This year CMS has made several changes to billing, reimbursement and coverage, for both Medicare and Commercial plans and coverage. This webinar will Not only discuss in detail some of the 2024 Medicare coverage changes in 2024, but also you will get idea of dealing with Medicare and Commercial plans that are not following the law. You will be able to identify when the carriers including Medicare Advantage plans are lying about pre-auth and how to call them on it, and also address which law to quote to make the MA plans pay for everything that Medicare Part B pays for. This session will help you to understand valid information to support my appeals and disputes that continue to be denied and go unresolved.

Learning Objectives:

• Learn how to stop CIOX and others from large numbers of records requests. Learn what the law says they cannot do
• Identify when the carriers (Including Medicare Advantage Plans) are lying about pre-auth and how to call them on it
• Address which law to quote to make the MA plans pay for everything that medicare part B pays for
• Stop MA plans from paying you less than they are required to by law
• How to report carriers & MA plans for denying claims without a full and fair review
• It is a violation of law to require documentation on all surgeries
• No more requiring pre-auth when pre-auth is not required
• Learn how to educate third party plans that their requests for records are illegal & how to quote the law to them
• Find out who to report to on medicare part C denying pre-authorizations
• Discover how MA plans are not allowed to make up their own rules
• See how to make MA plans honor the 1 year timely filing that the federal law requires them to honor
• Find out why your timely filing periods are not what you think they are
• Get a list of the 268 CPT/HCPCS codes covered under provisional and permanent telehealth status
• Learn how your fees might be reducing the medicare allowed amount on services you are billing for

Areas Covered in the Session:

• Understanding record requests by Medicare Plans & Others
  • Learn to Stop Excessive Records Requests by CIOX and Others
  • Legal Boundaries: What Record Requestors Legally Can’t Do
• Navigating Carrier and Medicare Advantage Plan Tactics
  • Identify False Claims About Pre-authorization by Carriers
  • Addressing Medicare Advantage Plans: Ensuring Full Payment Compliance
  • Tackling Underpayment: Making MA Plans Pay Legally Required Rates
  • Reporting Unfair Claim Denials by Carriers & MA Plans
  • Countering Illegal Documentation Demands for Surgeries
  • Challenging Unnecessary Pre-Authorization Requirements
• Legal Strategies and Compliance
  • Educating Third Parties on Illegal Record Requests
  • Understanding MA Plans’ Limitations in Rule-Making
  • Ensuring MA Plans Adhere to Federal Timely Filing Standards
  • Deciphering Your Actual Timely Filing Periods
  • List of CPT/HCPCS Codes for Telehealth Coverage
  • How Your Fees Might Affect Medicare Allowed Amounts

Suggested Attendees:

• Hospital CEOs, CFOs and COOs
• Medical Providers
• Administrators
• Office Managers
• Medical Billers
• Claims Coders
• Billing Staff and Companies
• Physicians and Other Providers
• Healthcare Consultants
• Compliance Officers
• Practice Manager
• In and Out of Network Providers
• Medical Billing Companies
• Providers Office Staff
• Hospitals and Facilities
• Insurance Companies
• Healthcare Attorneys