General, nonspecific appeals might work some of the time, but increased specificity in your appeals will give you a better chance to obtain more overturns. Join us as AHDAM discusses specific techniques that you can start using immediately in your patient status, clinical validation, coding, and technical appeals. This educational activity is suited for new appeal writers as well as not so new writers who could use a refresher.
About the Presenters:
Karla Hiravi
Senior Vice President, Clinical Resources
Karla is the Vice President, Clinical Resources at AppealsMasters, the appeal service group of the PayerWatch family. Karla has a wealth of experience from her 30+ years as a registered nurse that allowed her to experience first hand the impact that denials have on our nation’s hospitals. Prior to her present role, she held numerous positions in the healthcare industry. Some of the highlights in her career included working as a Clinical Documentation Specialist, managing a highly successful Clinical Documentation Improvement Department, building a Medical Oncology Research Program, and building a multimillion dollar Denials and Appeals Program.
Karla is passionate about making sure that our hospitals are paid for the work that they do. To that end, she has written hundreds, if not thousands, of appeals and presented dozens of cases at the hearing level. In her current role, she works as an educator and enjoys teaching how to write winning appeals. She is responsible for the quality of appeals produced by PayerWatch, and is often a co-presenter for PayerWatch's webinars that reach a national audience. Karla is a current member of ACMA and AHIMA.
Kendall Smith
Chief Medical Officer & Chief Physician Advisor
Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Medical Officer and Chief Physician Advisor for PayerWatch, a leading appeal educator and appeal services firm for hospitals and health systems. He’s been deeply involved in denial and appeals management throughout his hospitalist career, working collaboratively with UR/Case Management departments as well as Managed Care and Hospital C-Suite executives.
His familiarity with managed care denials led him to design and implement a number of CDI programs, including those at the Cleveland Clinic in Florida and the MedStar Washington Hospital Center. He has served as a physician leader on hospital revenue cycle management teams while also serving as a the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.
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