Expert guidance for navigating Claim Denials and Appeals
Whether the issue is inadequate payment, denial or rejection, participants will return to the office well-equipped to handle the toughest denials.
5 Reasons to Attend
- Know what you should be getting paid and pay attention to your denial reason codes on EOBs.
- Get the latest information on Medicare appeals process and amounts in controversy, including sample appeal letters.
- Discover how persistence and familiarity with federal and state laws will provide the necessary guidance needed when appealing claims.
- Understand the claims rejection methodologies that third-party payers use to deny claims.
- Review State Specific Guidance on "Prompt-Pay Laws" and accessing legal guidance, when needed.
Protect the practice's bottom line with specialized appeals training for your billing staff.
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. It is important to properly write an appeal for your claim in order for it to be reconsidered with the result in your favor.
This class will explain your rights and responsibilities when appealing claim denials. Receive tools and expert guidance on how to second-guess denials and recoup dollars rightfully due to the provider. The instructor will address questions head-on and provide new insight and tools to help billing staff successfully handle all of your appeals, refunds and recoupment requests.
- Learn about how to adhere to the Medicare 60-day rule for overpayments
- Learn how to take a closer look at modifiers, bundling, down coding, and other situations that can cause a claim to be rejected
- Get familiar with researching individual carrier policies for submitting and appealing claims
- Gain access to results-oriented appeal letters
- Effectively respond to inappropriate recoupments and payment inconsistencies, according to state and federal guidelines
Who Should Attend
This class is ideal for billing and claims processors, physicians, consultants and anyone seeking solutions for claim denials.
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.
What to Bring
A course manual will be supplied. No supplementary materials are required for this course. Bring questions and receive guidance for handling some of your toughest claim denials.
Continuing Education Units (CEUs)
Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).
If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.
Not able to attend a live session? Check out our self-paced version!