The Claim Game

EPISODE SUMMARY

Are you spending more time answering billing questions than actually growing your practice? In this episode of The Claim Game, Jeremy Zug breaks down the hidden cost of being your team's go-to help desk and how it could be costing you an entire workday every week.

Jeremy explores the risks of relying on one employee for billing knowledge, why documented workflows are essential for protecting your revenue cycle, and how a structured 30-day training program can turn existing administrative staff into confident, capable billers. Plus, discover how reimbursement rate comparisons can uncover missed revenue opportunities and help practices negotiate smarter payer contracts.

Learn how to build a stronger billing team, reduce costly interruptions, and reclaim your time to focus on growing your practice.

KEYWORDS

Revenue Cycle Management, Medical Billing Training, Biller Training, Practice Management, Billing Workflows, Insurance Claim Denials, Administrative Efficiency, Healthcare Billing, Practice Growth, Reimbursement Rates, Payer Contract Negotiation, Billing KPIs, Accounts Receivable, Practice Solutions

TAKEAWAYS

Being your team's help desk is costing you. Frequent billing interruptions can add up to 30 hours a month that could be spent growing your practice.

Don't let billing knowledge walk out the door. Relying on one employee without documented processes creates a major risk to your revenue cycle.

Standardized workflows protect your cash flow. Checklists, training resources, and clear procedures keep billing operations running smoothly through employee turnover.

You can train your existing team. A structured 30-day training program can equip administrative staff with the skills to manage billing confidently.

Training doesn't end after 30 days. Ongoing coaching and support help your billing team handle complex denials, payer questions, and unexpected challenges.

Know what your market is paying. Comparing reimbursement rates with similar practices can reveal missed revenue and strengthen payer negotiations.

CHAPTERS

00:00 The Hidden Cost of Being Your Team’s Help Desk

07:34 From Admin to Expert Biller in 30 Days

09:44 Know What Your Market Is Really Paying

RESOURCES

Today Sponsors: http://practicesol.com/

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcastThe Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance

EPISODE SUMMARY

Every denied claim costs your practice more than delayed revenue. According to the 2026 Availity Abrasion Index, reworking a denied claim costs an average of $52.74—and those expenses add up quickly.

In this episode, Jeremy Zug explains why many practices have a billing sequencing problem, not a billing problem. He breaks down the hidden costs of claim denials, common workflow mistakes, and how the six-stage Billing Blueprint can help reduce denials and improve revenue cycle management.

KEYWORDS

Claim denials, medical billing, revenue cycle management, clean claims, denial prevention, billing workflow, billing mistakes, claim submission, billing systems, group practice management

TAKEAWAYS

Every denied claim comes at a cost. Reworking a denied claim costs an average of $52.74, meaning just 10 denials per week can cost a practice over $27,000 annually.

Your billing problem might actually be a sequencing problem. Inefficient workflows and inconsistent processes can create unnecessary denials and lost revenue.

Preventable denials are system failures. Incorrect patient information, expired eligibility, and missing authorizations can often be caught before claims are submitted.

Claim submission should come last. Following the six-stage revenue cycle management process helps ensure claims are clean and ready before submission.

Consistency beats speed. A structured claim submission schedule and regular payment posting can help prevent costly billing errors.

Better systems create room for growth. An organized billing process allows practice owners to spend less time fixing claims and more time growing their practices.

CHAPTERS

00:00 The True Cost of Claim Denials in Your Practice

02:25 The Billing Sequence Mistake Costing Practices Thousands

06:18 How Denied Claims Cost Your Practice Thousands

07:44 Why Claim Submission Should Be the Last Step in Billing

09:18 Fix Your Billing Systems: Join the Free Webinar

RESOURCES

Today Sponsors: http://practicesol.com/

Register for October 29th’s Webinar here

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

As your practice grows, the way you handle billing may need to grow with it. What once felt manageable can quickly turn into weekends spent chasing claims, increasing AR, and less time focused on leading your business.

In this episode of The Claim Game, Jeremy Zug breaks down the signs that your practice may have outgrown DIY billing and when outsourcing can make sense. He explains why being capable of handling billing doesn’t necessarily mean you should—and how getting it off your plate can give you more time to focus on your clinicians, referral relationships, strategy, and growth.

Jeremy also discusses in-house vs. outsourced billing, why there isn’t one right solution for every practice, and how your billing needs can change as your business grows.

KEYWORDS

medical billing, outsourced medical billing, mental health billing, private practice billing, practice growth, practice management, billing services, medical billing company

TAKEAWAYS

Your billing process should grow with your practice. What worked when you were smaller may become overwhelming as claims, clinicians, and AR increase.

