highlights why every compliance and revenue cycle professional should question “the way it’s always been done” and instead build a culture of accountability, adaptability, and continuous improvement.

• Why tradition in compliance and coding often creates risk rather than safety

• A real-world case where poor documentation and unchecked templates led to denied claims and even patient harm

• How outdated CPT codes and robotic billing processes drain revenue silently over years

• Why documentation is the backbone of both compliance and AI effectiveness

• Contract review essentials—why rates, payer requirements, and responsibilities can’t be ignored

• How common “we’ve always done it” attitudes in billing, collections, and claims management create avoidable losses

• 🚫 The ophthalmology case that exposed the danger of “unspecified” documentation

• 💸 Outdated CPT codes still being billed years later—and the thousands lost

• 🤖 The limits of AI in coding: garbage in, garbage out

• 📄 The compliance risks buried in payer contracts not reviewed for 8+ years

• 🧾 Copay and deductible collection myths that delay payment unnecessarily

• Jennifer’s Substack – Insights on payer contracts, compliance, and healthcare operations

• AMA CPT® Code Book – the official “source of truth” for coding

• CMS Medicare Coverage Database – LCDs, NCDs, and coverage policies

• McVey Seminars – National healthcare training programs (Jennifer presents quarterly ENT updates)

• Healthcare Inspired – Learn more about our services in coding, compliance, and practice efficiency

👉 Coming soon: a special episode on the Medicare Physician Fee Schedule Proposed Rule for 2026 (dropping Monday the 18th). Don’t miss it!

In this special episode, Jennifer McNamara and Maya Turner break down the proposal, cut through the legal language, and highlight exactly what practices need to know to stay ahead.

From reimbursement shifts to compliance updates, this episode goes beyond the surface to answer the real question: What does this mean for your practice, your patients, and your bottom line?

• Key highlights from the 2026 MPFS Proposed Rule

• How reimbursement changes could affect different specialties

• Compliance implications you can’t afford to overlook

• The role of documentation and medical necessity in the new environment

• Action steps for practices to prepare before the rule is finalized

Medicare rules don’t just affect Medicare patients — they set the tone for payers across the board. Ignoring the proposed rule until it becomes final can leave your practice scrambling. Jennifer and Maya explain what to watch now, how to get your voice heard during the comment period, and what proactive steps can protect your revenue and compliance moving into 2026.

• CMS Medicare Physician Fee Schedule Proposed Rule

• Healthcare Inspired – Learn more about coding, compliance, and practice efficiency services

• Jennifer’s Substack – Articles and insights on compliance and payer policy

• AMA CPT® Code Book – Official source of truth for CPT coding

👉 Don’t miss this breakdown of the MPFS Proposed Rule 2026 — because knowing what’s coming is the first step to protecting your practice.

Every practice expects a dip in revenue during certain times of the year—but what if it’s not seasonal at all? In this episode, Jennifer McNamara and Maya Turner dive into how to tell the difference between predictable slowdowns and silent revenue leaks that quietly drain your bottom line.

They’ll explore how patterns in claims, scheduling, and payer response times can either confirm seasonal trends or expose deeper operational issues. From front desk to back office, you’ll hear practical strategies from two industry pros to keep revenue steady year-round.

• Spotting the difference between natural seasonal fluctuations and revenue leaks

• Key data metrics to track during slow periods

• How to pinpoint operational bottlenecks that impact cash flow

• Ways to keep your revenue cycle healthy even during patient volume dips

• Why payer behavior might be a bigger factor than you think

When every dip in revenue gets chalked up to “seasonality,” practices risk ignoring the underlying issues that could be costing thousands—sometimes for years. By understanding your patterns and knowing what to look for, you can prevent these leaks before they become permanent losses.

• Learn more about Healthcare Inspired’s auditing and business intelligence services: healthcareinspiredllc.com

• Follow Jennifer McNamara on LinkedIn: Jennifer McNamara

• Follow Maya Turner on LinkedIn: Maya Turner

• Book a complimentary billing and coding assessment

Episode Summary

-

00:00 - Intros

04:15 - Revenue Leaks - Is Vacation the culprit?

