In-Network and Out-of-Network Billing: Successful Claim Appeal Process

Course Description:

Out-of-Network and In-Network healthcare providers are now struggling to recover their hard earned money. This webinar will provide the steps and tool necessary to draft an effective appeal, discussing the defences available and the documentation which should be submitted with the appeal. It will discuss the types of denial of claims from insurance companies and the best way to appeal each of them, including denials for lacking medical necessity, experimental or investigational, low pay, gap exceptions and coding issues. This webinar will provide you meaning of being in-network and out-of-network with payers; review the life of the claim; review what the appeal process means, review claim appeal guidelines and requirements, review what attachments are needed for the appeal, and how to set protocols for successful follow-up of denied claims for in and out of network providers.

Learning Objectives:

To review what is in and out of network billing
To review In and out-of-network requirements
To review federal plan requirements for out-of-network providers
To review the life of the claim
To review what the appeal process means
To review the appeal process for in and out-of-network providers
To understand the timing of when an appeal is appropriate
To understand what attachments are needed for appeal
To discuss ways how to set protocols for successful follow-up of denied claims for in and out-of-network providers

Areas Covered in the Session:

In and out of network billing rules and requirements
The appeal process for in and out-of-network providers.
When and how to Appeal
Documents required for the appeal
Setting protocols for successful follow-up of denied claims for in and out-of-network providers
What is In-Network Billing
What is Out-of-Network Billing
In and Out-of-Network Requirements
Commercial Payer Out-of-Network Policies and Products
Federal Plans Requirements for Out-of-Network
Medicare Advantage & Medicaid MCO
Dos and don’ts about being Out-of-Network
Examples of In-Network Reimbursement
Examples of Out-of-Network Reimbursement
Possible benefits of going Out-of-Network
Examples and general guidelines to state regulations for Out-of-Network and balance billing
No Surprises Act
No Surprises Act: good faith estimate
Life of the claim: Revenue Cycle Management
Denials and how do we deal with them?
Appeal process
Appeal rights for in and out-of-network providers
How to appeal?
Appeal example: Medicare
Appeal example: Medicare 2nd level
Medicare Appeal: Process Summary
Appeal example: AETNA
Appeal example: BCBS (Blue Cross Blue Shield Association) of MD
Appeal example: CIGNA
Appeal example: UHC (United HealthCare)
Appeal attachments
Ways How to be Proactive
How to have better control of your practice?
Live Q&A Session

Suggested Attendees:

Medical Providers, who are involved in the payment process of their practice
Physician
Practice Managers
Billing Managers
C-level Executives
Office Managers
Medical Billers
Medical Coders
Office Staff and Billing Managers
Medical Billing Companies
Providers Office Staff
Hospital Revenue Cycle Staff
Prior Authorization Staff

About the Presenter:

Kate has almost two decades of experience in the healthcare industry. She is an expert coder, and compliance officer, and trains healthcare providers all over the country. Kate utilizes her expertise to uncover ways to improve billing and coding inefficiencies, train staff, and ensure compliance while achieving maximum results and revenues for her clients.

Kate’s successes include small and large practices, ranging from primary care to specialists and surgeons. She is known for helping providers feel confident in their coding and have peace of mind with their compliance practices.

Kate’s acute attention to detail, deep understanding of coding and billing, and proactive approach make her an indispensable asset to all her clients.

Additional Information:

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com

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Testimonials:

"This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course"

Melissa Preston, Health Information Management Staff

"David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN"

Sandie Fowler, Out of Network Billing Staff

"Great presentation. Able to do during the day. Timing was great"

Tina Duffy, Compliance Officer

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