Conference Materials (Password Required)
As technology becomes more sophisticated, and insurance companies continue to attempt to save money, knowing and understanding denials will allow you to disagree with denials when they are not applicable. Once a denial is recognized as an error, sharing the reasons are important in contacting the insurance company and proving the claim was denied inaccurately. Supplying the insurance company with documentation of the services or procedures performed and the reference(s) that stand prove your position will assist those reviewing the facts to consider a turnover of the denial and a payment of the procedure or service.
Many practices and offices have denials on the back burner as they are considered a lower priority than processing current billing and other tasks that need to be completed. This session will offer tips and tricks on how to streamline the appeals process in your office and help you to design an effective appeals process.
Learning Objectives:
- Recognize when claims are denied in error
- Take advantage of tools of the trade
- Complete an effective appeal
- Documents requirements for successful appeal
- Create secondary appeals
- Know what to ask of the insurance company
- Collect on claims that should be paid
Areas Covered in the Session:
- Hierarchy of References
- The Appeal
- NCCI Edits
- NCCI Policy Manual
- Medically Unlikely Edits
- Procedure To Procedure (PTP)
- MUE Adjudication Indicator
- NCCI Procedure and E/M
- Down-coding E/M Services
- Cigna Policy May 23, 2023
- Bilateral Procedures
- Appeal Example: Visit and Injection
- Next Steps
- Reimbursement
- Sample of Appeal Letter Add-on Codes
- Unlisted Procedures
- Modifier 22
- Signed Operative Report
- Starting the Process
- Denial Process
- Methods to Capture Denials
- Quantify Denials
- Denial Trends
- Appeals For Correct Reimbursement
- Reimbursement
- Sample of Appeal Letter For Contract Compliance
- Next Steps
- State Insurance Commissioners
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Suggested Attendees:
- Billers
- Coders
- Administrators
- Managers
- Supervisors
- Physician
- Non-Physician providers
- Qualified Healthcare Professionals
- Claims processors
- Payment posters
- Claims adjusters
- Case Managers
Presenter Biography:
Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.
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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
