Nuts and Bolts of Out-of-Network Revenue Recovery

Event Information
Product Format
Prerecorded Event
Conference Date
Thu, Jan 12, 2017
60 minutes
Product Description

Best Practices for OON Providers to Increase Reimbursements and Appeal Claims Effectively

Out of Network Medical (OON) Providers are increasingly facing substantial obstacles to getting proper reimbursements from Health Plan Administrators. To increase your chances of getting paid accurately, it is vitally important that you implement best practices before, during, and after providing services. Once you ensure that you are prepared, you need to be aware of how to appeal claims timely and to the proper authority.

An OON provider cannot possibly obtain proper reimbursement and keep themselves compliant in the current climate without implementing best practices to ensure maximum payments and greater likelihood of success for appeals. Failure to implement the necessary policies and take proper steps will severely limit an Out of Network provider’s ability to contest denied and under-reimbursed claims.

This session by expert speaker Thomas J. Force, Esq. will provide a comprehensive overview of what an OON provider needs to be doing and best practices for proper reimbursements and success for appeals. You will receive strategies and techniques to assist in being prepared to treat out of network patients to maximize reimbursements and to appeal out-of-network denied and under-reimbursed claims. Also, get a complete list of patient forms that are essential and learn about current best practices in detail.

Session Highlights

  • Summary of issues that OON providers face dealing with Health Plans
  • Overview of OON Reimbursement/Charge Analysis
  • List of patient forms and disclosures essential to appeals and fraud audit defense.
  • Eligibility Issues.
  • Techniques to Appeal denied and under reimbursed claims.
  • Techniques to write an effective appeal letter/objection letter to audit.
  • Overview of ERISA protections and obligations of Plan Administrators
  • Overview of Prompt Payment Law and Insurers’ Obligations
  • Clinical Denials, how to handle External Appeals/ Independent Medical Reviews
  • Balance Billing and Recoupment Strategies
  • Current Best Practices in dealing with OON claims

Who Should Attend

Out-of-Network Healthcare Providers, especially Ambulatory Surgery Centers, Surgical Centers and Hospitals, their revenue recovery and billing staffs, consultants and attorneys.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-866-458-2965 Today

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About Our Speaker

Thomas Force - Compliance Coding Expert

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...   More Info
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