Insurance Denials: Appeals, Prevention & Contracting Advice


Physician Advisors are commonly tasked with conducting an onsite analysis of healthcare processes and documentation to avoid costly insurance denials. They must identify both strengths and opportunities for improvement in both the Centers for Medicare & Medicaid Service along with Commercial payment strategies. Prevention begins with the Emergency Department Case Manager to ensure the patient is being placed at the correct level of care from the start. Multidisciplinary rounds with a physician advisor move cases through the continuum of care for the best quality / economic and utilization outcomes.

This online course will deliver details on how to overturn denials, prevent insurance denials, and therefore providing cost savings by analyzing managed care contracts.

This session was recorded live at our 2019 Annual Health Care Quality & Patient Safety Conference and is a portion of the online course entitled: Connecting People, Purpose & Passion. They may be taken individually to earn incremental CME/CE credits. However, if you plan on taking the full 8-hour course, you will not be able to claim credit for these individual sessions.

At the conclusion of this activity, attendees will be able to:
  • Describe the insurance appeal process and strategies to overturn denials
  • Illustrate how to prevent insurance denials with good documentation and utilization
  • Analyze the impact the physician advisor has on managed care contracts that can reduce insurance denials

ACCREDITATION & CREDIT
The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This program is approved for Category 2 credit by the American Osteopathic Association.

Conflict of Interest Disclosure:
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

Valid Dates: May 23, 2019 to March 15, 2022
Original Release Date: April 26, 2019

Complimentary Course - Login to receive the course at no charge.
Diplomate Members $0.00
Professional Members $0.00
Non Members $0.00


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