Description

Your claim can be clinically appropriate, correctly coded, and supported by the medical record—and still be denied. Why? Because medical necessity alone does not guarantee payment.

Instead, your claim must also satisfy payer-specific coverage, diagnosis, policy-specific documentation, and units-of-service requirements (i.e., MUEs, LCDs, NCDs, Billing Articles, and other payer policies). Miss just one requirement and your practice suffers with increased denials, claims underpayments, or post-payment recoupments.

When is Medical Necessity Not Enough?

The good news is that revenue cycle expert Michelle Ronfeldt, RHIT, has developed a 60-minute online masterclass that helps you answer this critical question so you can get more of your claims paid.

Michelle will present a step-by-step masterclass that helps you utilize her repeatable process that allows you to better research and resolve coverage-related claim denials and get your practice paid more of what it’s due. The key steps in this process include:

• Uncover missing policy-required documentation that can trigger denials or post-payment recoupments.
• Calculate injectable-drug billing units and apply JW and JZ modifier requirements
• Pin down when to use an NCD, LCD, MUE, Billing Article, or other payer policy to determine the applicable coverage and billing requirements
• Determine whether reported diagnoses support services under applicable coverage requirements.
• Verify whether CPT® and HCPCS codes accurately reflect the service or drug provided.
• Recognize when orders or diagnoses require provider clarification before you submit claims.
• Evaluate paid claims for vulnerabilities before a payer audit results in a repayment demand.

Realistic Claim Scenarios

During this masterclass, Michelle will put you in the auditor’s seat.

You’ll examine claims and determine whether they should be paid, denied, appealed, or recouped—and see why the reason listed on a denial does not always reveal the underlying problem. You’ll also learn why simply changing a code and resubmitting the claim can lead to another denial or worse, get you audited.

Stop Guessing and Start Making the Right Correction

Claim denials are rarely as simple as they first appear. Bring your coverage, coding, units-of-service, and documentation questions to this live working session, and Michelle will answer them and help you understand how to apply her repeatable denial management process in your own practice.

Don’t continue correcting claims without knowing what actually went wrong. Register today for this expert-led online masterclass to learn how to identify the real reasons your claims are denied, choose the right next step, protect previously paid claims and prevent recurring reimbursement problems.  Reserve your access today.

NOTE: You’ll also receive access to Michelle’s free ARPro Medical Coverage Policy Resource Center, which provides convenient links to CMS coverage and billing resources. This tool makes it easier for you to research coverage requirements and determine the appropriate next step to combat your denied claims.