The Use of Prepayment Review by Managed Care PayorsOn Demand Recording: $25.00 Register Today
Webinar Objectives: Payors are increasingly turning to a process known as PrePayment review (“PPR”) when dealing with physician requests for reimbursement. S most know, a typical reimbursement request is submitted electronically, is sorted by a computer program that checks for patient eligibility, for services availability under a particular plan, and for reimbursement rate based on provider contract rates. Payors have started to NOT pay providers for a host of reasons and placing the provider on a program of PPR. Essentially, the typical PPR program requires that a provider remit underlying medical charts and documentation in paper form justifying the service provided. Those paper documents are then placed in a queue for personal review (allegedly) by a human reviewer before being approved for payment or disapproved for a host of reasons. Needless to say, this PPR process typically takes many weeks and deprives physicians of cash flow to their practices. This webinar will discuss some of the tactics being employed by payors, the remedies available to physicians and the effect the PPR practice is having on a physician’s economy. About the Speakers
Greg Pepe, Founding Principal, Neubert Pepe & MonteithGregory J. Pepe heads the Healthcare Law, Alternative Dispute Resolution & Mediation and Corporate & Business Transactions practice areas. His experience in the healthcare market, its accompanying regulatory constructs and related business matters, spans decades. Greg provides his clients the understanding necessary to navigate the changing healthcare landscape. Healthcare issues that Greg often addresses include how providers can successfully negotiate new market ventures and grow their business strategically while operating within policies and legal regulations. Greg has extensive experience in addressing the myriad of business issues facing healthcare providers. He skillfully provides counsel and solutions for his entrepreneurial clients. The business issues that hospitals, doctors, lab companies, and other healthcare providers face are extremely complex. Greg works with clients to establish business relationships such as partnership agreements, corporation agreements, noncompetition agreements, compensation arrangements, and provider contracts. The agreements and contracts are crafted to provide the legal structure for the entity to operate effectively. To that end they are constructed with the objective of avoiding future disputes.
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