The Denial & Appeals Management (C-DAM®) Institute focuses on identifying effective techniques to communicate with both clinicians and non-clinical staff in order to appeal current denials and prevent future denials. Your professionals are taught how to apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within hospitals. Evidence Based Case studies, InterQual criteria and practical instruction are provided in developing and/or enhancing your compliance methods in auditing, monitoring, and evaluating the implementation & effectiveness of your denial management program.
Our extensive professional experience and training in clinical care, case management, medical necessity, coding guidelines, and regulatory compliance are the foundation for our highly successful recovery audit defense.
Overall Learning Objectives
At the completion of this program, participants should be able to:
- Identify the challenges inherent in interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.
- Understand the changing state of today’s healthcare system, as related to the important trends toward required compliance activities to prevent future claims denials.
- Identify the diverse educational needs for healthcare personnel regarding the significant changes in the healthcare reimbursement field and how these impact the denials that an organization will confront.
- Identify important methods of (and how to manage) administrative & provider organizational acceptance and “buy-in” to improve the denial management and appeals processes.
- Describe the goals, key benefits, and strategies of having an on-site based denial management and appeals program.
- Identify effective techniques to communicate with both clinicians (physicians, mid levels, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.
- Apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within acute care hospitals.
- Identify compliance methods on auditing, monitoring, and evaluating the effectiveness of your denial management program.
- Accurate, precise and explicit medical records documentation
- Effective case management processes including level of care assignment
- Correct and compliant coding that reflects the true severity of illness and complexity of care
- Incorporating InterQual clinical criteria and regulatory requirements
- Concise, focused, rapid- response strategy
- Evaluate demand letters and denials for likelihood of successful appeals
- Prepare comprehensive responses to RAC, MAC and other auditors designed to maximize the chances of successful reversals as quickly as possible
- Identify your denial and recovery audit vulnerabilities and implement corrective action strategies to preempt future assessment risks
The C-DAM® Program recognizes and builds on your past experience, and prepares you for future healthcare challenges in medical necessity and clinical documentation. The C-DAM® Program is for professionals at varying levels of health care including:
- Physician Assistants
- Nurse Practitoners
- Clinical Documentation Specialists
- Case Managers/Utilization Reviewers
- Health Information Managers/Coding Professionals
- Quality Assurance Professionals
- Compliance Professionals
Attendees have the option of taking the Certification Exam within 6 weeks of this Program.
Registration accepted until seminar is full.
Registration Fee: $1,295
Denial and Appeals Specialist Certification Examination: $395
No refunds will be given for cancellations. A conference credit may be given when requested in writing prior to the seminar for which you are registered. No refunds will be given for no-shows. Registration fees must be paid by posted deadlines. Registration may be transferred to a member of your organization up to 24 hours in advance of the seminar.
For more information about our programs contact:
Paul E. Bibbins, Jr., PhD, CFO