Balance Billing for OON Practices: Manage Denials with Effective Appeals

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Understand ERISA Rules and Generate More Revenue for Your OON Practice

Frustrated by under-reimbursement, claims denials, and failed appeals letters? Many revenue recovery strategies that worked for out-of-network (OON) providers in the past are no longer effective today. The climate has changed and so must you.

It’s no secret that it is becoming more difficult to recover what is owed in a reasonable amount of time. Across the nation, practices and facilities are struggling to keep up. To thrive in this environment, you need to learn how to do more with less – reduce denials, manage appeals and recover lost revenue. We think it’s about time you learned what the insurers don’t want you know: how to push back and fight for what’s owed.

Join this informative audio session with industry veteran Thomas J. Force, Esq. to improve your revenue cycle workflow. Get a comprehensive overview of what an OON provider needs to be doing, now, to earn proper reimbursement—including best practices to address fraud audits, recoupment by insurers, and balance billing challenges. Plus, Force will equip you to defend against denied and under-reimbursed claims by improving your appeals letters. You will discover field-tested techniques, best practice tools and resources to help your practice effectively appeal claims- and improve your bottom line. Force will walk you through what it takes nowadays to excel at revenue recovery. From denial prevention to stronger appeals, he’s going to share inside techniques and strategies to help your organization recover more revenue in a shorter amount of time.

This audio conference will provide you practical advice on how to prevent, manage and appeal denied claims. You’ll learn the five best tools that you should be using to prevent denials from happening. You’ll learn how to strengthen a case by holding health plans accountable using state and federal law. You’ll also learn how to approach denial management overall and what to include to create a strong appeal letter.

After the strategy & workflow, you will learn how to send expert appeals using three specific examples, including low payment & medical necessity. Get a comprehensive overview of what a provider needs to be doing, now, to earn proper reimbursement, including best practices to address fraud audits, recoupment by insurers, and balance billing challenges.

After attending this session, you’ll be prepared to optimize your collections with effective, proven recovery techniques.

Session Highlights

This session will cover useful topics, such as:

  • Effective strategies for revenue recovery, collections, and appeals
  • How to use ERISA to hold insurers accountable to get claims paid
  • How to leverage small claims count to collect what you are owed
  • How to generate more revenue on the out of network
  • Effective OON work flow
  • Balance billing for OON practices
  • ERISA rules and regulations
  • Best practices to reduce fraud audits
  • Strategies to address recoupments by insurers

Session Agenda

This session will cover:

  • Industry overview
    • Denials by the numbers
    • In-network vs. out-of-network
    • Tools for denial prevention
  • Effective appeals and denial resolution
    • Insurer’s legal obligation: ERISA vs. state laws
    • The appeals process: State plans vs. self-funded plans
    • Denial resolution under ERISA
    • Strategy #1 - Low payment appeals
    • Strategy #2 - Uncovered service
    • Strategy #3 - Medical necessity
  • Overpayment and recoupment defense
    • Types of recoupment, overpayment and recoupment laws
    • Preparing your defense and follow-up
    • Strategy #4 - Recoupment
  • Summary and discussion
    • Identify, manage, monitor and prevent
    • Key takeaways
    • Best practices

Who Should Attend

  • Medical practices – owners and revenue cycle personnel
  • Medical facilities- owners and revenue cycle personnel
  • Healthcare consultants
  • Healthcare attorneys

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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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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