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Denials Aviodance & Appeals Management Institute Agenda

SESSION 1 (1.5 HOURS) 8:00 AM – 9:30 AM
OVERVIEW OF THE REVENUE CYCLE
FACULTY:

  1. Explain the Revenue Cycle
  2. Define The components of the Revenue Cycle
  3. Identify How the Revenue Cycle “breaks down”

SESSION 2 (1.5 HOURS) 9:30 AM – 11:00 AM
HOW HEALTH CARE GETS PAID
 FACULTY:

  1. Delineate policies governing third party payment
  2. Differentiate Reimbursement policies
  3. Analyze the challenges with  payment structures

BREAK 11:00 AM – 11:15 AM

SESSION 3 – PART 1 (1.0 HOURS) 11:15 AM – 12:15 PM
DENIALS & APPEALS MANAGEMENT – DENIALS
FACULTY:

  1. Define Denial
  2. Identify the causes of denials
  3. Review the regulatory processes in denials
  4. Evaluate “Where do we go from here”

BREAK 12:15 PM – 1:15 PM

SESSION 3 – PART 2 (1.5 HOURS) 1:15 PM – 2:30 PM
DENIALS & APPEALS MANAGEMENT – DENIALS
FACULTY:
Evaluation link:

BREAK 2:30 PM – 2:45 PM

SESSION 4 (2.0 HOURS) 2:45 PM – 4:45 PM
THE RIGHT SETTING AT THE RIGHT TIME – INPATIENT VERSES OUTPATIENT
FACULTY:

  1. Delineate in detail the differences between Inpatient and Outpatient status.
  2. Review and Examine Medical Necessity.
  3. Discuss the responsibilities and obligations of the treating physician.
  4. Review the vital role of Clinical Documentation.
  5. Examine the review process and the rationale of contracted reviewers.

DAY 2

SESSION 5 (2.0 HOURS) 8:00 – 10:00
DENIALS & APPEALS MANAGEMENT
FACULTY:

  1. Summarize strategies to reduce clinical denials
  2. Recognize Case Management and Utilization Management roles in the revenue cycle
  3. Identify how clinical documentation programs effect the revenue cycle
  4. Discuss strategy to build an effective Denial & Management program

BREAK 10:00 AM – 10:15 AM

SESSION 6 (1.5 HOURS) 10:15 AM – 11:45 AM
THE APPEAL PROCESS
FACULTY:

  1. Recognize what type of appeal is necessary.
  2. Utilize a strategy for appeal management.
  3. Investigate & analyze the medical record.

BREAK 11:45 AM – 12:45 PM

SESSION 7 (1.5 HOURS) 12:45 PM – 2:15 PM
A FIVE STEP STRATEGY TO WRITING EFFECTIVE CLINICAL APPEAL LETTERS
FACULTY:

  1. Validate defense with standard practices of evidence based medical criteria.
  2. Quote clinical documentation that is explicit and supports the issue being denied.
  3. Summarize coherently the rationale in defense of the denial.
  4. Demonstrate how to write compliant health care appeals.

Attendees will review case studies that include the denial letter, medical records, sample appeal letters and overturn letters.

After completing this session attendees will complete an appeal letter independently to be submitted to a faculty member for review and discussion.