Following the guidance provided and taking the proper precautions will promote increased revenue (both from insurance companies and patients), improved compliance, and an overall stronger practice that insurance companies will be less willing to try to intimidate, low-ball, take advantage, or seek recoupment.  In essence, the benefit of this presentation is that practice owners will have a better understanding of their rights, which, if relied upon, will put insurance companies back on the defensive for their oft-seeming underhanded tactics.

Key Points:

Verifying benefits and out-of-network eligibility is a critical first step.

For verification of benefits/eligibility, as well as for ensuring prompt, fair, and accurate payment, it is important to secure all underlying policy documentation.

Proper follow-up techniques and understanding the insurer’s obligations can prevent revenue loss and appeal timelines from expiring unexpectedly.

Use the procedures available, both internally and externally (i.e., grievance and appeal processes, external medical necessity reviews, etc.).

Data analysis regarding past EOBs and allowed amounts from various databases can go a long way in supporting an appeal or grievance, especially depending on the language contained in the Summary Plan Description.

Knowing your rights under ERISA and State Law can thwart intimidation tactics and prevent the insurer from underpaying, as well as improperly seeking recoupment.

Document everything and object to insurer claims in writing.

Who Should Attend:-

Practice Owners, Doctors, Surgeons, Physicians, Nurse Practitioners, Physician Assistants, Anesthesiologists, Facility Owners, Director of Operations, Chief Operating Officer, Revenue Cycle Manager, Office Manager, Billing Manager