"Melissa Hanley - Part 2"

[00:00:12] Speaker A: Hi, team. [00:00:13] Speaker B: I just want to let you know that the ASN M 2023 Fall Virtual Symposium will be hosted Saturday, September 23, 2023. The conference theme is how to Convince your surgeon. Two, dot, dot, dot. If you're unable to attend the live symposium, you should still register. You get full access to the virtual platform one week in advance to review all content and material, have access to all handouts, and you'll receive the recording of the meeting to watch at any date and time that's convenient for you. I'm rich, Vogel, and this is stimulating stuff. Welcome back to the stimulating stuff podcast. I'm Rich Vogel, and I'm with Melissa Hanley today. So this is part two of my interview with Melissa Hanley, CEO of Vertical RCM. She's one of the nation's foremost experts in coding, billing, collections, and revenue cycle for neuromonitoring. And she's here to give everyone some valuable advice. So let's jump back in. [00:01:20] Speaker A: A few weeks ago, when we were talking about the idea of having you on this podcast, I said I wanted to discuss some common errors that people make either in documentation or data archiving that create challenges for billing and collections. We talked about some already, and you gave me some ideas for what to discuss, so I thought we'd dive into that first. You listed several chart elements that should always be included in a chart, and I want to go through each item, and you just tell me why it's important. So the first one is physician orders. [00:01:55] Speaker C: So way back when we first started implementing this, and this was back in 2008, 2009, because nobody ever got a physician's order, it's required that anytime you lay hands on patients or anytime any service is requested, that there is a physician's order. And I remember being called by physicians yelling at me, why do you need an order? I'm like you write an order for an aspirin, for Christ's sake. What are you yelling at me for? This should be SOP you don't have to give me all the specifics. Just say, I'm ordering interoperative monitoring on this day for this patient, for this spine case, or this cranny, whatever, and you're done. But in order to really it's part of everything that we do in medicine has to have an order. And I have seen Payers do a retrospective look back, and if you are missing the order, they will recoup. And honestly, they have every right to recoup. I mean, I can try to get you out of pretty much anything. I know enough where I can argue both sides of it if it's possible. But if you're laying on of hands and you're doing interpretation, you have to have a physician's order for that. And it's an incredibly important part of the chart. Not only do you have to have physician's order, I just want to add it has to be a signed order. And the rules require that signed order have the signature on top of the printed name. If the printed name isn't underneath that signature, you have to have a signature log. That's what's required by CMS and they're going to be the first people to do a search. So make sure you have the physician's order as a chart element, make sure it's signed, and if the name isn't printed underneath that signature, then have a signature log that you can present. [00:03:58] Speaker A: Interesting. And the next one is the consent and AOB. So we all know what a patient consent is, the AOB or assignment of benefits. Why is that important? [00:04:15] Speaker C: It's important that the patient gives informed consent so that you explain what you're going to do. But it's more important for me, honestly, because what happens is me as someone who is going to eventually send a patient statement if they haven't met their coinsurance and deductible. Remember, the statements are coming from an organization's name that they may not necessarily be familiar with. And they will say, I don't know who this position is. I didn't ask for this position. I have no idea who you are. I did not ask you to be here. I did not get your services. F you, bye. And I'm like, yeah, but before you hang up, you sign consent, I have your signature saying that someone came to you and explained, I know everybody looks like everybody else in scrubs, I get it. And pre op is very busy time and you're nervous and you're scared, but you signed consent saying we could do this. You may not remember the name of the company or it may not have necessarily been given to you, but you signed consent for this and you gave us the ability to bill and collect on your behalf. And then of course no, I didn't. Let me see that. And I'm like, I can send it securely right now via email. It covers the IONM company itself, but more importantly, it also protects the ability to bill and collect on the patient's behalf. [00:05:47] Speaker A: Okay. And next one is face sheet. We already talked about that, so I'm going to skip that. The HMP, we sort of talked about that. I mean, that really helps to get more information about what the patient's potentially reimbursable diagnosis are. Screenshots. So these are sometimes if somebody's using, for example, one of the platforms out there like Usmon or Zinnia X, they can set it up to get automatic screenshots and then you always have the ability to take a manual screenshot. How are these used to support a claim? [00:06:24] Speaker D: I use them all the time. [00:06:25] Speaker C: I use them all the time. And here's why. When you're looking at the tech report, if you just send a tech report and a tech report says that I did EMG from these muscles and they don't say bilaterally. 