Julie W. Allison PA Hollywood, Florida, United States
Session Description: 1.- Learning at the Basic way to avoid health insurance denials a. Discussion of how health insurance reimbursement applies generally b. Learn what the minimum standards of medical necessity v. standard of care to avoid a claim denial. c. Learn about what rights to providers and members have under their plan to interpret and appeal claim denials 2. What Tools and Resources are available to fight reimbursement denials. a. How to access, appeal and document a denial for appeal to get reimbursement b. What a denial means as a matter of law under the plan so that you can create the necessary legal responses c. Handouts and guides to templates and legal forms before litigating 3. Learning what laws apply when litigating a health care claim denial. a. Identify when a claim denial is ripe for preparing a lawsuit to assert legal rights b. Learn what to expect in response to filing a lawsuit c. What the process and time frame consist of a lawsuit and what the most common outcomes are. 4. Explain recent healthcare cases a. Discussion of current healthcare cases beneficial to providers b. Discussion of current healthcare cases that have been detrimental to providers
Learning Objectives:
After this activity participants should be able to
Provider will know what they need to do before filing a lawsuit for reimbursement to be successful
Providers will have tools, forms and information that can utilize every day in preparation to avoid denials by insurance companies.
Providers will understand what laws they can use to help them every day in fighting for claims reimbursement.