Revenue Recovery: Stop Unfair Insurance Denials and Recoupment

Event Materials (Key Required)

Course Description

This one hour webinar by Don Self, CEO, CPC, CEMCS, CPCS will surprise even the most experienced manager or biller on the illegal tactics that insurance carriers use almost every day but believed by most to be legal. Expert Don will help you to learn how to effectively fight for and protect the patient’s rights to have their claims paid properly to you, the medical professional. We will not only show you what they are doing that is illegal or unethical, but where to find the laws or regulations and how to stop them from these unfair practices. This affects not only clinics, but also hospitals, therapy centers and all medical professionals. Every single provider dealing with insurance or Medicare plans are being misled daily and this webinar will open your eyes and give you tools you need.

Learning Objectives

• The truth regarding commercial insurance assignment and what it does not mean
• Dispel the myths regarding Out of Network coverages with Medicare Part C Plans
• Misleading statements regarding Timely Filing Limits by all commercial plans
• Why the Timely Appeal Periods are not what they have been taught they are
• The only instance (which is very rare) that a carrier can recoup on claims legally
• How the federal laws protect the patient and the medical provider
• The fact that pre-authorizations are not required nearly as often as providers believe
• A vital fact that gives the providers much more power with carriers than they thought
• The most effective way to deal with anyone at insurance carriers or TPA lying to them
• Illegal tactics used by many carriers to perform recoupments, & how they are illegal
• Proper responses when carriers send the checks to the patient & how to fight it
• Why complying with record requests may be opening clinics up to HIPAA violations
• Carrier time limits on paying and on denying claims - it’s not what you think
• How to make Part C plans cover all that Part B does - it’s the law!

Areas Covered in the Session

• Medicare Part C plans are dangerous for the patient and for the country
• How Much Medicare Disadvantage plans are required to pay on OON claims
• Why It is Improper for Part C plans to hold out the 2% Sequester
• Who the clinic can & cannot send PHI to, in spite of the demands by carriers
• How to respond when carriers send checks to the wrong address
• When the clinic should reach out to the patient to get help from the employer
• The limiting number of records that carriers can legally request
• Appropriate times to file Grievances with CMS to get their help
• Timing on reporting Commercial carriers to the Federal Government
• Winning Strategies
• Live Q&A Session

Suggested Attendees

• Healthcare CEOs
• Healthcare CFOs
• Healthcare COOs
• Clinic CXOs
• RCM Executives
• Hospital Administrators
• Claims Staff
• Appeal Specialists
• Office Managers
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• 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. 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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