Out-of-network (OON) billing and prior authorization hurdles remain two of the most challenging aspects of healthcare revenue cycle management. Healthcare providers and staff often find themselves stuck in a maze of denials, delayed payments, and unclear and inconsistent payer rules. This session is designed to demystify the out-of-network billing landscape and equip healthcare providers, administrators, and billing teams with real-world strategies to streamline the prior authorization process and secure appropriate reimbursement.  Whether you’re navigating insurance pushbacks, managing patient expectations, or dealing with surprise billing challenges, this webinar will give you the tools and clarity you need to operate efficiently and compliantly.  This webinar is built to deliver real-world, provider-focused solutions and not just theory, so that you can take back control of your billing and prior-authorization processes!

Webinar Objectives

Many healthcare providers struggle with inconsistent payer rules, unclear reimbursement timelines, and a lack of transparency in how OON claims are processed.  Delays, denials, and vague medical necessity criteria often lead to revenue loss and patient dissatisfaction.  Incomplete clinical documentation, missed deadlines, and breakdowns in communication can turn clean claims into costly appeals.  This leaves patients increasingly frustrated with unexpected costs and unclear financial responsibility.  Many healthcare organizations lack a reliable internal system for tracking prior authorizations and managing OON claims efficiently and compliantly.

Webinar Agenda

• Explain the key differences between in-network and out-of-network billing processes and requirements
• Identify the most common pitfalls in OON claims submission and reimbursement and how to avoid them
• Implement effective workflows for securing and tracking prior authorizations to reduce denials
• Develop communication strategies to set realistic patient expectations about cost, coverage, and timelines
• Apply best practices for documentation and appeals to maximize OON payment success

Webinar Highlights

• Step-by-step breakdown of the OON billing process from a provider’s perspective
• Explain how to navigate payer-specific nuances and authorization criteria
• Pro-Tips for clean claim submissions and proactive denial prevention
• Discuss real-world examples of successful prior authorization appeals
• Outline strategies for balancing compliance with patient-centered care
• Review updates on the No Surprises Act and state-level OON billing rules
• Q&A session to troubleshoot OON payer issues

Who Should Attend?

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees  
• Chief Medical Officer