Denials Avoidance &
Appeals Institute (C-DAM)
Overview
Agenda
Accreditations
Recertification
Overview
OVERVIEW
The Denials Avoidance & Appeals Management (C-DAM) Institute focuses on identifying effective techniques to communicate with both clinicians and non-clinical staff in order to appeal current denials and prevent future denials. Your professionals are taught how to apply techniques to develop and implement a structured Denials Management and Appeals Improvement Program within hospitals. Evidence Based Case studies, InterQual criteria and practical instruction are provided in developing and/or enhancing your compliance methods in auditing, monitoring, and evaluating the implementation & effectiveness of your denial management program. Our extensive professional experience and training in clinical care, case management, medical necessity, coding guidelines, and regulatory compliance are the foundation for our highly successful recovery audit defense and appeals services.
Overall Learning Objectives
At the completion of this program, participants should be able to:
• Identify the challenges inherent in interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.
• Understand the changing state of today’s healthcare system, as related to the important trends toward required compliance activities to prevent future claims denials.
• Identify 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.
• Identify important methods of (and how to manage) administrative & provider organizational acceptance and “buy-in” to improve the denial management and appeals processes.
• Describe the goals, key benefits, and strategies of having an on-site based denial management and appeals program.
• Identify effective techniques to communicate with both clinicians (physicians, mid levels, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.
• Apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within acute care hospitals.
• Identify compliance methods on auditing, monitoring, and evaluating the effectiveness of your denial management program.
Process Requirements
• Accurate, precise and explicit medical records documentation
• Effective case management processes including level of care assignment
• Correct and compliant coding that reflects the true severity of illness and complexity of care
At the completion of this program, participants should be able to:
• Identify the challenges inherent in interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.
• Understand the changing state of today’s healthcare system, as related to the important trends toward required compliance activities to prevent future claims denials.
• Identify 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.
• Identify important methods of (and how to manage) administrative & provider organizational acceptance and “buy-in” to improve the denial management and appeals processes.
• Describe the goals, key benefits, and strategies of having an on-site based denial management and appeals program.
• Identify effective techniques to communicate with both clinicians (physicians, mid levels, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.
• Apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within acute care hospitals.
• Identify compliance methods on auditing, monitoring, and evaluating the effectiveness of your denial management program.
Process Requirements
• Accurate, precise and explicit medical records documentation
• Effective case management processes including level of care assignment
• Correct and compliant coding that reflects the true severity of illness and complexity of care
Attendees have the option of taking the Certification Exam within 6 weeks of this Program.
Registration Fee: $1,695 Now Just $1149.
For more information about our programs contact:
740-968-0472
support@aihcd.org
Agenda
DENIALS AVOIDANCE & APPEALS MANAGEMENT INSTITUTE (C-DAM) AGENDA
SESSION 1
OVERVIEW OF THE REVENUE CYCLE (35 Minutes)
1. Explain the Revenue Cycle
2. Define The components of the Revenue Cycle
3. Identify How the Revenue Cycle “breaks down”
SESSION 2
HOW HEALTH CARE GETS PAID (50 Minutes)
4. Delineate policies governing third party payment
5. Differentiate Reimbursement policies
6. Analyze the challenges with payment structures
SESSION 3
DENIALS & APPEALS MANAGEMENT – DENIALS – Part 1 (40 Minutes)
7. Define Denial
8. Identify the causes of denials
9. Review the regulatory processes in denials
10. Evaluate “Where do we go from here”
8. Identify the causes of denials
9. Review the regulatory processes in denials
10. Evaluate “Where do we go from here”
DENIALS & APPEALS MANAGEMENT – DENIALS – Part 2 (40 Minutes)
DENIALS – Continued
SESSION 4
THE RIGHT SETTING AT THE RIGHT TIME – INPATIENT VERSES OUTPATIENT (1 Hour 20 Minutes)
11. Delineate in detail the differences between Inpatient and Outpatient status.
12. Review and Examine Medical Necessity.
13. Discuss the responsibilities and obligations of the treating physician.
14. Review the vital role of Clinical Documentation.
15. Examine the review process and the rationale of contracted reviewers.
SESSION 5
DENIALS & APPEALS MANAGEMENT (1 Hour 5 Minutes)
16. Summarize strategies to reduce clinical denials
17. Recognize Case Management and Utilization Management roles in the revenue cycle
18. Identify how clinical documentation programs effect the revenue cycle
19. Discuss strategy to build an effective Denial & Management program
SESSION 6
THE APPEAL PROCESS (1 Hour 15 Minutes)
20. Recognize what type of appeal is necessary.
21. Utilize a strategy for appeal management.
22. Investigate & analyze the medical record.
SESSION 7
A FIVE STEP STRATEGY TO WRITING EFFECTIVE CLINICAL APPEAL LETTERS (1 Hour 10 Minutes)
23. Validate defense with standard practices of evidence based medical criteria.
24. Quote clinical documentation that is explicit and supports the issue being denied.
25. Summarize coherently the rationale in defense of the denial.
26. Demonstrate how to write compliant health care appeals.
Attendees will review case studies that include the denial letter, medical records, sample appeal letters and overturn letters.
Accreditations
DENIALS AVOIDANCE & APPEALS MANAGEMENT INSTITUTE ACCREDITATIONS
THE ASSOCIATION FOR INTEGRITY IN HEALTH CARE DOCUMNTATION
This course has been approved by the Association for Integrity in Healthcare Documentation for 12.5 CEU contact hours. (AIHCD #21712)
Approval valid through 12/31/23
Recertification
IS IT TIME TO RECERTIFY?
The C-DAM certification is just the beginning of a new path in your career. It is your responsibility to maintain up-to-date continuing education to keep your credential active. Twenty (20) continuing education credits need to be earned in each two (2) year cycle. These credits can be earned through AIHCD® educational programs or any relevant Denials and Appeals Management education program in your field of expertise.
Please download the continuing education form and once completed, fax to AIHCD® via FAX at: 769-208-8613 to designate your credits.
Submit the re-certification fee of $150 to AIHCD for another two (2) year cycle.
C-DAM Re-Certification Fee $150
C-DAM Re-Certification Fee $150
Earn AHIMA CEUs
We offer 8 additional courses with up to 23 CEU credit hours approved by AHIMA and AIHCD.