TESTIMONIALS

Customized Medical Claims Training

“Hands On” Medical Claims Training can also come to your office, with topics chosen based on the needs you identify. The program is designed by your selection of practical current topics.  The cost for the program you choose is determined by the combined length of the topics, and includes copy-ready training materials.

“Hands On” Medical Claims Training can be performed for your claims staff, excess loss clients, and/or claims’ payment users.

Contact us to discuss details of your customized training program requirements.

TOPICS AVAILABLE

For Customized Medical Claims Training you select the topics to be covered, depending on the needs of your staff.

Some of our current topics include:

·        Coding, Billing & More Issues – Guidelines for evaluating unbundled medical and surgical claims, including evaluating the coding bundle, evaluating the operative report, rebundling tools and tips, PPO issues, factors impacting amount billed, quantifying discount/negotiation, surgical package, E&M codes, plan language, new trends, “hands-on” examples and actual claim cases.

·        Epogen and Dialysis – Guidelines to help you evaluate, including reasonable and customary, audit issues, standard protocols, medical necessity, overutilization, “red flags” for fraud, an actual fraud case, and a sample audit worksheet. 
          
·        Fraud & Abuse – Guidelines to help you identify, deter and investigate fraud, including provider verification, hospital coding diagnosis, specific types of potential scams, “red flags” to watch for, fraud training and awareness programs, documentation (good vs. bad) and actual live claim cases.

·        Hot Topics for Current Issues – Active group discussions on issues such as:  Pharmacy Benefit Management, bariatric coverage, breast reduction, outsourcing claims, at-home processors and opting out of PPO agreements.

·        Inhospitable Hospital Issues – Discussion regarding the impact of plan design, eligibility issues of facilities, PPO issues, alternative cost reduction methods, “red flags”, questionable billing practices and whether to audit or not.

·        Partnerships:  Administrators, Stop Loss Carriers and Vendors Working Together to Mitigate Losses  - Administrators, stop loss carriers and vendors working together to mitigate losses.  What have you done lately?

·        Physical Therapy – Guidelines provided to review these claims including:  Plan considerations, documentation, who’s providing care, fraudulent and/or abusive billing, hands-on or hands-off, timing and review tips.  We can also provide an exam to test your knowledge after discussion, articles and “hands on” exercises are provided.

·        Plan Language – Plan language is the basis of any claims decision.  Guidelines and discussion are provided regarding plan design, failure to comply, common problems, resources, recommendations and “hands on” exercises.

Many other topics are also available. Please contact us for more details on developing a custom training program to meet your needs.