KHIMA | Validation Denials Webinar Series – Session 3: Successfully Appealing Clinical Validation and Coding in Malnutrition and Congestive Heart Failure

Overview:

Session 3 | Successfully Appealing Clinical Validation and Coding in Malnutrition and Congestive Heart Failure

Malnutrition remains a target for both clinical and coding validation. This webinar will present current coding guidelines and clinical indicators for malnutrition.  The difference between coding and clinical denials for malnutrition will be explained as well as the different appeal strategies. This webinar also covers coding and clinical validation considerations and appeal strategies for congestive heart failure denials.

Learning Outcomes:

• Understand common denial rationale for malnutrition and congestive heart failure.
• Recognize the differences between coding and clinical denials for malnutrition and congestive heart failure.
• Discover successful strategies to compose winning appeals when the malnutrition and congestive heart failure diagnosis is denied, even though you got it right.

Date Published:

February 17, 2021

CEU:

1.0 – Revenue Cycle Management

Speakers:

Denise Wilson MS, RN, RRT

Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield.

Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing.

Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level. Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials. Denise’s special area of expertise is in writing and producing successful appeals.

Malissa Powers, B.S., RHIT, CCS

Coding Appeals Manager Malissa has a bachelors in Business Administration. She is a Registered Health Information Technician and an Inpatient Certified Coder. She has 20 years of experience in the Health Information Management field.

She has worked as an HIM Manager and also has over 12 years of teaching experience for the HIM profession. Her most recent teaching position was for J Sargeant Reynolds Community College in Virginia where she taught and was involved with the program for over 5 years. Malissa has spent her entire career involved with coding within the hospital, consultant coding for large teaching/Trauma facilities and as a Coding Team Lead for the CERT program until she relocated to Myrtle Beach, SC. During that time she also did contract work for Intersect Healthcare writing coding appeals.

In Malissa’s current role, she manages inpatient coding appeal writing for Intersect. She writes appeals as well as provides education and or training for the current contracted staff. She also directly interactswith our clients regarding feedback and education for the coding denials.