Billing shouldn’t keep you from leading. If billing is taking time away from recruiting, training, referrals, and strategy, it may no longer be the best use of your time.

Know when it’s time to outsource. If billing follows you home, takes over weekends, or becomes something you dread, getting it off your plate may be the right next step.

In-house billing can still be a great option. The key is building the department properly with the right people, processes, training, and systems.

Your billing solution can change as you grow. Outsourcing now doesn’t mean outsourcing forever—the right approach can evolve alongside your practice.

CHAPTERS

00:00 When Billing Becomes a Growth Problem

03:33 When It’s Time to Outsource Your Billing

06:44 Your Job Is to Grow the Practice

RESOURCES

Today Sponsors: http://practicesol.com

Book a Free Consultation

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

A full schedule doesn’t always mean a financially healthy practice. Sometimes the real problem isn’t patient volume—it’s revenue that’s getting stuck in the billing process.

In this episode of The Claim Game, Jeremy Zug explains how rejected claims, unresolved denials, aging AR, and inefficient billing workflows can quietly drain revenue even while a practice continues to grow. He shares why “busy” isn’t a useful measure of billing performance, what practice owners should actually be looking at, and why fixing revenue leaks should come before investing in more growth.

Jeremy also explains how a Practice Health Check can help owners step out of the day-to-day, identify where money is getting stuck, and determine whether their billing infrastructure is ready to support growth.

KEYWORDS

accounts receivable, AR management, medical billing, revenue cycle management, private practice billing, billing performance, claim denials, rejected claims, cash flow, practice growth, billing efficiency, Practice Health Check, Practice Solutions

TAKEAWAYS

A busy practice isn’t always a healthy practice. A full schedule can hide revenue leaks caused by billing issues.

Pay attention to aging AR. Claims sitting unpaid for 60, 90, or 120+ days deserve a closer look.

Busy doesn’t equal effective. Measure how quickly rejected claims and denials are worked—not simply how much activity your billing team produces.

Growth can mask billing problems. Adding clinicians and patients may increase collections while underlying revenue cycle issues continue to grow.

Collect before you create more. Before spending more on marketing or growth, make sure you’re collecting the revenue your practice has already earned.

CHAPTERS

00:00 The Hidden Revenue Problem Behind a Busy Practice

05:48 Stop Measuring Busy, Start Measuring Results

11:05 Find the Cash Hiding in Your AR

RESOURCES

Today Sponsors: Visit http://practicesol.com

Book a Practice Health Check

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

Your reimbursement rate isn’t necessarily the market rate. In this episode of The Claim Game, Jeremy Zug explains why practice owners should look beyond their own contracts to understand what comparable practices are actually being paid.

Jeremy explores how reimbursement benchmarking and market data can uncover hidden revenue opportunities, strengthen payer negotiations, and help practices make smarter decisions about their payer strategy. The bottom line: you can’t negotiate a rate you don’t know exists.

KEYWORDS

insurance reimbursement rates, reimbursement benchmarking, payer negotiations, insurance contracts, fee schedules, behavioral health billing, mental health billing, private practice, payer strategy, reimbursement data, rate negotiation, revenue cycle management, practice management

TAKEAWAYS

Your rate isn’t necessarily the market rate. Your contract shows what your practice is being paid, not what comparable practices are receiving.

Small differences can have a major impact. A seemingly modest reimbursement gap can translate into significant lost revenue at scale.

Market data creates leverage. Knowing what similar practices are paid can help you approach payer negotiations with better questions and stronger information.

Small practices have advantages, too. Solo and small group practices may lack volume, but they often have more flexibility to adjust payer mix, services, and strategy.

Reimbursement isn’t set in stone. Payers, services, markets, and rates can change—and practice owners can explore opportunities beyond their existing contracts.

You can’t negotiate what you don’t know exists. Regularly benchmarking reimbursement can help you make more informed decisions about the future of your practice.

CHAPTERS

00:00 Your Reimbursement Rate Isn’t the Market Rate

03:33 Using Market Data to Negotiate Smarter

07:11 Getting Creative With Payers and Reimbursement

10:22 See What Practices Like Yours Are Getting Paid

RESOURCES

Today Sponsors: Visit http://practicesol.com

Check Out Rate Vantage

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Gabrielle Juliano-Villani, LCSW, to discuss scaling a seven-figure group practice, navigating burnout, and stepping into the CEO role. Gabrielle shares lessons on leadership, delegation, and taking risks, plus why Medicare and Medicaid can offer valuable growth opportunities for behavioral health practices.

