Online Training Course

Prod ID: 253
Appeals, Refunds and Recoupments

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.




180 min



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 April 22 and 29, 2019

Lisa Maciejewski-West


Lisa has been involved in the medical billing, management and consulting field since 1982. In 2006, she founded Gold Star Medical Business Services, an award winning company that provides remote billing services for physicians in small to medium sized individual and group practices. Prior to starting Gold Star Medical, she worked for one of the largest Practice Management consulting firms in the country.

Lisa has consulted with hundreds of doctors as a practice management coach, and has spoken at hundreds of seminars throughout the United States, both as a teacher and motivational speaker. She is PMI's Director of Business Development for the West Central Texas region, and an adjunct instructor with the Angelo State University Small Business Development Center, and teaches a variety of business classes to new and prospective business owners.

Content assumes some knowledge of outpatient billing and carrier reimbursement.

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