Successful Insurance Claims Processing

Learn how to expedite claims and appeals and get paid. Gain confidence that you are securing correct payments from commercial carriers and receive tips to avoid common claims processing errors.

Up to 90% of revenue in a healthcare provider's practice flows through third-party payers. How much of it is hanging in limbo due to denials? Make sure that your dollars are flowing in the right direction. Spend less time fighting denials and more time ensuring that your front end details are in order. The window to appeal a denied claim is shrinking. Learn how to expedite claims and appeals and get paid. This program provides an overview of health insurance plans and payment models and tips on how to avoid common claims processing errors.

This training is appropriate for health insurance claims processors with limited experience.  Medical coders, practice managers, providers, clinical staff and consultants seeking a better understanding of the overall reimbursement process may also benefit.

Highlights:

• Explanation and analysis of federal and commercial carrier guidelines
• Overview of insurance plans and payment models
• How to ensure that chart documentation supports claims submitted
• Checklist of necessary patient information
• Insurance verification and preauthorization
• Working with pre-certification and authorizations for continued treatment
• Proper use of the Advance Beneficiary Notice
• Working with Medicare as a secondary payer
• How to appeal inadequate reimbursements
• Patient education and grievance issues
• Procedure for capturing lost charges
• Billing for pre-existing conditions
• Coordination of benefits for covered/non-covered services
• Working with general liability claims
• Address common claims processing errors
• Medicare's Correct Coding Policy as it pertains to billing
• Tips to avoid duplicate charge rejects
• How to handle refunds for overpayments
• Recovery Audit contractor claim review process
• Know your rights and responsibilities during an audit

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.

The content covered in this course assumes a basic understanding of insurance claims processing. No supplementary materials are required for this course.

CEUs
3

Length
164 min

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