Presentation Date: 7/20/2022
Writing a great clinical argument for medically necessary services is no longer enough to win appeals. Appeal specialists must employ all entitled rights of appeal and that includes understanding and incorporating legal arguments. In this session we will present legal arguments that any clinician can understand and that apply to the most common situations encountered in denials, such as Emergency Services and EMTALA, authorization, experimental or investigational, and others.
At the conclusion of the webinar, the learner will be able to Insert basic legal arguments into an appeal letter, incorporating the correct legal argument for the specific situation. The learner will be able to:
- Describe the purpose of including legal arguments in clinical appeals
- Identify the agency in their state that sets legal regulations for medical insurance
- Match up one legal argument with the appropriate circumstances for use
Presented By: Denise Wilson, MS, RN, RRT