KHIMA | Validation Denials Webinar Series

Overview:

These live sessions have been recorded and are available on demand.

Session 1 | Role of the Clinical Documentation Specialist in the Management of Clinical Validation Denials

This webinar will describe the CDS role in managing clinical validation denials. Identifying and implementing generally accepted clinical guidelines in documentation and in appeals will be presented. Clinical scenario case studies will be presented to provide real life examples of successful clinical validation appeal arguments.

Learning Outcomes:

• Describe how Clinical Documentation Specialists (CDS) are a natural fit for managing denials and authoring appeals.
• Explain how to establish clinical guidelines.
• Write a valid argument to support a clinical diagnosis entered in the medical record.

Session 2 | Appealing Denials for Coding of BMI, Obesity, and Morbid Obesity

This webinar will review what the provider, nurses, and dietary staff need to know to correctly document obesity on the front end to help prevent denials on the back end. Clinical scenario case studies will be presented to provide real life examples of successful obesity appeal arguments.

Learning Outcomes:

• Understand the coding rules concerning BMI, obesity, and morbid obesity.
• Learn who to involve on the front end, and how to do it, to make your medical record as “bullet proof” as possible.
• Discover successful strategies to compose winning appeals when the BMI and associated diagnosis are denied, even though you got it right.

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.

Session 4 | Successfully Appealing Clinical Validation and Coding Issues in Acute Blood Loss Anemia

Acute blood loss anemia remains a target for both clinical and coding validation. This webinar will present current coding guidelines and clinical indicators for acute blood loss anemia. The difference between coding and clinical denials for malnutrition will be explained as well as the different appeal strategies.

Learning Outcomes:

• Understand common denial rationale.
• Recognize the differences between coding and clinical denials for acute blood loss anemia.

Discover successful strategies to compose winning appeals when acute blood loss anemia is denied, even though you got it right.

Date:

Session 1: Recorded December 16, 2020
Session 2: Recorded January 13, 2021
Session 3: Recorded February 17, 2021
Session 4: Recorded March 17, 2021

CEU:

4.0 – Revenue Cycle Management

Speakers:

Denise Wilson MS, RN, RRT
Senior Vice President
Denial Research Group – AppealMasters
President
The Association for Healthcare Denial and Appeal Management

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.