Understand Telehealth Compliance, OON Billing, Pre-Auth Procedures, MDM Grid For Service Levels & Code G2211

With This "POWER PACKED" Bundle, You Will Be All Set For 2025!

                                                                                                                                                                                                                                                                                                                                                  

Session 1 - 2025 Telehealth Compliance: Avoid Penalties, Protect Your Practice

Live Date: August 05, 2025

Time: 01:00 PM ET | 12:00 PM CT

Duration: 60 Mins

Speaker: Osato F. Chitou, Esq.

As the telehealth landscape continues to evolve, healthcare providers face a complex web of regulatory updates, billing nuances, and documentation challenges. With CMS and commercial payers modifying telehealth rules through and beyond 2025, compliance missteps can now lead to audits, denials, and costly penalties.

In this practical and timely webinar, healthcare attorney and regulatory expert Osato F. Chitou explains what providers need to know to maintain compliance, safeguard their practice, and deliver care effectively across state lines.

This comprehensive webinar will help providers navigate the evolving telehealth compliance landscape with clarity and confidence. Attendees will gain practical insights into avoiding billing errors by mastering the new 2025 CMS coding rules, ensuring compliance with both federal and state licensure laws when providing care across state lines, and adhering to Medicare, Medicaid, and commercial payer guidelines.

The session will also cover essential practices for obtaining patient consent, safeguarding personal health information, and avoiding technology pitfalls that can lead to penalties. With guidance from healthcare compliance attorney Osato F. Chitou, participants will leave equipped to streamline telehealth delivery, protect their practice, and continue providing high-quality virtual care with peace of mind.

Webinar Objectives

Attendees of this webinar will understand:

• How to steer clear of costly errors due to new 2025 telehealth coding rules
• Avert audits due to problematic documentation requirements
• Master qualifying conditions for Medicare telehealth reimbursement
• Compliantly provide care across state lines (without audit worries)
• Uncover how to more easily comply with general telehealth licensure rules
• Comply with CMS–qualifying originating site directives
• Abide by complex commercial coverage criteria more easily
• Meet telehealth consent mandates with easy-to-employ tactics
• Block common technology screwups and massive violation penalties

Webinar Agenda

Errors related to your practice’s Medicare telehealth compliance, (even accidental ones), may result in overpayments and enforcement actions, that can significantly impact your bottom line.

Webinar Highlights

• 2025 CMS telehealth reimbursement updates — what changes and when
• Medicaid & commercial payer policies by state: what to watch
• How to confidently handle cross-state licensure requirements
• Real-world tactics for patient consent and documentation
• Protecting your practice from audit triggers and OCR violations
• Billing & coding insights for Medicare Advantage, Medicaid, and private payers
• Accessibility considerations for patients with disabilities or limited English proficiency
• Telehealth best practices for rural populations and behavioral health

Session 2 - Out of Network, in the Money: Prior Auth Power Moves for Providers

Live Date: August 07, 2025

Time: 01:00 PM ET | 12:00 PM CT

Duration: 60 Mins

Speaker: Toni Elhoms

Out-of-network (OON) billing and prior authorization hurdles remain two of the most challenging aspects of healthcare revenue cycle management. Healthcare providers and staff often find themselves stuck in a maze of denials, delayed payments, and unclear and inconsistent payer rules. This session is designed to demystify the out-of-network billing landscape and equip healthcare providers, administrators, and billing teams with real-world strategies to streamline the prior authorization process and secure appropriate reimbursement.  Whether you’re navigating insurance pushbacks, managing patient expectations, or dealing with surprise billing challenges, this webinar will give you the tools and clarity you need to operate efficiently and compliantly.  This webinar is built to deliver real-world, provider-focused solutions and not just theory, so that you can take back control of your billing and prior-authorization processes!

