An Effective Out-of-Network Workflow and Proven Appeal Techniques to Increase Reimbursement and Avoid Payor Audits and Refund Demands

Strategies for Financial Success in Out-of-Network Healthcare Providers

Join us for an enlightening webinar by renowned healthcare attorney Thomas J. Force, Esq., as he delves into the intricacies of a successful out-of-network workflow. This program is tailored to equip healthcare providers with the essential components to not only increase reimbursement but also maintain compliance and effectively counter insurer/payor audits and refund demands.

Thomas J. Force, Esq. will guide participants through the crucial elements of an out-of-network workflow, emphasizing strategies to handle eligibility, benefit verification, charge analysis, and navigating the challenges of low payments and denied appeals. The discussion will extend to encompass patient cost-sharing dynamics and effective responses to payor audits and recoupment attempts.

In a comprehensive exploration, the webinar will address fee forgiveness and balance billing, providing clear steps to sidestep payor fee forgiveness audits. Attendees will receive step-by-step instructions on crafting a compliant financial hardship policy, implementing prompt payment protocols, and establishing a professional courtesy policy.

Additionally, Thomas J. Force, Esq. will shed light on ERISA claims guidelines and dissect state prompt payment laws, offering a thorough understanding of legal frameworks governing out-of-network workflows. Don't miss this opportunity to gain actionable insights and fortify your approach to out-of-network challenges in the healthcare landscape.

Webinar Objectives

Out-of-Network (OON) providers often encounter hurdles in securing optimal payments for their claims, compounded by insurers directing payments to patients. The lack of awareness regarding distinct patient forms and disclosures required for OON patients further complicates matters. Additionally, the implications of the Federal No Surprise Act on OON practices remain unclear.

This webinar aims to address the pain points faced by OON providers, offering clarity on the intricacies of patient forms, disclosures, and the potential impact of the Federal No Surprise Act. Attendees will gain invaluable insights into handling the frequent audits initiated by payors, providing them with the knowledge to navigate and defend against refund attempts effectively.

By the end of this presentation, participants will be equipped with practical answers and a deeper understanding of the complex healthcare landscape, empowering OON providers to overcome challenges and optimize their reimbursement strategies.

Webinar Highlights

• Explain reasons that eligibility and verification of benefits are different and more important for an OON provider as compared to an in-network provider.
• Explain how an OON Provider should handle eligibility and verification of benefits.
• Explain how to successfully appeal low allowed out of network claims.
• Explain the importance of obtain SPD’s and Plan Documents.
• Discuss effective appeal preparation for low allowed claims and denied claims.
• Explain how to effectively object and appeal refund demands and payor audits.
• Instruct on how to craft compliant financial hardship, professional courtesy and prompt payment discount policies.

Who Should Attend

• Revenue Cycle Staff
• Billing Companies
• Healthcare Attorneys
• Healthcare Providers
• Healthcare Compliance Staff