Live Online Classes

Third-Party Billing Agreements from the Physician's Perspective

About this program

The billing contract is very important to both billers and the providers they serve. It’s a map for daily operations and options in event of the unexpected. But anyone tasked with reviewing third-party billing agreements knows they are about as exciting as watching paint dry. The detailed legalese can be tricky, especially if you're new to the process.

Providers and billers are under increased scrutiny by the government. Improper claims are increasingly investigated. Providers cannot view themselves as responsible only for the care provided, with little or no responsibility for ensuring claims are properly coded and billed. The business side of the practice must have your input and response.

"Billers cannot view themselves as the only source of data being input into the system," Richard says. "Medically necessary services, billing and coding all go hand in hand."

You must make every effort to comply with federal, state and local law or face serious penalties for a failure to do so. These agreements must be understood by you and your providers. Healthcare law and compliance attorney Richard Pecore will make this process easier to digest so you can avoid any disputes over terms of service. This fast-paced presentation starts with the basic framework and elements of every contract, then review the finer points of billing agreements and legal limits. He has many examples to draw from and share to help deepen your understanding of these important contracts.

• Oral vs. written contracts and elements of each
• Understanding the language and terms of an agreement
• Obligations of the providers, billing staff, and compliance
• Prepayment review actions, including the elements of a payable claim
• Secondary/optional terms, reminders and warnings
• Agreement limits, according to federal and state laws
• Cautionary areas to consider