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.
[styled_box title=”Have you experienced a denial?” color=”gray” class=”call-to-action”]Learn more about our Out-Of-Network Healthcare Reimbursement
Compliance Program (OHR), focusing on ERISA/PPACA compliance.Contact Us Now[/styled_box]