Does your organization utilize online healthcare claim review decisions? If so, please let us know the name of the site. We are also very interested in any comments related to how such information is used so that we can pass along tips for better denial management.
For example, the following is a Linked-In exchange regarding using the patient pain level to argue for coverage of emergency care treatment:
Appeal Question: I have been reviewing overturned claim denial data from the California Department of Managed Care. In regards to urgent care denials, the level of pain reported by the patient seems to be a significant determining factor on overturned decisions. Does anyone use this as a marker for selecting denials.
Answer: from Kathie Bender, CPHM, at Next Recovery Source: Absolutely, and the pain level can be supported by elevated BP, pulse and RR (respiratory rate).
Post appeal suggestions on the AppealLettersOnline.com users forum or email Tammy Tipton at t.tipton@appealsolutions.com.
