Title: Denials and Appeals: Maintaining an Effective Management Program

Presenter: Raven Ashton, Director of Revenue Cycle Management Operations/Consulting with Revenue Cycle Coding Strategies (www.rccsinc.com)

Time: 26.48 minutes

Description:
Learn to minimize claims denials and appeals and to track and manage denial and appeal data while gaining knowledge of effective practices for denial management for both government and commercial payers.

Objectives:
- Identify common coding errors and establish strategies for minimizing denials due to lack of documentation, medical necessity, unbundling, and more.
- Learn valuable methods for organizing and managing claims appeals for government and commercial payers.
- Gain understanding of practical methods for successfully appealing denied claims.

Main Points:
- What is the Job of a Denial Management Team?
- Understanding Common Secondary Denials
- Common Denials
- Top 5 Common Denial Reasons
- Missing Information
- Not Covered by Payer
- Limit for Filing Expired
- Understanding Denials: Actionable vs Non-Actionable
- Soft vs Hard Denials
- Current Denial Mapping: Out/Info only
- Denial Management?
- RCM Analytics High-level Values
- Common Denial Categories
- Medical Necessity
- Questionable/Inconsistent Documentation
- Complete and Timely Documentation CMS Guidance
- Appropriate Documentation
- “Coding” Errors Within Commonality
- Ancillary HB Top Denials by Provider
- Modifier 25 Usage
- Broken Workflow and Processes Denial Contributions
- The Appeals Process
- Managing Appeals Effectively

Revenue Cycle Consulting

Raven Ashton - Director of Revenue Cycle Consulting

Raven Ashton is the Director of Revenue Cycle Consulting at Revenue Coding Strategies LLC a national consulting firm that serves healthcare systems, physician practices, billing companies and other industry stakeholders. Raven’s areas of expertise include NLP mapping, prqs, risk adjustment coding, full revenue cycle, credentialing, OIG compliance, and revenue cycle operations improvement and she is recognized for her extensive revenue cycle compliance, decentralization, and optimization expertise.

Raven is subject matter expert in all areas of revenue cycle specializing in reimbursement resolution she has over 23 years of experience as it relates to all specialties of revenue cycle, to be inclusive of medical billing operations and over 7 years of consulting experience. She also has a vast knowledge in credentialing and revenue cycle analytics.

Raven holds certifications for health claims examiner, medical billing; and ICD10 proficiency through AAPC. She is also a super user in the following BI platforms/EHR systems; Epic, E-Clinical Works, Imagine, Athena, Nextgen, Webi, and Domo.

www.rccsinc.com

Revenue Cycle Coding Strategies

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