Basic Claim Assessment For Day-In-Hospital Benefits

[LeeAndro]

Last updated 4/2022MP4 | Video: h264, 1280x720 | Audio: AAC, 44.1 KHzLanguage: English | Size: 314.50 MB | Duration: 0h 44m

Overview of how to assess these claims, obtain documentation and interpret it to combat insurance fraud and abuse

What you'll learn
Effectively assess insurance claims for hospitalization
Understand how and why fraud is committed
Equipped with a proven claims assessment process
Verification of admission and treatment
Verification of hospitalization
EXTRA: Assessing COVID 19-related claims
EXTRA: Syndicate activity within in medical insurance fraud
Requirements
Understanding of insurance claims processing
Description
Are you a claims assessor that works with or wishes to work with medical / health related products​

Do you want to broaden your knowledge base about or gain insight into medical / health related claims Specifically how to assess claims that for a benefit that will pay out for every day that the insured client is admitted This is the course for you!This course is designed to equip you with insight into how to assess and therefore red flag and verify these types of claims and ultimately to prevent the payment of potentially fraudulent claims by learning about: Why effective claims assessment is necessaryThe reasons that fraud is committed Current trends in fraud related to the above mentioned insurance products How to verify diagnosis, treatment and hospitalizationsUsing medical documents as an integral part of the claims processI also provide case studies of actual, real life admissions I have reviewed and giving expert opinion on as well as investigations I have performed in the past to demonstrate how to use the above knowledge to assess your claims effectively and red flag suspicious claims and potentially form a basis for repudiation or rejection of the claimClaims assessors are the first line of defense against insurance fraud, they are the gate keepers that prevent abuse of insurance products and detect fraud by spotting discrepancies and asking questions. The skill and ability to do this can be learned as your deepen your insight into the assessment of insurance claims This will help you in your career and build your confidence as a medical claims assessor and allow you to stand out among your peers. PLUS!I have added some EXTRA videos for enhanced and deepened learning to this course to take your knowledge to the next level. These include: 1. Extra: Criteria for red flagging claims for admissions related to COVID 19 2. Extra: A discussion on a previous parastatal investigation related to massive medical fraud including document tampering and falsification of admissions

Overview

Section 1: Introduction

Lecture 1 Introduction

Lecture 2 Overview and why important claim assessment is required

Lecture 3 Understanding fraud and current fraud trends

Section 2: Case studies: Falsification of admissions and document tampering

Lecture 4 Case studies

Section 3: SOMETHING EXTRA: Parastatal investigation case study

Lecture 5 Parastatal investigation

Section 4: The process of assessing claims for day-in-hospital benefits

Lecture 6 Introduction

Lecture 7 Verifying the diagnosis

Lecture 8 Verifying the treatment received

Lecture 9 Verifying hospitalization

Lecture 10 Deteing whether the length of admission was appropriate

Lecture 11 Pre-existing conditions & non-disclosure

Section 5: SOMETHING EXTRA: Red flagging COVID 19-related admissions

Lecture 12 Criteria for red flagging claims for admissions related to COVID 19

Section 6: Red flag check list

Lecture 13 Summary of red flags

Section 7: Closing notes

Lecture 14 Thank you

Claim assessors,Insurance industry,Public adjustors,Claim adjustors,Medical investigators

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