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Author : Pam Waymack
Publisher : HC Pro, Inc.
ISBN 13 : 9781578397112
Total Pages : 170 pages
Book Rating : 4.3/5 (971 download)
Download or read book Denial Management written by Pam Waymack and published by HC Pro, Inc.. This book was released on 2005 with total page 170 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : AAPC
Publisher : AAPC
ISBN 13 : 1626889821
Total Pages : 16 pages
Book Rating : 4.6/5 (268 download)
Download or read book Denials Management & Appeals Reference Guide - First Edition written by AAPC and published by AAPC. This book was released on 2020-03-17 with total page 16 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!
Author : Tanja Twist
Publisher :
ISBN 13 : 9781683081470
Total Pages : 56 pages
Book Rating : 4.0/5 (814 download)
Download or read book The Denials Management Training Handbook written by Tanja Twist and published by . This book was released on 2017-01-17 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Denials Management Training Handbook (Pack of 5) Tanja Twist, MBA/HCM Many hospitals struggle with denials management thanks to the complex regulations and various types of denials. Payers often send denials to the wrong person, and hospitals may lose valuable research and appeals time as a result. In addition, drafting effective appeals letters that follow Medicare's regulations can be time-consuming and difficult even for experienced staff. Worst of all, the hard work of managing denials and submitting appeals on the back end can all be wasted if there is no system to use denials data to address root causes on the front end. The Denials Management Training Handbook provides clear, concise explanations of the complex appeal guidelines for Medicare and other payers. This information is presented in an easy-to-understand handbook for distribution to staff members involved in preventing and handling appeals. This handbook will help you manage the denials management process by: Providing an overview of common denial types and appeal timelines Giving you sample forms and templates Exploring best practices for improving the denials management process throughout the revenue cycle Gliding in the use of denials data to track recurrent denials and address their causes
Author : Ingenix (Firm)
Publisher :
ISBN 13 : 9781563379529
Total Pages : pages
Book Rating : 4.3/5 (795 download)
Download or read book Denial Management Tool Kit written by Ingenix (Firm) and published by . This book was released on 2007-06-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The denial management tool kit helps physicians manage the complete claims process, from data collection and claims submission to responding to payer inquiries and managing denials.
Author : Ingenix, Incorporated
Publisher : Elsevier Health Sciences
ISBN 13 : 9781563377310
Total Pages : 0 pages
Book Rating : 4.3/5 (773 download)
Download or read book Denial Management Tool Kit written by Ingenix, Incorporated and published by Elsevier Health Sciences. This book was released on 2005 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The denial management tool kit helps physicians manage the complete claims process, from data collection and claims submission to responding to payer inquiries and managing denials.
Author : Jared Del Rosso
Publisher : NYU Press
ISBN 13 : 1479847887
Total Pages : 311 pages
Book Rating : 4.4/5 (798 download)
Download or read book Denial written by Jared Del Rosso and published by NYU Press. This book was released on 2024-05-14 with total page 311 pages. Available in PDF, EPUB and Kindle. Book excerpt: "In this new book, Jared Del Rosso argues that to understand contemporary social problems we need to become aware of the strategies that people use to deny the existence of those very problems. Drawing on research in sociology, criminology, psychology, and communication studies, Del Rosso develops a new vocabulary for describing denial and its consequences. With examples from everyday observations, current events, and social scientific research, Del Rosso also reveals just how widespread and varied the uses of denial are. Some uses of denial can help people repair their interactions and relationships with others. But most uses of it allows problems to fester, unrecognized. We need, Del Rosso concludes, forms of acknowledgement to surface long-denied problems. But more than that, we need collective forms of action to remedy the harms that those problems and our denial of them have done"--
Author : Terence T. Gorski
Publisher : Independence Press
ISBN 13 : 9780830908509
Total Pages : 0 pages
Book Rating : 4.9/5 (85 download)
Download or read book Denial Management Counseling Workbook written by Terence T. Gorski and published by Independence Press. This book was released on 2000 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : David W. Plocher
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780834219304
Total Pages : 332 pages
Book Rating : 4.2/5 (193 download)
Download or read book The Case Manager's Training Manual written by David W. Plocher and published by Jones & Bartlett Learning. This book was released on 2001 with total page 332 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stem Cell and Bone Marrow Transplantation
Author : Richard S. Tedlow
Publisher : Penguin
ISBN 13 : 1101196262
Total Pages : 275 pages
Book Rating : 4.1/5 (11 download)
Download or read book Denial written by Richard S. Tedlow and published by Penguin. This book was released on 2010-03-04 with total page 275 pages. Available in PDF, EPUB and Kindle. Book excerpt: An astute diagnosis of one of the biggest problems in business Denial is the unconscious determination that a certain reality is too terrible to contemplate, so therefore it cannot be true. We see it everywhere, from the alcoholic who swears he's just a social drinker to the president who declares "mission accomplished" when it isn't. In the business world, countless companies get stuck in denial while their challenges escalate into crises. Harvard Business School professor Richard S. Tedlow tackles two essential questions: Why do sane, smart leaders often refuse to accept the facts that threaten their companies and careers? And how do we find the courage to resist denial when facing new trends, changing markets, and tough new competitors? Tedlow looks at numerous examples of organizations crippled by denial, including Ford in the era of the Model T and Coca-Cola with its abortive attempt to change its formula. He also explores other companies, such as Intel, Johnson & Johnson, and DuPont, that avoided catastrophe by dealing with harsh realities head-on. Tedlow identifies the leadership skills that are essential to spotting the early signs of denial and taking the actions required to overcome it.
