Reduce the risk of claim rejection and/or denial due to lack of specificity or erroneous billing. Learn how to identify erroneous billing procedures that result in denials and rejections. Create a tracking system designed to minimize problems, lost revenue and audit risk. Troubleshoot denials and work within claim guidelines.
When correctly-submitted claims are inappropriately reduced, delayed or denied, it is imperative to appeal claims in a timely manner with as much supporting documentation as possible. This course will explain the provider’s rights and responsibilities when appealing claim denials. Whether the issue is inadequate payment, denial or rejection, participants will learn to handle difficult claims management issues.
Key Highlight of The Session:
- Review Medicare rejection code examples
- Learn strategies for educating providers on the necessary documentation requirements that support medical necessity
- Distinguish the differences between a rejection and a denial and implement effective strategies for both
- Understand each step of a proper denial tracking system
- Eliminate exposure for lost revenue and audits by government and private payers due to inappropriate billing
- Understand the top reasons claims are delayed/denied
- Learn protocols to eliminate rejections
- Identify efficient methods for denial resolution
- Improve documentation strategies for accurate diagnosis coding
- Review modifiers, bundling, downcoding, and other situations that cause a claim to be rejected
- Work within claim guidelines to avoid further delays
- Address payment inconsistencies
- State and Federal Guidelines for refunds/recoupments
- Guidance on Prompt-Pay laws
- Troubleshoot repeat denials
- Mid-Level Providers
- CDI Specialists
- Office Managers
Meet The Presenter:
Rose B. Moore, CMC, CMIS, CMOM, CMCO, CCP, PCS, CEC, CERT, CMA-ophth, has been in the medical field since 1976 where she has worked through the trenches in all aspects of a medical practice. She has worked with PMI for more than a decade while she was the Physician Practice Advocate at the Medical Society of Virginia. During that time, she consulted with physicians on health care reimbursement and the importance of correct documentation and coding. Now a part of PMI’s Faculty team, Rose’s expertise and love for teaching is reflected in the seminars and workshops on coding, financial management and practice management throughout the country. In addition to her talents as an instructor, Rose also serves as President and CEO of her own consulting firm, Medical Consultant Concepts, LLC.