Wednesday, March 8, 2017 • 2:00 PM – 3:00 PM EST
If your hospital or health system serves a large Medicare Advantage population, you likely have significant Medicare Advantage denials and audits to deal with. Join our Medicare Advantage appeal experts in a practical review of Appeal Strategies, Appeal Writing and Appeal Escalation specifically related to Managed Medicare payment challenges. We’ll have specific appeal language, appeal rights and sample appealsfor Medicare Advantage denials including Diagnosis Validation/DRG Reassignment, Medical Necessity and Level of Care denials.
This second part of the webinar series covers real appeal writing tips and enforcement strategies, Wilson and Smith will be joined by a panel of clinical and legal appeal experts with first-hand successes and stories of what works and what doesn’t. We’ll address Medical Necessity as well as Diagnosis Validation/DRG Reassignment denials, and what you can immediately do to begin to turn the tide.
Let Our Experts Equip You to Win
- Brian McGraw, Co-founder, President & CEO of Intersect Healthcare
- Denise Wilson, RN, MS, RRT, Vice President, Clinical Appeal Services
- R. Phillip Baker, MD, Physician Advisor and Medical Director for Case Management, CDI and Denials Management for Self Regional Healthcare in Greenwood, SC
About Ms. Wilson: Denise brings over thirty years of clinical experience and 12 years of appeals experience to her training. Denise is a nationally recognized educator providing Appeal Training Program for Hospital Staffs. She has personally trained some of the largest systems in the nation, has been a regular speaker at national and local conferences, and has presented hundreds of cases at the ALJ level with a 95% success rate. She holds a Master of Science degree in Management Information Systems from the University of Illinois, Springfield, is a Registered Respiratory Therapist and Registered Nurse. She is currently the Vice President of Clinical Audit and Appeal Services at AppealMasters.
About Brian McGraw: Brian is the Founder, President & CEO of Intersect Healthcare and the Denial Research Group, each firm a national leader in their respective categories for Appeal Support services and next-generation Denial/Appeal Management. The denial technology and revenue recovery methods he designed are currently used by over 300 hospitals and health systems nationwide. As a fierce advocate for hospitals and physicians in their right to be fully paid, he consults with and educates revenue cycle and compliance leaders throughout the U.S. on government and commercial claim dispute resolution management. He is a nationally recognized speaker and sought-after expert in the areas of Revenue Risk Management, Regulatory Audit Management and Payer Compliance. Brian pioneered the early design and development of BPM software for revenue compliance and next-generation RCM technology to improve hospital net revenue performance. Over the last twenty years, he has worked with hundreds of hospitals and many of the nation’s largest healthcare systems to improve their managed care reimbursements, denied claim recoveries, billing integrity, RAC audit management and Medicare compliance.
About R. Phillip Baker, MD: Dr. Baker was a practicing OB/GYN for 32 years, and has an extensive background in managed care contracting. Dr. Baker took on the role as a full time Physician Advisor and Medical Director for Case Management, CDI and Denials Management for Self Regional Healthcare in Greenwood, SC. He has been an instrumental voice in strategies to overturn Medicare Advantage denials, and is nationally recognized as an authority on the CMS requirements for Managed Medicare plans.