Appeals, Refunds & Recoupment Requests
This class will explain your rights and responsibilities when appealing claim denials. Receive tools and expert guidance on how to second-guess denials and recoup dollars rightfully due to the provider. The instructor will address questions head-on and provide new insight and tools to help billing staff successfully handle all of your appeals, refunds, and recoupment requests.
Whether the issue is inadequate payment, denial, or rejection, participants will return to the office well-equipped to handle the toughest denials.
- Know what you should be getting paid and pay attention to your denial reason codes on EOBs.
- Get the latest information on Medicare appeals process and amounts in controversy, including sample appeal letters.
- Discover how persistence and familiarity with federal and state laws will provide the necessary guidance needed when appealing claims.
- Understand the claims rejection methodologies that third-party payers use to deny claims.
- Review State-specific Guidance on "Prompt-Pay Laws" and accessing legal guidance, when needed.
When correctly-submitted claims are inappropriately reduced, delayed or denied, it is imperative to appeal claims in a timely manner with as much supporting documentation as possible.
- Learn about how to adhere to the Medicare 60-day rule for overpayments
- Learn how to take a closer look at modifiers, bundling, down coding, and other situations that can cause a claim to be rejected
- Get familiar with researching individual carrier policies for submitting and appealing claims
- Gain access to results-oriented appeal letters
- Effectively respond to inappropriate recoupments and payment inconsistencies, according to state and federal guidelines
This class is ideal for billing and claims processors, physicians, consultants, and anyone seeking solutions for claim denials. The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
A course manual will be supplied. No supplementary materials are required for this course. Bring questions and receive guidance for handling some of your toughest claim denials.
Continuing Education Units (CEUs)
PMI Certified Professionals will earn 3 PMI Continuing Education Units (CEUs) for attendance at this program. If you are seeking CEU credits for other certifications, contact your organization for preapproval and credit guidelines. A certificate of attendance will be provided for attendance at this program.