Steve Verno. I am NOT a lawyer. I DO NOT provide legal advice. The information in this presentation is for training purposes only!

Slides:

Advertisements

Similar presentations

Federal Tort Claims Act (FTCA) Free Clinics Program Technical Assistance Call Department of Health and Human Services Health Resources and Services Administration.

Advertisements

OUTLINE OF SALE PROCEDURE FOR THE SALE OF THE STATE’S SHARES HELD BY THE STATE IN THE GOVERNMENT COINS AND MEDALS CORPORATION LTD. (the “MEDALS COMPANY”).

What is an Accountable Care Organization?

HIPAA HIPAA Health Insurance Portability and Accountability Act of 1996.

Certified Medical Coders (CMC) translate clinical data from patient health records and assign appropriate medical codes. Their work is submitted to.

Module 14: Claims & Appeals. 2 Module Objectives After this module, you should be able to: Describe the purpose of a claim Explain who can file claims.

2011 FRAUD & ABUSE UPDATE John Hellow Hooper, Lundy & Bookman, PC All views expressed in the seminar materials and.

Module 13: Claims & Appeals. Module Objectives After this module, you should be able to: Identify claim basics and where to submit claims Recognize who.

Claims Recovery Service. Prerequisites Treat patients with commercial health insurance and/or out-of-network Possess/have access to claim records: + 835s.

House Bill 2437 Health Carrier Access Payment Commissioner Kim Holland Oklahoma Insurance Department.

Bradley J. Berg | Rev Introduction to the Interlocal Cooperation Act AWPHD Annual Membership Meeting October 10, 2012.

How to create a sense of Urgency with Payers Presented to the Wisconsin Revenue Cycle Co-Op/AAHAM May 8, 2014 By Isaac S. Schreibman, Esq.

© 2007 Prentice Hall, Business Law, sixth edition, Henry R. Cheeseman Limited Liability Companies and Limited Liability Partnerships.

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Step 7 in the Medical Billing Cycle: Prepare and Transmit Claims 1-16 Medical practices produce.

The Medical Billing Cycle

The Blue Plans, Private Insurance, and Managed Care Plans

Employment Law (Management 445) Professor Charles H. Smith Employee Retirement Income Security Act (Chapter 9) Fall 2006.

 Indemnity or Fee-for-Service coverage- -allow you go to the doctor of your choice and pay for services at the time of the visit. -The amount that your.

Central TRICARE Service Center

© 2009 Cengage Learning. All Rights Reserved. State and Federal Roles in Health Care Regulation.

2010 UBO/UBU Conference Title: How to Interpret an EOB Session: R

1 Prompt Payment to Providers 28 TAC §§ Patricia Brewer Director of Project Oversight - Life Health & Licensing Texas Department of Insurance.

Insurance Terms and Concepts Medical Insurance involves a contract in which a business agrees to pay a portion of a patient’s medical expenses in exchange.

Introduction to US Healthcare. History Patients paid directly Help from religious and charitable organizations Technology Advances in healthcare made.

From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference 1 Briefing:The JAG’s Role in the Third Party Collections & Policy.

1 Contract Do’s and Don’ts Henry W. Lavandera Lynn Cash.

Insurance Lori Howard. Terms n Claim n Premium n Deductible n Benefits n Primary Coverage n Secondary Coverage n Rider n Exclusions n Provider n Co-pay.

Legal Issues in Hospital- Hospice (and Other) Partnerships Brooke Bumpers, Esq. Hogan & Hartson, LLP Washington, D.C. October 12, 2002.

2006 Medical Group Forum Group Practice Operating Issues Session II C.

Copyright © 2004 by Prentice-Hall. All rights reserved. PowerPoint Slides to Accompany BUSINESS LAW E-Commerce and Digital Law International Law and Ethics.

Dental Insurance.  The Plan – A contract between the employer and the Insurance company  Provider – The healthcare facility where treatment is rendered.

Insurance.  Many people in the US are ________ – assume all responsibility for health care costs.  Insurance _______ out of pocket expenses for health.

Health Insurance Portability and Accountability Act (HIPAA)

Computerized Networking of HIV Providers Workshop Data Security, Privacy and HIPAA: Focus on Privacy Joy L. Pritts, J.D. Assistant Research Professor Health.

Module 13: Claims & Appeals. Module Objectives After this module, you should be able to: Identify claim basics and where to submit claims Recognize who.

CLINICAL RESEARCH STUDIES Janette Hannam, MS, CTRA Asst. Director for Research, OSP.

Chapter 11 The Blue Plans, Private Insurance, and Managed Care Plans Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier.

Insurance. Health Insurance  Many people in the US are uninsured – assume all responsibility for health care costs.  Insurance decreases out of pocket.

