A payer says no—but does that mean you should appeal?

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/

Change at work is inevitable. New leadership, new processes, new technology, new expectations—and sometimes an entirely new organization. But how we respond to that change can say a lot about us as professionals.

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.

The elephant in the room is here — and waiting until January is not a strategy. 🐘

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.

The revenue cycle is undergoing its most significant transformation in a generation. AI-driven automation, evolving payer behavior, workforce shifts, and mounting compliance demands are redefining what it means to lead in orthopedic and musculoskeletal practices, ASCs, and health systems.

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

Why do patients feel blindsided by medical bills even when they receive good faith estimates? Why can't healthcare workers confidently explain why care costs what it does? And why does talking about money create so much fear in healthcare?

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.

What does it take to build a financially resilient orthopedic practice in today's healthcare environment?

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

The countdown to October 1 has already begun.

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.

Jennifer McNamara and Maya Turner dive deep into the Office of Inspector General's (OIG) February 2024 guidance on Medicare Advantage compliance, focusing on network adequacy and access to care. This episode unpacks the hidden compliance risks that medical practices and Medicare Advantage organizations face, exploring the tension between gatekeeping policies, utilization management, and patients' right to timely access to medically necessary care. The hosts discuss systemic failures in prior authorization processes, outdated policies, and the role of artificial intelligence in claims processing—offering practical insights for healthcare practices navigating these complex regulations.

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