Case Management's Role in Managing Third Party Payer Denials

Duration: 60 Minutes
Case management, as a member of the revenue cycle team, plays a strategic role in the implementation of strategies aimed at reducing and/or preventing third party payer denials. Reducing and preventing denials requires proactive and hard-wired processes that engage the entire interdisciplinary care team. The causes of denials are complex and therefore require complex solutions. This program will review the causes of denials and key strategies for reducing and preventing them. Solutions will include key members of the interdisciplinary care team including physicians, physician advisors, case management leaders and case managers. Strategies for analyzing your denial rate will also be included.
Managing Third Party Payer Denials
Instructor: Dr. Toni Cesta
Product ID: 504198
Objectives of the Presentation
  • Understand the role of the case manager in providing strategies for reducing denials
  • Discuss the key roles for preventing denials, including the roles of the interdisciplinary care team
  • Review key case management strategies for denial prevention and management
Why Should you Attend
Before a department of case management can reduce its denial rate, it first needs to understand what elements within and outside the hospitals are contributing to these denials. Once these root causes have been identified, strategies for correcting them and hard-wiring new practices can be implemented. Reducing denials is an interdisciplinary problem and can only be solved using interdisciplinary solutions.

If your hospital wants to reduce its rate of denials using a strategic approach, this program is for you. Understanding denials in a comprehensive way will positively affect your practice as a case manager or a case management leader.

Areas Covered
  • Key case management roles impacting denials
  • Types of clinical reviews
  • Denial management
  • Categorizing denials
  • Key case management strategies for reducing denials
  • Roles of team members
  • Definition of revenue cycle
  • Revenue cycle process steps
  • Stakeholders
  • Definitions of medical necessity
  • Steps in care coordination where denials can occur
  • Steps in the discharge planning process where denials can occur
  • Payer expectations
  • How case management causes denials
  • How third party payers cause denials
Who will Benefit
  • RN Case Managers
  • Directors of Case Management
  • Case Management Senior Leaders
  • Directors of Finance
  • Physician Advisors
  • Director of case management
  • Case managers
  • Directors of nursing
  • Directors of patient flow
  • Director of revenue cycle
  • Chief financial officers
  • Chief operations officers
  • Chief medical officer
  • Hospitalists
  • Director of quality management
  • Nursing home directors
  • Director of home care
Topic Background
Third party denials of payment remain a challenge for case management departments across the country. While in the past the majority of denials came from commercial payers, today's denials come from Medicaid and Medicare as well. The impact of denials has increased with the implementation of the two-midnight rule and the requirements associated with placing patients in the right level of care based on their medical necessity needs and expected length of stay. Loosing reimbursement as a result of denials can have a significant impact on the bottom line of any organization. Many of these denials can be prevented!!
$300
Recorded Session for one participant
Get life time access with download option!
Book this course
Pay Now
  $450.00 Training CD
Free shipment within 4 Working Days of placing the order. Get life time access for unlimited participants.
  $550.00 Training USB Flash Drive
Free shipment within 4 Working Days of placing the order. Get life time access for unlimited participants.
For multiple location please contact our customer care team +1-510-857-5896.
How it works
Live Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • The webinar joining link, username and password for joining the webinar will be updated on your OCP Account 24 hours prior to the webinar
  • Presentation handouts in Downloadable PDF format will be updated on your OCP Account 24 hours prior to the live session
  • Login to the audio conference on the scheduled date and time
  • Get answers to your queries through interactive Q&A sessions via chat at the end of the session
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account 24 hours after the completion of the session
  • Please let us know your thoughts and views at the end of the webinar, your valuable feedback will help us improve
Recorded Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • Upon purchase of the recorded session a link will be updated on your OCP Account within 24 hours
  • Please click on the link to access the Recorded Session
  • Presentation handouts in downloadable PDF format will be updated on your OCP Account within 24 hours of the purchase of the product
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account after 48 hours of the product Purchase
  • Please share your valuable Feedback at the end of the session
Instructor Profile:
Toni G. Cesta, Ph.D., RN, FAAN owns and operates Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management. Dr. Cesta has held positions as Senior Vice President - Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York where she was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore - Long Island Jewish Health System and Director of Case Management, Saint Vincent's Catholic Medical Centers of New York, in New York City and also designed and implemented a Master's of Nursing in Case Management Program and Post-Master's Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
View More