Learn How to Reverse Denials and Reprocess Low-Reimbursed Claims

In today's challenging healthcare landscape, both Out-of-Network and In-Network providers are facing increasing difficulties in securing fair reimbursements for their services. Denials and low reimbursements are becoming all too common, impacting the financial health of medical practices and facilities. This webinar is designed to provide you with the strategies and tools needed to effectively appeal denied claims and secure higher reimbursement rates for underpaid out-of-network claims.

Led by Thomas J. Force, J.D. Esq., a leading expert in medical billing and compliance, this session will guide you through the intricacies of the appeal process. You’ll learn how to combat the tactics used by insurers to deny claims and how to draft compelling appeals that get results.

Key Challenges Addressed:

• Claims Denied Due to MRS Issues: Understand why insurers deny claims on the grounds that medical records do not support services billed.
• Medical Necessity Denials: Learn how to appeal claims denied for lacking medical necessity or being labeled as experimental/investigational.
• Inclusive/Bundling Denials: Navigate the complexities of bundled services and how to argue for separate reimbursements.
• Retroactive Denials and Claw-Backs: Strategies for challenging payor actions that attempt to recover previously paid claims.

Webinar Objectives

• Reverse Claim Denials: Master techniques to get denials overturned, ensuring you receive the payment you deserve.
• Reprocess Low-Reimbursed Claims: Learn how to have underpaid out-of-network claims reprocessed at higher reimbursement rates.
• Defend Against Payor Audits: Equip yourself with the knowledge to effectively defend against payor audits and refund demands.
• Drafting Effective Appeals: Gain step-by-step instructions on drafting appeal letters that include all necessary documentation to avoid rejection.

Webinar Agenda

• Introduction:
  • Overview of Denial and Under-Reimbursement Issues
  •  Key Differences in Out-of-Network and In-Network Claim Handling
• Biggest Offenders & Most Common Complaints:
  • Identify the insurance companies that make reimbursements challenging.
  • Common tactics used by insurers to deny claims.
• Understanding Denial Reasons:
  • How to read and interpret denial letters.
  • Identifying and addressing common reasons for claim denials.
• Documenting Successful Appeals:
  • Essential documentation for a successful appeal.
  • Understanding your appeal rights under ERISA and state-specific laws.
• Techniques to Capture Payments:
  • Effective strategies to appeal denials based on medical necessity, coding errors, and low reimbursement.
  • Navigating the complexities of recoupment demands and cross-plan offsetting.
• Legal Frameworks:
  • Utilizing state prompt pay laws and unfair claim settlement practices to bolster your appeals.
• Final Q&A:
  • Address your specific concerns and get expert advice on challenging denials.

Webinar Highlights

This session will cover a wide range of appeal scenarios, including:

• Medical Necessity Denials: Learn to demonstrate that services provided were medically necessary.
• Experimental/Investigational Denials: Overcome denials related to treatments deemed experimental or investigational.
• Bundled/Inclusive Denials: Understand when and how to argue against bundled service denials.
• Low-Reimbursed Out-of-Network Payments: Techniques to increase reimbursement rates for underpaid out-of-network claims.
• Denials Due to Documentation Issues: Ensure your claims are supported by proper documentation to prevent denials.

Who Should Attend

• Revenue Cycle Managers and Staff
• Healthcare Providers and Practice Managers
• Medical Billing and Coding Professionals
• Compliance Officers
• Legal Professionals specializing in Healthcare Law