Reduce the risk of claim rejections and/or denials due to lack of specificity or erroneous billing. This class explains how to identify and resolve billing problems before your claims go out the door.
This course will explain the provider's rights and responsibilities when appealing claim denials.
MHL, CMC, CMIS, CMOM, CMCO
Jan Hailey has more than 20 years of experience in healthcare with proficiency in administration, coding, and billing roles. She joined Saint Joseph Physician Network located in Mishawaka, IN as the Director of Quality in November 2015. In 2019, her role transitioned into Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. This transition allowed for her expertise to expand beyond the physician network to lead a comprehensive interdisciplinary team across the health system and work closely with providers, management, staff, community and payers to develop strategies on process improvement, gap closures and patient experience.
Jan also developed a documentation improvement program and is currently implementing an education program for Hierarchical Condition Category (HCC) coding in order to improve risk scores. She holds four professional certifications in office management, coding, and compliance. She is a member of WPS Medicare’s Provider Outreach and Advisory Group, Indiana Association for Healthcare Quality.
Jan has a passion for teaching and facilitates educational programs nationwide. Prior to joining Saint Joseph, Jan was the Director of Quality, Coding and Compliance for one of the largest health systems in Northern Indiana.
Attend this class to learn how to identify and resolve billing problems before claims go out the door.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
The instructor will review rejection codes and review modifiers, bundling, and downcoding examples, and explain how to create a tracking system to minimize problems, lost revenue, and audit risk.
Participants will review claim guidelines and examples that cause a claim to be rejected - including issues specific to telehealth claims. Learn how to monitor payer policies, resolve denials, and implement efficient methods for resolution.
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.