Summary: Providers have rights to retain funds voluntarily paid for healthcare services. Often, refund requests and recoupment activities are based on unlawful or incorrect retro-denials. Even when a GHP may have had a legitimate reason to deny treatment prior to services or prior to payment of a claim, a provider is generally entitled to retain voluntary payments already made. Recoupments create accounting nightmares that cost providers time and money to decipher; working to prevent recoupments before they happen by defending refund demands and enforcing providers’ rights will help to avoid these expensive consequences.
Learning Objective 1: Define the difference between proper and improper refund requests.
Learning Objective 2: List the tools necessary to fight improper refund demands and retain more money.
Learning Objective 3: List tactics to encourage repayment of already recouped funds.
Speaker 1: Tammy R. Bryant, CFC
Tammy Bryant is Legal Administrator & VP of Client Services for The Gibson Firm LLC, Healthcare Law, a specialty law firm in Woodstock, Georgia. The firm began in 2004 with the sole purpose of advocating for healthcare providers’ and patients’ rights in the state of Georgia. It quickly grew to include providers and patients all about the Southeast, and later, throughout the U.S. Tammy has a BS in Political Science, with a concentration in Alternative Dispute Resolution, also having graduated from the University of San Diego’s post-baccalaureate Legal Studies program. She worked in California for nearly a decade in insurance defense litigation and civil investigative arenas. With that experience, she brought to medical providers an insight into that which motivates insurers to honor medical claims. Upon moving to Georgia, prior to inception of The Gibson Firm, she was Legal Administrator for another law firm for six years, during which time she developed its healthcare reimbursement law section. Currently, Tammy oversees the firm’s daily operations and staff, as well as acting as a liaison for its clients. Her primary goal is to facilitate medical provider clients’ rights to reimbursement for services provided to patients, while working with the firm’s attorneys, staff and clients to ensure patients’ rights to healthcare services and the respective insurance coverage for that care. These goals are achieved through provider education, client training, and the firm’s handling of problematic accounts, including situations where they act directly as the patient’s advocate in cases involving victims of violent crime and for Social Security Disability benefits. Tammy has been a member of the Georgia Chapter of HFMA since 1998, having volunteered as a member of and chaired several committees, as well as taught many sessions on various healthcare reimbursement topics throughout the years. She attained her HFMA Certified Financial Counselor certification in May 2006, as well as taught CPAR coaching sessions for those seeking certification throughout the state.
Speaker 2: Jes Demyen, RN, LNC
Jes Demyen is the Director of Case Management and has been with The Gibson Firm since 2011. She obtained her Registered Nursing degree (RN) in 1999 from Chattanooga State, and worked for 10 years as a staff nurse and charge nurse in both the Emergency Department (ER) and Post-Anesthesia Care Units (PACU). She obtained her Legal Nurse Consulting certificate through the University of Georgia in 2006 and immediately began working in litigation for the defense. When the opportunity arose with The Gibson Firm for Jes to instead represent patients and providers, she whole-heartedly accepted. Her skill-set, expertise, and experience make her the ideal candidate to lead our amazing team of case managers and legal analysts to victory on behalf of our clients.
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