This webinar will discuss the basics of insurance coverage, eligibility, and prior authorization to assist providers in obtaining this information from insurance companies to help patients understand what their insurance will pay, and what may be their responsibility. Attendees will learn the differences between a patient’s insurance coverage, eligibility, and prior authorization and then be able to apply their knowledge in their office. Most insurance companies offer different plans that cover different services and procedures. Once an office has verified that a patient is eligible for benefits on a particular day, the coverage will determine what the insurance company will pay, and what may be the responsibility of the patient. We will also look at the ins and outs of contacting the insurance company of prior authorization and what to do in the circumstances when the procedures performed change during the surgery.

Learning Objective:

• Learn when eligibility is effective and important
• Use insurance company websites for eligibility information
• Where to go to receive the information about prior authorization
• When are retro-authorizations needed
• Reporting medical necessity on a claim
• Identify technology that may be available for efficient eligibility
• Procedures that require prior authorization
• Checklists to make sure you have the necessary information
• Meeting medical necessity based on insurance company policies

Areas Covered in the Session:

• Coverage plans and the difference between plans
• Ways to obtain eligibility and when should it be done
• Determine what services or procedures need prior authorization before they are performed
• What to do if procedures change and prior authorization is no longer correct
• Meeting medical necessity even when prior authorization has been obtained

Suggested Attendees

• Billers
• Coders
• Administrators
• Managers
• Physicians
• Claims Adjusters
• Surgery Schedulers
• Caseworkers
• Nurses
• Reimbursement Staff

About the Presenter

Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 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 Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.