It’s easy for out-of-network (OON) healthcare providers to make critical mistakes that jeopardize their compliance with state and federal laws. For instance, many providers will tell patients that they accept any payment from their health plans as payment in full. But this practice is risky and may invite accusations of fraud from the health plans.

Recent lawsuits have put the spotlight on billing related errors such as overpayments, negligent misrepresentation, OON write-offs and balance billing, and ended in very real legal nightmares for practices. In addition, HHS is actively watching and waiting to catch billing errors and non-compliant practices. The bottom line is that failure to balance bill patients can lead to large recoupments, audits and litigation for fraud.

In this session, expert speaker Thomas Force, Esq. will instruct OON providers and their revenue recovery staff on how to maintain compliance and avoid litigation while collecting the proper amount of money from patients’ health plans. You’ll also learn about state laws relating to balance billing requirements for OON providers, as well as recent cases in which health plans sued OON providers who failed to balance bill their patients. He will also discuss the penalties for noncompliance and provide a patient-friendly sample balance bill letter and sample charity care policy.

  1. Current best practices in dealing with OON claims
  2. Providers face dealing with Health Plans 
  3. Overview of OON Reimbursements & Charge Analysis 
  4. Techniques to appeal denied and under reimbursed claims 
  5. Clinical denials, how to handle External Appeals and Independent Medical Reviews
  6. Techniques to write an effective Appeal letter/Objection letter to audit
  7. Overview of ERISA protections and obligations of Plan Administrators
  8. Overview of Prompt Payment Law and insurers’ obligations
  9. List of patient forms and disclosures essential to appeals and fraud audit defense
  10. Review of Eligibility Issues
  11. Balance Billing and Recoupment Strategies

Learning Objectives:

  1. Know the current legal and regulatory environment associated with balance billing
  2. Learn how to maintain compliance and avoid litigation while collecting the proper amount of money from patients and their health plans
  3. Know how you may avoid compliance pitfalls and litigation by health plans in 2018 and beyond
  4. Analyse litigation pertaining to out of network healthcare providers, “fee forgiveness”, “balance billing” patients, and health plan audit strategies
  5. Be prepared to optimize your collections with effective balance billing techniques
  6. Understand ERISA rules and guidelines, as well as state mandates, on how to handle balance billing
  7. To strengthen your balance bill letters and protect you practice without losing patient volume.

Areas Covered in the Session:

  1. Overview to Balance Billing
    • Balance Bill Defined
    • Health Plan Language in the Summary Plan Document
    • When is Balance Billing Required?
  2. OON audits by Health Plans – Fee Forgiveness
    • Exceptions to Balance Billing requirements
    • The Passage of Surprise Bill Laws to Deal with Balance Billing Issues
  3. Relevant Case
    • OON Provider Committed Fraud by Not Balance Billing Patients
  4. Best Practices & Discussion
    • Financial Hardship Waiver
    • Transparency & Disclosure
    • Practice Management

Who Should Attend:

  1. In-Network and Out-of-Network Practitioners and Facilities
  2. Office staff and Billing Managers
  3. Physician
  4. Healthcare Attorneys
  5. Medical Billing Companies
  6. Billing and Coding Specialists
  7. Providers’ Office Staff
  8. Hospital Revenue Cycle Staff

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) 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
Email: support@skillacquireupdate.com