Webinar Objectives

Many healthcare providers struggle with inconsistent payer rules, unclear reimbursement timelines, and a lack of transparency in how OON claims are processed.  Delays, denials, and vague medical necessity criteria often lead to revenue loss and patient dissatisfaction.  Incomplete clinical documentation, missed deadlines, and breakdowns in communication can turn clean claims into costly appeals.  This leaves patients increasingly frustrated with unexpected costs and unclear financial responsibility.  Many healthcare organizations lack a reliable internal system for tracking prior authorizations and managing OON claims efficiently and compliantly.

Webinar Agenda

• Explain the key differences between in-network and out-of-network billing processes and requirements
• Identify the most common pitfalls in OON claims submission and reimbursement and how to avoid them
• Implement effective workflows for securing and tracking prior authorizations to reduce denials
• Develop communication strategies to set realistic patient expectations about cost, coverage, and timelines
• Apply best practices for documentation and appeals to maximize OON payment success

Webinar Highlights

• Step-by-step breakdown of the OON billing process from a provider’s perspective
• Explain how to navigate payer-specific nuances and authorization criteria
• Pro-Tips for clean claim submissions and proactive denial prevention
• Discuss real-world examples of successful prior authorization appeals
• Outline strategies for balancing compliance with patient-centered care
• Review updates on the No Surprises Act and state-level OON billing rules
• Q&A session to troubleshoot OON payer issues

Session 3 - Eligibility, Prior Authorization, and Medical Necessity

Live Date: August 13, 2025

Time: 01:00 PM ET | 12:00 PM CT

Duration: 60 Mins

Speaker: Lynn M. Anderanin

Front-end processes are a key line of defense against denials that disrupt cash flow and patient satisfaction. This session is designed to help healthcare professionals improve outcomes by strengthening eligibility verification, prior authorization procedures, and medical necessity documentation. Attendees will learn how to proactively identify and avoid common front-end denial triggers, use available technology and resources for insurance verification, and understand the rules behind payer-specific prior authorization requirements. Real-world examples and checklists will be shared to improve staff workflows, minimize retro-authorization delays, and enhance documentation to support medical necessity. Whether you're new to patient access roles or seeking to update internal policies, this webinar provides actionable insights to reduce claim denials and accelerate reimbursement.

Webinar Objectives

This session addresses common administrative failures that result in eligibility and authorization-related denials. It will present actionable strategies for verifying insurance in real time, securing prior authorizations efficiently, and ensuring documentation supports medical necessity across all payers. The webinar will empower staff to use checklists, payer websites, Medicare tools, and NCD/LCD guidance to support clean claims and successful appeals when needed.

Webinar Agenda

• Importance of real-time eligibility verification
• Tools and resources for checking benefits and network status
• Payer-specific prior authorization workflows and documentation tips
• Retro-authorizations and what qualifies as valid exception scenarios
• Medical necessity: definitions, policies, and payer guidelines
• Coverage criteria: Medicare NCDs, LCDs, and commercial payer bulletins
• Checklist-based workflows to prevent denials
• Appeal processes for denied eligibility and medical necessity claims

Webinar Highlights

• What to look for in real-time eligibility responses
• How to identify and document medical necessity correctly
• Using payer websites and Medicare coverage tools
• The role of LCDs and NCDs in determining coverage
• How to build effective eligibility and pre-authorization checklists
• Key reasons why retro-authorizations are denied
• Preventing claim delays through proper front-end workflows
• Sample appeals and documentation tools for denied services

Session 4 - Auditing of Office or Other Outpatients Services - Level 3 or 4 ?

Live Date: August 14, 2025

Time: 01:00 PM ET | 12:00 PM CT

Duration: 60 Mins

Speaker: Jill M. Young

When the rules for Office and Other Outpatient services changed in 2021, we all adjusted to the Elements of Medical Decision-Making grid as the guide for determining the level of service.  When Hospital Inpatient and Outpatient services changed in 2023, there were some minor adjustments but, honestly, providers were still learning the rules from the 2021 changes.

