Appealing Chemotherapy and Biologicals Denials Provider

Successfully overturning chemotherapy and biologicals denials goes beyond writing a great medical necessity appeal. Appeal specialists must understand medical necessity requirements, but also need to understand documentation requirements, billing of these drugs, where to find the information they need, and how to apply that information in an appeal.

Join us as we discuss successful strategies for overturning these often high dollar denials. At the conclusion of the webinar, the learner will be able to: Prepare an appeal for chemotherapy or biologicals denials with arguments based on the necessary documentation requirements. At conclusion of the webinar, at least 90% of participants will share on the evaluation:

1. The ability to identify two (2) places in a healthcare system where necessary documentation to include in an appeal for outpatient chemotherapy or biologicals might be found

2. The ability to identify chemotherapy or biologicals billed and wasted on a UB04

3. The ability to identify 2 Medicare administration requirements for chemotherapy and biologicals

About the presenter:

Karla Hiravi, RN, BSN

Vice President | PayerWatch – AppealMasters

Karla is a registered nurse and holds a BSN from the University of Pittsburgh, Johnstown. She has over thirty years of varied experiences in healthcare, including Clinical Documentation Improvement (CDI), development of a hospital-based denial and appeal program, development of an oncology research program, nurse and physician education, appeal writing, presentations at the Administrative Law Judge (ALJ) level, and direct management of appeals at every level, up to post ALJ appeals.

She has extensive experience developing material for continuing education. She was a frequent guest speaker at the University of Pittsburgh, Johnstown for many years, and served as a preceptor for nurse practitioner and Pharm D. students. Karla has been with PayerWatch – AppealMasters since 2016 and continues to educate clinicians and coders.