Denial$ to Dollars: Writing a Winning Appeal
Thursday, November 14, 20247:30 AM – 4:00 PM |
Soaring Eagle Casino & Resort, Mt. Pleasant, MichiganApproved for 7.0 AAPC CEUs
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The average denial rate is 18.12% for in-network claims based on data reported from the Health Insurance Exchanges. Much of that is low-hanging fruit. During this one-day intensive training, presenter Joe Rivet, known as the “King of Claims,” will explore numerous reasons for denied claims and the right appeal approach for each, including the harder-to-reach fruit. Joe will help your practice unlock many lesser-known rules in the claim appeals process — Ultimately turning denials into dollars.
This course helps you bring the power to your pen with ample information, examples, and explanations of rules, regulations, and laws to help turn your denials into dollars. All attendees will receive a comprehensive resource to take back to your practice – A binder full of key sources, flow charts, grids, sample appeal letters, and topic-specific strategies to serve as your toolkit as you navigate the process of drafting a successful appeal.
What is the investment for this course?
The financial investment for this course is only $449 per attendee. With the knowledge and tools you’ll be given to tackle your claims denials, your practice will certainly make that money back in no time.
What makes this course unique and worth the investment?
Attendees will be instructed by an industry-known reimbursement attorney, Joe Rivet, Esq., CCS-P, CPC, CEMC, CPMA, CHRC, CHPC, CHEP, CHC, CAC, CACO, who has extensive firsthand experience as a coder and auditor. Prior to becoming an attorney, Joe spent years as an auditor on both the provider side and the payer side. He has written hundreds of successful appeal letters and challenged audit results and overpayment demands. If you have ever attended one of Joe’s presentations, you know he is very open to sharing his knowledge. Joe is committed to making the topic engaging and boiling down complex concepts so they are easy to understand. If you have never attended one of his presentations, check it out. We are confident you will find the investment well worth your time and money. In addition to the high quality education, you’ll receive a valuable resource binder and 7.0 AAPC CEUs.
What types of denials and appeal letters are covered?
This session will educate you on appeal writing strategies for common denials, including:
- Medical necessity denials
- No prior authorization
- Non-coverage despite being told and affirmed there was coverage
- Retroactive denials
- Workers Compensation
- Duplicate claims
- Emergent and urgent claims
- Previously paid claims
- Different appeal processes
- And more!
Denial Rates by State
Denials vary widely across states, ranging from 4.28% to 25.67% for in-network claims. Prevention is the best management of denials; however, not all can be prevented. Knowing how to analyze denials and effectively write solid appeals is a critical part of a practice’s revenue cycle process.
Many state laws require specific coverage, yet denials often occur, violating state coverage mandates. Writing an effective appeal takes time and knowledge of where to research to bring forward a solid appeal.
Here in the interactive map you can see denial rates of in-network claims by state.
Denial Rates by Payers
Based on the Public Use Files reported by CMS, in 2023, denials of in-network claims by specific payers ranged from 2.21% to as high as 50.16%. This vast variation underscores the need to invest in combating denials. Not every denial can be nor should be appealed. Joe will cover different methods available to handle denials of high volume related to the same issue to common and often challenging denial reasons.
The states with the highest in-network denial rates based on CMS data reported from the Health Insurance Exchanges in 2023 are:
| State | In-network Highest Payer Denial Rate |
|---|---|
| Florida | 50.16% |
| Iowa | 49.09% |
| Oklahoma | 47.52% |
| Arizona | 45.02% |
| Kansas | 41.85% |
| North Carolina | 41.77% |
| Illinois | 35.10% |
| Texas | 34.09% |
| Louisiana | 33.68% |
| Indiana | 33.48% |
| Michigan | 33.07% |
How is the training structured?
This is a live, in-person event. We aim to make the session as interactive as possible and will allow plentiful time for Q&A. We know this is an investment in an important part of the revenue cycle. As such, great details have been considered to bring you the most thorough training possible, leaving you with tangible takeaways and realistic resources that can be modeled and used in your practice or facility’s revenue cycle.
What about meals?
We have those covered, too! We will provide breakfast and lunch onsite. No cold (or room temperature) continental breakfast or box lunches – You will get actual meals to help fuel your full day of learning. Coffee, tea, and water will also be available throughout the day. A comfortable learning environment is important to us, and like denials, the details matter.
Can you earn Continuing Education Credits?
Yes, CEUs are just as valuable as a paid claim! This program has been approved for 7.0 AAPC CEUs. Other coding CEUs are pending approval.