Description

This one-hour webinar by Don Self, CEO, of CPC, CEMCS, and CPCS will surprise even the most experienced manager or biller with the illegal tactics that insurance carriers use almost every day but are believed by most to be legal. Expert Don will help you learn how to fight for and protect the patient’s rights effectively and have their claims paid properly to you, the medical professional. We will not only show you what they are doing that is illegal or unethical but also where to find the laws or regulations and how to stop them from these unfair practices. This affects not only clinics but also hospitals, therapy centers, and all medical professionals. Every single provider dealing with insurance or Medicare plans is being misled daily and this webinar will open your eyes and give you the tools you need.

Learning Objectives

• The truth regarding commercial insurance assignment and what it does not mean
• Dispel the myths regarding Out of Network coverage with Medicare Part C Plans
• Misleading statements regarding Timely Filing Limits by all commercial plans
• Why the Timely Appeal Periods are not what they have been taught they are
• The only instance (which is very rare) that a carrier can recoup on claims legally
• How the federal laws protect the patient and the medical provider
• The fact that pre-authorizations are not required nearly as often as providers believe
• A vital fact that gives the providers much more power with carriers than they thought
• The most effective way to deal with anyone at insurance carriers or TPA lying to them
• Illegal tactics used by many carriers to perform recoupments, & how they are illegal
• Proper responses when carriers send the checks to the patient & how to fight it
• Why complying with record requests may be opening clinics up to HIPAA violations
• Carrier time limits on paying and on denying claims – it’s not what you think
• How to make Part C plans cover all that Part B does – it’s the law!

Areas Covered in the Session

• When You Mark Accept Assignment on the Claim Form
• If You Are Out of Network Provider, Do Commercial Carriers Have to Send You the Checks?
• For Medicare Part C Plans, If You Are Out of Network, Are They Required to Send You the Checks?
• For Commercial Carrier Plans Provided by Employers, Who Set Your Timely Filing Limit?
• For Medicare Part C Plans: Who Set Your Timely Filing Limit?
• For ERISA or PPACA Plans, What Is the Minimum Appeal Period?
• If You Are Out of Network with Medicare Part C Plans, How Much Are They Required to Pay You on The Claim?
• When Can a Commercial Insurance Company Make the Doctor Refund Money Paid on A Claim?
• What Is ERISA?
• Employment Compensation
• When Is It an ERISA Claim?
• How Does ERISA Help Me with My Insurance Claims?
• Provider Agreement:
• Patient’s Policy
• How Do I See the Patient’s Policy?
• Carrier Requires Pre-Authorization When Pre-Authorization Is Not Required Per the Policy
• Language In Every SPD on Every Policy
• Stop Recoupments
• ERISA: Are There Any Timely Limits?
• 1140 Is A Civil Crime – But 1141 Is Criminal
• Who Can They Recoup From?
• What If They Already Recouped – What Can We Do?
• Carrier Time Limits on ERISA
• What Is a CFR?
• CMS Plan on Having All Medicare Patients Switched Over to Part C Plans By 2030
• Lie about MA Plan: “We Don’t Cover RPM” – Medicare Part C Must Cover What Part B Does
• MAOs Must Pay Within 30 Days
• PPACA & Medicare Filing Time
• The Record Requests
• CMS – Limits Medical Record
• HIPAA Minimum Necessary
• Government Definition Entity
• HIPAA Protections
• Are You Helping MAOs Break the Law?
• Medicare Advantage CMS Contact.

Who will Benefit?

• Healthcare CEOs
• Healthcare CFOs
• Healthcare COOs
• Clinic CXOs
• RCM Executives
• Hospital Administrators
• Claims Staff
• Appeal Specialists
• Office Managers
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• Providers Office Staff
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys.