Demystify Pre-Auth Approvals, Denials Management & Maximize Reimbursements

Session 1 - How To Get Payers To Approve Authorization Requests Quick!

Speaker - Stephanie Thomas

Duration - 60 Min

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 payers 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 payer-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 payers 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 payer 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

• Payer guidelines and processes
• How to appeal a denied authorization
• How to organize information to best deliver to payer
• 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

Session 2 - Denials Management

Speaker - Lynn M. Anderanin

Duration - 60 Min

Claim denials are an important part of the revenue cycle and a reason for low reimbursements. The first step of denials management is understanding the transaction codes sets that are used by insurance companies to deny claims and confirm that a denial is valid. Once a denial is found to be incorrect, it has to be appealed to show the denial was incorrect. This process can be set up to be streamlined to save time and resources. Organizing the process allows multiple staff to be involved so that staff strengths are used. This process will also assist in identifying trends when insurance companies have changed their policies or coding and billing staff are unaware that errors are being made.

Too often processing denials is put on the back burner to charge processing and payment posting. This webinar is going to look at the most common denials and give attendees valuable information on how to better manage denials so that reimbursement is not left on the table. Also this webinar will discuss methods of creating a process to ensure that timely filing limits are met and learn how tracking denials can assist in understanding changes in insurance carrier policies.  

Webinar Agenda

We will review the denial and remark codes of the most common denials and where these can be found as well as common claims edits that also code denials. We will walk through setting up a proven denials management process that includes recognizing trends in denials that can assist in seeing policy or coding changes that need to be implemented. When the denial is incorrect it is important to write an effective appeal for reimbursement and real examples will be shared

Webinar Highlights

• Finding and understanding denial and remark codes
• Common denials and how they will need to be reconciled
• NCCI policies that create denials
• Creating a denials management process based staff and technology
• Trending denials using your practice management system
• The appeals process
• Writing an effective appeal
• Knowing what to do when an appeal is not enough

Who Should Attend

• Reimbursement team
• Collectors
• Biller
• Coder
• Revenue cycle manager
• Administrator
• Cash poster

Session 3 -An Effective Out-of-Network Workflow to Increase Reimbursement and Stay Compliant

Speaker - Thomas J. Force, Esq

Duration - 60 Min

Create an Out-of-Network Workflow to Maximize Reimbursements

Join this information-packed webinar with, out of network veteran attorney Thomas J. Force, J.D., Esq. to learn about eligibility, charge analysis and understanding the Summary Plan Description and its terms.  During the webinar Mr. Force will discuss on low-payments and denial resolutions.  The webinar will also address the application of  ERISA, ERISA requirements and what happens when ERISA demands are not met.  The attendees will learn about the appeals process and patient collections. Thomas will also discuss the different strategies for In-Network v. Out-of-Network claims.

The Attendees will learn the effective techniques for Balance Billing.  They will learn about the Federal Prompt Payment requirements.  The Webinar will discuss what a recoupment and audit is, the reasons that insurance companies give as the basis for the overpayment demands and what steps should be taken to defend against the insurance company’s overpayment demands.  The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits.  It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment.  

Mr. Force will go through what should be done when a provider receives an audit or overpayment demand, how to object, appeal, hire an expert and make document requests.  He will also address the state insurance laws regarding time frames to request recoupments.

The Attendees will also be informed of the best practices to reduce the risk of fraud allegations. 

Webinar Highlights

This program will teach you how to: 

• Combat decreasing out-of-network revenue 
• Design and execute a successful appeal
• Work within regulations that limit out-of-network revenue and caps on reimbursement 
• Create a workflow to enhance out-of-network revenue
• Develop compliance tools to keep your practice/facility compliant and safe 

Who Should Attend

Out of network healthcare providers/revenue cycle managers/practice owners and managers who are now struggling to recover profits for their facilities and medical practices; billing company staff and healthcare attorneys. Hospitals, out-of-network ASC’s, practices, surgery centers. And medical associations and societies.