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

In this episode, Jennifer and Maya unpack the “Mean Girl Effect” at work — the subtle, strategic behaviors that create confusion, undermine credibility, and erode psychological safety without ever appearing overtly aggressive.

From social exclusion and information control to polite denial and professional gaslighting, they explore how toxic dynamics operate beneath the surface — and why high-performing, ethical professionals are often the most impacted.

You’ll learn:

• What the Mean Girl Effect actually looks like in real workplaces

• The psychology behind gaslighting and why it escalates near accountability

• How subtle manipulation destabilizes confidence and increases stress

• Why your nervous system reacts before your logic does

• Practical strategies to protect your clarity, credibility, and mental health

In the Eye on Healthcare Business segment, Jennifer and Maya provide a deep dive into the OIG’s updated Medicare Advantage Compliance Program Guidance — including key risk areas such as risk adjustment, marketing and enrollment, vendor oversight, and documentation expectations. They also discuss what increased enforcement activity from Attorneys General means for healthcare organizations today.

This episode is about naming patterns, protecting integrity, and understanding how culture, compliance, and credibility intersect.

OIG Medicare Advantage Industry Segment-Specific Compliance Program Guidance:

🔗 https://oig.hhs.gov/compliance/ma-icpg/

Do your days in the practice feel… the same?

Same problems.
Same conversations.
Same frustrations—just on repeat.

In this episode, we’re talking about The Groundhog Day Effect—that feeling of reliving the same challenges over and over, even though you’re working hard and staying busy.

This isn’t about motivation.
It’s about awareness, leadership, and breaking patterns that quietly keep practices stuck.

If you’ve ever thought, “Why does it feel like nothing is changing?” — this episode is for you.

The Groundhog Day Effect happens when:

• Problems repeat because systems never change

• Goals reset every year but behaviors stay the same

• Teams feel busy but not aligned

• Growth feels stalled despite effort

This episode dives into why this happens and—more importantly—how to break the cycle.

• Why repetition is often a system issue—not a people issue

• How leadership patterns create recurring outcomes

• The difference between activity and progress

• Why unresolved problems keep showing up in new forms

• How clarity and intentional goals disrupt the cycle

• The role staff support plays in creating real change

• Why awareness is the first step toward momentum

• How to stop “resetting” and start evolving

If your team keeps:

• Struggling with the same issues

• Revisiting the same conversations

• Feeling frustrated or disengaged

This episode will help you see where the loop is happening—and how to lead your way out of it.

Change doesn’t come from doing more.
It comes from doing things differently.

Ask yourself this week:

“What keeps repeating in my practice—and what haven’t I changed yet?”

That answer holds the key to momentum.

Growth doesn’t have to mean longer days, burned-out teams, or constant overwhelm.

In this episode, we’re breaking down how to set SMART growth goals for your healthcare practice—goals that are clear, achievable, and actually supported by the people responsible for delivering patient care.

This is a deep dive into intentional growth, leadership clarity, and the often-missing link between goals, staff support, and patient success.

If you’re ready to grow smarter this year, this episode is for you.

• Why being “busy” isn’t the same as real growth

• How to redefine growth so it supports your vision—not stress it

• The SMART goal framework explained for real healthcare practices

• Common goal-setting mistakes that keep practices stuck

• Why staff support is essential for achieving patient goals

• How to align your team so goals don’t feel like extra work

• Ways to create systems, training, and clarity that empower staff

• How supported teams lead to better patient outcomes

• Why focus beats hustle every single time

• How to review, adjust, and celebrate progress without burnout

Patient goals don’t live on spreadsheets—they live in daily interactions.

In this episode, we dive into:

• Connecting goals to purpose so teams understand the “why”

• Making goals role-specific so everyone knows how they contribute

• Replacing pressure with training, coaching, and clarity

• Fixing systems instead of blaming people

• Creating psychological safety so teams can speak up and improve

• Celebrating progress to build momentum and confidence

When staff feel supported, patient care improves—and growth becomes sustainable.

• Healthcare practice owners

• Practice managers and leaders

• Clinical teams ready for better systems

• Anyone who wants growth without chaos

Check out our books on Amazon for practical strategies, leadership insights, and growth frameworks designed specifically for healthcare practices:

👉 Clear and Connected: How Effective Communication Builds Trust in Healthcare🔗 Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

This week, write down one SMART growth goal for your practice—and ask this question:

“How are we supporting the team responsible for achieving this?”

That answer changes everything.

If you found this episode helpful, be sure to follow the show, leave a review, and share it with another practice leader who’s ready for smarter growth.

Thanks for listening 🎧
Here’s to intentional, supported, sustainable growth.

Join Jennifer McNamara and Maya for a powerful episode tackling one of healthcare’s most pressing issues: team mental health and resilience. From burnout to bold leadership moves, this episode delivers real talk, real strategies, and a few unexpected movie quotes along the way.

💡 What You’ll Learn in This Episode:

• The Hidden Strain Behind the Scenes

  • Why healthcare teams — from clinicians to coders — are feeling more pressure than ever.

