Silent PPO Networks

Today, in the NSCHBC podcast, we're exploring a growing trend in healthcare that is changing the traditional physician-patient relationship: Concierge Medicine.With physician burnout, declining reimbursement, increasing administrative burdens, and patients frustrated by rushed appointments and limited access to their doctors, concierge medicine is becoming an attractive alternative for some practices.But is it really the answer?For physicians, concierge medicine may offer smaller patient panels, more predictable revenue, and greater professional satisfaction. For patients, it promises personalized attention, longer appointments, and improved access to their healthcare providers.However, there are some important questions. Is concierge medicine affordable for the average patient? What happens to patients who cannot pay a membership fee? And how do Medicare regulations, commercial insurance contracts, and billing compliance fit into this model?Today, our host Terry Fletcher will discuss the advantages, disadvantages, financial realities, and potential future of concierge medicine with her guest, fellow NSCHBC member Bob Wittenmore. Listen in for this timely topic

In this month’s episode of the NSCHBC Podcast Terry welcomes Healthcare Consultant Brian Williams of Moxie Healthcare Solutions to discuss a new concern on the healthcare horizon and that is “Silent PPO Networks”. What are they? How does it affect physician reimbursement and who’s running them? Join us for this important topic.

You have less than one month to submit your thoughts or questions about the proposed 2027 Medicare physician fee schedule to CMS. The comment period will end Sept. 14, 11:59 p.m., ET. To be part of the reimbursement process you need to be heard! CMS must read every comment it receives by the deadline and include a response in the final rule. Therefore, submitting a comment is more than a way to share your opinion: you can make suggestions and ask questions.The fastest way to submit a comment is online at www.regulations.gov/docket/CMS-2026-2377. Click the “Open for comments” button on the left, scroll down to the “Comment” button on the lower right and follow the instructions.Terry goes over some of the Final Rule 2027 highlights and encourages all stakeholders to send in your comments now!

Welcome to NSCHBC Edge Podcast, where we separate facts from assumptions in the world of revenue cycle management.Today we're talking about what it really means to be evidence-based. In healthcare, that phrase gets used a lot, but in RCM it has a simple meaning: show your work. Otherwise, you're just making confident guesses.Too many billing and compliance decisions are still driven by tribal knowledge, office habits, or someone's gut instinct instead of actual data. But data should be driving every operational and financial decision.

Artificial intelligence is rapidly transforming healthcare, and it's a topic that's on everyone's mind. As consultants, we believe it's our responsibility to ask the tough questions as this technology reshapes the industry.In this episode, Terry is joined by Vinod ("Vinny") Sankaran for a candid discussion about the opportunities and risks of AI in healthcare. Together, they explore the real-world benefits, potential pitfalls, and the practical guardrails every healthcare organization should have in place to protect patient care, preserve operational integrity, and ensure responsible business practices as AI becomes part of everyday healthcare.

A commonly cited concern regarding Telehealth utilization is that it may not provide an equivalent experience—or may even offer an inferior one—for both patients and providers, due to the absence of shared physical presence. For example, one concern that has been raised includes missing patient non-verbal cues as the provider may not be able to view all of the physical manifestations of the patient during a video visit. While the patient and provider may not be in the physical presence of one another, the environmental elements at both ends of the interaction can still influence the effectiveness of a Telehealth visit. In this episode of the NSCHBC Edge Podcast, Terry Fletcher, discusses the newly gathered information that patients' have shared that would make for a more conducive Telehealth encounter.

HHS and CMS will use its statutory authority to control unnecessary increases in the volume of covered outpatient department services to align payments for certain services delivered in hospitals and off-campus facilities. This is called “HHS Transparency”. As of April 1st, 2026, many regulatory rules took effect and Terry and her guest Tim Jodway, from RubinBrown Consulting, discuss the details and how it impacts provider practices and hospitals.

Healthcare attorneys can encourage physicians to adopt best practices without defaulting to legal statutes by focusing on clinical quality, risk management, efficiency, and peer-benchmarking. By rephrasing compliance as "patient safety" or "practice efficiency," attorneys can make best practices more palatable than just regulatory mandates. Terry discusses this an more with fellow NSCHBC member and PA Healthcare Attorney Colin Callahan on today’s episode of the NSCHBC Edge Podcast.

Many medical practices hire marketing firms — but the why isn’t always clear. Are you promoting new services, trying to attract more patients, or working to strengthen trust within your existing patient base?In this episode, Terry Fletcher and member Carl White break down the difference between marketing and promotion for medical practices, and what practices should evaluate before bringing on a marketing consultant.

The No Surprises Act (NSA) continues in 2026, protecting patients from surprise bills for emergency care and certain out-of-network services, with key developments involving extended enforcement discretion for the Qualified Payment Amount (QPA) calculation (possibly to August 2026) and ongoing regulatory focus on GFE’s and IDR’s. However, there are Congressional stalls with legislation to also protect providers. In this episode of the Edge podcast, Terry welcomes back Healthcare attorney Amanda Waesch, to discuss the current NSA policy enforcement and when is it time to contact an attorney?