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