On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage (MA or Part C) regulations to implement changes related to health equity, coverage criteria, prior authorization, and other programmatic areas. Join us as experts in the field discuss the key points of the final rule that clarifies Medicare Advantage payer behaviors. We’ll also be discussing the impact the final rule will have on providers.
About the presenters:
Carolyn Dutton, MD, FACEP, FACP, CHCQM-PHYADV, CWSP
Senior Physician Advisor, Wound Care Director, Emergency Medicine, Internal Medicine; Atrium Health
Dr. Carolyn Dutton is board certified in Internal Medicine and Emergency Medicine. She completed medical school at St. George’s University School of Medicine and her training at Allegheny General Hospital where she served as Chief Resident. She has worked both in emergency medicine and as a hospitalist with Atrium Health since 2006. She continues to work clinically as the Medical Director for University City Wound Care Center and serves as the Director of Operations for Atrium Health Physician Advisor Services.
Dr. Dutton is also board certified in health care quality and management with a physician advisor sub-specialty by the American Board of Quality Assurance and Utilization Physicians (ABQAURP). She is Chair of the American College of Physician Advisors (ACPA) Government Affairs Committee and serves on the ACPA Board of Directors.
Denise Wilson MS, RN, RRT
President | Association for Healthcare Denial and Appeal Management
Senior Vice President | PayerWatch – AppealMasters
Denise serves as the Senior Vice President at PayerWatch – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a master’s degree in management information systems from the University of Illinois, Springfield. 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 medical care denials. Denise’s special area of expertise is in writing and producing successful appeals.
Kendall Smith, MD
Chief Physician Advisor | PayerWatch + AppealMasters
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 Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.
Bill Haynes, Esq.
Managing Attorney, Legal Director – Clinical Legal Unit | PayerWatch + AppealMasters
Bill is a member in good standing of the Maryland Bar, a member of The Association for Healthcare Denial and Appeal Management, and a member of the American Health Law Association. Bill personally manages a team of attorneys who consult, do legal research, answer legal questions, and draft language for Medicare, Managed Medicare, Medicaid, and Commercial appeal cases, independent reviews, and arbitrations.