95861 isn't just a code for bilaterality. It has to be five muscles per limb. If it's not five muscles per limb, you can't build 95861, you have to build 95870 times two. So that's where six one is a bilateral code. 70 is a unilateral code which also covers axial. So if they don't document, even though it's embedded in the code, you would think, duh, it's a bilateral code, you still have to indicate laterality. I'm not going to give up payment on that. So I'm going to look at your screenshots and I'm going to show that you tested bilaterally. So it's not the best documentation, it's more work on our end to do it, but german. [00:07:33] Speaker A: Fair enough. [00:07:33] Speaker C: I'm sending those screenshots to support it. [00:07:37] Speaker A: And the last one is Tech and Reader Reports. I don't want to belabor something if we've already done it, but this is the reports that describe what happened interoperatively and they obviously support the claim, so those are important. Do all of these things get submitted to the carrier upfront? Are they used to support in the event that there is a question or a denial that you want to appeal? [00:08:06] Speaker C: So it depends. Normally for workers comp and no fault claims, we always drop the claims paper and we know they're going to ask for records, so we send them all together at the same time instead of there's no sense of waiting for the request when we know it's. You know, those things that support what are on that claim form get sent and other than that, UnitedHealthcare Habitually asks for the chart upfront before they'll adjudicate the claim. There are a few other payers that will do the same thing. So they'll pend your claim awaiting medical records. Then of course we'll lose medical records and you have to send them again. And then they'll say, oh, by the way, we want the Op report, which is a whole nother thing, but you send that, you want to send the least amount of documentation that supports your claim. The more crap you send, the more they have to wait through. They don't understand what they're looking at anyway. So we try to keep it simple. If life were wonderful, you all would know the diagnosis, you'd know the level of the herniation or the degeneration. You would know where the scoliosis is or if it's Idiopathic or not. Just 41.9, which is unspecified. It's like, for Christ. But anyway, so if that was all listed on the techer reader report, we wouldn't have to send it to anything else, but because there are many times that I won't bill what's on the techer reader report and so now I have to pull that piece of the H and P out and send that with it. Or pull their Mr results and literally highlight where it says of the lithesis and support. Because I'm not going to put something on a claim that isn't. But by God, if that's in that chart, I'm going to find it. And even if it's when you bill a cancer, metastatic cancer, you also have to have the primary cancer, even if you don't know the primary cancer. There's a code for that. I think it's C 80 something or whatever. But you bill the reason that you're doing the monitoring first, some records tend to be a lot thicker than others when we send them. And then of course, when you get post payment reviews, they're always lovely because then you better send the whole chart. And some auditors have become, I guess, more critical in that you have to obtain the Op report, you have to send the chat, you have to send a signature log. There's a whole bunch of other elements that you have to send with it. Again, you don't want to send if you're using usmon. They have the super bill and other things. You don't have to send those things, but you do have to send things that are compliant, the physician's order, the consent to treat any modalities, and anything that supports the CPT codes and the acute Ten codes that you build. [00:11:11] Speaker A: The next thing that you sent me in our previous correspondence that we had just kind of leading up to this were some common documentation issues, and I wanted to go through some of these things to help people in the field understand what's necessary and why it's important. So in the general category of documentation, you said after the patient introduction in the chat, which should include the diagnosis, and we already talked about that document baselines obtained and communicated with the surgeon, and that the surgeon acknowledged. Now, this seems like a really good practice in general, and it's certainly a good practice from a medical legal perspective. And then the same thing you say at the end of the chat shouldn't include a statement change or no change from baseline. Why are these things important from a medical