Create an Effective Out-of-Network Work Flow to Maximize Reimbursement

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Key Insights from an ERISA Attorney and a Certified Coder


Frustrated with the decline in out-of-network reimbursement? You’re certainly not alone. Issues such as under-reimbursement, claims denials, and failed appeals letters have several practices frustrated. And conventional wisdom isn’t working to get revenue back on track.

The good news: You can reduce denials, manage appeals, and recover lost revenue. But: You’ll need to do so in a new way, say healthcare law attorney Thomas Force and certified coder Zia Clarkson. Join their presentation to find out how to create an effective workflow to prevent, catch, and resolve your out-of-network revenue challenges. You’ll learn about eligibility and insurance benefit verification investigations, as well as how to determine whether insurance payments are correct and how to write effective appeals. Plus, Force and Clarkson will give you specific strategies to deal with increasing patient cost shares and rising demand on specific appeals, so you can plan for potential bumps in the road.

After attending, you’ll understand your practice’s strengths and weaknesses (e.g., eligibility, disclosure, follow up, charge analysis, or appeals) and know exactly where to start to design a personalized workflow that works for you.

Session Highlights

This program will teach you how to:

  • Combat decreasing out-of-network revenue
  • Design and execute a successful appeal
  • Work within regulations that limit out-of-network revenue and caps on reimbursement
  • Create a workflow to enhance out-of-network revenue
  • Develop compliance tools to keep your practice/facility compliant and safe

Who Should Attend

  • Healthcare Revenue Cycle personnel at medical facilities, hospitals & private practices
  • Healthcare attorneys
  • Medical billing personnel
  • Coding professionals

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About Our Speaker

Thomas J. Force  And Zia Rivera-Clarkson

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...   More Info
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