PRIVATE PRACTICE - Beating the Payers at their Own Games with APPEALS

This course will be presented live on March 3, 2026 at 7:00 p.m. ET / 4:00 p.m. PT 

.1 CEUs/ 1.0 Contact Hours
Course Level: Intermediate

Arbitrary and capricious denials are on the rise – both at the prior authorization and post-service stages. Payers know that providers will stop asking for visits if they can make prior authorization administratively burdensome enough. However, filing appeals doesn’t have to be time-consuming. And when a critical mass of PTs embrace pushing appeals to the independent review level, it is very costly to the Payer and can make the Payer change their utilization review practices. This session will educate PTs and admins on the appeal laws that apply to commercial plans and Medicare Advantage Plans and how to use those laws to change payer business practices. Template appeal letters and sample policies and procedures will be provided to make appeals easy. We will also discuss how to file complaints with insurance regulators and CMS and get patients involved in the process. It’s time to get a critical mass of PTs involved in pushing appeals to the independent external review level if we are going to change payer conduct!

Upon completion of this course, you will be able to:
• Understand the appeals laws and procedures under Medicare and the Affordable Care Act that apply to all commercial payers (fully insured and self-insured health plans) in every state.
• Know how to implement the right strategies for each level of appeal according to what laws apply, so the appeals process can be efficient and easy.
• Know how to set up appeal templates for the most common types of appeals to make the process easy.
• Know how to engage your patients in your appeal and complaint efforts and who to direct your complaints to when the Payer violates the applicable laws.