Key takeaways from this episode

• Keep doing the cystoscopy and the E/M on the same day, and fight the modifier 25 denials rather than splitting the visit. Scheduling a separate E/M day is easier for the billing team, but it is the first step down a path of folding to payers; with a good appeal letter PRS overturns roughly 90 to 95 percent of these in Colorado, usually within one or two appeals, with a few Blue Cross Blue Shield and UnitedHealthcare plans and some East Coast payers taking two or three rounds.
• The E/M billed with modifier 25 must be significant and separately identifiable, and a separate diagnosis is not required but helps. The cysto package already covers the pre-procedure discussion, the procedure, recovery instructions and telling the patient what was found; only the medical decision making about a diagnosed problem and what to do next supports the separate E/M.
• Reviewing a negative CT urogram after a negative cystoscopy does not support a separate E/M. Looking at a piece of data you ordered and reporting the result is included in the visit; without further cognitive work and a treatment plan, the modifier 25 claim will fail on medical necessity.
• Make the E/M visibly separate in the note, either with a lead-in phrase or a separate encounter. Write "A significant, separately identifiable evaluation and management service was performed, see below," or label the section "E/M visit separate from procedure"; an attendee who moved to a separate note reported denials dropped significantly, but the billing team must then send both encounters with every records request.
• Do not appeal an E/M that the note does not support. Sending an unsupported record is as damaging as failing to appeal a supported one, because payers use it to increase denials; the billing team should send the note back to the provider to confirm the separate service before appealing.
• Corrected claims, redeterminations and appeals are different submissions with different addresses and rights. A modifier fix, diagnosis reordering or unit change is a corrected claim; a redetermination adds a short explanation (for example Xiaflex units or waste); a true appeal tells a documented story, and some payers allow only two appeals, so mislabeling a corrected claim as an appeal forfeits those rights and can add 90 to 180 days.
• Send every record for the date of service when a payer requests records. A video urodynamics request answered without the urodynamics note triggered a recoupment of the whole service, which is why some payers now want everything from a date of service on one claim.
• Negotiate disposable cystoscope cost to under $80 and collect the E/M co-pay up front. Two same-day cysto plus E/M visits a day, three and a half days a week for 48 weeks, is about $45,000 a year at stake; set a rule that a BPH cysto plus transrectal ultrasound visit collects the E/M co-pay, and refund the occasional hematuria workup with no E/M rather than chase balances.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 276, recorded live in January 2026 at the Urology Advanced Coding and Reimbursement Seminar in New Orleans, with Scott Painter, Mark Painter and Marianne Desciose of PRS Network, guest Dr. John Lin, and questions from seminar attendees.

The listener question: cystoscopy plus E/M denials

[00:00] Scott Painter: On this episode, live from New Orleans at our Urology Advanced Coding and Reimbursement Seminar, we want to talk about a question that came in to the Thriving Urology Practice Facebook group. Welcome to episode 276 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter, special guest Dr. John Lin, and other special guest Marianne Desciose. We are the presenters at the Urology Advanced Coding and Reimbursement Seminar, and we want to cover a question that came in and also see if we can get some audience participation and any questions from the attendees at the seminar. John, welcome. Do you want to read the question that we got?

[01:00] Dr. John Lin: Yes, this is great. This question came from the Thriving Urology Practice Facebook group, and Joan, thank you so much for posting it. It goes like this: "We just learned that our billing company has been screwing up big time." Full stop. We could end the episode right there and talk about this problem. "Many bundles of cystoscopy with evaluation and management do not get paid. The insurance company pays for the lower portion," which I assume is the E/M portion, "so we end up losing money on the visit given the fact that we use disposable cystoscopes. Do most of you schedule cystoscopies for a separate visit? What if they come in and you do a cystoscopy and then discuss the stone they have on CT urogram or X-ray as well? Do you bill only the cystoscopy? Thank you."

Scott: All right. How do we want to unpack this? Mark, do you want to start breaking it down?

Modifier 25 and why the practice should keep fighting

[02:00] Mark Painter: We can go ahead and start. From a coding perspective, as we all know and as we discussed yesterday, modifier 25 is what's used to unbundle an E/M visit from a cystoscopy. We have to have the definition met of significant, separately identifiable. We don't have to have a separate diagnosis, but we definitely have issues with the payers, and if we can get a different diagnosis, that helps. So that's the theoretical.

