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In-Network and Out-of-Network Billing: Successful Claim Appeal Process

$249.00$649.00

Session Information:
By: Kate Gilman, CPC, CPCO
Event Date: 02/14/2023
Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Duration of the training: 60 Minutes
SKU: SA00018 Categories: ,

Conference Material (Password Required)

The goal of this presentation is to understand the meaning of being in-network and out-of-network with payers; review the life of the claim; review what the appeal process means, review claim appeal guidelines and requirements, review what attachments are needed for the appeal, and how to set protocols for successful follow-up of denied claims for in and out of network providers.

Learning Objective:
  • To review what is in and out of network billing.
  • To review In and out-of-network requirements.
  • To review federal plan requirements for out-of-network providers.
  • To review the life of the claim.
  • To review what the appeal process means.
  • To review the appeal process for in and out-of-network providers.
  • To understand the timing of when an appeal is appropriate.
  • To understand what attachments are needed for appeal.
  • To discuss ways how to set protocols for successful follow-up of denied claims for in and out-of-network providers.
Areas Covered in the Session:
  • In and out-of-network billing
  • In and out of network billing rules and requirements
  • Federal plan requirements for out-of-network providers.
  • Life of the claim
  • The appeal process for in and out-of-network providers.
  • When and how to Appeal
  • Documents required for the appeal.
  • Setting protocols for successful follow-up of denied claims for in and out-of-network providers.
  • Live Q&A Session
Suggested Attendees:
  • Medical providers, who are involved in the payment process of their practice
  • Physicians
  • Practice Managers
  • Billing Managers
  • C-level executives
  • Office managers
  • Medical billers
  • Medical Coders
  • Office staff and Billing Managers
  • Medical Billing Companies
  • Providers’ Office Staff
  • Hospital Revenue Cycle Staff
Presenter Headshot and Biography:

Kate has almost two decades of experience in the healthcare industry. She is an expert coder, and compliance officer, and trains healthcare providers all over the country. Kate utilizes her expertise to uncover ways to improve billing and coding inefficiencies, train staff, and ensure compliance while achieving maximum results and revenues for her clients.

Kate’s successes include small and large practices, ranging from primary care to specialists and surgeons. She is known for helping providers feel confident in their coding and have peace of mind with their compliance practices.

Kate’s acute attention to detail, deep understanding of coding and billing, and proactive approach make her an indispensable asset to all her clients.

Snippet From Our Previous Session

TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!”
–CHRISTINE JACOB MD, CDI SPECIALIST

“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

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”
–BARBARA CAPRIOTTY, REHABILITATION DIRECTOR

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