Denials Management: CDI Professionals’ Role in Fighting and Prevention

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Denials Management: CDI Professionals’ Role in Fighting and Prevention

Product Code: YHHA062520A

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Denials Management: CDI Professionals’ Role in Fighting and Prevention

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Presented on:Thursday, June 25, 2020 | 1:00-2:30 p.m. Eastern

Presented by: Shirlivia Parker, MHA, RHIA, CDIP and Susanne Warford, MBA-HCM, RN, CCDS

Denials. Every organization has them, but not every organization knows how to fight them effectively. When an organization gets hit with a denial, they need to know how to review the denial and effectively argue the case for their documentation, query, coding, and billing practices.

On the front end, organizations need to understand how their clinical validation CDI efforts fit into denials management, preventing as many denials as possible. On the back end, they need to understand the levels of the appeals process and how to craft an appeal that gets results.

During this 90-minute program, Shirlivia Parker, MHA, RHIA, CDIP, and Susan Warford, MBA-HCM, RN, CCDS, will examine CDI professionals’ role in denials management from soup to nuts. They’ll cover denial prevention tactics including front-end physician education, interdepartmental collaboration, and payer contracting. And because some denials will inevitably arrive despite CDI’s best efforts, Parker and Warford will also cover writing appeals.

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

  • Identify CDI professionals’ role in denials management as well as whom to involve
  • Describe the elements of an effective basic appeal
  • Explain the levels of appeal for denials
  • Identify opportunities for denials prevention when it comes to education, payer contracting, and documentation hazards
  • Explain the importance of interdepartmental collaboration in regard to denials management

Agenda

  • CDI’s role in denials management
    • How to get involved
    • Whom to involve
  • Back-end fighting
    • Appeal writing 101
    • Levels of appeal
  • Front-end prevention
    • Physician and CDI education
    • Interdepartmental collaboration
    • Payer contracting
    • Organizationwide clinical criteria
  • Tracking and trending
  • Live Q&A

Who Should Listen?

  • CDI specialists
  • CDI managers/directors
  • HIM managers/directors
  • Inpatient coders
  • Physician advisors
  • Hospital quality staff
  • Denials management staff

Meet the Speakers

Shirlivia Parker     

Shirlivia Parker, MHA, RHIA, CDIP, is the senior manager of physician partnership and CDI advocacy at Providence St. Joseph Health System (PSJHS) in Irvine, California. She has a master’s degree in health administration from the University of Phoenix in Arizona and a bachelor’s degree in health information management (HIM) from the University of Louisiana at Lafayette. Parker has 19 years of revenue cycle experience, which includes roles such as HIM director, CDI physician educator, clinical coder/auditor, CDI specialist, and denials management expert. She has worked with PSJHS for the past four years.

Susan Warford

Susan Warford, MBA-HCM, RN, CCDS, is the system CDI analyst and appeals nurse for Baptist Health in Louisville, Kentucky. She has more than 16 years of experience in high-level patient care areas, including the emergency department and neurosurgical intensive care at a Level I trauma center, as well as supervisory experience in compliance. Prior to her present role, she was the regional manager of the CDI program for approximately three years. In this role, she worked to systemize and standardize processes across the healthcare system, which consists of seven facilities spread throughout the state of Kentucky. Warford currently serves on the leadership team for the Kentucky ACDIS local chapter and is a member of the ACDIS Chapter Advisory Board.

 

Continuing Education

Association of Clinical Documentation Integrity 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 and CCDS-O (outpatient) certification, offered as a service of the Association of Clinical Documentation Integrity Specialists (ACDIS).

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 Tservice of the National Association of Healthcare Revenue Integrity (NAHRI).

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.