Increase Pay-up by Successfully Appealing Claim Denials

The Problem:  What if every time you had a patient in v-fib, you were allowed to shock him only once? What would your success rate be? Everyone in EMS knows that defibrillation often works only on the second, or even the third, shock. The same principle holds true when it comes to getting reimbursed for medical transportation. It often takes one, even two, appeals before claims are paid. In fact, as many as 50 percent of denied claims are eventually paid when the provider appeals the Explanation of Benefits (EOB).

The Solution:  “Insurance companies deny thousands of claims a year with what appears to be substantial evidence to support such non-payment,” explained Tammy Tipton, president of Appeal Solutions, a manufacturer of software to help process EOB appeals. “They do this knowing that most denials are accepted without question or action. They know many medical providers do not have the time, legal expertise and insurance industry experience to investigate the basis, or lack thereof, of claim denials.”

AppealLettersOnline.com provides articles & case studies to assist medical providers resolve denied insurance claims.

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AppealLettersOnline.com can assist providers implement an effective denial management program. 

You will find appeal letters, case studies, articles, other resources and the latest intelligence necessary to help healthcare providers make vital decisions and take strategic actions to address payer denial issues.

AppealLettersOnline.com will help health care providers actively develop the processes, analytical tracking information, educational programs and procedures needed for implementing an effective denial management program.
 

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Some of the topics covered at AppealLettersOnline.com include addressing payment reductions such as usual and customary and out-of-network care reductions, lack of timely filing denials, pre-existing conditions and medical necessity appeals and improving verification of benefits procedures. Treatment exclusions, maximum benefits denials and subrogation/coordination denials are also discussed.

Training & tips are provided on appealing for interest and penalty payment on late payments and appealing a request for a refund of previously paid claims.

AppealLettersOnline.com discusses all types of claims including Managed Care, Indemnity, Government, Self-Funded, ERISA claim issues and managed care contractual payment discrepancies.

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Signup for immediate access to our database of 1600+ Appeal Letters 1600 Professionally Written Appeal Letters Hundreds of Denial Management Articles & Case-Studies Knowledge-building online seminars, presentations & training tools State Resources with links to court cases, state statutes Complete access for less than a dollar per day.				Download free sample appeal letters from our database of 1600+ Letters. Medical Necessity Timely Filing Preexisting Conditions Lack of Precertification Benefit Reductions Refund Requests Stalled Claims Specialty Care Appeal Reviews Workers' Comp Verification of Benefits Issues Coding Issues