Nuts & Bolts of Out-of-Network Revenue Recovery

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...truly the best appeals specialists
that I have ever encountered in the industry...

~ Long Island Eye Surgical Centers

...have been the key to
fighting my appeals when these cases were going nowhere...

~ Dimitri Koumanis, MD

...are, without question, the
foremost insurance appeals authority in the industry...

~ Medicomp, Inc.

Many out-of-network (OON) providers today wish they had a business degree to go with their medical one. The increasing cost of treatments and procedures coupled with reduced reimbursements from insurance companies—as well as Medicare and Medicaid—are putting a major squeeze on many practices, bringing the question: What can I do to stop this significant reduction of revenue?

To increase your chances of getting paid accurately as an OON provider, it is vital that you implement some best practices before, during, and after providing services. Once you have implemented them, you need to be aware of how to appeal claims timely and to the proper authority. Not being aware of these best practices will severely limit your ability to contest denied and under-reimbursed claims and optimize payments in the current climate.

Listen to this informative webinar to get a comprehensive overview of what an OON provider needs to be doing for proper reimbursement and appeal success. Get strategies and techniques that will prepare you to treat OON patients while maximizing reimbursements and properly appealing denied and under-reimbursed claims. Also, get a complete list of patient forms that are essential and learn about current best practices in detail.

* 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.
Material: 45-minutes
Q&A: 25-minutes

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.

Many out-of-network (OON) providers today wish they had a business degree to go with their medical one.

The increasing cost of treatments and procedures coupled with reduced reimbursements from insurance companies—as well as Medicare and Medicaid—are putting a major squeeze on many practices, which begs the question: What can I do to stop this significant reduction of revenue?

To increase your chances of getting paid accurately as an OON provider, it is vital that you implement some best practices before, during, and after providing services.

Not being aware of these best practices will severely limit your ability to contest denied and under-reimbursed claims and optimize payments in the current climate.

Listen to this informative webinar to get a comprehensive overview of what an OON provider needs to be doing for proper reimbursement and appeal success.

Get strategies and techniques that will prepare you to treat OON patients while maximizing reimbursements and properly appealing denied and under-reimbursed claims.

Additional Benefits

Topics Include:
* Balance Billing & Fee Forgiveness
* The Rise of Audits (prevention, security & defense)
* Eligibility, Disclosures & much more!

Bonus Material:
*Registrants can access Replays
*Attendees will receive the slides (+ Bonus tools)

Meet The Host

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.

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"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