Now we also know that modifier 25 is one of the most highly scrutinized codes, and denials are very common. It's almost like a medical records request, as they try to audit things before they pay them. This is an area where I've battled Marianne and the RCM team on for years, because the reality of patient flow is that you should be able to do a cysto and an E/M on the same day. It's better for the patient, it's better time-wise for the physician and for the overall practice. So this is something the insurance companies are overly bashing physicians on, for sure, and we take it with everything else an insurance company does, like our downcodes and everything else. It's just one of those hassles across the board.

If you were to do the easy thing for the RCM team, you would schedule the E/M visit on a different day. But in the end, I'm still a big fan of: this is the way it should be. We should try to battle this with the insurance companies. We should really try to keep our practices flowing the way they should and stop bending to the insurance companies, and push the denials back and forth. But this does require good documentation and a really solid split between what's in the cysto, which we all know includes the package for that day: how are you doing, are you okay to have a cysto, do you understand what a cysto is, we're going to do the cysto, this is what you have to recover from it, and this is what I found in the cysto. The part you're going to bill for separately is the medical decision making about the problem, whatever was diagnosed at the time of the cysto, how you're going to treat that problem and what you're going to do next. That's what really needs to be separate.

Sometimes it helps, if you're doing it all in the same note on your EHR, to add in "A significant, separately identifiable evaluation and management problem was performed. See below," and put that information in there. Make sure it's very, very clear. And then we push the appeals out the door. So I'm going to ask Marianne: how well are we doing as far as fighting those things, do we have more success with one payer or another, and what's the flow we use to appeal that works?

Appealing successfully: what works and with which payers

[06:00] Marianne Desciose: This is what I was talking about yesterday, when you have to have communication as well. Your providers can be documenting this and understand it, or maybe they don't understand this separate identifiable piece, but if your billing team does not understand it, then they may be appealing things or not appealing things and coming to you and suggesting a write-off. I work for Mark, and he won't let me suggest, most times, that the provider bring the patient in for the E/M on a separate day from the cysto because it would be easier. We've had to work around a lot of templates for our billing team, and I have some of my billing team here. We've had to identify, through an appeals letter that you can either send to the payer or put on their portal, depending on their process, what is in that medical record note from the provider that would make this payable.

These aren't easy to fight. They are increasing, and I do agree that they are a burden on your billing team. However, we are being successful in appealing these. They should be paid. So I do see Mark's point, after several conversations, that we should fight this so that they stop doing this to you. We take an appeal letter and we process those over, and I would say that for the most part, with the exception of a couple of Blue Cross Blue Shield and UnitedHealthcare plans, we are very successful. Now, when I say successful, it's usually one or two times that we have to appeal these. However, as we were saying yesterday, once you have a pattern with a payer, they may stop denying these, or when you send your appeal, they get pushed through a little easier.

We've also gone to the extent, where we've had a bulk of them from a provider, of getting on a phone call with the payer for a peer-to-peer, and the provider speaks to that medical director and lets them know, "By the way, I have 50 of these in front of me. What is going on?" And then we start working with them on getting those appealed. But I do agree at this point that you should appeal these. I understand the process in your practice. Colorado is one of the states where we are getting most of them, probably 90 to 95 percent, overturned. We have some East Coast payers that are a little more resilient, and it takes two, sometimes three times. But it's a good appeal letter. It's having your billing staff understand, highlighting through the note what is separate and identifiable, and if they don't understand, asking an administrator or a provider what is going on there. And it's really understanding, and not appealing things that don't meet that, so you can get the communication back to your provider that the documentation doesn't meet it. Appealing is great, and you should when it's documented, but you should not appeal if it's not. Because when you submit that appeal and the record doesn't support it, that's just as detrimental as not appealing when it does support it. They get that record, and guess what they do when they get it: they start increasing those denials.

Mark: So it's about education.

Marianne: It is.

Coding and AR teams, and the difference between a corrected claim, a redetermination and an appeal

[09:00] Mark: At every step, right? Your RCM and AR team need to work with your coding team, depending on how you have those skill sets in your practice. We've gone back and forth with our coding team, and we use them at both ends of the spectrum. At the very beginning of all the computer stuff, maybe five or six years ago, we had our AR team and our coding team in lockstep, because we were ending up on the back end fighting everything. Then we moved our coding team up to the claim submission side to look at things before they went out the door, to make sure everything was clean. And now we have them on both ends, because that's where they're required. We have to look at claims going out the door. And yes, you get patterns and templates, and we can pull people off those things. Quite frankly, we also know which doctors are good and which are not as good based on what happens with it.

