Online Training Course

Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M

Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program. 

Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.

Participants will learn how to troubleshoot and handle payment inconsistencies and respond to inappropriate recoupments for in-person and virtual care healthcare claims. Samples of results-oriented appeal letters will be provided.

Content assumes some knowledge of outpatient billing and carrier reimbursement.

When correctly submitted claims are inappropriately reduced, delayed or denied, it is imperative to file a timely appeal with as much supporting documentation as possible. This course provides tools and expert guidance to challenge denials and recoup dollars rightfully due to the provider.

• Understand the reasons claims are delayed/denied

• Efficient methods for combating denials

• Modifiers, bundling, downcoding, and other situations that cause a claim to be rejected

• Appealing bundled or downcoded claims

• Working within claim guidelines to avoid further delays

• Write results-oriented appeal letters

• Effectively respond to inappropriate recoupments

• Handling payment inconsistencies

• State and Federal Guidelines for refunds/recoupments

• Guidance on Prompt-Pay laws

• Troubleshooting repeat denials

• Accessing legal guidance if needed