Cracking the Code: Payor Audits, Denial Appeals, and Quick Pre-Auth Approvals

Session 1

How To Audit Your Payor Contracts & Increase Business Profits?

Managing payor contracts is one of the primary challenges that every healthcare provider faces. From changing reimbursement to network irregularities, clauses and understanding fine print, contracting can be a painful part of practicing medicine. Declining income and increasing workload is at the forefront of most medical practices’ minds. Understanding and auditing your current payor contracts is imperative to a successful profitable business.
 
When reviewing contracts, do you know what to look for? What verbiage to be wary of? Do you know your contract renewal date? All of these are important and significant items that need to be addressed.
 
Renegotiating contracts, although sometimes time consuming, can be worth the effort and can bring new markets to your practice.
 
Join this webinar and let our expert walk you through each part of a payor contract, how to understand and utilize this information to be sure your being paid correctly, auditing for hidden clauses, and renew/analyze data for potential renegotiation.

Webinar Objectives

• Low reimbursement
• Incorrect denials
• Wrong timely filing limits
• Network level/tier payment confusion
• Evergreen contracts
• Incentives
• Capitated payments
• Fee for service payments
• Retro-denial/ retraction of payments

Webinar Highlights

• Understanding payor contracts
• How to analyze real data – visit based
• Properly identify payor matrix
• Auditing Explanation of Benefits
• How to renegotiate successfully

Session 2

How To Draft An Effective Appeal Letters & Increase Reimbursements

Out of network and In-Network healthcare providers are now struggling to recover profits for their facilities and medical practices. In this session, Out of network and In-Network healthcare providers will learn techniques designed to get denials reversed and low-reimbursed out-of-network claims reprocessed at higher reimbursement rates.

In general, insurers/payors use numerous tactics and make various assertions in order to avoid payment. These tactics and assertions, based on your feedback often include:

• Claims denied because MRS do not Support Services Billed.
• Claims denied for Medical Necessity/Experimental/Investigational.
• Inclusive/Bundling.
• Retroactive denials and claw-backs

Join this information packed session with industry expert speaker Thomas J. Force, Esq. to learn about effective techniques to get denials reversed and under-reimbursed out-of-network claims reprocessed at higher reimbursement rates. Attendees will receive instructions from Thomas Force how to draft an effective appeal including documents to enclose to ensure the appeal is processed and not rejected.

Webinar Objectives

Attendees will learn techniques to effectively defend payor audits and refund demands.

Webinar Agenda

• Biggest Offenders & Most Common Complaints
• Understand Why a Claim Was Denied
• ID the Necessary Documents for a Successful Appeal
• Know Your Appeal Rights (Including Under ERISA)
• Capture Payment on Medical Necessity Claim Denials
• Capture Payment on Coding-Based Claim Denials
• Appealing GAP Exception Request Denials 
• Capture Payment on Low-Pay Claim Appeals
• Recoupment Demands
• Cross-Plan Offsetting
• State Prompt Pay Laws
• State Unfair Claim Settlement Practices
• Appeals and Reconsiderations
• No Surprises Act

Webinar Highlights

Types of appeals/denials to be discussed include:

• Medical necessity denials.
• Experimental/Investigational denials.
• Bundled/Inclusive denials.
• Low Reimbursed out-of-network payments.
• Denials for lack of documentation or service not supported by records.

Our expert speaker Thomas Force will share his vast experience in handling denials and drafting appeal letters as an attorney and owner of a medical billing company.

Session 3

How to get payors to approve authorization requests quick!

Pre authorizations is an important part of a medical practice. If you are seeing patients out of network, even more so! Commonly health care providers and practices are scrambling to find balance between time for patient care and the increasing administrative burden of prior authorizations and denials. On average, 14.6 hours per week is spent on pre authorizations and UM (utilization management), totalling more than $68,000 per year, per practice. Let us show you how to simplify this process and save valuable time for your staff and practice.

Some of the major insurance companies have extremely specific guidelines, being educated and confident of this up front will significantly increase your success rate. Provider cannot allow payors to determine how patients are treated, this webinar will allow your practice to take back that power and get authorizations and referrals upon first submission. Our expert speaker Stephanie Thomas will show your team tips on how to identify where to find payor specific guidelines and what to provide in requests to get better results from their hard work!

Make sure your entire care team attends this highly informative webinar, this will protect your bottom line.
 

Webinar Objectives

• Provide you with the knowledge of what payors are looking for!
• Help you to streamline internal processes.
• Guide you to appeal a denied authorization properly.
• Train you on how to identify areas of risk.
• Enable you to know the pros and cons of each type of preauthorization request.
• Make you feel confident about the documentation you are submitting for various authorization requests.
• Time Management, how to structure your day.
• Guide you on how to obtain correct information from patients so you have everything you need to request authorizations.
• Pros and cons of outsourcing this process.
   

Webinar Agenda

• Referrals and pre-authorization - details defined.
• Creating efficient workflow: Recommended items for workflow creation and approval success
• Obtaining correct info
• Insurance verification
• Organizing payor info
• Time management 
• Documentation recommendations 
• Dealing with external companies and auths
• Live rep authorizations
• How to appeal a denied authorization, Denial trends
• Utilizing online portals
• To outsource or not
   

Webinar Highlights

• Payor guidelines and processes
• How to appeal a denied authorization
• How to organize information to best deliver to payor
• Importance of insurance verification 
• Efficiency in workflow
   

Who Should Attend

• Medical office staff
• Administrators
• Office managers
• Pre authorization staff
• Billing staff
• Billing managers
• Front desk staff
• Medical assistants
• CNA’s
• Revenue cycle managers and staff
• Healthcare facility
• practice owners
• billing companies
• Any medical practice