Online Training Course

Linda D'Spain CMPE, CMC, CMIS, CMOM, CMCO, CMCA-E/M

Linda is President of her medical practice management consulting firm, D'Spain Consulting. She travels the country conducting national seminars, workshops and webinars and consulting with physician practices, hospitals and medical societies on healthcare reimbursement, documentation guidelines, procedural and diagnostic coding, financial management, human resources, medical office management and compliance with fraud and abuse, OSHA, and HIPAA. She has also served as an Independent Review Organization (IRO) for the Office of the Inspector General and consulted for the Texas Medical and Dental Boards.

With more than 30 years of experience in medical practice management, Linda has managed cardiology, cardiothoracic, vascular surgery, physical therapy, orthopedics, pediatric orthopedics, gynecology and reproductive endocrinology and large multispecialty group practices. She maintained broad responsibilities in business and clinical operations, financial management, governance and organizational dynamics, human resource management, marketing, customer service, compliance, information system management, mergers and acquisitions and risk management.

Linda has attained all five PMI certifications. She also has a degree in Business Administration and is a Board Certified Medical Practice Executive through the American College of Medical Practice Executives, a member of the San Antonio Medical Group Managers Association (MGMA) and has served as an advisory board member with PMI.

This class is appropriate for health insurance claims processors with limited experience. Physicians, consultants and clinical staff seeking a better understanding of the overall commercial carrier reimbursement process may also benefit.

The content covered in this course assumes a basic understanding of insurance claims processing. No supplementary materials are required for this course.

Highlights:

• Explanation and analysis of federal and commercial carrier guidelines
• Overview of insurance plans and payment models
• How to ensure that chart documentation supports claims submitted
• Checklist of necessary patient information
• Insurance verification and preauthorization
• Working with pre-certification and authorizations for continued treatment
• Proper use of the Advance Beneficiary Notice
• Working with Medicare as a secondary payer
• How to appeal inadequate reimbursements
• Patient education and grievance issues
• Procedure for capturing lost charges
• Billing for pre-existing conditions
• Coordination of benefits for covered/non-covered services
• Working with general liability claims
• Address common claims processing errors
• Medicare's Correct Coding Policy as it pertains to billing
• Tips to avoid duplicate charge rejects
• How to handle refunds for overpayments
• Recovery Audit contractor claim review process
• Know your rights and responsibilities during an audit

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.