Appeals, Refunds & Recoupment Requests
Stand up to denials and win!
Whether the issue is inadequate payment, denial or
rejection, participants will return to the office well-equipped to handle the
5 Reasons to Attend
- Know what you should be getting paid and pay
attention to your EOBs.
- "Noâ€ť doesnâ€™t always mean "Noâ€ť - you donâ€™t have
to stop at the first level of appeal.
- Persistence and familiarity with federal and
state laws will provide ammunition when appealing claims.
- Understand the claims rejection methodologies
that third-party payers use to deny claims.
- Receive sample appeal letters and step-by-step
instruction on the five levels of appeal.
Protect the practiceâ€™s bottom line with specialized appeals
training for your billing staff.
When correctly-submitted claims are inappropriately reduced,
delayed or denied, 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
This class will explain your rights and responsibilities
when appealing claim denials. Receive tools and expert guidance on how to
second-guess denials and recoup dollars rightfully due to the provider. The instructor
will address questions head-on and provide new insight and tools to help
billing staff successfully handle all your appeals, refunds and recoupment
- 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
- Write results-oriented appeal letters
- Effectively respond to inappropriate recoupments
- Handling payment inconsistencies
- State and Federal Guidelines for
- Guidance on Prompt-Pay laws
- Troubleshooting repeat denials
- Accessing legal guidance if needed
Who Should Attend
This class is ideal for billing and claims processors,
physicians, consultants and anyone seeking solutions and for claim denials.
The content covered in this course assumes basic to
intermediate knowledge of outpatient billing and carrier reimbursement.
What to Bring
A course manual will be supplied. No supplementary materials
are required for this course. Bring questions and get guidance for handling
some of your toughest claim denials.