On Thursday, September 24, Buchanan Ingersoll & Rooney and McBee will join together to present the webinar Responding to Refund Demands and Managing Claim Denials from Health Plans.
Many different factors can lead health plans to conduct audits of and demand refunds from health care providers. Even when all the boxes seem to be checked, plans will routinely deny claims and seek to recoup past payments. This webinar will provide practical guidance to health care providers facing refund demands from insurance health plans (commercial and Medicaid/Medicare managed care). Attendees will also take away multifaceted, proactive approaches for preventing future denials and strategies for winning appeals.
Buchanan – Responding to Refund Demands (1:00 - 1:35 p.m.) Walk through a hypothetical refund scenario based on the many cases of this type we’ve handled, often in response to demands from the Special Investigations Units of the plans. We will cover the key considerations the providers face in these circumstances, including among others:
the provider's network status;
the plan’s alleged basis for finding an overpayment;
key leverage points, like separate amounts the plan may owe the provider and the past course of conduct between the parties;
the use of claim sampling and extrapolation; and
the use of coding experts, statisticians, and other important resources.
McBee – Multifaceted Approaches to Denials Management (1:35 - 2:10 p.m.) Preventing denials and creating winning appeals needs a multifaceted approach that includes efficiency and optimization in every step of your workflow. Audits and denials continue to be a growing trend in healthcare facilities. Large volumes of denials lead to confusions, delays, unfair business practice and backlogs. This can delay and decrease your revenue. In this session, we will cover:
Denial Trends and Tactics
DRG Validation & Authorization denials along with process improvement strategies
Techniques to evaluate your revenue system and mitigate denials