Uncovering Improper Insurance Practices: Protect Your Billing and Claims

Are you losing thousands in revenue due to illegal insurance tactics? This eye-opening webinar will reveal the shocking truth about what insurance carriers are doing to medical providers every single day—tactics that appear legal but are actually violations of federal law.

Expert Don Self will expose:

• Hidden illegal recoupment schemes costing your practice thousands
• Medicare Part C myths that are stealing your rightful payments
• Federal laws that protect YOUR rights as a provider
• Powerful tools to fight back and get paid what you're owed

KEY TAKEAWAYS

Commercial Insurance Secrets

• The REAL truth about assignment of benefits
• When carriers MUST send checks directly to you
• Hidden timely filing tricks they use against you

Medicare Advantage Exposed

• Out-of-network coverage myths debunked
• How Part C plans MUST cover everything Part B does
• 30-day payment requirements they don't want you to know

Legal Protection Arsenal

• Federal laws that give you MORE power than you think
• When pre-authorizations are actually NOT required
• How to stop illegal recoupments in their tracks

ERISA & Appeal Strategies

• Real appeal periods vs. what they tell you
• Minimum requirements they can't legally ignore
• Civil and criminal violations (1140 vs 1141)

STOP LOSING MONEY TO ILLEGAL PRACTICES

Common Illegal Tactics We'll Expose:

• False Recoupment Claims - When they can legally take money back (spoiler: it's rare!)
• Timely Filing Deceptions - The real deadlines vs. their fake ones
• Record Request Traps - How they trick you into HIPAA violations
• Payment Redirections - Illegally sending YOUR money to patients
• Pre-Auth Lies - Requiring authorizations when none are needed

LEARNING OBJECTIVES

By the end of this webinar, you will:

1. Master Commercial Insurance Laws - Understand your true rights with assignment and out-of-network coverage
2. Decode Medicare Part C Rules - Force proper coverage and payment from advantage plans
3. Identify Illegal Tactics - Spot and stop carrier fraud before it costs you money
4. Leverage Federal Protections - Use ERISA, PPACA, and CMS regulations to your advantage
5. Fight Back Effectively - Handle lying representatives and illegal recoupment attempts
6. Protect Patient Privacy - Avoid HIPAA violations while managing record requests
7. Maximize Revenue - Ensure proper and timely payment on all claims

DETAILED TOPICS COVERED

Commercial Insurance Deep Dive

• Assignment marking on claim forms - what it really means
• Out-of-network provider payment requirements
• Employer plan filing limits vs. carrier limits
• ERISA claim identification and benefits

Medicare Advantage Mastery

• Part C out-of-network payment calculations
• CMS 2030 plan implications for providers
• MAO 30-day payment requirements
• RPM coverage mandates they deny

Legal Protection Framework

• CFR regulations and your rights
• HIPAA minimum necessary standards
• Government entity definitions
• CMS medical record limitations

Revenue Protection Strategies

• Stopping illegal recoupments
• Appeal period realities
• Record request management
• Carrier time limit enforcement