What has worked for out-of-network providers in the past is no longer effective in recovering revenue for your practice. The climate has changed and so must you. In this information-packed session, expert speaker Thomas Force, ESQ., will talk about effective revenue recovery techniques that will facilitate the out-of-network practitioner to maximize their recovery against health plans while ensuring that their patients pay their fair share of charges. Procedures necessary to be successful as an out-of-network provider involving the entire revenue cycle, starting with scheduling, will be analyzed and discussed in detail.

After attending this session, participants will learn about eligibility, charge analysis and understanding the Summary Plan Description(SPD) and its terms. There will be a discussion regarding low-payments and denial resolutions. The webinar will also address the application of ERISA, ERISA requirements and what happens when ERISA demands are not met. The Attendees will learn about the appeals process and patient collections. We will also discuss the different strategies for In-Network v. Out-of-Network claims.

The Attendees will also learn the effective techniques for Balance Billing. They will learn about the Federal Prompt Payment requirements. The webinar will discuss what a recoupment and audit is, the reasons that insurance companies give as the basis for the overpayment demands 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.  

Learning Objectives:

  1. How to maximize their revenue
  2. Learn the effective techniques for Balance Billing
  3. Learn about the Federal Prompt Payment requirements
  4. Learn about take backs and recoupment defenses
  5. What should be done when a provider receives an audit or overpayment demand
  6. How to object, appeal, hire an expert and make document requests
  7. Educated about the best practices to reduce the risk of fraud allegations
  8. Benefits of obtaining the Summary Plan Description and understanding its terms.
  9. Learn how to write effective appeals.

Areas Covered in the Session:

  1. The Path to Maximizing Your Revenue
  2. Eligibility
  3. Charge Analysis
  4. The Summary Plan Description(SPD)
  5. Low-Payment, Denial Resolution & Applying ERISA
  6. The Appeals Process & Patient Collections
  7. Compliance, Audit Prevention & Defense
  8. Effective Techniques for Balance Billing
  9. Federal Prompt Payment, Take-Backs & Recoupment Defense
  10. State insurance laws regarding time frames to request recoupments
  11. Best Practices to Reduce the Risk of Fraud Allegations

tWho 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