You build these within your practice. If you've worked with your practice for a while, you know where your good documenters are and where your bad documenters are, those that use the templates and those that don't. Those that don't use the templates and want to fly off on their own probably need to pay more for the AR support they get, because it takes that much more time to deal with those folks. Now, on the back-end side: if you're going to change payer behavior, you have to win. It's about wearing them down too, so you have to appeal, but you have to appeal and win to actually get things changed. That's the game we're currently in.

And then, Marianne, as we went over yesterday, all the back-end work and the write-offs that we've seen as we've gone in to help practices with their old AR and some of those issues. One of the things we find, and that you tell me, is that a lot of AR teams aren't really clear on the difference between a resubmission and an appeal and a redetermination. Understanding what each of those steps is and what is required is also key. Can you run through those issues?

[12:00] Marianne: Yes. When we're working with AR teams, and even our own AR teams when we have new staff, there are different ways to send requests to the payers. There are requests they are sending to you that need to be answered, when they send you a letter or a correspondence, and you want to make sure you're answering that correspondence and identifying that you're answering it.

There is also a corrected claim. Corrected claims are necessary in your system when you are correcting a modifier or changing the order of a diagnosis code. For example, we get denials because the doctors send out the Z code as the routine diagnosis, as the primary diagnosis, or erectile dysfunction as the primary diagnosis. The payer does not accept those, so we have to change the order. Those are corrected claims. Those should not be appeals. Those should not be redeterminations. When we're bogging up the system at the payers, it's really important to know what you should rebill and how you should rebill it. A corrected claim is just correcting information: anything with the patient, anything on the CPT code line, the units. Those are all corrected claims.

When you're doing a redetermination, you are giving them a little bit of an explanation as to why you want this reprocessed. That is maybe a corrected claim with a reason for why you're correcting it. Maybe it's the Xiaflex units, maybe it's the waste. You want to give them a little explanation so they don't do a duplicate denial. The redetermination is usually done on the portal, or on a form they have on the portal, or sometimes on paper.

And really make sure you understand that appeals should be a story. You need to validate the information you're giving them, because they have denied something that you believe is an error. You have backup documentation or information you're giving them, and you're giving them a story as to why this needs to be done. When we say "appeals" in quotation marks, oftentimes when I'm with practices, the appeals are just "reprocess this claim, you paid this in error." When we identify those as appeals, you have to know that at the payer end, some payers only allow you a certain number of appeals before they will not even hear your story anymore. So when you label an item as an appeal, and you only have two chances to appeal with the payer, and you're only sending in a corrected claim, you are losing those rights. Make sure that when you put an appeal to paper and put a story behind it, it really is an appeal and not something that should be labeled a redetermination, because you will lose rights there. Also, anything you turn to paper at the payer bogs up their system, and as anybody working AR knows, it's probably 90 to possibly 180 days plus before you're getting those claims paid. So really make sure you know which one you're supposed to be sending over. And when you are appealing, you are truly creating a catalog. Keep that for the next UroLift you're appealing, and the next Xiaflex you're appealing, so the next person can use that same narrative and the same information to appeal.

Dr. Lin's experience and the disposable scope math

[15:00] Scott: John, what are you experiencing in your practice?

[16:00] John: Thankfully, we work with payers that don't play these types of games, and if they do, like Marianne said, we push back, correct them, and they stop doing it. You have to appeal correctly. First of all, I have to do my job as a physician to document appropriately, so that when we do fight the fight and take it back to the insurance companies, we will win. And once you start winning, they stop playing these games, or you can ask them to stop playing these games.

Now, as with anything posted in the Thriving Urology Practice Facebook group, one question has multiple questions within it. This question started out by saying, "Our billing company has been screwing up big time." Well, yes and no. It's your job as a practice to make sure they're not screwing up big time, so that you're not being shortchanged whenever you bill an E/M service the same day as a cystoscopy. Cysto slash E/M on the same day is something I do. Right before I flew out here, I did six of these types of procedures in combination, and I'll be paid for both. As I mentioned yesterday, just two a day, three and a half days a week, 48 weeks a year, is about $45,000 every single year if you don't do it appropriately and you're not being paid.

