Addressing Carrier Repayment Demands

Addressing Carrier Repayment Demands Webinar Increasingly, payers will extrapolate alleged overpayments and demand across-the-board repayments, even for valid claims. Worse, carriers will reduce payments on future claims as a means of correcting alleged overpayments on past claims. Most repayment demands are based on carrier mis-interpretation of "CPT" and "ICD" guidelines. Pediatricians need to be prepared to challenge inappropriate repayment claims. Otherwise, faced with unstable revenue and disbursements, pediatric practices will not be able to maintain operations. Knowing correct coding and having documentation to support the case against repayment demands will protect and preserve practice revenue and diminish charges of fraudulent billing. This 60-minute webinar will provide pediatricians and practice staff with the tools needed to effectively minimize the occurrence of repayment demands as well as challenge inappropriate repayment claims. By the end of the webinar, participants will Apply key steps in responding to payer take-back demands. Use coding guidelines and documentation to build your case. Learn how to include key provisions in contracts that protect the practice and define the scope of take backs and repayments. Be aware of state regulations on repayments. Incorporating appropriate coding and documentation to minimize carrier take back demands. About the Presenter: Kathleen Cain, MD, FAAP, is an entrepreneurial pediatrician who has built a thriving practice from the ground up. She learned business strategy and negotiation as a means of financial survival. For the last 6 years, she has been a member of the American Academy of Pediatrics (AAP) Private Payer Advocacy Advisory Committee (PPAAC). Her interest in the management of a financially successful practice and her relationship and successes with managed care have afforded Dr Cain opportunities to be a leader and teach others that good business is good medicine. As a member of the PPAAC, she has had the opportunity to address many coding and payment concerns of pediatricians. She has lectured and written articles for the AAP on coding, Current Procedural Terminology, and the Resource-Based Relative Value Scale.