Medicare Appeals: Compliance Issues, Denied Claims and Recoupment

Event Information
Product Format
Prerecorded Event
Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow
Conference Date
Tue, Oct 17, 2017
90 minutes
Product Description

Learn the Medicare Appeals Process to Secure Your Practice’s Rightful Reimbursement

Spending time and resources to appeal denied claims can be taxing for a physician practice. However, appeals can not only help your practice recoup money, but can also divert auditors from honing in on problematic claims. For an auditor, if a practice is unable to show that it’s made an effort to appeal denied claims, it appears as though physicians and their staff are not aware of potential compliance issues.

It’s a fact that many denials are not valid. Whether they’re due to a simple typo on a claim or a payer’s oversight, you have the right to knock on your carrier or intermediary’s door and argue your case. Fortunately, recouping your denied payment is really quite simple — if you know the details of the appeals process.

In this session, expert speaker Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, will help you learn each step of this effective method for securing your practice or facility’s rightful reimbursements.

Session Highlights

  • A fresh perspective on coding versus reimbursement
  • Review of the elements that affect reimbursement
  • How the appeals process actually works
  • Insights on common payer opportunities for underpayment or denial of services
  • The biggest appeals opportunities to collect the most for your persistence
  • Medicare vs. private payers: Tailor your appeal based on who’s paying you
  • Payers’ and providers’ perspectives on what could possibly go wrong
  • Four pieces of must-have information when communicating with a payer
  • One key contact to hone in on when you file your appeal
  • How you can use payer appeal forms effectively
  • State and federal claim processing laws
  • The next level: Medical necessity demand, clinical attachments, timely filing demand
  • Review provider vs. patient appeals
  • AMA contract: Fee schedule disclosure
  • Options you have when an appeal is not successful
  • Insights on modifiers 59, 25 and 57 … and other hot targets for appeals
  • Appealing a dismissal: Review of dismissal options
  • Tips for filing an appeal
  • Make filing as easy as 1-2-3 with this handy checklist

Session Agenda

  • Why even correct coding does not assure proper reimbursement
  • The easiest denials to miss are when electronic remittance advice (ERA) are auto-posted
  • The micro level for appeals and corrections, including cost for appealing denials
  • How denial codes on Explanation of Benefits determine payers' reason for denial or underpayment
  • Common payer opportunities for underpayment or denial of services
  • Medicare's 5-step formalized appeal process
  • What the state and federal claim processing laws have to say
  • Involving your patient and the state medical society in the appeal process
  • Checklist for filing an appeal required by CMS
  • Over 65% of Medicare appeals are approved in the doctor’s favor
  • Reconsiderations and redeterminations by qualified independent contractors (QIC)

Who Should Attend

  • Billing managers
  • Billers
  • Practice managers and administrators
  • Physicians
  • Other clinical staff
  • Front desk staff
  • Coders
  • Surgical schedulers
  • Anyone involved in the revenue cycle

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

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About Our Speaker

Barbara J. Cobuzzi - Healthcare Compliance Training Expert

Barbara J. Cobuzzi owns CRN Healthcare Solutions which provides value added provider consulting services. She holds a B.S. in industrial engineering from Rensselaer Polytechnic Institute and an MBA from New York University. She holds certifications from the AAPC as a CPC (certified physician coder), COC (certified hospital outpatient coder), CPC-P (certified payer coder) a CPC-I (certified coding instructor) and a CPCO (certified professional compliance officer). She also holds...   More Info
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