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Membership Continuing Education
Denials Management Success Strategies

Publication Date: 4/1/2020

Speaker: Marcy Adelman,Jean Chandler-Robledo, Merlynda De Lira, Lupita Mora
Length:1 hour


Abstract
Physician advisor leadership can be a creative solution to many challenging situations facing utilization management. A dedicated physician advisor for peer-to-peers is essential for improving overturn rates and maximizing claim reimbursement in a timely fashion. Another challenge facing acute care hospitals is the increase in frequency and duration of patients in observation status. In addition to a dedicated utilization management team, daily huddles with a physician advisor for early status determination is key to managing observation patients. Get innovative ideas to manage Medicare short-stay admissions, while improving communication between the utilization management team and patient financial services.


Learning Objectives:
1. Identify advantages of centralized denial management by physician advisor to improve peer-to-peer overturn rates.
2. Describe utilization management processes for effective management of observation patients with physician advisor leadership.
3. Evaluate benefits of electronic management of Medicare short-stay admissions.

Denials Management Success Strategies


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