KEYWORDS

Group Practice, Private Practice, Medicare for Therapists, Medicaid, Practice Burnout, Group Practice Growth, Practice Management, Healthcare Billing, Medicare Billing, Practice Leadership, Revenue Cycle Management

TAKEAWAYS

Growth Can Come at a Cost: Scaling to seven figures taught Gabrielle that growth isn't worth sacrificing your well-being or alignment.

Boundaries Make Better Leaders: Clear expectations and systems protect your time while helping your team work more independently.

Step Into the CEO Role: Delegating routine tasks gives practice owners more time to focus on leadership and growth.

Do It Afraid: You don't have to eliminate fear before taking action. Progress often requires risk and a willingness to fail.

Don't Fear Medicare: Medicare and Medicaid can provide meaningful opportunities for behavioral health practices to grow and get paid for valuable work.

Compliance Matters: Strong documentation and appropriate billing can help reduce the fear surrounding audits and clawbacks.

CHAPTERS

00:00 Gabrielle's Journey to Private Practice

17:24 Stepping Into the CEO Role & Doing It Afraid

29:54 Why Practices Shouldn’t Fear Medicare

37:25 Connect with Gabrielle

RESOURCES

Today Sponsors: Visit http://practicesol.com

Visit http://gabriellejulianovillani.com

Visit http://medicareconsultingfortherapists.com

Connect with Gabrielle on Instagram

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with clinical psychologist and practice owner Dr. Michelle Perry to discuss innovation, problem-solving, and leadership in private practice.

Michelle shares how the limitations of insurance led her to explore new models of care, including wellness services, therapy intensives, and ketamine-assisted therapy. She also explains how she uses data to solve business problems, recognize when it’s time to pivot, and lead with both compassion and accountability.

KEYWORDS

Private Practice Leadership, Group Practice Growth, Practice Management, Ketamine-Assisted Therapy, Therapist Leadership, Lean Six Sigma, Mental Health Practice, Practice Growth, Employee Accountability, Practice Owner

TAKEAWAYS

Innovation May Require a New Approach: When traditional insurance models limit care, practice owners can explore creative, compliant alternatives.

Solve the Right Problem: Identify the root cause and use data before jumping to a solution.

Pivoting Isn’t Failure: When something isn’t working, use what you’ve learned to find a better opportunity.

Hold Space AND Hold Standards: Great leadership requires protecting your vision and setting clear expectations.

Compassion and Accountability Can Coexist: You can support your team while still holding people accountable to their commitments.

Protect Your Culture: Addressing underperformance and establishing clear standards helps protect the entire team.

CHAPTERS

00:00 Breaking the Mold of Traditional Therapy

20:16 Stop Forcing It: Knowing When to Pivot

34:08 Protecting Your Vision as a Practice Owner

47:45 Connect with Michelle

RESOURCES

Today Sponsors: Visit http://practicesol.com

Connect with Michelle on LinkedIn

Email Michelle: michelle@getcenteredwellness.com

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with retired psychologist and business coach Nicole McCance to discuss how she grew from a burned-out solo practitioner to building a 55-therapist, multi-seven-figure group practice.

Nicole shares the systems and strategies behind that growth, including hiring the right team, creating SOPs, using AI and automation, attracting and retaining clients, and focusing on your zone of genius. She also breaks down her five-step approach to scaling and the mindset that helped her make the leap from clinician to CEO: “do it scared.”

KEYWORDS

Group Practice Growth, Private Practice, Scaling a Therapy Practice, Practice Management, Systems and Automation, Hiring Therapists, Digital Marketing, Client Retention, AI for Private Practice, Practice Growth

TAKEAWAYS

Systemize Before You Hire: Document your processes and build clear SOPs so your practice can operate without everything depending on you.

Hire for the Right Fit: Nicole shares why your first hire should reflect your personality, energy, clinical approach, and brand.

Growth Is More Than Marketing: A scalable practice needs systems to attract, convert, and retain clients—not just generate leads.

Delegate, Automate, Eliminate: Create more time for your zone of genius by removing tasks that don’t require your expertise.

Do It Scared: Growth can feel uncomfortable. Nicole explains why moving forward despite fear was key to becoming a CEO and building a practice that could run without her.

