Insurance Coding and Billing for the Medical Office

Complete Seminar Details

Discover the most efficient way to prepare claims, submit and follow up! Included will be Medicare, Medicaid and Third Party Insurance.

The 2008 CMS Payment Report Update shows that during 2006-2007 Medicare UNDERPAID claims by $900,000,000 (Nine Hundred Million Dollars). This translates into YOUR practice's money that is sitting out there waiting for you to claim it. In the majority of cases, improper coding and documentation was the culprit. Of the claims rejected by Medicare, 57.7% of the errors are due to coding mistakes and 27% due to insufficient documentation. Routinely a practice will resubmit only 40% of the claims that are rejected, due to issues with documentation being insufficient for an appeal. The medical billing process starts long before the patient actually arrives for the appointment and continues after the patient leaves the office. Medical billing and collection problems often occur as a result of oversight or error and in some instances due to lack of knowledge in the billing department. Reimbursement involves the complex system of ICD-9 and CPT codes for diagnosis and procedures and on coordinating and properly submitting those codes. The financial success of the practice and a positive cash flow depends on proper reimbursement. Dealing with denied and rejected claims can be costly and frustrating!

The purpose of this one-day seminar is to help you understand the claims process and avoid unnecessary back end work. Optimal reimbursement means to submit a claim once and be reimbursed—the FIRST time you submit it. Attendees will discover tips and techniques to help achieve this goal for timely and optimal reimbursement. Examine the most common reasons for claim denials and how to correct them. Discover how to document for medical necessity and determine when to appeal if a claim is rejected. Learn how to handle downcoding, decipher an EOB and navigate the "ins and outs" of billing Medicare, Medicaid and private party insurance. Participants will leave with a better understanding of how to effectively utilize CPT, ICD-9, HCPCS II and modifier codes to ensure proper payment. This course is a MUST for anyone who is involved in coding, billing or reimbursement for the physician practice—including the physicians themselves!!

WHAT YOU WILL COVER

• Discuss diagnosis coding and linking ICD-9 to CPT codes to ensure you aren't coding creatively just to conform to payment policies
• Examine how modifiers can be used effectively for reimbursement
• Determine how to effectively navigate the ins and outs of Medicare, Medicaid and private party insurance
• Understand documentation requirements and recognize the components of a good narrative
• Discover how to code your claim correctly the first time you submit for maximum reimbursement and fewer hassles!
• Maximize your reimbursement by emphasizing proper coding
• Examine how documentation can make or break an appeal
• Determine when to appeal and when to submit a corrected claim
• Identify when to use attachments
• Outline how to write proper appeal letters
• Explain how to treat medical necessity denials
• Analyze the credentialing process and what it means to your practice
• Identify what your EOB and insurance contracts mean
• Discuss tips and techniques to obtain optimal and timely reimbursement
• Examine how profiling your physician can translate to maximum reimbursement
• Learn about bundling and how or when to unbundle codes
• Illustrate proper submission of incident-to claims
• Recognize what downcoding is, how to fight it and avoid it

WHO SHOULD ATTEND

• All Coding and Billing Personnel
• All Physicians
• Physician Assistants
• Nurse Practitioners
• All Office Managers
• Medical Assistants
• Cross-Training Receptionists, Cashiers
• Anyone responsible for medical services reimbursement

Sponsor Background:

Leading the Way in Professional Development.

Cross Country Education is a national leader in high-quality educational products and services for the entire health care industry. Our seminars and training programs are designed to help health care providers achieve improved performance and results in all areas of clinical, financial and operational management. Our faculty of more than 150 instructors are the "best of the best" in their field of expertise and know how to provide programs that really make a difference to participants.

Since 1995, we have trained over 1,000,000 providers, managers, nurses, behavioral health professionals and other key personnel throughout the entire healthcare industry. We produce over 5,000 seminars and conferences annually for the health care industry. Plus, we coordinate in-house training for health care facilities. Let us provide your training and professional education needs!

Our Mission Statement

“CCE exists to identify and provide opportunities for relevant continuing education in a timely and geographically friendly manner that will meet and exceed the needs and expectations of targeted professionals.”

Quote From Past Participants:

"The course and this instructor should be part of residency programs. I know that I have saved or will make tens of thousands of dollars as a result of this knowledge. I do my own coding and wonder how much money I lost before this class. She was great!" - MD, Physician, Fairfax, VA

"Excellent course. I particularly like the way Debra keeps the participants involved throughout." - George Washington University Hospital, Administrator Physician, Fairfax, VA