Cost:

Free for HFMA Members
Buy HFMA Membership to Attend

Audience:

Hospitals and Other Providers
Business Partners
Physicians and Other Practitioners

Career level:

Experienced Professional
Student
Early Careerist
Mid-Senior

Recommended for:

Patient Accounts
Claims
Billing
Patient Access
Reimbursement
Revenue Cycle

Delivery Method:

Self Study

Advance Preparation:

None

Prerequisites:

None

Course Availability:

18 Months

How To | Denials Management
Distinguishing coding denials from clinical validation denials is an ongoing challenge, and a good place to review processes.
Save
How To | Denials Management
Root causes for denials should be defined operationally to determine the level of analysis required internally.
Save
How To | Denials Management
Coders need to understand billing expectations, how the billing process works and how the revenue cycle is affected.
Save
How To | Denials Management
Successful denial management and prevention strategies require the right mix of people capable of handling the process from beginning to end.
Save
Course | Intermediate | Denials Management
This course defines claims denial management and explains the impact of claims denials on hospitals. It highlights the benefits to hospitals of managing claims denials effectively and describes how claims denials can be managed both before ...
Save
Course | Intermediate | Denials Management

Successfully Appealing Denials

Course | Intermediate | Denials Management

Successfully Appealing Denials

Description

This course explains how improving management of the claims denial process can have a positive effect on a hospital's bottom line. It presents best practices that will help to capture a significantly higher proportion of claims and increase collections, including steps and strategies for successful appeals.

Estimated course completion time: 3 hours
After this program, you'll be able to..
  • Recognize the importance of effective claims denial management to the hospital's overall financial picture
  • List five practices that have been effective in improving the claims denial management process
  • Identify why and how to develop a denial recovery unit
  • Recognize the purpose of having a denial database
  • Identify the benefits of having a dedicated authorization clerk
  • Recognize why, how, and what to document during the claims follow-up process
  • Recognize why timeliness is important in claims follow-up
  • Recognize how to enlist the patient as a collaborator in claims follow-up
  • Recognize how to speed up the process of submitting medical records
  • Recognize how to use internal reporting to identify patterns of denials
  • Identify the five tiers of the appeal process - from informal review to federal court hearings
  • Recognize the purpose of a systematic process for appealing claims
  • Summarize some tips that can help ensure a successful appeal
  • Recognize the importance of a comprehensive denial management program to the appeal process
  • Demonstrate how to use templates to capitalize on the types of appeals letters that have worked in the past
  • List the essential components that should be in every appeal letter
  • Recognize the importance of relying on facts and documentation rather than emotion to make your case

Related Courses | Denials Management

On Demand Webinar | Overview | Revenue Cycle

Use the butterfly effect to prevent denials, improve financial results

A butterfly flaps its wings, causing a hurricane halfway around the world.  Learn how to apply the butterfly effect by making minor changes in the front-end of your revenue cycle to eliminate denials, increase POS collections and improve patient satisfaction, causing minor financial improvements.

We'll breakdown how Magnolia Regional Health Center used the butterfly effect to impact patient access, leading to a 50% reduction in denials, 600% increase in cash collections and 90th percentile in patient satisfaction. You'll learn how to put the butterfly effect to work in the front-end of your revenue cycle.

Original Live Webinar Date:  4/7/20

On Demand Webinar | Intermediate | Revenue Cycle

Denial management and prevention: What is the difference and why you need both


Working denials is costly, it delays collections and uses valuable and expensive resource time.

The webinar will cover the process and analytics needed to identify denials that are preventable, how to work within your organization to assign actions needed to prevent denials and how to continuously measure and monitor data and workflows to increase clean claims.

We also cover how to develop and implement a denial management plan, using reporting, analytics, technology, measuring, monitoring and communication to reduce denial and appeal turnaround time, decreasing days in A/R, timely filing and appeal denials.

The subject will be presented from three perspectives: billing operations, front-end operations and analytics development.

You will be introduced to a 12-step program for developing and implementing your own denial prevention and management plan.

Course | Basic | Patient Access

Importance of Insurance Verification

In this course we highlight the various types of health insurance that your patients may present at registration. We'll review the fundamentals of Medicare, Medicaid, and third-party liability plans. You'll learn how verifying a patient's insurance eligibility and benefits affect the coordination of benefits process, which determines the primary payer and secondary payer on a claim.


Estimated course completion data: 30 minutes

Course | Intermediate | Denials Management

Strategies to Prevent Claims Denials

This course defines claims denial management and explains the impact of claims denials on hospitals. It highlights the benefits to hospitals of managing claims denials effectively and describes how claims denials can be managed both before and after denials take place. The course describes types of denials and discusses key strategies for preventing and correcting some common causes of denials.


Estimated course completion time: 1 hour