Appeals, Refunds & Recoupment Requests
Expert guidance for navigating Claim Denials and Appeals
Securing accurate payment for services rendered has become a minefield for providers. It takes skill to navigate through all the third-party payer rules, and, if you do not submit claims correctly, there are Recovery Audit Contractors (RACs) and other government and commercial payer audits on the lookout for errors and overpayments to take back.
View printable PDF
Hear from your peers.
The American Medical Association reports that one in five claims are incorrectly processed by health insurance plans. ¹
That adds up to an enormous bottleneck in claims processing and, if your billing staff does not stay on top of denials, your bottom line will take a hit.
Why is this happening? Carriers make mistakes. Rules change. Your billing staff may be unfamiliar with appeals procedures, or miss the window for appeals.
This course was developed by Practice Management Institute to help demystify the appeals process and aid in the dialogue between medical personnel and health insurance plans when disputes over claims arise.
Your practice may be losing thousands of dollars in reimbursement that is rightfully due.
Even when a practice codes claims correctly, health insurers may still inappropriately deny, delay or significantly reduce payments. Let us address your questions head-on with instruction that will equip your staff with the latest skills and techniques to successfully handle all your appeals, refunds and recoupment requests.
1 Source: The American Medical Association's fourth annual National Health Insurer Report Card, released June 20, 2011.
Learn your current rights and responsibilities when appealing claim denials. 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.
- Understand the reasons claims are delayed/denied
- Efficient methods for combating denials
- Modifiers, bundling, downcoding, and other situations that cause a claim to be rejected
- Appealing bundled or downcoded claims
- Working within claim guidelines to avoid further delays
- Write results-oriented appeal letters
- Effectively respond to inappropriate recoupments
- Handling payment inconsistencies
- State and Federal Guidelines for refunds/recoupments
- Guidance on Prompt-Pay Laws
- Troubleshooting repeat denials
- Accessing financial support if needed
Who Should Attend
Claims processors, billing service professionals, physician coding and billing staff, and anyone in the practice wanting to learn solutions for claim denials.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
What to Bring
Bring questions and get guidance for handling some of your toughest claim denials. No supplementary materials are required for this course.
Tips from Class Participants:
"Appeals: be more persistent and get more familiar with my state laws. I did not know we could request a doctor in the same specialty as our office to review/appeal claim." - C. Mendrin
"Rental Network PPOs, black box edits, downcoding appeals, level of appeals - don't stop at the first level." - C. Vaquilar
"No" doesn't always mean "no" on appeals!" - K. Hamilton
"Best advice: know what you should be getting paid and pay attention to your EOBs!" - S. Cruz