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The Insurance Playbook: Strategies for Managing Eligibility, Prior Authorization, and Medical Necessity

By - Lynn Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC

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Understanding Eligibility, Prior Authorization, and Medical Necessity

Healthcare providers often face challenges navigating the requirements set by insurance companies to ensure claims are processed and paid. Even with the proper steps taken, there is no guarantee of payment. Many services require prior authorization, which must be secured before performing certain procedures. Insurance companies frequently update their prior authorization rules, and changes in employer-provided insurance plans can complicate matters further.

This webinar will guide healthcare professionals through the process of verifying patient eligibility before services are rendered, ensuring that insurance details are accurate and up-to-date. We will also cover the necessary steps for obtaining prior authorization for specific services and procedures to facilitate reimbursement. Additionally, we’ll discuss the importance of meeting medical necessity criteria as defined by insurance companies, which is crucial for claim approval.

By attending this session, participants will learn to navigate the complexities of eligibility, prior authorization, and medical necessity, significantly reducing the risk of claim denials and improving the efficiency of the claims process. The webinar will provide actionable steps to ensure claims are submitted correctly and comply with insurance company guidelines and policies.

Webinar Objectives

Presenting an insurance card does not guarantee coverage for all services and procedures. Offices must verify patient eligibility for the date of service, secure prior authorization when required, and understand the insurer’s medical necessity criteria for the services performed. Mastering these components will enhance the success rate and speed of claim reimbursements.

Webinar Agenda

  • Techniques for verifying patient eligibility
  • Key information obtained through eligibility checks
  • Medicare options available to patients
  • When and why prior authorization is required
  • Strategies for securing authorization, including coding tips
  • Key policies of major insurance carriers on eligibility and authorization
  • How to assess and confirm medical necessity
  • Deciphering insurance carrier policies
  • Approaches to managing claim denials
  • Crafting effective appeal letters

Who Should Attend

  • Healthcare Consultants
  • Auditors
  • Compliance Officers
  • Physicians
  • Physician Assistants (PAs)
  • Nurses
  • Medical Billers
  • Coders
  • Claims Collectors
  • Claims Representatives
  • Claims Adjusters
  • Claims Processors
  • Managers
  • Supervisors
  • Administrators
  • Medical Assistants
  • Office Staff

This webinar is designed for anyone involved in the medical billing and coding process, aiming to enhance their understanding of the complex insurance claim landscape.

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Choose an option
Recording
$199.00
Flash Drive
$249.00
DVD
$249.00
Transcript
$199.00
Recording & Transcript
$299.00
Recording, DVD & Transcript
$349.00
DVD & Transcript
$299.00
Flash Drive & Transcript
$299.00

Speaker Detail

Lynn Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC

Lynn Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 40 years’ experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other Committees for the AAPC.

Webinar Information

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