Event Materials (Password Required)
This year CMS has made several changes to billing, reimbursement and coverage, for both Medicare and Commercial plans and coverage. This webinar will Not only discuss in detail some of the 2024 Medicare coverage changes in 2024, but also you will get idea of dealing with Medicare and Commercial plans that are not following the law. You will be able to identify when the carriers including Medicare Advantage plans are lying about pre-auth and how to call them on it, and also address which law to quote to make the MA plans pay for everything that Medicare Part B pays for. This session will help you to understand valid information to support my appeals and disputes that continue to be denied and go unresolved.
Learning Objectives:
- Learn how to stop CIOX and others from large numbers of records requests. Learn what the law says they cannot do
- Identify when the carriers (Including Medicare Advantage Plans) are lying about pre-auth and how to call them on it
- Address which law to quote to make the MA plans pay for everything that medicare part B pays for
- Stop MA plans from paying you less than they are required to by law
- How to report carriers & MA plans for denying claims without a full and fair review
- It is a violation of law to require documentation on all surgeries
- No more requiring pre-auth when pre-auth is not required
- Learn how to educate third party plans that their requests for records are illegal & how to quote the law to them
- Find out who to report to on medicare part C denying pre-authorizations
- Discover how MA plans are not allowed to make up their own rules
- See how to make MA plans honor the 1 year timely filing that the federal law requires them to honor
- Find out why your timely filing periods are not what you think they are
- Get a list of the 268 CPT/HCPCS codes covered under provisional and permanent telehealth status
- Learn how your fees might be reducing the medicare allowed amount on services you are billing for
Areas Covered in the Session:
- When You Mark Accept Assignment on Claim Form
- Do Commercial Carriers Have to Send You the Checks If You Are OON (Out of Network)?
- Medicare Part C Plans: Reimbursement OON (Out of Network)
- Timely Filing Limit for Commercial Carriers
- The Provider – Carrier Agreement
- The Patient’s Policy
- State Law
- Federal Law
- Timely Filing Limit for Medicare Part C Plans
- For ERISA or PPACA Plans, What is the Minimum Appeal Period?
- Reimbursement for Out of Network with A Medicare Part C Plans
- When Can a Commercial Insurance Company Make the Doctor Refund Money Paid on A Claim?
- What is ERISA?
- Employment Compensation
- When is It an ERISA Claim?
- How Does ERISA Help with My Insurance Claims?
- Provider Agreements with The Carriers
- Patient’s Policy
- Carrier Requires Pre-Authorization When Pre-Authorization is Not Required Per the Policy
- Summary Plan Description (SPD)
- Language in Every SPD on Every Policy
- Recoupments
- Demanding Refund
- Who Can They Recoup From?
- What Can We Do If They Already Recouped?
- Carrier Time Limits on ERISA
- Managed Medicare Regulatory – OON Coverage Guidelines
- Managed Medicare Regulatory Guidelines – Prompt Payment
- Patient Protection and Affordable Care Act (PPACA) & Medicare Filing Time
- Payor Audit
- Medical Record Request Verify Compliance
- HIPAA – A Great Resource
- Medical Record Limitations
- Utilize HIPAA Protections
- HIPAA Disclosures and Healthcare Operations (MR Requests) – 45 CFR 164.501 & 164.506
- Receipt of Chart Audit Requests
- Medicare Advantage
- DOJ Monitoring MA Plans
- Medicare Advantage CMS Contact
Related Webinars You May Like
Suggested Attendees:
- Hospital CEOs, CFOs and COOs
- Medical Providers
- Administrators
- Office Managers
- Medical Billers
- Claims Coders
- Billing Staff and Companies
- Physicians and Other Providers
- Healthcare Consultants
- Compliance Officers
- Practice Manager
- In and Out of Network Providers
- Medical Billing Companies
- Providers Office Staff
- Hospitals and Facilities
- Insurance Companies
- Healthcare Attorneys
Presenter Biography:
Don Self, CPC, CMCS, CASA, is the CEO and founder of Don Self & Associates, a consulting firm specializing in medical reimbursements and helping physician practices improve patient outcomes and increase profits while staying compliant with all regulations. Don is also the President of Telecare-USA. Don has taught more than 900 seminars/ webinars over the past 38 years to tens of thousands of physicians, NPPs, coders and billers on coding, revenue, reimbursement and billing and 49 webinars in 2020 on Telehealth Billing. He has helped thousands make sure they are paid properly by Medicare and other payers.
Additional Information:
System Requirement:
- Internet Speed: Preferably above 1 MBPS
- Headset: Any decent headset and microphone which can be used to hear clearly
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email:Â care@skillacquire.com
Purchase Order Form –Â Click Here to download PO form.
Snippet From Our Previous Session
Frequently Asked Questions:
HOW MUCH TIME DOES IT TAKE TO RECEIVE THE DVDs/ FLASH DRIVE? +
For DVDs/ FLASH DRIVE – It will take around 7 working days.
CAN I PLACE AN ORDER ON CALL? +
Yes, you can call our toll-free number 302-444-0162 and ask our representative for the enrollment. Alternatively, you can also mail us at care@skillacquire.com.
CAN I PURCHASE ANY OF YOUR TRAINING FORMATS, AT ANY TIME? +
For DVDs/ FLASH DRIVE – Yes, you can place the order at care@skillacquire.com using the order brochure or can call us at our toll-free number 302-444-0162.
DO I REQUIRE A COMPUTER FOR ATTENDING A LIVE COURSE? +
The system requirements are quite basic: OS: 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, in case of live course you can raise questions using a microphone.
HOW CAN I BECOME FACULTY AT SKILLACQUIRE? +
Please share your detailed CV with us and our team will screen the best faculty for the specific field.
HOW CAN I GET ACCESS TO THE LIVE TRAINING? +
You can access the live training using Joining Link or Dial-In Number. To get the joining link, you can click on the conference materials on the product description page, and enter your email address and password that you received in your email.
We will also send you the joining link or dial-in number to the registered email address 2-3 days prior to the live training. You can simply click the joining link to join the live training.
HOW CAN I MAKE A BULK PURCHASE? +
You can call our customer service department at 302-444-0162 and may also avail some discounts on the bulk orders.
WHAT’S THIS DIFFERENT FORMAT? +
- Live (One Attendee) – Only 1 person will be able to join the webinar
- Live (2 to 4 Attendees) – Upto 4 persons are allowed to join the webinar
- Live (5 to 10 Attendees) – Upto 10 persons are allowed to join the webinar
- On-Demand Recording (One Attendee) – Webinar recording link will be provided for a single attendee
- On-Demand Recording (Multiple Attendees) – Webinar recording link will be provided that can access by more than one person
- DVD – DVD will be shipped physically to the address provided
- Flash Drive – Flash drive will be shipped physically to the address provided
- Live + DVD – This allows you to attend live webinar plus you also get DVD shipped to the address provided
- Replay + FLASH DRIVE – Allows you to get webinar recording link plus you also get DVD shipped to the address provided
- Live + REPLAY + DVD – This allows you to attend live webinar plus you also get webinar recording to your email and DVD shipped to the address provided
WHAT CERTIFICATION DO I GET POST THE TRAINING? +
After successful completion of the training, you will be awarded the course completion certificate (on request). The certifications/ recertifications should be mentioned under the description of every course.
TESTIMONIALS
“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.”
Melissa Preston, Health Information Management Staff
“David Vaughn covered the material completely and I have a new understanding of when, where and why we need to use an ABN”
Sandie Fowler, Out of Network Billing Staff
“Great presentation. Able to do during the day. Timing was great.”
Tina Duffy, Compliance Officer
