The Denials Avoidance & Appeals Management (C-DAM) Institute focuses on identifying effective techniques to communicate with both clinicians and non-clinical staff in order to appeal current denials and prevent future denials. Your professionals are taught how to apply techniques to develop and implement a  structured Denials Management and Appeals Improvement Program within hospitals. Evidence Based Case studies, InterQual criteria and practical instruction are provided in developing and/or enhancing your compliance methods in auditing, monitoring, and evaluating the implementation & effectiveness of your denial management program. Our extensive professional experience and training in clinical care, case management, medical necessity, coding guidelines, and regulatory compliance are the foundation for our highly successful recovery audit defense and appeals services.

 
Overall Learning Objectives
At the completion of this program, participants should be able to:
• Identify the challenges inherent in interpreting the payer payment systems, denial management and how to have your facilities prepared for success with appeals.
• Understand the changing state of today’s healthcare system, as related to the important trends toward required compliance activities to prevent future claims denials.
• Identify the diverse educational needs for healthcare personnel regarding the significant changes in the healthcare reimbursement field and how these impact the denials that an organization will confront.
• Identify important methods of (and how to manage) administrative & provider organizational acceptance and “buy-in” to improve the denial management and appeals processes.
• Describe the goals, key benefits, and strategies of having an on-site based denial management and appeals program.
• Identify effective techniques to communicate with both clinicians (physicians, mid levels, nurses, care managers) and non-clinical (coding & billing) staff in order to appeal current denials and prevent future denials.
• Apply techniques to develop and implement a structured Denial Management and Appeals Improvement Program within acute care hospitals.
• Identify compliance methods on auditing, monitoring, and evaluating the effectiveness of your denial management program.
Process Requirements
• Accurate, precise and explicit medical records documentation
• Effective case management processes including level of care assignment
• Correct and compliant coding that reflects the true severity of illness and complexity of care