Date: June 18, 2026

Time: 1pm ET | 12pm CT | 11am MT | 10am PT

Duration: 480 Minutes

Description:

Every denied claim that goes unchallenged is revenue your organization will never recover  and in today’s healthcare environment, that’s a risk you simply can’t afford.

Reimbursement models are shifting. CMS policy is in flux. And with ongoing uncertainty around healthcare legislation, organizations that passively write off appealable denials are putting their financial stability — and their doors  at risk. The margin for error has never been thinner.

Medicare Boot Camp— Denials and Appeals Online gives you the expert-level, practical knowledge to stop preventable denials before they happen and win the appeals that matter most. This comprehensive online training cuts through the complexity of Medicare’s audit and appeals framework to deliver proven, actionable strategies your team can apply immediately.

You’ll walk away with a thorough command of the entire denials management and appeals process  fully equipped to protect your organization’s revenue and pursue every winnable claim with confidence.

What You’ll Gain :

• A clear, working understanding of the Medicare audit landscape and how it directly impacts your revenue cycle

• Proven strategies for identifying, preventing, and overturning claim denials

• Practical tools for prioritizing appeal efforts to maximize recovery and minimize administrative waste

• Confidence to navigate CMS policy changes without disrupting your compliance posture

• A ready-to-implement framework for building a stronger, more resilient denials management program

Course Outline

Module 1: Denials & Appeals — The Foundation

• Understanding denial types and what drives them

• A step-by-step framework for handling denials effectively

• The core structure of the Medicare appeals process

• Critical timelines you must know to protect your appeal rights

Module 2: Medicare Overview & Contractor Landscape

• The Four Parts of Medicare and how each impacts claims

• Who the Medicare contractors are and what roles they play

• Independent government agencies and their involvement in Medicare compliance

Module 3: Research, Resources & Staying Current

• Essential web-based resources every compliance and billing professional should bookmark

• Key sources of authority — knowing what carries weight in an appeal

• Medicare Coverage Center: LCDs, NCDs, CED, and the Lab Coverage Manual

• Navigating Medicaid manual research and commercial payer resources

• Common contractual language in commercial payer contracts and how to interpret it

• Strategies for staying current as policies and coverage rules evolve

Module 4: Prepayment Claim Reviews & Audits

• What prepayment reviews are and why they happen

• Automated prepayment reviews — how they work and what triggers them

• Prepayment non-medical record reviews vs. medical record reviews

• How to respond effectively at the prepayment stage

Module 5: Postpayment Claim Reviews & Audits

• How the postpayment audit process is established and structured

• Postpayment non-medical record reviews and what to expect

• Statistical sampling and extrapolations — understanding the financial stakes

• Postpayment medical record reviews and documentation requirements

Module 6: Medicare Fee-for-Service (FFS) Appeal Process

• Initial determinations and how they set the stage for appeals

• Reopenings and where they overlap with the formal appeals process

• Level 1 — Redetermination: The first line of defense

• Level 2 — Reconsideration: Qualified Independent Contractor (QIC) review

• Level 3 — Administrative Law Judge (ALJ) Hearing: Building your strongest case

• Level 4 — Medicare Appeals Council: Escalating when necessary

• Level 5 — Judicial Review in U.S. District Court: The final avenue

Module 7: Commercial Audit & Appeal Process

• How commercial payer audits differ from Medicare audits

• Navigating the commercial appeal process from start to finish

• Proven strategies for constructing winning commercial appeals

• Common appeal levels and how to move through them efficiently

Module 8: No Surprises Act — Appeals & Dispute Resolution

• Overview of the No Surprises Act and its compliance implications

• Understanding the Qualifying Payment Amount (QPA)

• Good faith negotiation requirements and best practices

• The arbitration process — when it applies and how to prepare

Module 9: Drafting a Winning Appeal Letter

• Core elements every effective appeal letter must include

• Specific issues to address — and common mistakes to avoid

• How to structure your letter for maximum clarity and persuasive impact

• Identifying and citing the right sources to support your position

Who should Attend:

• Revenue Cycle Directors, Managers & Staff

• Revenue Integrity Directors, Managers & Staff

• HIM Directors, Managers & Staff

• CDI Directors, Managers & Specialists

• Compliance Directors, Officers & Auditors

• Business Office Managers

• Case Management Directors, Managers & Case Managers

• Utilization Review & Utilization Management Staff

• Physician Advisors

• Audit Directors, Coordinators & Auditors

• Appeal Coordinators

• Patient Financial Services Director

About Our Speaker

Dr. Kendall Smith, MD

Chief Physician Advisor, AppealMasters | Senior Fellow in Hospital Medicine (SFHM)

Dr. Smith brings a physician’s perspective to denial and appeals management, making complex clinical denial issues accessible to revenue cycle and compliance teams. He has worked extensively with UR/Case Management departments, Managed Care teams, and Hospital C-Suite executives on denial strategy. His dual clinical and administrative background adds significant credibility to topics like medical necessity denials and ALJ hearing preparation.