billing perspective? [00:12:07] Speaker C: The payers want to see that there's communication going on, that you're not just baby in the corner, that the physicians interacting whatever vehicle they're using. But there are some payers that specifically require that statement be made. And so there are sometimes when I'm not really sure when the case actually started, remember, we can't build professional component until after baselines are obtained. One can make the argument you're resetting and obtaining baselines multiple times throughout the case, maybe, but when those initial baselines are set, that's when you can really start billing if decision is already made. But you always want to make sure that you communicate those baselines that it's documented, because a lot of payers want to see that baselines were established, they were communicated to the surgeon, and the surgeon acknowledged. [00:13:07] Speaker A: And then the next one is and we talked about this a little bit, so we don't really need to dive into it too much. But you say upper and lower, MEP and SSEP need to be documented with laterality, not just upper and lower. In other words, you say, I am monitoring bilateral upper and lower motor of potentials bilateral upper extremity, low extremity, Sscps. Because this is directly related to the CPT code. It's a definition laterality, right? And then needle EMG with laterality. And I think we had needle underlined here, which is very different from doing a recording of EMG with a surface electrode, like a NIM tube or like what some people call a sticky pad electrode sometimes. [00:13:58] Speaker C: But the definition of all of our EMG code starts with the word needle. And you would be amazed that even if we have a needle count, here's your hint, Mr. Payer auditor. Here's your hint. The needle lectures are right at the bottom of the report. Does not matter. Doesn't matter. Every single EMG should be prefaced by the word needle. Interesting. And I'm telling you, god as my witness, you will get the denials. And denials can be very vague, incredibly vague sometimes. And don't think about calling and asking them what it means, because they don't know what it means either. But especially if you have there are certain auditors, there are certain third party administrators that will think they and they have us dead to rights, technically, because if you don't say it's needle EMG, it could be sticky pad, it could be, whatever, duct tape. If it doesn't say needle, you're not meeting the definition of the code. And they have no faith that anyway that you're meeting the definition of the code. So just document needle EMG, right? [00:15:08] Speaker A: So we're talking about event log, chat tech report, pro report. If you're saying EMG, you should say needle EMG in those circumstances. [00:15:19] Speaker C: If you're not using them, then please don't say needle EMG for recurrent laryngeal nerve, because that's not what you're doing. [00:15:29] Speaker A: Don't lie about it. But if you're doing needle EMG, tell. [00:15:33] Speaker C: Somebody, doesn't that require hook electrode? [00:15:36] Speaker A: You can do it that way. Yeah. And that would be considered needle. But if you're doing a surface recording, that would not be considered needle. AMG. You say have patient name. And one other Identifier, like date of surgery or date of birth, should be on every page of the chart that you submit. Now, that seems obvious to me because somebody somewhere prints all this stuff out, and then somebody in the next cubicle turns on a fan, and it ends up on the floor. Right? They need to know every single page in a packet. They all go together. And this is the same patient, same date of surgery or same date of birth. [00:16:22] Speaker C: Because, again, when you're submitting, especially if it's a post payment review or prepayment review, and a lot of times you say they didn't get them. Even if you upload them through the portal, we didn't get them somehow things get lost. Things get misplaced. And I think it's a requirement, actually, that every single page identify. You should be able to tie that page back to a specific patient, especially when we get lots of charts uploaded. And if you're not careful. We can see the face sheet for one patient and a chart for a different patient in the patient's chart. So it's always helpful to just make sure that we just identify the patient on everything that we do. [00:17:13] Speaker A: Absolutely. And the next category here is diagnoses. So we already talked about this and I'm just going to say it to double down on it, but reports that state stenosis when it is actually stenosis with neurogenic claudication are two very different things. So be specific, ask questions, document. The next one I think is really interesting because it shows how being either lazy or simply being someone who is trying to work quickly and get a lot done might use abbreviations and how it can backfire on you. So you say spondy is not a diagnosis. It is either spondylosthesis, spondylosis or spondylolysis. And that's important to spell it out exactly what it is. And if you can ask the surgeon what level it's