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Get an in-depth look at the appeals process. Our expert will dive into some of the more difficult appeals including bundling, downcoding, lack of recognition of modifiers 25, 59 and 57. This is a more advanced edition of our April topic, “Appeals, Refunds and Recoupment Requests.” Attendance at the previous webinar is not required.

Learn reasons for denials and how to write an appeal. Recovery Audit Contractors (RACs) and other government and commercial payer audits on the lookout for errors overpayments to take back. Make sure you aren’t letting reimbursement fall by the wayside unnecessarily.

Whether the issue is inadequate payment, denial or rejection, it is imperative to appeal claims in a timely manner with as much supporting documentation as possible. It is just as important to properly write an appeal in order for your claim to be reconsidered and result in your favor. Stay up-to-date on current rights and responsibilities.

Participants will walk away with the knowledge they need to appeal insurance claims efficiently and effectively, resulting in accurate reimbursement and how to enhance the overall reimbursement cycle. We will also discuss the new timelines for refunds required to maintain compliance, and explore how to successfully respond to a variety of recoupment requests.

This Webinar will cover:

• Working to correct billing errors to get paid
• Review of medical necessity including experimental and investigational claims
• Writing results-oriented appeal letters, with new samples included
• Tips to expedite an appeal resolution
• Accessing financial support, if needed
• Looking at your appeal from the Payer’s perspective
• Web site resources for federal and state-specific appeal guidelines
• Review of other considerations for refunds and recoupments
• Examining the reasons why a claim is delayed/denied
• How to handle repeated denials

About the Presenter

Sunjanel is a Senior Consultant with the Physician Practice S.O.S. Group, Inc. She has more than 10 years of experience in the healthcare industry. Her wide range of experience includes Management of the Division of Laboratory Medicine at MD Anderson Cancer Center, followed by administrative and clinical practice in family medicine, cardiology and general surgery. Sunjanel has experience teaching coding, medical record auditing and reimbursement, OSHA, OIG, and HIPAA compliance. She is adept at government rules and regulations, and personnel management. Sunjanel is a sought-after medical management consultant throughout the country. She trained and received licensing in the U.S. Army as a paramedic and nurse.