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Best Practices to Minimize Medical Necessity Denials

Understand how to overcome the challenges of medical necessity denials to avoid lost time and money. Health care providers face daunting challenges in addressing increasing volumes of medical necessity denials from third party payers. Medical necessity denials are extremely costly requiring rework, investigation, and appeal, not to mention the time value of money and lost opportunities to put the monies to work in the hospital. These types of denials are pervasive, difficult to successfully challenge and result in a low recovery rate. Due to often-times low dismal recovery rates and high volume of denials, there is a strong tendency to view these denials as the cost of doing business that is simply factored into the revenue cycle. An effective approach to managing third party payer denials is to invest in the resources, education of all relevant health care stakeholders, technology, and processes to mitigate and avoid denials in the first place. There are countless contributing factors to medical necessity denials beyond the reporting of a 'non-covered' diagnosis. During this topic you will learn best practice principles and practices in the revenue cycle to minimize medical necessity denials beginning with efforts to progressively transform inefficient repetitive denials management into a cross cultural environment embracing concepts and thought processes of denials avoidance.


Runtime: 88 minutes
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Why Lorman?

Over 30 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Historic Perspective of Medical Necessity

  • Local Coverage Determinations and National Coverage Determinations
  • Antagonistic and Punitive Approach
  • Perpetuation of the Treadmill

Evolution of Medical Necessity

  • Developments of the Last Two Years
  • Medical Necessity Physician Initiative vs. Hospital Initiative
  • Impact of Medical Necessity Upon Physician's Practice of Medicine
  • Elements of Medical Necessity Beyond Diagnostic Tests

Medical Necessity A Synergistic Approach

  • Necessity of Collaboration Between Physician and Hospital
  • Vested Financial Interest of Both Parties
  • Evolving Business Financial Model Financial Repercussions

Strategies to Promote Medical Necessity Synergies and Partnerships Physician and Hospital

  • Best Strategies to Promote Physician Education and Buy-in From Physicians
  • Proven Tips to Overcome Physician Resistance and Reluctance
  • Practical Advice and Guidance on Building and Expanding Upon Achieved Successes to Maintain Cultural Paradigm Shifts in Medical Necessity Mindset That Embraces Concepts of Denials Avoidance
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Why Lorman?

Over 30 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Webinar

This course was last revised on July 20, 2017.

Call 1-866-352-9540 for further credit information.

  • AHIMA 1.5 including External Forces 1.5
     
  • This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
     

This program format does NOT qualify, nor meet the National Standard for NASBA accreditation.

Audio & Reference Manual

This program format does NOT qualify, nor meet the National Standard for NASBA accreditation.

MP3 Download

This program format does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 30 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Glenn Krauss, B.B.A., RHIA, CCS, CCS-P, CPUR, FCS, PCS

Glenn Krauss, B.B.A., RHIA, CCS, CCS-P, CPUR, FCS, PCS

  • Senior Consultant for a health care consulting organization in Washington D.C.
  • Previously held position as director of clinical documentation improvement
  • Practice emphasizes all aspects of reimbursement and revenue cycle processes, including ICD-10 and CPT/evaluation and management coding, clinical documentation improvement, denials management/denial avoidance and physician practice management
  • Conducts regular seminars and workshops on numerous areas, including medical necessity establishment from a physician perspective, clinical documentation improvement, denials management, and coding education and training
  • Author of several publications related to clinical coding, establishment of medical necessity beyond Medicare local coverage determinations, soliciting buy-in from physicians in the roll-out of clinical documentation improvement programs, and the role of the clinical documentation improvement specialists beyond improving MS-DRG assignment and resulting financial reimbursement including how CDI can best transform and contribute to a denials avoidance approach to documentation excellence
  • Created and managed an active LinkedIn forum titled Physician Documentation Improvement-A New Paradigm intended to provoke thought provocative discussion on anything CDI related
  • B.B.A. degree in management, Hofstra University in Hempstead, New York
  • Certificate in health information management, University of Washington in Seattle
  • Member of AHIMA, WIIMA and HFMA
  • Can be reached at [email protected] or 603-303-3337
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Why Lorman?

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Product ID: 400969
Published 2017
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