at, even better, because then you don't have to say unspecified. You can clearly say what the diagnosis is and what level it is. [00:18:21] Speaker C: I see spondy and I want to grab a weapon and go and find that person and go, what are you thinking? What are you thinking here? Because there are different spondies and it's the difference between an M 43 and M 47. It matters specificity. We must code to the highest level specificity that we have. And so now you can say, well, Melissa, it's a lumbar case, that's great, it's a lumbar case. But what if it's a cervical thoracic or thoracic lumbar or lumbosacral? And you tell me, even if you say it's spinal thesis, I can't guess because you're spanning levels. If you don't tell me it's lumbar or you don't tell me it's lumbosacral, then I'm guessing and I'm not allowed to guess. It has to be specifically documented. So then when I see spondy, I'm like, well, Christ, Jesus, all the bad words come out. And then I got to go even further in the charts to try to figure out if it's documented anywhere. Because the last thing I want to do is look like we don't know what we're doing by submitting an unspecified claim. And it happens all the time. So help a sister tell me the spondy, tell me the level. [00:19:41] Speaker A: And then the next one is fairly common, I think if it's a tumor resection and frozen is sent, try to find out the path findings and document and chat. So I've been in so many of these cases, right, they send something off to pathology, pathology calls into the operating room, they put the person on speakerphone. It's set out loud. Everybody in the room hears what the path finding is and yet so many people sitting there with their ears open don't actually take that information and put it in the chat. And it's not just about the importance of communicating that to the oversight physician and having them understand what the pathology is. But it's also contributing to your ability to get paid for the case. Right. So important. If you didn't hear it get up, ask the circulating nurse. Couldn't hear it from back in the corner. [00:20:39] Speaker C: What was the word is when. And I've seen this in Chats many times. The surgeon will actually break scrubs, go to the lab and come back. And I'm on the edge of my seat. I'm waiting for it. Okay, closing. Have a nice night. And I'm like, you're kidding me? You took the time to document that he broke scrub to go to the lab to get the result, and you're leaving a sister hanging. It makes a difference. Is it a meningioma? Is it benign? Is it malignant? Is it metastatic? What is it? There is a specific code for it and I hate, especially in the brain. D 49.6. Unspecified brain tumor. Especially when I know something got sent to pathology. The other difference, too, is when you're doing a spine tumor, is it on the vertebrae, is it a bone or is it soft tissue? Because I have to code it totally differently. Because bone goes one way, it's usually metastatic. And if it's an epidural, that's a totally different code. And you all just don't think of me and just go on back your day. [00:21:58] Speaker A: And hanging this next one is very interesting to me. It's not something that I've heard before, but it has to do with the modality that is used in an overwhelming majority of surgeries. And you said if billing nerve conduction velocityemg for pedicle screw testing include the calculation of velocity, if that calculation was not obtained and documented, you can't bill for nerve conduction velocity. So in other words, you're looking for somebody to have in there a meters per second or centimeters per second, which is the units of measure for velocity relative to pedicle screw stimulation. Super interesting to me. That means that somebody actually needs to take a measurement, a tape measure into. [00:22:57] Speaker C: The operating room, I believe, right. [00:22:58] Speaker A: Which everybody should have one anyway to measure the head correct place and measure that. All right. Good to know. [00:23:09] Speaker C: Definition of the code is amplitude, latency, and the calculation of velocity. It's a definition of the code. If you're not doing those an EMG is an EMG is an EMG. Whether you call it stimulated, spontaneous, triggered, it's still, God bless this little heart. A needle EMG, that's all you're doing. You bill it, you're going to get paid. You probably will get paid, especially Blue. Blue will pay it. In fact, we've been told when we send records to United, there's a better code to build. They told us to build the nerve conduction velocity. And so, of course, here I am. I'm writing a really nasty letter back saying, do you know what you're talking about? [00:23:55] Speaker A: No, they don't. [00:23:56] Speaker C: Don't tell me that I'm building the wrong code. When you don't even know what a nerve conduction velocity means. And we are required to meet the elements of the code. Now, if you want to bill it and be compliant, then add the 52 modifier to it. And what that says is that it's a reduced service. And just remember that if you're doing the band TV, your EEG codes change to 858687. If you're not doing our