Ask The Appeal Experts
Mission
Our mission is to support and promote professionals working in the field of healthcare insurance denial and appeal management through education and collaboration.
Vision
Our vision is to create an even playing field where patients and healthcare providers are successful in persuading medical insurers to make proper payment decisions.
Definition of Denial and Appeal Management
Healthcare denial and appeal management is the cumulative work completed by administrative, clinical, coding, and revenue cycle professionals with specialized training in the field. These professionals process denials, underpayments, and overpayments issued by medical insurance agencies and file appeals for inappropriate denials. The goal of healthcare denial and appeal management is to prevent inappropriate denials from occurring through informing and assisting front-end revenue cycle administrative, clinical, and coding processes.
AHDAM Board of Directors
Providing leadership, expertise, and an industry voice for the AHDAM membership.
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.
Brian McGraw
Brian is a nationally recognized speaker and sought-after expert in the areas of Revenue Risk Management, Regulatory Audit Management and Payer Compliance. Brian pioneered the early design and development of BPM software for revenue compliance and next-generation RCM technology to improve hospital net revenue performance. Over the last twenty years, he has worked with hundreds of hospitals and many of the nation’s largest healthcare systems to improve their managed care reimbursements, denied claim recoveries, billing integrity, RAC audit management and Medicare compliance.
Richelle Marting
Richelle is a healthcare attorney with a focus on medical coding, billing and reimbursement; HIPAA privacy and security; health information management; and regulatory compliance. She has in-house experience as a health information management professional including as interim director of managed care contracting; interim health system privacy officer, compliance coordinator, billing office coordinator, medical coder, medical records clerk and certified nurse aide. She has helped successfully recover or retain millions of dollars for healthcare organizations and individuals through defending payor audits and preparing appeals. Richelle has also served as an expert in litigation supporting attorneys on matters related to health information management, reimbursement, and privacy.
Vivek Radhakrishna
Vivek has more than 22 years of experience designing/developing software and has worked across multiple domains in his professional life, including banking, telecommunication, K-12 education and Healthcare. He has been with Intersect Healthcare for 7+ years; Vivek believes that the customer is the most valuable asset an organization can have and that all software design should be driven by a unrelenting pursuit of end user focus and experience which enables them to effectively use applications to achieve business results. As the VP of Engineering he revels in solving problems, finding creative solutions to customer needs and clearing a path for the organization to do the very best they can while constantly moving forward.
Sean Lilley
Sean Lilley is a seasoned healthcare data strategist dedicated to enhancing transparency and accountability within the healthcare industry. As Chief Data Officer at Hyve Health, he leads the development of advanced analytics solutions that empower hospitals to hold payers accountable, comply with CMS price transparency mandates, and optimize financial efficiency. Sean’s expertise lies in transforming complex healthcare data into actionable insights, fostering a more equitable and efficient healthcare system. His commitment to innovation and collaboration has been instrumental in advancing Hyve Health’s mission to drive positive change through data-driven solutions.
AHDAM Advisory Board
Comprised of volunteers from the Healthcare Denial and Appeal Management community.
| Reggie Allen, MBA, RN Chief, Clinical Business Operations PayerWatch Towson, MD rallen@payerwatch.com | Karla Hiravi, BSN, RN Vice President Clinical Resources Towson, MD khiravi@payerwatch.com |
| DeAnna Fling, MHA, RRT Revenue Cycle Educator McKesson Pharmaceutical Solutions & Services The Woodlands, TX deanna.fling@mckesson.com | David Glaser, Esq. Attorney Fredrikson & Byron Minneapolis, MN dglaser@fredlaw.com |
| Cindy Pugliese Sr. Vice President of Revenue Cycle Hartford Healthcare Hartford, CT cynthia.pugliese@hhchealth.org |