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This information-packed webinar by expert speaker Thomas J. Force, Esq. will discuss two court cases involving Cigna v. Humble Hospital and Aetna v. Humble Hospital. The facts of the cases and findings and holdings of the Courts will be discussed and explained. Both cases involve an out-of-network hospital and issues with its billing practices. Mr. Force will explain how the findings in these cases can impact providers based upon their disclosures to insurers and patients, their billing practices, and referral programs. Mr. Force will walk the attendees through each case and the appeal of the Cigna case. He will discuss the outcomes of the cases and how they affected the financial status of the hospital.
Based on those findings, Mr. Force will instruct medical providers and their revenue recovery staff on how to maintain compliance and avoid litigation while collecting the proper amount of money from patients and their health plans. This session will explain how you may avoid compliance pitfalls and litigation by health plans. There will be an analysis of litigation pertaining to out-of-network healthcare providers, “fee forgiveness”, “balance billing” patients, and ERISA regulations and requirements.
By attending this informative session, you will learn important court cases, their findings, and strategies that will assist your practice in avoiding health plan audits and litigation based upon fee forgiveness, referral arrangements and failure to balance bill patients. You will learn the do’s and don’ts regarding how to effectively balance bill your patients and the implications of being non-compliant.
Attendees will get a comprehensive overview of what a provider is entitled to under ERISA and needs to be doing to remain compliant, including best practices to get claims paid by having a valid assignment of benefits, and to avoid balance billing audits, overpayment demands, recoupment and litigation by insurers.
Who Should Attend
|Oct 21, 2021||Summary Plan Description for In and OON Providers: How to Read, Analyze & Interpret an SPD||60 Mins||$199.00|
|Jun 24, 2021||An Effective Out-of-Network Workflow to Increase Reimbursement and Stay Compliant||60 Mins||$199.00|
|Jun 01, 2021||How to Draft Appeal Letters & To Resolve Denials Effectively 2021 Updates||120 Mins||$349.00|
|Apr 14, 2021||The Successful Clinical Appeal – A Guide for the reconsideration and Appeal of Medical Necessity Denials||60 Mins||$199.00|
|Mar 23, 2021||The New Federal No Surprise Act – Impact on Out-of-Network Providers||60 Mins||$199.00|
|Jun 16, 2020||How to Defend Against Insurance Company Recoupments, Repayment Demands, and SIU Audits||60 Mins||$199.00|