Learn how to challenge denials and recoup dollars rightfully due to the provider. Learn how to troubleshoot, handle payment inconsistencies, and respond to inappropriate recoupments for in-person and virtual care healthcare claims.
This course provides tools and expert guidance to challenge denials and recoup dollars rightfully due to the provider. The instructor will review state and federal guidelines, and explain how to get legal help if needed.
CMC, CMIS, CMOM, CMCA-E/M, CPCO
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.
Participants will learn how to troubleshoot and handle payment inconsistencies and respond to inappropriate recoupments for in-person and virtual care healthcare claims. Samples of results-oriented appeal letters will be provided.
Content assumes some knowledge of outpatient billing and carrier reimbursement.
When correctly submitted claims are inappropriately reduced, delayed or denied, it is imperative to file a timely appeal with as much supporting documentation as possible. This course provides tools and expert guidance to challenge denials and recoup dollars rightfully due to the provider.
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