Overturning Medical Necessity and Over Utilization Denials

What choices do you have when payers deny bonuses, reimbursements and other monies due? Learn how to manage and eliminate many reimbursement problems. Also, review use of the state-sponsored external review processes that assists patients in external appeals and coverage decisions resulting in lower payment to the provider. Finally, prevent and manage medical necessity denials from a contractual standpoint. Make it more difficult to merely dismiss services as "not medically necessary" and avoid charge offs without proper rights to appeal.

Course Objectives:

  • Learn the inherent differences between Arbitration, Mediation and Litigation and how each one works
  • Learn how to use of the state-sponsored external review processes to appeal denials - it's easier than you think!

Bonus Materials

A checklist to prepare denied claims for external review and appeal




Who Should Attend

  • Managed Care Contract Negotiators 
  • Revenue Cycle Staff and Managers
  • Chief Financial Officers
  • Physicians and Medical Group Practice Administrators 


About the Presenter


Maria Todd is a consultant, speaker, author and health care industry thought leader. With more than 30 years in health care and combined health plan, clinical, health administration and health law paralegal and mediation professional work experience, Maria Todd is a veritable tour de force when it comes to managed care and contracted reimbursement training.  She has trained more than 53,000 students and seminar participants in over 2600 seminars, lectures and webinars since 1989.  She has taught the 2-day Managed Care Contracting classes for the past 12 years for the HFMA and currently teaches contracting, integration and accreditation-related subject matter around the world for domestic and international healthcare providers seeking to establish contracted relationships with US and other Health Plans, Government Ministries and Employers.

Dr Todd is an Advanced Member of the Healthcare Financial Management Association (HFMA).  She has been named an HFMA Distinguished Speaker for every year that she has presented, and is a 2006 recipient of HFMA's Muncie Gold Award. She serves on the Editorial Board of HCPro's Managed Care & Contracted Reimbursement Advisor and has hundreds of journal articles, interviews and white papers to her credit. She is the author of The Managed Care Contracting Handbook (1996), IPA, PHO, MSO Development Strategies (1997), the Physician Employment Contract Handbook (1999), and is about to release 2nd Editions of each of these titles with Taylor and Francis in 2009, as well as new titles on Global Health Care Program Development and The Medical Tourism Facilitator's Handbook, slated for release in 2009. 

Maria is an active member of HFMA, MGMA and the American Society of Training and Development.

 What is Required to Participate?


A Computer with a sound card and speakers or a headphone. If you wish to ask questions during the class, you can type them in a chat-enabled screen during the program or you may ask questions orally if you have a microphone connected and enabled for VOIP chat.

Joining a Audio Webinar on a PC or Mac® computer is easy. When you receive a AudioWebinar email invitation, click the registration link and register for the AudioWebinar. You can then join the AudioWebinar at the scheduled time by clicking the “Join a Webinar” button or link in your confirmation email, which will be automatically sent shortly before the program upon completing your registration. You do not need to pre-install any software prior to joining the Webinar.

Upon receiving your invitation and at th e appointed time, join our Webinar by typing in the URL www.joinwebinar.com,  and then type or paste in the Webinar ID provided by us and enter your email address, click “Yes” or “Always” (or “Trust” on a Mac) if prompted to accept the download, and, if required, enter the Webinar password provided by us.

Webinar FAQs

What is a webinar?
A webinar is a live training presentation conducted via the internet and/or telephone. Participants log-on and dial-in at a designated time to hear the speaker over their computer speakers and view the slide presentation on their computer screen. Our webinars are the most cost-effective form of training because you can invite as many colleagues as you’d like to listen in on and you incur no travel expenses or additional time away from the office.

How do webinars work?
A few days prior to the conference, you'll receive by email a web link that will provide the information you need to join the conference. The email will include a link to download the agenda and the speakers' presentations prior to the call for your review, and a web link to access during the conference to follow along with the speaker's presentation online.

How do I join a conference that I registered for?
Approximately five minutes before the conference start time, click on the link to access the conference online. This will take you to a web page where you will be prompted to enter your name and email address. Once you have entered that information, click the "Join" button. To access the audio portion, turn on your computer speakers. (You must have a sound card and speakers or a headset to listen to the program online).

How can I register?
Online by visiting the links for registration provided

How do I get the handout(s)?
A link to download the speaker handouts will be emailed a few days prior to the webinar. The handouts will also be available online during the conference for participants to follow along.  

Name Sales End Price
Early Registration Ended $119
Regular Admission Ended $139

On the Web

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