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Home > Audio Learning Center > Carrier Contract Termination - Prevention and Appeal Strategies

Carrier Contract Termination - Prevention and Appeal Strategies

Date:December 10, 2019
Time:12 noon to 1:00 p.m. Central Time
Course fee:SPECIAL $99 1 HR WEBINAR
Presented by:Jeffrey Restuccio, CPC, COC, MBA

Webinar/Audio Conference FAQs

Your patient mix is good and the providers are pleased with the patient and reimbursement mix. Then, out of the blue, you receive a termination letter that could impact 25-50% of your business. Did you know that healthcare carriers may be able to terminate your provider's contract without cause? More carrier contracts than you would suspect include a “termination without cause” clause. Two of the most common are Medicare Advantage and Medicaid contracts.

Be prepared before you receive a termination letter. Join Jeff Restuccio for this "Lunch and Learn" webinar session and find out what to do to prevent a carrier contract termination. The key issue is to determine if any of your services are out of the ordinary from your peers. Carriers take the position that they are not required to contract with physicians, and are free to terminate provider status without stating a reason. If your services are much higher than your peers, it is imperative that you are able to explain why and are prepared for an audit/cancellation notice.

Non-renewal often follows the same pattern. Physicians are singled out because they are the highest earners. Termination for cause, in which the carrier gives a reason, may involve some alleged misstatement in the credentialing process, or some error in billing and coding; these are the easiest to appeal because you actually know the reason for the termination.

Don't delay! Learn how to prepare beforehand in the event of a carrier contract termination.

In this webinar you will learn:

  • Include contracts as part of your coding and billing compliance plan
  • Review your healthcare carrier contracts
  • Can a carrier terminate your contract due to excessive appeals?
  • Utilization review
  • The Rule-Out strategy
  • Coding, billing, and documentation strategies
  • The disadvantage patient strategy
  • Legal strategies (historical)
  • Insights from review of available literature
  • Know when to hire a lawyer

Continuing Education Units (CEUs)

PMI CEU APPROVED Earn 1 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.

Please read below before completing your webinar registration.

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Sign up now and you'll receive this webinar plus the following benefits for as long as you subscribe: access codes to all upcoming live webinars and unlimited access to the TOTAL ACCESS Library, more than 300 hours of on-demand, pre-recorded training sessions on over 100 topics relevant to medical office coding, billing, compliance, management, front desk, and much more. It's a GREAT VALUE!

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About the Presenter

Jeffrey has 25 years of experience as an educator, auditor, coding, and billing consultant. He has audited more than 10,000 medical records, both online and onsite. He has conducted more than 365 educational seminars on CPT, ICD-10 coding and billing, and trained thousands of doctors and medical professionals. He also has a strong background in databases and Information Systems, and an MBA in Finance.

Jeffrey has worked with hundreds of clinics, hospitals and government agencies worldwide. His website, focuses on coding and billing training.

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