  • How after-hours stress (like worrying about documentation or denied claims) quietly fuels burnout.

• Burnout: The Red Flags You Can’t Ignore

  • Behavioral signs: sudden withdrawal, irritability, or unusual changes in tone.

  • Cognitive signs: second-guessing, rising errors, and emotional exhaustion.

• The Real Cost of Neglecting Mental Health

  • High turnover, skyrocketing training costs, and patient dissatisfaction.

  • How poor morale can quietly erode your workplace culture — and why it’s so hard to rebuild.

• How to Build a Resilient Team (That Actually Wants to Stay)

  • Communication that works: Daily huddles, honest check-ins, and clear expectations.

  • Smarter workflows: Cutting out busywork, protecting focused time, and ongoing staff education.

  • Leadership’s role: Modeling calm, setting boundaries, and creating true psychological safety.

• 📊 CMS 2026 Final Rule — What You Need to Know Now

  • Two new conversion factors, payment shifts, and a –2.5% efficiency adjustment.

  • What these changes mean for budgets, staffing, and clinic productivity.

  • Telehealth shake-up: Permanent policy changes, supervision updates, and billing compliance tips.

• 🎬 Lights, Camera, Action — The Rainmaker Meets Healthcare

  • Three striking quotes that mirror today’s healthcare challenges:

    • Fear-based decisions around policy change.

    • Moral burnout when patient care takes a backseat.

    • The emotional toll of crossing lines to meet metrics.

• Closing Thoughts

  • Building resilience isn’t a trend — it’s a leadership mandate.

  • Healthy teams deliver better care, stay longer, and weather change with strength.

Silence may feel like the safest choice when facing toxic staff behaviors—but in healthcare, silence carries a cost far too high to ignore.

In this episode, we dive into the real-world impact of unaddressed toxicity on teams, patient safety, and organizational culture. Leaders often stay quiet out of fear—fear of conflict, fear of losing staff, or fear of mishandling HR processes. But avoiding action doesn’t preserve stability; it erodes it.

• The true cost of silence:
  How ignoring toxic behaviors fuels burnout, increases turnover, and jeopardizes patient outcomes.

• Red flags to watch for:
  Early indicators of problematic behavior that leaders often overlook.

• How to act with confidence instead of fear:
  Practical steps for addressing staff issues without hesitation.

• Documentation that protects you:
  Easy, effective documentation habits that prepare you for HR-aligned action.

• Partnering with HR the right way:
  When to involve HR, what information they need, and how to collaborate rather than fear escalation.

• Protecting your culture:
  Strategies for reinforcing expectations, supporting high performers, and preventing toxicity from spreading.

When leaders choose silence, teams suffer. When leaders choose courage, culture transforms.

📘 Clear and Connected: A Communication Guide for Healthcare Leaders
A practical roadmap to building stronger teams, improving communication, and leading with clarity.

Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

📗 Guiding the Next Generation
A powerful resource for mentoring, coaching, and shaping emerging healthcare professionals.

Amazon link: https://www.amazon.com/Clear-Connected-Effective-Communication-Healthcare/dp/B0DG8KFZWL#

October brings a wave of pink ribbons, powerful stories, and reminders to prioritize early detection — but behind the awareness campaigns lies a complex operational world that deeply affects both providers and patients. In this powerful episode, Jennifer McNamara and Maya Turner take listeners behind the scenes to examine the business side of breast cancer care.

From navigating payer rules to managing rising denial rates, Jennifer reveals how the revenue cycle intersects with clinical decision-making at every step of a patient’s journey. This conversation sheds light on the hidden administrative barriers that influence access, cost, and continuity of care — and why improving compliance isn’t just about accuracy, but compassion.

• Why Breast Cancer Awareness Month is about more than pink ribbons

• Common revenue cycle pain points in oncology, including prior authorization delays and documentation pitfalls

• Denial trends affecting breast cancer treatment and imaging services

• How payer policies shape patient access — often more than clinicians do

• Practical solutions for practices to reduce denials, streamline workflows, and elevate the patient financial experience

• The critical role of coding and billing teams in supporting both compliance and continuity of care

• Prior authorization hurdles for diagnostic imaging and treatment plans

• Complexity of breast cancer coding, documentation, and medical necessity

• The financial burden on patients when claims are delayed or denied

• Communication breakdowns between payers, clinicians, and billing teams

• Workflow strategies that improve accuracy and reduce rework

• Why revenue cycle training is essential in oncology practices

Behind every statistic is a person navigating fear, uncertainty, and hope. Administrative barriers shouldn’t be another burden. This episode empowers healthcare leaders, coders, and revenue cycle teams to make breast cancer care more accessible, compliant, and compassionate — supporting both the clinical mission and the business realities.

• Medical coders & billers

• Oncology practices

• Revenue cycle leaders

• Healthcare administrators

• Compliance professionals

• Anyone interested in how healthcare finance impacts patient care

If you’d like expanded resources, training, or consulting support for oncology revenue cycle challenges, Jennifer McNamara and Healthcare Inspired LLC are here to help.