The Power Behind Standards of Care in Successfully Appealing Medical Necessity Denials Payment for medically necessary services always comes down to whether treatment proposed or provided is equivalent to the current standard of care. Standards of care are used to determine patient status in the hospital as well as coverage of procedures or services. Join us as we present the power behind leveraging standards of care in medical necessity arguments for inpatient and outpatient medical services.Learning Outcomes:Make use of standards of care in the medical community to support an appeal argument that services provided for the patient were medically necessary and appropriate.Define a standard of care in the medical community.Describe two strategies for researching standards of care.Appropriately incorporate standards of care in medical necessity appeal arguments to support the medical necessity and appropriateness of the services performed.Presenter: Denise Wilson, MS, RN, RRTDenise 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.Presenter: Kendall Smith, MD; Chief Physician AdvisorDr. 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.