So I will do the cystoscopy and evaluation and management. I'm going to assume with this question that this is probably a gross hematuria workup. The patient comes in, is seen, and the doctor initially orders a CT urogram and a cystoscopy. The patient now returns, and this is the question: the patient returns, you go over the CT results, and you do the cystoscopy on the same day. The underlying assumption is that you're using modifier 25, and the issue is that the billing company is sending the claim out and the insurance company is paying just the cystoscopy and not the E/M, despite you appropriately using modifier 25. So the question is, do you have the patient come back another day and then go over the E/M, just so that you don't eat the E/M?

Because of the cost of disposables, for all of you listening and watching: you should be negotiating the cost of disposable scopes, and in general, as of January 2026, it should be under $80. If you're using disposable scopes and buying in volume, you should probably be much lower. Keep in mind that over the next couple of years, the practice expense portion of the payment for cystoscopy is going to continue to go down. So always keep in mind the cost and also what you're being reimbursed.

Now, yesterday during my modifier 25 presentation, this gentleman here was saying that he does bring the patient back another day for an E/M visit to talk about the incidental stone found on imaging. Can you share with us why you would do that? Remember what you told me yesterday?

[19:00] Attendee: First of all, in part for practical reasons, because I'd have to book out extra time after the cysto. Let's say the cysto is negative; then I've booked out half an hour for nothing, just to tell the patient it looks fine. Second, Florida is difficult as far as this is concerned. Even with modifiers, we've tried it and we get denials, and I'm tired of fighting at one point. I don't have the manpower, or woman power, to fight every time. So this is the easy way out. And most of my patients are from close by, so it's not a tremendous problem for them.

John: So for logistical reasons, some of you may want to bring the patient back another day, if the patients are all relatively local to your practice and it wouldn't be too much of a burden. But myself, as a patient, if my doctor saw something on the CT scan and I just had a cystoscopy, I would want to discuss that at the same visit, so I don't have to come back or have a follow-up visit to discuss the findings. If you decide to separate the two visits, consider using telemedicine to make it easier on me as the patient.

When the E/M does not meet significant and separately identifiable

[20:00] Mark: The other thing I will add is that we do see a lot of E/M bills that don't meet significant and separately identifiable. That's where a lot of the problem comes in for all of us. Take John's example: you have the CT urogram ordered for that visit and the cysto is done. Let's say the cysto is negative, non-conclusive, or doesn't really come up with anything, and you sit down and look at the CT urogram and there's nothing there. Yes, you've looked at a piece of data, but the patient at this point is not getting any further instruction, so that doesn't meet significant and separately identifiable. In that part of the visit, you have not done anything other than look at a piece of data which you ordered before, which included the review, and told them the results of both. It's a piece of data, and a little bit of extra work, but it doesn't meet the 25 modifier.

So that's the other part of this that slows us all down: that E/M code has to be fully supported. It needs to be significant, and that means the medical necessity needs to be supported. There has to be more of a cognitive effort that can be expanded upon and documented in the chart to make it a medically necessary, significant and separately identifiable visit. That's a big piece of this. A lot of the time we don't have that, and that's why there are a lot of fails on modifier 25 and why they're fishing for it.

The other thing you have to realize is that over 50 percent of denials are never appealed. Never appealed. And of those that are appealed, 50 percent fail because we haven't made the arguments or we don't have the documentation. Now, if I'm working for an insurance company, those are good odds. I'm going to deny a lot of stuff, because I'm already going to win 50 percent since nobody's going to do anything about it, and of the other 50 that come back, I'm still going to knock half of them down. You're down to 25 percent. That's a win for the insurance company. They've got to stop winning on this, so we have to build the documentation, build the right appeals, and submit the correct claims. But we also need to know when not to bill.

[23:00] Marianne: And when not to send the medical records. Many practices, because of time, have their medical records handled by a separate person, and maybe a separate department, that hasn't been educated. They're getting the requests and they don't understand what they're sending. A great example is video urodynamics. You get a request for records. Your medical records department sends the date of service, but guess what? They forget to send the medical records for the urodynamics. So now your billing team gets a recoup on the entire urodynamics, because they get the nice letter that says these medical records weren't supported, and now we're in an appeal process. Many times it's because we don't understand what we're supposed to be sending. Your staff has to understand that they have to send everything for that date of service when it's requested, everything that's on the claim form. There's a reason some payers are asking you to put everything from a date of service on one claim: this has been a huge issue. So knowing what is being sent out of your office, who's sending it, and that they understand what they're supposed to send is important too. Because if we're appealing on the back end and we get on a phone call and find out that medical records were sent previously, and that is why it's really being denied, we are now in a fight with the insurance company.

