Clinical Denials: Prevention is the Best Medicine

On Demand Training

Presented by Presented by Dr. Juliet Ugarte Hopkins – Physician Advisor for Case Management, Utilization and Clinical Documentation, ProHealth Care in Wisconsin | Dr. Ronald Hirsch – Vice President Regulations and Education, R1 RCM inc.

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While technical denials can be managed via automation, clinical denials remain a more complex challenge – often requiring time-consuming manual claim reviews or appeals by a multi-disciplinary denial management team. This is even truer post-COVID, as providers must ensure COVID-19 claims are submitted accurately while also maximizing all reimbursement revenue.

 

In this webinar, Drs. Hirsch and Ugarte Hopkins will address how to prevent clinical denials by reviewing the core elements of a robust clinical denial prevention program. You’ll learn how to prevent the most common types of clinical denials, such as those:

 

• Originating in the front end of the revenue cycle
• Due to medical necessity issues
• Resulting from variation in payer contracts

 

You’ll also gain a new perspective on the knowledge and specific skill set required from your physicians and utilization experts to continually protect your organization’s revenue. 

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