Presentation Date: Wednesday, June 25, 2025

Join us for an insightful follow-up webinar featuring Dr. Kendall Smith, MD, as we delve deeper into the complexities of ERISA and its impact on insurance claims. Building on the powerful stories previously shared in May by two women who faced egregious denials from their insurance companies, this presentation will equip you with essential knowledge and practical strategies to navigate ERISA effectively.

Upon conclusion of this activity, learners will be able to identify how ERISA-governed health plans differ from non-ERISA plans, recognize an effective tactic to address improper actions by third-party administrators (TPAs) and escalate to the plan sponsor, and determine advantages of referencing fiduciary duty in ERISA appeals.

Presenter:

Kendall Smith, MD | Chief Medical Officer & Chief Physician Advisor, PayerWatch

The post Unlocking ERISA: How to Win Appeals When the Stakes Are High appeared first on PayerWatch.

Presentation Date: Wednesday, May 21, 2025

Two patients share their firsthand experience battling health insurance denials for life-saving treatment—one with Alpha-1 Antitrypsin Deficiency, the other with Hodgkin’s disease.

Walk through the ERISA appeals process step-by-step from the patient’s perspective, including what worked, what didn’t, and what they wish they had known earlier.

Open discussion focused on practical strategies, challenges, and support tools—including downloadable templated appeals for Alpha-1 and lymphoma/leukemia patients.

Presenters:

Tiffany Ferguson | CEO, Phoenix Medical Management, Inc.

Anna Hocum | PA, Grad Student

The post Fighting for Coverage: Real Patient Stories and the ERISA Appeals Process appeared first on PayerWatch.

Presentation Date: Wednesday, March 26, 2025

Join us for an engaging session where we’ll tackle the increasing challenges in hospital reimbursement and highlight the crucial teamwork between physicians and revenue cycle management (RCM) teams.

Our expert speakers will dive into the financial impact of clinical validation and medical necessity denials and discuss how physicians are playing a bigger role in aligning clinical care with payer expectations. They’ll also share practical strategies, like using AI-driven analytics and structured workflows, to help reduce denials. Through real-world case studies, you’ll see how hospitals are successfully fostering collaboration and implementing physician-led appeal strategies to transform their operations.

About the Presenters:

Kendall Smith, MD, SFHM, ACPA-C 

Chief Physician Advisor | PayerWatch – AppealMasters 

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for PayerWatch – AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. He’s been deeply involved in denial and appeals management throughout his hospitalist career. He has served as a physician leader on hospital revenue cycle management teams while also serving as the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

Ryan O’Hara

Managing Principal | Denial Research Group

Ryan O’Hara is an accomplished healthcare executive with a wealth of experience in revenue cycle operations. Throughout his 20+ year career, Ryan has demonstrated a deep understanding of the complexities of healthcare financial management and has worked to develop strategies and solutions to drive efficiency, reduce costs, and improve patient outcomes.

He has spent the majority of his time on the healthcare provider side, working as a revenue cycle operations leader across many hospitals and health systems. He also has spent several years working on the EMR and 3rd party business partner side. This has provided for a diverse and rounded background; but one that is always rooted in being a trusted and value-add contributor for healthcare providers.

About the Moderator:

Karla Hiravi, BSN, RN 

Senior Vice President Clinical Resources, PayerWatch 

President, AHDAM 

Karla is a registered nurse and holds a BSN from the University of Pittsburgh, Johnstown. She has over forty years of varied experiences in healthcare, culminating with Clinical Documentation Improvement (CDI), management of a CDI department, followed by development of a successful hospital-based denial and appeal program, authoring of thousands of varied healthcare related appeals between her positions at her local hospital and then at PayerWatch/AppealMasters, presentations at the Administrative Law Judge (ALJ) level, and direct management of thousands of appeals at every level, up to post ALJ appeals.

She has served in many capacities from contracted appeal writer up to and including Senior Vice President of Clinical Resource Management for PayerWatch/AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. She serves as President of AHDAM (Association for Healthcare Denial and Appeals Management), the nation’s only association dedicated to healthcare denial and appeal management. 

The post Bridging the Gap: Physician and Revenue Cycle Collaboration to Optimize Denial Prevention & Appeals appeared first on PayerWatch.

Presentation Date: Wednesday, February 26, 2025

Transform Your Healthcare Appeal Writing! Dive into our dynamic webinar and uncover the secrets to mastering emergency department level of care appeals and validating acute heart failure in TAVR patients. Elevate your skills, boost your confidence, and make a real difference in patient outcomes. Don’t miss out—register today and become a standout appeal writer!

