Everything the Out-of-Network Provider Needs to Know to Generate More Revenue for its Practice

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Effective Revenue Recovery Techniques for the Out-of-Network Practitioner to Maximize Their Recovery against Health Plans

What has worked for out-of-network providers in the past is no longer effective in recovering revenue for your practice. The climate has changed and so must you.

In this information-packed session, expert speaker Thomas Force will talk about effective revenue recovery techniques that will facilitate the out-of-network practitioner to maximize their recovery against health plans while ensuring that their patients pay their fair share of charges. Procedures necessary to be successful as an out-of-network provider involving the entire revenue cycle, starting with scheduling, will be analyzed and discussed in detail.  

In addition to this, you will receive instructions for revising patient forms, drafting appeals and balance bill letters, and steps necessary in holding the health plan accountable to the law.

Session Highlights:

  • Discussion on out-of-network claims
  • Out-of-network vs. in-network: the advantages and disadvantages
  • The importance of patient disclosures and upfront estimates of charges
  • ERISA: friend or foe?
  • How to use ERISA law to appeal denied and under-reimbursed claims for employer-sponsored plans
  • Are you getting an appropriate response from the health plan?
  • What is a recoupment and what to do when faced with one?
  • How to get a full and fair review in case of a recoupment?
  • Affordable Care Act (ACA) emergency services mandate
  • How to object to and defend health plan recoupments
  • The importance of charity care program/ financial hardship policy
  • Review of dispute resolution for emergency services
  • Review of dispute resolution for non-emergency "surprise bills"
  • Timing of benefit determination
  • Manner and content rules
  • Fee forgiveness (insurance fraud): how to avoid them
  • Interplay with state insurance laws
  • Disclosure rules
  • Dispute resolution for emergency and non-emergency services
  • Insights on Affordable Care Act and the emergency services mandate
  • Mandatory disclosures for OON providers
  • Expanded consumer protections

Who should attend

Out-of-network practitioners, facility and consultants who service such practitioners and facilities

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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