Denials, Appeals and Prior Authorization: How to Protect Reimbursement

Claim denials are an important part of the revenue cycle and a reason for low reimbursements.  Too often processing denials is put on the back burner to charge processing and payment posting.  This webinar is going to look at the most common denials and give attendees valuable information on how to better manage denials so that reimbursement is not left on the table.  We will discuss methods of creating a process to ensure that timely filing limits are met and learn how tracking denials can assist in understanding changes in insurance carrier policies.

Webinar Objectives

• The first step of denials management is understanding the transaction codes sets
• Confirm that a denial is valid.  Once a denial is found to be incorrect, it has to be
• Show how to appeal when the denial is incorrect.
• Organizing the process so it allows multiple staff
• This process will also assist in identifying insurance company trends
• Best practice for obtaining Prior Authorization
• Submitting affective appeals- what should they say

Webinar Agenda

• We will review the denial and remark codes
• Locate common claims edits that also code denials
• Walk through   recognizing trends in denials that can assist in seeing policy or coding changes
• When the denial is incorrect it is important to write an effective appeal
• Prior authorization
• Medical Necessity
• Checklists for all of the steps

Webinar Highlights

• Finding and understanding denial and remark codes
• Common denials and how they will need to be reconciled
• NCCI policies that create denials
• Creating a denials management process based staff and technology
• Trending denials using your practice management system
• The appeals process
• Writing an effective appeal
• Knowing what to do when an appeal is not enough

Who Should Attend

Reimbursement team, collectors, biller, coder, revenue cycle manager, administrator, cash poster, claims adjuster, claims manager.