Keeping Up with Managed Care: Navigating Claims Denials and Early Termination in 2025

Recent Medicare Advantage (MA) rule changes have introduced critical tools to help skilled nursing facilities (SNFs) better manage claims denials and early termination of services. The Calendar Year (CY) 2024 Final Rule brought long-overdue improvements to transparency and accountability in the appeals process, helping reduce improper denials and clarify reimbursement pathways.

Building on this, the CY 2025 Final Rule—effective January 1, 2025—empowers SNFs with access to independent reviews and the ability to escalate cases to an Administrative Law Judge (ALJ). These changes are an important step in breaking the cycle of insurer-dominated appeals and ensuring fairer outcomes. 

This session will focus on best practices to:

• Utilize independent review processes effectively.
• Escalate denials strategically to maximize reimbursement.
• Strengthen internal workflows to ensure compliance and timely responses.
• Proactively manage early terminations of services with documentation and appeal readiness.

Attendees will leave with actionable strategies to improve outcomes, reduce administrative burden, and deliver better care under evolving managed care rules.

Speakers: Christy Beard, AVP, Clinical Reimbursement, National Healthcare Corporation; Jay Nason, Senior Regional Vice President, NHC Eastern Region; Maureen McCarthy, Celtic Consulting

Registration is free to AHCA/NCAL members and $65 non-members. 

If you are not able to attend live, the recording will be provided to you. 

Instructions to Register: 

• To avoid technical problems, use Google Chrome. 
• Members will need to log in using their existing email and password first. 
• Once you are logged in to the website, you will be able to register by clicking the green register button at the top of the page. 
• If you have forgotten your password, click here. 
• If you are new to the site, you can create an account here. Answer all fields on the create an account page- especially locating your company name. You can search by name or zip code. After creating an account, you will be able to register for the webinar. 

Instructions to join, after registering:

• On the day of the webinar, you will be able to join 15 mins before. 
• Log in and return to the contents page to open the webinar.
• For optimal performance, please use the latest version of Chrome, Firefox, Edge, or Safari 14+. Internet Explorer is not supported. Disable pop-up blockers in your browser settings. A wired internet connection is recommended over WiFi for stable bandwidth.
• Ensure your speakers are unmuted and functioning correctly.

Email educate@ahca.org if you need assistance.

STATEMENT OF AHCA/NCAL’S ARTIFICIAL INTELLIGENCE (AI) POLICY

To foster an environment of candor and the open exchange of ideas, AHCA/NCAL prohibits the recording of meetings by attendees. This includes but is not limited to any use of artificial-intelligence tools or assistants that record and transcribe information. AHCA/NCAL has the right to immediately remove AI tools or assistants present on calls and placed by attendees.

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