The Claim Game

EPISODE SUMMARY ​​In this episode of The Claim Game , host Jeremy Zug breaks down one of the most misunderstood and frustrating domains of the revenue cycle: Appeals . While many providers’ knee-jerk reaction is to fight every denial with a passionate letter, Jeremy explains why an appeal should actually be your fifth line of defense, not your first. We’re pulling back the curtain on how insurance...

EPISODE SUMMARY Is your private practice’s front office running like a well-oiled machine, or a "clogged emotional drain"? This week on The Claim Game , Jeremy Zug sits down with Brent Metcalf, LCSW , founder of Tri-Star Counseling , to discuss the wild ride of scaling a multi-niche group practice in the Appalachian region. Brent shares the "serendipitous" story of how he was essentially "voluntol...

EPISODE SUMMARY In the world of Revenue Cycle Management (RCM), ignoring your aging report is like planting a garden and never pulling the weeds—eventually, you’ll lose your harvest. Jeremy Zug walks us through the anatomy of an aging report, defining the levels of urgency for claims sitting in 30, 60, and 90-day buckets.  We discuss the critical difference between a rejection and a denial, how to...

EPISODE SUMMARY In this episode, Jeremy Zug takes a strategic pause to interview a true healthcare game changer: Dr. Jeremy Friese , founder and CEO of Humata Health . Dr. Friese isn't just a tech executive; he’s a "recovering Mayo Clinic physician" who spent two decades in the trenches as an interventional radiologist. After witnessing the systemic failures of healthcare during his mother’s battl...

EPISODE SUMMARY Jeremy explains that accounts receivable is like a treasure chest with two different locks: Payer Aging (insurance) and Patient Aging (people). While insurance is a game of logic and data, patient aging is a game of relationships and communication.  We dive into the "90-day mistake"—the friction created when a provider waits too long to bill, leaving patients feeling "ambushed" by...

EPISODE SUMMARY Dealing with insurance denials can feel like a special kind of rejection. You’ve done the work, you’ve served your patients, and then— BAM—denied. It’s the healthcare equivalent of a "check engine" light: frustratingly vague but impossible to ignore. In this episode, Jeremy Zug dives into the nitty-gritty of denial resolution, reframing these "no’s" as puzzles waiting to be solved....

EPISODE SUMMARY Is your practice running like a high-performing business, or is it just surviving from one grant cycle to the next? In this episode of The Claim Game , Jeremy and Kathryn Zug sit down with Jill Steeley , a powerhouse in community health and former CEO of PureView Health Center. Jill shares the incredible story of how she walked into an organization facing a nearly $1 million defici...

EPISODE SUMMARY Ever feel like you’re playing a game of "Red Light, Green Light" with insurance companies, only the light is always stuck on red? We sat down with a true healthcare game changer, Amy Turner, Deputy Director for Policy at the CMS Innovation Center (CMMI), to talk about how they are trying to fix that. Amy breaks down the mission of CMMI—lowering costs while boosting quality—and intr...

EPISODE SUMMARY Is your practice’s revenue stuck in "limbo"? You do the work, you see the patients, you submit the claims—and then... silence. No check, no deposit, just a line item on a spreadsheet getting older by the second. In this episode of The Claim Game , Jeremy Zug dives into what is arguably the most intimidating territory in the entire revenue cycle: Aging Follow-Up . Jeremy demystifies...

EPISODE SUMMARY Is your practice’s bank balance giving you a false sense of security? In this episode, Jeremy Zug moves the game piece into the territory of Payment Posting . While it might sound as exciting as watching paint dry, Jeremy breaks down why this "menial chore" is actually the scorecard for your entire practice. We’re moving from the dopamine hit of seeing money in the bank to the prec...

EPISODE SUMMARY In this episode, Jeremy breaks down the critical distinction between your Billed Amount (your "sticker price") and the Allowed Amount (the "club member price" you negotiated in your contract). Using the story of "Sarah," a clinician frustrated by receiving $112.50 for a $180 session, Jeremy explains the "Lesser of Two" rule. You’ll learn why setting your fees too low prevents you f...

EPISODE SUMMARY Ever opened your EHR expecting a paycheck only to find a big fat zero staring back at you? It feels like adding insult to injury—you’ve done the credentialing, nailed the notes, and submitted everything on time, yet you’re left with nothing but frustration.  In this episode of The Claim Game , Jeremy Zug dives into the most dreaded part of the revenue cycle: denials . Instead of tr...

EPISODE SUMMARY Jeremy breaks down the critical distinction between an EOB (what the patient sees) and a Remittance Advice (the professional version for the provider). He walks through the "detective work" required to audit these documents, highlighting why the Allowed Amount —not just the paid amount—is the number that determines if you’re being underpaid. The episode also explores the "digital p...

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...