Online Training Course
Prod ID: 558
Winning the Denials Battle
Don't let time constraints or outdated payer policy details put your clinic in financial jeopardy. Build an efficient denial work queue and organize your approach to appeals to speed up resolutions and increase the likelihood of an overturned claim denial.
CEUs
1
Length
61 min
Price
$119.00
This essential session will teach you how to plug leaks in your revenue cycle. The instructor breaks down the true cost of claims denials - from stalled cash flow to compliance risks - and dissects the "Big Six" categories: medical necessity, eligibility, authorization, coding, bundling, and timely filing.
Stop the "revenue bleed" with proactive strategies:
- Front-End Fixes: Prevent denials before claims are ever submitted.
- Audit-Proofing: Comprehend and apply documentation and coding guidelines to prevent audit flags.
- Workflow Mastery: Build high-efficiency work queues and master the "appeal vs. write-off" decision.
- Performance Tracking: Establish staff accountability and monitor key metrics for revenue performance.
By standardizing and organizing your approach to appeals, you can significantly improve efficiency, speed up resolutions, and increase the likelihood of overturned denials.
Learning Objectives
- Identify the most common root causes of claims denials
- Implement preventive strategies at registration, coding, and charge capture
- Analyze denial reports to spot trends and prioritize recovery efforts
- Apply structured appeal techniques to improve overturn rates
- Develop a proactive denial management process that improves revenue performance
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Jan HaileyMHL, CMC, CMCO, CMIS, CMOM, CMCA E/M |
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
Other classes like this.
Effective Denial Management and Rejection Prevention
From Chaos to Clarity: Data-Driven Denial Prevention
Minimizing Hard Denials and Non-payments