conduction, it's just the 60617 of that whole bunch. Make sure your code sets match. [00:24:32] Speaker B: Okay, let's take a quick break here for a word from our spot. [00:24:34] Speaker D: Answered in 2006 and Joint Commission accredited since 2010, intraneve Neuroscience provides 24/7 neuroscience services, including professional interpretation, IONM, and EEG throughout the country. Our mission is to deliver high performance neuroscience services with a common goal to improve patients lives. Inn is privately owned and operated, allowing us to focus on decision making in the best interests of the patient. If you need professional interpretation, IONM, or EEG, we will be honored to work with you. Our commitment to excellence extends beyond our services. It defines our culture. Join our team and be part of a dynamic community pursuing the highest standards, upholding integrity, fostering respect, driving innovation, and fueling our shared passion for delivering exceptional neuroscience services. To join the Inn team, visit www.intranernerve.com or email us at [email protected] today. [00:25:53] Speaker B: And we're back. I'm talking to Melissa Hanley, CEO of A ridicul RCM. Let's jump back in. [00:26:00] Speaker A: Okay, so the next one is and I'm going to use this to bridge to a bigger picture question. So this next one is that the physician report should include the fact that monitoring is performed from outside of the or. And I get that. I think that's important, obviously, but just high level. All the stuff that we just mentioned, and I'm just going to say the laterality of upper and lower maps, SCPs the needle, EMG the diagnosis with the levels, the frozen sample, the nerve conduction velocity. Should all of these things be in the physician report, too, in order to support the claim? [00:26:41] Speaker C: I hate to say it, but the. [00:26:43] Speaker A: Worst thing nodding your head yes. [00:26:46] Speaker C: Well, the worst thing sending a report and the physician says eng was recorded from the appropriate muscles, like, really? [00:26:57] Speaker A: Or it says, refer to the technologist report. [00:27:03] Speaker C: I just lose I lose it. It's a professional report. One of the biggest challenges we've always had is the number of cases that a physician reads at the same time. It's always been an argument. People have it in their policy saying you can only do one, you can only do three, whatever. We don't do ourselves any favors by cheaping out, for lack of a better way to say it, your physician, you're in that case represent. This could go to court. And that's how you have to think. It's a very litigious society. How do you say you were engaged. [00:27:43] Speaker A: And not know the information is not accurate? [00:27:46] Speaker C: Not judging, just saying. [00:27:49] Speaker A: This next question is probably an extension of that. And I think I know the answer. But one thing that I've never understood is why there are separate technical and professional reports. It seems to me that a technical report, for lack of a better phrase, has no real value and it only serves to create potential discrepancies between two reports. What's the role of the technical report from where you sit? Because back in the day when we were at SMA, we had a single report that was signed by well, once we had physicians that came on, then it was signed by both people, but the professional report was written by the person in the operating room. And then we had a combined report with two signatures. And then I got out into the quote unquote, real world. I'll call it the other world, and there's two reports. And I was like, what is this technical report thing? So what purpose does it serve? [00:28:46] Speaker C: It serves me very well because at least they're giving me the muscles. [00:28:51] Speaker A: Okay, you know what I mean? [00:28:53] Speaker C: So nine times out of ten, and this is nothing against the physician, but the tech is in the room. And unless we start doing a better job of communicating with the physician that's outside of the room, then I'm looking at that tech report and those waveforms to code that claim because it's just not I mean, can we have one interoperative report that's interpretive? That would be the best. Because I can tell you, weird things happen in between the tech and reader report sometimes where you're thinking, is this even the same patient? So anytime that you can decrease the amount of documentation that you have to send anywhere or just have available that's discoverable you want to try to make that as small as possible. [00:29:50] Speaker A: I'm going to shift directions a little bit here. We're slowly winding down. Blue Cross and Blue Shield of Texas, Oklahoma, illinois. They require live bi directional audio communication and the neurologist to verbally report baselines data changes and closing data to the surgeon. I have a couple of questions related to this. So first, is this new? [00:30:19] Speaker C: Nope, been around forever. [00:30:23] Speaker A: Is it. [00:30:27] Speaker C: They oh, they won't pay it unless it's documented. Now, it used to be just Oklahoma. Oklahoma was the one that