Audience questions: separate notes and highlighting the E/M

[24:00] Scott: All right. Let's open it up for a question or two. Anybody have a question or comment?

Marianne: I think it's too early.

Scott: Too early. All right, here we've got a question.

Attendee: I think you just made my point. It is so much more work to fight the denial than to just work around it like that.

Marianne: I should have you work for Mark. I keep telling you, you have to do it.

Mark: I wouldn't hire you.

Marianne: We have gone back and forth on this, because it is easier not to send it. I've tried to make that point. It's easier to tell our providers, "Split these visits up, because then you'll get paid right away." But then I see what's happening in the industry, and I see that this is increasing tenfold: medical records requests, denials, downcoding. And I agree with Mark that we should keep fighting. He was right.

[25:00] Mark: It's the first step down a path you don't want to go. That's the issue. If you keep folding, they will continue to fold you up. That's just the way it works.

Scott: All right. Another question or comment?

Attendee: Hi. Thank you for doing this. Ali Kasian from Jacksonville. You mentioned doing a separate note when you're doing a cystoscopy and then having the discussion. How much does that improve the probability of not even having an issue with modifier 25? And if there is one, obviously it gives you more strength that there are two separate episodes. How valuable is it to make that part of your routine process, where for the cystoscopy you put a separate note and then a separate note for the discussion component? Or is it worth just templating it, like you mentioned, with a comment that a separate E/M was created for the discussion, see below? What's the value-add for doing a completely separate note?

[26:00] Mark: I'll jump in first, then I'll let Marianne go. Number one, when I said separate note, it doesn't have to be a separate encounter. It needs to be separated within the note so that it's highlighted and clearly not a part of the cysto. So finish your cysto note, tell what you found, all the stuff about recovery, and then add your note. That could be in the same encounter, if you will. On the other side, if you do open a separate encounter, that helps in the appeal process for sure. It still needs to actually justify the separation of the two, but it does create one other thing your team needs to know about, which is what Marianne just said: now both notes have to go, so you have to pull both encounters down.

I'll let Marianne comment on how successful we are with one versus the other. But it is something everybody needs to be aware of, and why you look at the process as the factory assembly line that is revenue cycle management. Everybody needs to know exactly what you're doing, so that whoever's doing the appeal knows, because neither move actually stops the denials until you win a lot. So it may be worth it, if it's a better success rate on the win, but only if your team is totally behind you and you're submitting both notes. Marianne?

[28:00] Marianne: I talk about the assembly line a lot. If you, as the provider, understand your documentation and the definition of 25, using that separate identifiable language, and in turn your billing team understands that you understand it and they are seeing it in your note, whichever way you choose to do it, a separate encounter or listing it out separately from the cysto on the same note, that's the process that wins in your practice. It's the fact that everybody understands the process that needs to happen, so that when we send that medical record in, they've highlighted what they know you understood to be separate and identifiable, and they can be confident in their appeal.

What I see is that the confidence isn't there, and so we're just writing "please pay this E/M." They're not understanding why from the note, and they're sending that appeal in without understanding the process. So if you understand it in your note and your team understands it, that's the win, and that's when we're successful on the back side. My team leads are here; we highlight those in the notes, and we tell the providers, "That's why this needs to be in here." And when it's not in there, we come back and say, "We don't see this in here. Can you verify that you want us to send this in and that this is separate and identifiable?" That communication loop, I can tell you time and time again, has opened doors and windows I never thought would open with some providers, and it has been a great success story in many practices that communicate that way.

Attendee: I'll tell you from a practical standpoint, I took this information back from the last conference I attended, and I made a separate note for the cysto. It has improved the denials significantly. I think that word "separate" for the payers is just that simple: it's a separate note, it looks like a separate discussion, and it's made it a lot easier for my billing team to make that happen. I tried it in the same note for years until I came to the conference last year, and making that simple change made a huge difference. I understand the workflow issue of creating a separate visit when you're not planning on it, so it might back up your office flow. But from an efficiency standpoint, it makes a huge difference.

[30:00] Marianne: Remember, on the payer end as well, some of these people may not understand medical billing at all. They may have just stepped into the role. They're looking at a note and looking for those words, "separate and identifiable." So when we provide it for them, it's just a check mark. I know this for a fact; I have somebody who works at a payer, and it's a checklist. Check, check, check, and when something's not checked, it's denied. So if we just point to those checklists, let it be easy. That makes it a little easier.

