Successfully Appealing Denials Involving Clinical Policy Bulletins

2:00 PM EST | 3/6/19

 

When it comes to describing the medical necessity of procedures and services provided to patients, commercial insurers have their Clinical Policy Bulletins and Medicare has its Local and National Coverage Determinations. As an appeal specialist it’s important to understand the purpose of each, where to locate them, and how to use them successfully in appealing denials.

Join us as we share what we’ve learned over the years from appealing hundreds of denials for procedures and services on behalf of our hospital clients. We’ll reveal payer behaviors regarding auditing and denying these services. And, as always, we will share proven, successful appeal strategies that you can use right away.

Learning Objectives:

  • Describe the use and purpose of clinical policy bulletins and coverage determinations
  • Demonstrate how to locate appropriate policies
  • List successful strategies to compose winning appeals when procedures or services are denied, even though you got it right.

Don’t miss this excellent educational opportunity designed to better equip you for successful appeals.

Hosted By:

Denise Wilson MS, RN, RRT
Vice President, Clinical Appeal Services