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WEBINAR: Appeal Letter Workshop - Tools for Effective Appeals
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4/23/2020
When: Thurs. Apr. 23, 2020
12:00-1:00 p.m. Eastern
Where: GoToWebinar
United States
Contact:


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Do you struggle with interpreting denials? Do you often wonder if your appeal argument is compelling? If so, this session is for you! Medicare and Managed Care efforts to prevent improper payments have resulted in increased medical reviews. When a denial occurs, it’s necessary to understand the specific reason for the denial in order to formulate an appropriate appeal strategy. An effective appeal strategy often includes input from billing and medical records in addition to rehab. This session will discuss the roles of the various team members in gathering and interpreting the denial information. In addition, it will highlight elements to include in an effective appeal letter and share common appeal letter pitfalls to avoid. Tools provided will include appeal templates and a comprehensive Medicare citations list.

Educational Objectives

  • Explain the role of various team members in denials interpretation and effective appeals management.
  • Describe the meaning of common denial terminology.
  • List elements to include in an effective appeal letter.
  • Identify appropriate citations to use in Medicare appeals.

 

Presented by:

Jaclyn Warshauer, PT, CRC, is the National Director of Medical Review and Quality Services at Aegis Therapies and is a certified coder. At Aegis Therapies she monitors and trains on regulatory affairs, trains therapists on conducting documentation auditing, and is a resource regarding Medicare coverage, coding and documentation requirements. Prior to employment with Aegis therapies, Jaclyn was a Medicare Medical Reviewer for 9 years with National Government Services, a Medicare MAC. Jaclyn has served as a resource to CMS on subjects related to coverage and documentation of therapy services. She is a member of the HPA section of the APTA and has served as a past chair of the HPA Payment & Practice committee.

Mary Saylor-Mumau, MPT, RAC-CT, is a Medical Review and Denials  Manager at Aegis Therapies where she assists therapists and facility/agency staff with denials interpretation, appeal strategy development, and billing and documentation auditing and training for denial prevention. Across her therapy career, Mary has held various treatment and managerial positions that span multiple therapy settings. She has served as adjunct instructor for a PTA program and has previously presented oral sessions at APTA’s CSM, the ASHA national conference, and AOTA national conference.

Rebecca Setaro, OTR/L, RAC-CT, received her Master's degree in Occupational Therapy from Duquesne University in Pittsburgh, PA. Rebecca currently works for Aegis Therapies as Medical Review and Denial Manager. She provides education and feedback to therapists regarding documentation, billing compliance, and denials management in skilled nursing, home health and direct bill. She has over 20 years’ experience in the skilled nursing environment in both clinical and operational areas. Rebecca has educated at local universities to nursing home administrators regarding the roles, billing regulations, and expectations of rehab in long term care. Most recently she has presented at ASHA and CSM on topics related to appeals, denials, and improving clinical documentation.

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