An Effective Out-of-Network Workflow and Proven Appeal Techniques to Increase Reimbursement and Avoid Payor Audits and Refund Demands

Event: Live Webinar
Event Date: March 05, 2024
Presenter: Thomas J. Force, Esq.
Event Time: 1:00 PM EST
Duration:60 Minutes


Join us for an enlightening webinar by renowned healthcare attorney Thomas J. Force, Esq., as he delves into the intricacies of a successful out-of-network workflow. This program is tailored to equip healthcare providers with the essential components to not only increase reimbursement but also maintain compliance and effectively counter insurer/payor audits and refund demands. Thomas J. Force, Esq. will guide participants through the crucial elements of an out-of-network workflow, emphasizing strategies to handle eligibility, benefit verification, charge analysis, and navigating the challenges of low payments and denied appeals. The discussion will extend to encompass patient cost-sharing dynamics and effective responses to payor audits and recoupment attempts.

In a comprehensive exploration, the webinar will address fee forgiveness and balance billing, providing clear steps to sidestep payor fee forgiveness audits. Attendees will receive step-by-step instructions on crafting a compliant financial hardship policy, implementing prompt payment protocols, and establishing a professional courtesy policy.

Additionally, Thomas J. Force, Esq. will shed light on ERISA claims guidelines and dissect state prompt payment laws, offering a thorough understanding of legal frameworks governing out-of-network workflows. Don’t miss this opportunity to gain actionable insights and fortify your approach to out-of-network challenges in the healthcare landscape.

Session Highlights:

  • Explain reasons that eligibility and verification of benefits are different and more important for an OON provider as compared to an in-network provider.
  • Explain how an OON Provider should handle eligibility and verification of benefits.
  • Explain how to successfully appeal low allowed out of network claims.
  • Explain the importance of obtain SPD’s and Plan Documents.
  • Discuss effective appeal preparation for low allowed claims and denied claims.
  • Explain how to effectively object and appeal refund demands and payor audits.
  • Instruct on how to craft compliant financial hardship, professional courtesy and prompt payment discount policies.

Learning Objectives:

Out-of-Network (OON) providers often encounter hurdles in securing optimal payments for their claims, compounded by insurers directing payments to patients. The lack of awareness regarding distinct patient forms and disclosures required for OON patients further complicates matters. Additionally, the implications of the Federal No Surprise Act on OON practices remain unclear.

This webinar aims to address the pain points faced by OON providers, offering clarity on the intricacies of patient forms, disclosures, and the potential impact of the Federal No Surprise Act. Attendees will gain invaluable insights into handling the frequent audits initiated by payors, providing them with the knowledge to navigate and defend against refund attempts effectively.

By the end of this presentation, participants will be equipped with practical answers and a deeper understanding of the complex healthcare landscape, empowering OON providers to overcome challenges and optimize their reimbursement strategies.

Who Should Attend:

  • Revenue Cycle Staff
  • Billing Companies
  • Healthcare Attorneys
  • Healthcare Providers
  • Healthcare Compliance Staff

Speaker Profile:

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. 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.

Mr. Force is nationally recognized as an expert in revenue collection techniques, managed care contracting and appeal strategies. Mr. Force remains an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, the Suffolk County Bar Association, and other organizations. A United States Marine, Mr. Force received the prestigious Meritorious Mast Award for Leadership in 1987. Mr. Force is also co-Chairman of the Health and Hospital Committee of the Suffolk County Bar Association. He is co-founder of the Healthcare Reimbursement Attorneys Network, a national association of attorneys that represent physicians and hospital clients. Mr. Force also works closely with the American Medical Association and various state Medical Associations.