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. Whether the issue is inadequate
payment, denial, or rejection, your billing and auditing staff need the knowledge and tools to properly handle difficult
claims management issues.
Protect the practice bottom line with specialized
instruction on claims rejection/denial management and prevention. Participants in this course will review claim guidelines and examples that cause a claim to be rejected - including issues specific to telehealth claims. Learn how to monitor payer policies, resolve denials, and implement efficient methods for resolution. Topics include knowing the practice's rights and responsibilities when appealing claims, and educating providers on the necessary
documentation requirements that support medical necessity. 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.
5 Reasons to Attend
- Participants will return to the office equipped to handle inadequate payments, denials, rejections, and other claims management issues.
- Reduce the risk of claim rejection and/or denial due to lack of specificity or erroneous billing.
- Learn strategies for educating providers on the necessary documentation requirements that support medical necessity.
- Distinguish the differences between a rejection and a denial and implement effective strategies for both.
- Eliminate exposure for lost
revenue and audits by government and private payers due to inappropriate
Participants will receive tools and expert guidance on how to recoup dollars rightfully due to the provider. The instructor will address questions and provide new insight, expert guidance, and tools to help billing staff successfully manage all your claims rejections and denials.
- Review Medicare non-covered service requirements
- Understand the top reasons claims are delayed/denied
- Learn each step of a proper denial tracking system
- Learn protocols to eliminate rejections
- Identify efficient methods for denial resolution
- Discuss how to make determinations of medical necessity that must adhere to the standard of care
- Modifiers, bundling,
downcoding, and other situations that cause a claim to be rejected
- Working within claim guidelines to avoid further delays
- Handling payment inconsistencies
- State and Federal Guidelines for refunds/recoupments
- Guidance on Prompt-Pay laws
- Accessing legal guidance if needed
Who Should Attend
This class is ideal for billing and claims processors, managers, providers, consultants, and anyone seeking solutions and for claim rejections and denials.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
What to Bring
A course manual will be supplied. No supplementary materials are required for this course.
Practice Management Institute
Practice Management Institute® (PMI) teaches physicians and their staffs how to properly
care issues and secure every dollar rightfully due. Our courses focus on solutions for coding, reimbursement, compliance and practice productivity. These training programs have been hosted in leading hospitals,
societies and colleges across the U.S. since 1983.