The Claim Game

EPISODE SUMMARY Jeremy and Dr. Dylan Ross explore the "back door" of managed healthcare, tracing Dylan's journey from direct care delivery to the high-level strategic world of major payers. They dive deep into the current "recalibration" of behavioral health—where stigma is eroding and utilization is up, but the backend business models are struggling to keep pace. Dylan explains why payers are oft...

EPISODE SUMMARY Jeremy introduces the fourth billing domain, Payment Posting , and explains why it must follow eligibility and benefits. He defines posting as the reconciliation of your expectations (contracts and CPT codes) versus reality (what the payer actually sends). The episode covers the four macro-moves of the territory: Receipt, Posting, Denial Capture, and KPIs . You'll learn the differe...

EPISODE SUMMARY In this domain-specific deep dive, Jeremy explains why tracking metrics for eligibility and benefits (E&B) is the secret weapon of a proactive practice. Many providers view E&B as a "time suck," but without clear KPIs, you’re flying blind. Jeremy breaks down three essential metrics—Time to Completion, Accuracy Rate, and Call Time Logs—to help you identify which payers are d...

EPISODE SUMMARY Ever felt like you were crushing a game of Monopoly or Catan, only to have one bad card flip the entire board? In the world of private practice, Eligibility and Benefits (E&B) often feels exactly like that. You think your revenue is secure, and then—BAM—a missed rule or a shift in patient benefits leaves you disoriented and losing ground.  In this episode of The Claim Game , Je...

EPISODE SUMMARY Prior authorization (PA) is the boss level of the Eligibility & Benefits domain, the giant locked door that stands between you and getting paid. This week, Jeremy is diving deep into the controversial world of prior authorizations, debunking the persistent myth of the "retro auth" and breaking down exactly how to conquer this gatekeeper of revenue. We walk you through the three...

EPISODE SUMMARY Is your practice tired of wrestling with insurance denials? In this episode, Jeremy Zug flies solo to dive into the crucial third stage of the Revenue Cycle Management (RCM) Game Board: Eligibility and Benefits (E&B) . Jeremy breaks down a two-step, methodical strategy designed to drastically cut down your denial rate and eliminate costly billing surprises. Learn why checking E...

EPISODE SUMMARY Host Jeremy Zug welcomes Practice Solutions' Billing Director, Kelley Sonnenberg, to dive deep into a core RCM challenge: Insurance Eligibility and Benefits (E&B) verification . This episode cuts through the confusion, addressing the controversial question of who is ultimately responsible for E&B checks (patient or practice?) and the reliability (or lack thereof) of these c...

EPISODE SUMMARY In this essential episode (with Jeremy flying solo as Kathryn welcomes their third child!), we tackle the critical third territory on the RCM Game Board: Eligibility and Benefits Verification . Think of E&B as your practice's scouting phase . We break down exactly what E&B means, why it’s a non-negotiable step before any claim is mentioned , and how mastering this repeatabl...

EPISODE SUMMARY You’ve mastered the day-to-day tasks of patient registration, but how do you know if your processes are actually winning? In this episode, Jeremy and Kathryn Zug zoom in on the Key Performance Indicators (KPIs) space within the Patient Registration territory of The RCM Game Board. They break down how practice owners can stop being reactive and start being proactive by moving beyond...

EPISODE SUMMARY This week on The Claim Game, Jeremy and Kathryn Zug make the final move in the Patient Registration territory of the RCM Game Board:  Checkout . It’s easy to think the work is done when a session is over, but this final step is absolutely critical for a practice’s revenue cycle and reputation. We break down the key elements of a solid checkout process—from physically guiding the pa...

EPISODE SUMMARY Welcome back to The Claim Game! In this round of mastering Revenue Cycle Management, we're taking a magnifying glass to the crucial territory of Patient Registration and zooming in on the seemingly "riveting" world of HIPAA Compliance . We know that when practice owners hear "HIPAA," their first instinct might be to "run for the hills", but understanding this federal law is absolut...

EPISODE SUMMARY Are you tired of grappling with insurance denials due to a simple mismatch in credentialing? Patient registration is more than just a clerical task—it's a key part of your RCM strategy, and this episode zooms in on the next critical step:  Provider Assignment and Scheduling . Matching the patient to a provider with the right credentials and specialty is crucial for ensuring a smoot...

