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Format: On-Demand Webinar
Presenter: Don Self, CPC, CMCS, CASA
Time: You can access the webinar anytime
Duration: 60 minutes
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This year CMS has made several changes to billing, reimbursement and coverage, for both Medicare and Commercial plans and coverage. This webinar will Not only discuss in detail some of the 2024 Medicare coverage changes in 2024, but also you will get idea of dealing with Medicare and Commercial plans that are not following the law. You will be able to identify when the carriers including Medicare Advantage plans are lying about pre-auth and how to call them on it, and also address which law to quote to make the MA plans pay for everything that Medicare Part B pays for. This session will help you to understand valid information to support my appeals and disputes that continue to be denied and go unresolved.

Learning Objectives

  • Learn how to stop CIOX and others from large numbers of records requests and what the law says they cannot do
  • Identify when the carriers (Including Medicare Advantage Plans) are lying about pre-auth and how to call them on it
  • Address which law to quote to make the MA plans pay for everything that medicare part B pays for
  • Stop MA plans from paying you less than they are required to by law
  • How to report carriers & MA plans for denying claims without a full and fair review
  • It is a violation of law to require documentation on all surgeries
  • No more requiring pre-auth when pre-auth is not required
  • Learn how to educate third party plans that their requests for records are illegal & how to quote the law to them
  • Find out who to report to on medicare part C denying pre-authorizations
  • Discover how MA plans are not allowed to make up their own rules
  • See how to make MA plans honor the 1 year timely filing that the federal law requires them to honor
  • Find out why your timely filing periods are not what you think they are
  • Get a list of the 268 CPT/HCPCS codes covered under provisional and permanent telehealth status
  • Learn how your fees might be reducing the medicare allowed amount on services you are billing for

Areas Covered in the Session

  • When You Mark Accept Assignment on Claim Form
  • Do Commercial Carriers Have to Send You the Checks If You Are OON (Out of Network)?
  • Medicare Part C Plans: Reimbursement OON (Out of Network)
  • Timely Filing Limit for Commercial Carriers
    • The Provider – Carrier Agreement
    • The Patient’s Policy
    • State Law
    • Federal Law
  • Timely Filing Limit for Medicare Part C Plans
  • For ERISA or PPACA Plans, What is the Minimum Appeal Period?
  • Reimbursement for Out of Network with A Medicare Part C Plans
  • When Can a Commercial Insurance Company Make the Doctor Refund Money Paid on A Claim?
  • What is ERISA?
  • Employment Compensation
  • When is It an ERISA Claim?
  • How Does ERISA Help with My Insurance Claims?
  • Provider Agreements with The Carriers
  • Patient’s Policy
  • Carrier Requires Pre-Authorization When Pre-Authorization is Not Required Per the Policy
  • Summary Plan Description (SPD)
  • Language in Every SPD on Every Policy
  • Recoupments
  • Demanding Refund
  • Who Can They Recoup From?
  • What Can We Do If They Already Recouped?
  • Carrier Time Limits on ERISA
  • Managed Medicare Regulatory – OON Coverage Guidelines
  • Managed Medicare Regulatory Guidelines – Prompt Payment
  • Patient Protection and Affordable Care Act (PPACA) & Medicare Filing Time
  • Payor Audit
  • Medical Record Request Verify Compliance
  • HIPAA – A Great Resource
  • Medical Record Limitations
  • Utilize HIPAA Protections
  • HIPAA Disclosures and Healthcare Operations (MR Requests) – 45 CFR 164.501 & 164.506
  • Receipt of Chart Audit Requests
  • Medicare Advantage
  • DOJ Monitoring MA Plans
  • Medicare Advantage CMS Contact

Suggested 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

About the Presenter

Don Self, CPC, CMCS, CASA, is the CEO and founder of Don Self & Associates, a consulting firm specializing in medical reimbursements and helping physician practices improve patient outcomes and increase profits while staying compliant with all regulations. Don is also the President of Telecare-USA. Don has taught more than 900 seminars/ webinars over the past 38 years to tens of thousands of physicians, NPPs, coders and billers on coding, revenue, reimbursement and billing and 49 webinars in 2020 on Telehealth Billing. He has helped thousands make sure they are paid properly by Medicare and other payers.

Snippet From Our Previous Session

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
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