More than 90% of your revenue rests in the hands of commercial carriers. Fight denials more effectively and ensure that your staff understands how to correctly file claims on the front end.
Claims Crash Course
Is your staff operating at maximum productivity? Claims rejection deadlines are getting shorter and shorter. In order to win at the claims processing game, your staff needs to understand how to identify and eliminate hang-ups that delay payment. Confront challenges head-on and ensure that your dollars are flowing in the right direction. Spend less time fighting denials and more time ensuring that your front end details are in order.
Did you know that, on average, physicians win denials 70% of the time? Don't let your money hang in limbo.
1. Explanation and analysis of commercial and carrier federal guidelines
2. Implement a proven road map to achieve claims processing success
3. Identify and correct careless mistakes and potential hang-ups before claims are filed
4. Valuable tips to avoid duplicate or lost charges
Participants will gain comprehension in the following areas:
- Understanding the evolving role of insurance plans
- Ensuring chart documentation supports claims submitted
- What the RACs are looking for when they review your claims
- Working with Medicare as a secondary payer
- How to appeal inadequate reimbursements
- Patient education and grievance issues
- Procedure for capturing lost charges
- Insurance verification and preauthorization
- Billing for pre-existing conditions
- Obtaining initial referrals
- Pre-certification and authorizations for continued treatment
- Checklist of necessary patient information
- Coordination of benefits including covered/non-covered services
- Handling general liability claims
- Address common claims processing errors
- Medicare's Correct Coding Policy as it pertains to billing
- Avoiding duplicate charge rejects
- How to handle refunds for overpayments
- Proper use of the Advance Beneficiary Notice
- Improve understanding of audit triggers
- Know your rights and responsibilities during an audit
Who Should Attend
New and experienced claims processors and physicians and staff seeking a better understanding of the overall commercial carrier reimbursement process are welcome to attend.
This content covered in this course assumes a basic to intermediate understanding of third-party claims processing.
What to Bring
No supplementary materials are required for this course. A course manual will be provided which includes new information on prompt pay rules and avenues for ERISA plans.
A certificate of attendance will be provided. PMI-certified professionals (CMC, CMIS, CMOM) receive up to 6 CEUs for attendance. PMI CEU credit is based on total number of instructional hours. Review pre-approval and credit guidelines prior to enrollment if you are seeking CEUs from other organizations.