Megann Denefrio, JD | Managing Attorney & Director of Clinical Audit Services

Megann E. Denefrio oversees resolution of complex legal and regulatory issues related to the healthcare industry and hospital revenue cycle management for multiple large hospital systems and long term acute care hospitals.   In addition to acting as the Director for SHP’s Audit and Government Payer Service Line, managing a team of attorneys, registered nurses and certified coders, and maintaining her own case load, Ms. Denefrio regularly assists with projects to identify root cause denials and payer trends for SHP’s clients and works closely with payer representatives to achieve resolution or settlement of wrongfully denied claims. Ms. Denefrio also has extensive experience coordinating with hospitals, cancer centers, physicians, and patients to address complex experimental and investigational denials through the internal and external appeal process. Her industry experience includes Medicare regulations and appeals processes, RAC audits, experimental and investigational denials, medical necessity denials, DRG downgrades, and pre-arbitration/litigation claim review.

Prior to joining the SHP management team, Ms. Denefrio was an Attorney Advisor for an Administrative Law Judge (“ALJ”) with the Office of Medicare Hearings and Appeals (“OMHA”) in Miami, Florida.  While at OMHA, Ms. Denefrio managed a docket of over 3000 cases involving services such as DME, inpatient care, hospice, Part B outpatient services, SNF, home health, IRF, and entitlement.  She provided legal advice and assistance to the ALJs, reviewing third level appeals for denied Medicare services, performed extensive research to identify legal issues related to Medicare coverage of services, reviewed medical records, and drafted legal memoranda in preparation for administrative law hearings.

Education and Credentials:

        Juris Doctor, Cum Laude, St. Thomas University School of Law, Miami
                Editor, St. Thomas Law Review
        B.A., Political Science, Cum Laude, Union College, New York
        State Bar Member, Florida and New York
        Member, Florida Bar Health Law Section