Tackling Denials: Starting Out the New Year on the Defense

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Tackling Denials: Starting Out the New Year on the Defense

Product Code: YHHA011421A

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Tackling Denials: Starting Out the New Year on the Defense

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Presented on: Thursday, January 14, 2021 | 1–2:30 p.m. Eastern

Presented by: Nicole Crytser, BA, AA, CRCR, and Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA

Effective denials management is more important than ever, but it’s an uphill effort for many organizations. Knowing where—and how—to start is difficult, and simply gathering and analyzing denials data can be complex. Payers often flood organizations with denials. With resources already stretched thin, staff may struggle to keep up when faced with shifting denial targets and inconsistencies between payers.

During this 90-minute program with live Q&A, expert speakers Nicole Crytser, BA, AA, CRCR, and Rose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA, will walk through the processes to identify, dissect, prioritize, monitor, and reduce denials and ensure claims are processed correctly. Using real-life examples, the speakers will explain how they reduced denials and detected issues with payers’ denial explanations. They will share a case study highlighting the resolution of a payer’s conflicting denial information and the composition of an ideal denial defense team with a sample job description. The speakers will additionally examine the components of a compelling appeal letter.

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

  • Explain methods to address common denials
  • Define the components of a successful appeal letter
  • Demonstrate how to construct a denials management program

 

Agenda

  • Addressing denial challenges
    • Peeling the onion to identify denial targets
    • Using data analytics and creating reports
    • Prioritizing denials
  • Who should be involved
    • Determining the role of each participant
  • Assessing common denial types and how to proactively avoid them
    • Additional information requests
    • Clinical denials
    • Eligibility denials
    • Authorization denials
    • CDM triggering denials
    • Hard coding edits
    • Case study
      • Analyzing the disconnect between the remittance advice and the denial reason codes
  • Components of a compelling appeal letter
    • Identifying the elements of a successful appeal letter
  • Providing feedback to providers and the contracting department
    • Identifying education needs and tips
    • Identifying concerns with payer contracts
  • Creating a denial defense team
    • Staffing the team
    • Defining roles
  • How denials management relates to revenue integrity
    • Understanding the connection between denials management and revenue integrity
  • Q&A

Who Should Listen?

  • HIM directors
  • HIM managers
  • Revenue cycle directors
  • Revenue cycle managers
  • Revenue integrity directors
  • Revenue integrity managers
  • Nurse auditors
  • Coding directors
  • Coding managers
  • Patient financial services directors
  • Patient financial services managers
  • CDI directors
  • CDI managers
  • Billing managers
  • Denial management staff
  • HIM staff
  • Coding staff
  • Patient financial services staff
  • Billing staff
  • Revenue integrity staff
  • CDI staff

Meet the Speakers

Nicole CrytserNicole Crytser, BA, AA, CRCR, is the senior manager of patient financial services and denial defense at Palomar Health in San Marcos, California. Crytser is a financial healthcare professional with 19 years of success in multiple areas of hospital revenue cycle, including access, patient financial services, and revenue cycle integrity. She is an established leader focused on accountability to drive metrics, increase productivity, and optimize operations to achieve efficiency and fiscal results. Crytser is capable of building and rebuilding various revenue cycle teams and supporting analytics teams, as well as executing cash applications, billing and follow-up, clinical appeals, and government auditing. She is a results-focused team player with extensive knowledge of hospital financial operations, specifically revenue cycle from front end to back end. As a denials manager, she reduced denials by 4%, equating to an average of a $10 million decrease in denied dollars.

 

Rose T. DunnRose T. Dunn, MBA, RHIA, CPA, CHPS, FACHE, FHFMA, is chief operating officer of St. Louis–based First Class Solutions, Inc., a national HIM consulting firm providing coding compliance, skilled nursing facility, and HIM operational consulting services. She is a prolific author and has spoken on a variety of HIM and compliance subjects. Dunn is the author of NAHRI’s Revenue Integrity Manager’s Handbook. She has held faculty appointments with St. Louis University, Stephens College, and the University of Minnesota. Her firm assists healthcare providers and organizations with their HIM and coding operational concerns, coding and coding compliance requirements, HIPAA privacy and security readiness, and institutional review board activities. Dunn is a past president of AHIMA and chair of the AHIMA Foundation and recipient of AHIMA’s 1997 Distinguished Member and 2008 Legacy Awards. In 2011, she served as the interim CEO of AHIMA. In addition to AHIMA, she is active with HFMA, AICPA, and ACHE.

 

Continuing Education

National Association of Healthcare Revenue Integrity (NAHRI)
This program has been approved for 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).

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.