Author : Terence T. Gorski
Publisher :
ISBN 13 : 9780830909650
Total Pages : 0 pages
Book Rating : 4.9/5 (96 download)
Download or read book Denial Management Counseling Professional Guide written by Terence T. Gorski and published by . This book was released on 2000 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Kari Marie Norgaard
Publisher : MIT Press
ISBN 13 : 0262294982
Total Pages : 300 pages
Book Rating : 4.2/5 (622 download)
Download or read book Living in Denial written by Kari Marie Norgaard and published by MIT Press. This book was released on 2011-03-11 with total page 300 pages. Available in PDF, EPUB and Kindle. Book excerpt: An analysis of why people with knowledge about climate change often fail to translate that knowledge into action. Global warming is the most significant environmental issue of our time, yet public response in Western nations has been meager. Why have so few taken any action? In Living in Denial, sociologist Kari Norgaard searches for answers to this question, drawing on interviews and ethnographic data from her study of "Bygdaby," the fictional name of an actual rural community in western Norway, during the unusually warm winter of 2000-2001. In 2000-2001 the first snowfall came to Bygdaby two months later than usual; ice fishing was impossible; and the ski industry had to invest substantially in artificial snow-making. Stories in local and national newspapers linked the warm winter explicitly to global warming. Yet residents did not write letters to the editor, pressure politicians, or cut down on use of fossil fuels. Norgaard attributes this lack of response to the phenomenon of socially organized denial, by which information about climate science is known in the abstract but disconnected from political, social, and private life, and sees this as emblematic of how citizens of industrialized countries are responding to global warming. Norgaard finds that for the highly educated and politically savvy residents of Bygdaby, global warming was both common knowledge and unimaginable. Norgaard traces this denial through multiple levels, from emotions to cultural norms to political economy. Her report from Bygdaby, supplemented by comparisons throughout the book to the United States, tells a larger story behind our paralysis in the face of today's alarming predictions from climate scientists.
Author : Paul Arias
Publisher : Hcpro, a Division of Simplify Compliance
ISBN 13 : 9781601466419
Total Pages : 0 pages
Book Rating : 4.4/5 (664 download)
Download or read book Prevent Denials and Win Appeals written by Paul Arias and published by Hcpro, a Division of Simplify Compliance. This book was released on 2009-09 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Prevent Denials and Win Appeals: The Hospital Case Manager's Guide to Revenue Integrity Paul Arias, RN, BSN, MIS Optimizing revenue integrity and turning denied claims into payments just got easier. Using actual case studies, proven reporting methods, and evidence-based information, this book and CD-ROM package will show you how to prevent denials on the front end by managing level-of-care decisions, distilling payer methodology and contract language, and zeroing in on proper documentation practices. With strong and compliant processes in place, you'll know how to track and trend denials. And when you understand their root cause, you can tailor your appeal to the denial at hand and take steps to change the errors that led to the denial. Your copy: Guides you through the denials management process Instructs you how to track and trend denials to identify their root cause Explains your role in denials management, reduction, and prevention Shows you how to comply with medical necessity standards and use best-practice information to manage level of care determinations The accompanying CD-ROM contains the forms, templates, and checklists found in the book, so you can download, adapt, and start using them right away. Who needs to read this book? Hospital case managers and directors of case management will find Prevent Denials and Win Appeals to be a valuable partner in compliance revenue integrity efforts. Your coworkers in the finance, health information management, and clinical documentation improvement areas will also find it to be an important tool.
