The Patriot Group Logo: The Future of Revenue Recovery

The Balance Billing Requirement: Why Providers Must Balance Bill Patients

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...truly the best appeals specialists
that I have ever encountered in the industry...

~ Long Island Eye Surgical Centers

...have been the key to
fighting my appeals when these cases were going nowhere...

~ Dimitri Koumanis, MD

...are, without question, the
foremost insurance appeals authority in the industry...

~ Medicomp, Inc.

It’s easy for out-of-network (OON) healthcare providers to make critical mistakes that jeopardize their compliance with state and federal laws. For instance, many providers will tell patients that they accept any payment from their health plans as payment in full. But this practice is risky and may invite accusations of fraud from the health plans.

Recent lawsuits have put the spotlight on billing related errors such as overpayments, negligent misrepresentation, OON write-offs and balance billing, and ended in very real legal nightmares for practices. In addition, HHS is actively watching and waiting to catch billing errors and noncompliant practices. The bottom line is that failure to balance bill patients can lead to large recoupments, audits and litigation for fraud.

In this session, expert speaker Thomas Force, Esq. will instruct OON providers and their revenue recovery staff on how to maintain compliance and avoid litigation while collecting the proper amount of money from patients’ health plans. You’ll also learn about state laws relating to balance billing requirements for OON providers, as well as recent cases in which health plans sued OON providers who failed to balance bill their patients. He will also discuss the penalties for noncompliance and provide a patient-friendly sample balance bill letter and sample charity care policy.

* Current best practices in dealing with OON claims
* Summary of issues that OON providers face dealing with Health Plans
* Overview of OON Reimbursements & Charge Analysis
* Techniques to appeal denied and under reimbursed claims
* Clinical denials, how to handle External Appeals and Independent Medical Reviews
* Techniques to write an effective Appeal letter/Objection letter to audit
* Overview of ERISA protections and obligations of Plan Administrators
* Overview of Prompt Payment Law and insurers’ obligations
* List of patient forms and disclosures essential to appeals and fraud audit defense
* Review of Eligibility Issues
* Balance Billing and Recoupment Strategies

[Attendance Special] Lookout for bonus material following the event.
Material: 45-minutes
Q&A: 25-minutes

Thomas J. Force, Esq. is a nationally recognized expert and frequent speaker on managed care issues, managed care contracting, managed care appeals, ERISA and out-of-network reimbursement issues. He has been a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries.

He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general counsel and chief compliance officer of a small New York-domiciled health insurer, a former chief operating officer, general counsel and chief compliance officer of a large East Coast billing, collections and healthcare consulting company, and a former co-chair of the Health & Hospital Law Committee of the Suffolk County Bar Association. 

Thomas recently presented on ERISA-related issues to the American College of Osteopathic Surgeons in Las Vegas and to the Medical Society of New Jersey.

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Additional Benefits

Topics Include:
* Balance Billing & Fee Forgiveness
* The Rise of Audits (prevention, security & defense)
* Eligibility, Disclosures & much more!

Bonus Material:
*Registrants can access Replays
*Attendees will receive the slides (+ Bonus tools)

The Patriot Group Webinars

Meet The Host

Thomas J. Force, Esq.
As a state and federally licensed attorney in both New Jersey and New York, Mr. Force has over 30 years of experience in the healthcare and insurance industries. Mr. Force is nationally recognized as an expert in revenue collection techniques, managed care contracting and appeal strategies.

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"Tom Force and Patriot Group have been instrumental to the growth of my practice. They are true advocates of both physicians and patients at a time when no such industry advocates can be found. His services are a great asset to the medical field."
~ James Bruno MD

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