HAHIMA | Why the Payers are Winning and You’re Not

How do you explain when all the money invested in CDI, Physician Advisors, Coding, Billing, Case Managers doesn't show a real improvement in denials, appeals and write offs? Many programs and tools being offered to hospitals today either fail to deliver as promised or fail to deliver solutions that work for very long. At least part of the reason for this has to do with what is expected of them, even before they are purchased and implemented.

How do you explain when all the money invested in CDI, Physician Advisors, Coding, Billing, Case Managers doesn’t show a real improvement in denials, appeals and write offs?

Many programs and tools being offered to hospitals today either fail to deliver as promised or fail to deliver solutions that work for very long. At least part of the reason for this has to do with what is expected of them, even before they are purchased and implemented.

We will explore what Game Theory can teach us about the Why and What is happening in so-called healthcare reform, and look at how to address the challenges present in value-based performance programs and overzealous efforts by third party payers to reduce their medical loss ratios and enhance their own profitability through engagement in medical necessity and clinical validation denials strategies.

Learner Outcomes

After completing this session, attendees will:

By attending this highly informative and thought-provoking session, participants will gain the practical mindset to recognize the strategies and tactics necessary to begin playing the same “game” and with the same rules being used by the payers, better insuring the survival of their facilities, their jobs, and sometimes even the lives of their patients.

Published March 15, 2021

  • HAHIMA/AHIMA Member $30
  • Non-Member $45

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# of CEs: 1.0 – Revenue Cycle Management

AHIMA
This educational offering has been approved for continuing education credit for use in fulfilling the continued education requirements of the American Health Information Management Association (AHIMA).

AAPC
CEUs are accepted from programs sponsored by AHIMA national offices and the state or regional AHIMA branches. One hour of instruction is worth one CEU.  A certificate of attendance or completion is necessary to show participation.

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You will have 60 days to access the course after access has been granted.

Once the course is completed, you will have the ability to download the CE certificate under My Certificates.

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Course Includes

  • 1 Lesson
  • Course Certificate