10:53 - What is the solution?

14:28 - Another Critical Element

21:30 - The Hard Truth

26:21 - Wrapping up

From hilarious personal stories to hard-hitting truths about insurance delays, this episode is packed with real talk and practical insights.

• The difference between a rejection and a denial

  Rejections never make it through the system. Denials are processed and then kicked back due to payer rules or errors.

• Why automation matters

  AI (like Athelas) can prevent delays by correcting errors before submission, automatically resubmitting denials, and eliminating lag time.

• The power of site-specific vs. global rules

  Cameron explains how custom rulesets based on payer and specialty drastically reduce denials.

• Real-world examples

  Including one from an autism center battling denials from unlisted codes—and how automation fixed it.

• Domain-trained AI in action

  Think: bots that sit on hold with payers so your staff doesn’t have to. Yes, really.

• Underpayments and the dollars you're leaving on the table

  AI can track every claim and compare it to your fee schedule to recover revenue you didn’t even know was missing.

• The burnout problem

  We talk about billers working weekends, late nights, and how automation can protect your team’s well-being.

“AI works on Saturdays.” – Cameron Lewellen

“You earned every dollar. AI helps you collect it.” – Jennifer McNamara

“Appeal letters should be short and to the point. If it’s two pages long, no one’s reading it.” – Maya Turner

• Clearing up common misconceptions about rejections vs. denials

• How AI augments—not replaces—your revenue cycle team

• Using data to identify patterns and prevent denials

• UI/UX in RCM software: why it matters

• Operational tips for using automation to protect your AR

• Benchmarking payer behavior and setting smarter expectations

• Athelas – Learn more about their AI-driven RCM platform

• Bone & Joint Summit – Join us July 17–18 to meet the Athelas team in person

• Contact Cameron Lewellen for your free financial health analysis

We’re talking:

– What copy/paste looks like in provider notes

– Why it's a major liability in audits

– How coders, auditors, and providers can clean it up

– Tips for starting the conversation with your team

– Real-world examples that prove shortcuts aren't worth it

🎧 Listen in to protect your documentation—and your bottom line.

📌 Need support with EMR audits or education?

Email Info@healthcareinspiredllc.com

What You'll Learn:

• Why behavioral health is a high-risk area for compliance breaches

• The unique challenges providers face in documenting time-based services

• Medical necessity requirements that often go unmet

• Telehealth-specific compliance issues in behavioral care

• How compliance audits can proactively reduce risks

• Steps providers can take now to strengthen behavioral health compliance

Hot Topics Covered:

• Time-based E/M codes and psychotherapy documentation

• CMS expectations for medical necessity

• Common audit triggers in behavioral health

• Modifiers and telehealth policies under scrutiny

• Real-world compliance examples and red flags

Takeaway Message: Behavioral health is not immune from audits or enforcement. As the industry grows, so does regulatory scrutiny. Providers need proactive education and tools to remain compliant and protect their practices.

Resources Mentioned:

• CMS Behavioral Health Guidance

• OIG Compliance Recommendations

• Telehealth Modifier Guidance

• What is G2211? A quick refresher on the 2024 complexity add-on for longitudinal care and complex decision-making.

• Specialty Scenarios How CMS’s guidance plays out in orthopedics vs. general surgery vs. other specialties.

• Documentation Must-Haves What language drives approval—and what red flags to avoid.

• Billing Best Practices Reminder: as of 2025, you can bill G2211 with an AWV using modifier 25—here’s how to do it right.

While they may sound similar, these distinctions have major implications for providers, payers, and—most importantly—patients.

We explore how these classifications affect insurance claims, appeal rights, provider obligations, and patient financial responsibility. Whether you're a healthcare administrator, clinician, or just navigating your own care, understanding this difference can help you advocate more effectively within the system.