CHAPTERS

00:00 Scaling from Solo to 55 Therapists

13:28 SOPs, Training, and Smarter Systems

22:30 The Five Steps to Practice Growth

34:23 Systems, ROI & Doing It Scared

RESOURCES

Today Sponsors: Visit http://practicesol.com

The Business Savvy Therapist Podcast: https://mccancemethod.com/podcast/

Sign up for Nicole’s FREE Masterclass: How to Build a 7-Figure Group Practice + earn 1 CE Hour:
https://mccancemethod.com/webinar-free-masterclass-from-solo-to-superteam/

Facebook Group:
https://www.facebook.com/groups/947689352498639

Instagram:
https://www.instagram.com/nicole.mccancemethod/

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Tara Wells, sports social worker and founder of Finish Line Mindset, to discuss building a private practice around therapy, coaching, and prevention.

Tara shares her approach to separating coaching from clinical work, transitioning from insurance to private pay, and using networking to grow her practice. They also discuss setting boundaries, finding the right niche, and building the confidence to create a practice that works for you.

KEYWORDS

Private Practice, Sports Social Work, Sports Mental Health, Private Pay Practice, Mental Health Practice, Practice Growth, Alma, Headway, Private Practice Marketing

TAKEAWAYS

Know the Line Between Coaching and Therapy: Clearly defining the scope and boundaries of each service is essential when offering both.

Your Niche Can Be an Advantage: Specific messaging helps the right clients and referral partners understand who you serve.

Insurance Isn't the Only Path: Tara shares how she moved from insurance platforms to a private-pay model that better fits her practice.

Relationships Build Practices: Networking and word-of-mouth referrals have become key drivers of Tara's growth.

Set Boundaries Around Your Business: Creating intentional time away from clients and work helps protect your life outside the practice.

Start Before You Feel Ready: Experiment with marketing, networking, and new opportunities while you still have a safety net.

CHAPTERS

00:00 Building a Practice Around Therapy and Coaching

13:41 The Journey from Insurance to Private Pay

28:43 Setting Boundaries as a Practice Owner

37:50 From Self-Doubt to Taking the Leap

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn More About Finish Line Mindset and The Unpacked Mastermind

Connect with Tara on Instagram and TikTok

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Alexandra Hoerr, founder of Optimum Joy, to discuss building and leading a growing group therapy practice. Alexandra shares how burnout inspired her approach to practice ownership and how Optimum Joy balances growth, accessibility, clinician development, and strong organizational systems.

They also explore the challenges of leading a 45-provider practice, making values-driven decisions around insurance, supporting clinician retention, and using AI to improve efficiency without replacing human connection in therapy.

KEYWORDS

Group Practice Growth, Private Practice Leadership, Therapy Practice Management, Mental Health Practice, Insurance Billing, Clinician Retention, Therapist Burnout, AI in Therapy, Leadership Development, Practice Culture

TAKEAWAYS

Growth Requires Strong Systems: Scaling a group practice requires intentional leadership, clear roles, and repeatable processes.

Values Drive Difficult Decisions: Optimum Joy balances access to care with supporting and investing in its clinicians.

Development Supports Retention: Mentorship, education, and career growth can help clinicians stay engaged and reduce burnout.

AI Is a Tool, Not a Replacement: AI can improve efficiency, but empathy and human connection remain essential to therapy.

CHAPTERS

00:00 How Burnout Sparked a Thriving Group Practice

09:19 The Hard Truth About Practice Leadership

17:34 How Core Values Shape Practice Decisions

25:21 Scaling with Purpose, Not Just Size

34:03 Where AI Belongs in Therapy—and Where It Doesn't

42:52 Where to Connect with Alexandra Hoerr

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn More About Optimum Joy and Resonate Joy

Connect with Optimum Joy on Instagram

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

Burnout isn't a personal failure, and feeling stuck doesn't mean you lack motivation. In this episode of The Claim Game, Jeremy Zug sits down with psychotherapist and bestselling author Britt Frank to discuss burnout, anxiety, leadership, and the mindset shifts that help practice owners thrive. From moving from clinician to CEO to setting boundaries, leading healthier teams, and using anxiety as a tool for growth, Britt shares practical strategies for building a more sustainable practice.

KEYWORDS

Burnout Prevention, Private Practice Leadership, The Science of Stuck, Therapist Burnout, Anxiety Management, Leadership Boundaries, Practice Owner Mindset, Team Accountability, Workplace Communication, Private Practice Growth, Mental Health Leadership

TAKEAWAYS

Burnout Is Systemic: Burnout happens when demands exceed resources—not because people aren't working hard enough.

Get Unstuck: Ask what you're stuck in, not why you're stuck, so you can take the right action.

