Drafting Effective Appeals and Defense of Recoupments

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.

Appeals for Denial of Medical Claims and under-reimbursement of Out-of-Network Claims

Out of network and In-Network healthcare providers are now struggling to recover profits for their facilities and medical practices. In this session, Out of network and In-Network healthcare providers will learn techniques designed to get denials reversed and low-reimbursed out-of-network claims reprocessed at higher reimbursement rates.

In general, insurers/payors use numerous tactics and make various assertions in order to avoid payment. These tactics and assertions, based on your feedback often include:
  • Claims denied because MRS do not Support Services Billed.
  • Claims denied for Medical Necessity/Experimental/Investigational.
  • Inclusive/Bundling.
  • Retroactive denials and claw-backs
Join this information packed session with industry expert speaker Thomas J. Force, Esq. to learn about effective techniques to get denials reversed and under-reimbursed out-of-network claims reprocessed at higher reimbursement rates. Attendees will receive instructions from Thomas Force how to draft an effective appeal including documents to enclose to ensure the appeal is processed and not rejected.

Webinar Objectives

Attendees will learn techniques to effectively defend payor audits and refund demands.

Webinar Agenda

  • Biggest Offenders & Most Common Complaints
  • Understand Why a Claim Was Denied
  • ID the Necessary Documents for a Successful Appeal
  • Know Your Appeal Rights (Including Under ERISA)
  • Capture Payment on Medical Necessity Claim Denials
  • Capture Payment on Coding-Based Claim Denials
  • Appealing GAP Exception Request Denials 
  • Capture Payment on Low-Pay Claim Appeals
  • Recoupment Demands
  • Cross-Plan Offsetting
  • State Prompt Pay Laws
  • State Unfair Claim Settlement Practices
  • Appeals and Reconsiderations
  • No Surprises Act

Webinar Highlights

Types of appeals/denials to be discussed include:

  • Medical necessity denials.
  • Experimental/Investigational denials.
  • Bundled/Inclusive denials.
  • Low Reimbursed out-of-network payments.
  • Denials for lack of documentation or service not supported by records.

Our expert speaker Thomas Force will share his vast experience in handling denials and drafting appeal letters as an attorney and owner of a medical billing company.

Who Should Attend

Revenue cycle managers and staff, Healthcare facility and practice owners and managers, attorneys and billing companies.

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Webinar recording (in mp4) with presentation handouts


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