was really nitpicky about it. Even though all three states share the exact same policy, there's absolutely no different verbiage in any of them. They just have the little state name at the top. That's different. But that's been in effect for as long as I can remember. Oklahoma started at least until 2012, 2013. Oklahoma used to be the big stickler about it, and they're the ones that actually want that beginning of the chat and the end of the chat to say baselines, obtained, communicated, surgeon acknowledged. So all three of those states have had those policies in place at least since 2012. And yes, it's enforceable. We've gotten many denials at least in the beginning from Oklahoma. And then as much as I love the country of Texas, I'm like, wait, what? Texas is now actually enforcing their home. Now, why, when Reimbursements on the heels of COVID where all active surgeries know canceled, we're on the heels of COVID then we have the no surprise act. And now my friends in Texas are actually going to enforce their policy, and there's a way to document it, and there's actually a way to do it. Not going to tell you, but where you can be compliant and you can get bill and you can get paid. [00:32:00] Speaker A: Well, I think the answer to that is that they have somebody on their medical director staff who is savvy enough about neuromonitoring or at least enough about surgery to know that surgeons don't want that by and large. And it's a good and easy way to deny a claim. Speaking of which, let's say that you submit a claim for neuromonitoring and you get reimbursed, but a close inspection of the insurance company's medical policy leads you to believe it probably shouldn't have been paid for one reason or another. So an example is an insurance company doesn't pay for neural monitoring in an ACDF for degenerative conditions, but the monitoring company submitted hundreds of claims last year and got paid for all of them. Are there any potential consequences there or is this just money in the bank? And too bad for the mistake on the payer's part for paying it. [00:32:55] Speaker C: Okay, so it's never too bad on the payer's part for paying it. They get away with everything. You get away with nothing. Here's the thing that's important to remember. A payer can have a policy like Cigna and their cervical policy and they say unless there's subluxation or tumor in the cord or trauma, they're not going to pay a cervical case. You submit the claim, you get paid. Yeah, hey, you didn't do anything fancy. There's two reasons why that happened. The plan level, the patient's plan can override that payer policy, and unless you have the summary plan benefit like documents, you're not going to know what it is. Right. The second thing is they paid it in error. I assure you they will do the recruitment and they will let you know. So there's no harm, no foul for a commercial payer. Where you run the risk is if you get paid by a government payer. Well, if you get paid by Medicare, when you submit a claim to Medicare and you know you don't have a covered diagnosis, there's actually a modifier you're supposed to put on that to say, hi Medicare, how are you? I know this line isn't going to get paid, but do me a favor, go ahead and forward it on to the secondary for payment. That's the appropriate way to do it. If you get an overpayment by Medicare and you realize it, which you should, you have 60 days to. Self report. I highly encourage you if it's Medicare and you receive an overpayment, because within 60 days, you should realize you got paid for something that you shouldn't have gotten paid for, you got 60 days to self report, and then you're fine. If you fail to do that, woe be unto. You totally different from the commercial payers. Commercial payers. Again, there are some good plans out there that will supersede their medical policy on that procedure. Most times they're going to realize their own mistake, and they're going to do a recoupment. All companies should be aware of every state's recoupment laws, because depending on the state you're in, if you submitted a clean claim and they paid it and there was no fraud involved and they're past their time to recoup, then you can flip them the bird and say, nice knowing you. I'm keeping the money. It's published everywhere what the state recruitment laws are. Before you get a recruitment or a request for a recruitment or a request for a check, you check those state recruitment laws to make sure they're within their time. You check to see if it's a valid recoupment, because a lot of times, if you don't fight it, they're going to go ahead and take that money back off of other claims. And a lot of times it's not inappropriate to take back. Can you hear my dog crying? [00:35:58] Speaker A: I have a dog behind me, too. So it's all good. Okay, now we're really going to wind down. This episode is going to air just after the football season starts. And I know you're an Eagles fan, so make a prediction. Make a prediction. Okay, I'm not going to ask you the question. Actually, I'm going to ask it so people know what I was going to ask, but I'm not going to ask you to answer it because there