Lead with Role Clarity: Practice owners need to shift from clinician thinking to CEO thinking.

Use Anxiety as Data: Anxiety is a signal that something needs attention—not something to ignore.

Healthy Teams Need Healthy Systems: Clear expectations, accountability, and recognition reduce workplace drama.

Slow Down to Go Further: Sustainable success comes from intentional pacing, not constant hustle.

CHAPTERS

00:00 From Addiction to Therapist: Britt Frank's Story

06:20 Stop Asking "Why Am I Stuck?"

14:59 Burnout Isn't Personal—It's a Systems Problem

23:45 Better Boundaries Start with Role Clarity

27:03 Turning Workplace Drama into Teamwork

31:00 Connect with Britt Frank

RESOURCES

Today Sponsors: Visit http://practicesol.com

Visit http://brittfrank.com

Connect with Britt on LinkedIn and Instagram

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Anne Neal, Vice President of Product Management & Payment Integrity at Availity, to discuss the future of revenue cycle management. Together, they explore Availity's Abrasion Index, payment integrity, AI, prior authorization, and preventing claim errors before submission.. They also discuss fraud prevention, responsible AI, and the future of touchless claims processing.

KEYWORDS

Availity, Revenue Cycle Management, Payment Integrity, Claims Management, Claim Denials, Prior Authorization, Healthcare AI, Payment Accuracy, Abrasion Index

TAKEAWAYS

Prevention Beats Correction: Preventing claim errors before submission reduces denials, appeals, administrative work and payment accuracy.

Shared Challenges: Providers and payers face many of the same pain points, creating opportunities to collaborate.

Payment Integrity Starts Early: Helping providers submit clean claims before submission improves reimbursement.

Responsible AI: AI can streamline claims management and prior authorization when combined with transparency, governance, and human oversight.

Touchless Claims: Automation, AI, and better data sharing are moving healthcare toward faster, more accurate reimbursement.

CHAPTERS

00:00 Introduction to Availity and Anne Neal's Journey

04:50 Availity's $4.5T Network Healthcare Network

09:37 Preventing Claim Errors

15:56 Prevention Over Clawbacks

22:40 What the Abrasion Index Reveals

26:40 What Is Payment Integrity?

29:50 Responsible AI in Healthcare

34:55 The Future of Touchless Claims

38:49 Innovation at the Speed of AI

40:43 Building a Better System Together

RESOURCES

Today Sponsors: Visit http://practicesol.com

Visit http://availity.com

Availity’s Payment Integrity, Availity Extend, and Abrasion Index

Anne Neal on LinkedIn

The Claim Game Podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub.

Practice Solutions Blog.

Book: Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Hemant Gupta, physician advisor and former Chief Medical Officer at UnitedHealthcare, to explore the intersection of clinical care, insurance, and healthcare innovation. Together, they discuss why claim denials happen, how better documentation supports medical necessity, the structural challenges of value-based care, and how AI can reduce administrative burden while improving patient outcomes. Whether you're a provider, practice owner, or healthcare leader, this episode offers practical insights into building a more transparent, efficient healthcare system.

KEYWORDS

Revenue Cycle Management, Medical Necessity, Claim Denials, Physician Advisor, AI in Healthcare, Clinical Documentation, Prior Authorization, Value-Based Care, Healthcare Transparency, Utilization Management, Healthcare Innovation, Insurance Billing

TAKEAWAYS

Bridge the Provider-Payer Gap: Strong documentation helps demonstrate medical necessity and supports appropriate reimbursement.

Claim Denials Aren't One-Size-Fits-All: Different denial types require different prevention and resolution strategies.

Better Documentation Matters: Clear, complete records reduce audits, strengthen claims, and support better patient care.

Value-Based Care Needs Alignment: Lasting change depends on aligning providers, payers, data, and incentives.

AI Should Reduce Friction: Used responsibly, AI can streamline documentation, speed approvals, and improve healthcare efficiency.

CHAPTERS

00:00 Introduction to Hemant Gupta's Journey

08:47 Closing the Gap Between Physicians and Payers

16:07 The Biggest Misconceptions About Insurance Denials

21:23 The Structural Barriers to Value-Based Care

35:45 Can AI Reduce Healthcare Friction?

42:53 Connect with Hemant Gupta

RESOURCES

Today Sponsors: Visit http://practicesol.com

Connect with Hemant on LinkedIn

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Daniel Fava, founder of Private Practice Elevation, to discuss how your website can become an extension of your administrative team. Daniel shares how building his wife's therapy practice website led to an agency specializing in web design, SEO, copywriting, and digital strategy for private practices.

