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Successful Insurance Claims Processing

Improve knowledge to secure correct payments from commercial carriers.

As much as 90 percent of provider revenue flows through third-party payers. How much of it is hanging in limbo due to denials?

5 Reasons to Attend

  1. Improve understanding of the claims process and unlock revenue hang-ups.
  2. Decrease denials and reduce your risk of an audit due to improper code selection.
  3. Proactively identify and correct mistakes before a claim is filed.
  4. Learn valuable tips to avoid duplicate or lost charges.
  5. Fight denials more effectively.

Make sure that your dollars are flowing in the right direction.

Spend less time fighting denials and more time ensuring that your front end details are in order. The window to appeal a denied claim is getting smaller. This class will explain how to expedite claims and appeals and get paid.

Class Highlights:

  • Explanation and analysis of federal and commercial carrier guidelines
  • Overview of insurance plans and payment models
  • How to ensure that chart documentation supports claims submitted
  • Checklist of necessary patient information
  • Insurance verification and preauthorization
  • Working with pre-certification and authorizations for continued treatment
  • Proper use of the Advance Beneficiary Notice
  • Working with Medicare as a secondary payer
  • How to appeal inadequate reimbursements
  • Patient education and grievance issues
  • Procedure for capturing lost charges
  • Billing for pre-existing conditions
  • Coordination of benefits for covered/non-covered services
  • Working with general liability claims
  • Address common claims processing errors
  • Medicare’s Correct Coding Policy as it pertains to billing
  • Tips to avoid duplicate charge rejects
  • How to handle refunds for overpayments
  • Recovery Audit contractor claim review process
  • Know your rights and responsibilities during an audit

Who Should Attend

This class is appropriate for claims processors with limited experience. Physicians, consultants and clinical staff seeking a better understanding of the overall commercial carrier reimbursement process are encouraged to attend.

Prerequisites

The content covered in this course assumes a basic to intermediate understanding of insurance claims processing.

What to Bring

No supplementary materials are required for this course. A course manual will be provided.

Program Schedule

There are no live classes available at this time. See below for more options.

    Can’t find training near you?
  • Visit our Online Training Center for more options.
  • Bring an Instructor onsite for group training. Contact info@pmiMD.com or call 800-259-5562, M-F, 8-5 Central
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  • Not able to attend a live session?
    Check out our self-paced version!

    Online Training

    Continuing Education Units (CEUs)

    PMI CEU APPROVED Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

    If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.


    tel: 1-800-259-5562 | fax: (210) 691-8972 | info@pmimd.com

    8242 Vicar Dr., San Antonio, TX 78218

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