Claim denials continue to rise, making them a top priority for healthcare executives. Denials cost organizations millions of dollars annually and require significant staff time and resources to resolve.

This presentation will outline strategies to analyze the root causes of denials, evaluate and optimate workflows, implement solutions to reduce recurrent and prevent future denials. We will also cover best practices for submitting successful appeals.

Learning Objectives:

Attendees will learn strategies to

• Identify denial types
• Form and engage cross-functional teams to address workflow issues
• Monitor, track and report denial trends and outcomes

Denials are no longer isolated events. They have evolved into a sophisticated strategy that challenges clinical judgment, documentation integrity, and organizational resources. While many hospitals focus on appealing denials after they occur, the most effective organizations are preventing them before they happen by strengthening the clinical narrative at the point of care.

Today, we will explore how Clinical Documentation Integrity, Coding, Physician Leadership, Utilization Management, and Revenue Cycle teams can work together to build a defensible record that withstands payer scrutiny. We will examine the diagnoses most frequently targeted for clinical validation denials, identify the documentation vulnerabilities that payers exploit, and discuss practical strategies for creating a proactive denial prevention framework.

The reality is that payers often succeed not because the care was inappropriate, but because ambiguity exists within the medical record. When documentation is clear, clinically supported, and aligned across disciplines, organizations are better positioned to protect both reimbursement and the integrity of the patient story.

As we move through this session, I challenge you to look beyond denials as isolated transactions and instead view them as signals that reveal opportunities for documentation improvement, interdisciplinary collaboration, and stronger organizational governance. Because in today’s denial environment, our greatest defense is not an appeal letter. It is documentation that is clear enough to be undeniable.

Learning Objectives:

• Describe the most frequent payor audit clinical denial types impacting CDI programs and the associated documentation deficiencies that contribute to denial risk.
• Demonstrate how CDI-driven workflows and interdisciplinary collaboration support proactive clinical denial prevention throughout the mid-revenue cycle.
• Assess payor audit findings and appeal outcomes to identify documentation improvement opportunities and implement targeted CDI education to reduce future denials.

Healthcare revenue cycle has spent decades evolving from manual processes to increasingly automated workflows. Today, artificial intelligence, machine learning, natural language processing, and emerging autonomous technologies are accelerating that evolution, but technology alone does not create an intelligent revenue cycle.
This session explores the transition from task-based automation to integrated, AI-enabled revenue cycle operations and examines what that shift means for HIM and revenue cycle professionals. Attendees will explore practical applications across coding, clinical documentation integrity, revenue integrity, denials, and payment processes, while considering the operational risks associated with accuracy, workflow integration, alert fatigue, and overreliance on automation. Drawing on current industry developments and research into human-AI integration within revenue cycle workflows, the session will also examine the continuing role of human expertise, governance, and performance measurement in creating sustainable technology-enabled operations.

Learning Objectives:

At the conclusion of this session, participants will be able to:

• Differentiate between traditional task-based automation and emerging intelligent, AI-enabled revenue cycle models and identify applications across coding, CDI, revenue integrity, denials, and payment workflows.
• Evaluate the operational opportunities and risks associated with AI-enabled revenue cycle technologies, including accuracy, false positives, workflow integration, alert fatigue, human oversight, and reimbursement integrity.
• Identify governance, workforce, and performance measurement strategies organizations can use to integrate AI responsibly while maintaining human expertise, accountability, and measurable revenue cycle outcomes.

This presentation will explore the differences between previous global prenatal billing and the new tailored prenatal care codes. Per AMA recommendations, this transition should occur no later than September 1, 2026. How does this impact your OB practice’s care model? What does it mean for billing? How do we level pregnancy visits using an E/M code?

 Learning Objectives:

At the end of the presentation, coders should be able to articulate:

• Changes to the global obstetric coding model
• How this new model improves obstetrics overall
• Transitioning to the new codes
• Leveling pregnancy using E/Ms
• Reimbursement surrounding the new model

This presentation equips coders and coding leaders to navigate workflow change with confidence, accuracy, and compliance. Using a fictional revenue cycle department, participants explore how decisions impact senior executives, departmental leaders, coding supervisors, and coders. The session blends theory, case studies, and interactive exercises to apply change management models to real-world scenarios including AI-assisted coding and process redesign.

Learning Objectives:

Participants will be able to:

• Understand the core principles of change management and why it matters for coders
• Recognize the unique impacts of organizational change within healthcare revenue cycles
• Identify leading change management methodologies and their applications
• Develop concrete strategies to navigate, adapt to, and lead workflow transitions
• Strengthen their role as a coder and leader in the era of AI integration

It’s Complicated: The CDI-Coding Relationship explores the unique partnership between Clinical Documentation Integrity (CDI) and coding professionals, highlighting how each discipline contributes to the accuracy, integrity, and value of the health record. Through real-world examples, practical strategies, and a touch of humor, attendees will examine common sources of friction, discover opportunities for stronger collaboration, and learn how mutual respect enhances organizational outcomes. Participants will leave with actionable ideas to improve communication, reduce conflict, and foster a more effective CDI-coding partnership. 

Learning Objectives

Upon completion of this presentation, participants will be able to:

1. Describe the distinct roles and responsibilities of CDI and coding professionals and how each contributes to accurate clinical and financial data.
2. Identify common challenges that create barriers to effective CDI-coding collaboration and their impact on coding quality, compliance, reimbursement, and reporting.
3. Recognize how understanding each other’s expertise can transform the CDI-coding relationship from “It’s Complicated” to “Working Together.”