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, CMCO, CMIS, CMOM
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
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.