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.
This course 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 requests.
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 legal guidance if needed
This course was recorded on October 18 and 25, 2016.
CPC, CMMP, NC
President of Your Business Medic has over 20 years experience in billing and practice management. She has spoken for The Coding Institute, Physicians Practice Magazine, PAHCOM, AAPC, POMAA, BC-Advantage Magazine and has been interviewed in many publications.
She is on the editorial board for BC-Advantage Magazine, the advisory board for Central Florida College, and is Past President of Tampa Bay Chapter of POMAA.
In 2008, our business was nominated for Tampa Bay Business Journals Rookie Business of the Year. Our CEO, Merrilee Severino, was interviewed in 2010 for the recently released book Paper Kills 2.0 Forwarded by Newt Gingrich and Tom Daschle (available at healthtransformation.net).
Merrilee is recognized as one of this nation’s healthcare industry experts and contributes to Billing Coding Advantage Magazine as part of their editorial board.
Content assumes some knowledge of outpatient billing and carrier reimbursement