Common challenges healthcare providers encounter in establishing and maintaining an effective process for managing patient admissions and access to healthcare services in conjunction with ensuring prompt reimbursement.

In addition to clinical denials, healthcare providers are increasingly experiencing denied or reduced payments due to self-funded health plans, unauthorized discounts, inappropriate requests for refunds, and etc. In AHC’s “Appeals Strategy Workshop”, an attorney will provide information on common reimbursement challenges and provider friendly legislation that can be referenced in an appeal. Effective strategies for appealing payment decisions will also be discussed.

The Insurance Reimbursement Law Workshop will address common reimbursement challenges—enforcement of prompt payment, usual & customary discounts, pre-existing condition denials (HIPAA), misquote of benefits, coverage provided under COBRA, and refund demands—the goal being to empower attendees with helpful information they can use in administering insurance claims with carriers. Other topics addressed include recent federal legislation, case law, and specific state statutes governing healthcare reimbursement.

Negotiating a well-defined, balanced managed contract can forestall many of the reimbursement and revenue dilemmas that are prevalent in the healthcare industry today, such as slow payment, medical necessity and treatment disputes, unauthorized discounts, etc. AHC’s “Reimbursement Aspects of Managed Care Contracts” presentation recognizes the above challenges and provides hospital staff members with tools that will aide in safeguarding their interests and fostering better, more productive relationships with business partners and the community.

The practice of unilaterally applying “usual and customary” reductions to claims payments has become increasingly common. AHC’s workshop, “Managing Usual and Customary Denials: A Legal Perspective” will help providers develop a payer specific approach to resolving reimbursement reduction issues. Education will be provided on the different tactics employed by each payer, the state statutes, federal regulations, and case law that govern each payer, the correct guidelines to utilize in determining “reasonableness” of charges for each payer, and the appropriateness of patient involvement in each payer situation.