According to a government report, over 70% of insured Americans have out-of-network (OON) coverage. For many hospitals and providers however, “out of network” may mean “out of luck” as they come up against an increasing number of payers issuing total claims denials and overpayment recoupments worth millions of dollars. To help providers navigate the complexity of these denials, AVYM has created the Out-of-Network Healthcare Reimbursement Compliance Program (OHR), a series of modules focusing on compliance risk management, fraud and abuse prevention and ERISA/PPACA-compliant appeals.
These on-site programs consist of two-day seminars on fraud/abuse prevention and compliance and/or ERISA/PPACA appeal compliance. Both programs reflect the most recent federal and state court records, federal court decisions in nationwide provider UCR and overpayment class actions, DOL PPACA claims regulation guidance, HHS/OIG/CMS FAQs, OIG advisory opinions and DOJ/FBI advisories.
Have you experienced a denial?
Learn more about our Out-Of-Network Healthcare Reimbursement
Compliance Program (OHR), focusing on ERISA/PPACA compliance.Contact Us Now
Self-Insured Plan TPA Recoupments
Is your third-party administrator holding out on you? With more than $19 billion in anti-fraud and overpayment recoupments in the private sector, there’s a good likelihood your TPA has not restored or refunded the full amount to your ERISA plan as required. Our innovative Fiduciary Overpayment Recovery Specialist and Fiduciary Overpayment Recovery Contractor (FORC) programs can help self-insured plans like yours recover assets and protect revenue.
Find out how you can recover self-insured plan assets here.
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