As part of the NJDPA's Practice Enhancement Program, we are offering a billing optimization system that will protect you and your practice and enhance your monetary collections via a three-phase program:PHASE I:
Out-Of-Network Healthcare Reimbursement Compliance ProgramPHASE II:
Claims AppealsPHASE III:
Phase 1Out-Of-Network Healthcare Reimbursement Compliance Program
- Initiate a comprehensive practice review and consultation at a discounted rate for NJDPA members.
- Identify deficiencies and/or vulnerabilities in your reimbursement process due to missing or incomplete documentation or data.
- Implement a compliance program consistent with federal law and industry “best practices” for out-of-network billing.
- Protect yourself, and your practice from insurance-company driven particular investigation unit (SIU) audits that can result in massive fines or possible jail time for insurance fraud.
Phase 2Claims Appeal
- Know your appeal rights and appeal tactically.
- Exercise efficient and effective appeals to the relevant claims administrator (Aetna, UHC, BCBS, etc.) and ERISA plan sponsors.
- AVYM can assist NJDPA members on a discounted basis with the following:
- Learning basic claims appeal procedures
- Interpreting EOBs/ERA 835s and recognizing denial types
- Challenging and potentially overturning overpayment refund demands and offsets
- Challenging and possibly Reversing fake "PPO" or "Negotiated Discount" denials
- Preparing for and responding to audits and SIU reviews.
Phase 3Claims Litigation
- Once the administrative appeals process is thoroughly exhausted, the provider and/or patient can sue for benefits due and owing to a patient or provider holding a valid assignment of benefits with the patient.
- NJDPA members will enjoy the added interests of having a streamlined and cost-effective process, which is specifically designed to put individual members in the best possible position when facing the decision to prosecute.
- Each payment dispute may be different depending on the factual disposition of the case at the administrative level.
- Our legal partners have developed strong litigation experience in leveraging various state and federal laws such as ERISA to arm out-of-network providers with viable legal claims designed to place real pressure on payors to pay what is reasonably owed to providers for services rendered.
- Going even further, to the extent that a given NJDPA member wishes to become a participating provider but has been stonewalled in obtaining access to a given provider network or contract, our legal partners have assisted a multitude of providers in obtaining network access through a legal means.
Master Class Series
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