About the Presenters:

Kendall Smith, MD, SFHM, ACPA-C 

Chief Physician Advisor | PayerWatch – AppealMasters 

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Physician Advisor for PayerWatch – AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. He’s been deeply involved in denial and appeals management throughout his hospitalist career. He has served as a physician leader on hospital revenue cycle management teams while also serving as the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

Reggie Allen, MBA RN ACM

Principal Consultant, PayerWatch

Reggie has more than 35 years of experience in a variety of healthcare positions, including staff nurse, nurse manager, Chief Nursing Officer, Chief Operating Officer, and Vice President, Clinical/Business Operations Transformation.  He has been recognized nationally as an expert in care management and clinical operations.   He is a results-driven leader who emphasizes operational transformation by integrating clinical and financial care aspects.  He obtained a bachelor’s degree in nursing from Vanderbilt University and an MBA from the University of Phoenix.   He is a member of the American Case Management Association (ACMA) and the American College of Healthcare Executives.  

Reggie possesses comprehensive knowledge and experience in all facets of care management, including case management, utilization management, disease management, quality management, and resource management.  He has designed and implemented an enterprise-wide Clinical Appeals Unit and a clinical documentation program with success.  Using six sigma and Lean principles, he is an expert in clinical and operational efficiencies that enhance clinical outcomes and financial performance through a variety of methodologies. 

About the Moderator:

Karla Hiravi, BSN, RN 

Senior Vice President Clinical Resources, PayerWatch 

President, AHDAM 

Karla is a registered nurse and holds a BSN from the University of Pittsburgh, Johnstown. She has over forty years of varied experiences in healthcare, culminating with Clinical Documentation Improvement (CDI), management of a CDI department, followed by development of a successful hospital-based denial and appeal program, authoring of thousands of varied healthcare related appeals between her positions at her local hospital and then at PayerWatch/AppealMasters, presentations at the Administrative Law Judge (ALJ) level, and direct management of thousands of appeals at every level, up to post ALJ appeals. She has served in many capacities from contracted appeal writer up to and including Senior Vice President of Clinical Resource Management for PayerWatch/AppealMasters, a leading appeal educator and appeal services firm for hospitals and health systems. She serves as President of AHDAM (Association for Healthcare Denial and Appeals Management), the nation’s only association dedicated to healthcare denial and appeal management. 

The post You Asked for It!  Appeal Strategies: Emergency Department Level of Care PLUS Clinical Validation of Acute CHF in the TAVR Setting appeared first on PayerWatch.

Presentation Date: Wednesday, January 29, 2025

At the conclusion of the webinar, the learner will be able to determine factors that influence Diagnosis-Related Group (DRG) assignments, and identify critical components of compliant appeals for denied inpatient status.

About the Presenters:

Karla Hiravi, BSN, RN
Senior Vice President, Clinical Resources

Karla is the Vice President, Clinical Resources at AppealsMasters, the appeal service group of the PayerWatch family. Karla has a wealth of experience from her 30+ years as a registered nurse that allowed her to experience first hand the impact that denials have on our nation’s hospitals. Prior to her present role, she held numerous positions in the healthcare industry. Some of the highlights in her career included working as a Clinical Documentation Specialist, managing a highly successful Clinical Documentation Improvement Department, building a Medical Oncology Research Program, and building a multimillion dollar Denials and Appeals Program.
Karla is passionate about making sure that our hospitals are paid for the work that they do. To that end, she has written hundreds, if not thousands, of appeals and presented dozens of cases at the hearing level. In her current role, she works as an educator and enjoys teaching how to write winning appeals. She is responsible for the quality of appeals produced by PayerWatch, and is often a co-presenter for PayerWatch’s webinars that reach a national audience. Karla is a current member of ACMA and AHIMA.

Kendall Smith, MD
Chief Medical Officer & Chief Physician Advisor

Dr. Kendall Smith is a Senior Fellow in Hospital Medicine (SFHM) and currently acts as Chief Medical Officer and Chief Physician Advisor for PayerWatch, a leading appeal educator and appeal services firm for hospitals and health systems. He’s been deeply involved in denial and appeals management throughout his hospitalist career, working collaboratively with UR/Case Management departments as well as Managed Care and Hospital C-Suite executives.
His familiarity with managed care denials led him to design and implement a number of CDI programs, including those at the Cleveland Clinic in Florida and the MedStar Washington Hospital Center. He has served as a physician leader on hospital revenue cycle management teams while also serving as the Physician Advisor for Clinical Resource Management. Dr. Smith is also an AHIMA ICD-CM/PCS approved trainer/ambassador.

