As payer processes become more automated, assertive, and opaque, healthcare organizations face increased challenges protecting reimbursement and sustaining operational stability. This educational webinar explores the modern playbook and its impact on denials, including rising trends in medical necessity denials, level of care disputes, observation downgrades, and readmissions.
Participants will learn proactive strategies to both prevent and overturn clinical denials, with emphasis on the critical role of utilization review (UR) and physician advisor (PA) engagement within the first 24-48 hours of admission. We will focus on how to combat vague or templated denials, align documentation with payer expectations, and apply structured, evidence-based appeal techniques.
Attendees will hear real-world examples of how leading healthcare systems are defending patient care, minimizing revenue loss, and adapting internal workflows as payers narrow coverage, tighten policies, and expand review tools. This session will arm you with insights and practical tactics to push back against harmful payer trends and build a defensible appeal strategy.
Learning Objectives:
- Recognize current and emerging payer tactics contributing to denials, including observation status extensions and automated denial logic.
- Discover the critical importance of early clinical review by UR and PAs within the first 24-48 hours to prevent avoidable denials.
- Identify documentation, escalation, and workflow strategies that improve defensibility and reduce payer pushback.
- Apply structured, evidence-based frameworks to craft stronger appeals and improve overturn rates.
- Leverage data to anticipate denial patterns, manage financial risk, and drive strategic revenue recovery.
Register now to discover essential strategies for preventing and managing clinical denials.
