1.Identify the challenges inherent to interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.
2.Discuss the changing state of todays healthcare system, as it relates to the important trends in required compliance activities to prevent future claims denials.
3.Define the diverse educational needs for healthcare personnel regarding the significant changes in the healthcare reimbursement field and how these impact the denials that an organization will confront.
4.Describe important methods of, and how to manage, administrative & provider organizational acceptance and buy-in to improve the denial management and appeals processes.
5.Explain the goals, key benefits and strategies of having an on-site based denial management an appeals program.
6.Identify effective techniques to communicate with both clinicians (physicians, mid-level practitioners, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.
7.Apply techniques to develop and implement a structured Denials Management & Appeals Improvement Program within acute care hospitals.
8.Discuss compliance methods on auditing, monitoring and evaluating the effectiveness of your denial management program.