Successful Appeal Strategies for Federal Payor Claims

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Course Description

It’s a lot easier for your practice to win appeals and receive compensation. The CMS has made the Medicare Appeal process simple and faster by clearing its backlog. in the case of Medicare, and will immediately begin to process new claims. With a few easy changes to your appeal process, you can recover the substantial amount of reimbursement. The money’s yours, and you need to know how to take care of it. Changes to your appeal argument, regulatory support, and knowledge of how to interpret the decision on appeal can lead to lucrative results in a number of circumstances. 

This course will outline how to appeal denied claims from federal payors more effectively and efficiently. Understanding the different levels of appeals, the development of a strategy for each case, and writing persuasive appeal letters. You will also master the nuances of submitting appeals, such as reopening, network status, and clinical and coding reviews. By the end of this course, you will improve your appeal process and have the tools to recover more revenue, by ensuring success by understanding that details matter when it comes to keeping your money. 

Learning Objectives

• Understand the various levels of appeals within Medicare FFS, Medicare Advantage and Medicaid plans   
• Develop an appeal strategy to submit appeals timely and with favorable outcomes 
• Learn best practices based on contractor types for submission, tracking, and determinations 
•  Know All the Medicare and Medicaid Appeal Nuances 
• Understand In-Network and Out-of-Network Claims 
• Master Precertification (or Prior Authorization) Appeals Tactics that Get Your Claims Approved 

Areas Covered in the Session

• Hold payors accountable to their response deadlines
• Write a winning appeal argument and get more denials overturned
• Streamline your appeal content and don’t submit too much information
• Master Medicare and Medicaid appeal nuances
• Find out how to use appeal reopenings to collect even more revenue
• Cut through the confusion between appeals for in- and out-of-network claims
• Improve your appeals process with Payer-Specific strategies
• Demand clinical and coding reviews to overturn more
• Live Q&A Session

Suggested Attendees

• Healthcare CEOs 
• Healthcare CFOs 
• Healthcare COOs 
• C-level Executives 
• Office Staff and Billing Managers 
• Medical Billing Companies 
• Hospital Revenue Cycle Staff 
• Physician 
• Nurses 
• Physician Assistants 
• Nurse Practitioners 
• Medical Assistants 
• Practice Manager 
• Office Managers 
• Billers 
• Coders 
• Auditors 
• CDI Specialists 
• Collection Staff 
• Front Desk 
• Compliance Officers 
• Telemedicine System Vendors 
• Patient Accounts Personnel 
• Medical Record Supervisors 
• Other Personnel Interested in Billing and Appeal 
• Health Information Management Administrators and Technicians 
• Medical Providers, Who are Involved in the Payment Process of their Practice 

About the Presenter

Kelly Grahovac serves as the General Manager for The van Halem Group where she focuses on audits, compliance, education, and resolving complex issues for clients in the post-acute care space. Kelly has over 20 years of experience working at one of the nation’s leading Medicare contractors and with The van Halem Group and is a known lecturer in the HH&H and HME industry, speaking at national conferences, state associations, and for private events. In addition, Kelly is a common contributor to a variety of industry publications and serves as a board member for both the South Carolina Medical Equipment Suppliers Association (SCMESA) and Big Sky Association for Medical Equipment Suppliers (AMES). Kelly also serves on the National Supplier Clearinghouse Advisory Committee (NSCAC).  

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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.

Purchase Order Form - Click Here to download PO form. 

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