FTLORC Live Q&A! 10/14/25

In this episode of 'For the Love of Revenue Cycle,' host Vanessa Moldovan engages the community in a live Q&A session. The discussion covers the pressing issue of denials and reimbursement challenges in the healthcare industry. Key topics include recent policy changes by Cigna on automatic downcoding, the implications of DRG downgrades, and strategies for identifying downcoded claims. The episode also addresses how to measure denial rates, manage medical necessity denials, and successfully overturn denied claims. Expert insights and community contributions make this episode a valuable resource for anyone involved in the revenue cycle.

00:00 Introduction and Welcome
00:12 Open Q&A: Community Challenges
01:10 Discussion on Cigna's Downcoding Policy
03:01 Identifying and Handling Downcoding
07:33 Measuring Denial Rates and Overturns
12:00 Government Shutdown Impact on Telehealth
12:57 Combating Medical Necessity Denials
17:25 Escalating Denial Issues with Payers
22:20 Conclusion and Community Engagement