Successfully Defending Inpatient Authorization Denials

Authorizations for inpatient admissions remain a thorn in the sides of providers and utilization management personnel. Join us as experts in the field discuss ways to prevent authorization denials, how to hold payers accountable for delayed decisions, and strategies to defend inpatient authorization denials.

About the presenters:

Denise Wilson, MS, RN, RRT

Senior Vice President | PayerWatch + 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.

Reggie Allen, MBA, RN, ACM

Chief, Clinical/Business Operations | PayerWatch + AppealMasters

Reggie has more than 35 years of experience in a variety of healthcare positions, including staff nurse, nurse manager, Chief Nursing Officer, Chief Operating Officer, and Vice President, Clinical/Business Operations Transformation. He has been recognized nationally as an expert in care management and clinical operations. He is a results-driven leader who emphasizes operational transformation by integrating clinical and financial care aspects. He obtained a bachelor’s degree in nursing from Vanderbilt University and an MBA from the University of Phoenix. He is a member of the American Case Management Association (ACMA) and the American College of Healthcare Executives.

Reggie possesses comprehensive knowledge and experience in all facets of care management, including case management, utilization management, disease management, quality management, and resource management. He has designed and implemented an enterprise-wide Clinical Appeals Unit and a clinical documentation program with success. Using six sigma and Lean principles, he is an expert in clinical and operational efficiencies that enhance clinical outcomes and financial performance through a variety of methodologies.