is a little bit of well, in Philadelphia, there's a little bit of skepticism about answering questions like this. And that's why I wanted to see your face when I asked. [00:36:35] Speaker C: Very superstitious. [00:36:37] Speaker A: Very superstitious. So the question was going to be, the Eagles going to win the Super Bowl, but don't answer it. Let's move on to the next one. So I'm going to end by asking you three signature questions that I ask all guests, because I'm interested to see how different people answer these questions from where you sit. If you could give some advice to people in neuromonitoring in five to seven words and just think that it fits on a PowerPoint slide, what would it be? [00:37:05] Speaker C: Continue to learn your craft. Continue to take pride in the work that you do and know that what you're doing has value. Don't sit back and let things happen around you. Get involved, have a voice, and always keep the patient centric. I think that's the biggest thing, because if you do that, I think everything else kind of falls into place. After that. [00:37:32] Speaker A: Everything else follows I totally agree. Next. Question number two. Do you have any insights or thoughts regarding how to inspire people in general to be more invested in their careers? [00:37:44] Speaker C: If you don't love what you do, do something else. Just update. Honestly, when I got into this, and like I said, it took me a year to say interoperative neurophysiological monitoring. Had no clue what I was doing, but fell in love with it. Fell enough in love with it to learn as much as I could and to look under the covers and under those covers and under those covers to become an expert at what I do. And that was a painful process. I got yelled at, too, by the way. It wasn't just the clinicians at SMA, but be invested in it if you're not interested. I know this sounds stupid and corny, but if you don't love what you do, you're going to suck at it. Or maybe you won't suck at it, but you have to want to learn it. You have to want to always be better at it. And if you don't, then there are so many things you could be. Go back to when you were a kid. Go be that fireman. Go be that policeman. Be the ballerina. Don't be the monitorist. Absolutely. [00:38:57] Speaker A: I mean, just remember that there's a patient on the table, and if you don't want to be doing this, they don't want you to be caring for them. So go do something else, but take pride in your work while you're doing it. [00:39:09] Speaker C: I think that's it. It's called health care. It's not called health. [00:39:13] Speaker A: That's a good one, too. Health care. Okay, one final question. I'm supposed to be interviewing you, but I want to give you the opportunity this is a dangerous one for you, but I want to give you the opportunity to ask me any question you want. So what, if anything, do you want to ask me? [00:39:30] Speaker C: I want to ask you how the industry can somehow come together and find some way to not necessarily lobby, but to advocate for interoperative monitoring and the importance of interoperative monitoring. And I think you sit in the catbird seat because you know and are associated with many people, many organizations. And I'm not asking people proprietary information or anything else, but we are all in little silos right now, and it is killing everybody from a revenue perspective what we have to do now. And I will never complain, because I complained once about working hard to video. I love her, by the way, and she said, yeah, you know, Melissa, you may work hard, but you can pee anytime you want to. And I'm like that point. I'm not going to complain. But with the nose prize act and everything else, your revenue cycle team, whether it's internal or external, has just tripled their volume of work that they have to do for something that should already be payable. And so I don't even know how to be a lobbyist. I'm sure I'm not smart or cute enough to be a lobbyist, but I will go arm in arm with anybody to petition anybody. We have to to say, look, yes, there are things that I don't necessarily know that the clinical significance of monitoring an Epidural injection. Nobody monitored me when I was given birth, when I got my Epidural. I'm just saying. So again, is it really necessary? There's always going to be those things that aren't. But for the majority of the people that want to do good work, that do do good work, that they substantiate what they do, how do we get people to listen? Because those insurance companies and the government is going to hold you accountable. They will absolutely hold you accountable. Where is their accountability? Why, if they're only allowed to keep a certain percentage of the revenue that they get from premiums, are we not getting paid for the services? We'rendering where's that money going? I don't know. It's not coming to the IONM companies. Not unless we fight and fight and do open negotiations and do good faith estimates and send things to IDR and spend all this money and time, which they're banking on you not doing because they've made it so convoluted. Bring everybody together. How do you bring