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.
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. Learn how to identify erroneous billing procedures that result in denials and rejections, to troubleshoot denials, and work within claim guidelines.
MS, CMC, CMIS, CHI, CMAA, CBCS, CEHRS
Sharon Turner is an enthusiastic educator who has taught allied healthcare courses at Brookhaven, Collin, and Vista Colleges. She has received awards and recognition for outstanding achievement in teaching, leadership and community involvement. She is effective in developing lesson plans, providing quality instruction, and promoting a positive learning environment for her students.
She also has more than 12 years of experience as a Certified Medical Coder for OB/GYN, Anesthesia, Family Practice Medicine, Dermatology, Vein and Vascular, and Orthopedics Surgery specialties. She helped implement a new EHR system and successfully increased first pass on clean claims paid by 88 percent within 90 days of implementation.
Sharon is a doctorate student at Abilene Christian University majoring in Organizational Leadership in Adult Education. She has a Master of Science and a bachelor’s degree in Workplace Learning Performance in Applied Technologies from UNT. She currently serves on the Digital Faculty Consultant team at McGraw-Hill Education.
This course will explain the provider's rights and responsibilities when appealing claim denials.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
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
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.