Online Training Course

Prod ID: 421
Navigating Out of Network Billing Challenges

When your billing team knows how to identify and work through reimbursement problems, correct and complete reimbursement for Out of Network (OON) billing can be achieved.

CEUs

1

Length

62 min

Price

$119.00

Reimbursement expert, Maxine Collins, explains the terminology and proper processing of billing Out-of-Network (OON) claims. Confusion over OON claim guidelines has led to high-profile court cases, and more recently, the "No Surprises Act" which introduced clarification on OON reimbursement as compared to UCR.

Participants will learn:

  • OON terminology, and claim submission guidelines/requirements
  • Why these types of claims are subject to scrutiny
  • Grievance procedures for patients for denied OON claims
  • Out-of-Network referrals to physicians
  • "No Surprises Act" guidelines for OON billing
  • Health plan disclosure requirements under Insurance Law and Public Health Law
  • Fair Health and what it accomplishes for physicians and providers
  • Initial utilization of preauthorization approval
  • Alternative options for OON coverage requirements

Maxine Collins

MBA, CPA, CMC, CMIS, CMOM

Maxine has more than thirty years of experience in medical practice management, adult education and general business. She has taught courses at various levels, including teaching business communications and accounting at Midwestern State University in Texas. Maxine has extensive experience teaching administrative and clinical personnel essential medical office skills such as medical terminology, coding, reimbursement, OSHA, and HIPAA compliance. She is adept at personnel management, government rules and regulations, accounting and budgeting. Additionally, her experience with practice marketing and development make her a knowledgeable and much sought-after practice management resource.

Maxine has served as an administrator of a multi-specialty clinic, where she was responsible for all clinic operations including medical records, billing and collections, OSHA, HIPAA and Medicare compliance, and all accounting operations. She also has experience in medical practice consulting, and has successfully launched multiple practices.

Maxine holds a MBA in business from Midwestern State University. She is also a Certified Public Accountant and holds three PMI credentials.

Master out-of-network billing with techniques that will help your practice successfully submit OON claims and appeal underpaid or denied claims.
No prerequisites required.

Confusion over Out-of-Network (OON) claim guidelines has led to high-profile court cases including a 2014 class-action lawsuit that awarded $120 million to plaintiffs that included the American Medical Association. Last year, the "No Surprises Act" introduced clarification on OON reimbursement as compared to UCR.

This 60-minute session presented by reimbursement expert Maxine Collins will explain the terminology and processing of billing OON claims. Clarify the rules of out-of-network benefits vs in-network benefits for beneficiaries. Learn techniques that will help your practice successfully appeal underpaid or denied claims. When your billing team knows how to identify and work through reimbursement problems, correct and complete reimbursement for OON billing can be achieved.

Comments from past participants:

"Excellent content!"

"It helps you understand the out of network process."

"Very informative. It is great learning material."

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