Certification Institutes

C-DAM Agenda

C-DAM AGENDA

Program Agenda For the Denials & Appeals Management (C-DAM) Institute

Day 1

Registration

Welcome/Opening Remarks

Pre-Class Case Scenario – Letter Writing

Objectives:
  • Analyze sample case study for clinical documentation issues
  • Discuss case scenario results with fellow participants
  • Review established appeal letters
  • Design a compliant appeal letter

Session 1
Overview of Denials & Appeals Management

Objectives:
  • Explain the operations of the Revenue Cycle
  • Define why healthcare denials occur
  • Identify key denial management team members
  • Discuss methods needed to proactively track and monitor key performance indicators
  • Discuss implementation of initial strategies in denial appeals

Session 2
Introduction to Denials & Appeals Management: Understanding the Inner Workings 

Objectives:
  • Describe reimbursement strategies of third party policies and provisions
  • Explain the process of billing and claim submission
  • Discuss common reasons for denials and define medical necessity
  • Identify non-covered and excluded services
  •  Explain the Comprehensive Error Rate Testing Program

Break

Session 3
The Revenue Cycle ; How Healthcare Gets Paid

Objectives:
  • Identify various reimbursement mechanisms
  • Analyze the challenges with payment structures
  • Examine the differences between inpatient and outpatient ambulatory payment classifications
  • Discuss physician reimbursement strategies
  • Describe the Medicare Conditions of Participation
  • Explain the Revenue Cycle process breakdown

Lunch

Session 4
High Risk Areas Leading to Denials: The Proactive Approach to Denials & Appeals Management

Objectives:
  • Identify high risk target areas that lead to denials
  • Discuss the rationale for the focus on these high risk target areas
  • Discuss practical strategies to assess high risk areas and take steps to mitigate these risks
  • Explain how to use PEPPER and CERT Report data as part of a proactive risk reduction strategy


Session 5
Medical Necessity and Clinical Documentation Integrity

Objectives:
  • Discuss the RAC initiatives
  • Explain Case Management and Utilization Management roles in the Revenue Cycle
  • Describe how clinical documentation programs effect the Revenue Cycle
  • Identify strategies to reduce clinical denials
Questions/ Dismissal

Day 2

Registration

Welcome/Housekeeping Issues

Question & Answer Session

Session 6
Writing Effecting Appeals

Objectives:
  • Identify the appeal process
  • Explain the different levels of RAC appeals
  • Recognize what type of appeal is necessary
  • Create strategies for appeal management
  • Discuss how to write compliant health care appeals
  • Create sample appeal letters
Lunch

Session 7
Case Scenarios – Post Training Sessions/ Letter Writing

Objectives:
  • Prepare and review sample appeal letters
  • Discuss Day 1 Pre-Class case study scenario
  • Identify errors in Pre-Class appeal letters
  • Demonstrate proficiency in composing a compliant appeal letter

The Denials & Appeals management (C-DAM) Certification Examination will be administered electronically at the conclusion of the training program. (No CE credit associated)