Understand Your Patient's Eligibility & Audit Your Payor's Contracts To Increase Business Profits In 2025

Session 1 - Eligibility, Prior Authorization, and Medical Necessity

Pre-recorded Webinar (Instant download available)

Duration - 60 Mins

Presenter - 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 2 - Auditing Payer Contracts For Payment Accuracy

Pre-recorded Webinar (Instant download available)

Duration: 60 Mins

Presenter: Toni Elhoms

In today's rapidly evolving healthcare environment, ensuring payment accuracy is critical to maintaining a strong financial foundation.  Insurance payer contracts are complex and often riddled with ambiguous terms and hidden discrepancies that can lead to underpayments, delayed reimbursements, and revenue leakage. This webinar will explore the strategic importance of auditing healthcare insurance payer contracts and how regular audits can drive significant financial improvements for healthcare providers.  Attendees will walk away with practical insights into best practices for contract review, common pitfalls to watch for, and tools to identify discrepancies in claims and reimbursements. Whether you're in healthcare finance, revenue cycle management, or compliance, this session will equip you with the knowledge to improve contract performance and ensure your organization is paid accurately and timely.

Webinar Objectives

Each payer operates with its own unique reimbursement structure, making it easy for discrepancies to occur—whether from claim processing errors, misinterpretation of contract terms, or outdated fee schedules. Without timely and proactive audits, providers risk being underpaid without even knowing it, or may encounter costly delays in uncovering and correcting payment gaps.

Webinar Agenda

• Understand the financial and operational impacts of inaccurate payer reimbursements
• Identify key components and clauses in payer contracts that require regular auditing
• Utilize data analytics to uncover trends, inconsistencies, and underpayments
• Develop an effective contract audit framework for ongoing payer performance evaluation
• Implement corrective actions and negotiation strategies based on audit findings

Webinar Highlights

• Discuss the hidden costs of inaccurate payments
• Explore common contract clauses that contribute to underpayments and denials
• Discuss real-world examples of successful payer audits and recovered revenue
• Outline the tools and technologies to streamline the contract audit process
• Discuss how to build cross-functional teams for contract performance oversight
• Highlight compliance risks associated with unmanaged payer agreements

Who Should Attend

Medical coders, billers, front office staff, patient access representatives, revenue cycle managers, practice administrators, and prior authorization coordinators. Medical Coding Specialists, Medical Billing Specialists, Medical Auditing Specialists, Private Practice Physicians, Managed Care Professionals, Operations Leadership, Practice Administrators, Office Managers, Chief Medical Officer

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