Stay Ahead of the Curve in 2025: Master Prior Authorization & Appeals
In today’s fast-evolving healthcare landscape, staying compliant while maximizing reimbursements requires deep insight into payer processes. This exclusive two-part webinar combo equips you with the knowledge and tools to confidently navigate the complexities of prior authorization requirements and craft high-impact appeal letters in 2025.
From understanding the latest regulatory updates and insurer mandates to implementing effective documentation and appeal strategies, this training is designed to help providers, billing professionals, and compliance teams reduce denials, accelerate approvals, and safeguard revenue.
Whether you're proactively preparing for payer shifts or struggling with increasing prior auth burdens and claim denials, this dual session delivers actionable strategies to boost efficiency and outcomes.
Session # 1 - CMS Prior Authorization Rules: Tactics to Fight Back and Win
(Pre-Recorded, Available Instantly)
Originally focused on the costliest types of care, Payors now commonly require Prior Authorization for many mundane medical encounters, including basic imaging and prescription refills. Thus, PA is no longer used as a method to limit wasteful use of resources, but rather may be used as a tool that prevents patients from getting the vital care they need.
CMS recently finalized the Interoperability and Prior Authorization Final Rule. This final rule establishes requirements for Payors to streamline the prior authorization (PA) process. While prior authorization can help ensure medical care is necessary and appropriate, providers have been vocal that it is often an obstacle to necessary patient care when providers are forced to navigate complex and widely varying Payor requirements or face long waits for decisions. Beginning primarily in 2026, impacted Payors will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. While these future requirements will be critical in expediting Payor decisions related to patient care, there are techniques that providers can utilize today to help reduce their prior authorization burdens without compromising patient care.
Webinar Objectives
PA can delay treatment and impact optimal patient health outcomes. To reduce these negative consequences for both patients and physicians, practices can minimize the impact of PA in their operations by developing efficiencies and implementing best practices to navigate the dizzying landscape of Payor PA rules.
Webinar Highlights
- Understand CMS Final Rule and what it means for Providers
- Understand ways to reduce the prior authorization burden
- Understand practice operations that can make your prior authorization process more efficient
- Understand the advantages and disadvantages of the myriad Prior Authorization submission methods
- Understand the procedures and medications that likely to trigger prior-authorization requirements
- Understand how to respond to an inappropriately denied prior authorization
Session # 2 - How To Draft Appeal Letters That Get You Paid Quickly
(Pre-Recorded, Available Instantly)
Denied claims can have a significant impact on your revenue cycle, but not all denials are final. An effective appeal letter can be the difference between lost revenue and successful reimbursement.
In this comprehensive webinar, we will provide a step-by-step guide to drafting compelling appeal letters that get claims overturned quickly and efficiently. You will learn proven strategies, best practices, and real-world examples to help you navigate the appeals process with confidence.
Our expert speaker will break down the essential components of a successful appeal, including how to identify appealable denials, structure a persuasive letter, and use payer policies to your advantage. We’ll also cover the most common mistakes that lead to appeal rejections and how to avoid them.
By the end of this session, you’ll have the tools and knowledge to create clear, well-supported appeals that increase your chances of getting paid fast.
Webinar Objectives
- Recognize the top reasons for claim denials
- Learn how to structure an appeal letter
- Understand payer guidelines and legal considerations
- Develop a streamlined appeal process
- Gain confidence in handling denials
Webinar Agenda
- Understanding Denials
- Key Components of a Winning Appeal Letter
- Appeal Timelines & Best Practices
- Case Study & Example
- Q&A Session
Webinar Highlights
- Step by step guide to writing compelling appeal letters
- Understanding payer policies and how to use them to your advantage
- Common appeal mistakes – and how to avoid them
- Example of successful appeals
- Q&A Session
Who Should Attend
Medical Directors, Practice Administrators, Prior Authorization Specialists, Medical Assistant, Medical Coder, Provider Groups, Management Service Organizations (MSOs), Billing and coding professionals, revenue cycle managers, practice administrators, and anyone responsible for handling claim denials and reimbursements.
What Do You Think About This Webinar?
