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The association is currently focused on acute care inpatient and outpatient
hospital services, with plans to expand to all provider and patient communities.
Welcome to the nation's only
association dedicated to
Healthcare Denial
and Appeal Management

Welcome to the nation's only
association dedicated to Healthcare Denial
and Appeal Management

The association is currently focused on acute care inpatient and outpatient
hospital services, with plans to expand to all provider and patient communities.

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Welcome to AHDAM.org

The Association for Healthcare Denial and Appeal Management is the nation’s only association dedicated to Healthcare Denial and Appeal Management. We’re here to support and promote professionals working in the field of healthcare insurance denial and appeal management through education and collaboration.

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The Legal and Regulatory Aspects of Appeals in Denial and Appeal Management

Wednesday, July 22, 2020 • 11:00AM to 12:00PM (EST)

Summary:

A successful appeal may require the use of clinical, legal/regulatory, or contract language in the argument. Most appeals require all three. Many appeal writers are well versed in clinical or coding arguments, but the legal/regulatory arguments required for a successful appeal are just as important. David Glaser, Esq., attorney at Fredrikson & Byron, P.A.,  and Denise Wilson, senior vice president at Denial Research Group/AppealMasters and AHDAM president cover the legal and regulatory aspects associated with successful appeals. In this 60-minute webinar, David and Denise will teach you best practices for interacting with auditors, discerning regulatory rules, structuring complete appeal arguments, and preparing for hearing.

Learning Objectives:

At the conclusion of the webinar, the learner will be able to:

  • Explain the critical steps involved in the first contact with an audit/auditor;
  • Discern what rules apply to Traditional Medicare versus Commercial payers;
  • Prepare and submit a well-structured appeal argument complete with appropriate clinical, legal/regulatory, or contract language;
  • Describe best practices for preparing for hearing.

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From The Knowledge Center

How to Handle Payer DRG and SOI Denials that Provide No Detailed Explanation

By Malissa Powers, BS, RHIT, CCS, CDIP, CICA | July 7, 2020 Although the payer should provide a detailed explanation as to why the claim is being denied, that does not always occur. The best…

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The association is currently focused on acute care inpatient and outpatient hospital services, with plans to expand to all provider and patient communities.

The Association for Healthcare Denial and Appeal Management (AHDAM) publishes and distributes materials on its website that are created by our members or invited industry subject matter experts for the benefit of all AHDAM members. AHDAM does not certify the accuracy or authority of these materials. These materials are distributed and presented as research information to be used by AHDAM members, in conjunction with other research deemed necessary, in the exercise of AHDAM members’ independent professional judgment. AHDAM claims no liability in relation to reliance on the content of these materials. The views expressed in the materials are the views of the material’s authors and do not necessarily represent the views of AHDAM. Any references are provided for informational purposes only and do not constitute endorsement of any sources.