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Home > Curriculum > Effective Denial Management and Rejection Prevention

Effective Denial Management and Rejection Prevention

When correctly submitted claims are inappropriately reduced, delayed, or denied, it is imperative to appeal claims in a timely manner with as much supporting documentation as possible. Whether the issue is inadequate payment, denial, or rejection, your billing and auditing staff need the knowledge and tools to properly handle difficult claims management issues.
 
Protect the practice bottom line with specialized instruction on claims rejection/denial management and prevention. Participants in this course will review claim guidelines and examples that cause a claim to be rejected - including issues specific to telehealth claims. Learn how to monitor payer policies, resolve denials, and implement efficient methods for resolution. Topics include knowing the practice's rights and responsibilities when appealing claims, and educating providers on the necessary documentation requirements that support medical necessity. When correctly submitted claims are inappropriately reduced, delayed or denied, it is imperative to appeal claims in a timely manner with as much supporting documentation as possible. 

5 Reasons to Attend
  1. Participants will return to the office equipped to handle inadequate payments, denials, rejections, and other claims management issues.
  2. Reduce the risk of claim rejection and/or denial due to lack of specificity or erroneous billing.
  3. Learn strategies for educating providers on the necessary documentation requirements that support medical necessity.
  4. Distinguish the differences between a rejection and a denial and implement effective strategies for both.
  5. Eliminate exposure for lost revenue and audits by government and private payers due to inappropriate billing.
Participants will receive tools and expert guidance on how to recoup dollars rightfully due to the provider. The instructor will address questions and provide new insight, expert guidance, and tools to help billing staff successfully manage all your claims rejections and denials.

Class Highlights
  • Review Medicare non-covered service requirements
  • Understand the top reasons claims are delayed/denied
  • Learn each step of a proper denial tracking system
  • Learn protocols to eliminate rejections
  • Identify efficient methods for denial resolution
  • Discuss how to make determinations of medical necessity that must adhere to the standard of care 
  • Modifiers, bundling, downcoding, and other situations that cause a claim to be rejected
  • Working within claim guidelines to avoid further delays
  • Handling payment inconsistencies
  • State and Federal Guidelines for refunds/recoupments
  • Guidance on Prompt-Pay laws
  • Accessing legal guidance if needed
Who Should Attend
This class is ideal for billing and claims processors, managers, providers, consultants, and anyone seeking solutions and for claim rejections and denials.

Prerequisites
The content covered in this course assumes basic to intermediate knowledge of outpatient billing and carrier reimbursement.

What to Bring
A course manual will be supplied. No supplementary materials are required for this course.

Practice Management Institute
Practice Management Institute® (PMI) teaches physicians and their staffs how to properly navigate complex health care issues and secure every dollar rightfully due. Our courses focus on solutions for coding, reimbursement, compliance and practice productivity. These training programs have been hosted in leading hospitals, medical societies and colleges across the U.S. since 1983.

Program Schedule

There are no live classes available at this time. See below for more options.

Can’t find training near you?

  • Visit our Online Training Center for more options.
  • Bring an Instructor onsite for group training. Contact [email protected] or call 800-259-5562, M-F, 8-5 Central
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  • Not able to attend a live session?
    Check out our self-paced version!

    Online Training

    Continuing Education Units (CEUs)

    PMI CEU APPROVED Earn 3 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

    If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.


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