How to Avoid Getting Wiped Out by the Wave of Commercial Payor Behavioral Health Audits: Medical Necessity and Waivers of Co-Insurance and Deductibles
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Paul D. Gilbert – Member, Epstein Becker Green
John A. Mills – Partner, Nelson Hardiman
There is a confluence of national and local public policy developments regarding mental health, substance use disorders, and treatment. The federal government, working in partnership with states, addresses behavioral health issues and establishes and enforces minimum standards. States, however, have significant power in making decisions—mental health regulations and available services can look very different from state to state, and even from county to county.
Please join the Behavioral Health Association of Providers, Epstein Becker Green, and Nelson Hardiman for a fall webinar series that will address topics highlighting the accelerating legal and policy issues for the behavioral health industry.
Topics for the October 4 session:
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar will examine the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters will also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Have questions? Please contact the presenters or David Stone at [email protected].