Denials Avoidance and Appeals Management Institute

Within the Denials Avoidance and Appeals Management Institute, healthcare professionals receive the tactical knowledge necessary to address and preempt denials effectively. By communicating strategically with clinicians and support staff, participants can reduce financial losses, bolster compliance, and streamline revenue cycles. 

The curriculum, led by trusted authorities like Dr. Keith Stokes, focuses on interdisciplinary strategies that forge communication bridges, ensuring future disputes are minimized. Cultivate confidence in managing denials through strategic planning and skillful execution. Discover how targeted training can refine your ability to uphold the financial integrity of your institution. Register now to further refine your expertise and support your organization's financial health.

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”

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.

Download the Complete Syllabus