✅ What "statutorily excluded" means under federal healthcare programs like Medicare

✅ How "not medically necessary" determinations are made

✅ Why the distinction affects patient billing and appeals

✅ Key compliance and documentation tips for healthcare providers

1. Statutorily Excluded: Services never covered by law, regardless of medical need (e.g., cosmetic surgery under Medicare).

2. Not Medically Necessary: Services denied based on clinical judgment or guidelines—even if technically covered.

3. Appeal Rights: Patients typically cannot appeal statutory exclusions but can appeal denials based on medical necessity.

4. Documentation Matters: Accurate clinical notes can be the difference between a denied and an approved claim.

5. Proactive Communication: Providers should notify patients in advance using tools like ABNs (Advance Beneficiary Notices).

   Advance Beneficiary Notice (ABN) Guide

   Get to know how to reduce redundant billing headaches with our partners at Athelas

   Get a DEMO today

In this conversation you’ll learn:

• How to navigate the four must‑read sections of every path report (and why the microscopic description isn’t always the MVP).

• Pro tips for translating diagnostic phrases into precise ICD‑10‑CM codes—without over‑coding malignancy.

• When a single tumor can drive multiple CPTs (and when bundling rules shut that down).

• Common abstracting traps—margin language, laterality gaps, and “NOS” pitfalls—and how to fix them before they hit the claim.

• Simple query templates that get pathologists to clarify size, grade, or margins without slowing the lab down.

Loved the episode? Subscribe, leave a review, and share it with your favorite lab or HIM team.

You'll learn:

• How to recognize the early signs of burnout

• Why stress doesn’t always lead to burnout—but poor systems do

• Real-world strategies to build calm into your workflows

• How leadership can set the tone for psychological safety

• Tools your team can use today to reduce chaos and improve morale

April is Stress Awareness Month, making it the perfect time to talk about how your team can reset, recharge, and reclaim productivity without sacrificing well-being.

If you’ve ever felt like your team is stuck in survival mode, this episode is your permission to make a change—and the roadmap to get there.

• Jennifer McNamara – Founder of Healthcare Inspired LLC, expert in compliance, coding, and revenue cycle management.

• Maya Turner – Owner of Turner Expert Consulting, passionate about helping practices thrive through expert guidance and simplified solutions.

Episode Summary: In this episode, Jennifer and Maya bust some of the biggest myths surrounding payers. From payment delays to the misconceptions about small claim errors, they bring the truth to light with engaging facts and real stories. Listen in as they break down why you can—and should—negotiate with payers, and how to navigate common payer challenges for a healthier revenue cycle.

Key Topics Covered:

• Common Payer Myths:

  • “Payers never pay on time.”

  • “Small claim errors always lead to rejection.”

  • “You can’t negotiate with payers.”

    And lot's more...

• Facts to Set the Record Straight:

  • Causes of payment delays and what you can do about them.

  • The truth about claim rejections and how to handle minor errors.

  • Negotiation strategies that work with payers to secure better deals.

• Improving Your Payer Relationships:

  • How to use knowledge of payer myths to your advantage.

  • Building better payer relationships for improved revenue.

Featured Segments:

• Jennifer’s Insights: The real impact of payer myths on revenue and how to approach them.

• Maya’s Takeaways: Actionable tips for handling negotiations and improving payer relations.

Call to Action: Stay tuned for the next episode, where we’ll uncover Abstracting from the Path Report. Learn essential abstraction techniques that can enhance accuracy and efficiency in medical coding. Subscribe, leave a review, and let us know your thoughts and questions!

Let's debunk those payer myths together!

In this episode of Practice Perfect Podcast, we break down the most overlooked yet crucial aspects of payer contracts. Are you leaving money on the table? Do you know when to negotiate, push back, or walk away? We’re diving into the must-know contract terms, red flags to watch out for, and insider tips to ensure you’re getting the best deal.

From understanding your leverage to why you should treat contracts like relationships (yes, sometimes you just need to walk away!), this episode is packed with practical advice, humor, and surprising insights to help your practice stay profitable and protected.

