How to Negotiate on Out of Network Claims

Format :On-Demand Webinar
Presenter :Stephanie Thomas, CPC, CANPC
Time: All Day Long
Duration :60 minutes


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Product Description

Getting paid on Out of Network claims (OON) is one of the greater difficulties every healthcare service provider face. And if the regular roadblocks were already not enough, the payers are now continually pushing to constrain OON reimbursement rates. You need to improve the bottom line, which can only be achieved by maximizing reimbursements and minimizing denials.

Expert Stephanie Thomas, CPC, CANPC will take you dive into how payers typically handle OON claims and how to avoid costly denials on OON claims; the verbiage to use for successful OON conversations; the best negotiation practices with a payer for higher reimbursement for OON bills; working with a payer without a contract, and more. Gain and acquire knowledge of how to work with out of network patients and how to help them understand their insurance benefits. Medical necessity denials will be a thing of the past, we will go through some specific examples of notes and how to spell out medical necessity to ensure you are paid the first time.

Session Objectives:

Participant will be able to learn:

  1. How to identify specific pros and cons of an out of network situations
  2. How to work with patients so they understand their benefits
  3. Review of contract verbiage and guidelines and what they really mean
  4. How to get patients to pay their portion with ease.
  5.  Follow up of claims with ease as you will learn how to be extra aggressive with payers to get the results you need.
  6. Be comfortable with appealing claims and proving medical necessity for claims.
  7. Top 10 tricks to ensure you are paid appropriately out of network

Session Agenda:

  • Verification of out of network benefits
  • Denials for OON
  • Appeals for OON
  • Benefit investigation and authorization
  • Billing rules for OON
  • Contracts for OON
  • Payers to avoid
  • Financial Agreements
  • Authorizations
  • Patient Cost Sharing
  • Contract Negotiations
  • In network vs Out of Network

Suggested Attendees:

  • Office Managers
  • Administrators
  • ASC Owners
  • Credentialing Manager or Specialists
  • Billing Manager
  • Coder
  • Physician
  • Mid-Level Providers
  • Non Physician Practitioner such Physician Assistants, Nurse Practitioners
  • Healthcare Staff
Related Courses:

About the Presenter:

Stephanie Thomas, CPC, CANPC has a widespread background in medical billing, internal audit and health care administration. She is a Certified Professional Coder as well as a Certified Anesthesia and Pain Coder. Stephanie’s combination of clinical experience, coding education and revenue cycle management offer insights that speak well to both the clinician and the revenue cycle expert.  Stephanie’s experience includes working in large and small private practices, ambulatory surgery centers as well as with hospital-based physicians. She is responsible for proposing, budgeting, staffing, leading and conducting various compliance and internal reviews. Stephanie is currently a member of the American Academy of Professional Coder’s (AAPC) and Society for Pain Practice Management (SPPM). She speaks nationally on billing and compliance topics regularly and has nearly 20 years of experience in this field.

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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

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