How to Defend Against Recoupments, Repayment Demands and SIU Audits

Marketing and Empathy Psychology

By - Thomas J. Force, Esq.

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Webinar Overview

This webinar will provide strategies for defending against demands from insurers and health plans seeking refunds due to retroactive denials. These denials may be based on various reasons, including medical necessity and fee forgiveness. The session will cover audits and refund demands grounded in both state and federal law. Additionally, techniques for drafting appeals will be discussed.

Agenda

Recoupments: Understanding why insurers’ Special Investigative Units (SIU) usually commence recoupments.
Retroactive Denials: Explanation of defund demands as retroactive denials and the importance of this distinction.
Auditor Requirements: Information auditors must include in refund demands or recoupment requests.
Cross-Plan Offsetting: How to stop health plans and auditors from using cross-plan offsetting tactics.
Legal Summary: Overview of state and federal laws governing refund demands and overpayment requests by insurers and health plans.
Appeal Drafting Techniques: Practical advice on drafting effective appeals.
Medicare vs. Commercial Insurer Requests: Differences between commercial insurer and Medicare refund requests.
ERISA Health Plan Obligations: Basic obligations under ERISA health plans and their significance in the context of refund demands by health plans and insurers.

Objectives

Participants will learn how to object to and appeal refund demands, audits, and recoupment demands from health plans and insurers. This knowledge can potentially save healthcare practitioners hundreds of thousands of dollars in repayments.

Who Should Attend

Healthcare providers and their revenue cycle staff
Medical practice office managers and billing staff
Healthcare compliance attorneys and consultants

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Webinar Type

Clear

Speaker Detail

Thomas J. Force is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group. Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students. Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations. On March 29th, 2022, Thomas J. Force, J.D, Esq, President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section. For more information on this forum, please email Mr. Force.