Out of network (OON) providers keep facing recoupment, refund demand and so-called special investigations (SIUs) from insurance payers and health plan. If you are an out of network provider, it is imperative that you balance bill your patients for the difference between charge and payment. The Webinar will discuss what a recoupment and audit is, the reasons that insurance companies state are the reasons for the overpayments and what steps should be taken to defend against the insurance company’s overpayment demands. The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits. It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment.
Sign up for this 60 min webinar where industry veteran Thomas J. Force, ESQ. will discuss the concept of full and fair review and that recoupment demands are considered “adverse benefit determinations”. He will advise the attendees of what information they are entitled to so that they can respond to and defend the audit findings and recoupment demands. Thomas will also discuss various court cases on these issues and most common basis for recoupments, such as services not covered under the plan or non-compliant.
As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based Accident and Health Insurance Company where he served as Chief Compliance Officer propelled the founding of The Patriot Group. The Patriot Group is a full service revenue recovery company that provides billing, collections, and follow-up services as well as assistance with managed care appeals, managed care contracting, credentialing and compliance.