The Importance of Eligibility, Prior Authorization, and Medical Necessity

Live Webinar

  • 60 minutes

The International Classification of Diseases, Version 10- ClinicalModifications, or ICD-10-CM, is maintained by the World Health Organization.(WHO)  This manual allows healthcareproviders to submit the diagnoses for services and procedures performed toidentify the medical necessity for them. Each year the ICD-10-CM manual is updated with additions, revisions, anddeletions.  These changes becomeeffective on October 1st of year with no grace period, but affectall services with dates of service October 1st and forward.  If healthcare providers do not submit validlyICD-10-CM codes, there claims will be denied for reimbursement, and correctionswill need to be made before the claim can be considered for payment.  This causes delays which has can cause revenueproblems for the healthcare provider.

Join this session by expert speaker Lynn Anderanin where she will walk through how offices can obtain eligibility before the patients areseen to confirm that the insurance information that is available is accurateand the patient is covered for services to be rendered.

Session Highlights:

  • Methods available for eligibility

  • When isthe best time to verify eligibility

  • Knowwhen prior-authorization is needed

  • Gettingauthorization for special circumstances

  • What todo when prior-authorization has to be changed

  • Whydoes medical necessity play a role in reimbursement

  • There is never a guarantee of payment

Why You Should Attend:

Insurance companies are requiring that authorization for services beobtained for more services and procedures. It is also common that employers will change insurance plans to savemoney on monthly premiums. The final piece is that the medical necessity requirements for theprocedure or service are being met according to insurance company policies andguidelines.  Attendees will benefit fromthis webinar in that we will discuss all of these aspects of a medical claimthat may have to occur before the insurance company even processes it, and willreduce the number of claims an office can receive because these steps were nottaken. These changes will be relevant to most medicalspecialties.

Who Should Attend:

  • Physicians

  • Non-physician providers

  • Billers

  • Coders

  • Surgery schedulers

  • Claims processors

  • Claims adjudicators

  • Managers

  • Supervisors

  • Auditors

  • Collections

  • A/R representatives

  • Anyone responsible for performing eligibility,prior-authorization in a medical office

You may ask your Question directly to our expert during the Q&A session.
** You can buy On-Demand and view it at your convenience.

Lynn M. Anderanin

Lynn M. Anderanin

Lynn Anderanin, CPC, CPPM, CPMA, CPC-I, COSC, is the Sr. Director of Coding Education for Healthcare Information Services, a physician’s revenue cycle management company. She has over 36 years’ experience in all areas of the physician practice, and specializes in Orthopedics. Lynn is currently a Workshop and Audio Presenter. She is a former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served on several other boards for the AAPC. She is also the founder of her Local Chapter of the AAPC.

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