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Eligibility, Prior Authorization, and Medical Necessity
Recorded Webinar
There are several parts of seeing a patient and receiving payment for professional services. Eligibility ensures that the patient’s insurance coverage is active on the date of service that the services will be rendered and that their plan covers the services planned. There are different methods of receiving eligibility information and we are going to discuss these. Once eligibility is verified, certain procedures require the provider to contact the insurance company to receive prior authorization. Unfortunately, every insurance company has different requirements, making it difficult to manage. It is important that offices keep track of the current policies for the insurance companies they work with the most, and ensure these authorizations are performed prior to the service being performed. Medical necessity is normally reported by the ICD-10-CM codes. These codes justify why a procedure or service is performed based on the patient’s condition. The insurance companies may have policies that define the services they consider medically necessary based on the diagnosis. If the information on the claim does not meet their guidelines, the claim will be denied.
Insurance companies are requiring that authorization for services be obtained for more services and procedures. It is also common that employers will change insurance plans to save money on monthly premiums. This session will walk through how offices can obtain eligibility before the patients are seen to confirm that the insurance information that is available is accurate and the patient is covered for services to be rendered. Then when the patient is seen, any services or procedures that are ordered may need to be prior authorized for that reimbursement will be received. The final piece is that the medical necessity requirements for the procedure or service is being met according to insurance company policies and guidelines. Attendees will benefit from this webinar in that we will discuss all of these aspects of a medical claim that may have to occur before the insurance company even processes it and will reduce the number of claims an office can receive because these steps were not taken.
Venue: Recorded Webinar
Pivot Tables are one of Excel’s most powerful and misunderstood tools but once you know how to use them, they can transform how you analyse and report on data. In just a few clicks, you can summarise thousands of rows into meaningful, dynamic reports - no formulas required. This session will show you how to quickly create and customise Pivot Tables to reveal trends, answer questions, and support better decision-making. You’ll also discover how to turn your Pivot Table into a visual dashboard using built-in charting tools, slicers, and layout options. If you've ever looked at a Pivot Table and thought, “I should really learn that”, this is your moment. Why you should attend Manually building summaries and reports from Excel data is time-consuming and error-prone. Pivot Tables eliminate the guesswork, automate the process, and give you instant insights. This session is perfect if you want to save time, reduce complexity, and finally get confident with one of Excel’s most powerful (but underused) features. Topics covered How to structure your source data for best results Creating Pivot Tables in just a few clicks Summarising data with totals, counts, and percentages Formatting your Pivot Table for clarity and impact Sorting and filtering with built-in tools and slicers Visualising data using Pivot Charts Understanding and using (or avoiding) GETPIVOTDATA Who should attend This session is for anyone who wants to level up their Excel skills and gain confidence with Pivot Tables. It’s ideal for professionals in admin, finance, HR, operations, or anyone who builds regular reports. You should be comfortable with basic Excel tasks like entering data, using copy/paste, and applying simple formatting. The training is delivered using Excel for Windows (Microsoft 365), but most techniques also apply to earlier versions and Excel for Mac.
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Everyone makes decisions, but of course some decisions are more important and complex than others. Whether it is a decision about what to wear to work to deciding on a merger, the decision making process is generally the same. Most decision making by management is convoluted with much fuzziness and backtracking. Research suggests that managers put little thought into the decision making process such as—analysis of the risk, what values are poignant, the alternatives evaluated, quantitative and qualitative data, identifying the stakeholders, bias, and the impact of the decision on the system, to name a few. Decision making is the basic foundation of the process of management. Yet most management training and development tactics ignore this essential skill. Learning Objectives To examine the “act of choice” To analyze roadblocks to effective decision making To discuss 10 decision making/problem solving tools To list the various models of decision making Analyze how managers make decisions Who should Attend? HR Management Any Employee
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