Negotiating With Payers on Out-of-Network Claims

Product Id : HE112
Instructor : Stephanie Thomas
May 09, 2019 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 60 Minutes

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Getting paid on Out of Network claims (OON) is one of the greater difficulties every healthcare service provider face. And if the regular roadblocks were already not enough, the payers are now continually pushing to constrain OON reimbursement rates. You need to improve the bottom line, which can only be achieved by maximizing reimbursements and minimizing denials.

Join us for this session with coding expert, Stephanie Thomas, CPC®, CANPC®, as she takes a deep dive into how payers typically handle OON claims and how to avoid costly denials on OON claims. She will discuss the verbiage to use for successful OON conversations and share the best negotiation practices you can use with a payer for higher reimbursement of OON bills.

You will also learn how to working with a payer without a contract and many more such tricks and tips of the trade. You will acquire knowledge of how to work with out of network patients and how to help them understand their insurance benefits. Medical necessity denials will be a thing of the past as Stephanie runs you through these specific examples. You will know how to correctly spell out medical necessity to ensure you are paid the first time.

If you want to increase OON claims success or is facing a challenge in this areas, this webinar is definitely a must-attend for you.

Session Highlights:

  • How to identify specific pros and cons of an out of network situations
  • How to work with patients so they understand their benefits
  • Review of contract verbiage and guidelines and what they really mean
  • How to get patients to pay their portion with ease
  • Follow up of claims and how to be extra aggressive with payers to get a desired outcome
  • Appealing claims and proving medical necessity for claims
  • Top 10 tricks to ensure you are paid appropriately out of network

Session Agenda:

  • Verification of out of network benefits
  • Denials for OON
  • Appeals for OON
  • Benefit investigation and authorization
  • Billing rules for OON
  • Contracts for OON
  • Payers to avoid
  • Financial Agreements
  • Authorizations
  • Patient Cost Sharing
  • Contract Negotiations
  • In network vs Out of Network

Also Includes:

  • Live Q&A session with speaker
  • PPT for reference
  • Certificate of attendance

Who Will Benefit:

  • Office managers
  • Administrators
  • ASC owners
  • Credentialing manager or specialists
  • Billing manager
  • Coders
  • Billers
  • Physicians
  • Mid-level providers
  • Non-physician practitioners, including physician assistants and nurse practitioners
  • Healthcare staff
Speaker Profile:

Stephanie Thomas is the Billing Director for CE Medical Group, a third party billing and consulting firm. Stephanie has been in the medical field for nearly 20 years. Her experience includes private practice administration, medical billing for several specialties, practice management consulting for numerous physicians and ASC’s across the nation.

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