Fighting Denials and Winning Appeals: Tools for Your CDI Arsenal

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Fighting Denials and Winning Appeals: Tools for Your CDI Arsenal

Product Code: YHHA061319

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Fighting Denials and Winning Appeals: Tools for Your CDI Arsenal

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Presented on: Thursday, June 13, 2019 | 1:00–2:30 p.m. EST

Presented by: Lillian Dickey, BSN, RN, BSBA-MIS, CCDS Haaris Ali, MD, CDIP

“Denied.” It’s a word no one wants to hear in response to their healthcare claims. Yet, it’s more frequently on the lips of both governmental and private payers. Whether it be clinical- or coding-related, denials are an ever-present reality in today’s healthcare environment, threatening the financial health of organizations large and small.

Though not a traditional avenue for CDI professionals to take, denials management and the appeals process offers broad opportunities for CDI expansion. And that expansion is happening at a rapid pace, answering the clear need in the industry.

Join expert speakers Lillian Dickey, BSN, RN, BSBA-MIS, CCDS, and Haaris Ali, MD, CDIP, for this 90-minute webinar to learn how and why CDI should be involved in denials management, the risk of staying out of it, how to identify a type of denial and appeal it, and much more.

At the conclusion of this program, participants will be able to:

  • Identify ways CDI can be involved in the denials management and appeals process
  • Define commonly used denials and appeals terminology
  • Identify documentation insufficiencies and common diagnoses that may lead to denials
  • Define the difference between a clinical- and coding-based denial
  • Describe the key points included in a successful appeals letter
  • Explain the potential financial implications of denials

Agenda

  • Denial basics
    • Clinical versus coding denials
    • Commonly used terminology
    • Current payer and audit trends
  • Potential impact of CDI specialists’ involvement
    • Financial outcomes
    • Effect on patient care
    • Effect on quality
  • CDI’s involvement with denials management
    • Risk and cost associated with denials
    • Collaborating with other departments
    • Forming a denials group or department
  • Commonly denied diagnoses and record review focuses
    • Sepsis
    • Respiratory failure
    • Acute renal failure and acute kidney injury
    • Encephalopathy and altered mental status
    • Surgical procedures
  • Live Q&A

Tools

  • Sample denial appeal letters

Who Should Listen?

  • CDI specialists
  • CDI managers/directors
  • HIM managers/directors
  • Inpatient coders
  • Physician advisors
  • Denial managers

Meet the Speakers

Lillian DickeyLillian Dickey, BSN, RN, BSBA-MIS, CCDS, is a CDI specialist UCLA Health in Los Angeles. Prior to entering CDI in 2015, Dickey worked as a bedside nurse for eight years, focusing in the emergency/trauma department, pediatric ICU, and various other specialties. During her CDI career, she worked directly with the DRG denials group, even before the group was formalized in 2016. Dickey is a current member of the ACDIS Chapter Advisory Board and a former member of the Washington Evergreen chapter leadership team.

 


Haaris AliHaaris Ali, MD, CDIP, is the director of CDI services for Prospect Holdings at the Nix Health Hospital in San Antonio. Ali has served as a leader providing oversight and expertise in CDI, denials management, utilization review, process improvement, and case management. He has trained hundreds of physicians and nurses in denials management, and centralized, standardized, and scaled appeals departments. He has been an active member of ACDIS and served on the Washington Evergreen chapter leadership team.


Continuing Education

Association of Clinical Documentation Improvement Specialists (ACDIS)
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certified Clinical Documentation Specialist (CCDS) certification, offered as a service of the Association of Clinical Documentation Improvement Specialists (ACDIS).

Ability to claim credits for this webinar expires on: 06/12/2020

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 1.5 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

Ability to claim credits for this webinar expires on: 06/12/2020

Instructions

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

CAN'T LISTEN LIVE? 
No problem. The On-Demand version will be available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

PLEASE NOTE 
Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email customerservice@hcpro.com if you have questions.