...truly the best appeals specialists
that I have ever encountered in the industry...
...have been the key to
fighting my appeals when these cases were going nowhere...
...are, without question, the
foremost insurance appeals authority in the industry...
Fraud Investigations are increasing from both governmental agencies and insurance special investigation units. Medical providers need to use best practices to avoid even the appearance of fraud. Once suspected, fraud allegations can put your practice on the radar for years and can be difficult to resolve or lead to large recriminations, fines, and even license revocation or suspension. This likely could result in significant lost revenue and bankruptcy.
In this session Thomas J. Force, Esq. will categorize the most common fraud actions brought against healthcare providers and include recommendations to avoid audits. Thomas will analyze recent court cases, fraud allegations, findings of fraud, and SIU investigations into fraud. You will receive strategies and techniques for avoiding those practices that may lead to fraud allegations. Additionally, Thomas will reveal current best practices that you can implement in your organization.
* Current best practices in dealing with OON claims
* Summary of issues that OON providers face dealing with Health Plans
* Overview of OON Reimbursements & Charge Analysis
* Techniques to appeal denied and under reimbursed claims
* Clinical denials, how to handle External Appeals and Independent Medical Reviews
* Techniques to write an effective Appeal letter/Objection letter to audit
* Overview of ERISA protections and obligations of Plan Administrators
* Overview of Prompt Payment Law and insurers’ obligations
* List of patient forms and disclosures essential to appeals and fraud audit defense
* Review of Eligibility Issues
* Balance Billing and Recoupment Strategies
[Attendance Special] Lookout for bonus material following the event.
Thomas J. Force, Esq. is a nationally recognized expert and frequent speaker on managed care issues, managed care contracting, managed care appeals, ERISA and out-of-network reimbursement issues. He has been a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries.
He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general counsel and chief compliance officer of a small New York-domiciled health insurer, a former chief operating officer, general counsel and chief compliance officer of a large East Coast billing, collections and healthcare consulting company, and a former co-chair of the Health & Hospital Law Committee of the Suffolk County Bar Association.
Thomas recently presented on ERISA-related issues to the American College of Osteopathic Surgeons in Las Vegas and to the Medical Society of New Jersey.
* Balance Billing & Fee Forgiveness
* The Rise of Audits (prevention, security & defense)
* Eligibility, Disclosures & much more!
*Registrants can access Replays
*Attendees will receive the slides (+ Bonus tools)
Thomas J. Force, Esq.
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. Mr. Force is nationally recognized as an expert in revenue collection techniques, managed care contracting and appeal strategies.
"Tom Force and Patriot Group have been instrumental to the growth of my practice. They are true advocates of both physicians and patients at a time when no such industry advocates can be found. His services are a great asset to the medical field."
~ James Bruno MD