✅ Compare before you commit – How active comparisons and expert consultations can help you negotiate better contracts. ✅ Know your worth – If a payer doesn’t value your extended hours or patient care efforts, you CAN say no! ✅ Contracts aren’t forever – They’re like relationships—if it’s not working, don’t be afraid to walk away! ✅ Telehealth & reimbursement trends – What you need to know about chronic care management, remote patient monitoring, and compliance changes. ✅ Maximize your revenue – Smart ways to increase income beyond direct patient visits.

Next Up: Top Payer Myths – Fact vs. Fiction

Think you know payers? Think again! In our next episode, we’re busting some of the biggest myths, including:

🚫 "Payers never pay on time." 🚫 "Small claim errors always lead to rejection." 🚫 "You can’t negotiate with payers."

Join us as we separate fact from fiction and give you the tools to take control of your revenue!

📲 Follow us on all our platforms for more insights!

In this episode of Practice Perfect Podcast, we dive into the crucial role of quality assurance in coding and audits. Our guest, Robin Ingalls- Fitzgerald, joins us to discuss common coding errors, the impact of compliance, and why strong auditing processes are essential for healthcare organizations.

From modifier 25 and 59 issues to the challenges of telehealth, we uncover why consistent education, collaboration, and compliance are key to avoiding costly mistakes. Plus, we explore how outsourcing and coding support services can enhance accuracy and efficiency without replacing in-house teams.

Key Takeaways:

✅ Why audits matter – Identifying and preventing common errors before they become compliance risks. ✅ Telehealth regulations – The evolving landscape and its impact on coding and billing. ✅ Collaboration in coding – How external experts support practices without taking over. ✅ Common documentation mistakes – How small errors (like wrong laterality in orthopedics) can have big consequences. ✅ Education & training – The role of continuous learning in maintaining compliance and quality assurance.

Notable Quotes:

💬 "It’s not about taking over your team’s work, but supporting them in delivering accurate and compliant coding." – Jennifer Mcnamara 💬 "Compliance isn’t just about following rules—it’s about ensuring patients get the right care." – Robin Ingalls-Fuchs-Gerald

Don’t miss Episode 9, where we break down payer contracts and reveal what practices often overlook when negotiating with payers. Learn how to get the best deal and avoid costly mistakes! 💰📑

🔔 Subscribe, leave a review, and join the conversation!

📌 LinkedIn: Jennifer McNamara | Maya Turner | Robin Ingalls-Fitzgerald

Tune in now and take control of your coding and auditing process! 🎧

Medicare Advantage plans come with their own set of rules when it comes to prior authorizations and coverage determinations. If you’re navigating the complex world of Medicare Advantage compliance, this episode is for you!

Jennifer and Maya are joined by Richelle Marting to break down: ✅ How prior authorization requirements differ from traditional Medicare. ✅ Key regulatory updates practices need to know. ✅ Strategies to streamline the approval process and reduce denials.

Whether you’re a provider, administrator, or compliance officer, this episode will help you stay ahead of the ever-changing Medicare Advantage landscape.

🔹 Understanding Prior Authorization in Medicare Advantage:

• The difference between Medicare and Medicare Advantage rules.
• How denials and appeals work in Medicare Advantage plans.

🔹 Regulatory Compliance & Coverage Determinations:

• The latest updates on CMS guidelines for prior authorization.
• What documentation is required for approvals.

🔹 Improving Workflow & Reducing Prior Authorization Delays:

• Strategies to speed up approvals and reduce administrative burdens.
• Best practices to avoid claim denials.

🔹 What Providers Need to Know About Coverage Policies:

• How to ensure services are covered under Medicare Advantage.
• Navigating exceptions and medical necessity requirements.

💡 Richelle’s Legal Insights: Breaking down the must-know regulations for 2025.

🛠️ Jennifer & Maya’s Practical Tips: How to optimize workflows and stay compliant.

Don’t miss Episode 8, where we welcome Robin Ingalls-Fitzgerald to discuss the importance of quality assurance in coding and audits. Learn how accuracy impacts compliance, reimbursement, and financial stability! ✅

🔔 Subscribe, leave a review, and join the conversation!

