Presented by PayerWatch & AHDAM.org | 9/28/2022
Summary:
In recognition of Sepsis Awareness Month, PayerWatch and AHDAM join together to present three Sepsis Denial/Appeal workshops. Sepsis is the leading cause of death in U.S. hospitals, and the lack of definition/treatment consensus between providers and commercial insurers is infuriating and dangerous. Join an expert faculty of Physician Leaders from Adventist Health, UNC Hospitals, Sound Physician Advisory, as well as CDI Nurses and Coders, and let’s challenge the #1 Payer Denial plaguing hospitals across the U.S. Please support the Sepsis Alliance and learn more at sepsis.org
9/28 – Sepsis Denial/Appeal Workshop 3 – Sepsis Current State – How to Appeal When the Payer Gets it Wrong. Dr. Hesham Hassaballa, Sound Physicians, Dr. Kendall Smith, PayerWatch, Denise Wilson, PayerWatch and AHDAM. This webinar will cover sepsis current state, appealing sepsis denials for non-par Medicare advantage payers, how to appeal for Sepsis 3 when the payer gets it wrong, and how to appeal inpatient admission denials for sepsis.
Presenters:
Hesham Hassaballa, MD, FCCP, FAASM
Hesham Hassaballa, MD, FCCP, FAASM is a practicing Intensivist with 17+ years of clinical practice and is Regional Medical Director for Sound Physicians’ Critical Care practice in the Midwest. He is board certified in Internal Medicine, Pulmonary Medicine and Critical Care. Dr. Hassaballa is also a Physician Advisor and serves on the Education and Advisory Board for Sound Physician Advisory Services. He has presented research a number of times at national meetings, and he has published numerous articles in peer-reviewed medical journals.
Dr. Hassaballa has won a number of awards, most recently the Leadership Award at Rush Copley Medical Center. In addition to his clinical and administrative roles, Dr. Hassaballa serves as Treasurer of the Bayan Hassaballa Foundation, set up by he and his wife to honor the memory of their daughter, Bayan, who lost her battle with cancer in 2009 (www.ourangelbayan.org).
Kendall Smith, MD
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.
Denise Wilson, RN, MS
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.
