All Episodes

This special bonus episode pulls together some of the most valuable conversations and updates across coding, compliance, and healthcare operations.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.

In this episode, we dive into the power of communication and how it shapes everything from workplace culture to payer negotiations.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.

In this episode of the Practice Perfect Podcast, Jennifer McNamara and Maya Turner tackle one of the most dangerous phrases in healthcare operations: “But that’s how we’ve always done it.”From ophthalmology documentation pitfalls to outdated CPT codes, and from billing inefficiencies to ignored payer contracts, Jennifer and Maya shine a light on the risks of clinging to old habits.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 safetyA real-world case where poor documentation and unchecked templates led to denied claims and even patient harmHow outdated CPT codes and robotic billing processes drain revenue silently over yearsWhy documentation is the backbone of both compliance and AI effectivenessContract review essentials—why rates, payer requirements, and responsibilities can’t be ignoredHow 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 unnecessarilyJennifer’s Substack – Insights on payer contracts, compliance, and healthcare operationsAMA CPT® Code Book – the official “source of truth” for codingCMS Medicare Coverage Database – LCDs, NCDs, and coverage policiesMcVey 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!

The 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule is here — and it’s packed with changes that will impact providers, coders, billers, and compliance teams across the country. 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 RuleHow reimbursement changes could affect different specialtiesCompliance implications you can’t afford to overlookThe role of documentation and medical necessity in the new environmentAction steps for practices to prepare before the rule is finalizedMedicare 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 RuleHealthcare Inspired – Learn more about coding, compliance, and practice efficiency servicesJennifer’s Substack – Articles and insights on compliance and payer policyAMA 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.

Seasonal Slowdown or Silent Revenue Leak?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 leaksKey data metrics to track during slow periodsHow to pinpoint operational bottlenecks that impact cash flowWays to keep your revenue cycle healthy even during patient volume dipsWhy payer behavior might be a bigger factor than you thinkWhen 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.comFollow Jennifer McNamara on LinkedIn: Jennifer McNamaraFollow Maya Turner on LinkedIn: Maya TurnerBook a complimentary billing and coding assessmentEpisode 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 Truth26:21 - Wrapping up

This episode dives deep into the confusion many practices face when it comes to rejections vs. denials. Jennifer and Maya welcome back Cameron Lewellen to talk about how AI and automation can transform how practices handle claim issues, boost efficiency, and get paid faster.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 denialRejections never make it through the system. Denials are processed and then kicked back due to payer rules or errors.Why automation mattersAI (like Athelas) can prevent delays by correcting errors before submission, automatically resubmitting denials, and eliminating lag time.The power of site-specific vs. global rulesCameron explains how custom rulesets based on payer and specialty drastically reduce denials.Real-world examplesIncluding one from an autism center battling denials from unlisted codes—and how automation fixed it.Domain-trained AI in actionThink: 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 tableAI can track every claim and compare it to your fee schedule to recover revenue you didn’t even know was missing.The burnout problemWe 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 TurnerClearing up common misconceptions about rejections vs. denialsHow AI augments—not replaces—your revenue cycle teamUsing data to identify patterns and prevent denialsUI/UX in RCM software: why it mattersOperational tips for using automation to protect your ARBenchmarking payer behavior and setting smarter expectationsAthelas – Learn more about their AI-driven RCM platformBone & Joint Summit – Join us July 17–18 to meet the Athelas team in personContact Cameron Lewellen for your free financial health analysis

Copy-paste documentation: it seems harmless, but it’s costing healthcare practices more than they realize. In this episode, Jennifer and Maya unpack the real risks behind cloned EMR notes—from audit red flags to compliance violations.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

In this insightful episode, we dive into one of the most commonly overlooked areas in healthcare compliance—behavioral health. Sonal Patel joins Jennifer McNamara and Maya Turner to discuss why behavioral health compliance deserves more attention, especially as demand for services grows. From documentation pitfalls to the nuances of medical necessity, we highlight key risks that can lead to denials, audits, and even enforcement action if ignored.What You'll Learn:Why behavioral health is a high-risk area for compliance breachesThe unique challenges providers face in documenting time-based servicesMedical necessity requirements that often go unmetTelehealth-specific compliance issues in behavioral careHow compliance audits can proactively reduce risksSteps providers can take now to strengthen behavioral health complianceHot Topics Covered:Time-based E/M codes and psychotherapy documentationCMS expectations for medical necessityCommon audit triggers in behavioral healthModifiers and telehealth policies under scrutinyReal-world compliance examples and red flagsTakeaway 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 GuidanceOIG Compliance RecommendationsTelehealth Modifier Guidance

In this episode of Practice Perfect, Jennifer McNamara dives into the CMS G2211 complexity add-on code—specifically how it applies (or doesn’t!) to specialty practices. Whether you’re in orthopedics, ENT, plastics, or any other niche, we’ll unpack CMS’s intent, share real-world scenarios, and give you actionable tips to document and bill confidently.What is G2211?A quick refresher on the 2024 complexity add-on for longitudinal care and complex decision-making.Specialty ScenariosHow CMS’s guidance plays out in orthopedics vs. general surgery vs. other specialties.Documentation Must-HavesWhat language drives approval—and what red flags to avoid.Billing Best PracticesReminder: as of 2025, you can bill G2211 with an AWV using modifier 25—here’s how to do it right.

In this episode, we break down two commonly misunderstood terms in healthcare coverage: "Statutorily Excluded" and "Not Medically Necessary."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 providersStatutorily Excluded: Services never covered by law, regardless of medical need (e.g., cosmetic surgery under Medicare).Not Medically Necessary: Services denied based on clinical judgment or guidelines—even if technically covered.Appeal Rights: Patients typically cannot appeal statutory exclusions but can appeal denials based on medical necessity.Documentation Matters: Accurate clinical notes can be the difference between a denied and an approved claim.Proactive Communication: Providers should notify patients in advance using tools like ABNs (Advance Beneficiary Notices).Advance Beneficiary Notice (ABN) GuideGet to know how to reduce redundant billing headaches with our partners at Athelas Get a DEMO today

Whether you’re a coder hunting for the right CPT, a tumor registrar assembling a perfect abstract, or a practice manager double‑checking documentation, that pathology report is gold— if you know how to mine it. In this episode Jennifer breaks down her go‑to process for turning dense, microscopic jargon into clean, billable data that tells the patient’s full story. 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.

Stress is inevitable, but burnout doesn’t have to be. In this powerful episode of Practice Perfect, Jennifer and Maya dive into the real reasons behind workplace burnout and what healthcare teams can do about it. From overloaded coders and overwhelmed managers to providers stretched thin, we explore what it takes to create a culture that not only survives—but thrives.You'll learn:How to recognize the early signs of burnoutWhy stress doesn’t always lead to burnout—but poor systems doReal-world strategies to build calm into your workflowsHow leadership can set the tone for psychological safetyTools your team can use today to reduce chaos and improve moraleApril 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.

Hosts: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!

Episode Summary: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. FictionThink 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!

Episode Summary: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-GeraldDon’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-FitzgeraldTune in now and take control of your coding and auditing process! 🎧