Available in:

OnDemand Course
MP3 Download

How to be Proactive After a Medical Denial

Learn how to respond to a denial adequately and professionally to increase your chances of a denial being overturned.

Medical denials come in various forms from the type of denial to the party making the adverse determination. When a medical provider receives a denial, it commonly includes limited reasoning justifying the denial and a summary of appeal rights afforded to contest the decision. However, even with the receipt of this information, the medical provider may not understand how this process works or how to present an adequate response to the denial. It prepares a submission that only responds to the initial basis of the medical denial not realizing an extended appeals process offers the party issuing the denial an opportunity to utilize other justifications for the adverse decision. It may not comprehend requirements as to how to submit evidence refuting the denial. Furthermore, a medical provider may not understand the long-term implications of failing to respond adequately to such a denial. One may overcome these issues by being proactive in addressing medical denials. This topic explains the medical denial appeals process and how one should proactively prepare their case to take advantage of the opportunities afforded to them. It will also describe in detail how to present a response to address the initial denial, how to proactively anticipate and circumvent in advance subsequent reasoning that may be used against the medical provider, and ensure that a waiver of appeal rights does not occur. This information will assist those individuals responsible for responding to medical denials to develop and implement best practices by illustrating examples of approaches to take when creating standard operating procedures for responsive actions. Failure to do so may result in the submission of insufficient evidence to support the medical provider's argument or even result in a waiver of a right that is guaranteed under law or by contract. This material is critical for medical providers to adequately approach, prepare, and present their reasoning and evidence to support their argument that the medical denial should be overturned.

65 minutes
Course Exam
Certificate of Completion
Purchase Options

Add to Wishlist

More Program Information

Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Introduction

  • What Is a Medical Denial?
  • When Are Appeal Rights Triggered?
  • How Should One Approach a Medical Denial?
  • Why Should I Appeal a Medical Denial?

Types of Medical Denials

  • Types of Payors
  • Coverage Decision vs. Appeal Decision
  • Due Process Concerns

The Proactive Approach to Building Your Case

  • Analyzing and Compiling a Response to an Adverse Decision
  • Recognize Who Is Reviewing Your Appeal
  • Compiling Responsive Evidence and How to Present the Case
  • The Question of Use of Expert Witnesses
  • Thinking Long Term Rather Than the Immediate Denial

Best Practices in Presenting Your Case

  • Methods to Format the Response
  • What Are the Limitations for the Response?
  • Does the Kiss (Keep It Short and Simple) Approach Work?
  • Waiver and How It Can Limit Your Appeal Rights
Purchase Options

Add to Wishlist

More Program Information

Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Course

This course was last revised on December 5, 2023.

Call 1-866-352-9540 for further credit information.

No Credit Available

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

MP3 Download

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

Purchase Options

Add to Wishlist

More Program Information

Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Patrick D. Souter

Patrick D. Souter

Gray Reed & McGraw LLP

  • Of Counsel, Gray Reed & McGraw LLP
  • Representation of physicians, hospitals and ancillary providers in operational, regulatory and administrative matters
  • Board Certified in Healthcare Law by the Texas Board of Legal Specialization
  • Adjunct Professor of Healthcare Studies at Baylor University School of Law and the Baylor University Hankamer School of Business’ Robbins Institute for Health Policy and Leadership
  • Frequent speaker to national and local healthcare organizations on physician, hospital and other provider issues
  • Recognized as a leading healthcare lawyer in Texas by Chambers & Partners USA (2020 - 2023) and selected by his peers for inclusion in Woodward/White, Inc.’s The Best Lawyers in America in the field of Health Care Law (2019 - 2023)
  • Frequent author of books and articles on various topics
  • LLM degree in Health Law from Hofstra University; JD degree from Baylor University School of Law, MBA degree, Health Services Management from the University of Dallas, BBA degree, in Finance from Baylor University Hankamer School of Business
  • Can be contacted at [email protected] or (214) 954-4135
Purchase Options

Add to Wishlist

More Program Information

Why Lorman?

Over 37 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

All of your training, right here at Lorman

All of your training, right here at Lorman.

Pay once and get a full year of unlimited training in any format, any time!

  • OnDemand Courses
  • Live Webinars
  • MP3 Downloads
  • Course Manuals
  • Executive Reports
  • White Papers and Articles

Additional benefits include:

  • State Specific Credit Tracker
  • All-Access Pass Course Concierge

Questions? Call 877-296-2169 to speak with a real person.

Sign Up Today
With This Course

Access to all training products for one year
$699/year

Unlimited Lorman Training

With the All-Access Pass there is no guessing what you will need for your yearly training budget. $699 will cover all of your training needs for an entire year!

Easy Registrations

Once you purchase your All-Access Pass you will never be any further than one-click away from attending any Lorman training course.

Invest in Yourself

You haven't gotten to where you are professionally by luck alone; it's taken a lot of hard work and training. Invest in yourself with the All-Access Pass.

Product ID: 411042
Published 2023
Purchase Options

Available in Multiple Formats

Purchase this course and learn on your schedule!