“Sometimes you are the only thing that stands between the single crushing blow of a negligent HMO utilization decision and your patient.”
With the health care safety net for millions of Californians imperiled by the economic crisis and payor unfair payment practices, ERN/The National Council on Reimbursement Advocacy (ERN/NCRA) has organized a powerful, interactive session to arm physicians, case managers and admission professionals with administrative laws that overturn denials for emergency services and care, post-stabilization treatment, lack of authorization and medical necessity.
- Untimely authorizations of poststabilization services and transfers have been on the rise.
- Plans are failing to make a decision to authorize care or effectuate transfer for patients within the 30-60 minute statutory timeframe.
- Millions of dollars in hospital and professional claims have been lost as a result of plans improperly denying payment after the patient is discharged or expired.
SOMEONE HAS TO DO SOMETHING.
In this session, participants will learn:
- How to advocate for medically appropriate healthcare as required by CA Business and Professions Code §510.
- How to convert tracking/reference numbers to authorization numbers to avoid denied days (beyond stabilization) for statutorily authorized services.
- How to challenge observation vs. inpatient LOC denials.
- How to fight concurrent denials and initiate a notice of disagreement of care to trigger the plan’s responsibility to assume care for patients.
- How to challenge a plan’s refusal to conduct retrospective review for unauthorized medically necessary services (i.e. provided after normal business hours, or when the patient’s insurance information was not provided, etc.)
- How to challenge improper requests for medical review/records when the plan failed to respond to a request for authorization timely.
- HMO, MA, VA & CCS laws that relate to emergency and poststabilization reimbursement and prevent improper denials and MORE!
For one low price—just $399.00 per person—you’ll get: 1.) Hundreds of pages of informational and practical instructional materials 2.) Sample Letters, Affidavits and Case Study Examples 3.) NCRA/ERN administered PDUs AND 4.) A Free Online Post-Practice Assessment Test. Best of all, you’ll get answers to your specific questions, as we open up deliberations with your Master Trainer!
Minimum of 10 attendees required.