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The Webinar will discuss what recoupment and audit are, the reasons that insurance companies state are the reasons for the overpayments, and what steps should be taken to defend against the insurance company’s overpayment demands. The Webinar will address the ERISA obligations and protections and the importance of a provider obtaining a valid Assignment of Benefits. It will also set forth the notifications which must be sent out by the insurance company when it conducts an audit and seeks recoupment.
The Webinar will discuss the concept of full and fair review and that recoupment demands are considered “adverse benefit determinations”. It will advise the attendees of what information they are entitled to so that they can respond to and defend the audit findings and recoupment demands. The presenter will discuss various court cases on these issues and the most common basis for recoupments, such as services not covered under the plan or non-compliant.
The Webinar will go through what should be done when a provider receives an audit or overpayment demand, how to object, appeal, hire an expert and make document requests. It will also address the state insurance laws regarding time frames to request recoupments. Finally, it will discuss what happens when the insurance company does not comply with the ERISA demands.
Areas Covered in the Session: