The post The Future of Appeal Writing for Appeal Writers appeared first on PayerWatch.

Payer denials continue to strain revenue cycle teams, often because appeals rely solely on clinical arguments while overlooking powerful contractual, legal, and regulatory protections. This webinar explores how a combined clinical and legal approach can significantly improve overturn rates, strengthen payer accountability, and drive measurable financial results.

Attendees will learn how to leverage contract language, regulatory requirements, and legal arguments to enforce payer “Rules of Engagement” and reduce unnecessary friction in the appeals process. We’ll examine when and how to incorporate legal reasoning into clinical appeals, identify the financial risks of limited visibility, and demonstrate how a more disciplined, informed strategy can improve operational efficiency and protect the bottom line.

Designed for revenue cycle and appeals leaders, this session provides practical guidance to help teams move beyond reactive denial management and toward a more assertive, results-driven appeals strategy.

Attendees will:
-Gain a better understanding of the purpose of including legal arguments in clinical appeals.
-Learn how to apply their contractual, legal and regulatory protections that can improve operational efficiency
-Learn how to enforce payer compliance with the Rules of Engagement
-Be able to identify the types of legal arguments that could be included in clinical appeals.
-Learn how to apply the correct legal arguments with the appropriate circumstances for use.
-Become familiar with the financial risks and dollar impact that “zero visibility” creates

Presenters: Brian McGraw, Chief Executive Officer | PayerWatch

Craig DeFrancisco, General Counsel & Corporate Compliance Officer | PayerWatch

The post Decrease Denials and Increase the Bottom Line: Using Your Contract Rules and a Clinical/Legal Approach to Improve Overturns appeared first on PayerWatch.

Presented on October 22nd, 2025

Attendees will learn to differentiate between tasks AI can safely assist with and those that require human judgment, recognize the essential elements of a provider-side AI governance committee to ensure responsible and compliant use of AI, and identify measurable success metrics to evaluate the impact of AI integration on appeal workflows.

Presenter:

Kendall Smith, MD, SFHM, ACPA-C Chief Medical Officer & Chief Physician Advisor | PayerWatch – AppealMasters

The post AI in Appeal Writing 2025: What It Can Do, What It Can’t, and What’s Coming Next appeared first on PayerWatch.

Presented on September 17, 2025

Join us for an engaging webinar with DeAnna Fling, MHA, RRT, Revenue Cycle Educator, as she demystifies the prior authorization process and empowers you to craft winning appeals. Don’t miss this opportunity to boost your knowledge, stay ahead of regulatory changes, and help your patients get the care they deserve!

Presenter: 

• DeAnna Fling, MHA, RRT | Revenue Cycle Educator, McKesson

The post From Denial to Approval: Your Guide to Prior Authorization Success in Today’s Changing Healthcare World! appeared first on PayerWatch.

Presentation Date: Wednesday, August 20, 2025

Understanding DRG (Diagnosis-Related Group) downgrades is essential for professionals working in denial and appeal management, coding, and revenue cycle roles. This introductory webinar will break down the foundational concepts behind DRG downgrades—why they happen, how they impact reimbursement, and what strategies can be used to identify, respond to, and appeal them effectively. Whether you’re new to the field or looking for a refresher, this session will equip you with the terminology, processes, and key documentation considerations needed to navigate DRG downgrade denials with more confidence.

Presenters:

Kendall Smith, MD | Chief Medical Officer & Chief Physician Advisor, PayerWatch

Reggie Allen, MBA, RN, ACM | Chief of Clinical/Business Operations, PayerWatch

The post Clinical Validation in 2025: Back to the Basics—What Changed & How to Win appeared first on PayerWatch.

Presentation Date: Wednesday, June 25, 2025

Join us for an insightful follow-up webinar featuring Dr. Kendall Smith, MD, as we delve deeper into the complexities of ERISA and its impact on insurance claims. Building on the powerful stories previously shared in May by two women who faced egregious denials from their insurance companies, this presentation will equip you with essential knowledge and practical strategies to navigate ERISA effectively.

Upon conclusion of this activity, learners will be able to identify how ERISA-governed health plans differ from non-ERISA plans, recognize an effective tactic to address improper actions by third-party administrators (TPAs) and escalate to the plan sponsor, and determine advantages of referencing fiduciary duty in ERISA appeals.

Presenter:

Kendall Smith, MD | Chief Medical Officer & Chief Physician Advisor, PayerWatch

The post Unlocking ERISA: How to Win Appeals When the Stakes Are High appeared first on PayerWatch.

Presentation Date: Wednesday, May 21, 2025

Two patients share their firsthand experience battling health insurance denials for life-saving treatment—one with Alpha-1 Antitrypsin Deficiency, the other with Hodgkin’s disease.

Walk through the ERISA appeals process step-by-step from the patient’s perspective, including what worked, what didn’t, and what they wish they had known earlier.

Open discussion focused on practical strategies, challenges, and support tools—including downloadable templated appeals for Alpha-1 and lymphoma/leukemia patients.

Presenters:

Tiffany Ferguson | CEO, Phoenix Medical Management, Inc.

Anna Hocum | PA, Grad Student

The post Fighting for Coverage: Real Patient Stories and the ERISA Appeals Process appeared first on PayerWatch.

Presentation Date: Wednesday, March 26, 2025

Join us for an engaging session where we’ll tackle the increasing challenges in hospital reimbursement and highlight the crucial teamwork between physicians and revenue cycle management (RCM) teams.

Our expert speakers will dive into the financial impact of clinical validation and medical necessity denials and discuss how physicians are playing a bigger role in aligning clinical care with payer expectations. They’ll also share practical strategies, like using AI-driven analytics and structured workflows, to help reduce denials. Through real-world case studies, you’ll see how hospitals are successfully fostering collaboration and implementing physician-led appeal strategies to transform their operations.

About the Presenters:

Kendall Smith, MD, SFHM, ACPA-C 

Chief Physician Advisor | PayerWatch – AppealMasters 

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for PayerWatch – 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. He has served as a physician leader on hospital revenue cycle management teams while also serving as the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

Ryan O’Hara

Managing Principal | Denial Research Group

Ryan O’Hara is an accomplished healthcare executive with a wealth of experience in revenue cycle operations. Throughout his 20+ year career, Ryan has demonstrated a deep understanding of the complexities of healthcare financial management and has worked to develop strategies and solutions to drive efficiency, reduce costs, and improve patient outcomes.

He has spent the majority of his time on the healthcare provider side, working as a revenue cycle operations leader across many hospitals and health systems. He also has spent several years working on the EMR and 3rd party business partner side. This has provided for a diverse and rounded background; but one that is always rooted in being a trusted and value-add contributor for healthcare providers.

About the Moderator:

Karla Hiravi, BSN, RN 

Senior Vice President Clinical Resources, PayerWatch 

President, AHDAM 

Karla is a registered nurse and holds a BSN from the University of Pittsburgh, Johnstown. She has over forty years of varied experiences in healthcare, culminating with Clinical Documentation Improvement (CDI), management of a CDI department, followed by development of a successful hospital-based denial and appeal program, authoring of thousands of varied healthcare related appeals between her positions at her local hospital and then at PayerWatch/AppealMasters, presentations at the Administrative Law Judge (ALJ) level, and direct management of thousands of appeals at every level, up to post ALJ appeals.

She has served in many capacities from contracted appeal writer up to and including Senior Vice President of Clinical Resource Management for PayerWatch/AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. She serves as President of AHDAM (Association for Healthcare Denial and Appeals Management), the nation’s only association dedicated to healthcare denial and appeal management. 

The post Bridging the Gap: Physician and Revenue Cycle Collaboration to Optimize Denial Prevention & Appeals appeared first on PayerWatch.

Presentation Date: Wednesday, February 26, 2025

Transform Your Healthcare Appeal Writing! Dive into our dynamic webinar and uncover the secrets to mastering emergency department level of care appeals and validating acute heart failure in TAVR patients. Elevate your skills, boost your confidence, and make a real difference in patient outcomes. Don’t miss out—register today and become a standout appeal writer!

About the Presenters:

Kendall Smith, MD, SFHM, ACPA-C 

Chief Physician Advisor | PayerWatch – AppealMasters 

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for PayerWatch – 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. He has served as a physician leader on hospital revenue cycle management teams while also serving as the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

Reggie Allen, MBA RN ACM

Principal Consultant, PayerWatch

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. 

About the Moderator:

Karla Hiravi, BSN, RN 

Senior Vice President Clinical Resources, PayerWatch 

President, AHDAM 

Karla is a registered nurse and holds a BSN from the University of Pittsburgh, Johnstown. She has over forty years of varied experiences in healthcare, culminating with Clinical Documentation Improvement (CDI), management of a CDI department, followed by development of a successful hospital-based denial and appeal program, authoring of thousands of varied healthcare related appeals between her positions at her local hospital and then at PayerWatch/AppealMasters, presentations at the Administrative Law Judge (ALJ) level, and direct management of thousands of appeals at every level, up to post ALJ appeals. She has served in many capacities from contracted appeal writer up to and including Senior Vice President of Clinical Resource Management for PayerWatch/AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. She serves as President of AHDAM (Association for Healthcare Denial and Appeals Management), the nation’s only association dedicated to healthcare denial and appeal management. 

The post You Asked for It!  Appeal Strategies: Emergency Department Level of Care PLUS Clinical Validation of Acute CHF in the TAVR Setting appeared first on PayerWatch.

Presentation Date: Wednesday, January 29, 2025

At the conclusion of the webinar, the learner will be able to determine factors that influence Diagnosis-Related Group (DRG) assignments, and identify critical components of compliant appeals for denied inpatient status.

About the Presenters:

Karla Hiravi, BSN, RN
Senior Vice President, Clinical Resources

Karla is the Vice President, Clinical Resources at AppealsMasters, the appeal service group of the PayerWatch family. Karla has a wealth of experience from her 30+ years as a registered nurse that allowed her to experience first hand the impact that denials have on our nation’s hospitals. Prior to her present role, she held numerous positions in the healthcare industry. Some of the highlights in her career included working as a Clinical Documentation Specialist, managing a highly successful Clinical Documentation Improvement Department, building a Medical Oncology Research Program, and building a multimillion dollar Denials and Appeals Program.
Karla is passionate about making sure that our hospitals are paid for the work that they do. To that end, she has written hundreds, if not thousands, of appeals and presented dozens of cases at the hearing level. In her current role, she works as an educator and enjoys teaching how to write winning appeals. She is responsible for the quality of appeals produced by PayerWatch, and is often a co-presenter for PayerWatch’s webinars that reach a national audience. Karla is a current member of ACMA and AHIMA.

Kendall Smith, MD
Chief Medical Officer & Chief Physician Advisor

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Medical Officer and Chief Physician Advisor for PayerWatch, 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 the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

The post You Asked for It! Advanced Strategies for DRGs, Inpatient Status Appeals, and Tackling MA Noncompliance with the 2-Midnight Rule appeared first on PayerWatch.