Presented by PayerWatch & AHDAM.org | 9/22/2022
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. One complimentary registration will ensure you receive access to all three workshops. Please support the Sepsis Alliance and learn more at sepsis.org
9/22 – Sepsis Denial/Appeal Workshop 2 – Staying the Course in Sepsis Documentation and Avoiding Sepsis Diagnosis Challenges (Dr. Agvanyan, Christi Drum, Garnette McLaughlin) This webinar will cover how to successfully manage sepsis documentation when payers try to dictate the use of a single set of criteria to clinically validate the diagnosis. Learn how to successfully challenge that practice on appeal.
Presenters:
Edgar Agvanyan, MD
Dr. Agvanyan is the System Director, Case Management and CDI for Adventist Health in California, Oregon and Hawaii. Dr. Agvanyan has a history of achievement in Primary Care and IPA medical management. His areas of expertise include outpatient/inpatient utilization review and management, Quality management, provider network, health plan guidelines and criteria, CMS/NCQA standards and 340B specialty drug cost management. He is responsible system-wide for clinical metrics producing actionable information in support of medical management and LOS initiatives, developing and administering the methodology for determining medical necessity of procedures and diagnostic tests.
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.
Garnette McLaughlin, DBA, RHIA
Garnette moved into the HIM field in 2011. Prior to discovering this fascinating profession, her background was in IT and management. She has over 15 years of experience in management, training, and customer service. After completing her Bachelor of Science in health informatics, Garnette became an inpatient coder for an academic tertiary care hospital. While her primary coding specialty is inpatient – she also codes ED, ancillary, and outpatient surgery. Her coding expertise paved the way to transition into the world of denials management. Her areas of specialty are writing winning appeals of coding denials and serving as an appointed representative in hearings. Additionally, Garnette has a passion for educating coding and CDI professionals regarding pro-active strategies to reduce the risk associated with audits and denials.
Christi Drum, CCDS, CCS
Christi is a registered nurse with over 16 years of experience in emergency services, interventional radiology, cardiovascular services, and administration. In 2013, Christi joined the Clinical Documentation Integrity department where she completed concurrent and retrospective reviews with a broad work scope of DRG reimbursements, CC/MCC capture, SOI/ROM improvements, mortality reviews, and HAC and PSI improvements. She found great success in query writing with excellent capture/agreement rates. Christi also became the first CDI Educator for the health system and was privileged to share her CDI passion through teaching and training nurses and physicians.
Currently, Christi works for Intersect Healthcare + AppealMasters where she is a clinical appeals consultant, generating detailed and well-articulated appeal letters and presenting cases as the Administrative Law Judge level. Her specialties lie in clinical validation and coding appeals.
