Online Training Course

Prod ID: 472
Maximize Your Practice's Out-of-Network Revenue

Master out-of-network (OON) billing when you learn techniques to successfully submit and be correctly reimbursed for OON claims. Gain clarification on the rules of out-of-network benefits for beneficiaries. When you know how to identify and work through reimbursement problems, accurate and complete reimbursement for Out-of-Network billing can be achieved.

CEUs

1

Length

67 min

Price

$119.00


The instructor will clarify the definition of Out-of-Network provider and guide you through the claim submission guidelines, reviewing the requirements for proper billing of Out-of-Network claims. The following key concepts are explained:

  • Understand different types of insurance
  • Out-of-network billing options
  • No Surprise Act guidelines
  • Financial Communication
  • Deductibles (in network vs out of network)
  • Out-of-network / self-pay discounts
  • Assignment of benefits vs. Accept assignment
  • Coordination of benefits
  • Prior authorizations
  • Benefit verification
  • Documentation/request for records
  • OON Denials/ rejections
  • The patient experience

Jan Hailey

MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M

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.

Participants will improve their understanding of claim submission guidelines and requirements for proper billing of Out-of-Network(OON) claims.
No prerequisites required.
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable PowerPoint handout for 6 months.

Comments from past participants:

"Great presentation with real life examples. The instructor gave the information in an easy to understand manner."

"Great, informative presentation for medical practices and other healthcare organizations."

"It was VERY informative and presented in a clear and concise manner."

"I knew about the No Surprises Act, but Jan explained it in a way that made it easy to understand."

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