Description
Like a spacecraft maneuvering through an asteroid field, we’ll navigate the complex space between denials and approvals, exploring the critical process of medical reviews and appeals to avoid pitfalls and ensure successful claim resolutions. We’ll examine key strategies for effectively managing denials, understanding the appeal process, and presenting the strongest case for reconsideration. Attendees will learn how to streamline their workflow, reduce claim rejections, and successfully appeal denied claims, ultimately improving financial performance and compliance.
Speakers/Course Authors - Melinda Gaboury
Objectives
Course Objectives
-Learner will identify the key types of medical review and their triggers to ensure a timely response
-Learner will demonstrate the ability to interpret and analyze medical review request letters and denial notices to determine appeals
-Learner will apply documentation best practice to support medical necessity and compliance for audits or reviews
-Learner will develop an organized strategy for compiling, submitting and tracking appeals
-Learner will evaluate reasons for claim denials and determine effective tactics for successful redeterminations and reconsiderations
Certificate
By completing/passing this course, you will attain the certificate HCAF Course Certificate
Learning credits
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