Appeals, Refunds and Recoupment Requests

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. Participants will learn how to troubleshoot and handle payment inconsistencies and respond to inappropriate recoupments for in-person and virtual care healthcare claims. 

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 the 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 how to access legal guidance.

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.

Whether the issue is inadequate payment, denial, or rejection, participants will return to the office well-equipped to handle the toughest denials. Samples of results-oriented appeal letters will be provided. 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.

Class Highlights:

• 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

Who Should Attend:

This class is ideal for billing and claims processors, physicians, consultants, and anyone seeking solutions for claim denials.

Prerequisites:

The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.

What to Bring:

Includes instructional materials. No supplementary materials are required for this course. Bring questions and receive guidance for handling some of your toughest claim denials.

CEUs
3

Length
182 min

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