Education Track Sessions

Navigating Payer Reimbursement Challenges

Navigating reimbursement challenges in the infusion industry requires a deep understanding of common claim denials, underpayments, and payer errors. This session will provide an in-depth analysis of key denial issues, including refill threshold limitations, coordination of benefits complexities, and incorrect contract rate applications. Attendees will also gain insight into underpayment disputes, payer pricing references, and Medicare Medically Unlikely Edits (MUE) and Maximum Frequency Per Day limits.
Navigating reimbursement challenges in the infusion industry requires a deep understanding of common claim denials, underpayments, and payer errors. This session will provide an in-depth analysis of key denial issues, including refill threshold limitations, coordination of benefits complexities, and incorrect contract rate applications. Attendees will also gain insight into underpayment disputes, payer pricing references, and Medicare Medically Unlikely Edits (MUE) and Maximum Frequency Per Day limits.

Learning Objectives

  • Identify common reasons for claim denials related to refill thresholds, coordination of benefits, and payer pricing references.
  • Analyze how underpayments and incorrect contract rates impact reimbursement and financial viability.
  • Develop proactive strategies to prevent denials and underpayments through proper documentation and billing practices.
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