“Finally Friday!” Subjectivity in Denials

FRIDAY February 24 2017:

Subjectivity in Denials


How MAP Payors See Reality Differently

Motivational Poster from a Medicare Advantage Plan Payor Auditing Bull Pen

Motivational Poster from a Medicare Advantage Plan Payor Auditing Bull Pen – recently secreted out by a RAC Shadow agent…

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Finally Friday! Broadcasts are Sponsored by
The Health Law Partners, ZirMed,
and The American College of Physician Advisors

Denise Wilson, RN MS RRT

Denise Wilson, RN MS RRT

THIS WEEK, we have a great preview of some free webinars coming up by Denise Wilson, Vice President at AppealMasters / Intersect Healthcare. Denise is doing a 2-part webinar on appeals topics – the first one on March 1st is about how to understand and appeal Medicare Advantage Plan (MAP) denials, especially how to write a winning appeal. The second one on March 9th will have a little different content, focusing more about strategies for appealing.

Anyway, THIS week on our show, Denise is doing a bit of a preview of what she will be doing on the March 1st webinar.

ANYWAY… the question for us this week is:

Do MAP Auditors see reality the same way we do?

Be SURE to join us when Denise will be discussing these key points:

  • WHAT policies do Medicare Advantage Plans follow?
  • HOW can you make sense of those policies? (Assuming that’s possible?)
  • WHAT is their definition of Medical Necessity?
  • WHAT is their definition of Clinical Validation?
  • HOW to speak their language for your best defense?
  • WHEN can you really challenge MAP denials? (when you have a contract)
  • HOW can you challenge MAPs you do NOT have a contract with?

So join us, share your own insights and bring your questions for us!

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FRIDAY – 1:00PM to 2:00PM EDT

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Handouts for This Show


RACTrac Flyer from AHA 514.32 KB 52 downloads



RACTrac Results PPT - 3rd Qtr 2016 830.47 KB 44 downloads



MAP Motivational Poster 74.82 KB 44 downloads


Video Replay of THIS WEEK's Show

CCMA CMAS CEU Certificate

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