Dive deep into the latest innovations and best practices in appeals and UR, including hands-on strategies to enhance service quality and efficiency. Discover the top ten winning UR program services for today, and fine-tune your skills in writing impactful appeal letters that get results.

Courses in this Module:

• The TopTen WINNING UR Program Services in 2023
• What’s in YOUR UR Program?
• Clinical Documentation and Quality Improvement 
• How to Write Better Appeal Letters
  
• 1,005 Reasons to Appeal 100% of Your Denials
  
• The Transformation of Physician Advisor Services with Automation

Gain clarity on the Two Midnight Rule and its implications four years later, understand the fundamentals of Medicare reimbursement, and stay updated with the latest Medicare claims processing changes. This module ensures inpatient services are appropriately billed and compliant.

Courses in this Module:

• The CMS Two Midnight Rule ‐ 4 Years Later
• Medicare Reimbursement Primer for Physician Advisors
• Medicare Claims Processing Updates
• All Aboard the Two Midnight Train to Inpatient

Master the use of HINN/ABN forms and unravel the nuances of Condition Code 44 with case studies and decision trees. Equip yourself with the know-how to handle inpatient self-denial and Part B inpatient services billing effectively.

Courses in this Module:

• Compliant Use of HINN and ABN Forms
• Condition Code 44 Revisited: Case Studies & a Decision Tree
• Condition Code 44 Revisited in 2022 Case Studies & A Decision Tree
• Medicare Inpatient Self Denial & Billing Part B Inpatient Services on 012X TOB

Learn from real-world denials, including those related to COVID-19, sepsis, and readmissions. This module presents a retrospective analysis of denials to prepare you for future challenges in medical appeals.

Courses in this Module:

• Lessons Learned from Ridiculous Denials for COVID‐19
• Lessons Learned from Ridiculous Denials
• Lessons Learned from Ridiculous Sepsis Denials
• Lessons Learned from Ridiculous Readmission Denials

Understand the subtleties of patient discharge, readmission criteria, and the intersection of behavioral health with medical necessity reviews. Develop critical thinking with tools for clinical decision support.

Courses in this Module:

• Readmissions: Bundled or Unbundled?
• When is a Patient *REALLY* Discharged?
• Decisions vs. Judgements: Tools for Clinical Decision Support
• Behavioral Health Care & Medical Necessity Review

Get insider perspectives with interviews from a retired Administrative Law Judge (ALJ), and learn the art of writing proposed decisions. Stay up-to-date with the latest Medicare hearing book updates.

Courses in this Module:

• Medicare Hearing Book Update Part 1 of 2
• Medicare Hearing Book Update Part 2 of 2
• Going the Extra Mile: Interview with Bob Soltis Retired ALJ
• Writing Proposed Decisions: Interview with Bob Soltis Retired ALJ

Tackle surgery denials head-on with proven peer-to-peer (P2P) strategies, and learn how to prevent them. Discover the role of revenue cycle automation in enhancing your financial health and compliance.

Courses in this Module:

• P2P Strategies That Overturn IPOL Surgery Denials
• Avoiding Denials for Inpatient & Outpatient Surgeries
• Why do Peer to Peer (P2P) discussions?
• More on the Use of Revenue Cycle Automation
• CMS Slaps the Hands of Bad Little MA Plans
• Copy & Paste Dangers – A Chest Pain Example