Together, they explore how AI is changing SEO, why Google holds healthcare websites to a higher standard, and practical ways to improve your website. From creating helpful FAQ pages and clearly explaining insurance participation to building topic-focused content that attracts the right clients, this episode is packed with actionable advice for building trust, reducing confusion, and converting more website visitors into clients.

KEYWORDS

Private Practice SEO, Website Redesign, Revenue Cycle Management, Therapist Marketing, Insurance Clarity, AI Search Optimization

TAKEAWAYS

Directories Get You Found; Your Website Gets You Chosen: Directories help prospective clients discover your practice, but your website is what builds trust and turns visitors into clients.

Google Expects Expertise: Therapy websites fall under Google's YMYL (Your Money or Your Life) category, making trustworthy, high-quality content essential for SEO.

Focus on Topic Depth: Create content that answers specific client questions instead of relying on keyword repetition.

Reduce Intake Questions: FAQ pages, insurance information, and billing expectations eliminate confusion before a client reaches out.

Clarity Improves Lead Quality: Listing pricing, insurance networks, and coverage details upfront attracts better-qualified leads.

Invest in Strategic Copywriting: Strong messaging paired with SEO helps visitors feel understood and encourages them to schedule.

CHAPTERS

00:00 Meet Daniel Fava: From WordPress to Private Practice Websites

05:41 Is SEO Dead? How AI Is Changing Therapist Websites

12:01 Why Clear Website Messaging Wins More Clients

19:31 Why Therapist Bios Matter More Than You Think

23:45 The SEO Strategy Every Therapy Practice Needs

27:13 Directories Get You Found. Your Website Gets You Chosen.

30:37 How Therapist Websites Build Trust Before the First Session

35:31 How to Structure a Therapy Website That Converts

44:46 Final Advice for Building a Better Therapy Website

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn More About Private Practice Elevation: Visit http://privatepracticeelevation.com

Check out the Private Practice Elevation Podcast

The Claim Game Podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates.

Practice Solutions Blog.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Dr. Marina Badillo-Diaz, LCSW, founder of The AI Social Worker, to explore how artificial intelligence is transforming mental health and human services. Dr. Badillo-Diaz shares practical guidance on using AI ethically, protecting client privacy, and maintaining clinical judgment while embracing new technology. Together, they discuss AI documentation tools, HIPAA compliance, AI companions, and how therapists can confidently integrate AI into their practice without losing the human connection.

TAKEAWAYS

AI Should Support, Not Replace, Clinicians: Dr. Badillo-Diaz's "Co-Star" framework emphasizes that providers must review, edit, and guide AI outputs to preserve clinical judgment.

Always Verify AI Documentation: AI scribes can save significant time, but every note should be carefully reviewed before becoming part of the client's record.

Know the Risks of AI Companions: AI can improve administrative workflows, but relying on AI for emotional support raises important ethical concerns, especially for younger users.

Use AI Transparently: The AI Assessment Scale encourages thoughtful, transparent AI use while recognizing when human expertise is essential.

Choose Secure AI Tools: Paid, HIPAA-compliant platforms with Business Associate Agreements (BAAs) provide stronger privacy protections than free consumer AI tools.

CHAPTERS

00:00 Dr. Marina Badillo-Diaz's Background and Journey

10:38 Using AI in Therapy Without Losing the Human Touch

13:03 Beyond ChatGPT: Smarter Ways to Use AI

19:54 Choosing the Right AI Tool for the Job

27:11 The Risks of AI Becoming a Companion

39:09 Why AI Needs Human Oversight

40:50 Helping Therapists Embrace AI

46:43 Connect With Dr. Marina Badillo-Diaz

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn more About The AI Social Worker: Visit http://theaisocialworker.com

Connect with Dr. Marina on LinkedIn

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Daniel King of Fireside Strategic to explore the realities of healthcare mergers and acquisitions (M&A). Together, they discuss what makes a practice attractive to buyers, how valuations are really determined, and why factors like payer diversification, clinician retention, and operational readiness can significantly impact practice value. They also examine how AI is reducing administrative burden and helping practice owners build stronger, more sustainable businesses.

TAKEAWAYS

Practice Value Is About More Than EBITDA: Strong valuations come from reducing risk, maintaining healthy operations, and building a sustainable business—not chasing industry myths.

Diversify Your Payer Mix: Heavy reliance on one insurance payer increases financial risk and can reduce your practice's appeal to potential buyers.

