We will provide strategies to defend demands by insurers and health plans who seek refunds due to retroactive denials based upon a variety of reasons including medical necessity and fee forgiveness. We will discuss audits and refund demands grounded in state as well as federal law. Appeal drafting will also be discussed.

Agenda:

• What is a recoupment and reason it is usually commenced by an insurer Special Investigative Unit (“SIU” Unit).
• Explain how a defund demand is nothing more than a retroactive denial and reasons that is important.
• The specific information that an auditor is required to include in a refund demand or rercoupment request.
• Discuss Cross-Plan offsetting and how to stop health plans and auditors from using this tactic.
• Provide summary of state and federal law governing refund demands and overpayment request by insurers and health plans.
• Appeals drafting techniques will be discussed.
• The difference between commercial insurer versus Medicare refund requests will be explained.
• Basic ERISA Health Plan obligations will be discussed and explained reasons this is important with respect to refund demands by health plans and insurers.

Objectives:

Audience will learn how to object and appeal refund demands, audits and recoupment demands from health plans and insurers which can save the healthcare practitioner hundreds of thousands of dollars in potential repayments.

Who Should Attend:

Healthcare providers and their revenue cycle staff, medical practices office managers and billing staff, healthcare compliance attorneys and consultants