Veterans Access, Choice and Accountability Act of 2014 (VACAA) The Choice Program, the Choice Card, and the Future.

VA/TRICARE Business Practices. TRICARE Basics Prime (HMO) Requires enrollment Primary Care Manager Requires authorization for outside care Extra (Preferred.

The Process of Appealing/Filing a Grievance for a Commercial Insurance Claim Steve Verno 1.

VACAA – The Choice Program / Choice Card Fast Facts Overview

Jeopardy. Office #1Insurance Finance Risk Mngmt Hodge Podge

OHCAs, ACEs and Hybrid Entities Paul Smith Davis Wright Tremaine LLP One Embarcadero Center Suite 600 San Francisco, CA (415)

Component 1: Introduction to Health Care and Public Health in the U.S. 1.4: Unit 4: Financing Health Care (Part 1) 1.4 c: Insurance and Third-Party Payers.

HIPAA Privacy Rules: What Are Plan Sponsors Required to Do?

HEALTH SYSTEMS ORGANIZATION 18 February HEALTHCARE ORGANIZATIONS In-patient Out-patient Home services Day care Equipment/Supplies Spa.

1 Insurance Billing Unit Overview 2 Who We Are Group of coders and insurance professionals who generate claims on behalf of registered providers for.

The Physician Payments Sunshine Act Legislation Ann Leopold Kaplan October 27, 2008.

2011 OGS State Purchasing Forum Navigating Proof of Coverage May 18-19, 2011 Required Proof of NYS Workers' Compensation and Disability Benefits Insurance.

HEALTH SYSTEMS ORGANIZATION 6 February HEALTHCARE ORGANIZATIONS.

Forms of Business Ownership GOALS UNDERSTAND THE THREE MAJOR FORMS OF BUSINESS OWNERSHIP. DETERMINE WHEN EACH FORM OF BUSINESS OWNERSHIP IS MOST APPROPRIATE.

1 Ministry of Labour, Invalids and Social Affairs.

FOCUS Spring Conference 2014 Legal Updates on Third Party Contracting and DME for Sleep Labs Jayme R. Matchinski May 16, 2014 Orlando, Florida.

Non-Student Accounts Receivable Julie Justice East Carolina University.

An Introduction to the Administrative Applications of Computers: Practice Management, Scheduling, and Accounting Chapter 3.

Common payor - provider contract language allowing Silent PPOs to thrive Common Contract LanguageContract less vulnerable to Silent PPO “Provider shall.

Chapter 4 The Legal and Regulatory Environment of Health Care.

Kelli Back, Attorney and APMA Consultant

Electronic Data Interchange (EDI)

Electronic Transactions Workshop

3 An Introduction to the Administrative Applications of Computers: Practice Management, Scheduling, and Accounting.

DRAFT - FOR REVIEW PURPOSES ONLY

Patient Financial Service Delivery (Health Information Management)

Brussels, June 6, 2007 Paul E. Kalb, M.D., J.D.

Chapter 17 Medical Insurance.

HMO IPA Health Maintenance Organization (HMO) Models Staff Model

LIMITED LIABILITY COMPANIES AND LIMITED LIABILITY PARTNERSHIPS

AR Can of Worms Where We Started

Recording Purchases and Cash Payments Using Special Journals

Presentation transcript:

Steve Verno

I am NOT a lawyer. I DO NOT provide legal advice. The information in this presentation is for training purposes only!

Health Insurance Contracts can be very complicated and should be reviewed by an expert, preferably a health care lawyer!

Most health insurance contracts are Pro- Insurance Company

Silent PPO Claim Submission Claim Payment Overpayments Appeal Termination

This Agreement is entered into by and between Insurance Company A, contracting on behalf of itself, Company A and the other entities that are its Affiliates (collectively referred to as Company A) and Provider B (Name of Provider). Any corporation, partnership or other legal entity (including any Plan) directly or indirectly owned or controlled by, or which owns or controls, or which is under common ownership or control with Company. An insurance company could have 5,000 affiliates or entities.

List anyone and everyone authorized access to YOUR contract within the Contract! If they aren't listed, they aren't allowed access. Give approving authority, in writing, to any new entity or affiliate that the insurance company wants to add or purchases.

Physician Group must submit these claim forms to Company A within one hundred eighty (180) days of 1) the date such services were provided when Company A is the primary payor, or 2) the date of Physician Group's receipt of the explanation of benefits ("EOB") when Company A is the secondary payor in order for Physician Group to be entitled to payment for such services provided pursuant to this Agreement.

State Law for claim submission timeframe The Patients claim submission timeframe Federal Regulation 29 CFR (ERISA)