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Catalog Number : ugw1602
Title : Defining Denials: Understanding the Prevalence of the Epidemic
Speaker : Pam Waymack

Duration : 60 minutes

Webplay Recording Date : 4-2-2009
Webplay Price : $ 150 for two weeks viewing

Overview:

Best Practices in Denial Management Today - Webinar Series Pam Waymack, MBA, FHFMA …web-based Education for the Healthcare Professional Is your organization leaving money on the table when it comes to getting paid by insurance companies? Over 14% of your claims received by payers are not paid on the first pass according to 2006 health plan industry data!

This series of webinars on denial management best practices can be attended from your own computer or conference room. You can attend any combination or all of the webinars depending on your needs.

The Denial Management Best Practices Webinar Series will explore the growing epidemic of claim denials- including underpayments, denials, nonpayment’s and late payments. We will look at some of the myths about denials and explore a variety of advanced strategies to prevent their occurrence and assure recovery.

Ample time will be provided both during and at the conclusion of the Webinars for participant questions.

Webinar # 1 - Defining Denials: Understanding the Prevalence of the Epidemic Understanding what a denial is and how denials occur is essential to effective management today.

This Webinar is designed to help managers and staff address the variety of definitions applied to denials and set up measures today as we explore both payor and provider uses of the term ?denial.? We will then examine data of denials in the industry from both health plan data, as well as provider studies. We will identify some of the common business challenges that result in denials whether caused by the provider or the payer.

As a result of attending this Webinar, participants will be more confident in their approach to defining and discussing the prevalence of denials and will be better able:

  • To guide your organization in development of a definition for denials
  • To understand payor perspective on the reasons for denials and their incidence
  • To explain the prevalence of denials within all types of provider organizations
  • To identify the most common types of denials

At the conclusion of the program, participants will receive a complimentary copy of Pam Waymack's "Ten Questions to Focus Your Organization’s Denial Definition Discussion”

Webinar # 2 - Measuring Denials: The Denial Database as a Diagnostic Tool

You cannot manage what you cannot measure. This webinar will look at the denial database as a key tool in not just measuring but also managing and reducing denials. Explore with us a variety of approaches to measure the extent of denials within your organization and benchmark your efforts to reduce their occurrence. We will explore advanced ways to use your denial database to analyze your experience and improve results including looking at what variables to add to the database and questions you can start asking now using your database. The Webinar will conclude by examining advanced uses of the database internally and externally.

As a result of attending the webinar attendees will be able to:

  • Identify several approaches to starting a denial database
  • Describe the basic and advanced variables that should be included in a denial database
  • Demonstrate an understanding of additional uses of their existing denial database
  • Describe some of the questions and answers that can be pulled from a denial database

Attendees will receive Pam Waymack's template for their own use "Denial Tracking Database”.

Webinar # 3 - Preventing Denials: One Dozen Opportunities to Reduce the Denial Epidemic

This Webinar leads healthcare managers through more than a dozen opportunities to prevent denials that may occur along the patient experience-from scheduling, registration, medical records, case management, charge entry, billing, payment posting, revenue recovery, managed care contracting and compliance. Unique issues and solutions related to technology, information systems and clinical management will also be discussed. We will identify opportunities to improve your operations through advanced prevention strategies and highlight best practices and new approaches for hospitals and medical groups to improve their managed care contract language, as well as internal operations to help prevent the occurrence of denials.

This Webinar will provide participants with an understanding of the many upfront causes of denials and the role preventive denial management plays as a key component of the revenue cycle management process. Participants will be equipped to bring new ideas and approaches to their organization’s denial management efforts. Participants will also receive a complimentary copy of Operational Indicators by Department for Monitoring Payor Compliance.

As a result of attending the webinar attendees will be able to:

  • To head off denials that occurs by function throughout the patient flow process
  • To identify new operational approaches to further reduce the incidence of denials throughout the organization
  • To use contract language to reduce specific denials
  • To know where automation can be applied
  • To examine operational measures to monitor payor problems by functional area

Participants in this webinar will receive a complimentary copy of "Operational Indicators by Department for Monitoring Payor Compliance”.

Webinar # 4 - Appealing Denials: Enhancing the Success of Your Revenue Recovery Program

Providers lack the resources to successfully appeal every denial. How then do you organize an effective appeal program? In this Webinar, we will look at best practices for organization and management of the critical task of revenue recovery. We will examine various remedies for denials once they occur including how to develop a successful appeal, as well as specific strategies for unique denial reasons. We will look in detail at the elements to include in a successful appeal letter. Step up your efforts to turn your denials into dollars through this program.

As a result of attending the webinar attendees will be able to:

  • Identify best approaches to organize the revenue recovery function whether starting up or established
  • To focus your efforts to achieve maximum benefit
  • To move beyond refiling the claim
  • To translate specific denials into proven appeal strategies to recover

Webinar participants receive a copy of Pam Waymack's one page "Anatomy of a Successful Denial Letter”.

Target Audience:

  • Healthcare managers and staff who are involved in or oversee denial prevention or recovery, management and staff involved at the front end of the revenue cycle in patient access, at the end of the revenue cycle in billing, collection and recovery, as well as those involved in managed care contracting, medical and case management, auditing, health information management and decision support.

Level:

  • Intermediate

Sessions:

  • Defining Denials: Understanding the Prevalence of the Epidemic Thursday, 2 April 2009
  • Measuring Denials: The Denial Database as a Diagnostic Tool Thursday, 9 April 2009
  • Preventing Denials: One Dozen Opportunities to Reduce the Denial Epidemic Thursday, 16 April 2009
  • Appealing Denials: Enhancing the Success of Your Revenue Recovery Program Thursday, 23 April 2009

All sessions are scheduled from 1:00 pm - 2:15 pm Central Time. Log-in begins at 12:45 pm session.

Contact Hours:

This course has been approved for 1.2 Iowa Nursing Contact Hours. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.