Prevent Denials through Case Management
Product Description:
AUDIO CONFERENCE ON CD OR AUDIO ON-DEMAND
Sponsored by Case Management Monthly
presented on December 4, 2008
Optimize reimbursement through denial prevention
Case management plays a critical role in preventing denials but a single case manager can’t do it alone. To maintain the financial integrity of your facility and capture the healthcare dollars you deserve, your facility needs to take a team approach to denials prevention.
Learn how to create—and get buy-in for—a denials prevention team during HCPro’s 90-minute audio conference Prevent Denials through Case Management: Proactive Strategies to Optimize Reimbursement. Industry experts Randi Ferrare, RN, BSN, MHA, M.Ed, and Brenda Keeling, RN, CPHQ, CPUR, will explain proactive strategies you can implement at your facility to minimize denials and optimize reimbursement. Front-line case management director Paul Arias, RN, BSN, MIS, from Crouse Hospital in Syracuse, NY, discusses real-life case studies about how his team has created a program with a denial rate of less than 1% and a 72% reversal rate.
AGENDA
- The importance of denial prevention management in today’s healthcare environment
- Capturing healthcare dollars/maintaining the financial integrity of the hospital
- Ensuring patients receive quality healthcare
- Proactive strategies to prevent denials
- Establishing a Denials Prevention Team
- The role of the Case Management Financial Coordinator
- Achieving senior management buy-in and support for a Denials Prevention Team and commitment to denial prevention strategies
- Education of all key players (case managers, administration, nurse managers, physicians, admitting department, financial assistance department, etc.) on payers, financial reimbursement and strategies for denial prevention
- Reduction of net denial ratio
- Monitoring of case management reports and requests for clinical information from payers by non-clinical staff (case management assistant)
- Monitoring of Medicaid denials and reviews
- Monitoring of high dollar and high LOS cases
- Real time intervention and reporting of denial data
- Tracking avoidable days
- Empower UM Committee to assist with denial reduction and prevention
- Committee Members
- UM Plan including actionable steps to reduce denials
- Oversight of a Denial Program; a Denial Prevention Team reports their findings/recommendations to this committee
- Case studies in denial management
- Question and answer session
LEARNING OBJECTIVES
By the end of the program you’ll be able to:
- Integrate effective strategies for denial prevention in a cost-effective manner
- Develop a denials prevention team
- Determine the steps necessary to create a position of case management financial coordinator for your denials management team
- Educate senior management on the benefits of strategic denials prevention management
- Empower UM committee to assist in denial prevention strategies
BONUS TOOLS
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and
- Denial tracking form
- Appeal templates
- QA monitoring tools
- Job description for a financial coordinator
These materials are provided with PDF links.
MEET THE SPEAKERS
Randi Ferrare, RN, BSN, MHA, M.Ed, is the president of Optima Healthcare Consulting, LLC. Ferrare was the 2008 recipient of the ACDIS CDI Professional of the year award.
Brenda Keeling, RN, CPHQ, CPUR, is the president and owner of Patient Response, Inc. in Milburn, OK. Keeling was the guest speaker for the Physician Hospital Association 2008 symposium, “Recovery Audit Contractors and Medicare Compliance” and was the 2006 recipient of the Who’s Who in Healthcare Professionals and Best Practice Awards for her work presentations titled “Simplifying Regulatory Requirements” and “Pay for Performance.”
Paul Arias, RN, BSN, MIS, is the Director of Care Coordination for Crouse Hospital in Syracuse, NY. He has spent his 14 years as a nurse primarily in leadership roles, including ED manager, critical care director, and chief executive nurse/director of patient care services. He has spent the last two years as a denial management coordinator for Crouse Hospital, which currently has a denial rate of less than 1%.
WHO SHOULD LISTEN?
Case Managers, directors of case management, compliance officers, clinical documentation improvement specialists, physicians, revenue cycle managers, patient access staff, nurses, utilization reviewers
AUDIO ON-DEMAND
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, an audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.
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