The Road to External Review

Many denial and appeal management specialists are not aware that there are often opportunities to continue an appeal outside of the payer’s internal appeal process. Join us to learn how to move an appeal to an external review where the best opportunity for overturn exists.

Learning Outcomes:
Determine whether a denied claim has the option of being filed to external review.
Identify the primary state and the primary federal organizations that describe the steps for taking an appeal to external review.
Explain how to research state external review processes in the learner’s state.

Presenter: Denise Wilson, MS, RN, RRT
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.
Presenter: Bill Haynes, Esq.
Bill serves as the Managing Attorney for Denial Research
Group – AppealMasters. Bill is a member in good standing of the
Maryland Bar, a member of The Association for Healthcare
Denial and Appeal Management, and a member of the American Health Law Association. Bill has experience in healthcare law, including managed care contract analysis, payer-provider arbitrations, and the independent review processes.
Bill personally manages a team of attorneys who do legal research, answer legal questions, and draft language for Medicare, Managed Medicare, Medicaid, and Commercial appeal cases, independent reviews, and arbitrations.