Successful Insurance Claims Processing
Improve knowledge to secure correct payments from commercial
carriers.
As much as 90 percent of provider revenue flows through
third-party payers. How much of it is hanging in limbo due to denials?
5 Reasons to Attend
- Improve understanding of the claims process and
unlock revenue hang-ups.
- Decrease denials and reduce your risk of an
audit due to improper code selection.
- Proactively identify and correct mistakes before
a claim is filed.
- Learn valuable tips to avoid duplicate or lost
charges.
- Fight denials more effectively.
Make sure that your dollars are flowing in the right
direction.
Spend less time fighting denials and more time ensuring that
your front end details are in order. The window to appeal a denied claim is
getting smaller. This class will explain how to expedite claims and appeals and
get paid.
Class Highlights:
- Explanation and analysis of federal and
commercial carrier guidelines
- Overview of insurance plans and payment models
- How to ensure that chart documentation supports
claims submitted
- Checklist of necessary patient information
- Insurance verification and preauthorization
- Working with pre-certification and
authorizations for continued treatment
- Proper use of the Advance Beneficiary Notice
- Working with Medicare as a secondary payer
- How to appeal inadequate reimbursements
- Patient education and grievance issues
- Procedure for capturing lost charges
- Billing for pre-existing conditions
- Coordination of benefits for covered/non-covered
services
- Working with general liability claims
- Address common claims processing errors
- Medicare’s Correct Coding Policy as it pertains
to billing
- Tips to avoid duplicate charge rejects
- How to handle refunds for overpayments
- Recovery Audit contractor claim review process
- Know your rights and responsibilities during an
audit
Who Should Attend
This class is appropriate for claims processors with limited
experience. Physicians, consultants and clinical staff seeking a better
understanding of the overall commercial carrier reimbursement process are
encouraged to attend.
Prerequisites
The content covered in this course assumes a basic to
intermediate understanding of insurance claims processing.
What to Bring
No supplementary materials are required for this course. A
course manual will be provided.
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Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).