Webinar Overview:

In today’s challenging healthcare environment, both in-network and out-of-network providers face increasing difficulties in recovering profits due to denied claims and under-reimbursement. This comprehensive session equips healthcare providers, revenue cycle teams, and billing professionals with actionable strategies to reverse denials and secure higher reimbursements for out-of-network claims.

This session will empower attendees with practical tools to combat insurers’ tactics, draft compelling appeals, and defend against recoupment demands.

Key Learning Outcomes:

By the end of this webinar, participants will:

• Understand common denial tactics employed by insurers/payors.
• Learn effective techniques to appeal denied claims and under-reimbursed payments.
• Master the art of drafting robust appeal letters with appropriate documentation.
• Explore legal and regulatory frameworks, including ERISA rights and the No Surprises Act, to support appeals.
• Gain strategies to handle retroactive denials, claw-backs, and recoupment demands.

Webinar Agenda:

Identifying Common Offenders and Complaints:

• Top reasons claims are denied or underpaid.

Decoding Denial Reasons:

• Medical necessity or experimental/investigational denials.
• Inclusive/bundling claims issues.

Building Successful Appeals:

• Documents required for effective appeals.
• Key considerations under ERISA and state-specific laws.

Winning Low-Pay and GAP Exception Appeals:

• Strategies to secure higher out-of-network reimbursements.

Navigating Recoupment Demands and Cross-Plan Offsetting:

• Proactive measures to defend payor audits and refund demands.

State Regulations and Industry Standards:

• Leveraging State Prompt Pay Laws and Unfair Claim Settlement Practices.

Updates on the No Surprises Act:

• Practical insights for compliance and enforcement.

Webinar Highlights:

This session will cover:

• How to reverse medical necessity and experimental/investigational denials.
• Techniques to appeal bundled/inclusive claim denials.
• Steps to reprocess low-reimbursed out-of-network payments.
• Best practices for addressing denials due to insufficient documentation.

Who Should Attend:

• Revenue cycle managers and staff.
• Healthcare facility and practice owners.
• Billing professionals and companies.
• Attorneys specializing in healthcare claims and reimbursements.