How To Audit Your Payor Contracts, Appeal For Denials & Get Your Pre-Auth Requests Approved Quickly?

Stephanie Thomas, CPC, CANPC, COSC

Stephanie Thomas, CPC, CANPC, COSC

Stephanie has worked in the medical, billing and coding industry for nearly 20 years. It is truly her passion. Stephanie works closely with small and large private practices to audit and collaboratively improve their revenue stream. She prides herself in her dedication to her clients and has built a team of incredible billers and coders to...
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Stephanie Thomas, CPC, CANPC, COSC & Thomas J. Force, Esq. & Vicki Myckowiak

How To Get Payers To Approve Authorization Requests Quick!

Pre-authorizations is an important part of a medical practice. If you are seeing patients out of network, even more so! Commonly health care providers and practices are scrambling to find a balance between time for patient care and the increasing administrative burden of prior authorizations and denials. On average, 14.6 hours per week is spent on pre-authorizations and UM (utilization management), totalling more than $68,000 per year, per practice. Let us show you how to simplify this process and save valuable time for your staff and practice.

Some of the major insurance companies have extremely specific guidelines, being educated and confident of this up front will significantly increase your success rate. Provider cannot allow payers to determine how patients are treated, this webinar will allow your practice to take back that power and get authorizations and referrals upon first submission. Our expert speaker Stephanie Thomas will show your team tips on how to identify where to find payer specific guidelines and what to provide in requests to get better results from their hard work!

Make sure your entire care team attends this highly informative webinar, this will protect your bottom line.

Webinar Objectives
  • Provide you with the knowledge of what payers are looking for!
  • Help you to streamline internal processes.
  • Guide you to appeal a denied authorization properly.
  • Train you on how to identify areas of risk.
  • Enable you to know the pros and cons of each type of preauthorization request.
  • Make you feel confident about the documentation you are submitting for various authorization requests.
  • Time Management, how to structure your day.
  • Guide you on how to obtain correct information from patients so you have everything you need to request authorizations.
  • Pros and cons of outsourcing this process.
Webinar Agenda
  • Referrals and pre-authorization - details defined.
  • Creating efficient workflow: Recommended items for workflow creation and approval success
  • Obtaining correct info
  • Insurance verification
  • Organizing payer info
  • Time management 
  • Documentation recommendations 
  • Dealing with external companies and auths
  • Live rep authorizations
  • How to appeal a denied authorization, Denial trends
  • Utilizing online portals
  • To outsource or not
Webinar Highlights
  • Payer guidelines and processes
  • How to appeal a denied authorization
  • How to organize information to best deliver to payer
  • Importance of insurance verification 
  • Efficiency in workflow

How To Draft An Effective Appeal Letter

Learn How To Maximize Revenue And Minimize Claims Errors

Many providers including physician practices regularly suffer from claims denials due to coding issues or lack of medical necessity. Whether you’re an in-network or out-of-network provider, there is something you can do to recoup. 

Register for this pre-recorded webinar presented by our Healthcare Law and Regulatory Expert and learn to draft an appeal letter that will get results. The key, of course, is to understand why your claim was denied in the first place, so you can provide the necessary evidence to demonstrate your right to payment. 

Our speaker, who is an attorney is fully equipped to deliver several real-world methods that do (and don’t) work to recapture payment after an initial denial. He’ll guide you on how to interpret plan terms and provide Explanations of Benefits documents. 

This webinar is designed to help you understand why a claim was denied and then collect and submit the documentation required to make a successful appeal. The speaker will explain how and when to make a second appeal, if necessary—and how to appeal not just no-pay claims but low-pay claims as well.

Webinar Agenda
  • Understand why a claim was denied
  • Know your appeal rights
  • Identify the documentation needed to file a successful appeal
  • Capture payment on claims denied due to lack of medical necessity
  • Capture payment on claims denied due to coding issues
  • Capture payment on claims denied due to gap exception issues
  • Capture payment on low-pay claims (e.g., Medicare low R&C percentage)

How To Respond To Audits By Payors Including Medicare, Medicaid And Commercial Insurance Companies

Government payors and commercial insurance companies rely on pre- and post-payment medical record and billing audits to determine if provider services were medically necessary, accurately billed, and appropriately paid. Over the past few years, Medicare significantly increased the types and numbers of audits and outsourced many the record reviews to private companies. With so many of these private companies conducting audits on behalf of the Medicare program, it is not a matter of if a provider will be audited, it is a matter of when. Moreover, many of the contracts with private auditing entities incentivize denials by tying compensation to the amount of money recovered. Negative audit results can lead to significant penalties, including repayment, financial penalties, de participation, and even prison in the worst cases.

Commercial insurance companies also rely on medical record and billing reviews of participating providers to ensure that the services meet all utilization, medical necessity, and payor policies.

There are steps providers can take to minimize the chances of a negative audit result. Join our expert speaker Vicki Myckowiak for an intensely practical discussion on the best way to handle payor audits from the receipt of the record request through submission of the records and learn about best practices for handling appeals of adverse findings.

Webinar Objectives

Medicare, Medicaid, and commercial insurance companies rely on medical record and billing audits to ensure proper utilization and medical necessity of billed services as well as the accuracy of payment for services provided. This webinar will walk providers through best practices for responding to audits and appealing negative findings, if needed.

Webinar Agenda
  • What are the types of payor audits?
  • What is the best practice for complying with audit demands?
  • What are best practices for appealing denied claims?
Webinar Highlights
  • The types of payor audits
  • How providers are selected for payor audit
  • Best practice for providing requested records to payors
  • The merits and pitfalls of providing more than the requested records
  • Tips for successful appeals of audit denials

Who Should Attend

Medical office staff
Office managers
Pre authorization staff
Billing staff
Billing managers
Front desk staff
Medical assistants
practice administrators
billing companies
This program is designed for in-network and out-of-network providers

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