When looking at the practical aspects of office and other outpatient coding, it seems to come down to is the service one of low or moderate complexity.  A level 3 or level 4.  Visits are frequently incorrectly coded as providers, and sometimes auditors, do not fully understand the nuances of the three columns from the grid and the concepts contained within. 

• Multiple illnesses do not necessarily advance you to the next higher level in the column
• Acute and Severe can mean different levels if properly documented
• A test that is ordered usually gets credit in the middle column while a test interpreted usually does not
• The decision for surgery in the last column does not include referral to a surgeon
• Refill meds is not enough documentation to get credit for medication management

These are a few of the misunderstanding and misnomers that exist about the table.  As an auditor you must understand what is needed.  Providers must understand this as well so they can be sure their documentation will pass on audit.

Webinar Objectives

Understanding what is needed in the documentation to support the requirements of each of the three columns in the table of elements of medical decision making is a must for auditors.  Going through each column and the appropriate documentation will help auditors to see when things are missing but also to help them discuss with their providers when presenting  audit results.

Many providers feel prescription drug management is indicative of a level four office visit.  It might be but the documentation must support the management and satisfactorily meeting another columns requirement.  Simple ways of recognizing compliant documentation of a level four office visit will help one explain to providers what is missing.

Whenever auditing, and then educating providers, a thorough understanding of the requirements is needed to fully explain to the provider why their documentation is deficient and what would be needed to meet the higher level of service. 

Webinar Highlights

• Documentation differences for each column in the Elements of Medical Decision-Making Grid between a level three and level four office visit
• How a simple word or two can make the difference between levels of low and moderate in columns of the MDM grid
• Why a high level of medical decision making is hard to achieve
• How diagnoses can help achieve a higher level of MDM
• A simple explanation of Social Determinants of Health and how they can increase the level of medical decision making.  What documentation is needed for them?
• Time – where does time come into play with level three and level four office visits?

Session 5 - Is the Risk Worth the Reward? Navigating Compliance for Reporting G2211 in 2025

Live Date: August 27, 2025

Time: 01:00 PM ET | 12:00 PM CT

Duration: 60 Mins

Speaker: Toni Elhoms

In 2025, reporting HCPCS code G2211 remains a source of confusion and compliance concern for healthcare organizations and providers.  Despite being active since 2024, HCPCS code G2211 continues to present compliance headaches across the healthcare landscape.  This webinar, designed from the lens of a healthcare compliance auditor, will break down the latest updates, payer nuances, and documentation requirements surrounding G2211.  Attendees will gain clarity on when its use is appropriate, how to defend its medical necessity, and what red flags auditors and payers are watching for. Whether you're in coding, compliance, auditing, or billing, this webinar will help you protect revenue while staying audit ready.

Webinar Objectives

G2211 may have gone live in 2024, but for many, it is still causing confusion, coding uncertainty, and compliance headaches.  In this session, we will clarify appropriate use cases of G2211 through real-world examples and CMS guidance, break down documentation best practices that support medical necessity and defend audit scrutiny, and understand payer nuances surrounding G2211.

Webinar Agenda

G2211 may have gone live in 2024, but for many, it is still causing confusion, coding uncertainty, and compliance headaches.  In this session, we will clarify appropriate use cases of G2211 through real-world examples and CMS guidance, break down documentation best practices that support medical necessity and defend audit scrutiny, and understand payer nuances surrounding G2211.

Webinar Highlights

• Discuss the intent and purpose background behind G2211
• Outline updates new in 2025 with CMS and commercial payers
• Dissect real-world case studies: appropriate vs. inappropriate usage of G2211
• Outline documentation do’s and don’ts from an auditor's compliance checklist for G2211
• Highlight top denial reasons for G2211 and how to avoid them

Who Should Attend

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees  
• Chief Medical Officer
• Practice Managers
• Medical Managers
• Health Information Technology Practice Managers
• Office Billers/Coders
• front office staff
• patient access representatives
• revenue cycle managers
• practice administrators
• prior authorization coordinators
• Office Administrators
• Nurse Practitioners
• Physician Assistants