The post You Asked for It! Advanced Strategies for DRGs, Inpatient Status Appeals, and Tackling MA Noncompliance with the 2-Midnight Rule appeared first on PayerWatch.

Presentation Date: Wednesday, January 15, 2025

The way we approach denial management requires change. In 2025, data-driven insights and measurable outcomes will be at the heart of strategies to combat payer denials, delays, and unfair practices. Join six of the nation’s top denial management experts for a candid, practical discussion about what’s working now—and how you can apply it. This roundtable will dive into:

• Using data to uncover patterns in payer behavior and inform stronger appeal tactics.
• Turning insights into action, empowering your teams to push back on denials more effectively.
• Connecting the dots between actionable data and better outcomes—for patients and your organization.

Discover how these denial management leaders are leveraging data to drive meaningful change and using proven tools for tackling denials. This discussion will equip you with ideas and strategies you can start using immediately. This is more than just theory – it’s about giving providers the tools, tactics and necessary steps to protect the patients’ right to access care while holding payers accountable for timely and fair reimbursement.

2025 is the year we disrupt denials and drive better results as a collective community of providers watching payers. We’re in this together.

Meet the Panelists:
 
Brian Moore, MD, FACEP, CHCQM-PHYADV
Chief Medical Officer – Physician Advisor Services | Atrium Health

Edgar Agvanyan, MD
System Director – Case Management and CDI for Adventist Health in California, Oregon and Hawaii.

Sean Lilley
Chief Data Officer | Hyve Health

Richelle Marting
Attorney, Director of Managed Care Contracting | Marting Law, LLC

Ryan O’Hara
Managing Principal | Denial Research Group

Kendall Smith, MD
Chief Medical Officer & Chief Physician Advisor | PayerWatch

Moderator: 

Brian McGraw – Founder & Chief Executive Officer | PayerWatch

The post Disrupting Denials & Holding Payers Accountable with Actionable Data & Better Outcomes appeared first on PayerWatch.

Presentation Date: Thursday, December 19, 2024

2024 brought increasing payer denials, unfair and unexplained DRG downgrades and more audit claw-backs than ever before. If 2024 was the “Year of Denials”, then 2025 can and should be the “Year of Not Taking it Anymore”. Join denial management experts Brian McGraw and Ryan O’Hara as they unwrap their favorite winning appeal tools, tips and treats, served with warm cookies and cold milk. You’ll take away language, ideas, tools and actual proven-effective strategies to immediately defend and protect against unfair claim denials.

Presenters: 

Brian McGraw – Founder & Chief Executive Officer | PayerWatch

Ryan O’Hara – Managing Principal | Denial Research Group

The post Our Holiday Gift to You! Writing Stronger Appeals that Win & Improving Denial Prevention appeared first on PayerWatch.

Presentation Date: Wednesday, November 13, 2024

Join Dr. Kendall Smith and Reggie Allen, MBA, RN, ACM, as they discuss effective strategies for appealing neonatal intensive care unit (NICU) level of care denials and the clinical validation of respiratory distress syndrome. This session will provide practical guidance for advocating on behalf of neonatal intensive care services. Attendees will gain valuable insights to enhance their proficiency in addressing high-dollar cases and learn to craft compelling arguments to overcome NICU denial challenges.

Presenters: 

Kendall Smith, MD, SFHM – Chief Physician Advisor, PayerWatch – AppealMasters

Reggie Smith, MBA, RN, ACM – Chief of Clinical/Business Operations, PayerWatch – AppealMasters

The post You Asked For It! High Dollar NICU Denials appeared first on PayerWatch.

Presentation Date: Wednesday, September 25, 2024

General, nonspecific appeals might work some of the time, but increased specificity in your appeals will give you a better chance to obtain more overturns. Join us as AHDAM discusses specific techniques that you can start using immediately in your patient status, clinical validation, coding, and technical appeals. This educational activity is suited for new appeal writers as well as not so new writers who could use a refresher.

Presenters: 

Karla Hiravi, BSN, RN – Senior Vice President, Clinical Resources

Kendall Smith, MD – Chief Medical Officer & Chief Physician Advisor

The post You Asked For It! Winning Appeal Language appeared first on PayerWatch.

Presentation Date: Wednesday, August 21, 2024

Unlock the mystery of the revenue cycle as Ryan O’Hara, Managing Principal of the Denial Research Group, explains basic concepts and how denials and appeals impact YOUR hospital’s revenue cycle. This webinar is tailored for hospital-based healthcare professionals managing insurance denials.

Presenters: 

Ryan O’Hara – Managing Principal | Denial Research Group

The post Revenue Cycle 101 appeared first on PayerWatch.