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Home > Audio Learning Center > Out-of-Network Billing

Out-of-Network Billing

Date:Tuesday, August 1, 2017
Time:12 noon to 1:30 p.m. Central Time
Course fee:$199
Presented by: Maxine Inman Collins, MBA, CPA, CMC, CMIS, CMOM

Webinar/Audio Conference FAQs

Recent court cases have placed the spotlight on physician out-of-network-billing and reimbursement. In a recent example, a judge awarded $51.4 million to Aetna for an out-of-network (OON) billing case against a surgical hospital in Austin, Texas.

A 2014 settlement of $120 million to plaintiff's (including the American Medical Association) in a class-action lawsuit in which several organizations and individuals alleged that the insurer skewed data in their market databases with the intention of lowering the “usual, customary, and reasonable” rates used to reimburse providers for OON charges.

Find out how settlements such as this can impact your office. Learn the terminology, features and provisions of OON billing such as:

  • OON benefits vs In-network benefits for Beneficiaries
  • Confusion over the term "Balance billing"
  • The definition of UCR
  • Determining Out-of-Pocket (OOP) for OON patients

In addition, the session will review the legal issues surrounding OON billing, such as:

  • Details on recent Court Cases that caused added attention to OON billing and reimbursement
  • Defining Health Plan Disclosure requirements under Insurance Law and Public Health Law
  • Clarification on OON Reimbursement Compared to UCR
  • An overview of Fair Health – what is it and what does it accomplish for Physicians and Providers?
  • Claim submission requirements for OON billing
  • Initial utilization of Preauthorization approval
  • Grievance procedures for patients for Denied OON claims
  • Alternative options for OON coverage requirements
  • NAIC Network Adequacy Model
  • Out of Network Referrals to Physicians
  • Surprise OON Bills to Patients – a Review of State Regulations

Don't miss this important session to learn successful tips on billing Out-of-Network Claims Successful and to receive information on techniques to appeal underpaid or denied claims.

Continuing Education Units (CEUs)

PMI CEU APPROVED Earn 1.5 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.


Please read below before completing your webinar registration.

Have you heard about PMI's TOTAL ACCESS Webinar subscription program? TOTAL ACCESS puts a full library of training in the hands of your entire staff for a monthly fee of just $249. TOTAL ACCESS is the newest way to develop your own talent, without leaving the office to attend training classes. It's also the fastest way to bring both experienced and new staff up-to-date on current issues.

Sign up now and you'll receive this webinar plus the following benefits for as long as you subscribe: access codes to all upcoming live webinars and unlimited access to the TOTAL ACCESS Library, more than 300 hours of on-demand, pre-recorded training sessions on over 100 topics relevant to medical office coding, billing, compliance, management, front desk, and much more. It's a GREAT VALUE!

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About the Presenter

Maxine has more than 30 years of experience in medical practice management, adult education, and general business. She is the former administrator of a multi-specialty clinic and has taught numerous practice management, accounting and business communications courses at various levels at Midwestern State University in Texas. She has extensive experience as a practice consultant and has taught both administrative and clinical personnel.



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