How to Negotiate on Out of Network Claims
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.
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
Verification of out of network benefits
Benefit investigation and authorization
In network vs Out of Network
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Stephanie Thomas, CPC, CANPC has a widespread background in medical billing, internal audit and health care administration. She is a Certified Professional Coder as well as a Certified Anesthesia and Pain Coder. Stephanieâs combination of clinical experience, coding education and revenue cycle management offer insights that speak well to both the clinician and the revenue cycle expert. Â Stephanieâs experience includes working in large and small private practices, ambulatory surgery centers as well as with hospital-based physicians. She is responsible for proposing, budgeting, staffing, leading and conducting various compliance and internal reviews. Stephanie is currently a member of the American Academy of Professional Coderâs (AAPC) and Society for Pain Practice Management (SPPM). She speaks nationally on billing and compliance topics regularly and has nearly 20 years of experience in this field.
