The ultimate challenge of operating an OBL is staying profitable. In this episode of BackTable, we bring on healthcare administrator Laurie Bouzarelos and interventional radiologist Dr. Mary Costantino to talk through the intricacies of revenue cycle management as an IR managing an OBL.

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SYNPOSIS

The conversation covers the full lifecycle of getting paid in an IR practice, from initial patient contact through final claim resolution. Key topics include credentialing, determining medical necessity, coordination of benefits, prior authorizations, and the importance of working with billing and practice management teams experienced in interventional radiology. The episode also examines how EHR and practice management platform selection impacts clinical workflows and reimbursement, and closes with a discussion on payment plans and how emerging technologies, including AI, may shape the future of revenue management in IR-led OBLs.

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TIMESTAMPS

00:00 - Introduction
01:08 - The Importance of Revenue Cycle Management
09:29 - The No Surprises Act and Data Transparency
12:03 - Professional Societies and Continuing Education
17:50 - Credentialing and Taxonomy Codes
40:28 - Impact of Insurance Credentialing on Patient Care
42:08 - Revenue Cycle Management Walkthrough
48:18 - Challenges with Medicare Advantage and Coordination of Benefits
54:20 - Covered vs. Non-Covered Services
59:03 - Medical Necessity and Insurance Policies
01:01:04 - Prior Authorization and Payment Issues
01:13:11 - Payment Plans and Compliance
01:23:10 - Practice Management Software
01:31:10 - AI in Healthcare and Compliance
01:38:57 - Final Thoughts

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RESOURCES

Medical Group Management Administration (MGMA)
https://www.mgma.com/

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