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Winning Upfront with Denial Prevention/Avoidance: Using Your ADT Data and Payer-Specific Rules to Stop the Denial Freight Train

Wednesday, May 26th, 2021

Clinical Legal Partnerships to Overturn More Denials

Presented by | 4/7/2021

Summary: In response to payers overturning fewer and fewer denials in the face of appeals clearly proving the medical necessity of care provided to patients, providers should consider a Clinical-Legal Dispute Resolution approach.

A multi-disciplinary team at AppealMasters is finding new-found success using a variety of innovative methods to compel insurers to re-open and pay previously closed and upheld claims. Learn strategies such as involving state Departments of Insurance, CMS, and the Department of Labor for ERISA governed claims.

As insurers too often enjoy an unlevel playing field when it comes to denying care, appeal experts Brian McGraw and Kendall Smith share what is working for their clients. Revenue Cycle, Managed Care and Clinical Appeal Specialists will learn new appeal strategies to increase overturns and protect their hard-earned revenue.


Learning Outcomes:

  • Identify the first step in implementing state Insurance Department actions for egregious denials that are unfounded and not clinically supported.

  • Identify one federal provider protection that can be utilized in technical, medical necessity and clinical validation appeals.
  • Identify two avenues beyond the Payer Appeal procedures to escalate the decision outside of the Payer’s court of opinion.
  • Identify the state agency that regulates the state medical insurance laws that can be utilized to buttress clinical appeals.

COVID-19 Denials and Appeals

Presented by | 2/17/2021

Summary: As payer denials are now being issued for COVID-19 care, and as these denials involve new coding, billing, and level-of-care issues not dealt with previously, nurses, coders, and CDSs working in denial and appeal management need a thorough understanding of all aspects of avoiding denials and successfully appealing COVID-19-related denials.

Learning Outcomes:

  • List 2 clinical indicators that represent a severe COVID-19 diagnosis
  • List the 2 ICD-10 codes available for use in assigning a COVID-19 diagnosis in 2020

Successfully Master Level of Care Denials in a Managed Care World

Presented by | 12/02/2020

Summary: Managed Care Organization denials for inpatient level of care are some of the most difficult denials to prevent and overturn on appeal. Payer-specific rules, contracts, and definitions of inpatient care can overly complicate the process of avoiding denials and successfully appealing level of care decisions. Join us as we present successful strategies for mastering level of care denials in a managed care world.

Learning Outcomes:

  • Name the 2 primary locations where managed care payers publish their definition of inpatient status
  • Explain 2 differences between internal and external appeal processes
  • List 3 responsibilities of the clinical or coding appeals team in responding to managed care level of care denials to optimize denial avoidance and appeal success.

Looking for our old webinars?

Same great content. New location.

Please visit the Association for Healthcare Denial and Appeal Management to view all of our previously recorded Webinars.  In addition to our move, future live events will also take place via AHDAM.

Looking for CEU’S? Become a member!

For select upcoming webinars, AHDAM will be offering CEUs for nurses, coders, and CDS professionals

**Paid Membership is required for CEU acquisition**


AHDAM is a community of Healthcare Denial and Appeal Management professionals who share the latest tips, tools, and strategies to implement successful programs and achieve professional growth.