📌 LinkedIn: Jennifer McNamara | Maya Turner | Richelle Marting

Stay ahead of Medicare Advantage regulations—tune in now! 🎧

The healthcare revenue cycle is evolving fast, and staying ahead of the curve is essential for financial success. In this episode, Jennifer and Maya welcome Vanessa Moldovan to break down the biggest trends, challenges, and opportunities in Revenue Cycle Management (RCM) for 2025.

From payment models to automation, we’ll explore how practices can adapt and thrive in an ever-changing landscape. Whether you're a practice manager, billing professional, or compliance expert, this episode is packed with valuable insights to future-proof your revenue cycle. 💰

🔹 Emerging Trends in Revenue Cycle Management:

• How AI and automation are reshaping billing and collections.
• The impact of value-based care on reimbursement strategies.

🔹 Biggest Challenges Practices Face in 2025:

• Dealing with payer complexities and reimbursement delays.
• The rising demand for compliance in billing and coding.

🔹 Opportunities to Improve Financial Performance:

• Strategies for reducing denials and optimizing claims management.
• How data analytics can improve financial decision-making.

🔹 The Role of Patient Engagement in RCM:

• Improving price transparency to reduce surprise billing.
• Creating a smoother payment experience for patients.

💡 Vanessa’s Take: Key predictions for the future of RCM and how to prepare.

📊 Jennifer & Maya’s Insights: Practical steps to strengthen your revenue cycle today.

Call to Action:

Join us for Episode 7, where we welcome Richelle Marting to discuss Medicare Advantage requirements for prior authorization and coverage determinations. Gain clarity on the process and stay compliant with key regulations!

🔔 Subscribe, leave a review, and share your thoughts!

📌 LinkedIn: Jennifer McNamara | Maya Turner | Vanessa Moldovan

Let’s take control of the future of RCM together! 🚀

🔹 Identifying Workflow Bottlenecks:

• Common inefficiencies that slow down operations.
• How to analyze your practice’s workflow for improvement opportunities.

🔹 Enhancing Team Communication:

• The role of clear communication in reducing errors and delays.
• Strategies for fostering a culture of teamwork and accountability.

🔹 Leveraging Technology for Efficiency:

• Tools and automation solutions that simplify administrative tasks.
• How to integrate software seamlessly to reduce workload.

🔹 Creating a Patient-Centered Workflow:

• Improving scheduling, check-in, and follow-up processes.
• Ensuring a better patient experience while maintaining operational efficiency.

💡 Jennifer’s Insights: Top workflow mistakes and how to fix them.

🛠️ Maya’s Takeaways: Simple changes that make a big impact on efficiency.

Don’t miss Episode 6, where we look ahead to the future of revenue cycle management with special guest Vanessa Moldovan. We’ll discuss emerging trends, major challenges, and how to maximize financial performance in 2025. 💰📈 Subscribe, leave a review, and share your thoughts with us!

📌 LinkedIn: Jennifer McNamara | Maya Turner

Let’s optimize your workflow and work smarter, not harder! 🚀

Key Topics Covered: 

• The Essentials of Practice Start-Up: Licensing, compliance, and credentialing basics.  Choosing the right software and tools to support your goals.

• Financial Stability from Day One:  Managing startup costs without sacrificing quality.  The importance of revenue cycle management in a new practice. 
• Building the Right Team: Finding, hiring, and retaining top talent. Creating a culture of excellence and patient care. 
• Designing a Patient-Centered Experience: Workflow tips to keep operations smooth and stress-free.  Marketing strategies to make your practice stand out in the community. 

Featured Segments: Jennifer’s Insights: Key compliance steps to protect your practice from the start. 

Maya’s Takeaways: Practical tools and tips to create a seamless opening day experience. 

Call to Action: Don’t miss Episode 2, where we dive deeper into patient engagement strategies for new practices. Subscribe, leave a review, and reach out with your questions and feedback! Let’s take the first step toward your practice’s success together!