Live Online Classes

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About this program

Confusion over Out-of-Network (OON) claim guidelines has led to high-profile court cases including a 2014 class-action lawsuit that awarded $120 million to plaintiffs that included the American Medical Association. Last year, the “No Surprises Act” introduced clarification on OON reimbursement as compared to UCR.

This live 60-minute session presented by reimbursement expert Maxine Collins will explain the terminology and processing of billing OON claims. Clarify the rules of out-of-network benefits vs in-network benefits for beneficiaries. Learn techniques that will help your practice successfully appeal underpaid or denied claims. When your billing team knows how to identify and work through reimbursement problems, correct and complete reimbursement for OON billing can be achieved.

Participants will learn:

  • OON terminology, and claim submission guidelines/requirements
  • Why these types of claims are subject to scrutiny
  • Grievance procedures for patients for denied OON claims
  • Out-of-Network referrals to physicians
  • "No Surprises" Act guidelines for OON billing
  • Health plan disclosure requirements under Insurance Law and Public Health Law
  • Fair Health and what it accomplishes for physicians and providers
  • Initial utilization of preauthorization approval
  • Alternative options for OON coverage requirements