https://sterlingwebinars.com/product/claim-denial-management-101/

Type: Live Webinar Speaker: Lynn M. Anderanin, CPC, CPB, CPMA, CPPM, CPC-I, COS Date: July 31st 2025 Time: 01:00 PM EST Duration: 60 Minutes Session Overview 3 Critical Billing Challenges in the Healthcare Revenue Cycle Claim denials remain a leading issue undermining the financial health of healthcare organizations. As administrative tasks grow and payer requirements evolve, providers face a rising number of denials—many of which are avoidable. These denials contribute to cash flow disruptions, increased operational expenses, higher write-offs, and extended accounts receivable cycles. This session will explore how healthcare organizations can use a strategic, data-driven framework to reduce denials and boost both revenue and efficiency. The session takes an in-depth look at the underlying causes of denials—such as eligibility mismatches, authorization failures, coding errors, and missed submission deadlines. You’ll discover key trends among government and commercial payers, along with insights on how to prevent the most common denial types and improve your clean claims rate. Beyond prevention, we’ll focus on how to effectively manage and overturn denied claims. Many providers lack the infrastructure, staff, or standardized procedures to successfully appeal denials. This session will provide practical methods to improve denial follow-up workflows, create reusable appeal templates, and implement efficient time-bound processes to curb revenue loss. We’ll also discuss automation and denial management tools that can eliminate repetitive work and enhance productivity. You’ll also learn how to leverage denial data as a strategic resource. When examined properly, denial analytics can uncover inefficiencies, training gaps, and payer patterns. We’ll walk through practical use cases of denial dashboards and reporting metrics to support smarter decisions and greater accountability. Finally, the session will address compliance concerns. Mishandling denials—especially around documentation or billing—can invite audits, penalties, or repayment demands. You’ll gain insight into how robust denial management helps ensure compliance, reinforce documentation practices, and prepare your team for audits. Key Learning Outcomes Recognize and address the most frequent reasons for claim denials Design and implement an efficient, compliant workflow for resolving denials Use analytics to track patterns and improve organizational processes Involve clinical, administrative, and billing teams in denial prevention Strengthen revenue cycle results by reducing denials and improving cash flow Topics Covered Financial Impact of Denials How denials affect cash flow and performance The hidden costs of rework, write-offs, and delayed reimbursement Primary Causes of Denials Insurance eligibility and benefit errors Missing pre-authorizations or referrals Coding mistakes and documentation omissions Filing delays and timing issues Denials specific to payer types Strategies to Prevent Denials Front-office improvements: accurate registration, eligibility checks, and prior authorizations Better clinical documentation practices Coding accuracy and compliance Team training and interdepartmental communication Resolving Denials Effectively Step-by-step denial follow-up and appeal processes Establishing workflows with timelines and accountability Coordinating communication between payers, staff, and patients Appeal Process Best Practices Writing clear, compelling appeal letters Tracking appeal success rates Using payer guidelines to support your appeals Using Denial Analytics Identifying internal bottlenecks and payer trends Building and using denial dashboards Driving continuous improvement using actionable data Compliance and Risk Prevention Ensuring audit-ready corrections and documentation Avoiding coding abuse and billing risks Staying aligned with payer and legal standards Team Collaboration Engaging staff across departments to take ownership Fostering a proactive culture of accountability Background The complexity of today’s healthcare payment landscape means that denials can significantly impact financial performance. With up to 10% of claims being denied and many preventable, organizations leave large amounts of revenue uncollected. Poor denial management also increases administrative costs and can hurt patient satisfaction. Effective denial management involves identifying the causes, correcting the errors, and preventing future occurrences through better processes and communication. This presentation will help organizations transform denial handling from a reactive task into a strategic function that supports both financial and operational goals. Why Attend This Session? Gain Control Over Denials – Strengthen Your Bottom Line Claim denials are not just an operational burden—they’re a direct threat to financial health. With a significant percentage of denials being preventable, your organization has the opportunity to recover lost revenue and reduce resource strain by tackling denials head-on. This session will offer the tools, frameworks, and real-world examples you need to take a proactive and effective approach. What You’ll Learn The most frequent denial causes and how to prevent them Shifts in payer behaviors and audit focus High-impact tactics to reduce first-pass denials How to craft effective appeal responses Using data and dashboards to identify and fix weak points Training and compliance practices that foster prevention Who Should Attend This session is designed for: Revenue cycle professionals Billing and coding staff Practice administrators and office managers Healthcare compliance officers Clinical leaders involved in documentation and coding Anyone involved in claim submissions, audits, or payer interactions Whether you’re struggling with persistent denials or looking to optimize performance, this presentation offers practical, actionable insights to help you recover revenue and reduce administrative strain.