Defend Against Insurance Company Repayment Demand, Claim Denial and Downcoding

Event Materials (Key Required)

Course Description

Too many medical office and hospital personnel fail to fight denials that could easily be won if they knew how to win on the same claim denials. For 25 years, Don Self, a nationally known certified consultant and seminar leader has been teaching physicians, certified billers and coders how to win in these instances.  

Join us for this 90-minutes webinar outlining the main challenges that most medical practitioners face today when dealing with insurance companies, including reduced payments, claim denials, down-coding the level of office visit, hospital visit or other E&M visits, improper procedure code bundling, refund demands and more. This live webinar will also deal with correct coding edits and how some carriers are making up their own rules instead of following the national standards established by the Centers for Medicare & Medicaid Services and Medicare. 

We will go into great detail and show how than less than 6% of medical office personnel have any idea of the power and strength they have, thanks to a federal law that has applied for almost 50 years, which insurance company offices do not really want you knowing about. It is easier to pull the wool over the eyes of the medical community if they are unaware of what power and strengths they have when dealing with insurance companies. Too many believe the state board of insurance commissioners have jurisdiction over the claims they are fighting every tday, when in fact, they truly do not have the same authority once most policies are in force.  

It is estimated that less than 10% of health care attorneys fully understand the ERISA laws regarding health insurance claims, simply because most attorneys know the ERISA from the retirement benefit side and not the actual health insurance claim side. This is why many may suggest giving refunds to carriers, when in fact – the refunds are not due or required.

Although most people dealing with claims do not realize it, this law applies to more than 80% of the non-Medicare and non-Medicaid clinics, hospitals, medical and dental insurance claims and enables the medical providers to win almost 100% of the appeals – when used properly. This webinar will go into detail outlining how to fight back when insurance companies use unfair and unethical practices to keep from paying amounts that they really should.

As another nationally known medical claims seminar leader has stated “If you do not have ERISA tools in your denials toolbox, you are walking around with an empty toolbox and are unable to optimize the compliant income your providers worked for and should be paid for."      

99% of the people that have attended this webinar in the past two years were shocked at how much they learned in such a short amount of time and how many things they had previously believed that were not true. Come join us and be prepared to have your eyese opened to the true strengths of medical claims providers and personnel.

Learning Objectives

• Learn where your strength is when dealing with ALL commercial plans
• Identify who at the carrier to talk to & who not to waste time on
• Address when they Reduce payment when you use modifier 25
• Stop them from requiring documentation be attached to clean claims
• How to report Carriers for denying claims without a full and fair review
• It is a violation of law to require documentation on ALL surgeries
• No More Requiring Pre-Auth when Pre-Auth is NOT required
• Find out who to report to on Medicare Part C denying Pre-Authorizations
• Stop carriers from sending payment via VCC or Credit Card
• No more illegally demanding refunds or recoupments from provider
• Find out why your Timely Filing Periods are not what you think they are
• Discover what your true Appeal Period is and it’s not 60, 90 or 120 days

Areas Covered in the Session

• Commercial Insurance and Medicare Rules Are Not Always Identical
• When does the Federal Law ERISA apply?
• What is the ERISA law and who enforces it?  
• What exactly is a medical insurance policy?
• When does an insurance policy trump a physician-carrier agreement?
• What Timely Filing Period actually applies to a claim?
• When is the appeal period limited by the physician-carrier agreement & when is it not?
• Why do most healthcare attorneys have no clue about ERISA in health provider claims?
• When are pre-authorizations actually required & when are they not required?
• What law makes it illegal for insurance personnel to lie to a medical provider staff?
• Which law can be used to make carriers stop sending credit cards as payment?
• How to stop carriers from recouping & why you probably do not owe them what they say you owe?  
• Identify how long insurance carriers have to approve or deny claims or face penalties
• AWV Vs Preventive Codes
• 2 Criteria to Determine If It is an ERISA Policy
• Was the Policy Provided by An Employer to An Employee
• If Yes, Is the Employer Anyone Other Than the Government Or Church
• How Does ERISA Help with Insurance Claims?
• In-Network Agreement with The Insurance Company
• Provider Agreement and Patient Policy
• Pre-Authorization
• Timely Filing Period
• Denial Appeal Period
• Recoupments & Refunds
• Recoupments Without Any Warning
• Medical Necessity or Bundling or Down-Code
• Home Health Agencies
• How Many PCPs Reduce Payments by Charging Less Than They Should?
• 2 Services Can Be Jobbed Out Per Medicare
• Remote Physiologic Monitoring
• Chronic Care Management

Suggested Attendees

• Medical Providers
• Hospital CFOs and COOs
• Administrators
• Office Managers
• Medical Billers
• Claims Coders
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• Medical Billing Companies
• Providers Office Staff
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys

About the Presenter

Don Self, CPC, CMCS, CASA, is the CEO and founder of Don Self & Associates, a consulting firm specializing in medical reimbursements and helping physician practices improve patient outcomes and increase profits while staying compliant with all regulations. Don is also the President of Telecare-USA. Don has taught more than 900 seminars/ webinars over the past 38 years to tens of thousands of physicians, NPPs, coders and billers on coding, revenue, reimbursement and billing and 49 webinars in 2020 on Telehealth Billing. He has helped thousands make sure they are paid properly by Medicare and other payers.  

Additional Information

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

Purchase Order Form - Click Here to download PO form. 

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