COVID-19 Denials and Appeals

As payer denials are now being issued for COVID-19 care, and as these denials involve new coding, billing, and level-of-care issues not dealt with previously, nurses, coders, and CDSs working in denial and appeal management need a thorough understanding of all aspects of avoiding denials and successfully appealing COVID-19-related denials.

Learning Outcomes:

  • List 2 clinical indicators that represent a severe COVID-19 diagnosis
  • List the 2 ICD-10 codes available for use in assigning a COVID-19 diagnosis in 2020

Presenter: Denise Wilson, MS, RN, RRT; Senior Vice President, Denial Research Group – AppealMasters, President, AHDAM

Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing.

Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level. Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning healthcare denials.

Presenter: Kendall Smith, MD; Chief Physician Advisor

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for AppealMasters, 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.