The Legal and Regulatory Aspects of Appeals in Denial and Appeal Management

A successful appeal may require the use of clinical, legal/regulatory, or contract language in the argument. Most appeals require all three. Many appeal writers are well versed in clinical or coding arguments, but the legal/regulatory arguments required for a successful appeal are just as important. David Glaser, Esq., attorney at Fredrikson & Byron, P.A., and Denise Wilson, senior vice president at Denial Research Group/AppealMasters and AHDAM president cover the legal and regulatory aspects associated with successful appeals. In this 60-minute webinar, David and Denise will teach you best practices for interacting with auditors, discerning regulatory rules, structuring complete appeal arguments, and preparing for hearing.

Learning Objectives:

  • Explain the critical steps involved in the first contact with an audit/auditor;
  • Discern what rules apply to Traditional Medicare versus Commercial payers;
  • Prepare and submit a well-structured appeal argument complete with appropriate clinical, legal/regulatory, or contract language;
  • Describe best practices for preparing for hearing.