An Effective Out-of-Network Workflow to Increase Reimbursement and Stay Compliant

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.

Create an Out-of-Network Workflow to Maximize Reimbursements

Join this information-packed webinar with, out of network veteran attorney Thomas J. Force, J.D., Esq. to learn about eligibility, charge analysis, and understanding the Summary Plan Description and its terms.  During the webinar, Mr. Force will discuss low-payments and denial resolutions.  The webinar will also address the application of  ERISA, ERISA requirements, and what happens when ERISA demands are not met.  The attendees will learn about the appeals process and patient collections. Thomas will also discuss the different strategies for In-Network v. Out-of-Network claims.

The Attendees will learn the effective techniques for Balance Billing.  They will learn about the Federal Prompt Payment requirements.  The Webinar will discuss what recoupment and audit are, the reasons that insurance companies give as the basis for the overpayment demands, and what steps should be taken to defend against the insurance company’s overpayment demands.  The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits.  It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment.  

Mr. Force will go through what should be done when a provider receives an audit or overpayment demand, how to object, appeal, hire an expert and make document requests.  He will also address the state insurance laws regarding time frames to request recoupments.

The Attendees will also be informed of the best practices to reduce the risk of fraud allegations. 

Webinar Highlights

This program will teach you how to: 

  • Combat decreasing out-of-network revenue 
  • Design and execute a successful appeal
  • Work within regulations that limit out-of-network revenue and caps on reimbursement 
  • Create a workflow to enhance out-of-network revenue
  • Develop compliance tools to keep your practice/facility compliant and safe

Who Should Attend

  • Out of network healthcare providers
  • Revenue cycle managers
  • Practice owners and managers who are now struggling to recover profits for their facilities and medical practices
  • Billing company staff and healthcare attorneys  
  • Hospitals
  • Out-of-network ASC’s
  • Practices
  • Surgery centers
  • And medical associations and societies
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