Do you or your colleagues struggle with insurance denials?
It seems that, at least more recently, I keep hearing from clinicians and managers that more insurance companies and managed care organizations require peer to peer reviews for continued authorization. This sometimes results in insurance denials for continued authorization or denials of claims that are being appealed. We’ve noticed this as well at the clinic that I own & operate. Many of our payers have shifted to using authorization portals to determine which visits/cases to approve or disapprove.
So, this week, I’m sharing a conversation I had with Johanna Metzger, a physical therapist who owns a private practice (thenourishednestpt.com). But, prior to that, she spend seven years as an insurance reviewer for insurance companies in the commercial, workman’s compensation, and medicare advantage space. She has spent time on both ends of a “peer review call”, and she shares insights from her time and experience in her role as a reviewer.
What we cover in this Episode:
- The disconnect between clinician documentation and insurance or payer’s needs
- The different value perspectives of various stakeholders in healthcare
- Leveraging data to improve clinical documentation and decrease insurance denials
- Defining value in your clinical documentation
- Understanding who your audience is when writing a clinical note
- Not only delivering, but effectively documenting high-value care and services in healthcare
- Achieving Better Outcomes and fewer insurance denials by sticking to some fundamental principles of clinical documentation
We’re starting to create videos of certain podcast episodes, including this episode, which can find on the YouTube Channel.
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If you enjoyed this episode: Join Rafael E. Salazar II, MHS, OTR/L (Rafi), principal of Rehab U Practice Solutions and host of The Better Outcomes Show as he explores the possibilities of a new healthcare. Guests range from clinicians trying new techniques and treatments to executives and entrepreneurs exploring new service delivery methods, business models, and organizational structures. You can sign-up to receive new episodes delivered directly to your inbox by filling out the form below. Learn more about Rehab U Practice Solutions by reading The Manifesto for a New Healthcare, or listen to Episode 000. Or, grab a copy of the book: Better Outcomes: A Guide to Humanizing Healthcare.
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If you run an innovative healthcare company and are looking to develop a strategy that leverages best practices, new technology, and marketing/messaging in a way that returns the focus of healthcare to people, please reach out. I’d love to talk with you about how Rehab U Practice Solutions can help help you craft an business development strategy that leverages positioning, market research, UVP stakeholder alignment to drive business development strategy for specific healthcare stakeholders.
Rafael E. Salazar II, MHS, OTR/L (Rafi) is a healthcare consultant, speaker, and host of he Better Outcomes Show. He helps healthcare startups, SaaS platforms, and organizations craft clear positioning, humanize the patient experience, and go to market effectively. He’s the author of Better Outcomes: A Guide to Humanizing Healthcare and principal at Rehab U Practice Solutions. His work on Telehealth has been discussed in Forbes, and he’s advised on projects ranging from digital health product launches to multi-million-dollar healthcare transformation initiatives.
Today, Rafi helps innovative healthcare companies like technology startups, platforms, SaaS companies & innovative healthcare organizations develop effective positioning strategy and business development plans through his consulting work. He also leverages his experience as a professor and academic to speak and train on the topics around humanizing the healthcare experience & healthcare innovation. In addition, Rafi also owns and operates ProActive Rehabilitation & Wellness, a multidisciplinary outpatient clinic treating patients with musculoskeletal pain.
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Are you building something innovative in healthcare—like a digital health product, service, or platform that’s aiming to truly improve the patient experience?
I help healthcare startups, SaaS platforms, and forward-thinking provider organizations develop clear positioning strategies, identify high-value offers, and build go-to-market plans that actually resonate with both users and buyers.
Whether you're launching a new product, scaling an existing service, or navigating digital transformation, I bring 12+ years of experience across clinical operations, healthcare innovation, and strategic development.
How I help:
- Clarify your product/service positioning so customers “get it”
- Align your offer with real market needs
- Build a Digital Health Roadmap to scale your healthcare organization effectively
- Support business development with industry-informed strategy
I’ve consulted on projects from multi-million-dollar state initiatives to early-stage product launches. My work’s been featured in Forbes, and I also speak at healthcare events and conferences on topics like innovation, digital health, and humanizing care. I also speak and train at healthcare conferences, events, and organizations on topics related to technology-enabled care, healthcare innovation, healthcare positioning, and humanizing the healthcare experience.
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