Retention Drives Long-Term Value: Keeping clinicians engaged strengthens culture, improves patient continuity, and creates a more valuable organization.

Prepare for Due Diligence: Buyers closely examine compliance, operations, and financial processes. Addressing issues early can protect your practice's value.

Use AI to Reduce Burnout: AI is most effective when it supports clinicians by automating administrative work, allowing them to spend more time with patients.

KEYWORDS

Private Practice, Revenue Cycle Management, Practice Growth, Healthcare Business, Mental Health Billing, Medical Billing, Practice Valuation, Healthcare AI, Clinician Retention, Cash Flow

CHAPTERS

00:00 Welcoming Back Dan King

08:47 What Is Your Practice Really Worth?

12:03 What Investors Look for Before Buying a Practice

23:21 How Due Diligence Impacts Practice Value

29:25 Why AI Matters in Practice Growth

35:02 Conclusion: Buy, Sell & Grow with Confidence

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn More About Fireside Strategic: Visit http://firesidestrategic.com

Learn More About Your Group Practice Podcast: Visit http://yourgrouppractice.comhttps://yourgrouppractice.com/

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

Email Dan: dan@firesidestrategic.com

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Danny Freed, founder and CEO of Blueprint, to discuss how AI is transforming mental health practice management. Danny shares the personal journey that led him to healthcare, why Blueprint reimagined the traditional EHR model, and how AI is helping therapists spend less time on documentation and more time with clients. From automated billing workflows to real-time insurance eligibility and payer rate transparency, this conversation explores the future of efficient, therapist-first technology.

TAKEAWAYS

Rethinking the Traditional EHR: Blueprint's approach is simple: the core EHR should be free, and providers should only pay for AI tools that save meaningful time.

From Session to Submitted Claim in Minutes: Integrated AI can automate documentation, treatment plans, claim submission, and invoicing in just a few clicks.

Clinical-Grade AI Matters: Effective healthcare AI relies on secure clinical data and context—not generic chatbot responses—to support therapists safely and accurately.

Simplifying Insurance Eligibility: AI can translate complex eligibility data into clear, real-time coverage and out-of-pocket cost information for providers and clients.

Bringing Transparency to Payer Rates: Benchmarking tools help therapists better understand market reimbursement rates and negotiate stronger insurance contracts.

CHAPTERS

00:00 Introduction: From a Personal Mission to a Full-Stack EHR

06:10 Building Around Therapists, Not Software Limitations

10:31 AI, Automation, and the Future of Therapy Billing

20:15 Clinical-Grade AI: Beyond Generic Chatbots

29:04 How Therapists Can Stop Accepting Below-Market Rates

32:12 Keeping Therapists at the Center of AI

37:52 Personalization at Scale: Training the AI Assistant

41:51 Conclusion: Better Tools, Better Care, Better Outcomes

RESOURCES

Today Sponsors: Visit http://practicesol.com

Learn more About Blueprint: Visit http://blueprint.ai

Connect with Danny on LinkedIn

Email Danny: danny@blueprint.ai

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Danielle Hayes, founder of Therapy Austin, to explore how she grew a cash-pay therapy practice from three clinicians to more than 140 providers across multiple locations. Danielle shares the leadership strategies, hiring philosophies, and operational systems that supported sustainable growth, along with lessons on clinician development, practice culture, and selling a successful therapy business. Whether you're building your first team or planning your long-term exit strategy, this episode is full of practical insights for practice owners.

KEYWORDS

Group Therapy Practice, Therapy Austin, Private Practice Growth, Practice Leadership, Selling a Therapy Practice, Behavioral Health Business, Practice Operations, Private Practice Coaching, Healthcare Entrepreneurship

TAKEAWAYS

Invest in Clinician Development: Strong onboarding, mentorship, and leadership opportunities help clinicians grow while improving retention and practice stability.

Culture Is Your Competitive Advantage: Shared values and a supportive environment create consistency, strengthen teams, and drive long-term growth.

Hire for Character: Skills can be taught, but curiosity, accountability, and values alignment are essential for building a successful team.

Growth Requires Systems: Scaling a practice means shifting from founder-driven relationships to structured processes, leadership, and operational excellence.

Selling Takes Preparation: Successful practice sales require realistic expectations, careful planning, and finding a buyer who shares your vision.

Patience Wins: Sustainable growth comes from focusing on quality, consistency, and long-term goals—not chasing every new opportunity.

Build Strong Referral Networks: Trusted advisors and industry relationships provide valuable guidance as your practice grows.

