Description

This webinar will focus on navigating the complexities of compliance in the medical insurance claims process. This comprehensive session will explore the multi-faceted challenges clinics, hospitals, and medical providers face daily, dealing with a variety of payers, regulatory agencies, and laws as well as other compliance issues.

Throughout this webinar, we will cover the entire spectrum of the revenue cycle, including documentation, coding, billing, and the meticulous process of scrubbing claims. Each phase comes with its own set of compliance issues, making the field of compliance one of the most critical yet underemphasized areas that healthcare personnel must navigate.

In an industry governed by stringent regulations, such as HIPAA privacy laws, Medicare CMS regulations, and state Department of Human Safety statutes, professionals in the claims field must ensure adherence to the specific rules applicable to each claim, payer, and situation. The reality is that misinformation can often come from well-intentioned friends, social media, news articles, or companies with vested interests, leading to costly misunderstandings. Ignorance of the laws offers no protection, and numerous doctors and clinic managers have faced severe repercussions for non-compliance, even when unintentional.

This webinar aims to provide participants with a comprehensive overview of the regulatory landscape, highlighting the potential pitfalls and how to avoid them. Whether you’re a seasoned professional or new to the field, this session will equip you with valuable insights into the complexities of compliance in the healthcare sector.

Learning Objectives:

• Identify the essential information to gather from patients during their initial visit
• Learn how to locate specific rules relevant to each patient’s insurance type
• Determine which laws are applicable to a particular claim
• Recognize the documentation requirements that vary by insurance payer
• Discover the policies, articles, or coverage guidelines that govern each insurance claim
• Understand instances where legal regulations override provider agreements
• Familiarize yourself with the distinctions between the Assignment of Benefits and the Assignment of Authorized Representative
• Comprehend how HIPAA laws serve as a protective measure for both patient privacy and the healthcare provider
• Identify situations that necessitate assistance beyond what your healthcare attorney can offer

Areas Covered in the Session:

• Where Do You Start?
  • Knowing the Payers
  • Identify the Coding Rules
  • Stay Update on Laws
• Start With Correct Information
• Authorized Representative
• Integral Parts of Insurance Claims
  • Documentation
  • Coding
  • Billing
  • Scrubbing
• What Type of Payer?
• Determine Place of Service Code
  • Office (11 or 22)
  • Hospital (21 or 22 or 23)
  • Skilled Nursing Facility SNF (31)
  • Home (Residence) Rest Home, ALF, Campground, Cruise Ship (12)
• Selecting The Correct Billing Codes
• Ensure Documentation Supports the Level Selected
  • Using Either Time or Medical Decision Making (Current Rules)
  • Determine Medical Necessity
• Current Code Criteria
• Link CPT/HCPCS To ICD-10
• HIPAA Security
• HHS HIPAA
• Know The Laws
  • When to Use ERISA Laws To Help You & The Patient
  • Know When to Use HIPAA Laws To Help You & Protect The Patient
• Carrier Compliance
  • Medicare Part C
  • Commercial Plans
• Medicare Code of Federal Regulations
• Medicare Part C & D Compliance
• ERISA 29 CFR 2560.5603-1
• Know Patient Rights
• Incident-To Billing Compliance
• ADA Compliance
• Billing For New Provider Before Credentialing Is Accomplished
• Compliance With State & Federal Collection Laws
• Compliance With Medicare & Civil Agreements
• Live Q&A session

Attendees:

• Hospital CEOs, CFOs and COOs
• Medical Providers
• Administrators
• Office Managers
• Medical Billers
• Claims Coders
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• Medical Billing Companies
• Providers Office Staff
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys