Insurance Denials: Appeals, Prevention, and Contracting Advice

.50 CME Credit

ABQAURP sub-specialty credits: Case Management .50, Managed Care .50, Patient Safety/Risk Management .50, Physician Advisor .50, Transitions of Care .50

Nursing credit is not available as time in course is below the minimum number of hours to be considered for credit.


Physician Advisors are commonly tasked with conducting an onsite analysis of healthcare processes and documentation to avoid costly insurance denials. They must identify both strengths and opportunities for improvement in both the Centers for Medicare & Medicaid Service along with Commercial payment strategies. Prevention begins with the Emergency Department Case Manager to ensure the patient is being placed at the correct level of care from the start. Multidisciplinary rounds with a physician advisor move cases through the continuum of care for the best quality / economic and utilization outcomes.

This online course will deliver details on how to overturn denials, prevent insurance denials, and therefore providing cost savings by analyzing managed care contracts.

This session was recorded live at our 2019 Annual Health Care Quality & Patient Safety Conference and is a portion of the online course entitled: Connecting People, Purpose & Passion. They may be taken individually to earn incremental CME/CE credits. However, if you plan on taking the full 8-hour course, you will not be able to claim credit for these individual sessions.

At the conclusion of the activity, attendees will be able to:
  • Describe the insurance appeal process and strategies to overturn denials
  • Illustrate how to prevent insurance denials with good documentation and utilization
  • Analyze the impact the physician advisor has on managed care contracts that can reduce insurance denials

This course is intended for Physicians of all specialties with appropriate credit offered for each Profession. Nursing credit is not available as time in course is below the minimum number of hours to be considered for credit.

The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This program is approved for Category 2 credit by the American Osteopathic Association.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed.

This activity is valid from May 23, 2019 through March 15, 2022. Original release date: April 26, 2019.

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COURSE FEES: Diplomate $0.00      Member $0.00      Non-Member $0.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this online activity.

Howard Stein, DO, MHA, CHCQM-PHYADV
Dr. Howard Stein currently serves as the Associate Director of Medical Affairs of CentraState Medical Center in New Jersey. Acting as a full time Physician Advisor, he is also the President of CentraState Medical Associates. As a founding member, Dr. Stein has served on the Executive Board of the American College of Physician Advisors since its inception. Dr. Stein is board certified as a family physician, previously serving as a U.S. Air Force physician.

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