CHAPTERS

00:00 Introduction: From Solo Practice to a Mentorship-Driven Team

06:11 The Therapist Growth Mindset: Investing in Your Craft

14:33 The Shift from Relationships to Systems

17:26 Hiring for Character, Training for Skill

28:22 When It Was Time to Sell

33:17 Selling a Practice: More Than Just the Numbers

38:55 Conclusion: Patience Is the Ultimate Growth Strategy

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Email Danielle at danielle@hayestherapy.net

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

EPISODE SUMMARY

In this episode of The Claim Game, Jeremy Zug sits down with Shannon Hiser, founder of The Wellness Counseling Center LLC, to discuss the realities of scaling a multi-location therapy practice. Shannon shares the administrative and compliance challenges that tested her business—from staffing turnover and insurance audits to billing setbacks—and how she built a reliable in-house billing system with the help of Practice Solutions. Together, they explore practice growth, leadership, AI in healthcare, and creating a business that aligns with your values.

KEYWORDS

Revenue Cycle Management, Private Practice Scaling, Insurance Audits, W2 Therapists, 1099 Therapists, Supervisory Billing, In-House Billing, Practice Management Software, Value-Based Business

TAKEAWAYS

1099 vs. W2 Matters: Understanding worker classification is essential when clinicians bill under your Tax ID. Misclassification can lead to costly audits and compliance issues.

Verify Insurance Policies in Writing: Don't rely on verbal guidance from payer representatives. Always confirm billing rules through contracts and provider manuals.

Build a Business That Doesn't Depend on You: Sustainable growth requires systems and infrastructure—not an owner carrying an unsustainable caseload.

Use AI Thoughtfully: AI can reduce administrative burden through documentation and billing support, giving providers more time to focus on patient care.

Lead with Your Values: When challenges arise, solve problems one step at a time while keeping your practice aligned with your mission and long-term goals.

CHAPTERS

00:00 Introduction to Shannon Hiser and The Wellness Center

12:27 Navigating Administrative Storms and Compliance Challenges

26:58 From Founder-Dependent to Future-Ready

29:50 The AI Dilemma: Efficiency vs. Ethics

34:57 Growing the Team Without Compromising the Mission

37:14 Conclusion: Lead with Values, Not Just Goals

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Wellness Counseling Center

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

EPISODE SUMMARY

In this solo episode of The Claim Game, Jeremy Zug breaks down one of the most common—and most fixable—revenue cycle challenges: claim rejections. Learn the difference between rejections and denials, why small technical errors delay payment, and how to identify the issues preventing your claims from reaching the payer. From EDI enrollment problems and provider directory mismatches to telehealth modifiers and payer ID mix-ups, Jeremy shares practical strategies to help you resolve rejections faster and improve cash flow.

KEYWORDS

Private Practice, Revenue Cycle Management, Claim Rejections, Medical Billing, Insurance Billing, Mental Health Billing, Cash Flow, EDI Enrollment, Credentialing, Practice Growth

TAKEAWAYS

Rejections vs. Denials: Rejections are "soft failures" caught by the clearinghouse before a claim reaches the payer. Denials occur after the payer processes the claim and refuses payment.

Rejections Are Data, Not Disaster: Rejections aren't personal—they're technical alerts pointing to errors that can often be corrected and resubmitted quickly.

Your Digital Footprint Matters: Mismatches between your NPI, taxonomy, tax ID, or address and the payer's records can trigger preventable rejections.

Billing Requires Precision: Missing or incorrect modifiers, place of service codes, and EDI enrollment details can cause claims to bounce before they're processed.

Avoid the Sister Company Trap: Always verify the exact payer ID on the patient's insurance card. Similar company names don't always route claims to the correct payer.

CHAPTERS

00:00 Introduction: Claim Rejections—The Simplest Problem to Solve

02:12 Common Rejections and How to Fix Them

09:10 Small Errors, Big Rejections

11:46 Payer IDs, Prior Auths, and Preventable Delays

13:13 When Diagnosis Codes Trigger Rejections

13:59 Conclusion: Turning Rejections Into Solutions

RESOURCES

Today Sponsors: Jane | One Month Grace Period Promo Code: PRACTICESOLUTIONS1MO

Learn More About The Claim Game: Visithttps://www.google.com/search?q=https://www.practicesol.com/podcasthttp://practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visitinghttps://www.google.com/search?q=https://www.practicesol.com/learning-hubThe Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management athttps://www.practicesol.com/blogPractice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images: Rejection Resolution Guide