Appeals versus reconsiderations, and collecting the co-pay

Scott: Let's go over here. You have a question back there?

[31:00] Attendee: Yes. I think you already led into what I was going to mention, going back to the appeals part and the checklist. One thing we joke about at the office all the time is that the thicker the envelope, the faster it goes to the shred bin at the payer level. Not all payers allow you to upload records, so often you do have to use the mail service to send them. We also have to consider that at the payer level they have challenges with staffing, and they don't have critical thinking skills, so they will often just deny because they're not reading it, or they don't even know what they're looking for. So I agree with you. The other thing I wanted to mention is that appeal and reconsideration are two very different things. At my office, I tend to delay using the term "appeal" or checking off "appeal," because within our contracts, it is a different timely filing period once I start an appeal process. Just thought I'd mention that, and thanks for the lead-in to the checklist.

Marianne: You're welcome. And also know that there are different addresses to send a corrected claim, a redetermination and an appeal to. If you don't send it to the right address, guess what: they could even come recoup it.

Attendee: You mentioned that you can highlight in the note that it's significant and separately identifiable. How do you highlight it? What do you do in your note?

[32:00] Mark: As a clinician, what you want to do is put the phrase in there: "Significant, separately identifiable evaluation and management was performed." You put it in as a lead-in to where your note begins. Or label it "E/M visit separate from procedure." Anything that is a key. Or you open up an entirely separate encounter that has that information in it. Those are two decent ways to do that.

The other thing I'll add: we've talked about the payers not being educated about billing. That is true of many payers, but not all, as far as their personnel understanding the billing game. But I will tell you the urology expertise at the payer level is non-existent. In fact, most of the medical directors have little experience with urology. So as you think about highlighting your note for your team going in, it's also an education in why urology requires that. That clinical separation is something that goes into explaining why it's different across the board.

Marianne: And when he mentions what you can do as a clinician, you then communicate with your billing staff that you are making that note, so that when they are reprocessing it and trying to appeal that denial, they know what to look for, and they come back to you when they don't see it. It creates that back and forth.

Scott: All right. We have time for one more question.

[34:00] Attendee: Cystoscopy is typically a procedure-only visit, which may or may not have a co-pay associated with it, whereas if you tack on an E/M, there is a co-pay. How do folks handle that? You brought the patient in for a cystoscopy, the co-payment was not collected at the front desk, and now you've tacked on an E/M visit. How do you manage collection of the co-pay at that point?

Scott: John?

[35:00] John: Typically, depending on the type of visit, you can separate it by that. Or, for large practices, if you want to standardize it: a BPH patient comes back for cystoscopy and transrectal ultrasound on the same day, so we're changing the question a little bit. BPH patient, cysto, transrectal ultrasound. Almost always you are going to talk to the patient about what we found, what we're going to do about it, which decision we make regarding treatment, the upsides and downsides, risks, complications, and prognosis without treatment for, let's say, Rezum, UroLift or TURP. All of that is separate from the package of cystoscopy, so that is billable event number one, and you are rightly billing for the E/M service. You can just set a standard that whenever you do a cystoscopy and transrectal ultrasound for a BPH patient, you're going to collect the deductible or the co-pay for an E/M visit and a procedure, or procedures in this case. We can just set it as a rule.

Now, for instance, a hematuria workup: CT urogram benign, cystoscopy benign, no E/M service provided in that instance. Say your front desk were to collect that accidentally. Well, unfortunately or fortunately, I am writing a lot of refund checks at the end of the month. Ask any attendee, any billing or coding staff on the revenue cycle management team, whether they would rather collect the money up front and pay a lot of refunds or chase after the money. I've asked this numerous times across the years at this meeting, and no one has ever said, "I would rather chase after the money."

Sponsor and closing

[36:00] Scott: All right, let's wrap this episode up. We do want to thank ModMed for supporting this episode. If you're in the market for an EHR or practice management system, you can go to modmed.com/prsnetwork for specials for our listening audience. Do we want to get some final thoughts, or do we want to wrap this up?

Mark: I think we can wrap this one up. We've had a lot of discussion across the board today, so we'll leave it there.

Scott: Okay. That's all we have for today. Thank you all for listening, both live and on the podcast. Take us out, John.

John: As always, thank you so much for the privilege of your time. Please take care of yourself and each other. Until next time, happy coding.

Mark: Thank you.

John: Thank you for participating.

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