Update on Federal Litigation Affecting Out of Network Providers

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

What You Need to Know about the Latest Update on Federal Litigation Affecting Out of Network Providers

The best way to understand the strategies of various health plan insurers is to monitor federal cases because within them there are motions and memoranda which outline the various positions of the health plans relating to topics such as; balance billing, fee forgiveness, recoupments and fraud audits.

OON providers cannot possibly obtain proper reimbursement and keep themselves compliant in the current climate without understanding relevant federal laws and cases interpreting these laws.

This session by expert speaker, Thomas J. Force, Esq., will focus on recent federal litigation by and against health plans by and against Out-of-Network (OON) Providers. You will get strategies and techniques to assist in appealing out-of-network denied and under-reimbursed claims. Learn to defend yourself in fraud audits such as fee forgiveness audits and get a list of patient forms essential to the appeals process.

Session Highlights:

  • Type of disclosures that must be provided by the OON provider to their patients prior to rendering of services.
  • Written policies that must be in effect so as to assist the practice succeed against healthcare audits.
  • The purpose of patient assignment and benefit forms.
  • The impact of anti-assignment provisions in healthcare plan documents.
  • The danger of not collecting call insurance, deductibles or otherwise balance billing out of network patients.

Session Agenda:

  • Network Participation
    • In-network vs. Out-of-Network
    • Patient Cost Sharing
    • Balance Bill
  • Best Practices
    • Transparency and Disclosure
    • Practice Management
  • Case studies
    • Out-of-Network Reimbursement
    • Fee Forgiveness
    • Excessive Fees
    • Assignment on Benefit Cases

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.  

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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 counsel and...   More Info
More Events By The Speaker

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Dear Valued Customers


We regret to announce that ProEdTech LLC and all its affiliate brands will cease operations on April 1, 2019.


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