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 Please note that webinars archived below may contain links or features that are no longer applicable or available to viewers.
Dr. Kendall Smith and Reggie Allen, MBA, RN, ACM, as they discuss effective strategies for appealing neonatal intensive care unit (NICU) level of care denials and the clinical validation of respiratory distress syndrome. This session will provide practical guidance for advocating on behalf of neonatal intensive care services. Attendees will gain valuable insights to enhance their proficiency in addressing high-dollar cases and learn to craft compelling arguments to overcome NICU denial challenges.
General, nonspecific appeals might work some of the time, but increased specificity in your appeals will give you a better chance to obtain more overturns. Join us as AHDAM discusses specific techniques that you can start using immediately in your patient status, clinical validation, coding, and technical appeals. This educational activity is suited for new appeal writers as well as not so new writers who could use a refresher.
At the conclusion of the webinar, the learner will be able to self-report they can identify one successful strategy to consider when writing healthcare related appeals and one common mistake to avoid when writing healthcare related appeals.
Revenue Cycle 101: How Denials and Deductions Originate and Impact Your Health System
Presentation Date: Wednesday, August 28, 2024
Unlock the mystery of the revenue cycle as Ryan O’Hara, Managing Principal of the Denial Research Group, explains basic concepts and how denials and appeals impact YOUR hospital’s revenue cycle. This webinar is tailored for hospital-based healthcare professionals managing insurance denials.
At the conclusion of the webinar, the learner will be able to self-report they can:
identify one financial impact of denials on hospital
Identify the primary objective of revenue cycle operations
Identify the differences between gross revenue, net revenue, and cash revenue
Presenter: Ryan O'Hara, Managing Principal, Denial Research Group
Medicare’s Hospital Readmissions Reduction Program (HRRP) has expanded into the commercial and managed care arenas. Join us as we discuss the various readmission reduction programs and successful strategies for overturning the resulting denials.
Presenters:
Reginald Allen, MBA, RN, ACM, Chief of Clinical/Business Operations, PayerWatch
Karla Hiravi, BSN, RN, President, AHDAM and Senior Vice President, PayerWatch
The Emerging Role of Artificial Intelligence (AI) in Healthcare Denials and Appeals
Presentation Date: Wednesday, March 27, 2024
The emergence of artificial intelligence (AI) has undoubtedly already impacted healthcare denials and appeals processes. Join us as we provide a comprehensive overview of AI’s emerging role in healthcare denials and appeals processes by focusing on the benefits, regulatory limitations, and ethical considerations. This webinar is tailored for healthcare professionals managing insurance denials for care provided by hospitals.
Presenters:
Kendall Smith, MD, Chief Medical Officer/ Chief Physician Advisor, PayerWatch
Clinical Validation Appeals - Back to the Basics Part 2: Questions and Answers
Presentation Date: Wednesday, February 21, 2024
We asked for questions, and you sent them! Join us as we answer questions from Part 1 of Clinical Validation Appeals – Back to the Basics. Because 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.
Presenters:
Christi Drum, RN, BSN, CCDS, CCS, Senior Director of Clinical Appeals for Clinical Validation and Coding, PayerWatch/AppealMasters
Karla Hiravi, RN, BSN, President, AHDAM and Vice President, Clinical Resources, PayerWatch/Appeal/Masters
Medicare Advantage and the 2-Midnight Rule in 2024
Presentation Date: Wednesday, November 29, 2023
The 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.
Obtaining 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.
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:
Christi Drum, RN, BSN, CCDS, CCS, Senior Director of Clinical Appeals for Clinical Validation and Coding| PayerWatch + AppealMasters
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.
Experts 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:
Carolyn Dutton, MD, FACEP, FACP, Senior Physician Advisor, Wound Care Director, Emergency Medicine, Internal Medicine; Atrium Health
Successfully Appealing High Dollar Denials Involving NCDs and LCDs
Presentation 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.
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 Strategies
Presentation 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.
Everyone wants to know the most effective structure of a written medical necessity necessity appeal argument. Join us as we discuss efficient and effective methods for structuring the written appeal for medical necessity inpatient and outpatient services.
Dispelling 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.
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.
DeAnna Fling, RRT, MHA, Revenue Cycle Educator and Operations Support US Oncology Network-McKesson Pharmaceutical Solutions and Services
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.
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:
Brian McGraw, President & CEO of PayerWatch and the Denial Research Group (AppealMasters)
Dr. Brian Moore, FACEP CHCQM-PHYADV, Chief Medical Officer – Physician Advisor Services at Atrium Health
Legal Arguments for Clinical Appeals
Presentation 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:
Describe the purpose of including legal arguments in clinical appeals
Identify the agency in their state that sets legal regulations for medical insurance
Match up one legal argument with the appropriate circumstances for use
Presented By: Denise Wilson, MS, RN, RRT
Fighting Readmission Denials
Presentation 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:
Identify at least three of the conditions included in the Hospital Readmission Reduction Program from the Centers for Medicare and Medicaid Services
Identify one circumstance when a readmission may have been appropriate
Identify one method of defending appropriate readmissions through the appeals process
Presented By: Denise Wilson, MS, RN, RRT
Seal Training - The Simple Effective Appeal Letter
Presentation 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:
Identify the five areas of focus of medical record documentation for support of the inpatient admission
Identify the two sections of the history and physical that contain the most valuable information to include in the appeal for inpatient admission
Identify two objective patient assessments that support the patient’s need for inpatient admission
