How To Defend A Take-back Or Refund Request From A Commercial Insurer

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Improper Response To Refund Requests Can End In Paying Penalties. Here’s How You Can Protect Yourself!

Almost every healthcare provider has received a letter from a commercial insurer seeking refunds from previously paid claims. Some of these letters originate from Special Investigation Units. Regardless of whether you are in or out of network, it is imperative for the provider to understand how to respond to these demands. An insufficient response could result in a several thousand dollar recoupment as well as professional licensure suspension.

Sign up for this 60-minute session presented by expert speaker, Thomas J. Force and protect yourself from any penalties. You will get the checklist of items to include in response letters and also the references to state and federal statutes and case law.

Highlights of the session:

  • What do you do when faced with a take-back demand or refund request?
  • Types of refund or take-back requests and how to deal with them.
  • Items you should include in the take-back response letter.
  • How Commercial Payers’ Specìal Investigation Units hypothetically target every specialty and send demands for take-back?
  • Extrapolation—How ìnsurance companies come up with strategies to profit from take-backs.
  • How being aware of state-specific ìnsurance laws can protèct you from a take-back?
  • What ERISA demands you should include in the response letter?
  • Why should you ensure that the medical records you send for investigation are scrutinized, preferably by a third-party codìng company?
  • When you should involve an expert or attorney?
  • Understanding the use of regulatory bodies.
  • Litigation strategies that you should know about.
  • And more..

Who should attend?

Primarily health care providers, but also billing and accounting staff, hospital administrative personnel and healthcare attorneys


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About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas Force, a licensed attorney, ERISA litigator and former US Marine, is a national expert of revenue strategies and appeals strategies. He has filed and settled literally thousands of healthcare claims, many through litigation.

Mr. Force
is a frequent speaker of ERISA principles of revenue recovery and out of network claims. He is President and founder of The Patriot Group, a full service revenue recovery and...   More Info
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