Mastering Healthcare Appeals: Streamlining Revenue Cycle Management

Event Materials (Key Required)

Course Description

Effective revenue cycle management (RCM) is vital for healthcare providers to secure fair compensation for services. However, claim denials frequently disrupt this process, emphasizing the need for a strong appeals system. Healthcare providers face numerous denial reasons, such as incorrect coding and insufficient documentation, leading to financial instability and increased administrative burdens. A significant percentage of claims are denied initially, with many being preventable. Inefficient handling of appeals exacerbates cash flow issues, particularly when audits identify discrepancies resulting in recoupments.

All this occurs as healthcare providers are having staffing issues (due to financial constraints) further highlighting the problems associated with responding to payors effectively. This program presents a comprehensive strategy for managing healthcare appeals, beginning with staff education on common denial reasons to prevent issues proactively.

Key components of the appeal process include:

• Documentation: Teaching the importance of thorough record compilation, including medical records and payer correspondence.
• Timeliness: Guidance on adhering to submission deadlines, which vary by payer.
• Effective Communication: Training on persuasive narratives to address denial reasons.
• Follow-up Strategies: Establishing a tracking system to ensure timely responses to appeals.
• Utilizing Technology: Exploring tools that automate and streamline the appeals workflow and analyse denial trends.

Finally, the program will cover post-audit appeals to better manage recoupment requests. By providing these resources, the program aims to enhance RCM practices and ensure rightful reimbursements.

Learning Objective

• Understand RCM Fundamentals: Participants will be able to explain the importance of effective revenue cycle management in securing fair compensation for healthcare services.
• Identify Common Denial Reasons: Attendees will learn to recognize the most frequent reasons for claim denials, such as incorrect coding and insufficient documentation, and discuss strategies to prevent them.
• Enhance Documentation Skills: Participants will develop skills in compiling thorough and accurate medical records and payer correspondence to support claim submissions.
• Master Timeliness in Appeals: Attendees will understand the significance of adhering to submission deadlines and will learn how to effectively manage these timelines. 
• Communicate Effectively with Payers: Participants will acquire techniques for crafting persuasive narratives that effectively address denial reasons and enhance the chances of successful appeals.
• Implement Follow-up Strategies: Attendees will establish a systematic approach for tracking appeals and ensuring timely responses to payer communications.
• Utilize Technology in the Appeals Process: Participants will explore various tools and technologies that can automate and streamline the appeals workflow and analyze denial trends for improved management.
• Manage Post-Audit Appeals: Attendees will gain insight into handling recoupment requests effectively and learn best practices for post-audit appeals to safeguard against financial instability.

Areas Covered in the Session

• Understanding Claim Denials: Exploration of common reasons for claim denials, including coding errors and documentation insufficiencies, along with preventive measures.
• Best Practices for Documentation: Guidance on compiling thorough and accurate medical records and payer correspondence to support successful claim submissions.
• Timeliness and Deadlines: Importance of adhering to submission timelines, including variations by payer, and strategies for effective time management.
• Effective Communication Techniques: Training on how to craft persuasive narratives that address specific denial reasons and enhance the appeal process.
• Follow-up and Tracking Systems: Methods for establishing systematic approaches to track appeals, ensuring timely responses and follow-ups with payers.
• Technology in Appeals Management: Overview of tools and technologies that can automate workflows, streamline the appeals process, and analyze denial trends.
• Post-Audit Appeals Management: Strategies for effectively handling recoupment requests and managing appeals that arise from audits.
• Financial Impact of Denials: Discussion on how claim denials affect cash flow and overall financial health of healthcare organizations.
• Staff Education and Training: The importance of continuous education for staff on denial prevention and effective appeals processes to enhance overall RCM practices.
• Live Q&A Session

Suggested Attendees

• VP of Revenue Cycle Management
• Revenue Cycle Manager
• Billing Specialist
• Compliance Officer
• Healthcare Auditor
• Chief Financial Officer
• Medical Coder
• Practice Manager
• Denials Management Specialist
• Financial Analyst
• Clinical Documentation Improvement Specialist 
• IT Specialist

About the Presenter

Kevin Lasser is the Co-founder and CEO of RevKeep, the industry standard software solution that addresses all appeals a provider responds to including post-payment (i.e., RAC, private payor, takebacks, etc.) audits. The software solution (protecting over $50B in revenue) permits health care providers to manage all their appeals resulting in an increase in revenue, money retained and a reduction in personnel. RevKeep is currently being utilized by various hospitals and post-acute providers in the United States.

Due to the success with healthcare providers the RevKeep platform is now being used by legal professionals (attorneys and law firms) that have on-going relationships with healthcare providers. The ability to safely and securely pull records from any electronic health record (EHR) is a welcome solution in the legal field.

Prior to that he was the founder and CEO of JEMS Technology (JEMS), a medical device provider of HIPAA compliant mobile live-streaming video (telehealth). Technology allows clinicians to safely use mobile technology, such as smartphones, to "Consult. Anytime. Anywhere." – while complying with patient privacy laws. Launched in 2010, JEMS was generally recognized as the first company worldwide to deliver medical-grade telehealth direct to any smart-device.

Kevin was the Chair of Medical Main Street’s Mobile Health Advisory Committee, a Board of Director of ALS Association of Michigan, and was an inaugural member of the HIMSS Mobile Health Committee.

Kevin is the recipient of various professional awards/recognitions including, “Information Week – Healthcare – 9 Mobile Healthcare Applications to Watch,” “Edward C. Lowe Foundation – 50 Companies in Michigan to Watch,” as well as several entrepreneurial awards.

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Additional Information

After Registration: You will receive an email with login information and handouts (presentation slides) that you can print and share with all participants at your location.

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live? No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience.

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

This is a Live Virtual session.

A new way of immersive learning that allows you to engage live with our instructor and peers providing you with the flexibility to juggle the new work-life balance.

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