HFMA OK-Lone Star (PCCP Government)

If you are having difficulty getting government claims paid, more than likely it’s something you didn’t do.
Health insurance is something of an opaque industry. As a consumer, we know we have to pay the premium in full (no partial or UCR payments), we just have no clue how the payor arrived at that rate.
In contrast, when a provider bills, payors often want itemized statements, original invoices for implants or supplies, city fee schedules, rate surveys, etc. to substantiate what is being charged.
As advocates, we must demand substantiation of payor actions or inaction.
In this powerful half day session, you will learn:

1. How to challenge UCR payments and get 100% billed charges.
2. How to work DHCS refund reclamation claims.
3. How to waive Medicare/Palmetto Timely filing denials.
4. How to Increase CMS Oversight over Medicare Advantage Plans
5. How to request internal VA and CMS prompt payment/complaint directives and policies under the Freedom of Information Act.