Reduce the risk of claim rejection and/or denial due to lack of specificity or erroneous billing. Learn how to identify erroneous billing procedures that result in denials and rejections. Create a tracking system designed to minimize problems, lost revenue and audit risk. Troubleshoot denials and work within claim guidelines.
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 the provider's rights and responsibilities when appealing claim denials. Whether the issue is inadequate payment, denial or rejection, participants will learn to handle difficult claims management issues.
Review Medicare rejection code examples
Learn strategies for educating providers on the necessary documentation requirements that support medical necessity
Distinguish the differences between a rejection and a denial and implement effective strategies for both
Understand each step of a proper denial tracking system
Eliminate exposure for lost revenue and audits by government and private payers due to inappropriate billing
Understand the top reasons claims are delayed/denied
Learn protocols to eliminate rejections
Identify efficient methods for denial resolution
Improve documentation strategies for accurate diagnosis coding
Review modifiers, bundling, downcoding, and other situations that cause a claim to be rejected
Work within claim guidelines to avoid further delays
Address payment inconsistencies
State and Federal Guidelines for refunds/recoupments
Guidance on Prompt-Pay laws
Troubleshoot repeat denials
CMC, CMIS, CMOM
GeoJan has more than 25 years of health care experience in all phases of management, business operations, state and federal regulations. She has worked in billing and collection operations, human resources, payroll, accounts payable, accounts receivable, employee benefit programs, monthly management reports and reconciliations, daily financial activities, scheduling, OSHA regulations, CLIA regulations, radiology and laboratory operations. She has hands-on experience in all phases of insurance, including worker's compensation and HMO's. GeoJan has participated in expansion projects with the SmartLab system, developed programs for physician office training, and founded a local office manager's association. She has specialized training in insurance, coding and as an Authorized Trainer for OSHA 501 courses. Additionally, she has worked in collections for two large hospital systems. She has recent experience onboarding physicians and setting up and managing medical practices as the Market Operations Manager.
GeoJan's strong work ethic and organizational and problem-solving skills make her an excellent communicator who believes in fostering teamwork. She is PMI’s Director of Business Development in the Deep East Texas region. Her teaching experience includes serving as an instructor for Angelina College's Community Service division.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.