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From ophthalmology documentation pitfalls to outdated CPT codes, and from billing inefficiencies to ignored payer contracts, Jennifer and Maya shine a light on the risks of clinging to old habits.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 safety

• A real-world case where poor documentation and unchecked templates led to denied claims and even patient harm

• How outdated CPT codes and robotic billing processes drain revenue silently over years

• Why documentation is the backbone of both compliance and AI effectiveness

• Contract review essentials—why rates, payer requirements, and responsibilities can’t be ignored

• How 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• 💸 Outdated CPT codes still being billed years later—and the thousands lost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 unnecessarily

• Jennifer’s Substack – Insights on payer contracts, compliance, and healthcare operations

• AMA CPT® Code Book – the official “source of truth” for coding

• CMS Medicare Coverage Database – LCDs, NCDs, and coverage policies

• McVey 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 Rule

• How reimbursement changes could affect different specialties

• Compliance implications you can’t afford to overlook

• The role of documentation and medical necessity in the new environment

• Action steps for practices to prepare before the rule is finalized

Medicare 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 Rule

• Healthcare Inspired – Learn more about coding, compliance, and practice efficiency services

• Jennifer’s Substack – Articles and insights on compliance and payer policy

• AMA 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 leaks

• Key data metrics to track during slow periods

• How to pinpoint operational bottlenecks that impact cash flow

• Ways to keep your revenue cycle healthy even during patient volume dips

• Why payer behavior might be a bigger factor than you think

When 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.com

• Follow Jennifer McNamara on LinkedIn: Jennifer McNamara

• Follow Maya Turner on LinkedIn: Maya Turner

• Book a complimentary billing and coding assessment

Episode Summary

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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 Truth

26:21 - 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 denial

  Rejections never make it through the system. Denials are processed and then kicked back due to payer rules or errors.

• Why automation matters

  AI (like Athelas) can prevent delays by correcting errors before submission, automatically resubmitting denials, and eliminating lag time.

• The power of site-specific vs. global rules

  Cameron explains how custom rulesets based on payer and specialty drastically reduce denials.

• Real-world examples

  Including one from an autism center battling denials from unlisted codes—and how automation fixed it.

• Domain-trained AI in action

  Think: 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 table

  AI can track every claim and compare it to your fee schedule to recover revenue you didn’t even know was missing.

• The burnout problem

  We 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 Turner

• Clearing up common misconceptions about rejections vs. denials

• How AI augments—not replaces—your revenue cycle team

• Using data to identify patterns and prevent denials

• UI/UX in RCM software: why it matters

• Operational tips for using automation to protect your AR

• Benchmarking payer behavior and setting smarter expectations

• Athelas – Learn more about their AI-driven RCM platform

• Bone & Joint Summit – Join us July 17–18 to meet the Athelas team in person

• Contact 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 breaches

• The unique challenges providers face in documenting time-based services

• Medical necessity requirements that often go unmet

• Telehealth-specific compliance issues in behavioral care

• How compliance audits can proactively reduce risks

• Steps providers can take now to strengthen behavioral health compliance

Hot Topics Covered:

• Time-based E/M codes and psychotherapy documentation

• CMS expectations for medical necessity

• Common audit triggers in behavioral health

• Modifiers and telehealth policies under scrutiny

• Real-world compliance examples and red flags

Takeaway 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 Guidance

• OIG Compliance Recommendations

• Telehealth 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 Scenarios
  How CMS’s guidance plays out in orthopedics vs. general surgery vs. other specialties.

• Documentation Must-Haves
  What language drives approval—and what red flags to avoid.

• Billing Best Practices
  Reminder: 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 providers

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• 1. Statutorily Excluded: Services never covered by law, regardless of medical need (e.g., cosmetic surgery under Medicare).

  2. Not Medically Necessary: Services denied based on clinical judgment or guidelines—even if technically covered.

  3. Appeal Rights: Patients typically cannot appeal statutory exclusions but can appeal denials based on medical necessity.

  4. Documentation Matters: Accurate clinical notes can be the difference between a denied and an approved claim.

  5. Proactive Communication: Providers should notify patients in advance using tools like ABNs (Advance Beneficiary Notices).

     
     

     
     

     Advance Beneficiary Notice (ABN) Guide

     
     

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