MSHIMA | Decoding Payer Denials: Transforming Challenges into Revenue Optimization Opportunities

Decoding payer denials must be conducted and facilitated through the mindset of learning and continuous quality improvement with the deployment of clinically astute staff that embrace the mission  of “Proactive Preemptive Denials Avoidance.”

Live & Recorded Virtual Event

Overview

Payer denials are ever increasing on all fronts in both the inpatient and outpatient setting under the guise of medical necessity and clinical validation denials as well as DRG and level of care downgrades. Providers receive denial letters outlining their rationale for the denial, often with generic nonspecific terminology and rationale. Payer denials are generally thought of as an added cost of doing business, adding an expense line to the financial statement. Forward thinking organizations view denials as part of a continuous quality improvement initiative centered around improving revenue cycle processes with a focus upon identifying and focusing upon the weakest link under the theory of limitations. Decoding payer denials must be conducted and facilitated through the mindset of learning and continuous quality improvement with the deployment of clinically astute staff that embrace the mission  of “Proactive Preemptive Denials Avoidance.”

Objectives:

  • Creating an organizational vision and mission that embraces the notion of “Do It Right the First Time”
  • Learn how to motivate all revenue cycle staff to and think proactive preemptive denials avoidance
  • Hire, train, and motivate staff that changes and instills a culture of patient first supported by optimal net patient revenue streams
  • Learn how to interpret payer denial letters and read between the lines of the denial letter
  • Recognize and identify payer denial trends and formulate an effective denial mitigation strategy
  • Deploy and share Key Performance Indicators that validly and reliably measure revenue cycle denials avoidance performance.

Course Info

Published Date

October 2023

Total CEs

1.0

Domain(s)

Revenue Cycle Management

Pricing

MSHIMA Member

$25.00

Non-Member

$25.00

Speakers

Additional Information

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.

Learn More

ACDIS

AHIMA CEUs that are CDI-related are accepted.

Learn more

Register

In order to access this course, you will need to click on the button labeled “Register for this Course.“

Already Purchased Course?

If you have already purchased this course, then you will need to sign in to access and then click on the session(s) listed under Course Content.

Access instructions for the course will be emailed to you within 2 business days following receipt of payment.

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

How Do I Receive the CE?

You must click on the button labeled “Mark Complete” at the bottom of each course page before the CE will appear on the My Certificates page.

  • For on-demand events, access instructions for the course will be emailed to you within 2 business days following receipt of payment.
  • You will have 60 days to access the course. If your course has expired, and you need an extension, please contact us.
  • You must click on the button labeled “Mark Complete” at the bottom of each course page before the CE will appear on the My Certificates page.

View more FAQs.

Need assistance?  Contact us!

Course Content

Not Enrolled
From $25 | CE: 1.0

Course Includes

  • 4 Lessons
  • Course Certificate