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.

5 Reasons to Attend

• Participants will return to the office equipped to handle inadequate payments, denials, rejections, and other claims management issues.

• Reduce the risk of claim rejection and/or denial due to lack of specificity or erroneous billing.

• Learn strategies for educating providers on the necessary documentation requirements that support medical necessity.

• Distinguish the differences between a rejection and a denial and implement effective strategies for both.

• 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.

CEUs 3

Length 170 min

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