Education | Training
Healthcare Law

We offer a variety of Educational Sessions available at Institutions, Forums (Adv CPAR, PFS, Managed Care), CPAR Coaching, CFC Coaching, Webinars, Half Day Classes and Full Day Classes.

Our speakers, Douglas T. Gibson, Tammy R. Bryant and Kristopher R. Alderman, provide real world experience and expertise to give you an invaluable educational opportunity.

To find out more information about our educational services or to find out about Educational Sessions in your area please e-mail us at info@TheGibsonFirm.com or call us at 770.874.7004.

Education Sessions Currently Offered

Battling Refund Demands and Take Backs Too!
Course Description:

Vast revenue is lost due to commercial insurers failing to adhere to state and federal laws when “correcting” their own errors by demanding refunds from providers. Learn how to effectively fight back and keep your money!

What You’ll Learn:

1.    Establish when a refund is legitimate and warranted;
2.    Determine when a refund demand is erroneous, when monies should NOT be returned (almost always);
3.    Learn how to effectively dispute refund demands;
4.    How to avoid recoupments/offsets;  and,
5.    What to do if an offset occurs.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS, revenue cycle leaders, as well as refund demand specialists.


Proper Payments and Interest
Course Description:

Commercial Insurance and Group Health Plan are subject to contract laws and must pay accordingly to its policy terms. This course will teach you to identify underpayments, when interest may be due, and determine if a payer is allowed to use a network for a discount.

What You’ll Learn:

1. How to identify silent PPO situations.
2. How to determine if interest is due and what rate.
3. How to combat low UCR payments.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Denial Appeals
Course Description:

How to maximize success of your appeals in denial management.

What You’ll Learn:

1. How to write effective appeals.
2. When to appeal denials.
3. Who to appeal.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Provider Rights Under ERISA: What ERISA Plans Don’t want you to know!
Course Description:

Provide ways to effectively appeal ERISA plan reimbursement denials and re-capture lost revenue. Force ERISA plans to follow its language and federal law. Know your rights as the assignee of the patients/plan beneficiaries!

What You’ll Learn:

1. Fight reimbursement denial by ERISA plans.
2. Understand when ERISA laws are applicable to certain situations and when they are not.

Who Should Attend:

Advanced level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Verifications, Pre-certifications and Assignment of Benefits
Course Description:

Learn ways to increase revenue and fight denials before they ever occur. Know your rights when commercial insurance denies claims after verification and pre-certification. Protect appeal rights and receive payment directly through effective Assignment of Benefits.

What You’ll Learn:

1. Know how to instruct front end staff on effective verification of benefits procedures.
2. Fight claims denials based on “no benefits,” especially when originally verified.
3. Determine how to effectively appeal denials based on pre-certifications and when pre-certifications are not required (i.e. emergency services).
4. Know how to make the most of an assignment of benefits and what laws protect the provider’s right as assignee.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Third Party Liability: Medical Liens and Victim Compensation Programs
Course Description:

Most states have medical liens that can be filed on behalf of the hospital or other medical providers against the settlement of a personal injury claim- auto accidents, slip and falls, etc.

All states have implemented programs which provide victims of crime with financial assistance, including payment of medical expenses resulting from the crime. These programs are governed by regimented procedures and rules implemented by state agencies—learn to navigate the system in a way that ensures government benefits are paid quickly and efficiently.

What You’ll Learn:

1. How to identify a third party liability situation.
2. How to submit claims for VCP programs.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Emergency Medical Service Appeals
Course Description:

Hospitals are required to provide emergency services to individuals who need those services, most states, including Georgia, require insurers to pay for that treatment. Learn how to force compliance upon insurance companies with applicable state laws.

What You’ll Learn:

1. Who decides when a patient is stable.
2. Proper verifications procedures.
3. The prudent layperson definition of what constitutes an emergency admission.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS and revenue cycle leaders


Medicare as Secondary Payer Act
Course Description:

Medicare has specific, detailed provisions for determining when a GHP must pay its benefits primary to available Medicare benefits. Learn when a GHP must pay primary to Medicare and maximize your reimbursement from the commercial plans while complying with MSP laws.

What You’ll Learn:

1. Basics of coordination of benefits with a Group Health Plan and Medicare.
2. If GHP may voluntarily pay primary to Medicare.
3. Why MSP was enacted.

Who Should Attend:

Advanced level course for business office staff, supervisors, managers, PFS and revenue cycle leaders.


Medicare/ Medicaid Denials and Appeals
Course Description:

Class assists providers whose Medicare or Medicaid claims are denied for various reasons. Frequently, coverage decisions are made by intermediaries and appealed to contractors who apply local coverage determinations issued by the intermediary rather than CMS or DCH.

What You’ll Learn:

1. Basics of appealing Medicare and Medicaid Denials, including Outlier claims.
2. Ways to maximize changes of approval on appeal.
3. Know basic deadlines and other requirements that need to be met for appeals.

Who Should Attend:

Intermediate level course for business office staff, supervisors, managers, PFS, revenue cycle leaders, as well as, governmental payer specialists.