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Insurance Denials: Appeals, Prevention & Contracting Advice
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Physician Advisors are commonly tasked with conducting an onsite analysis of healthcare processes and documentation to avoid costly insurance denials. They must identify both strengths and opportunities for improvement in both the Centers for Medicare & Medicaid Service along with Commercial payment strategies. Prevention begins with the Emergency Department Case Manager to ensure the patient is being placed at the correct level of care from the start. Multidisciplinary rounds with a physician advisor move cases through the continuum of care for the best quality / economic and utilization outcomes.
This online course will deliver details on how to overturn denials, prevent insurance denials, and therefore providing cost savings by analyzing managed care contracts.
At the conclusion of this activity, attendees should be able to:
Describe the insurance appeal process and strategies to overturn denials
Illustrate how to prevent insurance denials with good documentation and utilization
Analyze the impact the physician advisor has on managed care contracts that can reduce insurance denials
Faculty includes:
Howard Stein, DO, MHA, CHCQM-PHYADV
About the Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.
ACCREDITATION & CREDIT
The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
ABQAURP designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Creditâ„¢. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This program is approved for Category 2 credit by the American Osteopathic Association.
This activity is valid from May 23, 2019 through April 25, 2022. Original release date: April 26, 2019.
This session was recorded live at our 2019 Annual Health Care Quality & Patient Safety Conference and is a portion of the online course entitled: Connecting People, Purpose & Passion. They may be taken individually to earn incremental CME/CE credits. However, if you plan on taking the full 8-hour course, you will not be able to claim credit for these individual sessions.
Pricing:
Diplomate Members $0.00
Professional Members $0.00
Non Members $0.00
Credits awarded per Session. See individual Sessions for further details.
Credits awarded
Name
Sub type
Value
Certificate awarded

About this item

Physician Advisors are commonly tasked with conducting an onsite analysis of healthcare processes and documentation to avoid costly insurance denials. They must identify both strengths and opportunities for improvement in both the Centers for Medicare & Medicaid Service along with Commercial payment strategies. Prevention begins with the Emergency Department Case Manager to ensure the patient is being placed at the correct level of care from the start. Multidisciplinary rounds with a physician advisor move cases through the continuum of care for the best quality / economic and utilization outcomes.

This online course will deliver details on how to overturn denials, prevent insurance denials, and therefore providing cost savings by analyzing managed care contracts.

At the conclusion of this activity, attendees should be able to:

  • Describe the insurance appeal process and strategies to overturn denials
  • Illustrate how to prevent insurance denials with good documentation and utilization
  • Analyze the impact the physician advisor has on managed care contracts that can reduce insurance denials


Faculty includes:
Howard Stein, DO, MHA, CHCQM-PHYADV

About the Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

ACCREDITATION & CREDIT
The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This program is approved for Category 2 credit by the American Osteopathic Association.

This activity is valid from May 23, 2019 through April 25, 2022. Original release date: April 26, 2019.

This session was recorded live at our 2019 Annual Health Care Quality & Patient Safety Conference and is a portion of the online course entitled: Connecting People, Purpose & Passion. They may be taken individually to earn incremental CME/CE credits. However, if you plan on taking the full 8-hour course, you will not be able to claim credit for these individual sessions.

Pricing:
Diplomate Members $0.00
Professional Members $0.00
Non Members $0.00

Course/Activity Information

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering.  

This activity is valid from May 23, 2019 through April 25, 2022. Original release date: April 26, 2019.

About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

Howard Stein, DO, MHA, CHCQM-PHYADV
Dr. Howard Stein currently serves as the Associate Director of Medical Affairs of CentraState Medical Center in New Jersey. Acting as a full time Physician Advisor, he is also the President of CentraState Medical Associates. As a founding member, Dr. Stein has served on the Executive Board of the American College of Physician Advisors since its inception. Dr. Stein is board certified as a family physician, previously serving as a U.S. Air Force physician.

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