Medical Necessity-Don’t Allow Payers to Deny Claims Incorrectly

Presenter :Stephanie Thomas, CPC, CANPC
Duration :60 minutes



Product Description

AAPC Medical Coding CEU Approved Vendor

This Program has been approved for 1.0 continuing education unit (CEU) from AAPC.

Learn the ins and outs of medical necessity and how payers interpret that. So many times procedures are “authorized” but later deny stating that the procedure was not medically necessary. The importance of dictation and specificity will be discussed at length. Use your EHR to the full capability and set macros to help your team be more efficient, turning time wasted into more revenue for your practice. We will be going over appeals for major payers, how they like the information to come over and what to include.

Knowing how to identify specifics of denial situations and how to avoid them in the future is very crucial element. Learn the top 10 tricks to ensure you are paid appropriately. Gain and acquire knowledge of how to work with payers and 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.

After attending this session, participant will become aware of how to understand insurance contracts, don’t get lost in the wordy contracts and gain experience of how decipher hidden meanings. Discover tips and tricks of getting authorizations even when out of network(OON). Follow up of claims with ease as you will learn how to be extra aggressive with payers to get the results you need. You will also be comfortable with appealing claims and proving medical necessity for claims.

Learning Objectives:

After attending the session, participants will be able to:

  • Become aware of how to understand insurance credentialing and contracting, and gain experience of how decipher hidden meanings and tricks up the payers sleeves
  • Discover tips and tricks of getting contracts even when out of network prior
  • Know top reason for denial
  • Follow up of applications with ease as you will learn how to be extra aggressive with payers to get the results you need
  • Be familiar with online credentialing websites
  • Be comfortable with appealing decisions and proving necessity for in network status.
  • Benefit investigation and authorization
  • To understand billing rules for denied claims
  • How to work with patients so they understand their benefits

Areas Covered in the Session:

  • Verification of benefits
  • Financial Agreements
  • Authorizations and pre determinations
  • Patient Involvement
  • Documentation
  • Denials
  • Billing rules for denied claims
  • Accounts receivable importance (timely etc.)

Suggested Attendees:

  • Billers
  • Coders
  • Administrators
  • Medical Assistants
  • Providers
  • Claims Processors
  • Collectors
  • Payment Posters
  • Anyone involved with professional fee for service billing and coding

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.

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

You can also use the order form for making orders. Click here to download.