Overcoming Out-of-Network Reimbursement Challenges: Assignment of Benefits, Improper Denials and Underpayments
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Health
- event Date
Wednesday, January 12, 2022
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
-
This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE webinar will guide healthcare counsel on the challenges facing providers seeking reimbursement for out-of-network (OON) services. The panel will offer guidance on properly documenting and billing for OON services and patient assignment. The panel will also discuss best practices to overcome challenges with improper denials and underpayments.
Ms. Anderson’s work is primarily in the areas of ERISA and other employee benefits litigation, healthcare litigation, and complex commercial litigation. Her recent litigation work includes representing medical providers seeking reimbursement from commercial health plans and insurers; defending companies and retirement plans against breach of fiduciary duty and benefits claims; and defending several defendants accused of violating the Medicare Secondary Payer Act. She also has recent experience in municipal and corporate bankruptcy; as well as in class action cases involving claims of government lending and disability discrimination.
Mr. Greenberg advises health care companies, including providers and suppliers, through an exceedingly complex and volatile regulatory environment. He focuses his practice on counseling health care clients on regulatory issues related to the Affordable Care Act, the False Claims Act, the Anti-Kickback Act, the Stark Laws, state licensure, self-disclosures, reimbursement and payment, and participation in Medicare, Medicaid, and other government health care programs.
Patients typically sign an assignment of benefits when they see a provider, assigning the patient's rights to recover benefits from the insurer. As a result, the provider is to be reimbursed directly for the healthcare services by the insurer. However, getting reimbursed is not as simple as executing an assignment of benefits. Insurers often challenge the validity and scope of these assignments.
As a result, OON healthcare providers face unique issues in obtaining proper payment from insurers when their patients have received OON services. It is important for the provider to have the patient properly assign his benefits as well as agree to take financial responsibility for the healthcare services received. Further, the provider should carefully bill patients, taking note that the patient, although OON, may still be a member of a plan with a repricing arrangement in which the provider also participates. The impact of state and federal surprise billing laws should also be considered.
When claims are denied or underpaid, healthcare providers need to understand the reason for the denial. Was there coverage for the patient? Is it a documentation issue? Did the claim fail to comply with payment policies and procedures? The provider must avail itself of any appeals available to it.
Listen as our authoritative panel of healthcare attorneys examines the challenges facing providers seeking reimbursement for OON services. The panel will offer guidance on properly documenting and billing for OON services, patient assignment, and the steps to take to overcome challenges with improper denials and underpayments.
- Assignment of benefits
- Improper denials and underpayments
- OON claim administrative appeals
- Best practices for navigating OON reimbursement
The panel will review these and other key issues:
- What steps can healthcare providers take to ensure patients correctly assign benefits?
- What actions can providers take when claims are denied or underpaid?
- What best practices should healthcare providers employ to successfully navigate OON reimbursement ?
Related Courses
Healthcare Speaker Programs and AKS Compliance: Regulatory Update, Lessons Learned From Recent Settlements
Tuesday, May 27, 2025
1:00 p.m. ET./10:00 a.m. PT
HIPAA and Beyond: Health Information Privacy Updates
Tuesday, May 27, 2025
1:00 p.m. ET./10:00 a.m. PT