New Guidelines on Claim Appeals and Procedure for Successful Follow-up of Denied Claims

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About Course

The goal of this presentation is to understand what the appeal process means; review claim appeal guidelines and requirements for Medicare and some of the most common commercial payers, such as Aetna, Cigna, Carefirst, and United Healthcare; review what attachments are needed for the appeal, and how to set protocols for successful follow-up of denied claims.

Learning Objective:

  • To review what the appeal process means.
  • To review the life of the claim.
  • To understand the timing when an appeal is appropriate.
  • To review claim appeal guidelines for Medicare.
  • To review claim appeal guidelines for some of the most common commercial payors, such as Aetna, Cigna, Carefirst, and United Healthcare.
  • To understand what attachments are needed for appeal
  • To discuss ways how to set protocols for successful follow-up of denied claims.

Areas Covered in the Session

  • Review of the appeal process.
  • Review of the life of the claim.
  • Review and understand the timing when an appeal is appropriate.
  • Review claim appeal guidelines for Medicare.
  • Go over examples of appealed scenarios for Level 1 and 2 Medicare appeals.
  • Review claim appeal guidelines for some of the most common commercial payers, such as Aetna, Cigna, Carefirst, and United Healthcare.
  • Go over examples of appealed scenarios for commercial payer appeals.
  • Understand what attachments are needed for appeal.
  • Go over ideas on how to set protocols for successful follow-up of denied claims.

Suggested Attendees

  • Medical providers, who are involved in the payment process of their practice
  • Physicians
  • Practice Managers
  • Billing Managers
  • C-level Executives
  • Office Managers
  • Medical Billers
  • Medical Coders
  • Office staff and Billing Managers
  • Medical Billing Companies
  • Providers’ Office Staff
  • Hospital Revenue Cycle Staff

About the Presenter

Kate Gilman has almost two decades of experience in the healthcare industry. She is an expert coder, compliance officer, and trains healthcare providers all over the country. Kate utilizes her expertise to uncover ways to improve billing and coding inefficiencies, training staff, and ensuring compliance while achieving maximum results and revenues for her clients.

Kate’s successes include small and large practices, ranging from primary care to specialists and surgeons. She is known for helping providers feel confident in their coding and peace of mind with their compliance practices. Kate’s acute attention to detail, deep understanding of coding and billing, and proactive approach make her an indispensable asset to all her clients.

Course Content

You can access all the webinar materials after successful payment

  • Webinar Link + Handouts PDF
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