Author : Tammy Tipton
Publisher : Opus Communications
ISBN 13 : 9781601460967
Total Pages : 155 pages
Book Rating : 4.4/5 (69 download)
Download or read book Appeals Toolkit written by Tammy Tipton and published by Opus Communications. This book was released on 2007 with total page 155 pages. Available in PDF, EPUB and Kindle. Book excerpt: Combat denied claims and get paid what you deserve Don't take no for an answer You can turn denied insurance claims on their head and recover millions of dollars in lost revenue - revenue that your organization deserves. Be informed of your legal rights and use them to your advantage when submitting denied claims. Here's your biggest ally in fighting denied claims: The Appeals Toolkit: Turn healthcare insurance denials into dollars provides extensive information on appeal strategies and methods to incorporate into your processes to avoid being denied in the first place. Sample letters found in this comprehensive resource. no need to look anywhere else The Appeals Toolkit includes 25 tested, proven, and effective sample appeal letters from which you can model your own claims. These letters demonstrate the inclusion of legal citations and how to effectively demand a thorough response from a carrier. You'll have access to appealing the following denials: Incorrect payment Incorrect contractual adjustments Medical necessity Utilization review Preauthorizations Underpayments And more As an added bonus, you will receive chapters dealing with appealing claim denials for Medicare and the Employee Retirement Income Security Act (ERISA) Accompanying CD allows you to customize Use the book version of the Appeals Toolkit for quick reference, or use the accompanying CD-ROM to download the letters and customize them to your specific situation. You can simply search the denial area you need, then copy, paste and edit to suit your needs.
Author : Stanley Keleman
Publisher :
ISBN 13 : 9780394487878
Total Pages : 184 pages
Book Rating : 4.4/5 (878 download)
Download or read book Living Your Dying written by Stanley Keleman and published by . This book was released on 1975 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: "This book is about dying, not about death. We are always dying a big, always giving things up, always having things taken away. Is there a person alive who isn't really curious about what dying is for them? Is there a person alive who wouldn't like to go to their dying full of excitement, without fear and without morbidity? This books tells you how." -- Front cover.
Author : Stefani Daniels
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780763733544
Total Pages : 356 pages
Book Rating : 4.7/5 (335 download)
Download or read book The Leader's Guide to Hospital Case Management written by Stefani Daniels and published by Jones & Bartlett Learning. This book was released on 2005 with total page 356 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text will address the role of the hospital case manager from a busniess perspective rather than a nursing perspective. Will engage all areas that are involved with the health care system, in pursuit of global objectives on behalf of every stakeholder.
Author : Kristin E. Heckman
Publisher : Springer
ISBN 13 : 3319251333
Total Pages : 263 pages
Book Rating : 4.3/5 (192 download)
Download or read book Cyber Denial, Deception and Counter Deception written by Kristin E. Heckman and published by Springer. This book was released on 2015-11-13 with total page 263 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book presents the first reference exposition of the Cyber-Deception Chain: a flexible planning and execution framework for creating tactical, operational, or strategic deceptions. This methodology bridges the gap between the current uncoordinated patchwork of tactical denial and deception (D&D) techniques and their orchestration in service of an organization’s mission. Concepts for cyber- D&D planning operations and management are detailed within the larger organizational, business, and cyber defense context. It examines the necessity of a comprehensive, active cyber denial scheme. The authors explain the organizational implications of integrating D&D with a legacy cyber strategy, and discuss trade-offs, maturity models, and lifecycle management. Chapters present the primary challenges in using deception as part of a security strategy, and guides users through the steps to overcome common obstacles. Both revealing and concealing fact and fiction have a critical role in securing private information. Detailed case studies are included. Cyber Denial, Deception and Counter Deception is designed as a reference for professionals, researchers and government employees working in cybersecurity. Advanced-level students in computer science focused on security will also find this book useful as a reference or secondary text book.
Author : Tony Cesta
Publisher : HC Pro, Inc.
ISBN 13 : 1601463537
Total Pages : 319 pages
Book Rating : 4.6/5 (14 download)
Download or read book Core Skills for Hospital Case Managers written by Tony Cesta and published by HC Pro, Inc.. This book was released on 2009-06 with total page 319 pages. Available in PDF, EPUB and Kindle. Book excerpt: Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills. Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders
