There are several parts of seeing a patient and receiving payment for professional services. Eligibility ensures that the patient’s insurance coverage is active on the date of service that the services will be rendered and that their plan covers the services planned. There are different methods of receiving eligibility information and we are going to discuss these. Once eligibility is verified, certain procedures require the provider to contact the insurance company to receive prior authorization. Unfortunately, every insurance company has different requirements, making it difficult to manage. It is important that offices keep track of the current policies for the insurance companies they work with the most, and ensure these authorizations are performed prior to the service being performed. Medical necessity is normally reported by the ICD-10-CM codes. These codes justify why a procedure or service is performed based on the patient’s condition. The insurance companies may have policies that define the services they consider medically necessary based on the diagnosis. If the information on the claim does not meet their guidelines, the claim will be denied.
Areas Covered in the Session:-
Learning Objectives:-
Why Should You Attend:-
In order for providers to receive reimbursement for professional services the insurance company must receive a clean claim. Part of creating a clean claim is verifying the patient has coverage, obtaining prior-authorization if necessary, and ensuring that the patient’s condition meets the medical necessity described by the insurance. Attendees will gain knowledge about these issues and understand the processes necessary to streamline this into workflow for efficiency.
Who Will Benefit:-
Any Organization, Institution or Group User can register
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Order FormAccess Information for Live Session will be emailed to you 12 hours prior the live date.
Access Information for On-Demand, and Transcript will be emailed to you 24 hours post of the live session.
Also, You can access the training information from your dashboard at WebianarAxis.
Lynn Anderanin, CPC, CPB, CPPM, CPMA, CPC-I, COSC, has over 40 years of experience in all areas of the physician practice, specializing in Orthopaedics For AAPC Lynn is currently a VILT Instructor, Workshop, and Audio Presenter. She is the founder of her Local Chapter and a former member of the NAB.
She is the Sr. Director of Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicagoland, area. She has over 30 years of 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 Orthopedics, Rheumatology, and Hematology/Oncology.
