An Effective Out-of-Network Workflow and Proven Appeal Techniques to Increase Reimbursement and Avoid Payor Audits and Refund Demands

Thomas J. Force, Esq.

Thomas J. Force, Esq.

As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance...
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60 Mins
Thomas J. Force, Esq.

Navigate Compliance, Enhance Reimbursement, and Overcome Payor Audits with Healthcare Attorney Thomas J. Force, Esq.

Join us for an enlightening webinar by renowned healthcare attorney Thomas J. Force, Esq., as he delves into the intricacies of a successful out-of-network workflow. This program is tailored to equip healthcare providers with the essential components to not only increase reimbursement but also maintain compliance and effectively counter insurer/payor audits and refund demands.

Thomas J. Force, Esq. will guide participants through the crucial elements of an out-of-network workflow, emphasizing strategies to handle eligibility, benefit verification, charge analysis, and navigating the challenges of low payments and denied appeals. The discussion will extend to encompass patient cost-sharing dynamics and effective responses to payor audits and recoupment attempts.

In a comprehensive exploration, the webinar will address fee forgiveness and balance billing, providing clear steps to sidestep payor fee forgiveness audits. Attendees will receive step-by-step instructions on crafting a compliant financial hardship policy, implementing prompt payment protocols, and establishing a professional courtesy policy.

Additionally, Thomas J. Force, Esq. will shed light on ERISA claims guidelines and dissect state prompt payment laws, offering a thorough understanding of legal frameworks governing out-of-network workflows. Don't miss this opportunity to gain actionable insights and fortify your approach to out-of-network challenges in the healthcare landscape.

Webinar Objectives

Explore the challenges faced by out-of-network providers, shedding light on patient forms, disclosures, and the Federal No Surprise Act's impact. Gain insights into handling payor audits, providing a roadmap to navigate and defend against refund attempts.

By the end of this webinar, participants will:

  • Understand the critical distinctions in eligibility and benefit verification for out-of-network providers.
  • Learn effective approaches to appeal low allowed out-of-network claims.
  • Acquire knowledge on obtaining SPDs and Plan Documents for optimal reimbursement.
  • Master the art of crafting compliant financial hardship, professional courtesy, and prompt payment discount policies.

Webinar Agenda

  • Introduction and Overview
  • Distinctions in Eligibility and Benefit Verification
  • Appeals Strategies for Low Allowed Claims
  • Navigating SPDs and Plan Documents
  • Defense Against Refund Demands and Payor Audits
  • Crafting Compliant Policies for Financial Hardship, Professional Courtesy, and Prompt Payment Discounts
  • Q&A Session

Webinar Highlights

  • Why Eligibility and Benefits Matter More for Out-of-Network Providers
  • How Out-of-Network Providers Should Check Eligibility and Benefits
  • How to Fight Back When Insurance Doesn't Pay Enough for Out-of-Network Visits
  • Why Getting SPDs and Plan Documents Is Important
  • Steps to Take When Insurance Doesn't Pay Enough or Denies Your Claim
  • How to Say 'No' to Refund Demands and Deal with Insurance Audits
  • Making Policies that Work: Helping Patients with Finances, Courtesy, and Quick Payments

Who Should Attend

  • Revenue Cycle Staff
  • Billing Companies
  • Healthcare Attorneys
  • Healthcare Providers
  • Healthcare Compliance Staff
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(5.0 from 65 ratings)

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