Description:

The healthcare landscape is continually shifting, influenced by advances in technology, changes in regulations, and evolving patient needs. In this dynamic environment, Prior Authorization has become a focal point where medical necessity, cost efficiency, and patient care intersect. Healthcare providers, insurance companies, and patients all have a stake in ensuring this process is efficient, transparent, and patient-centric. 

ICD-10-CM codes typically indicate the medical need for a procedure or service, explaining why a specific treatment is performed in response to a patient's condition. Insurance companies often have their criteria to determine what services they consider medically necessary based on the diagnosis. If the details on the insurance claim align with their standards, the claim will be accepted.

The webinar will provide a comprehensive overview of the current landscape to explore the latest trends and best practices in prior Authorization, revealing how stakeholders are modernizing and optimizing a process that profoundly impacts patient access to essential treatments and services also verifying the patient has coverage, obtaining prior Authorization if necessary, and ensuring that the patient's condition meets the medical necessity described by the insurance.

Areas Covered:

• Eligibility
• Prior-Authorization
• Retro-Authorization
• Medical Necessity

Webinar Highlights:

• The New Prior-Authorization Requirements of Medicare.
• Focus on Prior-Authorization, Retro, Medical Necessity, and eligibility.
• Insurance Policy Checklist.
• Methods were available to obtain eligibility efficiently.
• AIM Specialty guidelines for acromioplasty.
• Finding Medical necessity policies for the major insurance companies.
• Criteria used for coverage determination. 
• Provide secure access to eligibility information over the Internet.
•  Discuss on NCD and LCD.
• Writing an Appeal and moving towards the following steps when a claim is denied. 
• Methods of receiving eligibility information.
• Considering HIPAA Act and Guidelines for Medicare coverage.
• Prior authorization checklist of patient information and the procedures. 
• Plan benefits based on the provider's status in the patient's network.
• Eligibility operating rules require health plans to respond to providers' eligibility questions with a patient's financial information in real-time.

Why Should You Attend:

In a world where healthcare continues to evolve, the prior authorization process is critical in ensuring efficient care delivery while managing costs. Current trends and best practices emphasize a shift towards automation, transparency, and evidence-based decision-making. This development aims to reduce administrative burdens, expedite approvals, and provide patients timely access to the necessary treatments. Healthcare providers, insurance companies, and patients must stay informed about the trends and best practices for effective prior authorization management.

Who Should Attend:

• Billers
• Coders
• Administrators
• Collector
• Supervisors
• Claims adjusters
• Reimbursement Specialist
• Surgery Schedulers
• Prior authorization staff
• Providers-Physicians, therapists, non-physician.

Presenter Information:

Name: Lynn M. Anderanin

Lynn Anderanin, CPC, CPB, CPPM, CPMA, CPC-I, COSC, has over 40 years of experience in all areas of the physician practice, specializing in Orthopaedics For AAPC Lynn is currently a VILT Instructor, Workshop, and Audio Presenter. She is the founder of her Local Chapter and a former member of the NAB.

She is the Sr. Director of Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicagoland, area. She has over 30 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.