The “Building Blocks of Medicine” series is divided into three parts: Insurance Basics, Office Basics and Compliance Basics. Each part consists of four webinars.
Our speaker for this series of 12 webinars is Jen Searfoss, JD, CMPE, who serves as CEO of the Searfoss Consulting Group, LLC and Principal at Searfoss & Associates, LLC, a Maryland law firm that offers services to individual and group health care providers and integrated health systems.
Part One: Insurance Basics
May 15: Introduction to Health Insurance WATCH NOW
Health insurance companies provide the majority of direct revenue for virtually any medical group practice. Each company typically offers multiple different insurance plans to the patients who’ll visit your practice. Understanding the terminology and the rules these companies use to authorize services, process and pay claims is critical to the success of any practice. Get a substantive, easy-to-understand overview that will prepare you to understand the relationships between your patients, your practice and health insurance plans.
May 22: Medicare Enrollment and Health Plan Credentialing WATCH NOW
The first step to being able to get paid by Medicare and health insurance plans, as well as to negotiate your payment terms and treat patients is to go through complex enrollment and credentialing steps outlined by each payer. Learn how to collect the supporting documents you need, how you can streamline the process for private health plans using CAQH and how to follow up on pending enrollment and credentialing requests.
May 29: Medicare and Plan Payment Policies and Billing Rules WATCH NOW
Each health plan has thousands of pages of policies and rules to govern how you treat patients, how you document those treatments and how you bill for payment. Many policies borrow heavily from Medicare’s detailed rules. Learn how to navigate policies and billing rules to make sure the services you provide most are documented and billed correctly, as well as how to stay on top of changes to the rules that might impact your bottom line.
June 5: Insurance Myths WATCH NOW
You’ll hear a lot of things that insurance plans supposedly bar you from doing, including how you bill patients, how you decide to dismiss a problem patient and even whether you can charge administrative no-show fees. Separate the fact from fiction with this session that debunks that top myths about health insurance that continue to circulate around physicians’ offices.
Part Two: Office Basics
July 31: The Life of a Medical Claim WATCH NOW
If only it were as simple as sending a bill and getting it paid. Learn what happens to a claim after you submit it, including how to best track and follow up on your claims, how long payers have to try to reclaim money after you’re paid and how to respond to requests for additional information about your claims. Get a clear understanding of the claims process from the time the claim is filed all the way to payment posting and beyond.
Aug. 7: Getting Paid for Services WATCH NOW
Insurance payers typically set fees for each of the services you provide. But increasingly, more of the costs of patient visits are borne by the patients themselves, with strict rules and accountabilities requiring you to pursue these payments. There are also separate rules for how often a patient can have a service done, when pre-authorization is required and how to set fees for elective and non-covered services, as well as rules for some services requiring payers to waive the patient’s co-pay. Once you provide the service, it’s extremely difficult to collect your fee when the payer doesn’t cover the service, so it’s critical you know the rules for how to get paid before your providers treat the patients.
Aug. 14: Claims Appeals WATCH NOW
Nearly half of all claims denied by insurance payers are not appealed, leaving hundreds of millions of uncollected payments in the pockets of the insurance companies. Every payer uses its own set of rules to determine how you can appeal a denied claim, including submission of additional documentation, correction of errors over the phone and, in some cases, how to fight unfair payment policies. Get the best appeals strategies in this session. Don’t be one of the practices that lose thousands of dollars a year by not fighting for collectable claims.
Aug. 21: Patient Scheduling and No-Shows WATCH NOW
Every minute one of your providers spends not seeing patients is costing your practice lost revenue that adds up quickly. Learn your rights when it comes to charging administrative fees for patients who fail to keep appointments, as well as scheduling strategies that ensure your patients are reminded of appointments and scheduled for necessary covered services.
Part Three: Compliance Basics
Sept. 11: Introduction to Office Compliance and Employee Training WATCH NOW
Are you confident that every employee at your practice has the know-how and the tools to make the right decision and ensure accountability every time he or she is faced with a compliance challenge? If the answer is no, your practice is at risk. Learn how to establish a compliance plan and how to make employee onboarding and training a part of your practice’s culture in a way that promotes compliance, but doesn’t slow productivity.
Sept. 18: Document Retention WATCH NOW
Medical practices generate a lot of paper. Failure to retain some documents long enough will expose you to compliance risk. Keeping some documents too long will expose you to needless compliance risk and legal exposure. Learn the timelines you need to follow for retention of key documents, including how to make sure you have proper back-ups in place for the documents you need to have in case of an emergency.
Sept. 25: Oversight & Signatures WATCH NOW
CMS and other payers are cracking down on rules for signatures used on claims and orders – missing signatures and improper supervision of orders is an easy way for payers to pull back otherwise legitimate payments from your practice. Get the low-down on signature rules (including signature stamps) and how to properly order services.
Oct. 2: Professional Courtesy & Discounting Policies WATCH NOW
Handing out discounts and professional courtesy services without a plan or forethought could end up costing you far more than you realize. Payers see discounting as cause to reduce your payment for every service. See how to develop policies for discounting services for patients in need as well as how to offer charity care and professional courtesy services without running afoul of payer rules on allowed and actual charges for the care you provide.