EPISODE SUMMARY In this episode of The Claim Game, Jeremy sits down with Joe Murphy, the CEO and Co-founder of Checkpoint EHR. Joe shares his unique journey from the high-paced world of telecommunications to the mission-driven sphere of behavioral health technology, focusing on Checkpoint's core value: "Simply, period". Joe discusses how Checkpoint is working to move EHR systems into the backgroun...

EPISODE SUMMARY Welcome back to The Claim Game, the podcast that helps you turn claim denials into deposits! In this episode, we're diving into the second territory on our RCM board: patient registration. Jeremy and Kathryn Zug zoom in on the very first stage of this process—intake—and explain why perfecting it is so critical for both your practice's reputation and bottom line. Kathryn explains th...

EPISODE SUMMARY In this episode of The Claim Game , Jeremy Zug interviews Maya Topitzer, the founder of Breksey, an AI-powered client relationship management (CRM) tool built to help clinicians run their private practices like thriving businesses. The discussion dives into a critical, often-overlooked pain point for practice owners: patient registration. Maya explains that patient registration is...

EPISODE SUMMARY In this episode, we're taking a strategic pause to get a behind-the-scenes look at the very game we’re playing by talking to a game changer himself, Uriah Guilford. He's a licensed therapist, group practice owner, and the head nerd at Productive Therapist, a virtual assistant company that serves providers in private practice. We're diving into the complexities of the patient regist...

EPISODE SUMMARY Welcome back to The Claim Game! In this episode, Jeremy and Kathryn Zug shift from the "Credentialing" territory of the RCM game board to a new, crucial area: Patient Registration . They explain that while credentialing is about getting your player piece on the board, patient registration is about getting other players—your patients—onto the board so you can actually start playing....

EPISODE SUMMARY In this final installment of the credentialing series, Jeremy and Kathryn Zug break down how practice owners can track and measure the success of their credentialing efforts using a KPI dashboard. They explore five essential KPIs—insurance revenue target analysis, time to contract, application completion accuracy, credentialing efficacy, and application denial reasons—and explain h...

EPISODE SUMMARY In this episode of The Claim Game, Jeremy and Kathryn Zug dive into the final stage of credentialing: Stage Six, "Manage and Review". While many providers believe that credentialing is a one-time process, this stage is crucial for avoiding unexpected denials and even ejection from payer networks. The hosts compare ongoing credentialing management to maintaining a car after you've b...

EPISODE SUMMARY This week on The Claim Game, we’re taking a deep dive into the nuts and bolts of one of the most stressful parts of private practice: credentialing. Jeremy sits down with Kay Ward, the founder and CEO of Lanyard Health, a health tech platform that's reshaping how providers get credentialed and stay on top of their status with payers. Kay, who’s been in the credentialing game for 15...

EPISODE SUMMARY This episode of The Claim Game, "Accessing the Board," features an insightful interview with Cathy Gilbert, an expert with over 30 years of experience in the healthcare industry, including leadership roles at major national payers like Magellan and Beacon Health Options. Cathy shares her unique perspective from the payer's side of the table, demystifying the complex and often frust...

EPISODE SUMMARY This episode of The Claim Game marks a pivotal moment in the credentialing journey: the final initiation where you truly claim your network territory. Jeremy and Kathryn Zug guide you through the crucial stages of reviewing and finalizing a payer contract, helping you navigate the fine print that can make or break your practice's financial health. This is the stage where you transf...

EPISODE SUMMARY In this episode of The Claim Game, Jeremy and Kathryn Zug tackle the often-dreaded "credentialing black hole" – that period of frustrating silence after submitting your insurance applications. They equip you with a game-changing strategy to transform passive waiting into an active, strategic process. This episode zooms in on Stage 3 of the credentialing process: application follow-...

EPISODE SUMMARY Join Jeremy and Kathryn Zug in this tactical episode of The Claim Game as they dive deep into the initial stages of the credentialing process: information gathering and application completion. This episode is packed with essential tools and strategies, moving beyond a general overview to provide clear, actionable steps for practice owners and administrators. Kathryn outlines precis...

EPISODE SUMMARY Is your practice tired of wrestling with insurance denials, deciphering EOBs, and watching your revenue slip through the cracks? You are not alone! Welcome to The Claim Game, the podcast designed to cut through the confusion and provide you with the best practices for revenue cycle management (RCM) success. Join Jeremy and Kathryn Zug as they simplify the complex landscape of RCM,...