Thomas J. Force

Health Plan Recoupment Defense: How to Defend Against Insurance Company Overpayment Demands and SIU Audits

Presenter :Thomas J. Force, ESQ.
Duration :60 minutes



Product Description

There have been a lot of out of network (OON) provider facing recoupment, refund demand and so called special investigations (SIUs) from insurance payers and health plan. If you are an out of network provider, it is imperative that you balance bill your patients for the difference between charge and payment. The webinar will discuss what a Recoupment and Audit is, the reasons that insurance companies state are the reasons for the overpayments and what steps should be taken to defend against the insurance company’s overpayment demands.  The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits.  It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment. 

During webinar, nationally recognized expert, Thomas J. Force, ESQ., will discuss the concept of full and fair review and that recoupment demands are considered “adverse benefit determinations”. He will advise the attendees of what information they are entitled to so that they can respond to and defend the audit findings and recoupment demands. Mr. Force will also discuss various court cases on these issues and most common basis for recoupments, such as services not covered under the plan or non-compliant.

The session will go through what should be done when a provider receives an audit or overpayment demand, how to object, appeal, hire an expert and make document requests. It will also address the state insurance laws regarding time frames to request recoupments. Finally, it will discuss what happens when the insurance company does not comply with the ERISA demands.

Learning Objectives:

After attending this session, participant will learn:

  1. How to respond to an audit and refund demand by never refunding money without demanding a written explanation for the recoupment and verifying its accuracy.
  2. How to object to a recoupment in writing.
  3. About relevant court cases.
  4. How to make written ERISA Demands in objection letters.
  5. What to do if the insurance company does not comply with ERISA demands.
  6. About state insurance laws and their time frames for seeking recoupment.
  7. Importance of obtaining a valid and enforceable AOB

Areas Covered in the Session:

  • How to Defend Against Insurance Company Recoupments, Repayment Demands, and SIU Audits
  • What is a Recoupment?
  • Characteristics of Recoupment Letter
  • Understanding Basic ERISA Obligations
  • Full and Fair Review
  • Recent Court Cases
  • Importance of obtaining Valid and Enforceable AOBs
  • When faced with a Recoupment
  • Unsupported Services
  • Interplay with Insurance Law
  • Is ERISA Demands are Not Met
  • If the Insurance Company Does Not Comply with ERISA Demands
Related Courses:

Suggested Attendees:

  • In and Out of Network Providers
  • Medical Billing Companies
  • Billing and Coding Specialists
  • Providers’ Office Staff
  • Physician
  • Facilities
  • Healthcare attorneys

About the Presenter:

Mr. Thomas J Force, ESQ., is nationally recognized as an expert in revenue collection techniques, managed care contracting and appeal strategies. As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance Officer propelled the founding of The Patriot Group.

Mr. Force is the founder and president of The Patriot Group is a full service revenue recovery company that provides billing, collections, and follow-up services as well as assistance with managed care appeals, managed care contracting, credentialing and compliance.

Mr. Force remains an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, the Suffolk County Bar Association, and other organizations.

A United States Marine, Mr. Force received the prestigious Meritorious Mast Award for Leadership in 1987. Mr. Force is also co-Chairman of the Health and Hospital Committee of the Suffolk County Bar Association. He is co-founder of the Healthcare Reimbursement Attorneys Network, a national association of attorneys that represent physicians and hospital clients. Mr. Force also works closely with the American Medical Association and various state Medical Associations.

After Registration

You will receive an email with login information and handouts (presentation slides) 1 day before the live webcast that you can print and share to all participants at your location.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?
No problem. You can get access to On-Demand webinar. Use it as a training tool at your convenience.

For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162

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