Denial and Appeal Writing WebinarsRegister for an upcoming webinar or browse the archive of past webinars below.UPCOMING WEBINAR:MEDICARE ADVANTAGE AND THE 2-MIDNIGHT RULE IN 2024Wednesday, November 29, 2023 | 2:00 - 3:00 pm ETThe date for the CMS Final Rule (CMS-4201-F) on Medicare Advantage Plans (MAP) is approaching fast. The final rule published 4/15/2023 goes into effect on 1/1/2024. Are you ready? This is the rule that reinforces the expectation from CMS that MAPs follow the 2-midnight rule that has been in place for traditional, Fee-for-Service (FFS) Medicare for 10 years. The Final Rule also reinforces the expectation for MAPs to adhere to the inpatient-only procedures list. What is your team doing to prepare? Join us as we discuss the specifics of the Final Rule that apply to MAPs, the 2-midnight rule, the inpatient-only list, and denials and appeals. We’ll discuss what you need to do now to ensure your team is ready for the new rule. Special attention will be given to how to monitor and report MAP compliance with the new rule. We can’t level the playing field if we aren’t all following the same rules. ABOUT THE PRESENTERS:Denise Wilson, MS, RN, RRT, Senior Vice President, PayerWatch + AppealMasters, President, AHDAM Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level. Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning healthcare denials. Kendall Smith, MD, Chief Physician Advisor, PayerWatch + AppealMastersDr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. He’s been deeply involved in denial and appeals management throughout his hospitalist career, working collaboratively with UR/Case Management departments as well as Managed Care and Hospital C-Suite executives. His familiarity with managed care denials led him to design and implement a number of CDI programs, including those at the Cleveland Clinic in Florida and the MedStar Washington Hospital Center. He has served as a physician leader on hospital revenue cycle management teams while also serving as a Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador. REGISTER NOWYou must register with a business or provider email address. General email accounts such as Gmail or yahoo will not be approved for attendance. CEU's are for AHDAM members only. AHDAM WEBINAR ARCHIVE:These 60-to 90-minute free webinars provide in-depth study on successful denial and appeal management methods for specific issues or payers. Please note that webinars archived below may contain links or features that are no longer applicable or available to viewers.
Successfully Defending Outpatient Authorization Denials Presentation Date: Wednesday, October 18, 2023Obtaining preauthorization for outpatient services is vitally important in avoiding denials. But, even when preauthorization is obtained, denials can still occur. Denial and appeal management professionals must become experts in navigating the sea of outpatient preauthorization processes, denials, and appeals. Join us as experts in the field discuss ways to prevent authorization denials, how to hold payers accountable for delayed decisions, and strategies to defend outpatient authorization denials. Presenters:
Download the Slide DeckClinical Validation Appeals - Back to the Basics Presentation Date: September 20, 2023 Clinical validation denials continue to rise. It is imperative that denial and appeal management professionals understand the differences between coding and clinical validation denials and how to successfully appeal clinical validation denials. If you are new to clinical validation denials and appeals, or need a refresher on the basics, join us as experts in the field discuss how to identify coding versus clinical validation denials and learn proven strategies to successfully appeal clinical validation denials. Presenters:
Download the Slide DeckQ&ASuccessfully Defending Inpatient Authorization DenialsPresentation Date: July 19, 2023 Authorizations for inpatient admissions remain a thorn in the sides of providers and utilization management personnel. Join us as experts in the field discuss ways to prevent authorization denials, how to hold payers accountable for delayed decisions, and strategies to defend inpatient authorization denials. Presenters:
Download the Slide DeckQ&AExperts Discuss the Key Points and Impact of the 2024 Medicare Advantage Final Rule (CMS-4201-F)Presentation Date: June 21, 2023 On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C) regulations to implement changes related to health equity, coverage criteria, prior authorization, and other programmatic areas. Join us as experts in the field discuss the key points of the final rule that clarifies Medicare Advantage payer behaviors. We’ll also be discussing the impact the final rule will have on providers. Presenters:
Download the Slide DeckSuccessfully Appealing High Dollar Denials Involving NCDs and LCDsPresentation Date: May 3, 2023 Payment for many high-dollar procedures is governed by National or Local Coverage Determinations for traditional Medicare and Managed Medicare beneficiaries. Understanding the requirements of the NCDs and LCDs is instrumental to successful denial prevention and appeal success. Join us as we discuss identifying coverage requirements for common high-dollar procedures and how to employ the information in preventing denials and successfully appealing denials. Presenters:
