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. This course will explain the provider's rights and responsibilities when appealing claim denials. Whether the issue is inadequate payment, denial or rejection, participants will learn to handle difficult claims management issues.
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Review Medicare rejection code examples
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Learn strategies for educating providers on the necessary documentation requirements that support medical necessity
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Distinguish the differences between a rejection and a denial and implement effective strategies for both
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Understand each step of a proper denial tracking system
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Eliminate exposure for lost revenue and audits by government and private payers due to inappropriate billing
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Understand the top reasons claims are delayed/denied
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Learn protocols to eliminate rejections
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Identify efficient methods for denial resolution
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Improve documentation strategies for accurate diagnosis coding
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Review modifiers, bundling, downcoding, and other situations that cause a claim to be rejected
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Work within claim guidelines to avoid further delays
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Address payment inconsistencies
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State and Federal Guidelines for refunds/recoupments
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Guidance on Prompt-Pay laws
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Troubleshoot repeat denials
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Lisa Maciejewski-West
CMC, CMIS, CMOM, CMCA-E/M, CPCO
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Lisa has been involved in the medical billing, management and consulting field since 1982. In 2006, she founded Gold Star Medical Business Services, an award winning company that provides remote billing services for physicians in small to medium sized individual and group practices. Prior to starting Gold Star Medical, she worked for one of the largest Practice Management consulting firms in the country.
Lisa has consulted with hundreds of doctors as a practice management coach, and has spoken at hundreds of seminars throughout the United States, both as a teacher and motivational speaker. She is PMI's Director of Business Development for the West Central Texas region, and an adjunct instructor with the Angelo State University Small Business Development Center, and teaches a variety of business classes to new and prospective business owners.
Receive tools and expert guidance on how to recoup dollars rightfully due to the provider. The instructor will provide new insight, expert guidance, and tools to help billing staff successfully manage all your claims rejections and denials. This course is ideal for billing and claims processors, managers, providers, consultants, and anyone seeking solutions and for claim rejections and denials.
No supplementary materials are required for this course. The content covered assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
Protect the practice bottom line with specialized instruction on claims rejection/denial management and prevention. Learn current strategies and best practices. 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 Enroll
- This program will equip you 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 billing.
Highlights
- 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
Prod ID: 128