Insurance Considerations for the OMS: Effectively Handling Claims When Out‐of‐Network*
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From the AAOMS podcast library, Thomas J. Force, Esq., President of Patriot Group and The Force Law Firm, PC, discusses the challenges OMSs face in filing claims and/or receiving reimbursement when they are not participating in their patient’s insurance network. Topics discussed include techniques to maximize out-of-network revenue, appeals drafting, compliance and audit prevention, insurer settlement negotiation, reversal of denials, defense of refunds and recoupment attempts.
*Indicates that this activity is approved by AAOMS for continuing dental education credit ONLY.
Learning Objectives
At the conclusion of this program, participants should be able to:
- Discuss how to generate revenue when the dental practitioner is out-of-network.
- Explain how to be an out-of-network provider and stay compliant and safe from insurer audits.
Thomas Force, Esq.
Private Practice
New York, New York
Disclosure: No relevant financial relationships were disclosed.
An Internet-based CDE Activity
Original Podcast Date: December 26, 2023
Estimated time to complete this educational activity: 0.25 hours
Method of participation: Self-Study
Thomas J. Force Esq.
As a licensed attorney in New Jersey and New York, Thomas J. Force has over 34 years of experience in the healthcare and insurance industries. His success as a Wall Street insurance litigator and his tenure as General Counsel for a New York-based accident and health insurance company, where he served as Chief Compliance Officer, propelled the founding of The Patriot Group. He is nationally recognized as an expert in revenue collection techniques, appeal strategies and healthcare compliance. Force, a former U.S. Marine, is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations and other healthcare organizations.
Disclosures: No Relevant Conflict of Interest Disclosures were reported.
Continuing Education Provider Approval
The American Association of Oral and Maxillofacial Surgeons is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
The American Association of Oral and Maxillofacial Surgeons designates this activity for 0.25 continuing education credit(s).
AGD - Accepted Program Provider
FAGD/MAGD Credit
11/1/22-12/31/26
Provider ID# 214680
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