Download the Slide DeckAppealing Chemotherapy and Biologicals DenialsPresentation Date: 3/29/2023 Successfully overturning chemotherapy and biologicals denials goes beyond writing a great medical necessity appeal. Appeal specialists must understand medical necessity requirements, but also need to understand documentation requirements, billing of these drugs, where to find the information they need, and how to apply that information in an appeal. Join us as we discuss successful strategies for overturning these often high dollar denials. Presenter: Karla Hiravi, RN, BSN, Vice President | PayerWatch - AppealMasters Different Payers Means Different Appeal StrategiesPresentation Date: 3/1/2023 So often the answer to ‘How do I appeal this or that?” depends on the answer to “Who is the payer and do you have a contract?” Join us as we discuss the variability in the appeals process based on payers and payer contracts. Presented By: Denise Wilson, MS, RN, RRT, Senior Vice President, PayerWatch/AppealMasters, President, AHDAM Anatomy of Successful Medical Necessity AppealsPresentation Date: 1/25/2023 Presented By: Denise Wilson, MS, RN, RRT, Senior Vice President, PayerWatch/AppealMasters, President, AHDAM Download SlidesDownload Sample KneeDownload Sample IPDispelling Widespread Misunderstandings of the CMS Two-Midnight Rule
Presentation Date: 12/15/2022 Special guest speaker, David Glaser, shareholder at Fredikson & Byron, PA, clarifies widespread misunderstanding of CMS Two-Midnight Rule. David will be covering tips for ensuring the UM team is focused purely on physician expectation, not InterQual or MCG. He will be sharing how outdated Manual provisions may cause people to wrongly conclude inpatient status is improper. His guidance will help those involved in denial and appeal management recognize why auditors are wrong when they deny an admission asserting that the patient “only required an outpatient level of care.” And, he will present the compelling legal argument that Medicare Advantage cannot ignore the 2 midnight rule. Presented By:
Download HandoutTotal Joint Surgery Denials and AppealsPresentation Date: 11/9/2022 Receiving appropriate reimbursement for total joint surgeries requires solid processes and education of providers and revenue cycle staff. Join AHDAM Advisory Board member DeAnna Fling and AHDAM President Denise Wilson in discussing best practices to prevent denials and win appeals for total joint surgeries. Presented By:
Best Practices in the Appeals Process Provider
Presentation Date: 9/21/2022 Successfully overturning denials goes beyond writing a great appeal. Appeal specialists must employ best practices at every level of both the internal and external appeals process starting with peer-to-peer. Many AHDAM members are asking how best to manage various levels of appeal from a process as well as an appeal argument standpoint. In this session we will present best practices for government and commercial payers’ appeal processes. Presented By:
Download HandoutMedicare Advantage Denials: A Call to ArmsPresentation Date: 8/23/2022 Recently CMS requested that all interested healthcare providers make comments on the Part C Medicare Advantage program by Wednesday, August 31st. A 2022 report from the OIG shows just how much our patients are suffering as a result of the “big business” that are Medicare Advantage plans. By literally privatizing Medicare, CMS has let the proverbial foxes into the henhouse, and they have no incentive to leave. This needs to change. Join Medicare Advantage denial and appeal experts Dr. Brian Moore and Brian McGraw as they discuss the top 5-10 major issues that should be brought to the immediate attention of CMS program administrators and congressional leaders. Denise Wilson will moderate the discussion and provide additional step-by-step instruction on how to easily make your voices heard from every corner of the country. Presented By:
Legal Arguments for Clinical AppealsPresentation Date: 7/20/2022 Writing a great clinical argument for medically necessary services is no longer enough to win appeals. Appeal specialists must employ all entitled rights of appeal and that includes understanding and incorporating legal arguments. In this session we will present legal arguments that any clinician can understand and that apply to the most common situations encountered in denials, such as Emergency Services and EMTALA, authorization, experimental or investigational, and others. At the conclusion of the webinar, the learner will be able to Insert basic legal arguments into an appeal letter, incorporating the correct legal argument for the specific situation. The learner will be able to:
Presented By: Denise Wilson, MS, RN, RRT Fighting Readmission DenialsPresentation Date: 6/22/2022 Medicare’s Hospital Readmissions Reduction Program (HRRP) is approaching its 10th birthday. That has provided commercial and managed care plans plenty of time to follow suit and create their own version of a readmission review program with associated penalties. Join us as we discuss the various readmission reduction programs and successful strategies for overturning the resulting denials. At the conclusion of the webinar, the learner will be able to write a persuasive argument focused on defending the medical necessity of the patient’s readmission. The learner will be able to:
Presented By: Denise Wilson, MS, RN, RRT Seal Training - The Simple Effective Appeal LetterPresentation Date: 5/18/2022 AHDAM has received many requests for how to structure a successful appeal letter. Join us as we explore the simple, effective appeal letter format that brings efficiency and effectiveness to the management of denials and appeals. At the conclusion of the webinar, the learner will be able to:
Presented By: Denise Wilson, MS, RN, RRT SEAL Training - The Simple Effective Appeal Letter Q&A |
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