Out of network and In-Network healthcare providers are now struggling to recover profits for their facilities and medical practices. In this session, Out of network and In-Network healthcare providers will learn techniques designed to get denials reversed and low-reimbursed out-of-network claims reprocessed at higher reimbursement rates.
In general, insurers/payors use numerous tactics and make various assertions in order to avoid payment. These tactics and assertions, based on your feedback often include:
Join this information packed session with industry expert speaker Thomas J. Force, Esq. to learn about effective techniques to get denials reversed and under-reimbursed out-of-network claims reprocessed at higher reimbursement rates. Attendees will receive instructions from Thomas Force how to draft an effective appeal including documents to enclose to ensure the appeal is processed and not rejected.
Types of appeals/denials to be discussed include:
• Medical necessity denials.
• Experimental/Investigational denials.
• Bundled/Inclusive denials.
• Low Reimbursed out-of-network payments.
• Denials for lack of documentation or service not supported by records.
• Our expert speaker Thomas Force will share his vast experience in handling denials and drafting appeal letters as an attorney and owner of a medical billing company.
As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance Officer propelled the founding of The Patriot Group. The Patriot Group is a full service revenue recovery company that provides billing, collections, and follow-up services as well as assistance with managed care appeals, managed care contracting, credentialing and compliance.