everybody together to say, you know what? No, we do have value. We are allowing people to get up and walk and speak and not wait to get their voice back. Now, I'm sure a lot of husbands are happy. Their wife may lose their voice for six months until our RLN comes back. But what you do has value and you're supplying the instrumentation, that's a cost. You're supplying the disposables, that's a cost that is not being reimbursed right now or not reimbursed like it should be. Even the Medicare fee schedule, the technical component is usually higher. It's usually two thirds of the global payment. And yet we're not getting anything. So in your spare time, if you don't mind, if you could just grab everybody, get them together and do something. [00:43:13] Speaker A: Well, I will say this we're going to die. Oh, absolutely. And I've been singing this song for a while, but neuromonitoring has become so competitive from a business perspective, and you've got all of these different companies out there that are perfectly happy in their silos. But if you reach into each of those companies and you grab the owner and you put them all in a line, you're going to find that there's two types of people. There are people that are running a business because they want to suck the industry dry of every penny and dump it flat and walk away. And there are people who run a business because they love running a business and they love what they do in healthcare. And that latter group of people, when you say, hey, let's get together, let's band together, let's collaborate, who are my collaborative leaders that are in this for the long haul, that want to do something about this. Let's band together. Let's come up with a message. Let's go to the right people. Let's knock on doors. Let's make phone calls. Let's fight this. You'll find that those people will step up, but I think you'll also find that there are nevertheless people who aren't in Camp one, they aren't here to suck it dry, but they also aren't willing to collaborate in a meaningful way. They want to circle the wagons around their company and try to protect it. And any effort to collaborate on anything at all, they view as a risk. And it's ignorant and short sighted. [00:45:04] Speaker C: Risk what? [00:45:06] Speaker A: I don't know. They don't even know. They just don't want to collaborate. They don't want to invest in the things that will ensure long term stability. They want to make dumb decisions that will bring in more money now at the risk of no money later. And that's no way to run a business. In fact, that's 101 of how to go out of business. But I'm going to get off my high horse and I'm just going to say the need to get people together to collaborate on fighting these things is important. And I say this about a lot of things. The burden of getting people together can't rest on one person's shoulder. [00:45:50] Speaker C: No, I just put it on you, pumpkin. [00:45:52] Speaker A: I know you did. No, I get that a lot in like, ASN m. It's like, well, what are you going to do about this? Or what are you going to do about that? But part of driving change is people to look at themselves and saying, what am I capable of doing and how can I contribute? Because if you're always looking to somebody else and saying, what are you going to do about it? It's time to look in the mirror. And that's what I'm going to say about that. Okay, this was a great conversation. [00:46:23] Speaker C: Melissa, hang. I'm sorry, but can I say one more thing? [00:46:27] Speaker A: Sure. [00:46:28] Speaker C: Because it directly relates and it's a quote that says we must indeed all hang together or most assuredly we shall all hang separately. [00:46:38] Speaker A: So true. [00:46:39] Speaker C: Benjamin Franklin, by the way, one of. [00:46:42] Speaker A: My favorite Philadelphians see. Not as much as you, though. Melissa Hanley is CEO of Verticalrcm. That's revenue cycle management. You can check them out online at WW veridicalrcm.com. That is v as in victory. Eridicalrcm.com. Well, that's it for today. Thanks to all my listeners. Please continue sharing this podcast on socials and through word of mouth. Also, many thanks to everyone who's been sending me email and texts. I love reading your comments. Please continue sending your comments, insights, critiques, pushback, validation and thought provoking questions to [email protected]. I always love hearing from you. I'm Rich Vogel. This is Melissa Hanley. And that was stimulating stuff. [00:47:41] Speaker E: The information and opinions provided in this podcast are those of the individual speakers and do not represent the opinions of their employers, affiliates or other third party individuals or organizations. Sponsorship and other advertising messages do not constitute support of or preference for specific products or services. This Podcast is not designed to and does not provide medical advice, diagnosis, opinion, treatment or services. This Podcast, its host and all participants, including guests and sponsors collectively, participants provide general information for entertainment purposes only. 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