Nuts and Bolts of Out-of-Network Revenue Recovery

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Best Practices for OON Providers to Increase Reimbursements and Appeal Claims Effectively

Many out-of-network (OON) providers today wish they had a business degree to go with their medical one. The increasing cost of treatments and procedures coupled with reduced reimbursements from insurance companies—as well as Medicare and Medicaid—are putting a major squeeze on many practices, bringing the question: What can I do to stop this significant reduction of revenue?

To increase your chances of getting paid accurately as an OON provider, it is vital that you implement some best practices before, during, and after providing services. Once you have implemented them, you need to be aware of how to appeal claims timely and to the proper authority. Not being aware of these best practices will severely limit your ability to contest denied and under-reimbursed claims and optimize payments in the current climate.

Join this informative webinar with expert speaker Thomas J. Force, Esq. to get a comprehensive overview of what an OON provider needs to be doing for proper reimbursement and appeal success. Get strategies and techniques that will prepare you to treat OON patients while maximizing reimbursements and properly appealing denied and under-reimbursed claims. Also, get a complete list of patient forms that are essential and learn about current best practices in detail.

Session Highlights

This session will cover:

  • Issues that OON providers face when dealing with health plans
  • An overview of OON reimbursement/charge analysis
  • List of patient forms and disclosures essential to appeals and fraud audit defense
  • A review of eligibility issues
  • Techniques to appeal denied and under-reimbursed claims
  • Techniques to write an effective appeal letter/objection letter to audit
  • ERISA protections and obligations of plan administrators
  • Prompt payment law and insurers’ obligations
  • Clinical denials, how to handle external appeals/independent medical reviews
  • Balance billing and recoupment strategies
  • Current best practices in dealing with OON claims

Who Should Attend

Out-of-Network Healthcare Providers, especially Ambulatory Surgery Centers, Surgical Centers and Hospitals, their revenue recovery and billing staffs, consultants and attorneys.

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About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general counsel and...   More Info
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