OVERVIEW

How to Negotiate on Out of Network Claims (OON) is organized by Skillacquire and will be held on Mar 27, 2019.

Suggested Attendees:
• Office Managers
• Administrators
• ASC Owners
• Credentialing Manager or Specialists
• Billing Manager
• Coder
• Physician
• Mid-Level Providers
• Non Physician Practitioner such Physician Assistants, Nurse Practitioners
• Healthcare Staff

Description:
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.

Expert Stephanie Thomas, CPC, CANPC will take you dive into how payers typically handle OON claims and how to avoid costly denials on OON claims; the verbiage to use for successful OON conversations; the best negotiation practices with a payer for higher reimbursement for OON bills; working with a payer without a contract, and more. Gain and 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, we will go through some specific examples of notes and how to spell out medical necessity to ensure you are paid the first time.

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

Session Objectives:
Participant will be able to learn:

• 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 with ease as you will learn how to be extra aggressive with payers to get the results you need.
• Be comfortable with appealing claims and proving medical necessity for claims.
• Top 10 tricks to ensure you are paid appropriately out of network