Insurance companies are making it harder every day to give patients care without meeting their requirements for procedures with eligibility, prior authorization, and medical necessity.  A patient’s insurance coverage must be current, and then the policies of the insurance company have to be followed in order to receive payment.  Not authorizing services or procedures that the insurance companies require will result in a denial that cannot be billed to the patient.  Even when prior authorization is obtained, if you haven’t met the medical necessity guidelines, the claim is not guaranteed payment.  In addition to these complexities, medical offices are expecting to keep up with the different changes for each of the insurance carriers they are contracted with, which can happen almost daily.  The insurance companies publish changes, but many changes are quietly implemented and the only way offices become aware is when they receive a denial.

Areas Covered in the Session:-

• Methods of obtaining patient eligibility
• Information received from eligibility
• Medicare options to patients
• When Prior Authorization is necessary
• Tricks to receiving authorization for coding options
• Major insurance carrier information for eligibility and prior authorization
• How to determine medical necessity
• Interpreting insurance carrier policies
• Managing claims denials
• Writing effective appeals

Who Will Benefit?

• Medical offices
• Billing companies
• Insurance companies
• Consulting firms
• Consultants
• Auditors
• Compliance officer
• Physician
• PA
• Nurse
• Biller
• Coder
• Collector
• Claims representative
• Claims adjuster
• Claims processor
• Manager
• Supervisor
• Administrator
• Medical assistants
• Office staff

The target audience is anyone who codes and bills medical claims for professional services